Many people suffer from frequent, severe headaches, especially those with migraine. These headaches need careful treatment, with a focus on prevention. Talk to your health care provider about ways to prevent and treat your headaches.

• Limit use of over-the-counter pain drugs. If you are taking them more than two days a week, cut back.
• Avoid using prescription drugs containing opioids or butalbital, except as a last resort.

It is easy to use too much pain medicine. This can make headaches worse and cause other medical problems.

Over-the-counter pain medicines can have dangerous side effects.

Aspirin, acetaminophen and ibuprofen often work well for headaches if you don’t use them often.

But if you take these drugs too often, you can get serious side effects. In rare cases, if you often take acetaminophen a number of days in a row, you can damage your liver. This can happen even if you take just a little over the recommended dose.
Rarely, these drugs can also cause kidney problems. Aspirin and ibuprofen can, at times, cause stomach bleeding.

Watch out for overuse headaches.

If you take pain medicines for headache too often, they may no longer help as much, and you may also get headaches more often. This worsening of headache is called “medication overuse headache.” Although all drugs used for treating individual migraine attacks can cause medication overuse headache if taken too often, the following drugs are the most likely ones to cause overuse headaches. They may also make you more sensitive to pain:

Prescription drugs:

• Drugs with butalbital (Fiorinal, Pronal, Trinal, and generics)
• Opioid painkillers
  • Codeine (Tylenol 3 and other brands and generics)
  • Hycodon (5 mg)
  • Oxycodone (OxyContin, Percocet, others)
  • Morphine

Some pain drugs can cause addiction.

Drugs that contain opioids or butalbital can make you drowsy. Long-term use of these drugs can cause addiction or physical dependence, in addition to overuse headaches.

Some people need headache treatment for years, or even decades. They should take addictive drugs only if safer treatments don’t work. If you do have to take addictive drugs, ask your health care provider how to avoid overuse and addiction.

Lifestyle changes can help some people with severe headaches.

Often, you can prevent headaches or have them less often if you:

• Reduce stress, or learn to cope with it more effectively.
• Drink a minimum amount of alcohol.
• Get enough sleep, and maintain a regular bedtime and wake time.

If you still get headaches more than once a week, you can consider taking a daily preventive drug.

If you need pain relief during a bad migraine, drugs called triptans work well for most people. They usually have fewer side effects than other prescription drugs. There are seven triptans approved by Health Canada, and with the exception of frovatriptan, they are all available as generics.

Keep a record of each headache. Note possible triggers—foods, beverages, sleep patterns, or other things that cause your headaches.

Reduce triggers. For example, consider using tinted glasses to reduce the effects of bright light.

If menstruation routinely leads to migraines, ask your health care provider if you could ward off headaches by taking naproxen sodium regularly for a few days around your period.

Simple changes can sometimes prevent headaches:

• Cut back on alcohol.
• Consider controlling the effects of stress with activities such as meditation or relaxation.
• Don’t skip meals.
• Aim for 7 to 8 hours sleep each night. Go to bed and wake up around the same time. Don’t watch TV or use a computer in bed. If you snore, ask your health care provider if you should be checked for sleep apnea.

If you need preventive drugs, start with safer choices. Speak with your health care provider bout options available based on your medical history.

Visit the Canadian Headache Society’s website for more information.