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CNN Sunday Morning

Weekend House Call: Headaches

Aired March 09, 2003 - 08:30   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.


HEIDI COLLINS, CNN ANCHOR: Today on "Weekend House Call," we're focusing on headaches. We all get them from time to time, but few of us know exactly what causes them. There are some exciting new treatments and medications available now to offer some relief to those who suffer from headaches regularly.
Dr. Sanjay Gupta joins us now with more on this. Good morning to you.

SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. I get headaches.

COLLINS: I get them all the time.

GUPTA: You get headaches. We're part of the millions of people that do get headaches. And, just as you say, there are about 45 million, in fact. So what do you do about that? I think the answer really is inform yourselves, which we hopefully will do over the next half-hour. That will hopefully put you one step closer to getting rid of the pain.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Most people can identify with a headache.

UNIDENTIFIED MALE: Just real sharp pains. Sometimes it goes down the neck.

UNIDENTIFIED MALE: Sometimes it's really hard right over the front of my forehead.

UNIDENTIFIED FEMALE: It's just really a pounding headache. It hurts above my eyes.

GUPTA: Over 45 million Americans suffer from headaches each year, and they collectively shell out $4 billion a year on headache pain removers. While headaches are common, they can be difficult to treat, because there are many different types and causes. But figuring out the type of headache you have is important because it puts you one step closer to getting rid of the pain.

Most headaches are classified as tension headaches. The pain is typically generalized all over the head. They are stress-related and can often be treated by a couple of aspirin and a good night's sleep. At the other end of the spectrum are migraine headaches, which can be much more serious and more painful. Nearly 28 million people, primarily women, get these headaches each year.

Migraines are characterized by throbbing pain, usually located on one side of the head, often accompanied by nausea and sensitivity to light or sound. For years, there was no help for migraine suffers. It wasn't even considered a disease until recently. But now doctors have a better understanding of all headaches and a new arsenal of drugs to treat and even prevent migraines.

(END VIDEOTAPE)

GUPTA: All sorts of different new treatments. We're going to talk about those today. But first, let's give you a little bit of information, specifically about tension headaches and migraine headaches.

Tension headaches, these are the most common kind. They last about 30 minutes up to a week, they can last sometimes. Diffused, vice-like pressure typically with these sort of headaches.

Migraines, as we said, at the other end of the spectrum; one of the more painful types of headaches. They can last anywhere from four hours to three days. That's a very pulsing pain often on just one side of the head. That's an important characteristic. Nausea, sensitivity, people who have had these migraine headaches can really relate to that as well.

We want to hear directly from you. Call us, please: 1-800-807- 2620. Or you can e-mail us at housecall@cnn.com.

To help take your questions, we've invited Dr. Lisa Mannix, who is a neurologist from Cincinnati, Ohio. She's going to join us -- there she is -- and hopefully answer some of our questions as well.

I'll just point out right away, I'm a neurosurgeon, as many of the viewers at home know. Dr. Mannix is a neurologist. Dr. Mannix does primarily take care of headaches in her practice. I take care of patients who often need operations.

Today you're going to get two perspectives. And we already see the phone lines lighting up. The e-mails are rolling in. Let's go straight to our first e-mail question.

And this come questions comes to us from Kansas. And the question is, "For years, I complained to my doctor about two-day headaches. One day on one side of my head, the next day on the other side. I have tried five migraine medications; none have worked. Help."

Dr. Mannix, your practice is made up primarily of patients with headaches. This is someone who just is not getting any response to all these medications. What do you tell somebody like that?

DR. LISA MANNIX, NEUROLOGIST: Well, that's not uncommon to see patients suffering like this. And the two-day headache is more than most people are willing to put up with. Definitely education, understanding the headaches, trying the medications. But when medications fail, we have to make sure that you've used them properly. And that means especially for the new migraine medicines, taking them early in the headache, repeating the dose if the headache is not completely gone, and sometimes combining treatments for more complete relief or more better results with those.

GUPTA: Very good. OK.

COLLINS: All right. I think we have a caller right away, too. Joe (ph) from Tennessee is on the line. Hi, Joe (ph). What's your question?

