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MEDICATION FOR TREATING HEADACHE:
MOOD-ALTERING DRUGS-TRANQUILIZERS
The successful alleviation of pain, including headache pain, cannot always be achieved with analgesics. Emotions, such as anxiety and depression, influence the feeling of pain and its meaning to those suffering from it.
Two types of mood-altering medications are used in treating pain: medications that reduce anxiety and tension, and medications that raise spirits. The anxiety reducers are called
tranquilizers, and the latter are called antidepressants.
Tranquilizers: There are two types of tranquilizers. The minor tranquilizers are used for treating mild to moderate degrees of anxiety and tension. The major tranquilizers are used to treat severe states of agitation and to modify the abnormal behavior often associated with serious emotional disorders. Included in the group of minor tranquilizers are chlorazapate (Tranxene), chlordiazepoxide (Librium), diazepam (Valium), meprobamate (Miltown and Equanil), and phenobarbitol.
Like all drugs, tranquilizers have the potential for producing side effects, sometimes serious ones, even when taken in recommended dosages. Low dosages of mild tranquilizers may cause drowsiness and a loss of coordination that resembles drunkenness. These reactions tend to occur when the patient first begins taking the medication, but can develop later when an accumulation of the medication occurs. Prolonged use of the minor tranquilizers can result in dependence on them. Sudden reduction of high doses of these drugs can cause withdrawal reactions, including epileptic-like seizures.
A significant depression of mood can be a side effect of prolonged use of tranquilizers. Occasionally this results in a depressed, tearful, and uninterested state. Some people taking standard doses of tranquilizing medications report that they are unable to refrain from weeping over even small problems or frustrations. An overdose of tranquilizers, such as in suicide attempts, causes serious impairment of brain function, coma, cessation of breathing, and even death. Taking tranquilizers in combination with alcohol enhances the danger of fatal toxicity, even if they are taken several hours apart.
The major tranquilizers, such as chlorpromazine (Thorazine), prochlorperazine (Compazine), and perphenazine (Trilafon), used formerly for only severe psychiatric states such as schizophrenia, have also recently been used with success in the treatment of chronic pain. While these tranquilizers are not as “addicting” as the minor tranquilizers, they carry with their use a significantly greater medical risk. Nonetheless, current research as well as clinical experience suggest that the major tranquilizers may mitigate chronic pain through different mechanisms than those used for tranquilization.
For a variety of biological and psychological reasons, tranquilizers are frequently abused; this should discourage their casual use. When employed cautiously and for limited periods of time, however, tranquilizers may be occasionally helpful in treating some forms of head pain.
Minor tranqualizers are not particularly useful for stopping an exsiting headache, although they may assist in sedating the victim during the discomfort and sometimes are used to control the anxiety that can trigger a headache. The major tranquilizers (see above) may be used in some instances to reverse an existing headache, as well as to control the nausea that often accompanies migraine.
During the past several years, there has been a growing concern about the indiscriminate use of tranquilizers, because of the many problems that have resulted from such widespread and often inappropriate use. While the authors of this book agree that these drugs do not necessarily have a place in the treatment of all patients experiencing stress or who have anxious moments in their life, it is likewise important to recognize that stress is a major health hazard. It is impossible to measure the negative influence of stress in our society, but many physicians believe that stress, through biological mechanisms, enhances the risk of serious illness, ranging from heart attack to cancer. While we are not suggesting that the use of minor tranquilizers may indeed alter these consequences, it must be said that if a patient benefits from appropriate doses and limited usage of a tranquilizer, then perhaps the patient should not be made to feel guilty or inferior. Not everyone can afford long-term psychotherapy to help alleviate stress or anxiety. While effective nonmedicinal intervention is always desirable, the temporary use of tranquilizing medication may be, at times, the compromise of choice. Patients need to be carefully instructed in the use of these medications in the proper way for specific reasons, and within an agreed upon time limit. Open and trusting communication between you and your doctor regarding the use of these medications, their limitations, and their hazards is essential.
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