DEAR DR. GOTT: I have been having chronic headaches for years. I am on a prescription called Flexeral. People think I like taking meds and they think nobody has that many headaches every day. The past couple of years or so, they go down to my back. I’m seeing a specialist now and I asked him if it’s something that happened when I was younger. He said he doesn’t think so and we’ll be working on one thing at a time.
I am in my 50s now. I was around 15 when this problem started. A friend of my relatives banged my head on the floor. I tried getting medical attention but the relative who told him to do it was more worried about keeping his family together. In the past I tried over-the-counter stuff and I got yelled at for that. I’m tired of pain and people thinking I like taking pills. I’ll keep with the specialist for now but I would like to hear what you say on this matter.
DEAR READER: A 30+ year history of headaches should have been given proper attention long ago. I don’t know the type of headache you are having, so I will hit on a few that might bring something to light.
Tension headaches are often caused by tight muscles in the scalp, neck and shoulders and may be the result of head injury, depression, stress, anxiety, or simply because of poor posture. As I have said in previous columns, the head weighs about 10 pounds. Listing to the right, left, or off center can cause chaos and subsequent pain. Tension headaches tend to present on both sides of the head.
Cluster headaches can occur several times every day for months on end but may ultimately go away for a similar period of time. The cause is not known but it is thought that the hypothalamus, which contains the body’s “biological clock”, plays a role. The pain often centers at the front of the head and face and may be more noticeable when you awaken in the morning.
Migraines have a tendency to appear on one side of the head, although they can also spread to both sides. This type headache is often triggered by specific foods, caffeine withdrawal, the use of alcohol, or from a lack of sleep. The pain may be intense.
Rebound headaches — those that appear again and again — may be the result of a sleep disturbance, the over-use of caffeine or pain relievers, anxiety, and depression. If you take prescription pain relievers or over-the-counter analgesics more than three days a week, your medication may be to blame.
Finally, other more serious issues such as an abscess, high blood pressure, tumor, or other conditions may be contributory.
The Flexeril (commonly misspelled Flexeral) you have been prescribed is a muscle relaxant for relief of muscle spasms which works by blocking pain sensations to the brain. This medication should be used in conjunction with rest and physical therapy to effectively treat muscular stiffness and pain. To the best of my knowledge it is not commonly prescribed for headaches.
Treatment depends on the type of headache you are having. Therefore, you should begin by making an appointment with your physician or a headache specialist. Make a list of how frequently they occur, what might have preceded them, and — most importantly –the degree of pain that will assist greatly in determining the cause.
Your physician may begin with NSAIDs (non-steroidal anti-inflammatory drugs), particularly if you are attempting to wean yourself off other pain relievers. Beta blockers commonly prescribed for hypertension and antidepressants may also provide relief. Medications to prevent seizures may assist with chronic daily headaches. As you have likely heard me indicate in the past, medications designed for one purpose are often successfully recommended for another; however, you need better direction to determine which drug will be most beneficial.
On the home front, consider massage therapy, meditation, acupuncture, tai chi, yoga, vitamin B12, coenzyme Q10, or chiropractic manipulation. Keep your stress level low, exercise as much as possible, get adequate sleep and don’t pay attention to others who feel you are taking too much medication. Your specialist should be the judge of that.
Readers who would like related information can order my Health Reports “Headaches” and “Managing Chronic Pain” by sending a self-addressed, stamped number 10 envelope and $2 (US check or money order) for each report ordered to my attention at PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title(s) when writing or print out an order form from my website www.AskDrGottMD.com.
