Don’t Use these Medications for Headaches Headaches Are Different In the treatment of pain, there are a wide range of medications available. What must be emphasized in the selection of these medications is the difference between treating headaches and treating other types of body pain. There are two types of headaches. There are those occurring due to tumors or other invasive and tissue damaging processes. Then, there are the headaches that most of the rest of us experience, such as tension headaches and migraines. Headaches are not like pains elsewhere in the body. Most headaches we experience are not the result of bodily damage. The pain is caused by the undesired firing of neurons within the brain's pain centers. The reasons these nerve cells fire in the absence of tissue damage will be the topic of another web page. Nevertheless, it is sufficient to say it is a different type of pain than that of a broken ankle. With this in mind, it is important to realize that pain medications for a broken ankle may not be appropriate for treating a headache. While most medications may help relieve the pain of a headache, some medications have a high likelihood of causing a change in the way the brain processes pain signals. These medications often increase the severity and frequency of headaches even when used a few times per month. In fact, all pain medications if used too frequently can exacerbate the severity and frequency of headaches. We have identified a few medications that even with fairly infrequent use often lead to the development of frequent treatment-resistant headaches. These medications have not been shown in scientific studies to be any better at treating headaches than other common pain relievers. There are some patients who find that after a while their headaches no longer respond to the more common first-line headache drugs like Motrin, Tylenol, or even Imitrex. Instead, these headaches only respond to medications like Percocet, Demerol, or Fioricet. This patient is highly likely to be developing Rebound Headache. (See this web page for a more lengthy discussion.) Medications containing narcotics, barbiturates, and caffeine are highly linked to the development of this medication-resistant frequent headache syndrome. Because of this, I only rarely prescribe these medications. As well, I limit their use to no more than three times per month. Why do patients with frequent headaches find that these medications are the only ones that work for them? This condition comes about through over-exposure to these pain medications. These medications cause the brain to be less susceptible to other headache medications. Due to their powerful effects on the pain centers in the brain, their use will lead to headaches that will only respond to this type of medication. It is a vicious cycle. I have never seen a headache patient get out of a pattern of frequent severe headaches by increasing their intake of narcotics, barbiturates, or caffeine. I have seen the frequency and severity of the headaches decrease when these medications are withdrawn. Unfortunately after being exposed many times to these medications, it can take several weeks or months of abstaining from pain medication before the brain resets its pain center. Only after abstaining will the headaches become less frequent and once again treatable with simple pain medications like Tylenol. Here are some examples of medications I encourage all physicians and patients to avoid in the treatment of headaches. These medications are not appropriate for most patients. Because they so often cause the development of treatment-resistant daily headaches, I will not prescribe them to patients with more than three headaches per month. Medications Containing Barbiturates Fioricet Fiorinal Medications Containing Caffeine Excedrin Migraine BC Powder Cafergot All Medications Containing Narcotics (Here are a few examples) Morphine Codeine Demerol Butorphonal Methadone Tramadol Percocet Vicodin  There are some headache specialists who will use some of these medications more frequently. I believe that their use should be reserved for those patients being seen by neurologists who have completed a headache fellowship. I will be happy to refer any patient who believes these are the only medications that will possibly work for them to a headache specialist. Go Back to Medications I Use for Headaches Return to Headaches

Don’t Use these Medications for Headaches

Headaches Are Different

In the treatment of pain, there are a wide range of medications available. What must be emphasized in the selection of these medications is the difference between treating headaches and treating other types of body pain.

There are two types of headaches. There are those occurring due to tumors or other invasive and tissue damaging processes. Then, there are the headaches that most of the rest of us experience, such as tension headaches and migraines.

Headaches are not like pains elsewhere in the body. Most headaches we experience are not the result of bodily damage. The pain is caused by the undesired firing of neurons within the brain's pain centers. The reasons these nerve cells fire in the absence of tissue damage will be the topic of another web page. Nevertheless, it is sufficient to say it is a different type of pain than that of a broken ankle. With this in mind, it is important to realize that pain medications for a broken ankle may not be appropriate for treating a headache. While most medications may help relieve the pain of a headache, some medications have a high likelihood of causing a change in the way the brain processes pain signals. These medications often increase the severity and frequency of headaches even when used a few times per month. In fact, all pain medications if used too frequently can exacerbate the severity and frequency of headaches.

We have identified a few medications that even with fairly infrequent use often lead to the development of frequent treatment-resistant headaches. These medications have not been shown in scientific studies to be any better at treating headaches than other common pain relievers.

There are some patients who find that after a while their headaches no longer respond to the more common first-line headache drugs like Motrin, Tylenol, or even Imitrex. Instead, these headaches only respond to medications like Percocet, Demerol, or Fioricet. This patient is highly likely to be developing Rebound Headache. (See this web page for a more lengthy discussion.) Medications containing narcotics, barbiturates, and caffeine are highly linked to the development of this medication-resistant frequent headache syndrome. Because of this, I only rarely prescribe these medications. As well, I limit their use to no more than three times per month.

Why do patients with frequent headaches find that these medications are the only ones that work for them? This condition comes about through over-exposure to these pain medications. These medications cause the brain to be less susceptible to other headache medications. Due to their powerful effects on the pain centers in the brain, their use will lead to headaches that will only respond to this type of medication. It is a vicious cycle. I have never seen a headache patient get out of a pattern of frequent severe headaches by increasing their intake of narcotics, barbiturates, or caffeine. I have seen the frequency and severity of the headaches decrease when these medications are withdrawn. Unfortunately after being exposed many times to these medications, it can take several weeks or months of abstaining from pain medication before the brain resets its pain center. Only after abstaining will the headaches become less frequent and once again treatable with simple pain medications like Tylenol.

Here are some examples of medications I encourage all physicians and patients to avoid in the treatment of headaches. These medications are not appropriate for most patients. Because they so often cause the development of treatment-resistant daily headaches, I will not prescribe them to patients with more than three headaches per month.

Medications Containing Barbiturates

Fioricet

Fiorinal

Medications Containing Caffeine

Excedrin Migraine

BC Powder

Cafergot

All Medications Containing Narcotics

(Here are a few examples)

Morphine
Codeine
Demerol

Butorphonal

Methadone

Tramadol
Percocet
Vicodin

There are some headache specialists who will use some of these medications more frequently. I believe that their use should be reserved for those patients being seen by neurologists who have completed a headache fellowship. I will be happy to refer any patient who believes these are the only medications that will possibly work for them to a headache specialist.

Go Back to Medications I Use for Headaches

Return to Headaches