Treatment depends on the type of headache disorder. We will pursue treatments with the best clinical evidence, starting with the least invasive moving on to more novel treatments if appropriate. For most disorders the most effective and least invasive treatments are drug treatments and not procedures, which is a common misconception. Some drug treatments include supplements such as riboflavin or magnesium. All potentially play a part in our holistic, multifaceted management strategy.
Where drugs are employed there are some general principals common to most headache disorders:
- Drugs used only when you have a headache: a wide variety of drugs can be used to treat a headache when it occurs. These range from paracetamol, anti-inflammatories such as ibuprofen, or more specific treatments such as the triptans. These treatments are often very helpful but they can cause problems in headache disorders such as migraine if used too frequently. If over-used these acute treatments can make headaches more frequent and severe, and they are also likely to stop other preventive treatments from working.
Medication overuse headache has been reported in individuals using painkillers on more than eight days a month. All drugs which can provide relief from headache when it occurs, have been reported to cause medication overuse headache.
- Drugs used to prevent headaches: when headaches become too frequent or debilitating, it may be appropriate to use a treatment to prevent headaches from happening. While these drugs were originally developed for a wide variety of conditions including epilepsy, high blood pressure, depression etc. they are also very useful for treating headache. To work however they must be taken:
- every day
- at an adequate dose
- for at least several months
The preventive drugs are started off at a low dose to minimize side effects but the doses must be increased. This is done slowly until either the maximum dose is reached, your headaches improve significantly, or side effects prevent further dose increases. If you have migraine pain killers and triptans must not be overused as they will interfer with the action of the preventative drug.
Drugs are an important part of treatment for many patients, but they represent only one aspect of your management. We will also look at lifestyle issues and psychological wellbeing.
Headache disorders, such as migraine, can be influenced by lifestyle factors such as sleep pattern, exercise, stress and meal patterns. General routine and optimizing lifestyle factors can have considerable impact on migraine headache.
Individuals with some headache disorders are also more prone to psychiatric and psychological disorders. Each disorder needs to be managed separately with the support of appropriate expertise. Headache disorders can be a very distressing and debilitating. They can have a very negative effect on life and one’s mood can suffer.
Psychological support plays an important role in breaking the pain cycle and developing robust coping strategies. Behavior modification along with use of non-pharmaceutic treatments such as Riboflavin, may, if appropriate, complement specific headache drug treatment.