Q. I have been suffering with daily migraines for more than 20 years. I am 69 years old. I have tried all kinds of medications, visit a chiropractor twice a week and have been using Excedrin Extra Strength® for the last two years. The medication has not completely removed my headaches, but they last only about an hour or two. I use ice packs religiously, which help. Once in a while I will get a really bad headache that lasts for hours.
I recently went to see a neurologist whom I found on the National Headache Foundation website, and he put me on Maxalt®. Six pills cost me $62—very costly. I have gone back to Excedrin®. I make sure to eat something when I take over-the-counter medications and recently had my blood levels checked, but I worry about liver or kidney problems from taking Excedrin every day. Do you think that I have arthritis in my neck? That is where it starts, and it goes up to the crown of my head. I had a scan of my head to rule out tumors as well. Unfortunately, the neurologist said I could possibly be a candidate for Botox®, but not until I try Maxalt for three months. Any advice? —Terry S.
A. You state that you have had daily headaches for 20 years. Did these headaches start suddenly one day and never resolve, or did they appear gradually? I suspect part of your problem is a long history of caffeine ingestion, which needs to stop. Caffeine is a double-edged sword: it initially helps headaches, but then causes medication overuse headaches, which makes things worse.
It would be smart to have a scan of your neck. Arthritis or disc pathology may cause cervicogenic headaches, which tend to start at the base of the neck and radiate upward to the back of the head. The use of trigger point injections around the neck and shoulders may help. Trigger point therapy may also relax your neck and help your chiropractor address any spasm you are having in your neck. Non-pharmacological therapy with heat and range-of-motion exercises may also be beneficial. Once you break the cycle of daily headaches, the resultant episodic headaches can be handled by headache-specific medication, which do not include barbiturates or narcotics.
Gary E. Ruoff, MD, Westside Family Medical Center, Kalamazoo, Mich.
