GIVE TREATMENTS A CHANCE “A patient and her physician should try out a medication for two to three months before deciding it’s not working,” says Loder. And several more medications should be tried after that before the question of narcotics is raised. “More often than not, physicians feel they have exhausted all their nonnarcotic options before they really have,” she adds.
ASK ABOUT PREVENTIVE MEDICATION If you are experiencing five or more migraines a month, or if your migraines last longer than two days, your doctor should also be talking about drugs that could reduce not only the pain of your attacks but the number you experience as well.
USE NARCOTICS CAUTIOUSLY There are times when opioids and barbiturates may really be the only viable treatments for your worst pain. “If your doctor does prescribe them, he should be prescribing only a small amount and making clear that they should only be used when all else fails and your only other option is a trip to the emergency room,” says Freitag. Silberstein takes a harder line: “If you are at the point where narcotics are being considered by your primary care physician, consult a more specialized doctor.”
[NAME THAT HEADACHE]
Migraines aren't the only type of pain in the head. Here are some other possibilities.
CLUSTER HEADACHES They occur frequently during a short period (perhaps three or four times a day for several weeks), then go into remission for months or years. Clusters are often considered the most intense of all headaches. Typically, the pain is burning behind one eye. These headaches occur in about one in 1,000 people.
TREATMENT Traditional over-the-counter analgesics such as ibuprofen and Excedrin generally aren’t effective against cluster headaches. Preferred medications include triptans and calcium channel blockers, the latter normally used for cardiovascular conditions. Oxygen therapy—which involves breathing 100 percent oxygen through a face mask for about 15 minutes—has been shown to provide fast, significant relief for many.
TENSION-TYPE HEADACHES A few years ago, the medical community replaced the term tension headaches with tension-type headaches (TTH) after research using electronic sensors revealed that tension in the neck and head muscles does not appear to spark the characteristic symptoms of this problem: soreness in the temples and the feeling that there’s a tight band around the head. TTH is extremely common: 67 percent of men and 80 percent of women will experience these headaches at some point in their lives.
TREATMENT Episodic tension-type headaches can generally be treated successfully with over-the-counter analgesics. Patients with chronic TTH often respond well to migraine medications.
ORGANIC HEADACHES If you’re like many other people, when you get a severe headache, you worry you may have a serious medical problem such as a tumor, aneurysm or hemorrhage. You probably don’t—headaches caused by those conditions are quite rare. Still, if you develop what you consider “the worst headache in your life,” possibly but not necessarily accompanied by loss of balance, seizures or speech difficulties, seek emergency medical attention pronto, since you could be dealing with a potentially deadly situation in which minutes can make a difference in the outcome.
[MIGRAINE AND HEADACHE RESOURCES]
AMERICAN HEADACHE SOCIETY COMMITTEE FOR HEADACHE EDUCATION: Its site provides a national directory of physicians who treat headaches; some, but not all, are certified specialists. It also supplies helpful patient tools, such as printable headache diaries.
NATIONAL HEADACHE FOUNDATION: The largest voluntary organization for the support of headache sufferers, NHF delivers tons of up-to-the-minute information on migraines and headaches on its site. Check out Headache U, info on support groups and pen pal programs, and comprehensive physician finder.