Headache cures may make pain worse
Wednesday, May 12 2010
Got a headache? If so, Consumer Reports dares to ask whether you’re accidentally causing yourself more pain by over-treating your symptoms with common pain relievers.
If you get frequent headaches, the last thing you might want to hear is that the over-the-counter or prescription medicine you use to treat them could be making your pain worse.
But that’s a distinct possibility if you take a higher-than-recommended dose or use the drug for a longer period than what the label advises, according to a new Consumer Reports review of migraine medications. Medication-overuse headaches are typically agreed to be those that occur at least 15 times a month or worsen because of too much treatment.
TOO MUCH OF A GOOD THING
Headache-prone people can end up with “rebound” headaches for a variety of reasons, said Dr. Orly Avitzur, medical adviser for Consumer Reports and a neurologist in Tarrytown, N.Y.
Some patients mistakenly believe they can prevent headaches by continuing to take pain relievers even if their head isn’t currently throbbing, she said.
“It’s easier to just pop a pill sometimes than maybe go to a doctor and explore what’s causing the headaches or what more can be done,” Avitzur said.
Patients often seek help when their headaches persist despite self-treatment with over-the-counter medications such as acetaminophen (brand name Tylenol), ibuprofen (brand names Advil or Motrin), naproxen (Aleve), aspirin or aspirin with caffeine (Excedrin), she said.
“By the time they come in to see me, they’ve converted sporadic migraines into chronic daily headaches,” Avitzur said.
What’s more, common pain medications including ibuprofen, aspirin and naproxen can produce side effects such as nausea and gastrointestinal bleeding, which can lead to serious health problems if taken for too long.
There are many kinds of headaches — including ordinary tension-type, cluster and migraine headaches — and it can be easy to slide into damaging self-treatment habits in a desperate effort to stay functional.
Headaches are a major source of debilitating pain and lost productivity due to missed work and school.
While many have no serious underlying cause, some headaches can signal bigger medical problems that merit prompt professional attention, Avitzur said. Your first or strongest headache, one that’s accompanied by speech or language difficulty, weakness, numbness or tingling should send you to a doctor or hospital emergency room, if you think it’s stroke-related, without delay.
But the good news for patients with medication-overuse headaches is physicians can help them taper off the meds that are causing the continued or worsening symptoms and start them on preventive therapy, she said.
Migraines are a kind of headache marked by a variety of neurological symptoms that can include intense throbbing on one or both sides of the head, dizziness, nausea, vomiting and extreme sensitivity to light, sound and smell.
Attacks affect three times as many women (18 per cent) as men (6 per cent).
For people with moderate to severe migraine pain, Consumer Reports recommends trying sumatriptan, available by prescription in tablet, nasal spray and injectable form. It’s been available in the U.S. since 1993 under the brand name Imitrex and went generic in 2008.
Sumatriptan is the only generic in a class of drugs called triptans. Their safety profile isn’t all-inclusive. They’re generally suited for men under 40 and women under 50 who have a healthy weight, don’t smoke and don’t have a heart condition, said Lisa Gill, editor of Consumer Reports’ Best Buy Drugs, based in Yonkers, N.Y. Sumatriptan is Consumer Reports’ first best-buy drug recommendation for 2010.
The seven alternatives in the triptan category typically cost $20 to $43 per pill, CR found, with prices for nasal-spray and injectable versions running even higher.
If sumatriptan doesn’t work to ease your pain, CR recommends trying rizatriptan, which has the brand name Maxalt, as the next step in migraine treatment.
Dr. Eric Wall, a family doctor in Seattle, said making the public more aware of the effectiveness of triptans for certain migraine sufferers is a valuable service.
“There still remains a remarkable number of patients who do have migraine headaches for whom triptans haven’t been used, and I’m not sure why,” he said. “I see them enough that it’s a bit surprising.
“I would agree in general that among the triptans there isn’t convincing evidence that one is superior to another,” he said. “Since sumatriptan has been out there for a long enough period of time and available in generic form, it’s certainly more prudent to start with sumatriptan than others.”
Still, timing a patient’s triptan administration to within a few hours of the migraine onset is important to its effectiveness, said Wall, who’s also senior medical director for Qualis Health, a Seattle-based nonprofit health-care quality-improvement organization.
“A triptan clearly needs to be offered as a first-line trial for a patient with a migraine,” he said. “The dilemma has been they’re more effective at the beginning of a headache. So when you’re coming to a physician’s office and you’re already in pain and had a day or two of headache, it’s not clear triptans will always be effective.”
PREVENTING, TREATING HEADACHES WITHOUT DRUGS
Of course, not all headache relief has to come from a pharmacy. In some cases, physical therapy, biofeedback, yoga or stress-management techniques can help ease the pain or frequency of the problem.
Migraine sufferers also can help themselves by avoiding triggers such as certain food and drinks and getting enough sleep, Avitzur said. Consuming beer, red wine or cheese may raise the likelihood of an attack. Even a break from fluorescent lights, TV screens or computer monitors might make a difference.
Avitzur advises migraine patients to keep a food and headache diary to try to identify their personal triggers. “What was different about today possibly that could be contributing?”
By Kristen Gerencher, McClatchy News
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- Device Offers Cluster Headache Relief
- FDA warns on use of certain migraine drugs during pregnancy
- Causes of migraines nearly impossible to determine
- Migraine triggers may not be as strong as you think
- Children’s headaches rarely indicate a need for eyeglasses
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- Are migraines more common than thought?
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- New Migraine Guidelines Rank Rx, OTC Efficacy
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