Chronic Migraine Headaches,
Tension Headaches & Cluster Headaches

Chronic migraine sufferers know that migraine headaches are much worse than tension headaches, but not as bad as cluster headaches.

A tension headache causes constant, steady ache and tightness around your forehead, both temples, or back of your head and neck. Usually, pain from a tension headache is mild to moderate and doesn't keep you from performing your daily tasks. Treatment for tension headaches may include pain medications such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory medications, or NSAIDS, (for example, aspirin or ibuprofen). Additional therapies, including stress management or biofeedback, may be tried or added to medications to reduce or prevent tension headaches.
The term "cluster headache" refers to a type of headache that recurs over a period of time. People who have cluster headaches experience an episode one to three times per day during a period of time (the cluster period), which may last from 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur. A cluster headache typically awakens a person from sleep 1 to 2 hours after going to bed. These nocturnal attacks can be more severe than the daytime attacks. Attacks appear to be linked to the circadian (or "biological") clock. Most people with cluster headaches will develop cluster periods at the same time each year -- either in the spring or fall or the winter or summer. Cluster headaches are one of the most severe types of headache. It can be 100 times more intense than a migraine attack.

• The treatment for cluster headaches include: Abortive medications: The most successful treatments are Imitrex (sumatriptan) injections and breathing oxygen through a face mask for twenty minutes. Other choices include: Zomig (zolmitriptan) tablets, ergotamine drugs and intranasal lidocaine.

• Preventive medications: Your doctor can prescribe preventive medications to shorten the length of the cluster headache period as well as decrease the severity of the headaches. All cluster headache sufferers should take preventive medication unless their cluster periods last less than two weeks. Some medications used in the prevention of cluster headaches include: calcium channel blockers (verapamil), lithium, divalproex sodium, corticosteroids (only short courses), methysergide, melatonin and Topamax.

• Surgery: This may be an option for people with chronic cluster headaches who have not been helped with standard therapy. Most of the procedures involve blocking the trigeminal nerve.

Chronic migraine sufferers can have early warning signs of oncoming migraine headaches. One of the warning symptoms of a migraine is an aura, which involves both electrical and chemical changes in the brain as well as a reduction of blood flow to parts of the brain. The aura can affect vision, causing flashing lights, zigzag lines, or a vague awareness that something is wrong. Some people may experience numbness or difficulty forming words or thoughts.

Most patients, however, have no aura with a migraine. Irritability and mood swings may precede a migraine attack. Other symptoms associated with migraines are nausea, vomiting, sensitivity to light and noise, dizziness, lightheadedness, and throbbing or pulsating pain, sometimes located on only one side of the head. Fluctuations in estrogen levels seem to bring on migraine attacks. Thus, females usually experience changes in headaches during pregnancy, menopause, or when they use birth control pills. Severe attacks are common during or just before menstrual periods.

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MIGRAINE HEADACHES AND DRUGS

Many drugs can help, but the leading ones are called triptans. They include sumatriptan (Imitrex), zolmitriptan (Zomig), rizatriptan (Maxalt), and others. People respond differently, and one of these drugs may work better for you than others. Ergot alkaloids are another class of drug that can be used to abort a migraine. The most popular one is dihydroergotamine (DHE). It is available as a nasal spray or an injection. NSAIDs (nonsteroidal anti-inflammatory drugs), such as ketoprophen and ibuprofen, may also abort a migraine attack. Often, doctors recommend taking antinausea drugs such as Reglan or Phenergan.
If these medications don't work for you, there are a variety of others available, including Midrin, Fioricet, and opioid analgesics such as Stadol Nasal Spray, Vicodin, and Actiq.

Prophylactic treatment is usually recommended if you have more than two or three migraines per month. Medications intended to head off a migraine episode, so that it never fully develops, include:

• Tricyclic antidepressants, such as amitriptyline, nortriptyline, or doxepin.
• Beta-blocking agents (also used to treat high blood pressure), such as propanolol, metoprolol, timolol, nadolol, and atenolol
• Calcium-channel blockers (also used to treat high blood pressure), such as verapamil and nifedipine
• Antiseizure medications including Depakote, Neurontin, and Topamax
• Methysergide
• Vitamin B-2 (riboflavin)
• Botox injections

During an acute episode of migraine headache, you'll probably be most comfortable lying down in a darkened, quiet room and trying to sleep. A cold pack on your head may feel comforting. If you are unable to take medications by mouth, you may need to go to a hospital emergency room or be admitted to a hospital for treatment.

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