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Headaches: Medication

Tension: Try over-the-counter pain relievers like aspirin, acetaminophen, ibuprofen or naproxen sodium. Dr. Diamond recommends trying naproxen sodium first, since it lasts the longest. If that doesn’t work, try ibuprofen, acetaminophen or aspirin (in that order). If you need to take these medications three or more times a week, call your doctor. You may be having rebound headaches, which can occur when you take too many painkillers. These affect 3 to 4 million Americans.

Migraine: Mild to moderate attacks can be relieved with over-the-counter painkillers, such as aspirin, acetaminophen, ibuprofen, naproxen sodium or Excedrin Migraine (which contains acetaminophen, aspirin and caffeine). If your symptoms are more severe, meaning you’re vomiting or have extreme sensitivity to smells, for instance, you might be better off with prescription drugs. Keep in mind, many of these need to be taken as soon as the attack occurs or they don’t work as well. Here’s a rundown on what’s available:

Triptans, such as sumatriptan, frovatriptan and naratriptan, reduce inflammation and constrict blood vessels. They’re considered first-line treatment for moderate to severe migraines. They relieve headache pain, as well as nausea and light sensitivity. Side effects include facial flushing and tightness in your head.

Opioid analgesics, such as codeine and butorphanol, are effective painkillers. They’re best for people with moderate to severe pain who don’t respond to non-opioid medications such as triptans. You may feel disoriented when you take these painkillers, and you shouldn’t use them more than three days per week.

Ergot derivatives, such as ergotamine and DHE, constrict blood vessels in the body and are used to treat severe, throbbing headaches. They’re ideal for those who don’t respond to painkillers or who experience significant side effects from other migraine meds. Side effects include nausea.

            Are you taking the right migraine medication? Ask yourself these questions:

            • Are you pain-free in two to four hours?

            • Are you functioning normally in three to four hours?

            • Does your headache respond to treatment at least 80 to 90 percent of the time?

Menstrual migraine: Triptans are the first-line treatment for menstrually related migraines. They need to be taken early in an attack to be most effective. If you know when you’re going to get a migraine, you may be able to stave off the ache by taking the medication several days before the attack. That’s why it’s important to track when you get your headaches. Stephen Silberstein, M.D., a neurologist at Thomas Jefferson University in Philadelphia, found that the drug frovatriptan made menstrual migraines shorter, less severe and less frequent. Ask your doctor whether you should take your medication once the pain begins or beforehand.

Over-the-counter medications like NSAIDs can be used daily for 5 to 7 days around your period. They can help reduce headache frequency and relieve menstrual cramps.

Pregnancy migraine: You may need medication. Before taking anything, discuss your headaches with your doctor for her recommendation. In the first trimester, Tylenol or Tylenol with codeine are safe, says Dr. Diamond. In the second and third trimesters, Imitrex and other commonly prescribed drugs can be taken. [Although ibuprofen is considered safe to use occasionally, it should never be taken during the third trimester, because it can interfere with blood clotting, which is dangerous if you’re having a C-section or episiotomy.

Allergies: Take an antihistamine daily, suggests Dr. Diamond.

Caffeine withdrawal: Your doctor can prescribe an anti-inflammatory steroid medication called a Medrol dose pack to knock out the pain, says Dr. Diamond. The best solution is to gradually reduce your intake over time. You might start by substituting decaf for one-quarter of your caffeinated brew, then cut back to one-half decaf after five days, recommends Dr. Diamond.

Acupuncture, which involves inserting needles deeply into muscle, may prevent and treat migraines. It appears to work by releasing feel-good brain chemicals called endorphins. Although it’s never been studied in pregnant women, it’s believed to be safe during pregnancy, says Robbee Flan, a licensed acupuncturist and president of the American Association of Acupuncture and Oriental Medicine.

Biofeedback involves learning how to reduce your body’s response to stress, which can help fend off headache pain. An instrument that measures your muscle tension or skin temperature gives you feedback as you try to relax, and you ultimately learn how to do it on your own.

Headache sufferers who use biofeedback and relaxation training (see below) typically experience a 45 to 60 percent reduction in headache frequency and severity, according to the American Headache Society. That’s almost as effective as several widely used medications, and there are no side effects. When biofeedback is combined with propranolol, a blood-pressure medication used to prevent headaches, migraine sufferers experience a 70 percent reduction in headaches. Biofeedback and relaxation training are most effective at preventing headaches, but can also lessen the severity and duration of a migraine if they’re used at the first sign of an attack.

Relaxation training When you’re stressed out, your heart rate and blood pressure increase; your blood vessels constrict and your muscles contract. This can trigger a headache. When you relax, you’re able to reverse these stress responses and breathe more deeply, which allows more oxygen to reach your brain. That seems to help prevent headaches. Relaxation changes your body’s response to stress so it takes a greater amount to trigger a headache. A psychologist or other trained therapist can teach you deep breathing, in which you push your abdomen outward as you take a breath, then toward your spine as you exhale. You can also learn progressive muscle relaxation, in which you tense and then relax muscles throughout your body.

Cognitive behavioral therapy, which teaches you to change the way you think, helps to control the anxiety that can trigger headaches. Ask your doctor to recommend a therapist in your area.

Fish oil In a small study, women who took 15 fish oil capsules daily experienced a 40 to 50 percent reduction in the frequency and severity of their migraine attacks. The capsules contained omega-3 fatty acids, which are also found in salmon, trout and herring. Two 8-ounce fish meals per week would supply the same amount of fish oil that was used in these studies. Keep in mind, it’s best to steer clear of shark, swordfish, king mackerel and tilefish because they contain high levels of mercury, according to the U.S. Food and Drug Administration.