JOE: My question -- basically, I got hit in the back of the head when I was 8 years old with an iron by my sister. And for the past five or six years now I've been suffering with migraines on the left side of the back of my head. And here about three weeks ago I had a migraine that lasted almost four days. And I've tried Imitrex for the past several years, and Imitrex doesn't even touch it.

But the migraine was so bad here several weeks ago that, when I went to the hospital, I almost stroked (ph) out. And they had to give me 30 milligrams of morphine to get my blood pressure down so I wouldn't stroke (ph) out.

COLLINS: Wow. You know I've had these migraines where they last days and days and days, and you really don't know what to do after a while. You feel like, I just have to go to the hospital.

GUPTA: And it's interesting, because he sort of relates it, Dr. Mannix, to an event that happened many years ago. Is that something that you hear? He said when he was 8 years old he got hit in the back of the head. What do you tell someone like Joe (ph)?

MANNIX: Well, I mean we know that migraines can start in childhood. But we also know that it can occur for the first time after a head injury, whether with an iron or a car accident. So that makes Joe (ph) prone to these headaches, and now they've taken on characteristics of migraine and can be treated in the same way that we would any other type of migraine.

Now when it gets into three days like that, or goes on for a week, those get more difficult to treat. And sometimes people do end up in the emergency room or at the hospital, but it would be good to maybe have some medication that he could use at home. And just going over that with his doctor is going to be important.

GUPTA: And another thing I would just add, as well, if someone gets hit in the back of the head like that and is having headaches immediately after, that's a time for a CT scan, to make sure there's no blood collection or something else has occurred is an important thing to do as well.

COLLINS: All right. Well we do have to take a quick break for now. When we come back, do headache sufferers take too many pills and pain relievers? Are we overmedicating ourselves?

We'll answer that and your questions. Just call us at 800-807- 2620. You can also e-mail your questions to housecall@cnn.com. We'll be right back.

(COMMERCIAL BREAK)

COLLINS: Migraines are hereditary. If both parents have migraines, there's a 75 percent chance your kids will have them. If only one parent suffers from migraines, then there's a 50 percent chance you will pass it along to your children.

Welcome back, everybody. We are talking about headaches; their causes and some new treatments. We have Dr. Sanjay Gupta here with us to talk all about those things.

I've got to tell you really quickly, though, I have them, and neither of my parents do. So I'm sure there is a small percentage of people...

GUPTA: Small percentage. And I have them as well. My mom had them. So, there you go.

COLLINS: Thanks, mom.

GUPTA: No. She did many good things for me, I assure you.

Lots of e-mail questions coming up. Lots of people out there with headaches, apparently. We want to get to as many of these as we can. Let's go straight to an e-mail. This is sort of a longer one from Karen in Massachusetts.

"For people who are chronic migraine and headache sufferers, a combination of ibuprofen and the prescription IMITREX seems almost a daily routine." A lot of people can relate to that. "Are there any long-term effects from taking either of these meds on an almost daily basis?"

We're bringing back Dr. Lisa Mannix from Ohio. Dr. .Mannix, do you have any comments on that?

MANNIX: Well, I sure do. When people have a chronic headache, daily headache, as this person's talking about, that's a situation that's really different. It goes from using things like Ibuprofen and Imitrex, which are meant to be taken on an as-needed basis occasionally, not on a daily basis, and really brings up the idea that prevention is necessary or trying to reduce the headache frequency with other types of medications that are meant to be taken on a daily basis.

The long-term problem with taking things like ibuprofen or IMITREX is not just the damages that the ibuprofen can do, for example, to the kidneys, but the idea of rebound headache. And I think we'll talk about that when we talk about some other questions. But taking these medications on a regular basis may actually be contributing to that daily headache instead of helping it.

COLLINS: Interesting. All right. We have Kathy (ph) on the line who has a question. Go ahead, Kathy (ph).

KATHY: Good morning, Dr. Gupta.

GUPTA: Good morning.

