Headache Treatment

Headache Treatment

Headache treatment often depends on the type, the severity, and the frequency of occurrence. In many cases, tension headache can be effectively treated using conservative measures, such as lifestyle modifications (e.g., improvements in diet and sleep patterns) and over-the-counter pain relievers (e.g., acetaminophen, ibuprofen).

Cluster headache and migraine headache may require prescription medications and preventative (prophylactic) treatment.

Tension Headache

Occasional tension headache usually can be treated successfully with lifestyle adjustments and over-the-counter analgesics (e.g., aspirin, ibuprofen, acetaminophen). When headaches are severe or frequent, care must be taken to avoid analgesic overuse, which can lead to rebound headaches.

In rebound headache, high levels of the drug in the body actually cause daily headache. In most cases, rebound headaches improve when the medication is stopped.

Tension headaches that resist treatment with over-the-counter agents may be treated with antidepressant or anxiety-reducing medications, such as amitriptyline, nortriptyline or desipramine.

Some tension-headache patients report beneficial results from secondary treatments that help reduce the effects of stress and tension on the body, such as massage, meditation, and biofeedback. When appropriate, psychotherapy may help some patients learn to cope better with stresses that can lead to headache.

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Cluster Headache

Treating cluster headache involves relieving the severe, sometimes unbearable pain during the headache, and disrupting or shortening the cluster episode. Acute treatment medications are similar to those used for migraine and include:

• Sumatriptan (Imitrex®)—injectable or nasal spray (Other oral triptans may also be effective.)
  
• DHE (Migranal®)—injectable or nasal spray (May cause nausea and dizziness.)
  
• 100% oxygen—inhaled from oxygen tank (Oxygen tank can be kept for home use.)
  
• Narcotics (e.g., codeine)—oral form (May not act quickly enough.)
  

Prednisone is a corticosteroid, a potent chemical that occurs naturally in the body. It is taken initially in high doses and then tapered over days or weeks, depending on the response. This medication is best if used for short periods of time.

Long-term corticosteroid use can cause many serious adverse side effects because it is involved in several different functions in the body. Potential side effects include an increase in intraocular pressure, osteoporosis, behavioral changes, ulcer, and diabetes.

Lithium carbonate Lithium may increase the levels of dopamine and norepinephrine in the brain. It is taken orally, usually twice a day, to interrupt a cluster headache. Concentration of lithium in the blood is closely monitored with periodic blood tests. Side effects include tremor, increased thirst, nausea, and frequent urination. Lithium carbonate typically is used to treat manic episodes in manic-depressive patients.

Verapamil dilates blood vessels. It can be taken twice daily in a sustained oral preparation. Side effects include nausea, dizziness, and constipation. Verapamil typically is used to treat angina, hypertension, and arrhythmias.

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