Posts Tagged ‘headache’
Tuesday, May 13th, 2008
I see many patients with the following scenario; they go to a new neurologist/headache doc, with daily headaches. The doc asks what they are on, then proceeds to tell them that whatever meds they are on cause the headaches. The patient says “..But doctor, I have been on these for 3 months, while my headaches have been there for 18 years!!”…..Of course, rebound does occur, but it is overdiagnosed (in my opinion..but this is my blog, so I can pontificate…)…..We need to know much more about what causes rebound, which drugs, who, why, when yada yada….certainly it does occur, particularly with high-caffeine drugs, butalbital, opioids, some nsaids etc…..
Tags: butalbital, daily headache, headache, nsaids, opiods, rebound headahce
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Tuesday, December 17th, 2002
The main abortives for clusters remain:
- triptans (Imitrex, Maxalt, etc.),
- oxygen
- analgesics
- lidocaine nasal spray
- ergots.
Triptans do work the best, particularly Imitrex injections (many cluster sufferers get by with 2 or 3mg, which is half of a vial). Oxygen, 100% at 7 to 10l/min, works for about 60% of pts. Analgesics can take the edge off, but do not stop the headache. Lidocaine is very mildly, if at all, effective, but may be helpful while awaiting something else to work. Ergots are not used much anymore, but can be very helpful, albeit with more side effects.
Tags: cluster, cluster headache, ergots, headache, Imitrex, lidocaine, oxygen, triptans
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Saturday, December 14th, 2002
Caffeine is a ‘double-edged‘ sword. Too much (or in some very sensitive individuals, any) will cause headaches, while some will help headaches. Caffeine is used as an ‘adjunct’ to certain analgesics (65mg of caffeine in Excedrin, 32mg in Anacin), enhancing the effect of the nsaids. Studies have shown that adding small amounts of caffeine to ibuprofen renders it more effective than ibuprofen alone.
I try and keep people below 150mg daily of caffeine. Of course, sensitivity to caffeine varies widely; some experience rebound headaches from a little, while others may consume large amounts and not suffer rebound.
The caffeine content of the various substances is listed elsewhere on this site; a typical cup of brewed coffee has 150mg, while instant has 50 to 75mg. Starbucks is much stronger. tea (if it has caffeine) has about 30mg per cup, while a can of coke has 40mg. It is very important to regulate, or consider eliminating, your caffeine consumption.
Tags: caffeine, headache
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Friday, December 13th, 2002
The question always arises as to who truly needs an MRI. With routine headaches, and no neurological symptoms or signs, the usual dictum is that scans are not absolutely necessary. However, I would never fault any physician who does a scan on all headache patients. With newer onset headaches, new onset daily headache, neuro symptoms or signs, the ‘worst headache of my life‘, or a major change in pattern, MRI is often recommended. Whether you should have one (or a repeat) is a highly individualized decision between you and your doctor (I hope that you do have a doctor!).
…what do they show??…MRI scans are excellent at detecting tumors, multiple sclerosis, and similar pathology. They do NOT make the diagnosis of migraine, but rather they rule out significant pathology.
Tags: headache, migraine, MRI, multiple sclerosis, tumors
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Sunday, December 8th, 2002
Tags: acupuncture, headache
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