KATHY: My question is related to the triptans. I really had a lot of relief from the triptans. But I need to take more than -- I always need to take more than the inserts usually say is the effective dose. If I just take one, I might as well forget about it, but because it just doesn't work. And I know some of the people that I know who have migraines, they also just don't get relief from one, and that runs into a problem when it comes to...

GUPTA: That's a really good point, and we'll give you two perspectives on this. Dr. Mannix, first, the triptans and escalating dose, do you see patients who need increasing doses over time?

MANNIX: Yes. I mean let's clarify. The triptans are the migraine-specific medication. They're by prescription only, and they work on actually what's going wrong, the pain-producing bloods vessels and nerve endings in the brain. Now when available in prescription strength, many of these triptans are available in several different strengths. So certainly using the highest dose that the label says is important.

And remembering that these drugs have a very short half-life, meaning they only stay in your body a short time. And that you may need to repeat that dose to be able to get the most effective relief from them.

GUPTA: Yes. And while we're talking about that, as well, you were just talking a little bit earlier about preventive medications, daily preventive medications that gets into the whole issue of people taking medication every day to try to ward off these headaches to make sure they never come. What sorts of medications are those and what do you tell people about using those?

MANNIX: Well, the preventive medications are a different class. They're not really pain medications. In fact, we found most of them by accident.

For example, we use blood pressure medications on a daily basis to reduce the headache frequency. We use anti-depressant medications, not because people are depressed, but because of the brain chemicals that these medications work on. And the newer class of medications that we're using, at least in headache prevention, are anti-epilepsy or anticonvulsant medications that work on the brain and certain brain chemicals to reduce basically the sensitivity to or susceptibility to having these attacks.

So those are the type of medications. They need to be taken on a daily basis and usually for at least a month. And I suggest up to three months before we can tell whether they've had a beneficial effect.

GUPTA: See I think that's some really interesting information there. Anti-depressant medications, blood pressure medications possibly being used on a daily basis to try and make these headaches never come.

COLLINS: That's right. Mary (ph) in Illinois is on the line now, too, and has another question for us. Hi, Mary (ph).

MARY: Hi. Good morning. My question is, I've been diagnosed with migraines, as well as menstrual migraines. And I was wondering if you could suggest preventatives for menstrual migraines.

GUPTA: Yes, and that's a good point. We're just sort of getting into that, Dr. Mannix, a little bit right now. Menstrual migraines, any different advice for people who have menstrual migraines, also called hormonal headaches?

MANNIX: Sure. Well the one big difference with the menstrual migraines is you kind of know when they're going to happen if you can follow your cycle and predict it. The most common time is the two days before onset of menses or the first two days of menses.

Now some women will have headaches other times in the month and may need a daily preventive for all 30 days of the month. But if just have the ones around your period, sometimes you can use a preventive medicine just for maybe five or seven days around that time. One option there is to actually use the anti-inflammatory, something like ibuprofen, taken on a daily basis to try to reduce the probability of having one of those attacks. And then if an attack does come, you can use one of the triptans to quickly and effectively get rid of the pain.

COLLINS: All right. Dr. Mannix, thank you so much. And, also, I want to talk at some point, if we have a chance, about pressure points. And squeezing right here on your thumb is something I've been told to try. It actually worked for me once.

GUPTA: Did it work for you? I mean there's a lot -- we've been talking a lot about medications, but there are some other things, and we'll try to get to those as well.

COLLINS: OK, very good. For now, though, we are going to take a short break. And when we come back, can kids have headaches too? And what's best treatment for children? We'll have some answers when Weekend House Call continues.

(COMMERCIAL BREAK)

COLLINS: Welcome back, everybody. As you just saw there on the screen, women primarily suffer from migraine headaches and men suffer from what's known as cluster headaches.

GUPTA: That's right.

COLLINS: But now I'm wondering if children get any kinds of these headaches.

GUPTA: Yes, and a lot of people are curious about that very issue. People don't think of kids with headaches typically. And kids have a hard time sort of describing what it is they're experiencing. I think we have some callers about that.

COLLINS: We do. Actually, a very interesting one. Ashley (ph) is on the line from South Carolina. Hi, Ashley (ph).

ASHLEY: Hi.

