Headaches and Fibromyalgia.
by Jane Kohler (2007)

Headaches have many causes, and can make fibromyalgia harder to deal with– they can contribute to the pain, cause sleep problems, nausea, and fatigue.

Everyone has experienced a headache at some point in their life. That aching and throbbing pain behind the eyes, in the temples or in the forehead and cheek area, can hit without warning. Some headaches can be taken care of with over the counter painkillers, but for people with fibromyalgia, getting rid of a headache may not be not be so simple. People with fibromyalgia tend to suffer from three different types of headaches.

• Muscle tension headaches:
  Also referred to as muscle contraction headaches, tension headaches are caused by muscle contractions that occur in the neck, head, jaw, upper back, and shoulders. These muscle spasms are first felt at the base of the neck but soon work their way upwards, eventually spreading to the temples. People often describe these headaches as feeling like a band tightening around their entire head.

• Migraines:
  Migraines are caused by constrictions of  blood vessels and arteries, they are listed in the medical community as vascular headaches. Stress, fatigue and illness can cause the blood vessels in your head, and neck to constrict. this can cause severe pain, dizziness, nausea and a feeling that someone is stabbing your eyes with a hot poker. Migraine headaches are notorious for moving freely around your head. They can occur on the left side and then move to the right at will.
  
  The so called "Classic" migraine can be preceded by double vision, blurry vision, bright lights. This is called a migraine aura and can be experienced up to sixty minutes before the migrain manifests itself.

  The second type of migraine is called the "Common" migraine, this category covers about seventy percent of sufferers. It can be preceded by fatigue, illness, anxiety and depression.

• Combination headaches:
  People with fibromyalgia can suffer from combination both headaches, they involve migraine and tension headaches that occur together.

The following symptoms may accompany the headache pain.

• Throbbing or pulsating that occurs during both active, and inactive periods.
• Unbearable pain if you attempt to exert yourself
• Sensitivity to light, sound, odors and/or noise.
• Nausea and
• Vomiting
• Pain can last from two to seventy two hours.
• Sinus congestion and/or drainage.
• Bouts of chills or a feeling of being over heated.
• Diarrhea or constipation
• Dizziness
• A confused feeling
• Depression and anxiety

Headache Triggers

It is estimated that more than fifty percent of people with Fibromyalgia suffer from constant headaches. There is no cut and dried explanation for these headaches. Below are some of the proposed theories.

• Sleep Disorders: Many people with Fibromyalgia also suffer from sleep apnea and sleep-related disorders. This may be why so many people with the syndrome suffer from morning headaches. Current studies  on migraine sufferers found that their sleep patterns were significantly disturbed, particularly by sleep apnea, which tends to make the severity and frequency of headaches worse.
  
• Low and high blood pressure: Your blood pressure can trigger chronic headaches. Work closely with your health care team to make sure your blood pressure is not to high, or to low.
  
• Temporomandibular Joint Disorder (TMJD): Many fibromyalgia sufferers also suffer from TMJ. TMJ causes your jaw to be misaligned and causes muscle and joint pain in the face, jaw, and neck. .It can also cause bruxism, (grinding your teeth as you sleep), which would cause stress and muscle contraction, thus contributing to your headaches.
  
• Low Levels of Serotonin: One theory is that migraines are caused by the same factors that cause Fibromyalgia. People who adhere to this school of thought, belive that migraines are not a symptom of Fibro, but a concurrent illness. Serotonin is a neurotransmitter that communicates pain signals to the brain. Recent studies show that people with Fibromyalgia, and chronic migraines have a low level of serotonin in the brain.
  
• Hormones: Many women experience headaches before, or during their menstrual cycle. Chart your headache days and check them against your cycle. Let your health care team know if the headaches occur around your cycle.

