DAP headache unit English
The DAP pain clinic has the incredible excellence in treating pain sufferers in Baltic states.
DAP pain clinic headache unit is one of few private out patient and inpatient headache clinics in Baltic States, also it is the first headache center in the entire country to offer a complete, dedicated inpatient option. Located near the old town of Riga, our 12 – bed unit is the optimal destination for inpatient migraine and other headache treatment. At our inpatient and outpatient facility, acute and chronic pain sufferers adult or older adult patients – experience the benefits of work of headache team specialists.
Our Continuum of Care means the same doctor who treated You in our out patient unit if needed will direct Your treatments at the DAP inpatient headache clinic. You will see other doctors and caregivers, but a DAP headache unit physician will be there too, to make sure Your treatments are going well.
You have a say in what happens to you. We will make sure you know how to keep your headaches under control. Ask any question and we will take time to give You honest and professional answer you understand.
Special therapy methods that may be used are:
1. Individualized Drug Therapy
Recomendations of individualized drug therapy are made based on diagnosis, previous experience and response to drug therapy and based on European Pain Federation recommendations. Some patients require multiple drug therapy, which requires close inpatient monitoring by headache unit’s specialist.
2. Psychological intervention
If indicated in the treatment plan, individual or group sessions are initiated. Our clinical psychologists are experts in helping people cope with thoughts, feelings and behaviors that accompany chronic pain.
3. Relaxation training
relaxation therapy allows you to learn how to cope every day stress, whether it is spiraling out of control or it is already under control. Everyone can benefit from learning relaxation techniques. Learning basic relaxation techniques is easy and they are free to use nearly anywhere. Types of relaxation techniques include Autogenic relaxation, Progressive muscle relaxation, Visualization, also deep breathing, massage, meditation, Yoga, Biofeedback, Music and art therapy, Aromatherapy, Hydrotherapy. The most effective therapies are used in our center to get sure you have your pain under control.
4. Physical and Activity therapy
DAP pain unit specialist may prescribe physical therapy and activities like relaxation training, art therapy and music therapy.
5. Alternative therapies
Massage therapy and acupuncture serves to help patients relieve stress and tension.
6 Detoxification
If needed, our professional inpatient team will get sure that your withdrawal from analgesic medications will proceed smoothly. Patients will receive the necessary medical support while stopping these drugs.
Types of headaches
Headache disorders are real – they are not just in the mind. If headache bothers you, it needs medical attention.
The purpose of this information leaflet is to help you understand your headache, your diagnosis and your treatment, and to help you work with your doctor or nurse in a way that will get best results for you.
“When I get migraine it makes me very ill and really puts me out of action for the entire day or more. I can feel one coming on and then the full blown migraine emerges and I feel wretched and need to go to bed. As it progresses, I feel sick and eventually I am sick and then, finally, the pain begins to lessen. The next day I’m left with a vague pain and feel absolutely exhausted but otherwise okay.”
What is migraine?
Migraine is a medical disorder. It takes place in attacks, once or twice a year in some people but up to several times a month in others. The main feature of these attacks is headache, which may be severe. Other common features are feeling sick (nauseated) or being sick (vomiting) and finding light and noise uncomfortable.
Some people experience the above symptoms very often, when headache days are more often than those headache-free.
If you feel nauseated when you have a headache, or light and noise bother you, or if your headache makes it difficult to carry out your usual daily activities, it is quite likely that it is migraine.
What causes migraine?
Migraine comes from the brain. It is a disorder of the parts of the brain that process pain and other sensations. You probably inherited it from one or other parent or from a grandparent.
Who gets migraine?
About one in six adults have migraine, so it is very common. Women are three times more likely to be affected than men. It often starts in childhood or adolescence. In girls in particular it may start at puberty. Because of inheritance, migraine runs in families.
What are the different types of migraine?
The commonest is migraine without aura (aura is described later). About three-quarters of people with migraine have only this type; one in 10 have migraine with aura, and every fifth patient have both types, migraine without aura and migraine with aura. Much less common are attacks of aura alone, with no headache. This type of migraine tends to develop in older people. There are other types of migraine, less prevailing, including chronic migraine, so diagnosis supposes councelling at medical professional.
What are the symptoms of migraine?
Symptoms are present during the attack, which has four stages, although not all of these always happen. Between attacks, most people with migraine are completely well.
The premonitory phase comes before any other symptoms of the attack. Only half of people with migraine are aware of this phase. If you are one of these, you may feel irritable, depressed or tired for hours or even one or two days before the headache begins. However, some people find they are unusually energetic during this time. Some have food cravings. Others “just know” that a migraine attack is about to start.
The aura, when it happens, is almost always the next phase. Only a third of people with migraine ever have aura, and it may not be part of every attack even for them. Aura is a signal from the brain, which is being temporarily (but not seriously) affected by the migraine process. It lasts, usually, for 10 to 30 minutes, but can be longer. It mostly affects vision. You may notice blank patches, bright or flashing lights or coloured zigzag lines spreading in front of your eyes, usually to one side. Less common are sensory symptoms – pins-and-needles or numbness – which generally start in the fingers of one hand, and spread up the arm to affect that side of the face or tongue. When these happen, there are nearly always visual symptoms as well. Difficulty speaking or finding the right words can also be part of the aura.
