 Head Pain Treatment
Frequently Asked Questions
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Head Pain Treatment
(by MHNI Staff)
Some headache patients express concern about
the long-term adverse effects of taking prescription medicines. Are there any known
long-term harmful effects of taking daily preventive medications to treat headache?
Many migraine preventive medicines have been around for years, even decades,
and their long-term use in therapeutic doses, when used under appropriate medical
supervision, is considered generally safe. Though side-effects can be encountered
with the use of any medication, both in the short and long term, such risks are
reduced significantly with regular physician visits and evaluation. It must be stressed
that even "safe" medications such as aspirin, Tylenol, and other over-the-counter
medications can lead to disastrous consequences when used indiscriminately or excessively,
which underscores the need to use any medication or herbal remedy only with proper
medical advice.
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What are the difficulties in treating a headache
disorder in someone who has other significant health problems such as hypertension,
asthma, or stomach ulcers?
It is of utmost importance to understand the health and health problems of the patient
when treating head pain disorders, as many preventive and abortive medicines have potential to aggravate the underlying condition. Numerous medical
disorders can be aggravated by choosing the wrong pain medication. However, with
a good history and medical workup, it is sometimes possible for the physician to
select one medication to treat both headache and a coexistent health disorder.
For example, migraine prevention with Depakote will address
certain types of seizures and mood disturbance; Corgard is commonly used for hypertension;
Pamelor treats depression, anxiety and sleep disturbance; and Prozac lends itself
well in the management of anxiety and PMS disorders, among others. On the other
hand, anti-inflammatory medications should be used with caution or not at all in
those with a history of gastric ulcer disease, colitis or high blood pressure.
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How is botulinum toxin (Botox®) used in
treating head pain?
Botulinum toxin type A, or Botox®, has recently received a great deal of media coverage
as a potential treatment for migraine and other headaches.
Botox® is a purified neurotoxin from the bacteria that causes botulism, a medical
condition characterized by progressive muscle weakness and paralysis after food
poisoning or a deep wound infection. Small amounts of botulinum toxin injected directly
into muscle can cause localized muscle weakness. This substance has already been
widely used to treat diseases that cause uncontrollable muscle spasm or cramping.
Its action in controlling migraine headache is being tested at this time.
Even though early results of clinical tests are encouraging, continued research,
such as that being conducted at MHNI, is necessary before any firm conclusions can
be drawn concerning the effectiveness of Botox® as a primary treatment for migraine
and other headaches. Currently it is difficult to predict whose headaches may respond
to Botox®. However, patients who do respond may experience a reduction in headache
frequency and intensity for 3 months or more.
Unfortunately, Botox® is very expensive. In addition, most insurance companies do
not currently cover or reimburse the cost of this treatment when used solely for
the treatment of migraine or other common headaches. However, if muscle spasm is
present, Botox® treatment may be a covered benefit.
MHNI follows a strict protocol developed through clinical experience and ongoing
research.
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What are the common medications prescribed
for MHNI patients?
Generally, MHNI patients are prescribed preventive medications, which are the medications
a person takes on a daily basis in an effort to decrease head pain. Most head pain
sufferers are also prescribed abortive medications to use when they have a bad headache.
Hopefully, abortive medications will decrease a person's pain level.
Commonly prescribed prophylactic medications include tricyclic antidepressants (e.g.,
nortriptyline [Pamelor], amitriptyline [Elavil]); beta blockers (e.g., nadolol [Corgard],
propranolol [Inderal]); serotonin specific reuptake inhibitors (e.g., fluoxetine
[Prozac]); and antiseizure medications (e.g., valproate [Depakote]).
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What about side effects of prescribed
medications?
Side effects depend upon the medication prescribed and an individual's specific
reaction to a given medication. Most side effects are temporary and will either
improve or completely disappear with time. However, if the side effects are not
improving or actually get worse, then a patient should contact their physician for
an evaluation. Certainly if patients become sedated, have blurred vision, or feel
dizzy or lightheaded, they should not drive a car, operate dangerous machinery,
or perform any functions that require full alertness.
Certain side effects, such as a rash, hives, significant lightheadedness, difficulty
breathing, and passing out should be immediately reported to your physician. In
addition, most medications should not be taken during pregnancy.
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