To help improve patient care, The American Headache Society (AHS) recently released five practices that health care professionals and patients should avoid or question regarding headache treatment. The guidelines and considerable information about them appeared in the November-December issue of Headache. The list was created as part of the Choosing Wisely initiative of the American Board of Internal Medicine Foundation, which stresses the importance of physician and patient conversations in improving care and eliminating unnecessary tests and procedures. The Choosing Wiselyrecommendations should not be the final word in decisions about treating headache disorders or any other condition, experts say.  Instead, they are intended to foster conversation about what is — and is not — appropriate and necessary treatment.

Q. Excedrin Extra Strength gelcaps each contain 250 mg. of acetaminophen, 250 mg. of aspirin and 65 mg. of caffeine. Excedrin Migraine caplets contain exactly the same amounts of each ingredient. However, the first product allows the use of eight gelcaps in 24 hours, whereas the latter only allows the use of two caplets in 24 hours. Why the difference in the allowable use of two pills of apparently the same medication?

About half of people with migraine who take ibuprofen (Advil®, Motrin®, etc.) will get relief, according to a systematic review of nine studies with a combined total of 4,373 participants. In the studies, just over one-fourth of those who took 400 mgs., and 20% of those who took a 200-mg. dose, were pain-free in two hours compared to 11% of people who took a placebo. Another 57% of those who took the higher dose had their pain reduced to "no worse than mild." Nausea and other migraine-related symptoms also decreased.

MigraSpray, an herbal sublingual spray being marketed for the treatment of migraine, has not undergone any of the rigorous testing that is required by the Food and Drug Administration (FDA) for almost all medicines. MigraSpray is considered a supplement. The Dietary Supplement, Health and Education Action...

medications-cure-tablets-pharmacy-51004 Analgesic agents are prescription or over-the-counter medications used to control pain including migraine and other types of headaches. When used on a daily or near daily basis, these analgesics can perpetuate the headache process. They may decrease the intensity of the pain for a few hours; however, they appear to feed into the pain system in such a way that chronic headaches may result. The medication overuse headache (MOH) may feel like a dull, tension-type headache or may be a more severe migraine-like headache. Other medication taken to prevent or treat the headaches may not be effective while analgesics are being overused. MOH can occur with most analgesics but are more likely with products containing caffeine or butalbital.