The headache phase is the most troublesome for most people, lasting for a few hours or up to two or three days. Migraine headache is often severe. It tends to be one-sided, but can be on both sides, and although most commonly at the front or in the temple it can be anywhere in the head. It is usually a throbbing or pounding headache, very often made worse by movement. You probably feel nauseated, and may vomit (which seems to relieve the headache). You may also find light and noise unpleasant and prefer to be alone in the dark and quiet. In general, symptoms of migraine can considerably alter your usual daily activities.
The resolution phase follows as the headache fades. During this time you may again, like in premonitory phase, feel tired, irritable and depressed, and have difficulty concentrating. It can take a further day before you feel fully recovered.
What is my “migraine threshold”?
Migraine is unpredictable. An attack can start at any time. However, some people are more prone to attacks than others. The higher your migraine threshold, the less likely you are to develop an attack, and the lower your threshold the more at risk you are.
So-called triggers play a part in this. A trigger will set off an attack (although we do not understand how this happens). It does this more easily if your migraine threshold is low. If your threshold is high, two or three triggers may need to come together for this to happen. Separate from triggers are predisposing factors. These have the effect of lowering your threshold, so that triggers work more easily. Tiredness, anxiety and general stress have this effect, as can menstruation, pregnancy and the menopause in women.
What are the triggers?
Everyone wants to know what might trigger his or her migraine. This is often difficult and sometimes impossible to pin down because triggers are not the same for everybody, or even always the same for different attacks in the same person. Many people with migraine cannot identify any triggers. Possible triggers are many and varied.
- Diet: some foods (and alcohol), but only in some people; more commonly, delayed or missed or inadequate meals, caffeine withdrawal and becoming dehydrated.
- Sleep: changes in sleep patterns, both lack of sleep and sleeping in.
- Other life-style: intense exercise, or long-distance travel, especially across time zones.
- Environmental: bright or flickering lights, strong smells and marked weather changes.
- Psychological: emotional upset or, surprisingly, relaxation after a stressful period.
- Hormonal factors in women: menstruation, hormonal contraception and hormonereplacement therapy (HRT).
The commonest is hunger, or not enough food in relation to needs. This is particularly the case in young people – children prone to migraine should never miss breakfast. In women, hormonal changes associated with the menstrual cycle are important potential triggers.
These, and most other triggers, represent some form of stress, and suggest that people with migraine do not respond well to change.
What treatment can I take?
Medications that treat the migraine attack are called acute treatments. The right ones can be very effective, but need to be taken correctly and not overused. They include non-prescription painkillers, most of which contain aspirin, ibuprofen or paracetamol. Of these, paracetamol is least effective for most people. In all cases, soluble or effervescent preparations work faster and better. Codein-containing medicines are not advised.
You can also take medicine called an anti-emetic if you feel nauseated or likely to vomit. Some anti-emetics actually help the painkillers by causing your body to absorb them more quickly. You can have these as suppositories if you feel very nauseated during migraine attacks.
Your pharmacist can give you advice on the best non-prescription treatments to take. If none of these works for you, or you need more than the recommended dose, or you are to take non-prescription medicines more than twice a week, you better ask for medical advice.
Your doctor may prescribe one of the specific anti-migraine treatments. They work quite differently. They do not tackle pain but undo what is happening in your brain to cause an attack. They include ergotamine, widely used in some countries but not others, and a group of newer drugs called triptans. If your doctor advises it, you can use these drugs together with painkillers, anti-emetics or both.
There are some simple measures that can make medication more effective.
Take medication early…
Always carry at least one dose of the medication that has been recommended by your doctor, nurse or pharmacist. Take it as soon as you know an attack is coming on. Medication taken early is more likely to work well. During a migraine attack the stomach is less active, so tablets taken by mouth are not absorbed as well into the bloodstream as they would be normally.
… but not too often
Always carefully follow the instructions that come with your medication. In particular, do not take acute treatment too often because you can give yourself a headache from the treatment. This is called medication-overuse headache, and there is a separate leaflet on it. To avoid medication-overuse headache, never take medication to treat headache symptoms regularly on more than two days a week.
What if these don’t work?
If frequent or severe attacks are not well controlled with acute treatment, so-called prophylactic medication is an option. Unlike acute treatment, you should take this daily because it works in a totally different way – by preventing the migraine process starting. In other words, it raises your migraine threshold.
Your doctor or nurse can give you advice on the choice of medicines available and their likely side-effects. Most were first developed for quite different conditions, so do not be surprised if you are offered a medication described as treatment for high blood pressure, epilepsy or even depression. This is not why you are taking it. These medications work against migraine too.
If you are taking one of these, do follow the instructions carefully. Research has shown that a very common reason for this type of medication not working is that patients forget to take it.
What else can I do to help myself?
Exercising regularly and keeping fit will benefit you. Avoiding predisposing and trigger factors is sensible, so you should be aware of the full range of possible triggers. You may be able to avoid some triggers even if there are others that you find difficult or impossible to control.
