HeadWise HeadWise: Volume 3, Issue 2 | Page 17

helping prevent frequent headaches and are generally well-tolerated. As important as the active prevention of these daily headaches is, is the understanding that they cannot be treated acutely. As previously discussed, using a prescription or over-the-counter medication on 10 or 15 more days per month respectively, can lead to Medication Overuse Headaches. Treatment regimens for Chronic Headaches do not concentrate on what to take for acute pain but rather, what to take to prevent it. This is a vital point that must be understood and followed as any attempt at treating the headaches will likely be thwarted by the effects of overusing acute medications. With time, patience, dedication, and a good working relationship with a headache specialist, many patients who suffer from Chronic Daily Headache do report significant improvement. HW time period. She reported that every day she experienced some baseline discomfort, and 3 to 4 times a week, she had painful exacerbations that prevented her from doing her routine activities. She felt constantly sensitive to light and sound and felt her whole head was tender to touch. upon further investigation, it was discovered that one year ago Sarah lost her job and was frequently arguing with her husband over finances. She was very tearful in the office and admitted to feeling anxious and depressed about her current situation. She often had difficulty falling asleep as she was up worrying. She was taking Advil at least 4 days a week and was using 12 pills of sumatriptan each month. general medical and neurologic exams remained normal. Sarah was started on topiramate which was titrated up to 100mg daily. Additionally, she was counseled on the effect of medication overuse on her headaches and was asked to limit her usage of acute medications (both sumatriptan and Advil) to no more than 3 days a week. She kept a headache diary for 3 months and upon her return, noted that her headache frequency and severity had decreased. She was able to use biofeedback techniques to relax and tolerate the milder headaches and therefore was able to reduce her usage of acute medications. Her baseline discomfort was significantly reduced and she now had roughly two headaches a week that were effectively aborted with sumpatriptan. In addition, she had started to see a therapist with her husband and practiced relaxation techniques at night to help her sleep. unfortunately, Sarah transformed from episodic migraine into chronic migraine. She had multiple risk factors including a major life stressor, insomnia, depression, and anxiety. Additionally, she developed Medication Overuse Headache. By addressing and modifying her risk factors and making a concerted effort to reduce her usage of acute medication, Sarah was able to achieve the preventative effects of topiramate and subsequently noted a significant reduction in her headache frequency and severity. cASe RepORt Sarah is a 26-year-old woman who initially presented with a right-sided, throbbing headache associated with mild nausea, light sensitivity, and tenderness of her scalp. Each attack would last approximately 6 hours and was not relieved by Tylenol or Advil. upon initial presentation, she reported roughly two attacks per month. Her physical examination, including a thorough neurologic exam, was normal. She had no other medical history. Her family history was significant for a mother with severe headaches which she seems to have now “disappeared”. Sarah was initially diagnosed with episodic migraine without aura and given a prescription for sumatriptan 100mg tablets to be taken at the onset of her headache. For a few years, she continued to have a headache every few months that was aborted effectively with sumatriptan. However, 5 years later she returned to the office. Her headaches had gradually increased to daily over that www.headaches.org | National Headache Foundation 15