BLOCK OUT
I get three to four migraines per month, sometimes with aura, sometimes without. I find that my biggest triggers are my menstrual cycle and stress. Given this, which medication is more effective for migraine prevention: beta blockers or calcium channel blockers?— Heather G.
There is no single answer to that question since these medications are selected on a very individualized basis. I think most headache specialists, myself included, would probably select a beta blocker before the calcium channel blocker, unless there are issues such as heart failure, asthma or other diagnoses that would be contraindications. Personally, I consider these medications second-line or“ helper” drugs to add benefits to more commonly used first-line agents, such as amitriptyline or nortriptyline or the anti-epilepsy agents( e. g., topiramate or valproate) and others.
Since you mention a relatively small number of headaches per month, a straight abortive plan( using triptans) may fit your needs— especially if you can eliminate some of your triggers— rather than using a daily preventive medication.
Stress and the decline of estrogen levels at the end of a menstrual cycle will make migraines more likely to occur. Stress reduction techniques such as meditation, auto-relaxation or yoga are very helpful. Others find counseling for stress management or coping skills helpful. In extreme menstrual headache situations, gynecologists can offer non-estrogen strategies for eliminating menstrual cycles. Remember, the treatment of headache does not involve only medication; lifestyle and other factors must also be managed.
— Edmund Messina, MD, Michigan Headache Clinic, East Lansing, Mich.
SEVERE AND SWOLLEN
My 41-year-old son has been plagued with headaches for almost 15 years. His headaches were treated locally in Upstate New York; and then he traveled to Detroit where he was diagnosed with cluster headache and treated with Methergine ®. It somewhat worked, but then the headaches began to trouble him severely once again.
He has since had a CT scan and MRI and received treatment locally, plus he has been diagnosed with chronic paroxysmal hemicrania. The headaches are very severe, and sometimes he curls up in a fetal position on the bathroom floor. Sitting across from him, you can see the change in his face: swollen eyelids, etc. He is now on a new medication( but not indomethacin, which the Internet says is the drug of choice), but that too is not working all that well.
He works in a dangerous, stressful job( as a therapy aide at a psychiatric hospital for the criminally insane), and we are not in a metropolitan area where there is great health care. He needs to work, doesn’ t have a ton of time to travel here and there, and of course, there is always medical insurance, which plays a large part in care and treatment for anything. Is there anything he can do? Help he can obtain? A study to partake in?— Charlene R.
Cluster headaches are much more common than chronic paroxysmal hemicranias( CPH), particularly in males. The headaches are very similar, but cluster headaches usually occur once or twice a day for 20 minutes to two hours, whereas CPH attacks are much briefer and occur more often in a day. Both have eye tearing and nasal congestion and are very severe. CPH typically responds to indomethacin, whereas cluster headaches generally do not.
Your son needs to be seen by a headache specialist, as both of these syndromes need to be managed by experienced clinicians in headache medicine.
— Mark Green, MD, Mount Sinai School of Medicine, New York City
VARIETY SHOW
I’ m in a vicious cycle of chronic migraines / daily headaches / cluster headaches. I’ m trying to keep functioning by using pain medications only when I have no choice, while trying desperately to avoid rebound headaches. Does it do any good to vary the meds from day to day( Advil ® one day, Fioricet ® the next, aspirin the next, etc.)? I have Zomig ®,
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