Pain Medications for Headache
We often receive telephone calls requesting something for pain. This request is written up as a clinical note by the person who takes the telephone call, and then it is sent to the doctor or nurse practitioner for a clinical decision. We ask ourselves the following questions:
1. Are you having rebound headaches? If a person takes something to suppress pain more than a few days out of the week, headaches may be temporarily relieved but overall the condition will worsen. The situation is called "medication overuse headache".
2. Do you have a new condition? We do see patients who develop sinusitis, meningitis, aneurysm rupture, or other causes of change in headache pattern where the use of the pain medication may obscure finding the correct diagnosis.
3. If your previous pain medication and rescue plan is not working, is this because you are developing a tolerance to the medication? In the case of controlled substances, we have a responsibility to carefully assess the possibility of developing addiction or misuse of medications.
4. Has your overall use of medications for pain increased to the point where we should be concerned about liver, kidney, or gastrointestinal damage?
Over the years, we've seen enough complications from pain medication to become convinced that firm limits on pain medication are in the best interests of our patience with headache. If you have called requesting something for pain, we have the following recommendations:
1. Pain medication is used in limited quantities which are prescribed to last until your next planned visit. For your safety, we do not call in controlled substances and narcotics.
2. If you need to use something available over-the-counter, we recommend plain aspirin if you tolerate it. Many patients tolerate a "loading dose" of four aspirin taken once, followed by two aspirin as needed every four hours. A regular Coca-Cola may be taken on no more than two days each week with four aspirin and may increase the absorption and pain relieving effect of the aspirin. Avoid taking Goodie powders or BC powders more than two days each week. In general, pain medication and caffeine should be restricted to no more than two days each week to prevent the development of rebound headaches and complications of chronic pain medication use.
3. There are non-pharmaceutical ways to treat headache. Getting into a swimming pool and staying submerged for a half hour, can be just as effective as pain medication. Some people obtain considerable relief by soaking 12 to 20 minutes in a warm bath containing 2 cups of Epsom salts and a cup of baking powder.
4. If there's been a change in your need for pain medication request an urgent office visit so we can evaluate the reason your pain changed and treat it appropriately. The cause of the change in pattern can be evaluated, and in most cases treated immediately in the office.