Keep a diary
Diary cards can record a lot of relevant information about your headaches – how often you get them, when they happen, how long they last and what your symptoms are. They are valuable in helping with diagnosis, identifying trigger factors and assessing how well treatments work.
What if I think I may be pregnant?
You will need advice from your doctor or nurse. Some of the medications used for migraine are unsuitable if you are pregnant.
Do I need any tests?
Most cases of migraine are easy to recognize. There are no tests to confirm the diagnosis, which is based on your description of your headaches and the lack of any abnormal findings when your doctor examines you. A brain scan is unlikely to help. If your doctor is at all unsure about the diagnosis, he or she may ask for tests to rule out other causes of headaches, but these are not often needed.
Will my migraine get better?
There is no known cure for migraine. However, for most people with migraine, attacks become less frequent in later life. Meanwhile, doing all you can to follow the advice in this leaflet can make the change from a condition that is out of control to one that you can control.
For more information, visit www.l-t-b.org
Headache disorders are real – they are not just in the mind. If headache bothers you, it needs medical attention.
The purpose of this information leaflet is to help you understand your headache, your diagnosis and your treatment, and to help you work with your doctor or nurse in a way that will get best results for you.
“I get headaches that last for several days at a time and feel as though I’m wearing a hat that’s too tight – more like a pressure than a real pain. It doesn’t really stop me doing anything, but it’s much harder to get through the day.”
What is tension-type headache?
Tension-type headache is the common sort of headache that nearly everyone has occasionally. Although never serious, it can make it difficult to carry on entirely as normal. In a few people, it becomes bothersome enough to need medical attention, usually because it has become frequent and bothering.
What causes tension-type headache?
Tension-type headache is generally thought of as a headache affecting or arising from muscles and their connections. Its causes appear to be many and varied. However, there are some factors that are more important than others:
- Emotional tension: this can be anxiety, or excessive stress;
- Physical tension in the muscles of the scalp and neck: this may be caused by poor posture, for example when working at a computer, or by lifting a heavy object incorrectly.
Who gets tension-type headache?
Tension-type headache affects most people from time to time, but women more than men. It also affects children.
What are the different types of tension-type headache?
Episodic tension-type headache is often referred to as “normal” or “ordinary” headache. It happens in attacks (episodes) that last for anything from half an hour to several days. The frequency of these varies widely between people, and in individual people over time. In about three people in every 100, tension-type headache happens on more days than not. This is chronic tension-type headache. In some cases, tension-type headache is always present – it may ease but never goes completely. This type of headache can be quite disabling and distressing.
What are the symptoms of tension-type headache?
Usually, tension-type headache is described as a squeezing or pressure, like a tight band around the head or a cap that is too tight. It tends to be on both sides of the head, and often spreads down to or up from the neck. The pain is usually moderate or mild, but it can be severe enough to prevent everyday activities. Generally there are no other symptoms, although some people with tension-type headache dislike bright lights or loud noises, and may not feel like eating much.
What can I do to help myself?
You can try to:
- Relax. Taking a break, having a massage or a warm bath, going for a walk or taking exercise to get you away from the normal routine may help.
- Cope with stress. If you have a stressful job, or are faced with a stressful situation that you cannot avoid, try breathing and relaxation exercises to prevent a possible headache. E.g. you may benefit from the so called mindful-based stress reduction. Also, there are many books and applications to guide you in these exercises.
- Take regular exercise. Tension-type headache is more common in people who do not take much exercise compared with those who do. Try walking wherever possible, or take stairs rather than the lift, so that exercise becomes a routine part of your life.
- Treat depression. If you feel that you are depressed more often than not, it is important to ask for medical advice and get effective treatment.
Keep a diary
Diary cards can record a lot of relevant information about your headaches – how often you get them, when they happen, how long they last and what your symptoms are. They are valuable in helping with diagnosis, identifying trigger factors and assessing how well treatments work.
Take painkillers if needed…
Simple painkillers such as aspirin or ibuprofen usually work well in episodic tension-type headache. Paracetamol is less effective but suits some people. Codein-containig medicines are not recommended
… but not too often
Medication only treats the symptoms of tension-type headache. This is perfectly acceptable if you do not get many. To manage frequent headache over the long term, it is better to try to treat the cause. Always carefully follow the instructions that come with your medication. In particular, do not take painkillers too often because you can give yourself a worse headache from the treatment. This is called medication-overuse headache, and a separate leaflet on it is available if you are worried about it. To avoid this happening, never take medication to treat headache regularly on more than two days a week.
What other treatments are there?
If you have frequent episodic tension-type headache, or more so if you have chronic tensiontype headache, painkillers are not the answer. They will only make things worse over time. Socalled preventative medications are an option. Unlike painkillers, you should take these every day because they work in a wholly different way. Their purpose is to make you less prone to headache and so prevent headache from even starting.
Your doctor or nurse can advise on the choice of medicines available and their likely sideeffects. Most were first developed for quite different conditions, so do not be surprised if you are offered a medication described as treatment for depression or epilepsy, or as a muscle relaxant. This is not why you are taking it. These medications work in tension-type headache too, as they do in other painful conditions.
If you are taking one of these, do follow the instructions carefully. Research has shown that a very common reason for this type of medication not working is that patients forget to take it.
