Headache and Migraine

Chronic headache is very common, highly distressing and varies from person to person. Headache can be associated with severe disabling pain, nausea and vomiting, sensitivity to light, noise and smell, numbness and tingling of the limbs, sometimes affecting vision, tearing, nasal congestion, ringing of the ears (tinnitus). There are estimated 2 million of Australians suffering from recurrent migraine. 

While there is no cure for chronic headache, but treatments are available to reduce the intensity and frequency of the episodes. Headache Australia has a good summary on how to manage chronic headache to live a better life.

1. Learn and develop a headache plan when you are headache free, to prevent or lessen the impact of next headache.

2. Keep a Pain Diary. This helps you and your healthcare provider to understand the possible triggers, the frequency of your headache, and the impact on your life.

3. Find out what are the triggers. As headache is different from person to person, the journey to look fo the trigger might be long but definitely worthwhile to minimise the intensity or frequency of flares.

4. Lifestyle check. Is there any diet, posture, environment, emotional stress, routines, sleeping patterns that provoke or lessen your pain?

5. Talk to your doctor. It is essential to come prepared and find out what options are available to you. Headache is highly individualised. It could be from the nerve, cervical spine, myofascia, etc. Always consult your doctor to see if which treatments are suitable for you.

6. Talk to the people around you. While receiving education yourself helps you to understand the disease, it is also important to tell your spouse, family, friends and colleagues to create a supportive environment for your social wellbeing.

Treatments

You should develop a plan with your doctors for: (1) acute treatment when headache is developing ; (2) prophylactic treatment to reduce the intensity and frequency of your chronic headache.

1. Acute treatment. Over-the-counter medications have great efficacy for headache flares. Such as the combination of Paracetamol and anti-inflamamtories (e.g. Ibuprofen). Sometimes, stronger analgesia is required to reduce the intensity, such as triptans, anti-nausea medications (antiemetics), ergots, etc. It is important to stay calm, remove yourself from triggers and catch it as early as possible.

2. Prophylactic treatment. These are the treatments to take regularly. Common medications include Sandomigran, beta-blocker, anti-nerve medications.

3. It is important not to develop reliance to analgesia daily, as it might cultivate the medication overuse headache. Common medications like ergotamine, codeine, caffeine.

4. During the pain-free or pain-less days, your doctors might refer you to other therapies to learn how to tackle the chronic headache. This could range from physical therapy, acupuncture therapy, psychotherapy, relaxation technique, etc.

5. If you headache escalates further, there are more advanced treatments. This normally include a referral to Neurologist and Pain Specialist to manage together. Treatments could include Botox injection, receptor-targeting injection, Nerve Block, Radiofrequency treatments or Neuromodulation.

Sometimes headache comes in a cluster and requires a team of healthcare professional to manage together. Dr Chow Chow works closely with general practitioners, neurologist, psychologist, psychiatrist, dietitian, physiotherapist in Sydney to provide you a multidisciplinary plans. 

If you have any question, feel free to contact to find out more!