The experts urge you to journal your headache symptoms and keep them informed. Write down the foods you have eaten to rule out allergies and lactose issues. Record your physical activity and medications taken. Keep track of how many hours you sleep each night and make a note of when you wake up and how  you felt. If you are female, make checks on a calender each day you have a headache, then check to see if they correspond with your menstral cycle. They have many new treatments to help you overcome chronic headaches. It is a proven fact that almost forty percent of people with Fibromyalgia suffer from headaches that lead to greater levels of depression and anxiety. Please contact your health care team to find a suitable treatment plan. You do not have to live with chronic headaches.

Jane Kohler
(2007)

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Migraine most common: chronic headaches common in fibromyalgia patients
by Norra MacReady

RANCHO MIRAGE, CALIF. -- Headaches are frequently part of the pathology of fibromyalgia.

In a recent study of 57 patients with fibromyalgia, 75% had a history of chronic headaches, and of those patients, 86% said that the headaches had a severe or substantial impact on their lives, Dr. Dawn A. Marcus reported at a meeting sponsored by the Diamond Headache Clinic.

These findings suggest that headache screening and treatment should be part of the work-up for fibromyalgia, said Dr. Marcus, director of the headache clinic at the University of Pittsburgh Medical Center.

In the study, overall measures of pain, pain-related disability, and psychological distress were similar between patients with and without headache, suggesting that headaches may be part of the neurologic dysregulation that characterizes fibromyalgia, rather than a comorbid condition, she said.

The study included 56 women and 1 man seeking treatment for fibromyalgia at the university's pain clinic. Their assessment included a neurologic examination and a fibromyalgia tender-point examination. Headaches were diagnosed according to International Headache Society criteria. The patients also completed a variety of self-report measures to assess their levels of pain, disability, and psychological distress.

Headaches were reported by 43 of the patients. (See table.) Migraine was the most common headache type, followed by tension-type headache and headaches resulting from analgesic overuse. Posttraumatic headache was the least common type, diagnosed in only two patients, a surprising finding given that fibromyalgia frequently occurs after an injury, Dr. Marcus said.

Among the questionnaires the patients completed was the six-item Headache Impact Test (HIT-6), which measures the disruption in one's life caused by headaches on a scale of 36-78. Of the 57 patients, 35 (81% of those with headaches) had a score greater than 60, suggesting a very severe impact from headache. Two more patients (5%) scored 56-58, suggesting a severe, possibly disabling, impact from headache. The mean HIT-6 score for all patients with headaches was 62, compared with 50 for the patients without headaches, a statistically significant difference.

There were no differences between patients with or without headaches in scores on the McGill Pain Questionnaire, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, visual analog scales for pain, or the Medical Outcomes Survey Short Form Quality of Life Questionnaire.

Most of the patients who reported having migraines said the headaches predated the onset of fibromyalgia. In an earlier study, Dr. Marcus and her colleagues noted the existence of tender points in patients with chronic headaches who had not been diagnosed with fibromyalgia (Psychosom. Med. 61[6]:771-80, 1999).

These findings support the hypothesis that the occurrence of headache, especially migraine, in fibromyalgia patients is part of the overall dysregulation of pain that produces fibromyalgia, rather than a separate pain entity, she said.

Headache Diagnoses in Fibromyalgia Patients

                                     Number of
Headache Type                        Patients

Migraine alone (without aura)        12
Combined migraine and tension type   10
Tension type alone                    9
Migraine alone (with aura)            7
Probable analgesic overuse headache   3
Posttraumatic headache                2
Headache of any type                 43
No headache                          14

Source: Dr. Dawn A. Marcus

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Treating Headaches in Fibromyalgia
By Dr. Richard L. Bruno

At least once a week I get a sharp pain on one side of my head, sometimes the left, most often on the right. I sometimes I wake up with a headache, but also get one at the end of the day when I am tired. My neck also hurts on the side where my head hurts and I often feel nauseated. One doctor says I have fibromyalgia. Another says migraines. But I don't have flashes in front of my eyes and I don't throw up. Is my headache a migraine? Is it due to fibromyalgia? Probably neither. Patients tell me they have migraine headaches because there is pain on one side of the head plus nausea. But despite nausea, most people with headaches don't have migraines. Headaches are most often the result of muscle spasms in the neck, upper back and shoulder muscles. When a muscle on one side of the neck goes into spasm it causes not only a one-sided headache but also pushes on the vagus nerve in the neck -- the nerve that makes the stomach "turn on" -- and causes nausea. Such single-sided headaches sound like migraines, but aren't. What's more, we see many people with headaches, back and neck pain who are diagnosed with fibromyalgia but whose pain is actually due to muscle spasms.

