No More Headaches!

My 11:45 patient today was Sue Maddocks, who just turned 40. She is a relatively new patient, who told me she had had daily headaches for twenty years. She was taking 20 Tylenol (acetaminophen/paracetamol) a day, and she still had unrelenting headaches along with some pretty severe neck pain. She had had MRI’s of her head and neck and tried all kinds of medications, but nothing helped.

When I first met Sue, she had problems with anemia and that is what we had to deal with first. Two weeks ago we got down to business with her headaches. It was clear that she suffered from rebound headaches; she would have to stop taking Tylenol in order to get rid of her headaches.

There are several methods described in the literature for getting rid of rebound headaches, some more drastic than others – everything from steroids to hospitalization for frequent injections of dihydroergotamine.

My proposal to Sue two weeks ago was that we give her a simple muscle relaxant, cyclobenzaprine 10 mg, 1-2 tablets every night, and that she take the leap of faith to wean herself off the Tylenol. “It’s not helping you anyway, so what do you have to lose?” I suggested. She was willing to give it a try. I warned her she probably would have worse headaches for a while. We agreed on a two-week follow-up.

It was a busy morning, but I was running on time. I took a deep breath as I entered Room 8 at 11:47, not knowing how things had gone since I saw her last. I thought about how to proceed if she hadn’t been able to cut down on her Tylenol.

I knocked and entered the room. Sue got up, gave me a big grin and shook my hand.

“They’re gone!” she exclaimed. “No headaches for a week – for the first time in twenty years!”

“That’s great”, I replied.

“Yesterday I was driving around, and I turned my head and noticed my neck wasn’t hurting – it was only holding up my head!” She was ecstatic.

“That’s all it’s supposed to do”, I said.

I wrote a refillable prescription for cyclobenzaprine and we talked about how long to take it for, and how to taper and stop it.

By twelve o’clock I was out the door and headed home for lunch – much sooner than I had imagined.

2 Responses to “No More Headaches!”

  1. 1 drtombibey October 31, 2008 at 5:41 pm

    Extra good work friend. An encounter like that makes a doctor’s month.

    Dr. B

  2. 2 Steph November 2, 2008 at 4:33 pm

    What a great success story!

    Well done YOU and well done to Sue for being prepared to trust your wisdom.

    ‘Tis scary though to hear of people taking 20 pain relievers a day. I’m surprised she didn’t have liver damage as a result.

    I suffer from severe headaches with the recurrent infections in my head where even the tiny vibration caused by talking will increase the pain but I’d still NEVER take more than 4 doses of any medication in any 24 hours. Instead, I’ve learnt various techniques to cope with the pain such as distraction (keeping busy) or lying down in the bath with head immersed in hot water and I always tell myself that the pain will ease given time. And it usually does :-)

    I’m sure fear of the unknown is a big component of pain.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Bookmark and Share


contact @

RSS A Country Doctor Reads:

  • Doctors as Stewards, is that News?
    Maybe it’s because I grew up in a socialist country, or perhaps I am actually from a different planet, but an article in today’s New York Times left me scratching my head. The article describes how some doctors and medical groups are quietly beginning to consider the cost of treatments they provide or recommend, for […]
  • Simple Bedside Test Trumps Mega-Workup
    The Journal of Family Practice just published an illustrative case of a young woman with severe headaches and blurry vision. After a couple of hospitalizations with non-contrast and contrast brain MRIs, lumbar puncture and exhaustive laboratory testing, the diagnosis was made with a no-cost two minute bedside test, promoted by yours truly in a post […]
  • Miracle or Outlier?
    A story in the New York Times about a cancer patient who wanted to live to see her daughter’s wedding caught my attention. Haider Javed Warraich, a resident in internal medicine writes: As a physician, I never liked the word “miracle.” I preferred to think in terms of “medical outliers.” And yet that day of […]
  • Psychotherapy and the Dodo
    In “Alice in Wonderland”, the Dodo claimed everyone a winner. In many people’s view, every form of mental health treatment is equally effective. Not so, according to new research. Bulimia, for example, is said to respond better to CBT, Cognitive Behavioral Therapy, than other modalities. So when it comes to psychotherapy, it seems the dodo […]
© A Country Doctor Writes 2008-2014. Unauthorized use and/or duplication of this material without express and written permission is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given.