Managing Chronic Headaches in Seniors: Medication Concerns and Alternatives

Headache medication for the elderly?

I'm sorry to hear about your grandmother's situation.
It seems she has been taking headache medication prescribed by a local neurology clinic for many years, but due to a recent move, she now needs to obtain her medication from a provincial hospital in Taipei.
However, the new medications are causing side effects such as numbness in her limbs and swelling in her feet.
As a result, she has had to stop taking them, but her headaches persist and seem difficult to treat.
She finds relief only when using the medication from the small clinic.
You mentioned that you consulted a pharmacist who suggested that the medications are pain relievers and, given the long duration of use, recommended considering more natural alternatives.
The medications prescribed by the small clinic include Erispan tablets, Acetylcysteine tablets, Magnesium Hydroxide, Roumin, and Colsin-5.
You are unsure whether it is safe for her to continue taking these medications and are looking for alternative options.
Additionally, you expressed concern about the clinic's physician being uncooperative regarding providing a prescription for the medications, making it difficult for your grandmother to obtain them from a pharmacy, especially since traveling to the clinic is inconvenient for her.
It is important to consult a healthcare professional regarding the safety and appropriateness of continuing the current medications, especially given the side effects.
They may also be able to suggest alternative treatments or therapies that could help manage her headaches without causing adverse effects.
Thank you for reaching out, and I hope your grandmother finds relief soon.

Zhang Tongxue, 20~29 year old female. Ask Date: 2004/07/30

Dr. Huang Yicheng reply Pharmacology

Colsin-5, with the generic name diazepam, is a 5 mg medication belonging to the benzodiazepine class of sedatives.
It can alleviate mental anxiety and tension, or relieve muscle spasms and stiffness.
Taking this type of medication may cause drowsiness and dizziness, so caution is advised.
Erispan tab.
0.2, with the generic name fludiazepam, is a tablet formulation with a dosage of 0.25 mg, also classified as a benzodiazepine sedative, which can be used to treat anxiety with an effect that is eight times stronger than diazepam.
Long-term use of these medications in large amounts may lead to addiction or dependence; therefore, it is crucial to follow the physician's instructions strictly and never exceed the prescribed dosage or duration of use.
After a period of medication, the effects may gradually diminish, and it is important to consult a physician, who may consider switching to other medications.
One should never increase the dosage on their own.
If these medications are taken for 3 to 4 months, they should not be abruptly discontinued, as this may lead to withdrawal symptoms.
Generally, a physician will taper the daily dosage by 10% to 25% every 1 to 2 weeks or 4 to 8 weeks, monitoring for adverse reactions, so it is essential to follow the physician's guidance for gradually reducing the dosage or frequency before stopping the medication.
ACETAL TABLET, with the generic name acetaminophen, is an antipyretic and analgesic, equivalent to the over-the-counter medication Panadol, differing only in brand name as it is manufactured by different companies.
Some individuals may also develop dependence after long-term use of this medication.
Mag-Hydroxide, or magnesium oxide, is commonly used as an antacid for excessive stomach acid; due to its side effect of causing diarrhea, it can sometimes be utilized to treat constipation.
Roumin, with the generic name prochlorperazine, is a medication used to prevent or treat nausea and vomiting, and it can also be used to treat psychosis.
After long-term use in large amounts, sudden discontinuation may result in symptoms such as rapid heartbeat, insomnia, headache, tremors (especially in the elderly), and nausea or vomiting.
It is important to follow the physician's instructions for gradually reducing the dosage or frequency before stopping the medication.
These medications are quite common and are manufactured by qualified pharmaceutical companies in the country, making them readily accessible.
Moreover, the public has the right to know about the medications they are taking, and we should inquire in detail about the medications prescribed to ensure our health and safety.
The physician in question should have acted more responsibly.
However, since there are many causes of headaches, it is advisable to consult other physicians for a thorough diagnosis of the underlying condition to ensure appropriate treatment.
Self-medication should be avoided.
If there are further questions, please feel free to reach out again.
Sincerely,
Pharmacist Huang Yi-Cheng, Hualien Hospital, Department of Health, Executive Yuan

Reply Date: 2004/07/30

More Info

Managing chronic headaches in seniors can be particularly challenging, especially when long-term medication use leads to side effects such as numbness in the extremities or edema (swelling) in the feet. It’s essential to approach this situation with caution, as the elderly population often has unique health considerations and may be more susceptible to adverse effects from medications.

Firstly, it’s crucial to understand the medications your grandmother is currently taking. The medications you mentioned, such as Erispan, Acetaminophen, Mag-Hydroxide, Roumin, and Colsin-5, are often used for pain relief and gastrointestinal issues. However, long-term use of pain medications, especially non-steroidal anti-inflammatory drugs (NSAIDs) and certain types of analgesics, can lead to complications, including gastrointestinal bleeding, kidney issues, and cardiovascular problems. Additionally, some medications can cause side effects like peripheral neuropathy, which may explain the numbness in her hands and feet.

Given that your grandmother has been on headache medication for over a decade, it’s essential to reassess her treatment plan. Here are several steps you can take:
1. Consult a Neurologist: Since your grandmother has a history of chronic headaches, it would be beneficial to consult a neurologist who specializes in headache management. They can provide a comprehensive evaluation and may suggest alternative treatments or medications that are safer for long-term use.

2. Medication Review: A thorough review of her current medications is necessary. This can be done by a pharmacist or a physician who can assess potential drug interactions and side effects. If the current medications are causing significant side effects, it may be necessary to taper off these medications under medical supervision.

3. Consider Non-Pharmacological Treatments: There are several non-drug therapies that can be effective in managing chronic headaches. These include:
- Cognitive Behavioral Therapy (CBT): This can help manage the psychological aspects of chronic pain.

- Physical Therapy: Targeted exercises can help alleviate tension headaches, especially if they are related to neck or shoulder tension.

- Acupuncture: Some studies suggest that acupuncture can be effective in reducing the frequency and severity of headaches.

- Biofeedback: This technique teaches individuals how to control physiological functions, which can help reduce headache frequency.

4. Lifestyle Modifications: Encourage your grandmother to adopt a healthy lifestyle, which can significantly impact headache frequency and intensity. This includes:
- Staying hydrated
- Maintaining a regular sleep schedule
- Eating a balanced diet
- Engaging in regular physical activity, as tolerated
- Managing stress through relaxation techniques such as yoga or meditation
5. Natural Remedies: If your grandmother is interested in exploring natural alternatives, some supplements have been studied for headache relief, including magnesium, riboflavin (vitamin B2), and coenzyme Q10. However, it’s essential to discuss these with her healthcare provider before starting any new supplements, as they can interact with existing medications.

6. Medication Accessibility: If the medications prescribed by the rural clinic are effective but difficult to obtain, consider discussing this with the neurologist. They may be able to prescribe similar medications that are more readily available at local pharmacies.

7. Monitor Symptoms: Keep a headache diary to track the frequency, duration, and intensity of headaches, as well as any potential triggers. This information can be invaluable for healthcare providers in tailoring a treatment plan.

In summary, while it’s understandable that your grandmother may feel reliant on her current medications, it’s crucial to address the side effects and explore alternative treatments. A collaborative approach involving her healthcare providers can lead to a more effective and safer management plan for her chronic headaches. Always prioritize open communication with healthcare professionals to ensure that any changes in her treatment plan are safe and appropriate for her specific health needs.

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