Because posture sometimes plays a role in tension-type headache, and because of the muscles involved, your doctor or nurse may suggest physiotherapy to the head and neck. This can help some people greatly.
Other non-drug approaches involve relaxation therapies , including biofeedback or yoga, and acupuncture.
These are not suitable for everybody, do not work for everyone, and are not available everywhere. Again, your doctor or nurse will give you advice.
Will these treatments work?
If the cause is identified and treated, episodic tension-type headache rarely continues to be a problem. Very often, it improves on its own, or the cause goes away, and no further treatment is needed.
For some people, especially with chronic tension-type headache, these treatments do not help or only partially help. If all else fails, you may be referred to a pain clinic which uses a wider range of treatments.
Do I need any tests?
There are no tests to confirm the diagnosis of tension-type headache. This is based on your description of the headaches and the lack of any abnormal findings when you are examined. Be sure to describe your symptoms carefully. Also tell your doctor how many painkillers or other medications you are taking for your headaches, and how often you are taking them.
A brain scan is unlikely to help. If your doctor is at all unsure about the diagnosis, he or she may ask for tests to rule out other causes of headaches, but these are not often needed. If your doctor does not ask for any, it means they will not help to give you the best treatment.
For more information, visit www.l-t-b.org
Persistent idiopathic facial pain is real – it is not just in the mind. If facial pain bothers you, it needs medical attention.
The purpose of this information leaflet is to help you understand your headache, your diagnosis and your treatment, and to help you work with your doctor or nurse in a way that will get best results for you.
What is persistent facial pain?
This is generally a constant pain of the face, one-sided, which can be dull, burning, severe, with no obvious reason.
What causes PIFP
The cause of persistent idiopathic facial pain is unknown
What are PIFP symptoms?
Patients describe it as pain in cheek or lower jaw, sometimes around ear and in temporal area. Less often the pain is described as electric shock pain, mimicking trigeminal nerve neuralgia. Keep in mind that patient may have both of these conditions. Unlike with trigeminal neuralgia PIFP does not have specific triggers.
Who gets persistent facial pain?
This is a relatively rare condition. Usually this condition affects young women, although it can appear at any age.
Do I need any tests?
There are no tests to confirm the diagnosis of PIFP
What treatments are available?
Painkiller medicines are not useful in the treatment of PIFP. For most of the patients preventative medicines are the most suitable. However, those can be only prescribed by your doctor
Such drugs prevent onset of pain attack. Preventative medicines should be taken daily, possibly, for a prolonged time. Also, bigger medicines dosage can be required. Use of preventative medicines may be associated with adverse events and following regular check-ups at your doctor, including blood tests and cardiac check-ups. As soon as PIFP improves, reduction of preventative medicines dosage may be discussed with your doctor
What if these treatments don’t work?
There is a range of preventative therapies . While one medicine could appear ineffective, the other could be useful. Sometimes two or more medicines can be taken together.
What else can I do to help myself?
To make the treatment effective, you are to seek medical advice. People with PIFP sometimes visit dentists, but unreasonable dental procedures do not improve such pains. It is important to avoid healthy teeth unnecessary repair.
Use preventative medicines as your doctor prescribed you. Regular painkillers are not useful in PIFP treatment. Moreover, excessive use of those may harm your body.
Keep a diary
You can use diary cards to record a lot of relevant information about your pain – how often you get it, when does it happen, how long it lasts, etc. You records may help your doctor assess the effect of the treatment.
For more information, visit www.l-t-b.org
Trigeminal neuralgia is real – it is not just in the mind. If neuralgia bothers you, it needs medical attention.
The purpose of this information leaflet is to help you understand your headache, your diagnosis and your treatment, and to help you work with your doctor or nurse in a way that will get best results for you.
What is trigeminal neuralgia?
Trigeminal neuralgia (TN) is a facial pain of extreme discomfort, caused by trigeminal nerve. TN features strong, electric shock-like pain along the trigeminal nerve.
What causes trigeminal neuralgia?
Although there is a number of medical studies, the exact cause of trigeminal neuralgia is still unknown. In some people they found is a vessel, adjacent to involved trigeminal nerve and irritating it. Others have different TN causes. In most patients the reason of pain stays unknown
What are the symptoms of TN?
People with TN usually describe it as one-sided pain in cheek or lower jaw. The pain is short-lasting, but can return one after the other for up to two minutes, sometimes several times per day – for a day, weeks or even months. Night attacks are rare. Onset of pain usually has no prodrome, although pain attack can be triggered by mild touch on the face, wind or cold air, eating, drinking, toothbrushing, speech.
There is no pain between the attacks, but some people are so afraid of provoking the pain, that they avoid eating and drinking. So, TN is a disabling condition.
Who gets TN?
Trigeminal neuralgia is not too common condition. It affects one or two of thousand people. Women are twice more likely to have TH than men. The first attack usually happens after the age of 50, but TN can start at any age.
Do I need any tests?
Yes, it is necessary to undergo brain MR scanning. TN is pretty recognizable by specific symptoms, although some other conditions may also render similar symptoms
What treatments are available?
