The first line medication for headaches include amitriptyline or nortriptyline or antiepileptic drugs such as topiramate (Topomax) or valproic acid (Depakote). If the episodes are infrequent and occur less than 4-5 times per moth an abortive plan using a triptan medication is often best.
As always the focus should be on identification and elimination of triggers rather than using chronic preventative medication called prophylaxis. Migraine sufferers are generally more sensitive to various triggers including bright light, sounds and smells. These sensations can not only trigger a headache but make an ongoing headache worse. Stress reduction techniques and a holistic lifestyle that focuses on a consistent and appropriate sleep, an active lifestyle and a healthy diet remain the prime focus to eliminate headaches.
Cluster headaches are more common than chronic paroxysmal hemicranias (CPH) which are quite brief and can occur several times or more per day. CPH responds to indomethacin and cluster headaches do not. Cluster headache suffers often report alcohol is a trigger and frequently are exposed to smoke. Exposure to second hand smoke can trigger headaches. Nicotine which is one of the compounds found in smoke has blood vessel effects that may be involved with this causation.
Chronic headaches occur daily and tend not to have the GI and light or sound sensitivity and are more dull, begin in the morning and increase throughout the day. They are often seen with the overuse of abortive medication which if overused cause rebound headaches. A headache diary for triggers and patterns, an active lifestyle and a healthy diet that avoids caffeine, MSG and Nutrasweet can help. Remember, caffeine can help decrease headaches when used infrequently. Frequent caffeine ingestion can trigger rebound headaches.
Muscle strain and overuse especially in the neck and shoulder regions can cause headaches. Neck spasms in young children may be due to a sudden increase in certain repetitive activities or due to minor neck injuries. Local measures and patience usually are best. In adults with arthritis or disc problems other interventions or trigger point injections may be necessary to ease cervicogenic headaches. Over 50% of adolescents with migraine or tension headaches experience neck and shoulder pain with a headache.
The key with headache treatment is to keep multiple treatment options at hand, find the best way to deliver the treatment and find what is best for you or your child.