COLLINS: Tell us about your son, is it, right?

ASHLEY: Yes, it's my son. He's 13. Since he was 7 or 8 years old he gets headaches. He'll be playing, a normal day, and then all of a sudden out of the clear blue he gets a headache. And within an hour of getting the headache, he's very sick. And he goes to sleep; when he wakes up he's fine. I was wondering if this was possibly a headache since he's already seen doctors several times.

GUPTA: Yes. And, Dr. Mannix, in your practice do you take care of patients, pediatric patients as well, that have headaches like this?

MANNIX: Yes, I sure do. And we know that about five to 10 percent school-age kids have migraines. So they're not just faking.

Actually sun is a perfect example. They go out, they're playing, sometimes they get hot or overtired. The headache comes on. Kids often will vomit with the headaches. They sleep and they're fine.

And for kids, that's a pretty good treatment, just letting them sleep. But once these headaches start interfering, they're missing school or they're missing soccer games and things like that, then we've really got to beef up the treatment for these kids and not let them end up where some of our other callers have been, in terms of chronic, daily headaches.

GUPTA: All right. And you know what? It's interesting. And kids oftentimes have a hard time actually describing what's happening to them, as well, I have found. A headache is very easy for adults to describe, but kids have a much harder time.

Dr. Mannix, I just want to follow up on a point that you made earlier about these rebound headaches. We're getting a lot of questions about that. Again, you made a comment that taking headache medications, the well known ones, such as Advil or ibuprofen, a couple of times a week can actually lead to rebound headaches later on down the line. Can you talk a little bit more about that?

MANNIX: Yes. This is something that we see in people who are headache prone who start taking these analgesics to help their headaches. And they sometimes do help the headaches very effectively or sometimes only take the edge off. And so these patients begin to take more and more of the medication.

And the brain reacts by changing receptors such that taking this medication actually starts contributing to the headache. So instead of the headache going completely away, there's always kind of a low grade, kind of dull headache there. But these people can still have severe migraine attacks on top of that. And we see that with almost any of the pain medicines, the headache medications, even the triptans. And the rule of thumb I use is, if you're using an acute medication more than two treatment days per week, you can be at risk for this rebound headache.

GUPTA: All right. That is very interesting. And, Heidi, being an anchor and getting migraine headaches is sometimes very difficult for you.

COLLINS: Yes. Well I think what I understand it to be is this visual aura that some people get as a symptom that lets you know that the migraine is coming. I mean I literally go blind and then the vision gets spotty as it starts to come around, and that's when I know the migraine is coming. If I don't panic I do better.

GUPTA: Right. And so someone like you needs to be able to prevent these headaches, as everybody would love to prevent these sort of headaches. So what can you do? Reducing stress, that sounds like a simple thing to say, but it really does help.

Lower your blood pressure. Some of the medications that actually prevent these are actually anti-hypertensive or blood pressure medications. Botox, we talked a little bit about that yesterday. But that can also reduce the likelihood of these headaches.

Anti-seizure medications, and finally yoga and meditation. All of those things seem to help. All right.

We do have to take a break right now. But we are going to give you some final thoughts, both Dr. Mannix and I, and hopefully you've learned something today. Thank you.

(COMMERCIAL BREAK)

GUPTA: All right. And we've come to the end of our half-hour show on headaches. A final thought from Dr. Mannix in Cincinnati, Ohio.

MANNIX: Sure. Don't let migraines interfere with your life. Work with your health care provider to get control over these headaches.

GUPTA: Very good advice. And if you do go see your doctor, we so have some pieces of advice for you, things you can actually with you to your doctor. Keep a daily log. That really helps to give some information to the doctor.

Identify some triggers of you headaches. That helps, as well. Identify where the pain starts and also what makes your headaches better or worse.

Headaches are a real problem; they're a biological problem. Thankfully, most of the time they're not life threatening, so that's the good news. That's all of the time we have for today.

Make sure to join our Weekend House Call next Saturday and Sunday. That's at 8:30 in the East. This is the place for the answers to your medical questions.

I'm Dr. Sanjay Gupta. Thanks for watching. CNN SUNDAY MORNING continues right now.

