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American Morning
Headache Help
Aired January 10, 2003 - 09:12 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
BILL HEMMER, CNN ANCHOR: So then, which came first, the headache or the headache medicine you're taking? A "New York Times" magazine investigates the phenomenon in this weekend's issue. Fascinating results, too, here.
Dr. Sanjay Gupta, a quick update and a preview of what's happening and finding in this article.
What did they find, Sanjay?
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning.
Yes, very frustrating problem for lots of headache sufferers out there, not just because of the headaches alone, which 40 to 50 million Americans suffer from, but because of something called chronic daily headaches, where you're getting headaches 15 times a month or more than that, and what this article talks about -- a very fascinating article, written, by Dr. Jahar (ph) -- actually talked about the fact that these headaches could, in fact, be caused by overuse of the medication, getting yourself into a vicious cycle -- getting a headache, taking the medication, getting another headache, taking medication, to the point where all of a sudden, you're on these pain medications every single day, and they're not doing anything to help your headache, and even more alarming, Bill, they may actually be the cause of the rebound headaches, and that's what the article is about.
HEMMER: So the point is, rebound headaches are caused by the medication we're taking to stop the headaches in the first place?
GUPTA: That's right. If you look at it from sort of -- researchers looked at it from a scientific perspective and find out that actually your body has natural pain-fighting mechanisms. If you take a lot of pain medications, you sort of stall your body's own natural pain-fighting mechanisms, and therefore, your body can't fight pain the way it used to, and therefore, the medication is interfering with that. That is at least their theory.
There are some possible other causes. Take a look at the other causes. Just stress and tension, probably the most common cause of headaches. Use of pain and headache medications, that's the one we're talking about. Also use of caffeine. There are some signals to look for if you think that you might be somebody who actually suffers from rebound headaches. Look for some specific signals, taking more medication and your headaches continue to get worse, medications become increasingly less effective, headaches are worse hours after taking the medicine, and taking more medication and, ultimately, getting less relief, all good signals, again, of rebound headaches. Sort of, again, a frustrating problem for headache sufferers. I take care a lot of those patients myself, and they tend to be frustrated by the fact they keep taking more and more medications without any benefit.
GUPTA: Ultimately, how do you break the cycle? Thank you, Dr. Sanjay Gupta in Atlanta.
Now, for more on the rebound headache phenomenon, Dr. Steven Silberstein, director of the Jefferson Headache Center in Philly, and Andrea Nass, a psychology researcher, who suffers from the very problem.
Good to see both of you. Good morning to you.
Andrea, I want to talk about your condition. How old were you, and how intense were the headaches when you first noticed?
ANDREA NASS, PSYCHOLOGY RESEARCHER: I started getting headaches early in childhood, but I really started to noticed an increase in adolescence. And as I started to take medication for the headaches, they definitely increased in frequency and intensity to the point I was having them basically every afternoon.
HEMMER: Every afternoon. So you were taking Tylenol, Advil, Aleve, common products, is that right?
NASS: Basically everything I could get my hands on. I would switch from one to the other, once I felt that I was developing an immunity to one and then I would switch to get to get relief from a new medication.
HEMMER: So in the afternoon, you start feeling the pain. Give us an idea how bad it was?
NASS: Basically, it would start creeping up on me slowly, and then it would just increase in intensity pretty quickly, and if I didn't take something at the very beginning of the pain, I would bet get to the point where it was an intolerable pain to deal with by the evening.
HEMMER: You want to rip out your temples by that point.
NASS: Absolutely.
HEMMER: Other than medications, where did you turn to try and get help for your condition?
NASS: I saw many neurologist over the years, and tried every prescription drug we could think of. I went from injectable medications to oral medications, nasal sprays, everything, and the side effects were horrible. Some of them even ended me up in the emergency room, and then I decided to go back to over-the-counter medication, because it seemed like it had less side effects, and it was probably a less dangerous medication.
HEMMER: Seems like kind of a logical thing to do, but again, the problem wasn't going away, and then you turn to Dr. Silberstein.
Doctor, good morning to you.
DR. STEVEN SILBERSTEIN, DIR., JEFFERSON HEADACHE CENTER: Good morning.
HEMMER: So someone like Andrea comes to your clinic, and what do you tell them?
SILBERSTEIN: What we tell them is that people are headache prone, their brain and their nervous system is more sensitive, and it tends to react to stimuli and produce headache. And these are the people who have frequent headaches, and if they start to take over- the-counter or any other pain killers, the headaches get worse.
