So what kinds of drugs are helpful for treating headaches, and how do they work? First off, there are two major approaches for treating a headache with drugs. Acute, or abortive, treatments are designed to treat a headache once it begins. However, when a person suffers from frequent headaches that don't respond well to acute treatments, it's worthwhile to consider a regular dosage schedule with preventative drugs, which can help keep headaches from occurring in the first place.
Acute drugs, designed to stop headaches, should be the first treatment approach. For milder headaches, or headaches in their early stages, over-the-counter analgesic drugs are often effective for this purpose. Common examples include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Over-the-counter analgesics work by acting on pain centers in the brain or by reducing inflammation around pain-sensitive nerves.
Some common analgesic drugs contain caffeine, which can help to treat headaches by speeding the uptake of medications into the bloodstream. Because caffeine is a stimulant that can alter blood flow within the brain, shifting caffeine levels can also be the cause of headaches. For example, if you try to quit a caffeine addiction cold turkey, you'll be taking away a brain-altering drug that your body was used to having around. Removing it can shift the balance of other chemicals in your brain and lead to withdrawal symptoms -- including major headaches.
Other acute treatments are designed to act directly on parts of the pathways known to be involved in headaches. For example, drugs classified as triptans or ergotamines are used to combat migraines by constricting dilated blood vessels and adjusting the balance of certain chemicals in the brain. To speed delivery into the blood stream, acute treatments are often given as nasal sprays or are sometimes injectable. In the case of migraines, these non-oral delivery methods are important, since the digestive disturbances associated with migraines can interfere with the uptake of ingested drugs. Quick delivery is also important for cluster headaches, which can come on quickly without warning.
Acute treatments for cluster headaches can be similar to the treatments for migraines, although sometimes pure oxygen breathed through a mask or numbing nasal sprays, such as lidocaine, can offer relief. When normal acute drug treatments aren't enough to relieve the pain of a severe headache, a doctor might prescribe stronger narcotic drugs. However, because these types of drugs are habit-forming, health professionals avoid prescribing them when possible.
Patients who experience headaches on a frequent basis sometimes benefit from preventative drug treatments, designed to reduce the chance that a headache will ever start. For example, four drugs approved by the FDA for migraine prevention have been in widespread use for many years. When conventional preventative drug treatments are ineffective for reducing headache frequency, certain antidepressant drugs might be prescribed as an alternative. These are thought to work by affecting the balance of serotonin, a chemical in the brain often involved in the development of headaches due to its effects on blood vessels. Preventative treatments are seldom perfect, though, so it's important to have acute treatments ready as a backup.
Are drugs the only way to treat headaches? We'll look at alternative options on the next page.