Treating Chronic Headaches and Migraines

Treatment for chronic daily headache aims to cut the frequency of headaches so that they become intermittent and manageable. Those who aren't overusing painkillers start with a headache prevention regimen (see below). Currently, there aren't any FDA-approved therapies specifically designed to ease chronic daily headache, but another strategy for chronic migraine has shown promising results (see "Botox for chronic migraine").

If your headaches are complicated by medication overuse, the first step is stopping the drugs. Doctors say going "cold turkey" (quitting abruptly) works best, but another option is to gradually wean yourself off the painkillers by cutting back a little each day. If you find the headache pain unbearable or if you experience nausea, vomiting, and severe muscle pain in the neck and shoulder areas, other medications can ease the withdrawal process. One option is to use sumatriptan (Imitrex), usually at a dose of 25 milligrams (mg) three times a day for 10 days, or until you have one headache-free day. (Afterward, you take sumatriptan only when a moderate or severe headache develops.) Another option is to take tapered doses of prednisone to lessen headache pain. This can be done on a three- or six-day schedule, starting at 15 mg four times a day, then 10 mg, and finally 5 mg. A muscle relaxant such as diazepam (Valium) may help your sore neck or shoulders. An antinausea medication such as metoclopramide (Reglan) will help prevent vomiting.

If you have been taking frequent high doses of medications containing opioids or barbiturates, the withdrawal process is likely to be more difficult, as these medications can cause a physical dependency. With barbiturates, for instance, it's best to gradually taper the medications to prevent seizures. Likewise, withdrawal from opioid dependency requires close medical supervision and you may even need to be hospitalized briefly.