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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