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TREATING THE MUSCLE CONTRACTION HEADACHE: PART 1
The basic elements of treatment for muscle contraction headaches include reassurance, the establishment of a trusting relationship between the patient and the doctor, the removal of physical or emotional triggering factors, and treatment of the discomfort. This is not very different from what has been suggested as the treatment for migraine.
If a physical illness is present, that abnormality must be treated appropriately. If no physical abnormalities can be found to account for the headaches, it is often assumed that emotions play a critical role in the production of the headaches. This presumption should not be made prematurely, since emotional upset usually accompanies or follows any prolonged and painful event. Simply suffering from a regular and sometimes daily pain is enough to cause the
“pain-distress” cycle in which pain triggers the emotional upset and the emotional upset triggers the pain. It is, therefore, very important not to simply assume that emotion is the cause of the muscle contraction headaches, even though features of emotional upset may be present.
To interrupt and stop the pain-distress cycle and to alleviate the pain, it is often necessary to use combinations of analgesics, muscle relaxants, tranquilizers, and antidepressants. The use of these medications, particularly analgesics and tranquilizers, must be temporary. Regular and continued use of many of these drugs is potentially harmful to your body. Prolonged use of drugs encourages the development of emotional as well as physical dependence.
There seems to be a strong tendency for patients with recurring muscle contraction headaches to abusively use pain-relieving and tranquilizing medication. Not only does this have physical consequences, such as injuring the stomach, liver, and kidneys, but this abuse actually promotes headaches and physical and emotional dependence on these agents. The antidepressants (see below) may be appropriate for somewhat longer periods of time in certain situations, but indefinite reliance on any medication, including these, must be considered a failure of the overall headache treatment program.
A wide variety of analgesics can be used to treat the occasional muscle contraction headache. Aspirin and acetaminophen (Tylenol and Datril) are relatively safe and often very helpful.
Combination drugs are widely used although many doctors tend to avoid their use whenever possible.
Fiorinal is a combination brand-name drug, available in cheaper generic versions, that combines a barbiturate sedative, aspirin, phenacetin (a simple but potentially dangerous analgesic), and caffeine. Phenacetin, while an effective analgesic, can, like some other analgesics, injure the kidneys if there is prolonged and regular use. This combination product is popular and effective in many circumstances, but is so frequently abused that we generally
discourage its use except occasionally.
In Canada, phenacetin has been removed from all combination drug products containing salicylates (such as aspirin). In the United States, phenacetin is still available in prescription drugs (not in over-the-counter products), but it is likely that phenacetin will soon be removed from such prescription drugs in the United States as well.
*45/88/2*



