Lawrence Robbins - Headache Help: A Complete Guide to Understanding Headaches and the Medications That Relieve Them

Copyright 2000, 1995 by Lawrence Robbins, M.D., and Susan S. Lang

All rights reserved

For information about permission to reproduce selections from this book, write to Permissions, Houghton Mifflin Company, 215 Park Avenue South, New York, New York 10003.

www.hmhco.com

The Library of Congress has cataloged the print edition as follows:

Robbins, Lawrence D.

Headache help : a complete guide to understanding headaches and the medicines that relieve them / Lawrence Robbins and Susan S. Lang.Rev. and updated,
p. cm.
ISBN 0-618-04436-1
1. HeadachePopular works. I. Lang, Susan S. II. Title.
RB128.R628 2000 616.8'49Idc21 00-036940

Headache Calendar copyright 1993 by Lawrence Robbins, M.D., Management of Headache and Headache Medications, Springer-Verlag, New York.

Appendix B, Over-the-Counter Headache Medications, copyright PDR for Nonprescription Drugs , 1994, 15th edition, and 1999, 20th edition, published by Medical Economics Data, Montvale, New Jersey 07645. Reprinted by permission. All rights reserved.

The information presented in case histories and stories in Headache Help is medically accurate. However, all names, places, and identifying characteristics have been changed to protect privacy. Some case histories contain elements from more than one patient. Any resemblance to persons living or dead is coincidental.

e ISBN 978-0-544-34149-4
v1.0814

For my family
and those suffering
the burden of head pain

L.D.R.

For Solon J. Lang

S.S.L.

THE GRIEF OF THE HEADIS THE GRIEF OF GRIEFS .

James Howell,
English Proverbs, 1659

This book is intended for educational purposes only. Before you start the regimens presented here, consult your own physician to make sure that they are suitable for you. None of the information is intended to substitute for medical advice. If you have any problems or questions related to your health and fitness, you should direct them to your physician.

Visit our Web site, www.headachedrugs.com, to keep abreast of the latest headache information. Here youll find a vast amount of headache-related material, starting with our links:

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H EADACHE is an extremely common problem that affects tens of millions of people in the United States. As a headache specialist who suffers from migraines and daily headaches myself, I know firsthand the burden that headaches add to ones life.

In the past ten years, there has been a virtual revolution in the understanding and treatment of headaches. Yet headaches remain largely misunderstood by many physicians and patients alike and, in general, remain a poorly treated condition. Like asthma, shock, epilepsy, and many other medical problems once thought to be caused by stress or emotions, headache is a legitimate physiological medical condition, not a psychological one. People who get headaches do not bring them on themselves but rather have different levels of the brain chemical serotonin and a much greater reactivity of blood vessels about the head than others.

Despite tremendous strides in headache management, enormous amounts of time and money are wasted on useless diagnostic tests and treatments. As a result, headache sufferers, who have been unfairly blamed for their illness for far too long, become angry and frustrated, and many simply give up the search for effective headache therapy.

Many of the books currently available on headaches emphasize nonmedication techniques, which can be very useful but often only up to a point. These books give precious little information about the vast array of effective medications now available. Headache sufferers want to know more about their medications, and they should. Susan Lang and I felt there was a need for a book about the actions and side effects of the drugs that readers may take and the trial and error that is sometimes necessary to find the right medication at the right dose.

Thats why this book places a strong emphasis on drug therapy. Nonmedication techniques are important, and Headache Help explores them fully. But for people who suffer severe headaches, these remedies often fall short, and medication becomes the primary key to treatment. Our aim is to provide as much reference material as possible so that lay readers can be better informed.

Headache sufferers should be commended for fighting through life with head pain. We hope the burgeoning knowledge about headaches will lead to more compassion for their suffering. With our new understanding of headaches as a physical problem, we can help the vast majority of patients tremendously with current therapies. If you or a loved one suffers from head pain, you should know all about the options; hence, we give you this book.

A caveat: Although we discuss many medications and treatments for headaches, this information is not meant to be prescriptive, suggestive, or a substitute for the medical advice of a physician. Only a doctor who understands your particular situation can make well-informed decisions about your treatment plan. Similarly, although we offer lists of common or first-line medication choices, there are always exceptions, and your doctor is best equipped to make this judgment.

Our intent is to provide information and education. In most cases, we could present only the common uses and side effects of medications. When you get a prescription, we still recommend that you ask your doctor or your pharmacist for details about possible side effects. Physicians Desk Reference or the package insert also lists contraindications.

Lawrence Robbins, M.D.

Northbrook, Illinois

S OME OF MY VIVID childhood memories are of my fathers migraines. On bad days, he would retreat into his study, and the house became dark and gloomy. Although we four children tried to remember to stay quiet, we often forgot, and my mother would harshly scold us and banish us from the upstairs rooms. When would Daddy feel better and life resume its normal quality? Why did he have to get these things called migraines and disrupt our lives?

Since those days, my dad has outgrown his horrendous headaches, and weve emerged from the dark ages of headache treatments. But even the best treatments are useless if they are not sought out or adhered to. Information is empowering and is one of our most effective tools in our quest for better health and well being. As a medical writer, my goal is to provide you with information so that you are not the passive recipient of a doctors care, but an active, well-informed consumer.

To address those who may criticize Lawrence Robbins and me for focusing so heavily on medications: We do not minimize the power of mind-body techniques or of more natural therapies. Rather, we believe you should be fully informed of the full range of options. Only then can you properly weigh the risks and benefits of each potential therapy and weave your way through the maze of alternatives.

You deserve a pain-free life. We hope this book will help you achieve it.

Susan S. Lang

Ithaca, New York

I F YOURE READING THIS BOOK , chances are you know the misery of headaches all too well. One moment life is normal, but the next your temples begin to ache and your forehead throbs. Soon your head is your worst enemy. The pounding, splitting pain of the headache overwhelms all else.

Contrary to what most people believe, you dont have to put up with it. If you get headaches frequently, dont despair; you can gain more control over them than you probably ever thought possible. Unfortunately, far too many people accept headaches as a fact of life. This attitude cheats you and your loved ones. Although headaches cant necessarily be cured, they can be controlled with certain lifestyle changes and, if needed, the wise and judicious use of modern medications.