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Beyond Drugs: Tactics for Dealing with Headaches
Whether it's the brutal vise of a migraine, a congested sinus or the tension type caused by muscle spasms, headaches are one of the primary reasons people visit their doctors, according to recent surveys. Unfortunately, many persistent headache sufferers fail to find real, sustained relief with conventional approaches, and so many are turning to complementary and alternative medicine for added help.

In the past decade, powerful modern medications have revolutionized the treatment of many forms of headache pain. Using these drugs too frequently for chronic pain, however, can create a serious problem called analgesic rebound. "Taking too much painkilling medication for too long will make a headache more severe, more constant, and harder to treat with the standard medications," reports Alan Rapoport, MD, founder and director of The New England Center for Headache in Stamford, Connecticut and clinical professor of neurology at Columbia University's College of Physicians and Surgeons.

Many CAM users
Analgesic rebound is probably just one of many reasons that a 2002 survey in the neurology journal Cephalalgia found that nearly 85% of headache sufferers at a pain clinic at Columbia/New York Presbyterian Hospital also used complementary and alternative medicine (CAM) for their headaches. Some 60% of this group reported that CAM therapies provided real pain relief--particularly acupuncture/acupressure, exercise, chiropractic, relaxation therapy, massage, biofeedback and herbal therapies.

According to Casilda Balmaceda, MD, a neurologist at Columbia University's Neurological Institute and co-author of the Cephalalgia study, one the best aspects of CAM use is the fact that "most of these therapies have few side effects, and they can safely be used in combination with conventional treatments, in what is called an integrative approach."

Lots of Effective Choices
A number of alternative therapies have been found to be helpful for headaches, according to Dr. Rapoport. For example, all types of behavioral therapy, biofeedback, and relaxation training are now routine methods to treat many types of headache, especially in children. "These are often so helpful in children with migraine that they can prevent the need for medication," he notes.

Nutritional supplements also have proven benefits. "There's good scientific evidence that certain vitamins, minerals, and other supplements can be helpful," Rapaport adds. Double-blind studies have shown that Vitamin B2, or riboflavin, aids some migraine patients. "We also give magnesium, which many studies have shown is low in migraine sufferers. The herb feverfew may also be helpful in some cases."

The list of CAM options is extensive, according to Dr. Balmaceda, who knows the frustration of headache pain herself. "When I get one of my own migraines, I can barely put my stethoscope around my neck," she says. "Stretching and massage can be a real help."

"In my clinical experience, patients benefit most from CAM techniques such as massage, reflexology, and physical therapy," she continues. "This is probably because many headache patients have a combination of muscular pain syndromes. They may end up having muscle spasms and neck pain, and therapies like acupuncture, exercise, and therapeutic touch will relieve muscle spasms in the neck and forehead. These are proving to be invaluable tools for them."

Taking Control
One key piece of advice that Dr. Balmaceda has for anyone with chronic headaches is to keep a headache diary between appointments with the doctor. "It's very important that you learn to take control of your headache syndrome," she explains. "And the diary will help you to do that."

To be effective, she says, the diary should include the frequency and severity of your headaches, what seems to trigger them, benefits that seem to come from different types of treatment and the amount of medication (prescription and over-the-counter) that you take for pain relief.

Seeing the Whole Picture
Always be open with your physician about any CAM therapy you're using, Dr. Balmaceda advises. A neurologist may be prescribing a drug he believes is responsible for you feeling better, when in fact it's a CAM therapy that is really the main factor in the easing of the pain. Or, if you develop a side effect and your physician doesn't know you're taking some form of alternative medicine, he may attribute it to the medication instead of to an herb or a hands-on therapy.

What the Columbia group has found through their clinical experience as well as a result of this study "is that there is a discrepancy between what patients are using and what is being supported by conventional physicians," says Dr.Balmaceda. The Cephalalgia study found that a high proportion of headache patients know about CAM therapies, and about 84% of them actually use alternative techniques. Dr. Balmaceda concludes that "it's quite possible that sometimes physicians and neurologists may appear to be disbelievers because simply because they don't see enough hard statistical evidence that CAM works."

Her colleague, Dr. Rapaport, goes a step further. "Most headache specialists, particularly neurologists, don't believe in all forms of alternative therapy," he says. "I'm a neurologist and a headache specialist, and I think that if a patient is helped by an alternative therapy that won't harm them, there's no reason not to do it."

Date Published: 04/29/2003
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