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 March 9, 2003 - 08:30   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
HEIDI COLLINS, CNN ANCHOR: Today on "Weekend House Call," we're focusing on headaches. We all get them from time to time, but few of us know exactly what causes them. There are some exciting new treatments and medications available now to offer some relief to those who suffer from headaches regularly.
Dr. Sanjay Gupta joins us now with more on this. Good morning to you.

SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. I get headaches.

COLLINS: I get them all the time.

GUPTA: You get headaches. We're part of the millions of people that do get headaches. And, just as you say, there are about 45 million, in fact. So what do you do about that? I think the answer really is inform yourselves, which we hopefully will do over the next half-hour. That will hopefully put you one step closer to getting rid of the pain.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Most people can identify with a headache.

UNIDENTIFIED MALE: Just real sharp pains. Sometimes it goes down the neck.

UNIDENTIFIED MALE: Sometimes it's really hard right over the front of my forehead.

UNIDENTIFIED FEMALE: It's just really a pounding headache. It hurts above my eyes.

GUPTA: Over 45 million Americans suffer from headaches each year, and they collectively shell out $4 billion a year on headache pain removers. While headaches are common, they can be difficult to treat, because there are many different types and causes. But figuring out the type of headache you have is important because it puts you one step closer to getting rid of the pain.

Most headaches are classified as tension headaches. The pain is typically generalized all over the head. They are stress-related and can often be treated by a couple of aspirin and a good night's sleep. At the other end of the spectrum are migraine headaches, which can be much more serious and more painful. Nearly 28 million people, primarily women, get these headaches each year.

Migraines are characterized by throbbing pain, usually located on one side of the head, often accompanied by nausea and sensitivity to light or sound. For years, there was no help for migraine suffers. It wasn't even considered a disease until recently. But now doctors have a better understanding of all headaches and a new arsenal of drugs to treat and even prevent migraines.

(END VIDEOTAPE)

GUPTA: All sorts of different new treatments. We're going to talk about those today. But first, let's give you a little bit of information, specifically about tension headaches and migraine headaches.

Tension headaches, these are the most common kind. They last about 30 minutes up to a week, they can last sometimes. Diffused, vice-like pressure typically with these sort of headaches.

Migraines, as we said, at the other end of the spectrum; one of the more painful types of headaches. They can last anywhere from four hours to three days. That's a very pulsing pain often on just one side of the head. That's an important characteristic. Nausea, sensitivity, people who have had these migraine headaches can really relate to that as well.

We want to hear directly from you. Call us, please: 1-800-807- 2620. Or you can e-mail us at housecall@cnn.com.

To help take your questions, we've invited Dr. Lisa Mannix, who is a neurologist from Cincinnati, Ohio. She's going to join us -- there she is -- and hopefully answer some of our questions as well.

I'll just point out right away, I'm a neurosurgeon, as many of the viewers at home know. Dr. Mannix is a neurologist. Dr. Mannix does primarily take care of headaches in her practice. I take care of patients who often need operations.

Today you're going to get two perspectives. And we already see the phone lines lighting up. The e-mails are rolling in. Let's go straight to our first e-mail question.

And this come questions comes to us from Kansas. And the question is, "For years, I complained to my doctor about two-day headaches. One day on one side of my head, the next day on the other side. I have tried five migraine medications; none have worked. Help."

Dr. Mannix, your practice is made up primarily of patients with headaches. This is someone who just is not getting any response to all these medications. What do you tell somebody like that?

DR. LISA MANNIX, NEUROLOGIST: Well, that's not uncommon to see patients suffering like this. And the two-day headache is more than most people are willing to put up with. Definitely education, understanding the headaches, trying the medications. But when medications fail, we have to make sure that you've used them properly. And that means especially for the new migraine medicines, taking them early in the headache, repeating the dose if the headache is not completely gone, and sometimes combining treatments for more complete relief or more better results with those.

GUPTA: Very good. OK.

COLLINS: All right. I think we have a caller right away, too. Joe (ph) from Tennessee is on the line. Hi, Joe (ph). What's your question?

