Patients with FMS/CFS have described their body-wide pain as a terrible headache of the body. While this may be a true analogy, headaches themselves are frequent occurrences within both syndromes. Migraines and tension-type headaches are the two most common reasons for head pain in FMS/CFS patients, with roughly 70% succumbing to one or both problems on a chronic basis.

What Should You Do?

If you have problems with headaches, don't blame yourself! Instead, seek help. Even a dull, mild headache that you woke up with this morning can develop into a wall-banger by mid-afternoon. Once you feel like you have your head in a helmet that is two sizes too small and still closing in on you, the head pain is likely to spread to your jaw, neck, shoulders and upper back muscles. You could be on the road to a major symptom flare-up and you don't need that!

Author of HEADACHE HELP, Lawrence Robbins, M.D., writes: "People who get headaches do not bring them on themselves but rather have different levels of the brain chemical serotonin and a much greater reactivity of blood vessels about the head than others."

If you get headaches, you owe it to yourself to read Dr. Robbins' book. Robbins is the director of a Headache Clinic in Northbrook, IL, but he is not just another headache doctor; he is a patient who battles both tension and migraine headaches! The book is published by Houghton Mifflin with co-author Susan Lang and the cost is only $10.95. Click here to visit Dr. Robbin's Web site: www.headachedrugs.com

As Soon As You Notice the Headache Beginning...

Several practical strategies taken from Dr. Robbins' book are described below. If you are prone to severe or frequent headaches, Robbins recommends that you consult a physician. However, in the short-term and for mild headaches, these self-help measures may ease your pain.

Relax in a comfortable chair, recliner, or bed to help prevent the pain from causing the muscles to tense up and make matters worse. The room should be quiet and dark (if you are stuck at work, go to a room where you can close the door and turn off the lights). If you have taken biofeedback or some other relaxation training, now is the time to use it! If you have had no formal training, try closing your eyes for five minutes while you breathe deeply and slowly. Pretend that each time you exhale, a little bit of your pain is leaving with it.

Drink a caffeine-containing beverage (soda, tea or coffee), but be careful not to overdo it. While a little bit of caffeine can help relieve headaches, too much caffeine on a frequent basis can aggravate your headache problem. Unless you are fighting a headache, water might be your standard beverage of choice!

Take aspirin or ibuprofen (or acetaminophen if you can't tolerate these), but don't resort to this measure more than twice a week because it might increase your susceptibility for rebound headaches.

Wrap a blue-ice gel pack in a towel and place it on your head where it hurts the most. Always keep a gel-pack in the freezer (at home and work) so that you can use it on demand.

An Ounce of Prevention May be Needed

Several treatment guidelines (in addition to the self-help therapies indicated above) are given below for tension-type and migraine headaches. In general, both abortive and preventive strategies may be used. Once a headache begins, any course of action to curb it is considered abortive therapy. On the other hand, there may be ways to reduce the frequency and severity of your headaches through the use of preventive-type treatments.

"If you get frequent severe headaches that seriously impair your ability to get on with life's routines," writes Robbins, "your doctor may suggest switching from abortive medication each time you get a headache to preventive medication. Preventives are not only more benign than the abortives, but you end up taking less medication with preventives than if you just chase the pain with abortives."

Tension-Type Headaches

Although "tension" is in the name, Robbins claims that this type of headache is not merely the result of stress and tension. Genetic factors come into play as well. When a tension headache begins to occur, the muscles in your head and neck contract while the blood vessels in this region may expand. This can cause a throbbing pain (sometimes severe) and if you get these headaches often, they may not respond to the self-help measures described previously. More aggressive treatments to relieve the headache as well as preventive therapies may be needed.

