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

In his latest article, highly-experienced consultant neurologist Dr Philip Fletcher highlights some effective treatment options for chronic headaches, 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?

Simple pain killers such as ibuprofen, paracetamol or codeine-based medications are not designed for treating a long-term condition such as chronic headache as they associated with side effects such as gastric ulcers, kidney failure, so should only be taken for short time, and not too frequently. It is recommended that they are used for less than 15 days a month as otherwise it can result in a condition called medical overuse headache.

Patients should speak to their GP in the first instance and perhaps get referred to a headache specialist such as a neurologist or chronic pain specialists with a special interest in headache. They would aim to make a formal diagnosis for their chronic headache and recommend alternative type of medications designed to manage specific headache disorder such as an anti-migraine medication or medications used for treat other chronic pain conditions such as 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 medications and headaches has now become chronic and refractory, they should see a pain specialist. They should also see a pain specialist if they have other comorbidities, such as other pain conditions such as fibromyalgia, cervical spondylitis (degeneration of cervical spine). A pain specialist, apart from helping them to manage their chronic headaches, they will also help to manage the impact of their headache in daily life by using a variety of techniques including medications, self-management advice and special interventions.

So it is advisable for patients with complex headache and other comorbidities see a pain management specialist. They often work along with other members of a multidisciplinary team such as a neurologist, physiotherapist or a psychologist to offer best care to their patients.
 

What are the treatment options?

Treatment options include the following:

• Medications: including simple analgesics, specific anti-migraine tablets other medications such as antineurotic medications.
• Interventions: nerve blockers, facet joint injections, botox injection for migraine.
• Neuromodulation: including peripheral neuromodulation, occipital nerve stimulation.

Are there any preventative measures that a patient can follow?

We would encourage patients to maintain a headache diary, noting down patterns of headaches, giving information on timing, frequency, severity, triggers or precipitating factors for their headache.
A well-structured headache diary finds way we can avoid headaches, for example, addressing sleep, avoiding certain foods such as cheese and alcohol. Prophylactic or preventive medication is often used to anticipate and prevent a headache attack.

Sometimes we do periodic interventions (e.g. every 2-3 months) such as nerve blocks, Botox injections to anticipate and prevent headache attacks. This will often form part of their bespoke or individualized treatment strategy to help patients manage their long-term condition and help them maintain their quality of life.

To discover how to treat your headaches once and for all, it is recommended to chat with an expert such as Dr Philip Fletcher. Visit his Top Doctors profile today for more information.