The headache sufferer should not rely solely on medicine. Other than medication, it is crucial to avoid caffeine overuse, try to limit “as needed” medications (so as to avoid medication overuse headache (MOH)), and manage the headache triggers (missing meals, bright lights, sleep, etc.). We push “active coping,” through exercise, physical therapy, yoga, psychotherapy, etc. It is important not to rely solely on medicine.

Exercise (at least, on average, 20 minutes daily) and weight control may improve headache and quality of life. Yoga or Pilates may be beneficial. Physical therapy is often useful, and is primarily aimed at associated neck pain. While stress may be a major trigger, managing stress is difficult to achieve. For those with anxiety and/or depression, psychotherapy is helpful for improving quality of life. Biofeedback and other relaxation techniques are also underutilized, and should be considered.

Medication overuse headache (MOH) is a critical issue that must be addressed. If a patient is consuming pain meds, or triptans, 10 or more days per month, he or she may be suffering from some degree of MOH. However, these analgesics often are the only effective treatment for that person. Withdrawal off of the analgesics may be very difficult. MOH tends to be over diagnosed. Many patients overuse the pain meds, but the meds are not creating MOH.  Dr. Lawrence Robbins

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