Posted by Steve W. (192.211.116.34) on July 14, 1999 at 12:15:53:
In Reply to: Please Tell Me What Kind Of Migraine I Have posted by Jackie on July 14, 1999 at 00:21:38:
Jackie,
I went into Intelihealth as suggested by Chana below and copied this article for you.
I think it can help explain the rebound effect of pain relievers.
Steve W.
Hopkins Q&A: Treating Migraine Means Ending the
Rebound
Informed opinion from the experts at
America's foremost health institution
March 4, 1997, Baltimore
In this special, four-part series, InteliHealth explores with Johns
Hopkins neurologist David W. Buchholz,, M.D., how to recognize,
treat and prevent migraine pain. In Part 1, Dr. Buchholz,
associate professor of neurology and director of the Johns
Hopkins Neurological Consultation Clinic, explained that
migraine is not a type of headache; rather it is a mechanism in the
brain that results in a variety of headaches and other symptoms.
Symptoms may manifest as a crippling headache that we
traditionally label "migraine," or as the more familiar dull pain
that we mistakenly call a "tension headache." In Part 2, the
doctor notes that effective treatment for headaches must begin by
eliminating the rebound effect caused by taking pain-killers and
other "quick fixes," particularly narcotics or medications that
constrict blood vessels.
InteliHealth: What is the first step in treating headaches?
Dr. Buchholz: You have to stop rebounding before you can have
effective preventive treatment. Rebounding means that your underlying
headache problem - migraine - is made a little bit worse each time you
take a quick fix medication for temporary relief. Patients often become
dependent on these drugs without realizing what is happening. These
drugs end up actually promoting headaches. The culprits include
over-the-counter agents containing caffeine, decongestants, and a wide
variety of prescription medications taken to temporarily relieve
headaches. The worst part of rebounding is that it blocks your ability
to respond to migraine-preventive treatment.
IH: Does this happen a lot?
Dr. Buchholz: Yes. Most doctors, even those who should know better,
too often don't understand this. You have to eliminate rebounding.
Unfortunately, withdrawal is often painful; but it's necessary. Patients
can do it, if they're properly educated as to what is wrong -
rebounding - and what needs to be done - eliminating the quick-fix
medication.
IH: Is it difficult to explain?
Dr. Buchholz: People ask, "then what can I take when I get a severe
headache?" That's a question to which there is no good answer for the
individual with frequent severe headaches. There are plenty of bad
answers - namely, the many drugs that cause rebounding. It's a bad
question, with bad answers; so don't ask it. Instead, ask how your
headaches can be prevented.
IH: Does that mean that all headache sufferers should never
take a quick fix?
Dr. Buchholz: No. It's the patient with frequent, severe headaches who
should avoid these drugs.
IH: Why should people with frequent, severe headaches avoid
quick fixes?
Dr. Buchholz: First, quick fixes reinforce the victimization and
dependency that often develop with chronic headaches. Second, if the
painkiller is temporarily effective and provides an easy way out,
patients are less likely to make the necessary effort to prevent their
headaches. Preventive treatment pays dividends in the long run but can
seem difficult in the beginning, before it starts working. Finally, quick
fixes produce rebounding, which as we've discussed is a big problem.
IH: So what about quick fixes for patients with infrequent
headaches?
Dr. Buchholz: Some people have infrequent headaches by nature, and
others start out with frequent severe headaches but reduce the
frequency with preventive treatment. In either case, it's reasonable to
use a quick fix. I generally recommend ibuprophen or naproxen for
mild to moderate headaches and sumatriptan (Imitrex) for severe
headaches, but only if they're infrequent.
IH: What about treatments in the news like nasal drops such as
lidocaine or DHE?
Dr. Buchholz: These drugs are quick fixes that have no advantage over
sumatriptan. I wish that more attention would be paid to the existing
treatment we have for migraine - particularly preventive treatment that
is extremely effective if done properly - as opposed to searching for
the latest magic bullet.
Copyright The Johns Hopkins University, 1997. All rights
reserved. This interview is not intended to provide advice on
personal medical matters, nor is it intended to be a substitute for
consultation with a physician.