What causes muscle spasms? Spasms are triggered by physical and emotional stress. Physical stress can be doing too much and becoming fatigued or having "painful" posture. Painful posture is sitting or standing with your back looking like a C: your head falling forward, upper back curled over, shoulders elevated, being bent forward at the waist or tilting to one side (by the way, sitting at the computer may be the #1 cause of painful posture.) Emotional stress can be anything from the slings and arrows of living in the 21st century to the hard-driving, pressured, overachieving, work-till-you-drop Type A lifestyles that many CFS/ME patients have.

How do you treat headaches and other muscle spasm pain? First you need to make sure that the pain is indeed caused by a spasm. A morning headache can be a symptom of a sleep disorder like sleep apnea. A daytime headache can be a sign of high blood pressure or hypoglycemia. Having a breakfast with 16 grams of protein and an 8 gram protein snack at 10:00 am and 3:00 pm can significantly decrease spasms and pain.

If spasms are causing pain you need to take the stress off yourself and your muscles. You need to slow down, pace activities and rest during the day, even lie down to take the load off your muscle for 15-minute rest breaks, one in the morning and one in the afternoon. You also need to balance your body -- front to back and side to side, while sitting, standing and walking -- so that muscles don't have to fight gravity to keep you upright.

A physical therapist (PT) with lots of experience treating chronic pain can help you turn off long-standing spasms. PTs can teach proper posture and suggest assistive devices to balance your body while standing and walking. Using a lumbar cushion while sitting, and a contoured, fiber-filled cervical pillow while sleeping on your back, insure good posture and turn off back and neck spasms day and night. Since heat is usually more helpful for spasms than is ice, PTs can do ultrasound (the deep heating of muscle using sound waves) and you can warm your muscles at home by taking a hot bath or shower and by using a heating pad.

Actually, you always need to keep your painful muscles warm, especially those in your neck and shoulders, since cold also triggers muscle spasms. The change of seasons -- especially the transition from summer to fall -- is very troublesome for those with spasms since your body isn't sure just what the temperature is. Dress in layers and bring along a sweater to keep your cold-sensitive muscles warm wherever you are, inside or out.

And be careful if you go to a physical therapist. Too many PTs use the "shake and bake" method: gentle massage after your muscles have been heated by a hot pack. Although massage and heat can relax muscle spasms and make you feel better for a few hours, if you don't take the stress off your muscles and change your posture all day long the spasms and pain will return.

Once your spasms start to relax a home stretching program is indispensable. With help from your PT you can find a few stretches for the specific muscles in spasm. Stretch just before bed, first thing in the morning, every half hour during the day and whenever you feel muscles tightening. A handful of stretches combined with reduced physical and emotional stress, proper posture and staying warm will keep muscles relaxed day and night and stop muscle spasm pain, including those nasty headaches.

About the author: Dr. Richard Bruno is Director of Fatigue Management Programs and The Post-Polio Institute at Englewood (NJ) Hospital and Medical Center.

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Migraine? Take 'Triptan' Sooner Rather Than Later
By Karla Gale

NEW YORK (Reuters Health) - For migraine sufferers, the new "triptan" drugs like Imitrex or Zomig have been a boon. But "the sooner the better" should be the mantra for those who also experience abnormally sensitive skin on the face and scalp during attacks.

The throbbing pain and nausea of migraine is sometimes accompanied by "cutaneous allodynia," in which combing one's hair, shaving, or taking a shower can provoke pain. Some people can barely tolerate wearing glasses or earrings when this condition starts.