JOE: My question -- basically, I got hit in the back of the head when I was 8 years old with an iron by my sister. And for the past five or six years now I've been suffering with migraines on the left side of the back of my head. And here about three weeks ago I had a migraine that lasted almost four days. And I've tried Imitrex for the past several years, and Imitrex doesn't even touch it.

But the migraine was so bad here several weeks ago that, when I went to the hospital, I almost stroked (ph) out. And they had to give me 30 milligrams of morphine to get my blood pressure down so I wouldn't stroke (ph) out.

COLLINS: Wow. You know I've had these migraines where they last days and days and days, and you really don't know what to do after a while. You feel like, I just have to go to the hospital.

GUPTA: And it's interesting, because he sort of relates it, Dr. Mannix, to an event that happened many years ago. Is that something that you hear? He said when he was 8 years old he got hit in the back of the head. What do you tell someone like Joe (ph)?

MANNIX: Well, I mean we know that migraines can start in childhood. But we also know that it can occur for the first time after a head injury, whether with an iron or a car accident. So that makes Joe (ph) prone to these headaches, and now they've taken on characteristics of migraine and can be treated in the same way that we would any other type of migraine.

Now when it gets into three days like that, or goes on for a week, those get more difficult to treat. And sometimes people do end up in the emergency room or at the hospital, but it would be good to maybe have some medication that he could use at home. And just going over that with his doctor is going to be important.

GUPTA: And another thing I would just add, as well, if someone gets hit in the back of the head like that and is having headaches immediately after, that's a time for a CT scan, to make sure there's no blood collection or something else has occurred is an important thing to do as well.

COLLINS: All right. Well we do have to take a quick break for now. When we come back, do headache sufferers take too many pills and pain relievers? Are we overmedicating ourselves?

We'll answer that and your questions. Just call us at 800-807- 2620. You can also e-mail your questions to housecall@cnn.com. We'll be right back.

(COMMERCIAL BREAK)

COLLINS: Migraines are hereditary. If both parents have migraines, there's a 75 percent chance your kids will have them. If only one parent suffers from migraines, then there's a 50 percent chance you will pass it along to your children.

Welcome back, everybody. We are talking about headaches; their causes and some new treatments. We have Dr. Sanjay Gupta here with us to talk all about those things.

I've got to tell you really quickly, though, I have them, and neither of my parents do. So I'm sure there is a small percentage of people...

GUPTA: Small percentage. And I have them as well. My mom had them. So, there you go.

COLLINS: Thanks, mom.

GUPTA: No. She did many good things for me, I assure you.

Lots of e-mail questions coming up. Lots of people out there with headaches, apparently. We want to get to as many of these as we can. Let's go straight to an e-mail. This is sort of a longer one from Karen in Massachusetts.

"For people who are chronic migraine and headache sufferers, a combination of ibuprofen and the prescription IMITREX seems almost a daily routine." A lot of people can relate to that. "Are there any long-term effects from taking either of these meds on an almost daily basis?"

We're bringing back Dr. Lisa Mannix from Ohio. Dr. .Mannix, do you have any comments on that?

MANNIX: Well, I sure do. When people have a chronic headache, daily headache, as this person's talking about, that's a situation that's really different. It goes from using things like Ibuprofen and Imitrex, which are meant to be taken on an as-needed basis occasionally, not on a daily basis, and really brings up the idea that prevention is necessary or trying to reduce the headache frequency with other types of medications that are meant to be taken on a daily basis.

The long-term problem with taking things like ibuprofen or IMITREX is not just the damages that the ibuprofen can do, for example, to the kidneys, but the idea of rebound headache. And I think we'll talk about that when we talk about some other questions. But taking these medications on a regular basis may actually be contributing to that daily headache instead of helping it.

COLLINS: Interesting. All right. We have Kathy (ph) on the line who has a question. Go ahead, Kathy (ph).

KATHY: Good morning, Dr. Gupta.

GUPTA: Good morning.

KATHY: My question is related to the triptans. I really had a lot of relief from the triptans. But I need to take more than -- I always need to take more than the inserts usually say is the effective dose. If I just take one, I might as well forget about it, but because it just doesn't work. And I know some of the people that I know who have migraines, they also just don't get relief from one, and that runs into a problem when it comes to...

