Q. I have been on Fioricet for 2 years. I had been taking 6 tablets a day. My physician recommended that I cut back, due to rebound headache, every 4 days. I have now cut back to 3 tablets, and I’m experiencing extreme drowsiness and agitation.  I was told it’s not a side effect. Do you have any recommendations for alternative medication(s) that I can try? Also, I would like to know if you’ve ever heard of anyone else experiencing these types of side effects.

Q. I have had chronic daily headaches and migraines with aura for years. I also have fibromyalgia, TMJ (temporomandibular joint syndrome) disorder and irritable bowel syndrome (IBS). All of these involve chronic pain. I take Relpax® for the migraines, which helps a lot with the aura and works okay for the headache. I also take Cymbalta® for depression, but haven't noticed any pain relief from it. The only other medication I seem to tolerate is Advil®. Since I have a headache “24-7”, with no beginning or ending, I never really know what causes it. How many pain relievers (like Advil) do you have to take to get a rebound headache? I never take more than two a day, but I wonder if taking them for several days makes my headache worse. I want to do anything I can to prevent an already difficult situation from getting worse.

Health care professionals have known for decades that patients with headache disorders may make their headaches worse by overusing painkilling medication. In the United States, experts believe 30 to 80% of patients new to headache clinics suffer from medication overuse headaches, and in Britain, authorities believe more than one million people experience such headaches frequently. Last month, Britain’s National Institute of Clinical Excellence (NICE) provided new guidelines for physicians and other health care professionals there regarding this matter.

Q. I have had a kidney removed due to cancer. Consequently, I've been told to avoid nonsteroidal anti-inflammatories (NSAIDs) and other pain relievers that are metabolized through the kidneys so as to not stress the remaining kidney. Acetaminophen no longer provides any relief for my migraines. The triptans work, but always result in a bad rebound headache about 20 hours later. Are there any acute medications for migraine, other than the triptans, that are not metabolized through the kidneys? I have 9 to 11 days a month of migraine and have not found a preventive medication that works.

Sleep_woman Sleep is a fickle factor when it comes to headaches. While too much or too little sleep can often spark a migraine, napping can sometimes relieve unbearable head pain. How should you manage your sleep patterns in order to control your headaches? Here are some examples of sleep induced headaches that can possibly be prevented with a few simple adjustments.

Medication overuse headache is a growing global health problem, according to series of articles in the November issue of the journal Cephalalgia. In fact, it may be the third most common headache type in the United States, after migraine and tension-type headache. While pain medications may keep headache under control, they can also cause rebound headaches when used too often. Taking a medication more than twice a week to control headaches can build tolerance to the medication and place people at risk of developing medication overuse headaches (or rebound headaches), which occur 15 or more days a month.

Q. I am a migraineur who rarely responds to triptans. I have tried each class of preventives as well with no luck at all. After 14 years of suffering, I am participating in a Botox study. It has only been 10 days and I am still having migraines, but they could be due to my menstrual cycle. I am hoping that the Botox will prevent migraines at other times of the month. I also want to know if there is any surgery that is effective. And will insurance cover Botox injections or surgery?