There are a number of “comorbid(co-occurring)” conditions that may go along with chronic headaches. Chronic headaches represent what we call “central sensitization”, where the brain just keeps on firing those headache waves over and over, constantly. Central sensitization, in headache, occurs mostly in the bottom part of the brain(brainstem).
What are some of the other “central sensitization” syndromes??…These include: fibromyalgia, temporomandibular disorder(TMJ/TMD), chronic pelvic pain(CPP), irritable bowel syndrome(IBS), and possibly others. For instance, in IBS, the GI(gut) system has 93% of all of our serotonin(serotonin is a key neurotransmitter in the central nervous system, key in the brain and headaches). In many migraine people, the GI system just is too sensitive, resulting in IBS(IBS is a constellation of symptoms that may include(not necessarily all in one person) cramps/diarrhea/constipation/reflux/GI pain etc.). So, in the brain migraineurs have inherited this “hypersensitive” or too sensitive brain, firing constantly(or frequently), and also may have inherited a hypersensitive GI system, resulting in IBS. This is all inherited, genetic stuff, not in any way psychological.
These other conditions complicate the life of a person with headaches. Fibromyalgia is basically “widespread pain, and possibly tenderness(mostly in muscles), chronic, for at least 6 months”…….I view fibro as similar to chronic daily headache, but from the neck on down(it is not pain in joints, that is different). Insomnia often occurs with fibro.
How do we treat a headache person with these conditions??..the idea is to use non-medication approaches(yoga/pilates/exercise/massage/acupuncture/physical therapy etc…), and to minimize meds. Regarding medication, we want to treat with something that may help several conditions: for instance, if someone has frequent headaches, insomnia, and IBS with diarrhea, a tricyclic(amitriptyline) may be best, which helps all 3 conditions. By using meds that treat several conditions the person has, we minimize meds that way. In a sense, these comorbid conditions that headache people may “drive” where we go with meds. Of course, other things go into the medicine equation, such as: weight, people’s preference(after all, it is a partnership between doc and patient), level of fatigue, the person’s occupation(for instance, an accountant may not do well with the spaciness of Topamax) etc.. For comments:

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