HEMMER: How do you convince a patient that the medication they're on is actually doing them more harm than good?
SILBERSTEIN: They know it. By the time they get to us, they know the medication is not working anymore. If it was working, they wouldn't be coming to us.
HEMMER: How do you know as a doctor that that's the deal?
SILBERSTEIN: We don't know 100 percent, but we can tell from our vast experience about 80 percent of the time when you stop the medications, patients get better.
HEMMER: But they only get better over time, right? What I'm going to on this one is it doesn't happen instantaneously, as you refer to. Sometimes it takes months, does it not?
SILBERSTEIN: Well, in many cases, if we start somebody on a preventive medication and then stop the overused medicine, they will do well, and we've seen dramatic changes, sometimes in two or three days.
HEMMER: Wow. your advice, the bottom line from you anyway, depends on the frequency of the headaches. That is one thing you look at. And the other thing, if you get headaches two or more times a week, go ahead and seek that medical advice. What would you add to that, doctor?
SILBERSTEIN: I think the bottom line is over-the-counter medicines are safe and effective. It's not the drug. It's overusing the drug that is important.
HEMMER: Andrea, how are you feeling today? Are you completely cured? Or you still feel the pain every now and then?
NASS: I wish I could say I'm completely cured. I've gone cold turkey and I haven't been taking over-the-counter medication since July. Slowly by surely, I am starting to notice a reduction in the headaches, and I'm starting to break out of the cycle, but the process is definitely not complete.
HEMMER: I'm sorry, how long has it been, timeframe again?
NASS: Since July, so about six or seven months.
HEMMER: Are you willing to keep going until it's completely wiped out, or do you ever get the temptation to reach for the bottle of Advil again?
NASS: I get the temptation, but it's definitely not worth it. Once you start the process, it's only worth it to see it through.
HEMMER: Interesting stuff. Good luck to you, Andrea. All right.
NASS: Thank you.
HEMMER: Doctor, good luck to you.
SILBERSTEIN: Thank you.
HEMMER: Steven Silberstein and Andrea Nass down in Philly. The rebound headache. Have a great weekend.
NASS: Thank you. You, too.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Aired January 10, 2003 - 09:12 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
BILL HEMMER, CNN ANCHOR: So then, which came first, the headache or the headache medicine you're taking? A "New York Times" magazine investigates the phenomenon in this weekend's issue. Fascinating results, too, here.
Dr. Sanjay Gupta, a quick update and a preview of what's happening and finding in this article.
What did they find, Sanjay?
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning.
Yes, very frustrating problem for lots of headache sufferers out there, not just because of the headaches alone, which 40 to 50 million Americans suffer from, but because of something called chronic daily headaches, where you're getting headaches 15 times a month or more than that, and what this article talks about -- a very fascinating article, written, by Dr. Jahar (ph) -- actually talked about the fact that these headaches could, in fact, be caused by overuse of the medication, getting yourself into a vicious cycle -- getting a headache, taking the medication, getting another headache, taking medication, to the point where all of a sudden, you're on these pain medications every single day, and they're not doing anything to help your headache, and even more alarming, Bill, they may actually be the cause of the rebound headaches, and that's what the article is about.
HEMMER: So the point is, rebound headaches are caused by the medication we're taking to stop the headaches in the first place?
GUPTA: That's right. If you look at it from sort of -- researchers looked at it from a scientific perspective and find out that actually your body has natural pain-fighting mechanisms. If you take a lot of pain medications, you sort of stall your body's own natural pain-fighting mechanisms, and therefore, your body can't fight pain the way it used to, and therefore, the medication is interfering with that. That is at least their theory.
There are some possible other causes. Take a look at the other causes. Just stress and tension, probably the most common cause of headaches. Use of pain and headache medications, that's the one we're talking about. Also use of caffeine. There are some signals to look for if you think that you might be somebody who actually suffers from rebound headaches. Look for some specific signals, taking more medication and your headaches continue to get worse, medications become increasingly less effective, headaches are worse hours after taking the medicine, and taking more medication and, ultimately, getting less relief, all good signals, again, of rebound headaches. Sort of, again, a frustrating problem for headache sufferers. I take care a lot of those patients myself, and they tend to be frustrated by the fact they keep taking more and more medications without any benefit.
