Whether speaking of migraines, tension-type headaches or other recurring head pains, it's safe to say that
best headache attack is
one you don't have. Even if you have found an effective treatment for resolving a headache that is already underway, there is nothing about today's as-needed treatment that will keep next week's attack from occurring. Headache treatments come in two forms—abortive and preventive. The abortive form is familiar to most people. It means something you do to get rid of a headache that has already started. Usually it consists of an over-the-counter or prescription medication, but in some cases, a non-drug approach works. By contrast, a preventive treatment is something you do every day with
goal of keeping some future attacks from even starting. These, too, can involve drug and non-drug strategies.
Billions of dollars are spent each year on abortive remedies. For
most part, they are dollars well spent. And for people who have infrequent headaches that are rapidly and reliably resolved by an abortive treatment, a preventive treatment might be needless.
But if attacks are frequent, hard to resolve, interfere with usual activities—or side-effects from
abortive treatment interfere with usual activities—then a preventive treatment should be considered. Employing a preventive remedy does not preclude also using an abortive measure: each can be part of an integrated plan.
Before discussing specific treatments for specific headache types, let's consider
impacts of recurring headaches. The more obvious impact is
sheer unpleasantness and suffering involved in an attack. However, another impact—though less obvious—is in its own way just as important. And that is
associated disability or loss of function that comes with an attack.
If a headache attack is severe, then whatever else was planned for that day goes out
window—it's just not going to happen. If an attack is moderate in intensity, then usual activities might be possible, but occur more slowly, less efficiently, or require more effort to produce. This, too, represents headache-associated disability.
An increasing trend in
field of headache management is for practitioners to address their patients' loss of function as well as their pain and suffering. Drs. Richard Lipton and Walter Stewart designed a questionnaire to estimate headache-associated disability, called
MIDAS (Migraine Disability Assessment) scale which can also be used for non-migraine headaches.
Measuring and then re-measuring MIDAS is one method for judging if a preventive treatment is effective. But to accurately detect
effectiveness (or lack of effectiveness) of a preventive headache treatment there should also be some sort of day-by-day recording system.
It might be as minimal as a check-mark on
calendar for each day with any symptoms. Another system is to summarize at
end of each day that one day's headache-impact by selecting one of
following four descriptions—none, mild, moderate or severe. Numerically inclined people can assign scores of 0-3 to these choices and then run averages and other statistics for each calendar month.