A blood pressure medication telmisartan (Micardis) was shown to be effective in the prevention of migraine headaches by a group of German researchers led by H-C Diener. Several blood pressure medications have been proven to prevent migraine headaches. The oldest category of blood pressure drugs, beta-blockers have the most evidence to support their use and two of them (propranolol and timolol) are approved by the FDA for the preventive treatment of migraines. However, beta-blockers are not high on my list because they tend to cause more side effects than other blood pressure medications. The most common side effects are due to excessive lowering of blood pressure – lightheadedness, fatigue, and fainting. They also slow down the heart rate, which can make it difficult to exercise, while regular aerobic exercise is the first treatment I recommend to my headache patients. Calcium channel blockers, such as verapamil, are not as effective for migraine prevention as they are for the prevention of cluster headaches and can cause constipation, swelling and irregular heart beats. Another blood pressure medication, lisinopril which belong to the family of ACE inhibitors has also been shown to prevent migraine headaches. The most common limiting side effect of ACE inhibitors is coughing. A newer group of medications, which are similar in action to ACE inhibitors is ACE receptor blockers, or ARBs. ARBs do not cause coughing and telmisartan which is one of the ARBs caused as few side effects as the placebo.
Read MoreSmoking marijuana and taking its legal medicinal derivative, dronabinol helped one patient with cluster headaches, according to a report from the Montefiore Headache Clinic. Dronabinol is approved for the treatment of nausea and loss of appetite. The effectiveness of smoking marijuana or taking dronabinol for the relief of pain has been reported by many patients, but never proven in large trials. I generally discourage patients trying marijuana for the relief of any symptoms, unless they have tried and failed traditional medications and they have already tried marijuana and it did help. Marijuana not only has many negative effects on the body, but can be also contaminated by other harmful substances. Cluster headaches can be extremely intense and at times lead patients to thoughts of suicide. In view of this report it seems reasonable to try dronabinol in patients who failed Imitrex injections, oxygen and preventive drugs, such as high dose of verapamil, lithium, and topiramate.
Read MoreCluster headaches, which arguably cause the worst pain of any headache, are not likely to be cured by trigger point injections, according to a group of Spanish doctors. They treated 12 patients with trigger point injections and some of the patients reported some relief, but they all needed medications as well. This is a small study without placebo control, which means that no conclusions can be made about usefulness of this treatment. We do have better evidence that occipital nerve blocks can be helpful in aborting cluster headaches. This is a procedure similar to trigger point injections, but it involves injection not only of a local anesthetic, but also a long-acting steroid into an area of the occipital nerve on the side of the headaches. It is a simple and safe procedure and it should be tried in most patients, particularly those who in addition to pain around the eye have pain or tenderness in the back of the head or upper neck.
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