is located more in the middle of the forehead. Once it begins, it tends to occur most nights, but not as frequently or on as regular a schedule as cluster. It usually stops spontaneously after several weeks or months.
Taking caffeine at bedtime is reported to be helpful in preventing hypnic headache attacks for some people. Excedrin, which you are taking, contains a moderately high amount of caffeine. Other medications reported to be helpful include certain antidepressants, nonsteroidal anti-inflammatory drugs and lithium carbonate taken before sleep as a preventive medication.
Robert Kunkel, MD, consultant, Center for Headache and Pain Neurological Institute, Cleveland Clinic, Cleveland
THE MAGNETIC TREATMENT
Have you heard about the use of magnetic stimulation to treat headaches?
Transcranial magnetic stimulation( TMS) is a technique that applies a brief magnetic pulse to the scalp and underlying brain. It was evaluated for the treatment of migraine based on the theory that a fluctuating magnetic field applied to the scalp would induce an electrical current. This would then disrupt the spread of abnormal brain currents, called cortical spreading depression( CSD), that are involved in migraine. Animal studies suggest that CSD can trigger pain receptors in the membranes that envelop the brain.
A small, randomized, double-blind, sham-controlled trial evaluated the use of single-pulse TMS in 164 patients who had migraine with aura. The study found that more patients who received treatment with
TMS were pain-free at two hours than those who received the sham treatment( 39 % vs. 22 %). The trial was not able to show a reduction in pain from moderate / severe to mild / no headache.
TMS may be a promising and exciting new noninvasive, acute treatment option for patients who have migraine with aura, but more research is still needed to evaluate safety concerns, as it is theoretically possible that TMS could trigger seizures.
Barbara Lee Peterlin, MD, Drexel University of Medicine, Philadelphia
THE PERFECT FIT
Though lidocaine patches help with my chronic headache pain, they can be cumbersome to apply. My local pharmacists are in disagreement: One says patches cannot be cut, but the other said I could cut my lidocaine patch to a size more suitable to my needs. Who is correct?
As a general rule, medication patches should not be cut or otherwise altered. Cutting the patch could increase absorption of the drug, which could augment side effects, deplete the patch’ s medication too quickly and cause other problems.
Lidocaine patches are, to my knowledge, the only exception to that general rule. A lidocaine patch’ s dimensions are approximately 4 inches by 6 inches, which is rather large to place on the forehead( the location used by most patients). With a pair of scissors, patients can cut the patch to an appropriate size prior to applying it to their forehead or other hairless area. Typically, patches are left on for 12 hours and then removed for 12 hours prior to applying another patch.
Richard Wenzel, PharmD, Diamond Headache Clinic, Chicago
www. headwisemag. org | National Headache Foundation 11