This phenomenon may explain why up to half of migraineurs don't respond to many drugs used to treat migraine. And now scientists may have a solution for these folks: Don't put off taking your medicine, especially if you know that you are cursed by "tactophobia."

Dr. Rami Burstein and associates at Harvard Medical School (news - web sites) in Boston believe that headache and skin pain experienced by migraine sufferers don't even originate in the same area of nervous system. The throbbing starts in sensory nerve cells in the dura mater, a membrane that surrounds the brain.

If this pain signal continues unabated, nerves in the spinal cord become
overstimulated and start firing continuously, and as a result, even touching the skin hurts.

In the journal Annals of Neurology, Dr. Burstein's group reports what
happened in a study of 31 patients who took sumatriptan, a. k. a. Imitrex. The doctors examined responses when treatment was started at 1 hour or at 4 hours after onset of the headache.

The 12 subjects who did not develop symptoms of allodynia were best served by the medication. Treatment was effective in relieving pain for 10 of them, even if they waited 4 hours before taking it.

The other 19 patients did develop the exaggerated skin sensitivity. There were 12 for whom these distressing symptoms did not begin until after the first few hours of the attack, and all of them were rendered pain-free if sumatriptan was given before allodynia developed.

If these patients waited until afterwards, though, only 3 of 12 had complete pain relief. But even for patients with allodynia, triptan treatment usually terminated the throbbing kind of pain.

For the six individuals with onset of allodynia early in the attack, only
one patient's migraine could be completely aborted by sumatriptan taken 1 hour after the migraine started. None of them experienced relief if they waited for 4 hours.

The good news is that "patients know within 5 to 20 minute if a headache is absolutely a migraine, because the pain begins to throb," Burstein told Reuters Health.

"If patients pay attention to their scalp and their earrings and their
glasses and their eyebrows and their hair follicles, all the things that
make their skin feel hypersensitive, they will no longer have to guess if
and when they should take a triptan."

Based on his group's findings, he recommends that "patients with allodynia should be treated within 20 minutes of the migraine onset, because in more than 95 percent of these cases, allodynia has not developed yet."
SOURCE: Annals of Neurology November 7, 2003.

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Swaying By Migrainous Patients When Eyes Are Closed Indicates Vestibulospinal Dysfunction
A DGReview of :"Static stabilometry in patients with migraine and tension-type headache during a headache-free period"
Psychiatry and Clinical Neurosciences 02/28/2002 By David Loshak

Patients with migraines show a significant increase of body sway when their eyes are closed, indicating an underlying dysfunction in the vestibulospinal system, say researchers from Tottori University, Yonago, Japan.

Noting that patients with migraines often complain of dizziness or vertigo during attacks, and sometimes between, the neurologists evaluated the vestibulospinal system in patients with migraine and episodic tension-type headache when they were not having a headache.

The neurologists employed computerised static stabilometry, which they described as a reliable and non-invasive technique for evaluating equilibrium function in various diseases.

After recruiting 21 patients with migraine, 12 patients with episodic tension-type headache and age-matched and sex-matched controls, the neurologists carried out two sets of static stabilometric measurements with eyes open and eyes closed, each for 30 seconds.

The averages of six stabilometric parameters in the two sessions were used for the analysis. These parameters were: locus length, environmental area, rectangle area, locus length per second, locus length per environ area and root mean square area. Romberg quotients of the six parameters were also analysed.

The mean values of locus length, environmental area and rectangle area in the eyes closed session in the migraine group were significantly greater than in controls. Romberg quotients of all stabilometric parameters except the locus length per environ area in the migraine group were significantly greater than in controls.

Patients with episodic tension-type headache did not show any differences in the stabilometric study from the controls.
Psychiatry and Clinical Neurosciences 2002; 56(1):85-90.

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Low Melatonin Levels Suspected in Insomnia-Linked Chronic Migraine

source: http://content.health.msn.com/content/article/1826.50364

Nov. 29, 2001 -- Is melatonin the answer for chronic migraine sufferers with insomnia? Tantalizing new data suggest that it may help.

