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You ask. We answer. you said it hypersensitive nervous system that probably picks up all sorts of changes in your head, since nerves go to your sinuses. Anytime the sinuses get clogged or you have nasal congestion, the brain perceives that as pressure. I would suspect that pressure sensations are occurring from this phenomenon where the sinus gets blocked, causing negative pressure on the membranes in the sinuses.
I believe that sinus pressure is going to be best treated with some sort of decongestant or a nasal steroid; the steroid would work over days, whereas the nasal decongestant would work much quicker, particularly if it is in a nasal spray. However, you don’ t want to use a nasal spray decongestant for more than two or three days at a time because you can form a dependence on the medication, and every time you don’ t use it, your nose just swells completely shut. If you want long-term improvement from the pressure, you could use nasal steroids or a nasal antihistamine. Anti-inflammatories are very effective for treating pain originating from the sinuses. It’ s very possible that you could treat the after-effects of the sinus problem on the nerves by treating with the anti-inflammatories.
— Vincent Martin, MD, University of Cincinnati College of Medicine, Cincinnati
TOO MUCH OF A GOOD THING
How do you recommend treating tension-type headache without causing rebound headaches?— Lwellen H.
Rebound headaches, or medication overuse headaches, are the result of taking a medication that makes problems worse. The analogy I use for patients is over-fertilizing your plants. At a certain level, fertilizer is good. For example, for a certain amount of tensiontype headache, ibuprofen is good; but remember the old rule of thumb that too much of a good thing becomes a bad thing. For people with headache, that translates to a situation where pain relievers feed or perpetuate headache, escalating the problem and increasing the frequency of headache episodes. This often presents as a gradual increase in headache frequency over weeks or months.
To avoid this situation, first use medications that work effectively for tension-type headache. Such options might include NSAIDs, aspirin and acetaminophen. Then limit use of those medications strictly to 10 to 12 days per month. Medications that contain caffeine likely carry a higher rebound potential, so I recommend limiting use of medications combined with caffeine to eight days per month. If you require more frequent treatment( e. g., if you are having 15 or more headaches per month), then it’ s time to do more to prevent the headaches. This might include taking a daily medication such as amitriptyline. At a certain point, you need to stop treating the symptoms and start addressing the core condition.
Rebound headache is a tremendous problem with opioid or narcotic agents( see page 35) because the ceiling can be as low as three days a month before the medication-overuse effect appears. I strongly recommend avoiding narcotics. Not only are they not indicated for the treatment of tension-type headache, but they also carry a high risk of rebound headache.
— Robert G. Kaniecki, MD, University of Pittsburgh, Pittsburgh
Do you have a question for the NHF experts? Send it to info @ headaches. org, and it could appear in our next issue.
The Sick Headache“ I recently discovered a copy of your magazine, and I am moved to write about my own experiences regarding migraines. I am a 74-year-old man, born in a small market town into a working class family in England, and have suffered with migraine as long as I can remember. When I was a child, such attacks were known as“ sick headaches.” They would start with an odd odor in the nose, and then I would start to see vibrating semicircles that completely blurred my vision. Then one side of my face, usually the right side, would start to tingle and go numb. This feeling would move into the mouth and tongue, at which point I would invariably vomit, hence the“ sick” part of the diagnosis. The numbness would then move into my arm and leg, by which time I would be lying down in a dark room, and my head would start to ache. The only treatment considered at that time was aspirin, which did no good. The symptoms would persist for up to three days, and I had very little sympathy from my family, siblings or parents, and certainly never a visit to a doctor. Even if my parents had known the word“ migraine,” which they clearly didn’ t, it would have been associated at that time with upper-class ladies, who in the romantic novels of the time were always retiring to their bedchambers with a migraine.
“ As I grew up, I learned to cope with these attacks, which happened at least once a month, and I would go and lie down in a dark room until it passed. As I got older, I realized what it was I suffered from and tried all the suggested remedies I read about. Finally I found the only one that worked, an over-the-counter tablet called Migraleve™. Taken at the start of the symptoms, the attack would be reduced to only two to three hours, after which I would be able to return to work, though still feeling fairly groggy for maybe a day or two.
“ When I was in my early 20s, I started keeping a food diary. I soon realized that a meal containing cheese would invariably be followed within 24 hours by a severe migraine, which was unfortunate as cheese had always been a big part of my diet. I gave up eating cheese, and sure enough the frequency of attacks diminished to only three to four a year. These I could often trace to exposure to the smell of cheese. Also, sometimes an attack would be triggered after drinking red wine, and I discovered that a severe headache would follow a meal or snack containing chocolate. I later discovered that it was only cheese made from cows’ milk that caused the problem, so I could substitute goat cheese or cheese made from sheep’ s milk. Unfortunately, having recently moved to South Carolina, I find it quite difficult to source those cheeses, and they tend to be very expensive. It is also difficult, when eating out, to find food on menus that don’ t include cheese. Now at 74, when I do get a migraine attack it is very mild and usually over in less than an hour.”— TERENCE A.
HW: Thank you for sharing your story with us! We’ re glad to hear your migraines have waned. Readers, if you would like to share your headache story, visit www. headwisemag. org / WiseWords.
If you have comments or suggestions about Head Wise, send them to info @ headaches. org or post them on the NHF Facebook page.
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