Dr. David Buchholz published Heal Your Headache in 2002. While controversial, the book is still the #1 best seller on Amazon for headaches. I checked in with Dr. Buchholz to find out which of his recommendations still stand, which he’s changed his position on, and why he continues to take other doctors to task. In Part 3 of this 4-part series, we talk about hidden migraine triggers in non-migraine medications.
In the first part of our interview, we talked about your recommendation that people curtail using migraine abortives like triptans. You mentioned that other non-migraine medications can also be a problem. What should people be looking out for?
A big issue now is the medications routinely prescribed for acid reflux: proton-pump inhibitors like Prilosec® and Nexium® (referred to as PPIs). They are often migraine triggers and so many people are on them. I spend a surprising amount of time in my practice helping patients successfully transition off those medications, while still managing their acid reflux. They need to taper off them over a month or two while simultaneously building up an alternative medication. I usually recommend an H2 blocker (like Zantac® or Pepcid®). I have to watch the dosage very carefully. At home, elevation of the head of the bed by 3-6 inches can help a lot.
Birth control and HRT
As I mention in my book, birth control pills can be a big problem. Many doctors know that, but they don’t realize that the newer implanted forms of birth control, like NuvaRing and Mirena, which are supposed to have a primarily local effect, can also stir up migraines. Also, the use of birth control pills to suppress menstrual migraines generally backfires.
Stimulants and diet pills
There are a number of medications in this class, including bronchodilators for asthma, herbal and caffeinated stimulants, Ritalin®, Adderall®, other prescription stimulants, and diet pills.
This group includes nitrates for heart disease and erectile dysfunction drugs like Viagra® and Cialis®.
Another big issue is certain anti-depressants. SSRIs, SNRIs (Effexor® and Cymbalta®), and bupropion (Wellbutrin®) are all potentially migraine-triggering in many people. It’s a major problem because they are so commonly prescribed. Ironically, I often see them prescribed for chronic headaches. Apparently many doctors feel they can be helpful. I’m not sure why they think that; my experience indicates they are causing far more headaches than they are helping.
For those patients who need to be on an anti-depressant, I frequently discuss transitioning to a tricyclic antidepressant. Often the depression is in large part a product of the patient feeling out of control because of chronic headaches. By empowering them to gain control of their headaches, they may not need anti-depressants in the future.