Chronic migraine is when the disabling headaches occur on more than 15 days each month. Nobody's sure what causes them, or why they are so frequent. A Brazilian research team now suggests that they may be caused by hormone imbalance. Low melatonin levels appear to be part of the problem.

"Melatonin may have a role in the treatment of chronic migraine, particularly in those patients with insomnia, but further studies are necessary to confirm this," write M.F.P. Peres and colleagues in the current issue of the Journal of Neurology, Neurosurgery, and Psychiatry.

Peres's team took hourly blood samples from 17 patients with chronic migraine and from nine age- and sex-matched healthy volunteers. Analysis of these samples revealed that the migraine sufferers had abnormal hormone levels. Those who also suffered from insomnia had significantly lower
melatonin levels than those who did not have trouble sleeping.

Melatonin is a hormone with many functions. One of them is regulation of sleep and waking cycles. This isn't the first time that melatonin has been linked to headache. People with cluster headaches, episodic migraines, and menstrual migraines also appear to have low melatonin levels.

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Averting Migraines With Few Side Effects

Dec. 31, 2002 -- A member of the newest class of high blood pressure medications may prevent migraines with similar results but fewer side effect than other drugs employed for these crippling headaches, which are suffered by some 240 million people worldwide.

Norwegian researchers say that headache and migraine attacks were cut by nearly half in patients after starting a daily regimen of Atacand, one of six angiotensin II receptor blockers (ARBs) marketed in the U.S. Their study is published in the Jan. 1, 2003, issue of The Journal of the American Medical Association.

Atacand, which received FDA approval in 1998, is the latest hypertension drug being studied as a preventative treatment for migraine, although how the drug prevents migraines is not known. Beta-blockers such as Inderal and Levatol and ACE inhibitors such as Prinivil or Zestril are also effective, but often with troublesome side effects.

Beta-blockers can cause a range of problems from fatigue to sexual dysfunction and are not recommended for patients with asthma; ACE inhibitors which are used less frequently in migraine prevention, cause fewer side effects than beta-blockers but produce a nagging dry cough in about 20% of patients and may increase potassium levels in the body to dangerous levels.

"The main advantage of Atacand over beta-blockers would be its improved safety profile, especially since it does not lower pulse frequency, which is a main advantage when used in a younger population," study author Erling Tronvik, MD, tells WebMD. "In our study, Atacand also showed better results in reducing migraine than demonstrated in a study of ACE inhibitors. But it did not produce the same cough side effect."

ACE inhibitors and ARBs -- such as Atacand -- reduce the production of angiotensin, a hormone that causes arteries to narrow.

Migraine is also prevented with epilepsy drugs such as Valproate and antidepressants such as Elavil, Vivactil, and the popular serotonin-reuptake inhibitors such as Prozac and Zoloft. These drugs produce similar reductions in attacks to what was found in Tronvik's study -- but again, with more side effects.

Over-the-counter drugs such as aspirin and Tylenol and prescription "triptan" medications such as Imitrex are used for an acute attack, not prevention, but only about half of patients respond consistently to these medications. "But frequent use of these or other types of analgesics may lead to medication-overuse headache," says Tronvik, of the Institute of Neuroscience and Motion at the Norwegian University of Science and Technology. His study is among the first to test an ARB's effect on migraine.

"I'm happy -- especially with the promise of no side effects," says Stephen Silberstein, MD, director of the Jefferson Headache Center in Philadelphia. "If this finding is shown to be true in future studies, this might be a
reasonable treatment. But we need to see more about it."

In Tronvik's study, half the migraine sufferers were given Atacand for 12 weeks and later switched to a dummy pill for another 12 weeks. The other half of the migraine sufferers were first given the dummy pill and 12 weeks later switched to Atacand. The participants were unaware of the order of the medications they were receiving.

AstraZeneca, the maker of Atacand, provided the medication and funding for the study.

