The North Carolina Comprehensive Headache Clinic employs a wide range of therapeutic interventions for headache.  Treatment options depend on the specific diagnosis and associated medical conditions, such as insomnia, anxiety, neck pain, sinus symptoms, weight gain, and others.  In general, medication is used “as needed” for episodic headache.  For many chronic headache conditions, medication is used continuously to induce remission.

     In general, medications are used for the minimum length of time.  Treatment is directed at achieving specific goals.  Therapeutic options include adjustment of habits or diet, specific exercises, pharmaceutical agents to prevent headache and assist with other medical conditions, and in some cases surgical procedures such as nerve blocks or the use of botulinum toxin (Botox).

     For episodic headache the goal is to enable you to control the headache when it occurs.  Triptans, medication for nausea, and pain medication are frequently effective, but in some cases self-administered injections of dihydroergotamine or other regimens may be helpful.  The most common cause of failure to benefit from these medications is an associated muscle contraction or neck pain component.

      In treating episodic headache, how the medication is administered is important. 

     To take one example, many patients who do not respond to triptans may do so when taken earlier, or with medication that assists gastric motility and absorption, or taken with a medication that counteracts spasm of the esophagus, a very common side effect of  triptans.

     In many cases a recommended change in habits or diet may significantly reduce the frequency of episodic benign headaches and reduce and sometimes eliminate the need for medication.

     For chronic headache the goal is to induce a remission.  For many, that means reducing headache frequency from 15-20 days each month of uncontrolled headache, to 0-5 headache days each month that are effectively controlled when they occur.  

     As in treating episodic headache, how the medication is administered is important. 

      To take one example, the most common cause of intolerance of topirimate, a commonly used medication for migraine prevention, may resolve when taken with baking soda (which corrects the metabolic acidosis associated with the tingling side effect).  

We treat the whole patient.  All symptoms are considered as clues to diagnosis, and treatment is directed at improving your life overall.  We recommend treatments that benefits your health in other ways than simply reducing headache.