GUPTA: That's a really good point, and we'll give you two perspectives on this. Dr. Mannix, first, the triptans and escalating dose, do you see patients who need increasing doses over time?

MANNIX: Yes. I mean let's clarify. The triptans are the migraine-specific medication. They're by prescription only, and they work on actually what's going wrong, the pain-producing bloods vessels and nerve endings in the brain. Now when available in prescription strength, many of these triptans are available in several different strengths. So certainly using the highest dose that the label says is important.

And remembering that these drugs have a very short half-life, meaning they only stay in your body a short time. And that you may need to repeat that dose to be able to get the most effective relief from them.

GUPTA: Yes. And while we're talking about that, as well, you were just talking a little bit earlier about preventive medications, daily preventive medications that gets into the whole issue of people taking medication every day to try to ward off these headaches to make sure they never come. What sorts of medications are those and what do you tell people about using those?

MANNIX: Well, the preventive medications are a different class. They're not really pain medications. In fact, we found most of them by accident.

For example, we use blood pressure medications on a daily basis to reduce the headache frequency. We use anti-depressant medications, not because people are depressed, but because of the brain chemicals that these medications work on. And the newer class of medications that we're using, at least in headache prevention, are anti-epilepsy or anticonvulsant medications that work on the brain and certain brain chemicals to reduce basically the sensitivity to or susceptibility to having these attacks.

So those are the type of medications. They need to be taken on a daily basis and usually for at least a month. And I suggest up to three months before we can tell whether they've had a beneficial effect.

GUPTA: See I think that's some really interesting information there. Anti-depressant medications, blood pressure medications possibly being used on a daily basis to try and make these headaches never come.

COLLINS: That's right. Mary (ph) in Illinois is on the line now, too, and has another question for us. Hi, Mary (ph).

MARY: Hi. Good morning. My question is, I've been diagnosed with migraines, as well as menstrual migraines. And I was wondering if you could suggest preventatives for menstrual migraines.

GUPTA: Yes, and that's a good point. We're just sort of getting into that, Dr. Mannix, a little bit right now. Menstrual migraines, any different advice for people who have menstrual migraines, also called hormonal headaches?

MANNIX: Sure. Well the one big difference with the menstrual migraines is you kind of know when they're going to happen if you can follow your cycle and predict it. The most common time is the two days before onset of menses or the first two days of menses.

Now some women will have headaches other times in the month and may need a daily preventive for all 30 days of the month. But if just have the ones around your period, sometimes you can use a preventive medicine just for maybe five or seven days around that time. One option there is to actually use the anti-inflammatory, something like ibuprofen, taken on a daily basis to try to reduce the probability of having one of those attacks. And then if an attack does come, you can use one of the triptans to quickly and effectively get rid of the pain.

COLLINS: All right. Dr. Mannix, thank you so much. And, also, I want to talk at some point, if we have a chance, about pressure points. And squeezing right here on your thumb is something I've been told to try. It actually worked for me once.

GUPTA: Did it work for you? I mean there's a lot -- we've been talking a lot about medications, but there are some other things, and we'll try to get to those as well.

COLLINS: OK, very good. For now, though, we are going to take a short break. And when we come back, can kids have headaches too? And what's best treatment for children? We'll have some answers when Weekend House Call continues.

(COMMERCIAL BREAK)

COLLINS: Welcome back, everybody. As you just saw there on the screen, women primarily suffer from migraine headaches and men suffer from what's known as cluster headaches.

GUPTA: That's right.

COLLINS: But now I'm wondering if children get any kinds of these headaches.

GUPTA: Yes, and a lot of people are curious about that very issue. People don't think of kids with headaches typically. And kids have a hard time sort of describing what it is they're experiencing. I think we have some callers about that.

COLLINS: We do. Actually, a very interesting one. Ashley (ph) is on the line from South Carolina. Hi, Ashley (ph).

ASHLEY: Hi.

COLLINS: Tell us about your son, is it, right?