The researchers wanted to see if Atacand would reduce the number of days with a headache. In patients taking Atacand, about a 25% reduction in days with headaches as well as an almost 30% reduction in days with migraines was found compared with patients taking dummy pills. The researchers also found that about 40% of responders to Atacand reported a reduction in the hours that they suffered the migraine.

Some migraine sufferers must take extreme measures in diet and lifestyle to avoid triggering an attack, which can result from activities as benign as taking a hot bath, eating foods such as chocolate and citrus fruit, being exposed to loud noises, and even intense exercise.

"Many participants in our study told me that the worst thing about having migraine was the unpredictability -- it was difficult to plan ahead," says Tronvik. "A reduction in headache days would benefit in the form of increased quality of life. And in our study, the number of sick leave days lost to migraine were reduced with 64% (by those taking Atacand), which would mean a cost savings for society."

SOURCES: The Journal of the American Medical Association, Jan. 1, 2003  Erling Tronvik, MD, clinical doctor, department of neurology, St. Olavs Hospital; and scientist, Institute of Neuroscience and Motion, Norwegian University of Science and Technology, Trondheim Stephen Silberstein, MD, professor of Neurology, Jefferson Medical College of Thomas Jefferson University; and director, Jefferson Headache Center, Philadelphia

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Massage Therapy May Reduce Chronic Tension Headache By Steven Reinberg

NEW YORK (Reuters Health) Oct 11 - Massage therapy directed to the neck and shoulder muscles can reduce the frequency and duration of tension headaches, researchers report in the October issue of the American Journal of Public Health.

"The results of our study strongly support the efficacy of specific manual intervention to decrease the symptomatology associated with non-migraine headache," lead author Christopher Quinn told Reuters Health.

"Specificity of the treatment was critical in the successful outcomes that we reported. Our treatment protocol was very specific and included the manipulation of myofascial trigger points, post-isometric stretching techniques, and massage strokes applied to named musculature," he added.

Dr. Quinn and colleagues from the Boulder College of Massage Therapy, Colorado, evaluated four patients with chronic tension headache. Over 4 weeks, the researchers recorded the frequency, duration and intensity of headaches.

During the next 4 weeks, patients received 30 minutes of massage therapy twice a week. Dr. Quinn's group then compared the results of massage therapy with baseline headache frequency, duration and intensity.

Massage therapy significantly reduced the frequency of headaches from the first week of therapy through to the end of the trial (p = 0.009). Mean headache frequency was reduced from 6.8 at baseline to 2.0 during massage therapy, they report.

The duration of headaches also tended to decrease during the massage phase, from a mean of 8.0 hours at baseline to 4.3 hours during treatment, but this difference was not statistically significant. Headache intensity was not affected by massage therapy, Dr. Quinn's team found.

Dr. Quinn noted that "results from a second portion of this study, yet to be submitted for publication, show statistically significant improvements in psychological parameters associated with chronic pain--specifically, depression, anxiety, and somatization."

"Massage therapy, and other manual medicine modalities, are too often used as the 'last resort' on the treatment continuum," he said. "Once a diagnosis is definitively established, the use of such conservative treatments should be a front line consideration--particularly in consideration of the risk/benefit ratio. Massage therapy is also cost-effective; we achieved our published results with only 4 total hours of treatment over a 1-month period," Dr. Quinn said. Am J Public Health 2002;92:1657-1661.

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Olanzapine Effective For Chronic Headache But Should Be Used With Caution
By Veronica Rose

Patients with refractory headache, including those who failed to benefit from other prophylactic agents, may be effectively treated with olanzapine.

Caution is advised, however, for its use among patients who also have mania, bipolar disorder, psychotic depression or those previously treated successfully with other neuroleptic medications.

This new antipsychotic drug, has pharmacologic properties suggesting it might be an effective therapy for headaches. In addition, it has a low propensity for the induction of extrapyramidal reactions or tardive dyskinesia.

Subsequently, American researchers at the Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, assessed the therapeutic value of olanzapine for chronic refractory headache in 50 patients for the minimum of three months. They had all received at least four preventive medications, which failed.

