CHICAGO (AP) -- They are excruciating headaches that last for days and return at a moment's notice. Often, they surface in the teenage years and last through much of adulthood.
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November 28, 2003
By Howard LeWine, M.D.
Harvard Medical School
What Is The Doctor's Reaction?
For a person suffering from chronic daily headaches, watching a television advertisement that shows a person becoming headache-free after popping a couple of pills is fantasy. Finding some relief can be a huge challenge for the patient and doctor.
Chronic daily headache describes a condition of frequently recurring headaches or persistent headache. It rarely is caused by a single problem with a single solution. More often there are multiple issues that need to be considered and addressed. Of the many potential factors, three rise to the top of my list:
- Identifying and avoiding headache triggers
- Understanding rebound and trying to tackle it
- Preventing head pain before it starts
What Changes Can I Make Now?
Headache triggers can include certain foods, beverages or circumstances. Some common examples are alcohol, caffeine, monosodium glutamate (MSG), ripe cheeses, artificial sweeteners, processed meats, nuts and direct sunlight.
Of the alcoholic beverages, red wines and dark liquors are more of a problem. Vodka may be the least offensive.
Caffeine is tricky. Caffeine boosts the pain-killing effects of common pain relievers like aspirin, acetaminophen and ibuprofen. But if you use caffeine daily, you may develop headaches when you try to stop.
Rebound headache refers to the situation where a person takes pain relievers daily or several times per day. The dose and frequency often need to escalate to get even a little relief. This can be the sole cause of chronic daily headache. To be cured of the headaches, all pain relievers need to be stopped, but in the short term the discomfort can feel unbearable. Family and friends need to be very supportive to help the person through this.
Preventing headache before it starts means looking for ways to reduce tension and stress and avoid triggers. But that is usually not enough.
There are now a good number of medications to prevent headaches, especially migraine. These are not the typical pain relievers or narcotics. They need to be taken every day, even when you don't have a headache. Beta blockers, such as propranolol and nadolol, and tricyclic anti-depressants, such as amitriptyline and doxepin, have been used for many years. Newer agents include valproic acid and gabapentin.
What Can I Expect Looking To The Future?
Chronic daily headaches started receiving more attention during the last decade. Although answers and cures are rarely straightforward, neurologists and other headache specialists have more options to try. The approach still focuses on trial and error. This process can be very trying for the headache sufferer.
Related Areas:
Headache
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