Bringing a tension headache under control once it has started (i.e., abortive strategies) may include, in addition to the self-help measures already described, one of the following prescription medications: Anaprox DS, which is a high-dose prescription-strength naproxen, a drug that is now available over-the-counter in low-doses such as Aleve, Ansaid (flurbiprofen, a new anti-inflammatory drug), Midrin (contains blood vessel constrictor, mild non-addicting sedative and acetaminophen), or Norgesic Forte (contains aspirin, caffeine and non-addicting muscle relaxant). Other potentially habit forming drugs that may be used infrequently for a severe headaches when the previously mentioned medications fail might include Fiorinal, Codeine, or other narcotics and muscle relaxants. These need to be limited to one or two days a week at most.

When the above drugs don't work, your doctor may recommend that you take preventive medicines. They can reduce the frequency and severity of a headache episode, making the abortive drugs more effective. Serotonin altering medications include Elavil, Pamelor, Prozac, Sinequan, and Norpramin. These are antidepressants, but they are not working because of an affect on mood or depression. They help because they raise serotonin levels. If the above preventatives don't work, others might be tried such as Depakote (anti-seizure med), beta-blockers (e.g., Inderal), muscle relaxants (e.g., Flexeril, Robaxin) and calcium channel blockers (e.g., Verapamil).

More aggressive measures and combination therapies may also be tried with your physician's assistance. The point is, you should be aware that much can be done to dull your head pain. In addition, you may notice that you are already taking one of the drugs mentioned for headaches for your FMS/CFS pain.

Migraines

Robbins describes migraines as "throbbing or aching pain, usually on one side of the head, and are often coupled with nausea and sometimes vomiting, visual disturbances or dizziness." People may also experience an aura in which they see colors and shimmering lights. Stress, certain foods, weather changes, smoke, hunger, fatigue, and other factors may work to trigger a migraine attack, but genetic predisposition is likely the underlying reason for why people are susceptible to migraines in the first place. Abortive therapies that treat a migraine in progress may include anti-inflammatories or one of the drugs described previously for treating tension headaches. More aggressive abortive medicines specific for migraine-type headaches include Imitrex (sumatriptan in injectable form or as tablets), Dihydroergotamine (injectable) and ergotamine preparations (available in pill form but typically cause more nausea and believed to increase one's risk of heart attack). These three types of meds work to constrict blood vessels that have become abnormally dilated. In addition, the first two medications are thought to work on increasing brain serotonin which can help with pain as well. To treat the nausea, antacids, Phenegran, Compazine and other medications may be indicated.

Sumatriptan is the newest on the market, but it carries with it the problem of a headache recurrence the next day. You may not want to use the expensive injectable form and the pills may be preferred. However, the pills don't always work (they are not as fast-acting as the injectable form) and may only delay your headache recurrence. Dihydroergotamine is not as potent as sumatriptan, but it lasts longer so that rebound or recurrence headaches are less of a problem.

"It's one thing to have mastered the techniques for bailing yourself out of a migraine if it starts," writes Robbins, "but an important long-term goal is learning how to prevent your migraines before they start." First, identify frequent triggers and eliminate them when possible. Next, talk to your doctor about taking preventive medicines such as those indicated above for tension headaches.

The Serotonin & Substance P Connection

Tension headaches, migraines, and the pain of FMS/CFS may have something in common: serotonin and substance P. A 1993 Nov/Dec research article in Headache indicated that platelet stores of serotonin in people prone to getting either type of headache was lower than healthy controls. Low serotonin is believed to be a problem in FMS as well. In addition, a high level of substance P was found for both types of headaches, leaving researchers to conclude that this neurotransmitter might be linked to the pain. These findings may help explain why headaches and FMS pain occur together with an amazingly high frequency, and why serotonin-boosting drugs might be beneficial for both pain conditions.

Regional Pain Generators

Headaches are just one form of pain that often occurs in people with FMS/CFS. All sorts of regional pains may be present and each one can magnify your body-wide pain. Learn how to identify and intercept regional pain generators that feed your chronic pain state! Valuable suggestions for relieving the pain are provided in each issue of Fibromyalgia Network. Click here to join.

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