Patients were given olanzapine at varying doses from 2.5 to 35 mg daily. Nineteen were given 5mg daily while 17 received 10mg.

Response from this therapy provided a statistically significant decrease in the number of headache days relative to baseline. This ranged from 27.5 ± 4.9 before treatment, to 21.1 ± 10.7 after therapy. Researchers also established that the degree of headache severity differed significantly from pretreatment levels (8.7 ± 1.6) and post therapy (2.2 ± 2.1).
Journal of Head and Face Pain 20022 vol42 No 6 pp 515-518

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Local Anesthetic Eases Migraine

Quick injection also effective treatment for head and neck pain


TUESDAY, Dec. 23 (HealthDayNews) -- Some migraine sufferers and people with head and neck pain can get instant relief when an inexpensive local anesthetic is injected into muscle tissue at the back of the neck, say clinical studies in Georgia and Ohio.

Doctors in the emergency room at the Medical College of Georgia Medical Center (MCG) and at American Pain Specialists Inc. in Ohio injected small amounts of Marcaine into the muscle surrounding the seventh cervical vertebra, where the neck and shoulders meet.

Marcaine is a long-acting pain reliever that, among other things, is routinely used to numb an area for stitches.
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The studies say that Marcaine seems to be 85 percent to 90 percent effective in treating migraine and head and neck pain caused by many things, including facial injuries caused by a softball, glaucoma-related eye pain, concussion and tension headaches.

Along with almost immediate pain relief, the Marcaine also reduces many associated symptoms such as nausea and vomiting.

Several cases are profiled in the November/December issue of Headache.

"This works just like rebooting a computer or a key in the lock to turn off headache pain. We think this is somehow right to the core of how headaches happen. We think if we can unravel why this works, we will have a better understanding of why headaches happen," Dr. Larry B. Mellick, vice chairman for academic development and research at the MCG department of emergency medicine, says in a prepared statement.

Here's where you can learn more about headache (www.achenet.org).

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Epilepsy Drug Effective Against Chronic Headache

Gabapentin helped a third of patients in study
By Steven Reinberg     
   
MONDAY, Dec. 22 (HealthDayNews) -- The epilepsy drug gabapentin, when taken daily, relieves pain in a third of patients with chronic daily headache, Australian researchers report.

Chronic daily headache is a condition defined as headaches occurring on at least 15 days every month and lasting for more than four hours, says lead researcher Dr. Roy G. Beran, of the department of neurology at Liverpool Hospital in New South Wales. "Chronic daily headaches include migraines, chronic tension headaches or headaches from other causes," he says.

"Gabapentin proved to be effective in the treatment of chronic daily headache," Beran says.
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The researchers conducted a randomized, placebo-controlled study in which patients were selected to receive gabapentin or a placebo for six weeks. After the first six weeks, there was a one-week period when no treatment was given, and then the groups switched treatment for a second six-week period.

In the trial, conducted by the Australian Gabapentin Chronic Daily Headache Group, patients receiving gabapentin were given 2,400 milligrams a day. That is the maximum approved dose in Australia for treating people with epilepsy, Beran notes.

Of the 133 men and women in the study, data was available for 95, according to the report in the Dec. 23 issue of Neurology.

Beran's team found a third of the people in the study stopped having daily chronic headache while receiving gabapentin. "So it worked over the full spectrum of headaches," he says.

"Those who had a response did brilliantly," Beran says. However, he adds, "there was a significant number who did not have a response."

Beran points out that in Australia, as in the United States, gabapentin is approved only for the treatment of epilepsy. However, it is being used "off license" as a painkiller and to treat depression, mania and anxiety, he says.

Beran believes that with a physician's approval, gabapentin should be used to treat chronic daily headache in patients where all other treatments have failed.

He also speculates that higher doses of gabapentin may be even more effective and may improve the response among patients who do not respond to the dosage used in his current study.

"Gabapentin is one of the safest products ever made," Beran says. He believes it can be given in doses of up to 5 grams per day without harmful effects. "The upper limits of doses of gabapentin for epilepsy have not been defined," he says.

