Medicine overuse can bring daily headaches
DEAR DR. DONOHUE: Our 16-year-old daughter has been battling daily headaches for the past 18 months. She says the pain is at her temples and across her forehead, and the pain level is six out of 10 on a pain scale. A neurologist, an ear, nose and throat doctor, a chiropractor, a pediatrician, an orthodontist and a dentist cannot find a reason for the pain. She has been on numerous medicines, including migraine medicines, and has stopped using them because of their ineffectiveness and side effects. Biofeedback was not helpful. Her neurologist prescribed a new medicine. If she were your daughter, where would you look for a solution? — S.M.
ANSWER: More than 300 causes of headaches exist, but, for most, the kinds of headache can be reduced to four or five causes: migraine, cluster, tension, induced by physical exertion and medicine overuse.
Tension headaches — the most common kind, and the kind that more or less fits your daughter’s description — are felt on both sides of the head. People describe the pain as a squeezing, tight band. Any part of the head, including the back of the neck, can be involved. Stress and lack of sleep often bring them on, but frequently, no cause is found. Activity, like walking up and down stairs, doesn’t make the pain worse, as it does with other headaches. Tension headaches may make people sensitive to light or sound, but not to both. Standard medicines like Tylenol, aspirin and anti-inflammatory drugs regularly bring relief, but I don’t want to suggest medicines for your daughter. She has had plenty.
Overuse of headache medicines often can lead to daily headaches, which stop only when medicines are stopped. I know your daughter put an end to her medicine-taking for a while, but did she do so long enough? It can take two weeks to get over the medicines. Some have to be tapered. This is something to consider.
What would I do if this young lady were my daughter? I’d take her to a large medical center, like the medical school of your state. She is seeing a competent neurologist, but at a large center, a team of neurologists can put their heads together and come up with a new diagnosis and new treatment plan. Has your daughter had any imaging tests, like brain scans? I’m sure she has, but I want to mention them to anticipate reader curiosity.
The headache booklet details the problems of the more common headaches and their treatments. To order a copy, write: Dr. Donohue — No. 901, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I just read your article on sodium and am confused. I have Meniere’s disease, and all my doctors told me to stay away from sodium — salt. Is blood sodium different? — E.S.
ANSWER: Meniere’s disease is an inner-ear problem that brings episodes of dizziness, hearing loss and ear noises (tinnitus). One treatment is a very-low-sodium diet. That’s done to get rid of the excessive inner-ear fluid that causes the symptoms.
Blood sodium is a different matter and is kept at optimal levels by several mechanisms. If you are worried that your blood sodium will drop due to your low-sodium diet, don’t be. It won’t fall below normal values.
To set the record straight, sodium, sodium chloride and salt are one and the same — for our purposes, anyway.
DEAR DR. DONOHUE: My doctor tells me I have PVCs. Sometimes I can tell because I feel a thump in my chest. What’s the long-term outcome for PVCs? My doctor seems completely unconcerned. — R.W.
ANSWER: Many healthy people have PVCs — premature ventricular contractions. They’re extra beats sandwiched between two normal beats. Because the normal beat after a PVC ejects more blood, that beat can produce a thump in the chest. Most people are not aware they have them.
If a person has no other signs of heart disease and if the PVCs are infrequent, nothing need be done. If there are signs of heart disease or if the PVCs are frequent, medicines can suppress them.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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