Family Health Guide

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Headaches: Treatment

Tension: Reducing stress through exercise, deep breathing and other relaxation techniques can help. Using biofeedback and relaxation techniques as soon as you notice a headache can lessen the duration and severity of the ache. You can also knock out the ache by lying down in a dark, quiet room and applying an ice pack to your head for 15 minutes every hour.

Also, try over-the-counter pain relievers like aspirin, acetaminophen, ibuprofen or naproxen sodium. Dr. Diamond recommends taking 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.

Biofeedback is also useful because you’re able to reduce your body’s response to stress, which can trigger tension headaches. Antidepressant medications have been shown to help relieve pain even if you’re not depressed because they stabilize levels of brain chemicals known as serotonin, which may be involved in the development of a tension headache, according to the National Headache Foundation. 

Migraine: Avoid foods and activities that seem to trigger your headaches and eat, sleep and exercise regularly. Biofeedback, deep breathing, massage and heating pads or ice packs on your forehead can also help ease the ache. These techniques may even eliminate the need for medication. For some sufferers, however, medication is the magic bullet. Mild to moderate migraine 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: Lie down in a dark room with a cold washcloth draped over your forehead. Or try biofeedback, self-hypnosis or progressive muscle relaxation, which can help relieve migraines. (See “Complementary/Alternative Treatments.”) 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. Ibuprofen is considered safe to use occasionally in the second trimester, but the FDA says it should never be taken during the third trimester; ibuprofen can interfere with blood clotting, which is dangerous if you’re having a C-section or episiotomy.

Allergies: Wash your clothes and rinse your hair at bedtime to get rid of pollen. Consider putting a portable air filter in your bedroom, since it can reduce mold and pollen counts, and take an antihistamine every day.

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.