reader mail
You ask . We answer .
but I can no longer tell when my headaches are migraines and am afraid to take it in case it doesn ’ t work — and then if it doesn ’ t work , I ’ m afraid to take something else . Any advice ? I don ’ t remember the last day I didn ’ t have a headache , and my life has turned into daily battles of trying to function . I ’ m being treated at a VA medical center and they don ’ t have a headache specialist . I ’ ve learned more from your website than my doctors . Any ideas you have will be greatly appreciated ! — Linda D .
I suspect you started with episodic migraine headaches at some point in time . When the headaches become chronic or are present on a daily basis , migraine will evolve into a different type of headache , losing its basic characteristics of sensitivity to light and sound and nausea . It will start to present as a dull daily headache that worsens during the day .
Almost any medication used on a daily basis over time will cause rebound headache , and it is reasonable not to use any abortive medication more than two days per week . I suggest keeping a headache diary or calendar to note the type , incidence and severity of the headache and the medication you take for relief . If you have not done so , I would eliminate all caffeine , NutraSweet ® and MSG from your diet . Pay particular attention to your sleep pattern , and do not skip meals . Furthermore , your level of anxiety or depression may need to be addressed .
— Gary E . Ruoff , MD , Westside Family Medical Center , Kalamazoo , Mich .
CAFFEINE JOLT
I have been suffering with daily migraines for more than 20 years . I am 69 years old . I have tried all kinds of medications , visit a chiropractor twice a week and have been using Excedrin Extra Strength ® for the last two years . The medication has not completely removed my headaches , but they last only about an hour or two . I use ice packs religiously , which help . Once in a while I will get a really bad headache that lasts for hours . I recently went to see a neurologist whom I found on the National Headache Foundation website ( headaches . org ), and he put me on Maxalt ® . Six pills cost me $ 62 — very costly . I have gone back to Excedrin ® . I make sure to eat something when I take over-the-counter medications and recently had my blood levels checked , but I worry about liver or kidney problems from taking Excedrin every day . Do you think that I have arthritis in my neck ? That is where it starts , and it goes up to the crown of my head . I had a scan of my head to rule out tumors as well . Unfortunately , the neurologist said I could possibly be a candidate for Botox ® , but not until I try Maxalt for three months . Any advice ? — Terry S .
You state that you have had daily headaches for 20 years . Did these headaches start suddenly one day and never resolve , or did they appear gradually ? I suspect part of your problem is a long history of caffeine ingestion , which needs to stop . Caffeine is a double-edged sword : it initially helps headaches , but then causes medication overuse headaches , which makes things worse .
It would be smart to have a scan of your neck . Arthritis or disc pathology may cause cervicogenic headaches , which tend to start at the base of the neck and radiate upward to the back of the head . The use of trigger point injections around the neck and shoulders may help . Trigger point therapy may also relax your neck and help your chiropractor address any spasm you are having in your neck . Non-pharmacological therapy with heat and range-of-motion exercises may also be beneficial . Once you break the cycle of daily headaches , the resultant episodic headaches can be handled by headache-specific medication , which do not include barbiturates or narcotics .
— Gary E . Ruoff , MD , Westside Family Medical Center , Kalamazoo , Mich .
Do you have a question for the NHF experts ? Send it to info @ headaches . org , and it could appear in our next issue .
8 HEAD WISE | Volume 2 , Issue 2 • 2012