Don’t overuse headache medicine

Wed., Dec. 14, 2005

Paul G. Donohue, M.D. North America Syndicate

Dear Dr. Donohue: For the past three years I have had to use aspirin or Tylenol several times a day for headaches. My doctor can’t find what’s causing them and doesn’t have any suggestions. Where should I turn? — N.D.

Answer: A number of common headache types can become chronic, recurring headaches, and the key to stopping them requires an identification of the headache type.

•Migraine headaches can become daily affairs. Migraines are one-sided headaches that sometimes pound with each heartbeat. Physical activity worsens them. People with a migraine want to crawl into a quiet, dark place and be left alone. They’re often nauseated with the headache. Specific migraine medicines are needed.

•Chronic tension headaches are another possibility. These headaches are felt on both sides of the head, and people describe them as pressure on or a tightening of the head. Mild activity, like walking, doesn’t make them worse, as it does migraines. Simple pain-relievers can often stop tension headaches.

•Post-traumatic headaches are constant headaches that appear after a head injury. I’m sure you would be aware of it if you had had such an injury.

•One common thread, however, unites many chronic headaches, and that is overuse of headache medicines. Even though I can’t tell you what variety of headache you have, I can tell you that you are using too much medicine. Overuse increases the frequency and the severity of the headache. To reduce dependence of pain-relievers, you might have to take other medicines while you’re tapering off the pain-relievers. Valproate and topiramate are two examples. Magnesium and riboflavin (vitamin B-2) might also help.

•Always eat three meals a day. Skipping meals often brings on a headache. Stay away from ripened cheeses, chocolate, foods that are fermented, pickled or marinated, nuts, peanut butter, sourdough bread, pizza, pepperoni, salami and hot dogs to see if there might be a food link.

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