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Editor's Note: This is Part 2 of an original article by Catherine Kurosu. See Part 1 posted on October 15, 2018.
Other non-pharmacologic methods of treating chronic headaches have been recommended by the American Academy of Neurology. These include relaxation training, thermal biofeedback combined with relaxation training, or cognitive-behavioral training. All of these methods strive to decrease muscle tension that may contribute to the onset of the headache. This tension is usually found in the upper back and neck. Physical therapy, adequate sleep, exercise, and a regular, healthy diet can also be useful in this regard.
Alternative methods of muscle relaxation include mind-body interventions such as meditation, yoga, tai chi, and qigong. In a 2008 review of the literature found in Mind-Body Interventions: Applicatins in Neurology by H. Wahbeh, M.E. Siegward, and B. Oksen, there was strong evidence to support the use of mind-body techniques in the treatment of chronic headaches.
Occasional tension or migraine headaches can be treated with over-the-counter painkillers such as aspirin, non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen or acetaminophen. These medications, particularly aspirin and ibuprofen, are most effective for any sort of pain when taken as soon as possible. This is due to the mechanism of action of this class of drug. The chemical that is involved in the inflammation and pain response (prostaglandin) is blocked. Many people try to "tough it out" but while they are waiting for the headache to pass, more and more of this chemical is released. It then becomes more difficult to relieve the pain with these mild analgesics.
Rebound Headache Syndrome
On the other hand, constant use of these analgesics can create a situation where a headache results BECAUSE of their continued use. This is called "Rebound Headache Syndrome" and can be the start of a vicious cycle of pain, requiring stronger and stronger medications for temporary relief. Sometimes narcotics are prescribed but there is a risk that addiction could result.
Other drugs are prescribed at the onset of a migraine and are designed to stop it in its tracks. These drugs cause blood vessels in the brain to constrict, decreasing the typical migrainous pain that is caused by dilated blood vessels. Such medications are classified as triptans and examples include Imitrex. Because this class of drug can elevate your blood pressure, you should not be using it if you have high blood pressure, a history of stroke or heart attack, or any sort of neurological symptoms that accompany your headaches (like numbness, weakness, or difficulty speaking). In fact, stroke and heart attack can be adverse effects attributable to this class of medication.
Drugs used to prevent chronic migraines include a class of medications that block adrenaline and prevent the blood vessels in the brain from dilating in the first place. They also may prevent the release of inflammatory substances that would result in vascular dilatation and subsequent pain. An example of this medication is metoprolol. The safety profile of this medication is good and it has been used for many years to prevent chronic migraines.
All in all, the management of a patient with chronic headache can be difficult. It is important to ascertain the cause of the headaches and find an acceptable solution that will allow a patient to have a normal life without becoming dependent upon medications. For this reason, Eastern medicine can be indispensable in the treatment and prevention of chronic headaches and for many chronic pain syndromes.
Acupuncture
In 2012, a systematic review of randomized controlled trials of acupuncture for the treatment of chronic pain was conducted ("Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis," Arch Intern Med. Sept. 10, 2012, by A.J. Vickers, et al). These four conditions were included: chronic headache, neck and back pain, osteoarthritis, and shoulder pain. The researchers used data from 29 randomized controlled trials (RCTs) with a total of 17,922 patients. The results of their analysis showed that acupuncture was superior to both sham acupuncture and no-acupuncture controls for each of the four conditions observed. They concluded that acupuncture should be offered to patients with these conditions.
Acupuncture, along with Chinese herbs, tai chi, and qigong can be used instead of or along with Western modalities. If herbs are used, however, it is extremely important to discuss this prior with your Western and Eastern health care providers to ensure that there are no potential cross-reactions between the herbs and any medications that you may already be taking. Also, if you are taking drugs to treat or prevent chronic headaches, you must not stop them suddenly, or even taper them, without instructions from your physician. Doing so may result in elevated blood pressure, seizures or stroke.
As for Louise, (see Part 1 of this article) after trying various combinations of pharmacologic interventions, including NSAIDs, triptans, and Botox injections, she was still having four to five migraines each week. Her primary care doctor referred Louise for acupuncture and, with regular treatments, her migraine frequency and intensity almost immediately decreased. Her acupuncturist taught Louise some simple meditation techniques and encouraged her to exercise regularly, even if she could not exercise vigorously. Louise is combining Eastern and Western medicine, adding acupuncture and meditation to her occasional use of NSAIDs and triptans. Now Louise is on a maintenance schedule, receiving acupuncture once every three weeks. She gets a migraine only once every week or two, and for the first time in twenty-three years, Louise had a pain-free Christmas Day.
If you suffer from chronic headaches, do not lose hope. Like Louise, your unique prescription for headache relief can be found through the integration of Eastern and Western healing modalities.
The above is Part 2 of an original article by Catherine Kurosu, MD, Lac. Dr. Kurosu, the co-author, of True Wellness: How to Combine the Best of Western and Eastern Medicine for Optimal Health.