GUPTA: Ultimately, how do you break the cycle? Thank you, Dr. Sanjay Gupta in Atlanta.
Now, for more on the rebound headache phenomenon, Dr. Steven Silberstein, director of the Jefferson Headache Center in Philly, and Andrea Nass, a psychology researcher, who suffers from the very problem.
Good to see both of you. Good morning to you.
Andrea, I want to talk about your condition. How old were you, and how intense were the headaches when you first noticed?
ANDREA NASS, PSYCHOLOGY RESEARCHER: I started getting headaches early in childhood, but I really started to noticed an increase in adolescence. And as I started to take medication for the headaches, they definitely increased in frequency and intensity to the point I was having them basically every afternoon.
HEMMER: Every afternoon. So you were taking Tylenol, Advil, Aleve, common products, is that right?
NASS: Basically everything I could get my hands on. I would switch from one to the other, once I felt that I was developing an immunity to one and then I would switch to get to get relief from a new medication.
HEMMER: So in the afternoon, you start feeling the pain. Give us an idea how bad it was?
NASS: Basically, it would start creeping up on me slowly, and then it would just increase in intensity pretty quickly, and if I didn't take something at the very beginning of the pain, I would bet get to the point where it was an intolerable pain to deal with by the evening.
HEMMER: You want to rip out your temples by that point.
NASS: Absolutely.
HEMMER: Other than medications, where did you turn to try and get help for your condition?
NASS: I saw many neurologist over the years, and tried every prescription drug we could think of. I went from injectable medications to oral medications, nasal sprays, everything, and the side effects were horrible. Some of them even ended me up in the emergency room, and then I decided to go back to over-the-counter medication, because it seemed like it had less side effects, and it was probably a less dangerous medication.
HEMMER: Seems like kind of a logical thing to do, but again, the problem wasn't going away, and then you turn to Dr. Silberstein.
Doctor, good morning to you.
DR. STEVEN SILBERSTEIN, DIR., JEFFERSON HEADACHE CENTER: Good morning.
HEMMER: So someone like Andrea comes to your clinic, and what do you tell them?
SILBERSTEIN: What we tell them is that people are headache prone, their brain and their nervous system is more sensitive, and it tends to react to stimuli and produce headache. And these are the people who have frequent headaches, and if they start to take over- the-counter or any other pain killers, the headaches get worse.
HEMMER: How do you convince a patient that the medication they're on is actually doing them more harm than good?
SILBERSTEIN: They know it. By the time they get to us, they know the medication is not working anymore. If it was working, they wouldn't be coming to us.
HEMMER: How do you know as a doctor that that's the deal?
SILBERSTEIN: We don't know 100 percent, but we can tell from our vast experience about 80 percent of the time when you stop the medications, patients get better.
HEMMER: But they only get better over time, right? What I'm going to on this one is it doesn't happen instantaneously, as you refer to. Sometimes it takes months, does it not?
SILBERSTEIN: Well, in many cases, if we start somebody on a preventive medication and then stop the overused medicine, they will do well, and we've seen dramatic changes, sometimes in two or three days.
HEMMER: Wow. your advice, the bottom line from you anyway, depends on the frequency of the headaches. That is one thing you look at. And the other thing, if you get headaches two or more times a week, go ahead and seek that medical advice. What would you add to that, doctor?
SILBERSTEIN: I think the bottom line is over-the-counter medicines are safe and effective. It's not the drug. It's overusing the drug that is important.
HEMMER: Andrea, how are you feeling today? Are you completely cured? Or you still feel the pain every now and then?
NASS: I wish I could say I'm completely cured. I've gone cold turkey and I haven't been taking over-the-counter medication since July. Slowly by surely, I am starting to notice a reduction in the headaches, and I'm starting to break out of the cycle, but the process is definitely not complete.
HEMMER: I'm sorry, how long has it been, timeframe again?
NASS: Since July, so about six or seven months.
HEMMER: Are you willing to keep going until it's completely wiped out, or do you ever get the temptation to reach for the bottle of Advil again?
NASS: I get the temptation, but it's definitely not worth it. Once you start the process, it's only worth it to see it through.
HEMMER: Interesting stuff. Good luck to you, Andrea. All right.
NASS: Thank you.
HEMMER: Doctor, good luck to you.
SILBERSTEIN: Thank you.
HEMMER: Steven Silberstein and Andrea Nass down in Philly. The rebound headache. Have a great weekend.
NASS: Thank you. You, too.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