Regular painkillers are not useful in the treatment of TN. Mostly preventative medicines are the most suitable for TN. As TN is associated with severe and extreme pain, councelling at a doctor ASAP, which means correct treatment, is highly recommended.
Preventative drugs literally prevent onset of pain attack. These should be taken daily, possibly, for a prolonged time. Also, bigger medicines dosage can be required. Use of preventative medicines may be associated with adverse events and following regular check-ups at your doctor, including blood tests and cardiac check-ups. As soon as PIFP improves, reduction of preventative medicines dosage may be discussed with your doctor.
What if these treatments don’t work?
There is a range of preventative therapies . While one medicine could appear ineffective, the other could be useful. Sometimes two or more medicines can be taken together.
Will I get better?
Usually TN is controllable. Sometimes TN can subside on itself, although it is not predictable.
What else can I do to help myself?
To make the treatment effective, you are to seek medical advice. People with TN sometimes visit dentists, but unreasonable dental procedures do not improve such pains. It is important to avoid healthy teeth unnecessary repair.
Use preventative medicines as your doctor prescribed you. Regular painkillers are not useful in TN, as it takes too long for their effect to take place. Moreover, excessive use of those may harm your body.
It is important to recognize and avoid triggers, provoking TN. Should pain appear while eating or drinking, be prepared that such triggers cannot be fully avoided. To stay well and avoid extra health issues, try to take enough healthy food and drinks every day.
Keep a diary
You can use diary cards to record a lot of relevant information about your pain – how often you get it, when does it happen, how long it lasts, etc. You records may help your doctor assess the effect of the treatment.
For more information, visit www.l-t-b.org
Headache disorders are real – they are not just in the mind. If headache bothers you, it needs medical attention.
The purpose of this information leaflet is to help you understand your headache, your diagnosis and your treatment, and to help you work with your doctor or nurse in a way that will get best results for you.
“I began to get headaches which would come on every morning, soon after waking. I could carry on working through them but it was hard to concentrate. I found that a couple of painkillers would ease the headache. The headaches started to get more frequent and now I take painkillers most days. My head never seems to clear completely.”
What is medication-overuse headache?
Medication-overuse headache is permanent and regular headache, caused by frequent and prolonged use of medications (supposed to treat migraine or tension headache). MOH can be caused by overuse of other painkillers, aimed at treating other kinds of headache or any aches.
Any medication you use to treat the symptoms of headache can cause medication-overuse headache. Aspirin, paracetamol, ibuprofen, codeine – in fact, all painkillers, even those bought over the counter – are associated with this problem. And it is not just painkillers. Drugs that specifically treat migraine headache (triptans and, most of all, ergotamine) also lead to this problem when used too often.
A similar headache (although not strictly medication-overuse headache) can result from taking too much caffeine. The usual source of this is coffee, tea or cola drinks, but it can come from caffeine tablets or from caffeine included in many painkillers.
The exact way medication-overuse headache develops is not known, and may be different according to the nature of the medication. Triptans and ergotamine may cause a rebound effect, with headache returning after they wear off. Painkillers are believed to cause, over time, a change in pain-signalling systems in the brain. This means they become used to the effects of the medication so that you need more and more of it.
For most people with occasional headaches, painkillers are a safe and effective treatment. However, medication-overuse headache may develop in anyone taking ordinary painkillers regularly on more than three days a week, or when any other medications against headache are taken regularly more than twice a week. Usually, the person with medicationoveruse headache begins with occasional attacks of tension-type headache or (more commonly) migraine. For varying reasons, the headaches begin to happen more often. This may be through natural variation or because an extra headache has developed, perhaps due to stress or muscular pain. The increase in headache leads to use of more medication to try to control the symptoms, eventually until both happen every day.
Many people in this situation know that they are taking more medication than is wise, and try to reduce the amount. This leads them to have a withdrawal syndrome of worsening headache, for which they take more medication. It is easy to see how this results in a vicious cycle, which can be difficult to break. It makes not so much difference how much you take – if you regularly use the full dose of painkillers on one or two days a week only, you are unlikely to develop medication-overuse headache. However, take just a couple of painkillers on most days and you may well be making your headaches worse. It is frequent use over a period of time that causes the problem.
Who gets medication-overuse headache?
MOH is rather common condition. Surprisingly, about one in 50 people develop this problem. It is much more common in women than men, and it also happens in children.
What are the symptoms of medication-overuse headache?
The main feature is constant and frequent headache. This varies, but is often a dull pain, followed by migraine-like headache attacks. Other common symptoms, alongside headache, are feeling tired, feeling sick, being irritable and difficulty sleeping. Sometimes headache seems relentless, although it may change as you go through the day. Medication-overuse headache is often at its worst on waking in the morning.
Will my medication-overuse headache get better?
If your headache is already being caused by overusing medication of this sort, then it is likely to improve once you stop taking the medication, and not otherwise.
How MOH is treated depends on the kind of primary headache and what medications were overused. Getting the right treatment for primary headache is very important, so medical care is usually necessary. Although all types of MOH may be temporarily relieved by painkillers or anti-migraine treatments, in many cases this relief is only partial and the effect diminishes over time. These treatments are not appropriate because they will make the condition worse.
Do I need any tests?
