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Therapy
for Chronic Daily Headache
First one must be
sure of the diagnosis, that is, that the chronic daily headache with
which the patient suffers is not due to some other specific cause.
One must know that the condition is primarily a rebound
phenomenon. The headaches may have initially been standard common
migraine ( Migraine without aura) which have been transformed by
analgesic abuse, trauma, subarachnoid hemorrhage, or brain surgery into
chronic daily headache. If it is clear that analgesic overuse is
the major cause a detailed history of prior headaches and particularly
the amount and type of medication that the patient is taking must be
elicited. Often patients are receiving analgesic medication from a
variety of physicans and every effort must be made to keep all health
care providers in communication. If one assumes care of the
patient, both patient and physican should agree that there should be
only one prescribing physician involved. Following suggestions
from Ninan Matthews I have had patients keep a daily chart of headache
intensity and a detailed listing of all analgesic preparations being
used, including all Over the Counter (OTC) medications, vitamins,
alternative medical therapies and acute emergency room visits. The
patients need to be firmly convinced that a gradual reduction in
medication ( 10% reduction in number of pills taken each week ).
Patients should be
started on a preventive regimen which may include calcium channel
blocking medications, anticonvulsants, beta-blockers, and BOTOX. Combination
therapy may be appropriate, for example: verapamil, Topamax and
BOTOX. The patient should be made to understand that no preventive
regimen is likely to be effective until a MAJOR reduction in analgesic
medication is achieved. In some situations, when out-patient
"detox" is ineffective an in-patient stay in a facility or
service that understands analgesic abuse may be needed. Again,
coordination and communication among all health care providers is
manditory.
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