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Suggest Treatment For Severe Headaches Despite Taking Painkillers
Question: I am a female age 56 yrs. I have DAILY headaches (2-3 times) for last 20 years. I have been taking a combination of Topamac, Betacap Tr40, Libotryp excel and Nexito Forte for last 8 yrs. 50 % recovery. I take 2 to 3 painkillers daily(Vasograin, Combiflam, Disprin) and calmpose/zolfresh to get sleep. What are the Long Term effects of continuing these medicines and how long can I continue taking these? Can u suggest an alternate treatment ?
Brief Answer:
Need re-evaluation and treatment changes for medication overuse headache
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
The treatment you are taking are for chronic migraine.
But daily intake of painkillers may lead to medication overuse headache which becomes non-responsive to any medications as well as pain killers.
Long term effect of pain killers are also not good for body.
You need to consult a neurologist who can rationalise your therapy. Short course of steroid may be effective for medication overuse headache.
Try to reduce stress and change your lifestyle accordingly.
hope you found the answer helpful.
Do get back with further queries.
Regards
Dr Neeraj Kumar
Neurologist
Need re-evaluation and treatment changes for medication overuse headache
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
The treatment you are taking are for chronic migraine.
But daily intake of painkillers may lead to medication overuse headache which becomes non-responsive to any medications as well as pain killers.
Long term effect of pain killers are also not good for body.
You need to consult a neurologist who can rationalise your therapy. Short course of steroid may be effective for medication overuse headache.
Try to reduce stress and change your lifestyle accordingly.
hope you found the answer helpful.
Do get back with further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Dr XXXXXXX XXXXXXX
Thanks for your prompt response.
None of my questions have been answered. As already mentioned we are taking treatment from a Neurologist so what you have told is already known to us. I have paid fees here for getting second opinion from a specialist(neurologist) and not a GP. So your advice to go to a neurologist is not understood. You ARE a Neurologist, are'nt you ? As mentioned earlier, I am already taking sterroids. So there's nothing I gained from your advice. You also havent answered all my questions regarding long term effects of present copurse of treatment and how long can I continue taking this. Could you please read my mail again and answer all my questions ? Regards
Thanks for your prompt response.
None of my questions have been answered. As already mentioned we are taking treatment from a Neurologist so what you have told is already known to us. I have paid fees here for getting second opinion from a specialist(neurologist) and not a GP. So your advice to go to a neurologist is not understood. You ARE a Neurologist, are'nt you ? As mentioned earlier, I am already taking sterroids. So there's nothing I gained from your advice. You also havent answered all my questions regarding long term effects of present copurse of treatment and how long can I continue taking this. Could you please read my mail again and answer all my questions ? Regards
Brief Answer:
Require medication free interval to get relief from medication overuse pain
Detailed Answer:
Hello XXXX,
The current medications prescribed are too many and contain regular pain kileers which leads to medication overuse headache. In such case the effect of drugs decreases and pain persists .
The best treatment approach advocated in such situations is to stop all medications for a short duration lasting g for 2-3 weeks with cover of steroid (1mg/kg omnacortil) for 1-2 weeks in tapering doses.
You can take other measures for pain relief like oil application, rest and sleep medications or anxiolytics.
Drug free period has been shown to bring back the effectiveness of pain killers and migraine medications.
If your neurologist has prescribed so much medications then better to change the doctor.
Long term intake of pain killer leads to liver and renal damage with associated peptic ulcer disease.
Topiramate may lead to renal stones and sedatives will lead to dependence.
Hope you find the answer helpful.
Do get for any further queries.
Regards
Dr Neeraj Kumar
Neurologist
Require medication free interval to get relief from medication overuse pain
Detailed Answer:
Hello XXXX,
The current medications prescribed are too many and contain regular pain kileers which leads to medication overuse headache. In such case the effect of drugs decreases and pain persists .
The best treatment approach advocated in such situations is to stop all medications for a short duration lasting g for 2-3 weeks with cover of steroid (1mg/kg omnacortil) for 1-2 weeks in tapering doses.
You can take other measures for pain relief like oil application, rest and sleep medications or anxiolytics.
Drug free period has been shown to bring back the effectiveness of pain killers and migraine medications.
If your neurologist has prescribed so much medications then better to change the doctor.
Long term intake of pain killer leads to liver and renal damage with associated peptic ulcer disease.
Topiramate may lead to renal stones and sedatives will lead to dependence.
Hope you find the answer helpful.
Do get for any further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Thank you for your prompt response.
Since you advocate that in such situations one should stop all medications for a short duration lasting for 2-3 weeks with cover of steroid (1mg/kg omnacortil) for 1-2 weeks in tapering doses...could you please prescribe this tapering dose (body wt 61 Kg) ? Also please advise the name of oil for oil application, rest and sleep medications/anxiolytics.
Finally pl suggest a good neurologist. We are staying in XXXXXXX Kunj.
Thanks & Regards
Since you advocate that in such situations one should stop all medications for a short duration lasting for 2-3 weeks with cover of steroid (1mg/kg omnacortil) for 1-2 weeks in tapering doses...could you please prescribe this tapering dose (body wt 61 Kg) ? Also please advise the name of oil for oil application, rest and sleep medications/anxiolytics.
Finally pl suggest a good neurologist. We are staying in XXXXXXX Kunj.
Thanks & Regards
Brief Answer:
Follow the medications and consult the neurologist
Detailed Answer:
Hello XXXX,
In my patients with medication overuse headache I will prefer giving omnacortil 50 mg after breakfast for 5-7 days with omeprazole. Tapering of 10 mg every 2 days may be done.Local balm/ointment over forehead application and oil for application may be used. Pain killers (not used previously) like naproxen or aceclofenac may be used 2-3 times per week when suffering severe headache. Continuation of nexito forte and sedatives(zolfresh) may be required.
Best will be to attempt this drug free period under a good neurologist .
i will suggest you to contact Dr XXXXXXX XXXXXXX (neurologist) working at XXXXX XXXXX, XXXXXXX XXXXXXX He is specialist in headache.
Medanta-The Medicity
Sector – 000, XXXXXXX XXXXXXX 000 000, XXXXXXX
Phone +91- 000 0000 +91- 000 0000
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Follow the medications and consult the neurologist
Detailed Answer:
Hello XXXX,
In my patients with medication overuse headache I will prefer giving omnacortil 50 mg after breakfast for 5-7 days with omeprazole. Tapering of 10 mg every 2 days may be done.Local balm/ointment over forehead application and oil for application may be used. Pain killers (not used previously) like naproxen or aceclofenac may be used 2-3 times per week when suffering severe headache. Continuation of nexito forte and sedatives(zolfresh) may be required.
Best will be to attempt this drug free period under a good neurologist .
i will suggest you to contact Dr XXXXXXX XXXXXXX (neurologist) working at XXXXX XXXXX, XXXXXXX XXXXXXX He is specialist in headache.
Medanta-The Medicity
Sector – 000, XXXXXXX XXXXXXX 000 000, XXXXXXX
Phone +91- 000 0000 +91- 000 0000
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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