There are no specific tests to confirm the MOH diagnosis. This is based on your description of your headaches and the lack of any abnormal findings when you are examined. Therefore, it is very important that you carefully describe your symptoms and how they developed. It is also very important that you say how many painkillers or other medications you are taking for your headaches, and how often you are taking them.
Your doctor should be able to tell quite easily whether you have an illness more serious than MOH. If he or she is not sure about the diagnosis, or there is any sudden change in your headache, tests including a brain scan may be carried out to rule out other causes of your headache. However, these are not often needed. If your doctor does not ask for a brain scan, it means that it will not help to give you the best treatment.
What can I do to help myself?
The only way of treating this condition is to stop the overused medication (withdrawal). Clinical studies show that at least two of three people who withdraw from overused medication improve greatly. However, it can take up to two months before you see the full benefit. Even if headaches continue after that time, despite stopping the medication, their cause usually becomes clear and they will respond better to correctly-prescribed specific treatment.
You can withdraw either by stopping in one go or by gradually reducing the amount taken over two to three weeks. Whichever way you choose, you will almost certainly have withdrawal symptoms – worsening headache, feeling sick, perhaps being sick, anxiety and difficulty sleeping. These symptoms will appear within 48 hours. However, people who try to stop slowly seem more likely to experience moderate symptoms, although for longer time.
It makes sense to choose when to withdraw, and not begin shortly before an important event. Do warn your work colleagues that you may be unable to come into work for a few days.
Are there other treatments I can take?
There are medications, the so called bridge therapy, which a doctor can prescribe, that you can take not for long, but every day to help you withdraw. They work only if you stop all other headache medication, and even then it is uncertain how much they help. You will also have to stop these at some point, and, for most people, it is better to do without them.
What if I just carry on as I am?
If medication overuse is causing your frequent headaches, carrying on as you are is not an option. You will continue to have ever-more frequent headaches, which will not respond to painkillers or to preventative medicine. Eventually you may do yourself other harm as well, such as damage to your liver, kidneys and stomach.
How can I make sure it doesn’t happen again?
As it develops, medication-overuse headache largely replaces the original headache (migraine or tension-type headache) for which you took the medication in the first place. This means that, as your medication-overuse headache improves after withdrawal, you can expect your original type of headache to return.
There are separate leaflets on both migraine and tension-type headache. You may find one of these useful at this stage.
If you need to, you can cautiously restart using medication for this headache once the pattern of headache has returned to normal (usually after at least several weeks or longer).
Be careful, because there is a risk of following the same path as before. To prevent this, avoid treating headaches on more than three days in a row or on a regular basis on two or more days in a week. If a headache doesn’t get better, or keeps returning, see your doctor or nurse
Also, see your doctor or nurse if frequent headaches do not go, or if they return again in the future.
Keep a diary
You can use diary cards to record a lot of relevant information about your headaches – how often you get them, when they happen, how long they last and what your symptoms are. You records (also on how often do you take medications) are valuable to help your doctor to diagnose your condition correctly. For people at risk of medication-overuse headache, diaries are especially important. Diary info will also help to assess how good is the theatment.
For more information, visit www.l-t-b.org
Headache disorders are real – they are not just in the mind. If headache bothers you, it needs medical attention.
The changing pattern of hormones throughout a woman’s life, from puberty to the menopause, has an important effect on migraine and other headaches.
Knowing what to expect can help women understand why headaches occur and, importantly, when to seek help.
Given the strong influence of hormones on headache in women, you may wonder why doctors do not do any hormone tests. The simple answer is that no tests are able to show doctors the cause of the problem.
Headache and women’s hormones
The relationships between female hormones and the processes that cause headaches, or make them better or worse, are very complex. Even when hormones are clearly a factor in headache problems, all the standard hormone tests are usually normal. Studies measuring hormone levels show no differences between women with headaches triggered by hormonal changes and women without a hormonal trigger.
Headache, migraine and puberty
Puberty is the time when a girl begins to produce hormones in a monthly cycle that leads to the start of menstruation. This is therefore the time when hormones may first influence headaches. Although migraine can start at any age, puberty commonly brings about its onset.
Headache and the menstrual cycle
Many women notice a link between headaches and their menstrual cycle. Headaches are typically more frequent and more severe in the days around the menstrual period. At the same time, there may be mood changes, water retention and other premenstrual symptoms, which improve as the period starts.
Migraine is also affected by the menstrual cycle, and in some women is triggered by the natural drop in levels of the hormone estrogen that happens just around the time of the menstrual period. Other hormones that change with the menstrual cycle, such as prostaglandins, which are released just before and during a period, may also be an important trigger. This is particularly likely in women who get migraine only on the first or second day of bleeding.
So-called “menstrual migraine” can be more severe than headaches at other times of the month, so take your migraine treatments early. Should OTC medicines appear not useful, your doctor can give you prescription-only drugs to control the symptoms of migraine. Also, you can discuss other available treatment options with your doctor. No drugs are sold specifically for prevention of menstrual migraine, but there are some that often work well. The choice of drug depends on any other period problems that may benefit from treatment, so this is something to discuss with your doctor or nurse.
