Migraine or cluster headaches are severe irritating pain, which often are intolerable. Patients have tried over the counter medications such as aspirin, Tylenol and NSAIDs. These medications have caused life-threatening complications such as bleeding and liver damage. In late 1980 and early 1990 several preventive medications were approved by FDA. These medications were very expensive and its use was limited because of either the expense or denial by insurance provider. The focus of treatment at that time was to treat primary headache when pain become intolerable instead of preventing occurrence of primary headache. In recent years, the costs of these medications have become reasonable and are covered by major insurances except few. Since preventive medications are used regularly, one has to be careful with these medications. Some of these newer medications have had serious side effects, if not directed by physician.
Prevention of Risk Factors for Primary Headache
- Adult Patients-
- Headaches are more common in adult female population.
- Acute headache should be evaluated in young and middle age female patients to rule out life threatening causes of tension headache.
- Few children do complaint of headache on and often, which should not be ignored.
- Early prevention and treatment may discontinue occurrence or frequency of primary headache.
- Acute Headache
- Sudden appearance of severe headache is known as acute headache
- Acute headache could be secondary to serious problem within the skull, which needs immediate investigation and treatment.
- Radiological investigations and detailed examinations should be conducted to prevent risk of major complications.
Treatment of Headache during Aura-
- Preventive medication should be taken immediately to prevent or minimize intensity of migraine or cluster headache.
- Preventive medication may decrease the intensity of the symptoms.
- Symptoms of aura are observed during and prior to beginning of headache.
- Aura commonly felt is odd smells, sounds or sights.
Associated Symptoms Treated With Preventive Meds-
- Nausea precedes headache
- Loud noises or bright lights precedes severe headache
- Dull or throbbing pain at the base of the skull and upper part of the neck
- Headache associated with eye pain and diplopia.
Preventing Cluster Headache Attacks
- Attacks of Headache- Attacks are usually short, lasting from 15 to 180 minutes, and the excruciating pain may have subsided by the time a patient reaches a doctor's office or emergency room.
- Prevention of Headache- Headache is often difficult to treat during the severe attack. Treatment efforts focus on the prevention of attacks during cluster or migraine cycles.
- Selection of Medications- Although certain drugs are standard, preventive therapy needs to be individually tailored for each patient. The doctor may prescribe a combination of drugs.
Medications Used As Preventive Drugs For Cluster Headache-
- Verapamil (Calan)-
- Calcium-channel blocker drug, is the mainstay preventive treatment for cluster headaches.
- However, it can take 2 - 3 weeks for this drug to take effect.
- Corticosteroids (typically prednisone) are seldom used as an initial transitional therapy.
- For long-term treatment of chronic cluster headaches, lithium may be used as an alternative to verapamil.
- Although they are not approved for cluster headache, anti-seizure drugs such as valproate (Depakote), topiramate (Topamax), and gabapentin (Neurontin), are sometimes used for preventive treatment.
- An Attack of Headache- Migraine headache often begins following taking a shower or shaving.
- Avoid Triggering Factors-
- Avoid coffee
- Avoid alcohol, drugs and tobacco
- Avoid cold water bath or swimming
- Avoid strenuous exercise
- Avoid aroma, which may trigger headache
- Selection of Medications-
- Patient may have to try several medications to find out the most effective medication to prevent recurrence of headache.
Medications Used As Preventive Drugs For Migraine Headache-
- Beta Blockers –
- Inderal and Toprol- Beta blocker relaxes blood vessel and improves tissue oxygenation.
- Calcium Channel Blockers –
- Cardizem and Procardia, vasodilator and relaxes blood vessels causing migraine headache.
- Tricyclic Antidepressants - Amitriptyline.
- Tricyclic Antidepressants –
- Anticonvulsants –
- Depakote and Topamax
New Preventive Medication For Migraine Headache-
- Contains Imitrex (Sumatriptan) and Naproxen Sodium (a Nonsteroidal Anti-Inflammatory Drug: NSAIDs)
- Prevents blood vessels from dilating
- Arterial dilating causes migraine pain
- NSAIDs- Prevents release of prostaglandin, an inflammation triggering enzyme.
Preventing Tension Headache Attacks
- Anxiety- Avoid anxiety
- Fatigue- Avoid being fatigue
- Hypoglycemia- Avoid hypoglycemia
Medications Used As Preventive Drugs for Tension Headache-
- Tricyclic antidepressants - Amitriptyline.
- Anticonvulsants - Depakote and Topamax.
- NSAIDs - Advil and Aleve.
Alternative Preventive Treatment for Tension Headache
Chiropractic Treatment for Tension Headache
- Doctors of chiropractic often treat patients with tension-type headaches and headaches caused by problems with the joints and muscles in the neck, as well.
Joint Manipulation and Mobilization for Tension Headache
- Manipulation of neck with stretching and strengthening exercises.
- Effective in prevention of headache.
Massage for Tension Headache
- Helps to reduce frequency of tension type of headache.
- Migraine and cluster headache may respond to massage therapy.
Acupuncture for Tension Headache
- Mostly helps to treat acute primary headache.
- Acupuncture helps to reduce intensity of migraine and cluster headache.