Q. I’m in a vicious cycle of chronic migraines/daily headaches/cluster headaches. I’m trying to keep functioning by using pain medications only when I have no choice, while trying desperately to avoid rebound headaches. Does it do any good to vary the meds from day to day (Advil® one day, Fioricet® the next, aspirin the next, etc.)? I have Zomig®, but I can no longer tell when my headaches are migraines and am afraid to take it in case it doesn’t work—and then if it doesn’t work, I’m afraid to take something else. Any advice? I don’t remember the last day I didn’t have a headache, and my life has turned into daily battles of trying to function. I’m being treated at a VA medical center and they don’t have a headache specialist. I’ve learned more from your website than my doctors. Any ideas you have will be greatly appreciated! —Linda D.
A. I suspect you started with episodic migraine headaches at some point in time. When the headaches become chronic or are present on a daily basis, migraine will evolve into a different type of headache, losing its basic characteristics of sensitivity to light and sound and nausea. It will start to present as a dull daily headache that worsens during the day.
Almost any medication used on a daily basis over time will cause medication overuse headaches (or rebound headache), and it is reasonable not to use any abortive medication more than two days per week. I suggest keeping a headache diary or calendar to note the type, incidence and severity of the headache and the medication you take for relief. If you have not done so, I would eliminate all caffeine, NutraSweet® and MSG from your diet. Pay particular attention to your sleep pattern, and do not skip meals. Furthermore, your level of anxiety or depression may need to be addressed.
Gary E. Ruoff, MD, Westside Family Medical Center, Kalamazoo, Mich.
