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Reader's Mail: Complex Headache Picture Requires a Headache Specialist

Q. My father has a variety of medical conditions, including Parkinson’s disease and diabetes. He has severe headaches almost every day. His doctors continue to prescribe more and more medications, which are not working. He has had every test imaginable to rule out any serious medical issue that may be causing the headaches. He has tried acupuncture and Botox, which provide minor temporary relief.

I have read many articles on oxygen offering relief for chronic headache pain. For some reason, none of his many doctors are willing to even attempt this therapy. They just continue to prescribe more medications and, as you can imagine, he is using many medications already. Do you have any recommendations on how to convince any of his doctors to try oxygen treatments?

My father’s headaches are completely debilitating. He often can’t even hold his head up.

A. I’m sorry to hear that your father is having so many health issues. Extensive testing does not usually lead to headache control unless it reveals an abnormality through an MRI scan, a carotid ultrasound, or a blood test known as an erythrocyte sedimentation rate (sed rate).

If he is on many painkillers, he will continue to have headaches, overshadowed by medication overuse headaches (formerly called rebound headaches). According to the International Headache Society, medication overuse headaches occur when a migraineur takes combination analgesics, such as Excedrin, or narcotics for 10 or more days per month for more than 3 months. Medication overuse headaches can also be caused by the use of simple analgesics, such as Tylenol, for 15 or more days per month. Even Botox will not help people with medication overuse headaches.

Episodic use of oxygen has been very helpful in cluster headaches but not of much value in other headache types. You need to begin with an appropriate diagnosis before considering treatment plans. If outpatient treatment fails, inpatient headache care is a viable option.

It sounds like you are looking for a rational approach to your father’s debilitating headaches, and I strongly recommend that he see a board-certified headache specialist. His other illnesses may have an impact on medication choices, so a careful history and physical examination will be very important, as well as a careful assessment of other factors such as sleep apnea, depression, and other conditions that might worsen a headache condition.

Edmund Messina, MD
Michigan Headache Clinic
East Lansing, Michigan

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