Headache medical therapy: Difference between revisions
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Revision as of 01:16, 8 June 2015
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Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Headaches may be successfully treated through medical therapies such as analgesisa and, in some cases, a tandem approach with implanted electrodes.
Medical Therapy
Not all headaches require medical attention, and respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or members of the NSAID class (such as aspirin/acetylsalicylic acid or ibuprofen).
In recurrent unexplained headaches, healthcare professionals may recommend keeping a "headache diary] with entries on type of headache, associated symptoms, precipitating and aggravating factors. This may reveal specific patterns, such as an association with medication, menstruation or absenteeism or with certain foods. While it can be time consuming and complex, taking the effort to both determine the root cause of each headache type that the afflicted may have and then customize treatment for one aspect at a time can be quite fruitful. This is sometimes referred to as reducing total load [3].
It was reported in March 2007 by two separate teams of researchers that stimulating the brain with implanted electrodes appears to help ease the pain of cluster headaches.[1] Since cluster headache is ultimately an autonomic nervous system generated headache, evaluation for Barre lieou may offer an effective, non-invasive alternative.
Contraindicated medications
Headache with focal neurologic symptoms is considered an absolute contraindication to the use of the following medications:
- Drospirenone and Ethinyl estradiol
- Norethindrone acetate and Ethinyl estradiol
- Norgestimate and Ethinyl estradiol
Manipulative Therapy
A controversial approach to headache treatment is chiropractic care. Most research supporting the chiropractic adjustment (also known as spinal manipulation by the scientific community) has been self-funded by the chiropractic profession.
The most compelling study of chiropractic efficacy is Nelson's randomized trial, comparing chiropractic to medical care,[2] which included the drug amitriptyline, for the treatment of Migraine Headache. During the 4-week trial, both groups reduced in symptoms. After withdrawal of treatment, the medical group relapsed or got worse, whereas the group receiving chiropractic care maintained their improvements. The amitriptyline is more cost-effective as it is cheaper than the cost of visiting a doctor, but freedom from symptoms or a reduction in frequency only happened in the chiropractic group.
Independent (non-chiropractic) researchers reviewed research on many different types of behavioral and physical treatments for tension-type and cervicogenic headaches[3] and found that cervical spinal manipulation was associated with improvement in cervicogenic headache outcomes (but not for tension-type headache), and was superior to soft-tissue therapies like massage.
Reducing Total Load
Reducing the total number of things that can trigger a headache can be one of the most effective approaches toward headache relief. With this approach the patient and doctor try to identify all of the factors that contribute to that person's headache and whittle away at them one at a time [4]. Treatment therefor is specific to those factors that contribute that person's headache. Cerviogenic nerve irritation with degenerative disc disease and cycle (hormonal) headaches may be important for one patient, however stress and a history of sinus infections may be more important for another. The next patient may have all of these factors and more. In each case an individualized treatment plan is required.
References
- ↑ Brain Stimulation May Ease Headaches. Reuters, March 9, 2007.
- ↑ "The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache." J Manipulative Physiol Ther 1998; 21 (8) Oct: 511–519.
- ↑ "Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache." Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research.