For people with recurring or continuous pain there is a tendency to live moment-to-moment without a view of longer-term pattern. A recording system helps capture big picture. It would be a mistake to judge effectiveness of any treatment by what happened with symptoms in just last few days. Generally, a month or longer is required to judge fairly and accurately.

So now that we have decided to consider a preventive treatment for our headaches and have put in place a system for measuring treatment's outcome, what specific remedies are available?

It depends, of course, on kind of headaches being treated. Let's discuss two of most common types—migraine and tension-type headaches.

For prevention of migraine, best-studied and most effective drug treatments are available by prescription only in U.S. These include propranolol (brand name Inderal), amitriptyline (Elavil), divalproex (Depakote) and topirimate (Topamax).

Riboflavin (vitamin B2) at 400 milligrams per day was shown in one controlled study to have migraine-preventing actions. (At this dose—far higher than what is needed to treat vitamin deficiency—riboflavin should be considered a drug rather than a vitamin.) The herb feverfew has also shown benefit in controlled trials, but it is important to remember that this, too, is a drug and can have side-effects. As is case with other drugs, it should not be used during pregnancy.

Non-drug strategies of proven effectiveness in migraine prevention include therapist-supervised programs of stress management, relaxation, biofeedback and cognitive-behavioral therapy. Studies of acupuncture have shown mixed results. Avoiding individually determined triggers for attacks carries no risk and can reduce attack rate.

For tension-type headaches amitripyline is best-studied drug for prevention of attacks. Note that this drug is also a leading treatment for migraine, so people unlucky enough to have both kinds of headaches can obtain benefit from just one drug. Unfortunately, even at low doses used for headache prevention, amitriptyline can cause daytime drowsiness (even when administered at bedtime) or annoying oral dryness. Because of this, substitution of a better-tolerated, though less-studied drug in amitriptyline's family (tricyclic antidepressants) is sometimes required. Tizanidine (Zanaflex) has also shown benefit in controlled trials.

Non-drug strategies for tension-type headache have also been proved effective. These include similar behavioral interventions to those mentioned for migraine—stress management, relaxation, biofeedback and cognitive-behavioral therapy.

It would be wonderful if preventive treatments stopped headaches entirely. If they did, a measurement system would not be necessary. But a more realistic goal for preventive treatment is to reduce overall headache symptoms by at least half, or to an extent that an individual patient finds meaningful. When this occurs, a preventive approach can be a valuable addition to a program of headache management.

(C) 2005 by Gary Cordingley

Over three million Americans stutter. Stuttering affects all ages, but most frequently, children between ages of 2 and 6 are most affected. Preschool and toddler stuttering are especially affected while they are developing their language. When they grow up, most of them improve or cure. One percent or less of adults stutters.

Many famous people stutter. Marilyn Monroe, Bruce Willis, Winston Churchill and Mel Tillis are only a few whose success was not impeded by stuttering. Their speech language issue did not stop them to excel and express themselves magnificently.

With these encoraging news about famous people succeeding in spite of their common issue, I end part 1 of these series of articles. Much more information can be found at http://www.stutteringstop.com/ a site dedicated to stuttering problems and resources, as well as a library of speech language pathology.

This is end of Part 1 of Stuttering and speech therapy ideas. On next chapters I will be writing about different and effective therapies developed lately by researchers on field of stammering or speech language pathology.