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Dr. Andrew Rynne
Dr. Andrew Rynne

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Suggest treatment for chronic headache

Answered by
Dr. Dariush Saghafi


Practicing since :1988

Answered : 2474 Questions

Posted on Sat, 27 Aug 2016 in Headache and Migraines
Question: I have chronic headaches as a residual effect from a sub-arachnoid hemorrhage about 8.5 years ago. I have tried many different types of meds to improve this condition with only moderate success. I find the side effects from various meds to be almost as bad as the headaches so have reduced the dose to the minimum I can get by on. (Gabapentin - 2700 mg/day in three doses). I find my headaches vary tremendously with barometric pressure and since I live in an area where weather changes daily or even several times a day (thunderstorm alley), I frequently am nearly disabled by the headaches.

Any suggestions (besides moving to a different climate - I'm about there anyway).

Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
These are clearly very difficult to treat...ever try NON-PHARMACOLOGICAL?

Detailed Answer:
Thank you for your very pertinent and timely question about chronic headaches. I am a neurologist and headache specialist and therefore, I believe I understand what you are going through based on the numerous patients I've treated through the years with similar pathologies who have chronic headaches which are very difficult to treat.

What I've found to be more problematic than the pathology itself (SAH with chronic sequelae +/- TBI, etc.) is that both patients and doctors place too much emphasis on "pills" and pay almost no attention to UNDERSTANDING the headache and what actually makes it up from a cause/effect perspective, symptoms which may be present that need to be accounted, and then, very importantly lifestyles which can either make headaches WORSE vs. lifestyles and things patients can do that make headaches or symptoms BETTER.

This is a very time consuming'll agree that the option of simply "guessing" at the best medication just hasn't worked in you....and I'll bet you've been tried on virtually the entire known armamentarium of drugs typically what's next? Combinations of these drugs? I'll bet you've done that what next? Well, maybe it'll work if you do the whole thing all over again....well, that doesn't sound very productive nor attractive either to you, I'm what's left?

What's what I do in my clinic at the VA Medical Center and my private headache practice which is tedious, time consuming, without any guarantees EXCEPT that as a patient, if you follow these steps you will understand makes your headaches "tick" and you will learn a methodical way of tracking the most important parameters of your headaches as well as the treatments designed to go after the symptoms in an orderly, organized, logical, and as nearly a scientific approach as possible. When a person goes through that type of process then, the outcomes are generally pretty positive and as I said....worst possible scenario is that you will simply come to clearly UNDERSTAND a lot more in terms of the underpinnings of your headaches and how to keep track of things that work, don't work, or possibly work and that in and of itself gives you power at better management when it comes to long range goals of controlling what could be either a POSTCONCUSSIVE SYNDROME which is out of control, or perhaps some totally different evolution of headaches which is in CONJUNCTION with the postconcussive or post hemorrhagic headaches you've been suffering.

So, the nuts and bolts of this type of approach. You need to find a:

1. Neurologist (preferably Headache specialist) well versed in headache identification and therapy who is willing to take the time necessary to ferret information out and put it together in a way that conforms with practice and diagnostic guidelines since right now the only thing we know is that you have CHRONIC DAILY HEADACHES that are likely painful and debilitating. That's the extent of what you or anyone else knows. We need a DIAGNOSIS of the type of headache that this represents.....there are literally HUNDREDS of types of headaches.....identifying the right one is critical in order to choose the best medication or combination of medications. There is a guideline that has been published that is roughly 190 pages in length and lists every type of headache recognized as well as the potential pharmacological as well as nonpharmacological recommendations. You need a neurologist/headache specialist who is well versed in these guidelines and who is willing to sit and get the information from you.

2. You need to learn how to KEEP A HEADACHE DIARY with the salient information and points of what you refer to as your CHRONIC HEADACHES. You need to understand that your headache can be broken down into component symptoms and parts which together make up the whole that call "HEADACHE"....but the individual parts, if properly identified may have their own individual treatments which collectively could results in EFFECTIVE TREATMENT if put together by the right specialist....make sense?

3. You need to be evaluated in chronic headaches for not only the type of headache and its most appropriate treatment in order to take care of spikes and peaks which can occur during the course of the day....but you also likely need treatment for when it is just simmering, brewing, or even KINDLING which is a term we use to describe a headache that is percolating below the surface of clinical recognition but then, at some point bubbles over and to the need a way (whether by medication or alternatives such as acupuncture, deep breathing/relaxation techniques, biofeedback, or the use of devices that are now FDA approved for headaches such as a THERMAZONE machine which I use all the time in my practice to give quick...albeit temporary relief.

I know this response is likely not what you were EXPECTING. I made my disclaimer in the beginning when I recognized the fact that everyone's been guessing as to what to give you....and it's yet to work....which means that I'm not about to simply add myself to the list of common folk! HA! There are no magic pills in headache medicine....ZERO....things work because they are used in the appropriate circumstances and with full knowledge by physician and patient as to WHY they are likely to work or not. To increase the chances of success one must stack the deck in their favor and that can only come with study, analysis, and a thoughtful synthesis of the facts....luck at choosing the next drug in line for no better reason than you haven't tried it yet has very little to do with the equation of success. I hope that makes sense. And if it does then, you've understood the outline of the plan you must follow...that your doctor must follow (in my opinion) if you guys are to have any reasonable chance at licking or at least knowing BETTER had to cope with what could potentially turn out to be a chronic and lifelong condition...because I always tell people.....headaches...especially chronic headaches are very similar to childhood asthma.....It should never be the expectation by patient or doctor that they should BE CURED or entirely rid of from the body.....but well controlled? That's a different story....that's a very reasonable goal to embrace....and by well controlled I do mean the elimination of pain and other debilitating symptoms on a routine basis....but always with the knowledge that in order to maintain that state...certain things have to be respected and followed. Remember your brain is not the same brain it was before the's altered became anatomically and physiologically. If we can understand what and how those alterations came about and what it is about our routine lifestyle and approaches that have failed to gain us relief or even make things worse.....then, we should virtually know exactly what to do and what not to do to awaken the sleeping giant......with me?

I hope this information gives you some additional angles and perspectives that you've either heard of but never tried or never heard of because in either case you will be able to start the right dialog with the right doctor wherever you live to try and stop making the same mistakes over and over again by just "experimenting" with the next good looking drug to comes to mind....because without really reflecting on WHAT TYPE of headache this really is...and without DOCUMENTING the accompanying symptoms as well as carefully tracking how these symptoms respond...or don't the will forever be locked in a vicious cycle of experimentation leading nowhere fast.
If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.

Do not forget to contact me in the future at: for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 32 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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