Treating Chronic Headaches With Medication

Walk down the pain medicine aisle of any drugstore and you can easily get overwhelmed. Seemingly endless types of medications are available to treat chronic headaches. How do you know which one is right for you? It depends largely on two factors: what type of chronic headaches you have, and how severe your headache pain is.

Medications by Headache Type

Because there are many types of chronic headaches, there are many kinds of medications for them. Most, however, fall into two categories: pain medication you take every day to prevent a headache (known as prophylactic), and medicine you take after a headache has started (known as abortive).

Abortive pain medications may be available over-the-counter or by prescription and are taken at the time of attack, whereas prophylactic pain medication is taken on a regular basis to prevent chronic headaches from forming, and usually require a healthcare provider's prescription. Some types of chronic headaches require both kinds of medications.

Medications for Migraines

Migraines are often treated with regular preventative prophylactic medications, although abortive medications are useful for breakthrough migraine pain. Many prophylactic medications require a build-up period, and won't be effective at migraine prevention for a few weeks.

Because migraines are neurological, most of the prophylactic medications work by changing the way the brain responds to certain triggers. It may take several trials to find a medication that is effective for your migraine pain.

• Tricyclic antidepressants: Prescribed in lower doses than for clinical depression, tricyclics such as amitriptyline and nortriptyline may help prevent migraines before they begin.
• Other antidepressants: Serotonin-reuptake inhibitors (SSRIs) are not always as effective as tricyclics, but they do control migraines in some people. Common SSRIs for migraines include fluoxetine and sertraline.
• Beta-blockers: Usually used to control blood pressure, beta-blockers can reduce migraine frequency or intensity when taken regularly. Propranolol and timolol are commonly prescribed for this purpose.
• Calcium channel blockers: Though they may take many weeks to become effective, calcium channel blockers such as verapamil can be effective in preventing migraine attacks. Other calcium channel blockers are currently being researched for this purpose.
• NSAIDs: Nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen may be taken as an abortive medication. However, some healthcare providers prescribe them for prophylactic use as well.
• Botox (botulinum toxin A): Botox injections are believed to block the neurotransmitters that transmit pain signals to your brain, causing migraine.

Other migraine prophylactics include anti-seizure drugs, though they are often considered a last resort due to their side effects and a potential for toxicity. Currently, studies are being done to assess the effectiveness of angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), leukotriene antagonists, and dopamine agonists.

Medications for Tension Headaches

The most commonly used medications for tension headache pain include:

• Tricyclic antidepressants: Tricyclics such as amitriptyline and imipramine are used as prophylactics, preventing tension headaches from forming in the first place.
• NSAIDs: Ibuprofen and naproxen are available over-the-counter, but stronger concentrations require a healthcare provider's prescription. They are effective in controlling mild to moderate tension headache pain.

The roles of botulinum toxin A, anti-seizure medications and muscle relaxants in controlling chronic tension headaches are currently being investigated.

Medications for Cluster Headaches

Because most cluster headache attacks are short-lived, prophylactic medication tends to be more effective than abortive medication. Some of the more common medications used to control chronic cluster headaches include:

• Calcium-channel blockers: As with migraines, verapamil is a common calcium-channel blocker for cluster headache pain, though it is actually designed to treat heart disease.
• Lithium: Commonly used to treat bipolar disorder, lithium may be used on its own or in combination with other drugs to control cluster headaches.
• Anti-seizure drugs: Valproate and topiramate are designed to treat epileptic seizures. However, they have proven useful in controlling cluster headache frequency.
• Capsaicin: A nasal-spray version of capsaicin, a topical analgesic, has been about 50% effective in reducing the frequency of cluster headaches in clinical trials.
• Transitional agents: Transitional agents are the drugs used to stabilize a person after a cluster headache attack. These include ergotamine and prednisone.

Botulinum toxin A and baclofen, both of which are commonly used to decrease muscle spasticity, are currently being investigated for their potential to reduce the frequency of cluster headache attacks.

Headache Relief Without Medication

Pharmaceuticals are not the only option for controlling chronic headache pain. In fact, several complementary and alternative medicines (CAMs) are commonly used for this purpose. These include yoga, massage, acupuncture, and aromatherapy.

In addition to medications and CAMs, finding coping mechanisms for dealing with chronic headaches can go a long way toward prevention and pain control. Check out support groups and forums, involve your family and friends and establish a good relationship with your healthcare provider. When combined with the right drugs, coping mechanisms can help you get your chronic headache pain under control.