First, try to do some non-pharmacologic measures: try to eat healthy (avoid monosodium glutamate
) do not eat cured meat, aged cheeses, smoked fishes, alcohol, or sausages; use a hat or umbrella (avoid direct sunlight to the head), stay well hydrated, avoid heat and fasting, try to sleep well and do some exercise, and get a comfortable pillow.
If she is not allergic, I suggest trying triptans as zolmitriptan
, eletriptan or almotriptan for acute pain attacks. They are different kind of drugs, not lidocaine nor anti inflammatories. Also, if she is having more than 15 days of pain per month, botulinum toxin injection would be a good option for her. She may need prophylactic medication; amitryptiline could help her with the neck pain. Topiramate is another option.
When I see a patient with headache and neck pain, I usually order some cervical spine
X ray to see if there is any injury causing pain. Sometimes this kind of patients can get better with occipital nerve block
with steroids. I suggest looking for a pain and headache neurologist
for a complete evaluation before start any medication.
I hope this helps, please let me know if you have any doubt before your appointment.