For people with chronic daily headache, Beran stresses "there is hope out there -- don't give up. Our study clearly shows that there is benefit to using gabapentin in the treatment of chronic daily headache."

Dr. Stephen D. Silberstein, a professor of neurology and director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, calls the Australian finding interesting but not very persuasive.

"In my experience, gabapentin is not a very successful medication for headache disorders," says Silberstein, who wrote an accompanying editorial that appears in the journal.

Silberstein finds fault with the new study because it didn't differentiate between the types of headaches and how those headaches reacted to gabapentin. In addition, the overall beneficial effect of the drug was not very great, he says.

Silberstein agrees that very high doses of gabapentin would probably have a better effect. However, those higher doses could lead to unwanted side effects seen at high doses, such as lethargy, balance problems and cognitive changes associated with other epilepsy drugs.

For those reasons, Silberstein doesn't believe gabapentin will be useful in treating chronic daily headache. "There are other, newer drugs now in clinical trial that have as much as an 80 percent success rate with chronic every day headache," he says.

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Rebound headache: The cost of overmedication

By Mayo Clinic

If you have frequent, severe headaches, you may be tempted to take pain medicine in advance — even every day — to stave them off. But this strategy can backfire badly. The pills can eventually cause more headaches than they cure.

When you take pain medicine daily, even if it's just an over-the-counter remedy, your body can gradually become accustomed to it. You may not realize that you've been dosing yourself too often until, for some reason, you miss a day. Then your pain medicine will wear off and your head will start hurting again. You may think you just have an especially persistent headache, but the recurring pain actually is a symptom of medication withdrawal. The more often your head hurts, the more often you take your pain medicine. It becomes a vicious cycle.

If your head hurts at least 15 days a month, you may be having rebound headaches — especially if you're taking pain relievers for your headaches more than twice a week.

The usual suspects    

Almost any medication that provides prompt relief of headache symptoms can contribute to rebound headaches, including simple pain relievers such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others), especially if you're taking them in higher than recommended daily dosages.

Caffeine, a common ingredient in many pain medications, also is strongly linked to rebound headaches. Other medications that commonly cause rebound headaches include:

* Mixed analgesics. These drugs contain a combination of caffeine, aspirin and acetaminophen and are especially known for causing rebound headaches. They also include prescription agents such as Fioricet and Fiorinal, which contain butalbital, caffeine, and aspirin or acetaminophen.

* Migraine-specific medications. These drugs fall into two classes. Ergotamines (Ergomar, Migranal, others), which have been in use for many years, work by making blood vessels constrict. Triptans (Imitrex, Zomig, others), a newer class of drugs, work by altering levels of brain chemicals involved in migraine.

* Opiates. Medications that include any form of codeine, such as Tylenol 3, Vicodin and Percocet, must be used with care because they can cause dependency quickly.


When to treat a headache    

It's fine to take a pain reliever for the occasional headache. If you have migraines, you may need to keep prescription medication on hand for use when your symptoms occur. The important thing is to take headache medication — prescription or nonprescription — only when your head is actually hurting. Doctors sometimes refer to this type of medication use as acute therapy.

If you have headaches you can't control with acute therapy, your doctor might prescribe a daily preventive medication, perhaps an antidepressant or an anticonvulsant. Because these prevention-type medicines are not pain relievers, they don't lead to rebound headaches.

Preventive medicine will not work on rebound headaches. The only way to stop rebound headaches is to stop taking the pain medication that's causing them. You may want to undergo this weaning process under a doctor's supervision.

Headaches usually worsen for at least a few days after withdrawal. In some cases, these withdrawal headaches can last as long as two months.

Research has indicated that low doses of a pain reliever such as naproxen can take the edge off withdrawal headaches. However, some people require intravenous medications to control the nausea and pain associated with withdrawal.

Afterward, your doctor may prescribe preventive medicine to help you control your headaches without having to rely so heavily on pain remedies.

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