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Headache Medications: Pros and Cons

Headache medications include several classes of drugs that are effective. But how do you know which are the best headache medications? Most of them are quite effective as migraine headache treatments to prevent migraines. If you are suffering from chronic tension type headaches you might respond to treatment for a few months to break the spasming.

Most of the time, these drugs can be taken at doses MUCH LOWER than doses used for other problems. Unfortunately, some people are frightened of headache medications and will refuse to even try them, believing they will get every side effect listed.

Many times patients will ask me "What is the best headache medication?" Let's review the most commonly used prescription drugs from a sensible point of view, OK?

  • Anti-Seizure Medications

This is probably the most effective class of drugs for lowering frequency and pain level of headaches and migraines. I have used the drugs I discuss on thousands (!) of patients and am pretty familiar with how the patients respond. It is important to realize that this class of drugs is used at higher doses to prevent seizures. For treatment of headache, however, the dose is usually much lower, perhaps 1/10 of the anti-seizure dose.

These drugs are appropriate for you if:

1. You have 1 or 2 severe, disabling headaches per month and/or..

2. You have 2 to 3 headaches per week.

The most effective drugs for headache are as follows:

  • Anti-Depressants
Now don't freak out! This class of drugs is very effective not only to treat anxiety and mood but also to alieviate pain.

Almost 85% of all chronic pain patients have depression and/or anxiety to some degree.

Chronic illness such as fibromyalgia, MS, diabetes, and headaches can all lead to depression if the condition is more than six months old. More about the impact of depression on headaches.

  • Botox For Migraines

Botox for migraines is an exciting newer option for you if you have migraines that have failed to respond to the above options. Discuss this with your doctor and find a clinician skilled in doing Botox. This option is appropriate if you have 15 days a month or more where you have a migraine.

  • Opiods
This includes drugs such as hydrocodone, Lortabs, Tylenol with Codeine, Fiorcet and Ultram for headache.

Many times these medications are handed out by well meaning health care professionals to try and treat a patient in acute pain of headache. Unfortunately, too many times patients become addicted to these drugs as the headaches become worse and worse.

Using these types of headache medications more than three times per week for headaches can actually make the headache syndrome WORSE!

  • Anti-Psychotics
Once again don't freak out! These medications are not first line in treating constant chronic daily headache, but they are effective when nothing else has worked. They tend to dampen the pain pathways in the brain and reduce the frequency and pain level of the headaches.

The most promising in the class currently for headaches are Seroquel and Zyprexa and once again I use very low doses.

  • Beta-Blockers
Beta-blockers such as Inderal(propranalol) were also one of the earlier drugs found to be effective in preventing migraine. Unfortunately, it is not as effective as anti-seizure medications, but that does not mean it might not work for you.

For severe migraines during pregancy, beta-blockers in very low doses can be effective. The important thing to remember when pregnant and considering a drug, is that severe pain, nausea and vomiting is not good for you or the baby.

Pain raises adrenaline levels, causing an increase in blood pressure and repetative vomiting causes dehydration. It is best to treat the headaches and keep you and your baby healthy.

  • Calcium Channel Blockers
This is another class of anti-hypertensives like beta-blockers that may help treat migraine. This drug in particular is effective if you have a lot of vertigo or spinning feelings with your headaches.

The most commonly used drug for headaches is verapamil and is not used in higher doses for migraine as it is for cluster headaches.

Like the beta-blockers, this drug has the potential to lower your blood pressure and in addition may cause constipation.

Remember, not all headache medications and migraine medication will have side effects. Everyone is different, as is the response to drugs.

  • Anti-spasmotics

There are many anti-spasmotics on the market but not all are suitible to treat head pain. Medications such as carisoprodol (Soma) and cyclobenzaprine (Flexeril) are good but are very long lasting and can be in your system for several days. They also cause excessive sedation and when you first start them you may not be able to drive a motor vehicle. Although they treat muscle spasms, they may not be appropriate for chronic tension headaches. When it comes to headaches and neck pain there may be better choices.

Most of the time I have much better success when I start the patient on either amitryptiline (Elavil) or nortryptiline (Pamelor) low dose. The benefit here is that these headache medications also treat migraine. Another great choice is tizanadine (Zanaflex) and the nice thing about this drug is that it is out of your system in 10 hours. I have patients take this at nighttime to begin with as it does have mild sedation, but after a week or two that tends to wear off in the majority of people. They can then take a dose during the day if they want to.



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