Headaches and contraception
Hormonal contraception, such as combined hormonal contraceptives (pills, patches, rings and injectable preparations), is very safe for the majority of women who use it. This is equally true for most women with migraine. Many women find that combined hormonal contraceptives have no effect upon their headaches – or even help them. Even so, headaches are a commonly reported side-effect of these medications. In most cases, headaches of this sort improve after a few months, and they are rarely a reason to stop contraception.
In case you had migraine without aura before you started the contraceptive, you may notice that you get your attacks during the pill-free interval, when hormone drop causes “withdrawal” bleeding, similar to menstrual bleeding.
However, if you have migraine with aura, you should not take combined hormonal contraceptives. This is because the estrogen in the contraceptives can increase the risk of a stroke. Although the risk of a stroke is very low in women younger than 50, it is sensible not to increase it since there are many choices of other methods of contraception. Several of these are even more effective contraceptives than the combined hormonal methods.
However, if your migraine without aura converts to migraine with aura after beginning combined hormonal contraceptives, you should stop taking it immediately. Furthermore, you should seek medical advice – particularly since you may also need emergency contraception.
There is a separate leaflet explaining what migraine without aura and migraine with aura are. Ask your doctor or nurse if you would like to have this.
Progestogen-only methods (pills, implants, injectable preparations and intrauterine methods) do not increase the risk of a stroke but have varying effects on headaches. Most evidence suggests that, if the method “switches off” normal periods, headaches usually improve.
Headaches, pregnancy and breastfeeding
Fortunately, most women find that headaches improve during the latter part of pregnancy. This is especially likely for migraine without aura. The benefit may continue through breastfeeding.
In the first few months of pregnancy, however, headaches may be worse. One reason is that sickness, particularly when it is severe, can reduce food and fluid intake and result in low blood sugar and dehydration. If this happens to you, try to eat small, frequent carbohydrate snacks and drink plenty of fluids. Adequate rest is important to avoid over-tiredness. Other preventative measures that can safely be tried include acupuncture, biofeedback, massage and relaxation techniques.
Women who have migraine with aura before they become pregnant are more likely to continue to have attacks during pregnancy. If migraine happens for the first time during pregnancy, it is likely to be migraine with aura.
There is no evidence that headaches or migraine, either with or without aura, have any effect on the outcome of pregnancy or on the baby’s growth and development. It is, of course, important to make sure that any treatments taken for headaches are safe. Few drugs have been tested for safety in pregnancy and during breastfeeding. In fact, paracetamol (when used correctly) is the only medication shown to be safe throughout pregnancy and breastfeeding.
Unfortunately this is not the most effective treatment, especially for migraine, and even paracetamol should not be taken too often. However, there are other medications that can be taken under medical supervision. If you feel you need to take any other drugs for headaches, check with your doctor first.
Headaches, the menopause and hormone replacement therapy (HRT)
In the years leading up to the menopause, the ovaries produce less and less estrogen. During this time of hormonal imbalance, migraine and other headaches often become more frequent or severe. For most women, they settle again after the menopause, possibly because the hormonal fluctuations stop and the concentration of estrogen stabilises at a lower level.
Your decision to take HRT or not can be made regardless of headaches. Unlike the synthetic estrogens in contraceptives, the natural estrogens in HRT do not appear to increase the risk of a stroke in women with migraine with aura. It is reported that migraine is more likely to worsen with oral HRT and improve with non-oral HRT such as patches or gels. Too high estrogen dose can trigger migraine aura, which calls for a reduction in dose. Whichever type of HRT you start with, it is important to give it an adequate trial; the first three months are a time of imbalance as the body becomes used to the change of hormones.
Headaches and hysterectomy
Hysterectomy is of no benefit in the treatment of hormonal headaches. The normal menstrual cycle is the result of the interaction of several different organs in the body. These include organs in the brain in addition to the ovaries and the womb. Removing the womb alone has little effect on the hormonal fluctuations of the menstrual cycle even though the periods stop.
What can I do to help myself?
If you think that your headaches are worse with hormonal changes, the first thing to do is to keep a record of the dates of the first day of each period and the dates of each day of headache. After a few months, look back over the records and see if you can establish any patterns. This will tell you if hormones are having an important effect.
Remember to look at the other causes of headaches. Think about other possible trigger factors. These may still be part of the problem even if hormones are too – and you may be able to avoid them.
When you do start a headache, particularly migraine, do not delay taking treatment; if you leave it too late, it may be less helpful. If your treatments are not effective enough to allow you to continue your usual daily activities, take your diary to your doctor and discuss further options.
For more information, visit www.l-t-b.org
Headache disorders are real – they are not just in the mind.
If headache bothers you, it needs medical attention. The purpose of this information leaflet is to help you understand your headache, your diagnosis and your treatment, and to help you work with your doctor or nurse in a way that will get best results for you.
“They often wake me up in the middle of the night, a couple of hours after I’ve gone to bed. They build up in a matter of seconds and the pain is just excruciating. It’s only in my right eye. I don’t know where to put myself. I have to do something to distract from the pain. Sometimes I pace up and down the room holding my head, or just sit in the chair and rock.”
What is cluster headache?
Cluster headache is the name given to short-lasting attacks of very severe one-sided head pain, usually in or around the eye. These usually start without warning, one or more times every day, generally at the same times each day or during the night. Quite often, the first one will wake the person up an hour or so after falling asleep.
