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