Seizure treatment

Seizure treatment

The non-drug prevention methods mentioned in the section on behavior are extremely effective for many people and should always be used first. While they often reduce the frequency and severity of migraine attacks, they usually cannot make a life entirely without headache medication possible. It is therefore crucial that patients know exactly how to take which medications and what to pay particular attention to. One reason, of course, is that the pain should be eliminated as quickly and completely as possible. Another is that every medication has side effects, and the treatment should therefore be as effective as possible. And yet another important reason: painkillers themselves can cause headaches if taken incorrectly.

Medication-induced headache

Overuse of medication to treat headaches can lead to a condition known as medication overuse headache (MOH). Health insurance data shows that approximately 160,000 people in Germany require inpatient treatment for medication overuse headache each year. It is estimated that around 1 to 2 percent of the German population is affected by this problem – that's between 800,000 and 1.6 million people.

This is a diffuse and throbbing persistent headache, often without the typical accompanying symptoms of migraine. Furthermore, the overuse of painkillers and migraine medication can lead to an increase in the frequency of migraine attacks, longer duration of migraine attacks, greater intensity, and a reduced response to medication. The suspicion that the headache treatment itself is triggering the headaches should always be considered when..

• Headache medication is taken for more than 3 months on more than 10 days per month
• more than 15 headache days per month and
• An improvement in headaches occurs within two months after a break from taking the medication.

Many don't know it, others don't want to believe it

Few people consider that their headaches might have increased in frequency, severity, and duration due to the regular use of headache medication. On the contrary, those affected are constantly trying to find the one medication that solves all their symptoms. For this reason, medications are frequently changed, and new substances are often tried.

There is often a fear of effective medications, based on the assumption that what works well must also be strong and burdensome. Some patients prefer to take a moderately effective medication very frequently. They believe that if it doesn't help much, it can't be strong and cause dangerous side effects. However, the opposite is true. Potent migraine medications like triptans act like a safety key in a lock, requiring minimal force. They are better tolerated than frequently taken so-called "mild" and only moderately effective painkillers.

Initially, many patients don't believe that their headaches are perpetuated by the medication: they've learned that skipping it reliably leads to severe headaches after a few hours, while taking headache medication provides at least temporary relief – for a few hours at least. Many patients don't even dare to go outside without painkillers. Some patients, however, suspect the connection between their suffering and medication use. Responsible pharmacists who advise patients to see a doctor or even reduce their pain medication when purchasing the drugs are then avoided. To maintain appearances, some patients go to Pharmacy A on Monday, Pharmacy B on Wednesday, and Pharmacy C on Saturday.

The immediate reason for continuous medication use is withdrawal headache, which begins as the medication's effects wear off. In 90 percent of patients, this headache is of moderate to severe intensity. It is accompanied by nausea, vomiting, anxiety and restlessness, circulatory problems, dizziness, and sometimes even fever. Taking one or two tablets often relieves this torment—unfortunately, only temporarily for the next few hours—and simultaneously leads to a slow but steady worsening of the symptoms each time.

Medication break in the clinic

For medication overuse headache (MOH), a so-called medication break is now implemented; in English-speaking countries, this has been aptly termed a "drug holiday." In the first phase of treatment, we explain to the patient in great detail the mechanisms behind the development of headaches and the effects of continuous medication use. Furthermore, the patient is, of course, thoroughly informed about the ongoing treatment during the medication break.

A medication break usually requires inpatient treatment, as so-called rebound or adjustment headaches during the medication break at home often lead to a renewed need for painkillers. In specialized clinics – such as the Kiel Pain Clinic – the continuous use of headache medication is stopped abruptly. To alleviate the subsequent adjustment headache, the patient receives medication that replenishes the depleted neurotransmitters. This typically involves several days of intravenous infusion therapy. Alongside this, the patient participates in an intensive behavioral medicine program, learning strategies for preventing headaches through non-pharmacological measures. Naturally, the patient also learns the appropriate use of headache medication, enabling them to use it effectively and in the correct dosage. However, the primary focus is on behavioral prevention of headaches without medication.

To prevent it from getting that far

By observing the following critical thresholds, you can largely prevent medication overuse headaches:

Threshold No. 1: Time-related income behavior

• Do not take headache medication on more than 10 days per month.

Threshold No. 2: Headache frequency

• Do not self-medicate if you have headaches on more than 10 days a month. See a doctor!

Threshold No. 3: Analgesic preparation and type

• Do not take medications containing two or more active ingredients (and no opioid analgesics for migraine or tension-type headaches). Adding substances to the actual active ingredients of the painkiller (for example, codeine, caffeine, ethenzamide, thiamine, quinine, salicetamide, and others) does not increase its effectiveness against headaches, but it does increase the risk of side effects and the danger of psychological dependence, making a dose increase and thus chronic headaches very likely. Patients treated at the Kiel Pain Clinic for this problem showed that the more active ingredients a headache tablet contains, or the more different active ingredients are present in simultaneously taken medications, the longer and more difficult the withdrawal from painkillers becomes.