Cluster headache is sometimes said to be a type of migraine, but this is not so. It is a quite distinct headache and needs different treatment from migraine.
Who gets cluster headache?
Cluster headache is not common. It affects up to 3 in every 1,000 people. Men are three times more likely than women to have cluster headache, which makes it unusual among headache disorders. The first attack is likely to happen between the ages of 20 and 40, but cluster headache can start at any age, includng childhood.
What are the types of cluster headache?
Episodic cluster headache is more common. This type happens daily for limited periods (episodes) and then stops, a feature giving rise to the term “cluster”. Usually these periods last from six to twelve weeks, but they can end after two weeks or go on for anything up to six months. They tend to come at about the same time each year, often spring or autumn, but some people have two or three episodes every year and others have gaps of two or more years between episodes.
In between, people with episodic cluster headache have no symptoms of the condition at all. Chronic cluster headache, which accounts for about one in 5 cases of cluster headache, does not stop. Daily or near-daily attacks continue year after year without a break, or with short breaks, less than a month. Episodic cluster headache can turn into chronic cluster headache, and vice versa.
What are the symptoms of cluster headache?
There are a highly recognizable group of symptoms. Most importantly, cluster headache is excruciatingly painful. The pain is strictly one-sided and always on the same side (although in episodic cluster headache it can switch sides from one episode to another). It is in, around or behind the eye and described as searing, knife-like or boring. It becomes worse very quickly, reaching full force within five to 10 minutes, and when untreated lasts between 15 minutes and three hours (most commonly between 30 and 60 minutes). In marked contrast to migraine, during which most people want to lie down and keep as quiet as possible, cluster headache causes agitation. People with this condition cannot keep still – they will pace around or rock violently backwards and forwards, even going outside. Also, the eye on the painful side becomes red and waters and the eyelid may droop. The nostril feels blocked, or runs. The other side of the head is completely unaffected.
What causes cluster headache?
Despite a great deal of medical research into the cause of cluster headache, it is still not known. Much interest centres on the timing of attacks, which appears to link to circadian rhythms (the biological clock). Recent research has highlighted changes in a part of the brain known as the hypothalamus, the area that controls the body clock.
What are the triggers?
So-called triggers may set off a headache attack. Alcohol, even a small amount, may trigger an attack of cluster headache during a cluster episode but not at other times. Some drugs, like vasodilators, improving blood circulation, also can trigger cluster headache attack, e.g. Viagra, used to treat erectile dysfunction. Another drug to trigger cluster headache attack is Nitroglycerin, used to treat chest pain in patients with compromised heart vessels. The above associations and causative connections are not enough investigated and understood. Also, there do not appear to be other common trigger factors, like in case of migraine.
Do I need any tests?
Because of its set of symptoms, cluster headache is easy to recognize. There are no tests to confirm the diagnosis, which is based on your description of the headaches and other symptoms and the lack of any abnormal findings when your doctor examines you. Therefore, it is very important to describe your symptoms carefully. If your doctor is not sure about the diagnosis, tests including a brain scan may be carried out to rule out other causes of headaches. However, these are not often needed. If your doctor does not ask for a brain scan, it means that it will not help to give you the best treatment.
What treatments are there?
There are a number of treatments for cluster headache which often work well. They all need a doctor’s prescription. Drugs to treat the attack are named urgent treatment. If these drugs fail to sufficiently manage frequent and/or severe headache attacks, use of preventative drugs is available. Unlike with urgent treatment, you are to take these drugs every day to prevent the headaches returning.
The most usual treatments for the attack are 100% oxygen, which needs a cylinder, high-flow regulator and mask from a supplier, or an injected drug called sumatriptan, which you can give to yourself using a special injection device. Preventative medications are the best treatments for most people with cluster headache. You take these every day for the length of the cluster episode (considering usual duration of the episode). They are effective, but you do need rather close medical supervision, often with blood tests and heart check-ups, because of the possible side-effects. You may be referred to a specialist for this. The referral should be urgent because, if you have this condition, we know you are suffering greatly.
What if these don’t work?
There are a range of preventative medications. If one does not work very well, another may. Sometimes, two or more are used together. Treatment modalities using mild electrostimulation to relieve and prevent pain, are also available.
What can I do to help myself?
Ordinary painkillers do not work – they take too long, and the headache will usually have run its course before they take effect. For effective treatment, you will need to ask for medical help. Do this at the start of a cluster episode, as treatment appears to be more successful when started then. Preventative drugs to treat chronic cluster headache are to be used conitnuously.
Keep a diary
You can use diary to record a lot of relevant information about your headaches – how often you get them, when they happen, how long they last and what your symptoms are. They are valuable for your doctor in helping with diagnosis, identifying trigger factors and assessing how well treatments work.
Will my cluster headache get better?
Cluster headache may return for many years. In about one of 10 patients episodic cluster headaches become chronic cluster headaches, while in every third patient with chronic cluster headaches the condition switches to episodic cluster headaches. However, in later life pain-free gaps between cluster headache epizodes become longer for most people.For more information, visit www.l-t-b.org