Originally Posted by MicroMan

Hi MusicMafia,

PCS-related headaches have been a serious problem for me as well (going on 24 months). My headaches are without relent and influenced by activity and/or stimulation. They consist of tension-type headaches (bilateral, global throb) but also include magrainous types that tend to be unilateral and are show-stoppers. Both types are debilitating and made worse by mental engagement, physical activity, or environments that lead to over-stimulation, which evidently is anywhere outside of the house!

Recently, I've found some relief, though this is only a reduction in pain. Before getting to what has helped me, here's what I've tried:

a) Over the counter analgesics (Tylenol, aspirin, ibuprofen) all are useless for my headaches (e.g., no effect)

b) Tramadol afforded no reduction in pain for me

c) Tylenol 3 (Acetaminophen with 30 mg codeine) ARE effective at reducing my headache pain. However, chronic usage of these may damage your liver and also lead to constant issues with constipation. Further, any doctor that sees you taking these more then 1-2x per week will tell you that you have Medication Overuse Headaches (Rebound); if they suspect this, they will not believe your headaches arise from PCS. I've faced this several times, only to prove that I didn't have MOHs by discontinuing usage for lengthy periods (months). Note, other narcotic analgesics lead to MOHs so you need to be really careful here. The best option is not to use them (from a medical perspective), though it makes life pretty difficult at times. At 23 months, I could use these everyday but opt not to in order to ensure idiot doctor's don't suggest MOHs.

d) Antidepressants
- Cipralex (SSRI) (25 mg) - no pain reduction
-Cymbalta (SNRI) (30-60 mg) - no pain reduction
- Amitryptiline (TCA) (12.5-50 mg) - slight pain reduction at 25 and 50 mg, but the side-effects aren't pleasant... not a fan of this after feeling better coming off it
- Nortryptiline (TCA) (25-50 mg) - similar to the amitryptline but with less intense, but similar, side-effects
- Trazodone (TCA) (25 mg) - was using this more for sleep disturbance; it had no impact on pain reductions

e) Botox A injections
- did 3 rounds of injections (note: 2 rounds are required before determining efficacy) that consist of approx. 25 injections in head and neck; not sure why anyone would do this for cosmetics as the injections hurt like the dickens!!
- There was some reduction in headache pain, though I would define this as "slight"
- decided not to do a 4th round at this time as the benefit for me really isn't that great.

f) Increasing dose of Cymbalta from 60 to 120 mg (note: this is a very high dose of Cymbalta and is intended directly for pain relief, not depression). The transition period involved going to 90 mg for 2 weeks and then to 120 mg; these 4 weeks and the two that followed were quite difficult. Worse headaches, agitation, etc., etc. However, after having daily headaches that were 8s and 9s on a scale of 10 for 21 months, these have been reduced to 7-8/10, and occasionally a 6 or 9. I realise this might not seem significant, but there is a huge difference between a headache at 7 and one at 9. My days are more manageable and less painful; I've been able to interact with my family more and I get outside a bit more.

Unfortunately, though, I still have constant and chronic headaches. The Cymbalta has greatly reduced the migraine pain but has not had a big impact on my tension type headaches. Still, I am thankful for this relief as I deem it significant; Cymbalta has been the only thing other than Tylenol with codeine, that affords meaningful relief.

There are some other strategies used for treating migraine and headache pain linked to PCS. However, I'm not familiar with them but hopefully others will post about them.