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Ten steps to control your headaches


The US Headache Consortium recently published guidelines for improving migraine treatment. The consortium includes seven organisations: the American Academy of Neurology, the American Academy of Family Physicians, the American Headache Society, the American College of Emergency Physicians, the American College of Physicians-American Society of Internal Medicine, the American Osteopathic Association and the National Headache Foundation.

The consortium recommends ten steps for better migraine management:

1. Know your headache diagnosis. Headache is a symptom that can have many causes. Recurrent, disabling headaches are usually migraine headaches.

2. Find a good clinician. If you are troubled by headaches, find a clinician who understands the problem and is willing to work with you to find appropriate treatment. In most cases, migraine can be diagnosed based on a careful medical history and an examination without the use of expensive diagnostic tests such as magnetic resonance imaging or computed tomography.

3. Tell your doctor how your headaches affect your life. Migraine often causes temporary disability. The frequency and extent of disability are important guides to treatment. These aspects of migraine can be measured using the MIDAS questionnaire.

4. Avoid headache triggers. Once migraine is diagnosed, try to avoid or reduce the factors that can trigger your migraine. Possibilities include certain food (especially chocolate, cheese, and red wine), changes in sleeping patterns, and changes in the weather.

5. Find appropriate medication for your attacks. The DISC study shows that degree of disability predicts treatment need. Less severe migraine can be treated successfully with over- the-counter medication or with prescription pain medication. If migraine headaches interfere with your ability to function, as reflected by a high MIDAS score, you may need a migraine-specific medication such as a triptan. Triptans are highly effective for migraine, but not for pain in general. They are available as tablets, pills that melt on your tongue, nasal sprays, and injections.

6. Don't overuse pain medication. Overuse of medication, whether over-the-counter or prescription, can make your headaches worse by causing rebound headaches. As the medicine wears off, it can trigger the next headache.

7. Have at least two treatment options available. Ask your doctor to prescribe a "rescue" medication that you can take if your regular medication fails. This can prevent trips to the emergency room. 8. If one medicine doesn't work, try another one. Treat several attacks with each treatment to determine if it works. If the medication does not provide satisfactory relief after three attacks, ask for a new medication.

9. Ask your doctor about preventive drugs. If you have two or more headaches a week, ask your doctor about preventive medications that you can take on a daily basis to reduce the number of headaches you get. The benefits of preventive medication may develop over several months.

10. Use treatments other than drugs. Many people find that biofeedback and relaxation training improve their headaches.

For more information:

Migraine Disability Assessment Scale (MIDAS)

This site allows the MIDAS scale to be downloaded for use of your computer.

American Council for Headache Education (ACHE)

Migraine Awareness Group: A National Understanding for Migraineurs (MAGNUM)

American Academy of Neurology (treatment guidelines)

National Headache Foundation

American Headache Society