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My Head Still Hurts

What To Do When Headache Treatments Don't Work
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What Can I Expect from a Headache Specialist? continued...

If you take your headache medicine and the headache comes back when it wears off, you may be having rebound headaches. One clue is having a headache when you wake up in the morning.

"About 15% of the time, all we have to do is get patients to quit taking the medicines their primary doctor has been prescribing," Penzien says. "That is our sole intervention. We just have patients quit taking medicines that make them worse. They usually are prescribed by a doctor that really cares about the patient, but doesn't understand."

Problems like this are the first thing a headache specialist looks for.

"There should be some effort to identify headache triggers," Lipton says. "Every specialist takes a careful headache history to find out what makes a patient's headache worse. Understanding these factors is an important preventive strategy, because most of these things can be managed."

The next step is to find drug and non-drug headache treatments that help. Both come in two kinds. Acute headache treatments deal with headaches when they happen. Preventive headache treatments stop or limit headaches before they occur.

"In specialty care, the first objective is to relieve patients' pain and improve their ability to function," Lipton says. "In some patients, pain is relatively intractable. Then treatment becomes a rehabilitation strategy. We say, OK, we can't stop all the pain. What will we do is improve your function in spite of some pain.' In a small proportion of patients, you need to make this shift. For most, we say 'Let's relieve your pain and you can function.' For others we say, "Let's work on pain and function in tandem and see how much progress we can make in both areas."

"The goal is not cure. It is management," Penzien says. "Patients often give up on us before we give up on them. Once their pain is reduced, they feel as though they can now get on with their lives. But you don't have to settle for that. We almost always have more tricks up our sleeves."

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