Chronic headaches: what to do when your painkillers no longer help

We previously spoke with expert pain medicine specialist, Dr Shankar Ramaswamy, to find out what determines if a headache is chronic and what some of the main triggers are.
 

In this second part of our discussion with Dr Shankar Ramaswamy we found out how to treat headaches when pain medications such as Ibuprofen no longer help.
 

Dr Ramaswamy highlights some more effective treatment options, preventative measures that can be followed and information on when might be the ideal time to visit a pain management specialist.
 

What happens if simple pain medications (such as Ibuprofen) are no longer helping?

They’re not designed for taking long-term as they have, and they associated with side effects such as gastric ulcers, kidney failure, so should only be taken for short time, and not too frequently. Less than 15 days a month, otherwise it can result in medical overuse headache.
 

First go to a GP and to an alternative specialist, headache specialists, chronic pain specialists, alternative types of medication to designed to manage anti-migraine meds or medications we use for other chronic pain anti-neuropathic medications.
 

When should someone visit a pain management specialist about their headaches?

When simple pain medications don’t work or if they’ve taken conventional anti headache meds such as anti-migraine ones and headaches has now become chronic and they should see a pain specialist, if they have other comorbidities, such as other pain conditions. Fibromyalgia, cervical spondylitis, due to the degeneration of cervical spine. When they have complex conditions, they should see a pian management specialist and the condition is disabling enough to need pain interventions. Injection options for pain management.
 

What are the treatment options?

In terms of treatment:

• Analgesics, anti-migraine tablets.
• Antineurotic medication, for managing chronic headaches, any chronic pain.
• Prevention strategies include nerve blockers, injections, botox for migraine
• Chronic and disabling, neuromodulin options to manage longterm conditions.
   

Are there any preventative measures that a patient can follow?

A useful thing is that we want patients to have a headache diary, noting down patterns of headaches, giving information on when they have, how often, how severe, what precipitates the headache, what triggers are and other factors.


A well-structured headache diary finds way we can avoid headaches, for example, addressing sleep, avoiding foods such as cheese and alcohol. Prophylactic medication is currently the top preventative treatment for migraines, to mitigate attacks. Sometimes we do routine periodic interventions, nerve blocks, Botox injections to anticipate and prevent headache attacks. Again, we can identify how often the patient needs it so we can time when patients will need it/when it wears of and we do individualized treatment plans, often long-term treatment strategy for chronic cases.
 

To discover how to treat your headaches once and for all, it is recommended to chat with an expert consultant in pain medicine such as Dr Shankar Ramaswamy. Visit his Top Doctors profile today for more information.