My Treatment for Chronic Daily Headache

My Treatment for Chronic Daily Headache (CDHA)

Robert A. Nash, M.D.

I have had an interest in headache since the late 1970’s when I learned about myofascial pain and its associated sleep disturbance. I believe that myofascial pain and fibromyalgia have components of overarching recurrent muscle tenderness and disordered sleep and can best be treated by restoring normal sleep patterns. Restorative sleep raises endorphin production (the body’s natural painkiller) and serotonin production, as does acupuncture. I began to treat CDHA patients with the existing antidepressant medications and had some success in restoring their sleep and alleviating their pain with minimal negative side effects.

Later, in 1995, I copyrighted the “Nash Serotonergic Index,” which allows me to easily choose the best drug on a first-trial basis about 85% of time. I couple this with neck and shoulder exercises to loosen and stretch out the musculature in the neck and shoulders. The results have been most gratifying, with about 85% of CDHA patients becoming essentially headache-free. Another 6-10% of patients respond to acupuncture to break up deep muscle spasms which did not respond to medication and exercise alone.

I learned acupuncture in the early 1990’s and learned about the neurochemical changes induced by acupuncture. From my studies, my clinical experience and literature review, I learned that alcohol, barbiturates and benzodiazapines work at the gamma amino butyric acid (GABA) gate of the neuron. I hypothesized that narcotics may also work at the same place. So I began to detoxify my patients from these four substances, once I had restored their normal sleep patterns with medication. These patients were CDHA and chronic back pain patients. To the patients’ and my great satisfaction, approximately 85% got markedly better, with a large percentage becoming completely pain-free. I have not written prescriptions for CDHA or chronic back pain patients for barbiturates, benzodiazepines or narcotics since the early 1990’s.

· The more yes answers, the lower the serotonin.

· One to three yes answers indicates low norepinephrine, for which I prescribe desipramine.

· Four or five yes answers usually responds well to nortriptylene.

· Five or more yes answers responds to trazodone, with more yes answers (8 or 9) sometimes requiring SSRI’s in the morning in addition to the trazodone in at bedtime.

1.	Do you usually skip breakfast?	Yes _____	No_____
2.	Are you refreshed upon awakening from sleep in the morning?	Yes _____	No_____
3.	Do you have outbursts of anger for no apparent reason?	Yes _____	No_____
4.	Were your parents and/or grandparents heavy or daily users of alcohol or cigarettes?	Yes _____	No_____
5.	Do you have difficulty sleeping?	Yes _____	No_____
6.	Are you or your parents work-aholics?	Yes _____	No_____
7.	Do you prefer to be in control of most situations?	Yes _____	No_____
8.	Do you have morning stiffness if you don't sleep under more than one blanket at night?	Yes _____	No_____
9.	Does noise bother you?	Yes _____	No_____
10.	Do you feel really good about doing well in school, sports or your job?	Yes _____	No_____
11.	Do you eat before going to bed?	Yes _____	No_____
12.	Do you bite your fingernails?	Yes _____	No_____
13.	Are you a long distance runner or walker or do you do aerobic exercise regularly?	Yes _____	No_____

CDHA patients appear to have a genetic low neurotransmitter that requires continued daily use of medication for life, as opposed to the situational depressed patients. My experience over time indicates that low serotonin is seen in obsessive-compulsive, addiction-prone patients. These are the same patients that tend to develop CDHA and perhaps chronic pain. Although the long-term effectiveness of high dose narcotics within a small subset of these patients appears to be established, my thought is about 85% of CDHA patients can become pain-free without the use of barbiturates, benzodiazepines or narcotics.