HEADACHE AND FACIAL PAIN: WHAT IF MY HEADACHE DOESN'T RESPOND TO THERAPY?

Several drugs are effective in relieving an acute headache attack that does not respond to other medications. Generally, these drugs are not intended for ongoing treatment or prevention of migraine headaches but are administered in the physician's office of hospital setting for acute attacks.

Dihydroergotamine

Dihydroergotamine, sold under the brand name DHE-45, is given by injection. It may be administered for up to a week if you are hospitalized for headache pain. Possible side effects include diarrhea, leg muscle pain and abdominal cramps.

Opioids (narcotics)

Meperidine, sold under the brand name Demerol, can be injected, taken in tablet form, or as a syrup mixed with water. This narcotic pain reliever can become habit-forming if used regularly for a long time. Possible side effects include dizziness, light-headedness, drowsiness, nausea and vomiting.

Butorphanol, sold under the brand name Stadol, is injected or given as a nasal spray. Both injection and nasal spray provide rapid pain relief. Its pain-relief effect is highest about 30 minutes after administration; its effect lasts three to four hours. Possible side effects include drowsiness, nausea and sweating.

Both meperidine and butorphanol have some addictive potential.

Neuroleptics

Two neuroleptics, or phenothiazines, are most effective against headaches, especially when injected. Prochlorperazine is sold under the brand names Compa-Z, Compazine and Ultrazine-10. Chlorpromazine is sold as Thorazine and Ormazine. Possible side effects include constipation, dizziness, drowsiness, dry mouth and nasal congestion.

Corticosteroids

Corticosteroids are effective against headaches, especially when injected. Hydrocortisone is sold under the brand names A-hydroCort, Cortef, Cortenema, Cortifoam, Hydrocortone and Solu-Cortef. Among the brand names for dexamethasone are Decadrol, Decadron, Decaject, Dexasone, Hexadrol and Mymethasone. Possible side effects include hunger or loss of appetite, indigestion, restlessness and trouble sleeping.