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.