My experience in treating a number of headache patients over the years, many successfully but some less so, has turned up a set of barriers or blocks that prevent headache sufferers from successfully managing and controlling their headaches. Some of these headache blocks are personal, that is they lie within the boundaries of the individual headache suffer to deal with. Others are world blocks or ones that lie outside of the individual patient’s immediate influence.
Regardless, whether the blocks are personal or world they are real and prevent many patients from getting the upper hand on this debilitating illness. Most of the headache patients I’ve encountered who get better have effectively dealt with these blocks. And in dealing with world barriers successful patients have received help from family, friends, health care providers and others.
Patients who don’t improve are unable or unwilling to deal with these barriers. As I describe these barriers, both personal and world, you may think they are unfair. However, my point is that they are real and have to be confronted if chronic headache patients are to experience any kind of lasting relief. First, chronic headache sufferers usually experience more than one headache type. Notice I’m referring to chronic headache, not to occasional headaches experienced by the majority of individuals.
Occasional headache sufferers are able to take an over the counter pain reliever and deal with the headache successfully. They may need to rest while the medication takes effect but eventually they successfully cope with the invader. In contrast, chronic headache sufferers have multiple things wrong that have to be dealt with. With this group headache is a symptom of underlying multiple problems.
Since multiple things are wrong effective treatment must involve removing or reducing more than one cause of the headache. It is analogous to stones in one’s shoe; if only one stone is removed, the walker will still hobble. All of the stones have to be removed in order to walk freely. Similarly, the headache treatment needs to lay out a sequence of actions that will remedy the multiple problems involved.
Multiple headaches require an analysis of multiple types of headache possibilities. Each headache type requires its own individual treatment approach. This takes time, patience, effort and a willingness on the part of the patient to actively participate in the treatment effort. The treatment plan needs to be based on a comprehensive assessment of headache conditions.
Often, the chronic sufferer has analgesic rebound headache among their assortment of headache types. Caused by excessive use of analgesics or pain relievers, no treatment can proceed until the analgesic headache problem is resolved. In some cases analgesic rebound can be a deal breaker, so significant that the patient has to be hospitalized so the underlying situation can be treated.
Additionally, the general well being of chronic sufferers is often of lower quality than non-headache sufferers. Their sleep quality is often poor, accompanied by low energy and often mood disorder. When a patient has chronic headache syndrome, that is pain lasting 2 to 3 or more weeks certain brain chemicals become depleted. These chemicals, one of which is seratonin, must be restored in order to treat the chronic pain.
These factors make diagnosing and treating a chronic headache sufferer a difficult process. And due to other contributing factors such as mood disorders or sleep disturbances the unraveling of the headache complex can be a lengthy effort.
Interconnectivity of Headaches
It is often the case that one kind of headache contributes to the onset of another type of headache. That is why it is important to separate the different pain components. Vascular, tension or neuralgia type headaches are frequently at play. For some, tension headache is a “trigger” that brings on a vascular headache episode. Often, there is a “bi-directionality” of the headache conditions.
Sorting out various headache types is a time consuming business. Since the patient will still experience headaches during this period there may be a tendency to become disillusioned that any progress is being made and the individual may abandon the treatment that has been prescribed.
There is a social stigma to being a chronic headache sufferer and taking headache medicine. Medicines for heart disease or diabetes are examples of socially acceptable medicines. Society understands that our body becomes ill and medicine for these types of illness is required. There seems to be considerably less support and understanding for the chronic headache sufferer. Missing work or a major social event for reasons of a headache often fail to pass the social acceptance test. Headache pain is real. And it can be excruciating, denying the sufferer the opportunity to function in a normal manner and perform routine daily activities.
A Key Ingredient: Family Support
Missed social events, days away from work and inability to perform family chores can place a significant burden and strain on a family. For the headache sufferer who is in the midst of a severe headache storm simple acts become unbearably difficult. I have found that successfully treated patients often involve a family member in their diagnosis and treatment process. Involvement of a support person who can assist the a patient in dealing with headache often has a strong positive effect.
Support individuals can:
1. Prompt the patient to take medications
2. Help the patient complete therapeutic exercises
3. Help the patient maintain a schedule
4. Assist the patient in accurately tracking headache episodes
And family members can help reduce the sense of social stigma attached to headache by demonstrating their understanding of what the patient is experiencing and explaining to friends, co-workers and others that headache is a real and debilitating illness.
For many chronic sufferers adhering as close as possible to a fixed schedule, engaging in regular exercise and participating in outside events can be important in maintaining a headache free period. Since many chronic headache sufferers also experience low energy and mood disorder, encouragement from family members can be critical in helping the patient to normalize his or her routine.
I can’t over emphasize the importance of maintaining a headache diary. The headache sufferer has a very difficult task in recalling headache episodes with any degree of accuracy. And at the outset is unable to differentiate one type of headache from another. The diary or headache tracker is of enormous value in the diagnosis and treatment processes.
One thing experience has taught me is that among those who don’t get better is a failure to adhere to the treatment plan and that includes taking prescribed medication. Many of these individuals believe that because the prescribed medication has side effects they are better off not taking it.
The contraindication list or list of side effects can be lengthy. Given all the possible side effects such patients see it as sensible not to take their headache medications. However, the issue is not the general issue of side effects but the specific question of whether or not potential side effects of a given medication will affect the individual patient or not. Not whether they will affect someone else.
A particular medication may have side effect for another individual but be well tolerated by the patient under consideration. If not, the patient’s doctor can usually prescribe an alternative medication that will work toward the same therapeutic goal with fewer or no side effects.
I’ve also had patients who have stopped taking their medication tell me that the reason was they started to feel better, their headaches were under control. Therefore, they see no reason to continue; who wants to take medication when it is no longer needed. What they fail to understand if that the medication is prophylactic and is preventing the headache episodes from occurring. When returned to their normal state of not experiencing headache they mistakingly believe that the underlying conditions causing their headache distress will not return.
Avoiding Pharmaceutical Treatment
Another assumption is that there should be a natural substance that one can successfully take and thereby avoid pharmaceutical treatment. Some individuals are convinced that medical doctors are suspicious of and not supportive of natural or alternative treatments. Medical doctors are trained to be evidence based. For the most part they are not “anti-natural” if there is strong clinical evidence of the efficacy of the treatment.
The test is not whether a substance is “natural” or “synthetic.” The test is whether it is safe and effective. Natural substances have not gone through the same rigorous studies as pharmaceutical medicines. Putting an alternative substance into your body, a substance that has not been well researched and tested places you at risk. The alternative substance may confound other prescribed medications and abort their therapeutic effect. In a follow up article I will discuss the problem of analgesic rebound in more detail along with the cycle of pain that depletes body chemicals necessary to restore the patient to a non headache normalcy.