ASHLEY: Yes, it's my son. He's 13. Since he was 7 or 8 years old he gets headaches. He'll be playing, a normal day, and then all of a sudden out of the clear blue he gets a headache. And within an hour of getting the headache, he's very sick. And he goes to sleep; when he wakes up he's fine. I was wondering if this was possibly a headache since he's already seen doctors several times.

GUPTA: Yes. And, Dr. Mannix, in your practice do you take care of patients, pediatric patients as well, that have headaches like this?

MANNIX: Yes, I sure do. And we know that about five to 10 percent school-age kids have migraines. So they're not just faking.

Actually sun is a perfect example. They go out, they're playing, sometimes they get hot or overtired. The headache comes on. Kids often will vomit with the headaches. They sleep and they're fine.

And for kids, that's a pretty good treatment, just letting them sleep. But once these headaches start interfering, they're missing school or they're missing soccer games and things like that, then we've really got to beef up the treatment for these kids and not let them end up where some of our other callers have been, in terms of chronic, daily headaches.

GUPTA: All right. And you know what? It's interesting. And kids oftentimes have a hard time actually describing what's happening to them, as well, I have found. A headache is very easy for adults to describe, but kids have a much harder time.

Dr. Mannix, I just want to follow up on a point that you made earlier about these rebound headaches. We're getting a lot of questions about that. Again, you made a comment that taking headache medications, the well known ones, such as Advil or ibuprofen, a couple of times a week can actually lead to rebound headaches later on down the line. Can you talk a little bit more about that?

MANNIX: Yes. This is something that we see in people who are headache prone who start taking these analgesics to help their headaches. And they sometimes do help the headaches very effectively or sometimes only take the edge off. And so these patients begin to take more and more of the medication.

And the brain reacts by changing receptors such that taking this medication actually starts contributing to the headache. So instead of the headache going completely away, there's always kind of a low grade, kind of dull headache there. But these people can still have severe migraine attacks on top of that. And we see that with almost any of the pain medicines, the headache medications, even the triptans. And the rule of thumb I use is, if you're using an acute medication more than two treatment days per week, you can be at risk for this rebound headache.

GUPTA: All right. That is very interesting. And, Heidi, being an anchor and getting migraine headaches is sometimes very difficult for you.

COLLINS: Yes. Well I think what I understand it to be is this visual aura that some people get as a symptom that lets you know that the migraine is coming. I mean I literally go blind and then the vision gets spotty as it starts to come around, and that's when I know the migraine is coming. If I don't panic I do better.

GUPTA: Right. And so someone like you needs to be able to prevent these headaches, as everybody would love to prevent these sort of headaches. So what can you do? Reducing stress, that sounds like a simple thing to say, but it really does help.

Lower your blood pressure. Some of the medications that actually prevent these are actually anti-hypertensive or blood pressure medications. Botox, we talked a little bit about that yesterday. But that can also reduce the likelihood of these headaches.

Anti-seizure medications, and finally yoga and meditation. All of those things seem to help. All right.

We do have to take a break right now. But we are going to give you some final thoughts, both Dr. Mannix and I, and hopefully you've learned something today. Thank you.

(COMMERCIAL BREAK)

GUPTA: All right. And we've come to the end of our half-hour show on headaches. A final thought from Dr. Mannix in Cincinnati, Ohio.

MANNIX: Sure. Don't let migraines interfere with your life. Work with your health care provider to get control over these headaches.

GUPTA: Very good advice. And if you do go see your doctor, we so have some pieces of advice for you, things you can actually with you to your doctor. Keep a daily log. That really helps to give some information to the doctor.

Identify some triggers of you headaches. That helps, as well. Identify where the pain starts and also what makes your headaches better or worse.

Headaches are a real problem; they're a biological problem. Thankfully, most of the time they're not life threatening, so that's the good news. That's all of the time we have for today.

Make sure to join our Weekend House Call next Saturday and Sunday. That's at 8:30 in the East. This is the place for the answers to your medical questions.

I'm Dr. Sanjay Gupta. Thanks for watching. CNN SUNDAY MORNING continues right now.

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