Pain scale and treatment

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Posted by Don Pearson ( on February 09, 2000 at 11:17:50:

I found this site last week and posted that I had been free for two years. The night before I had a very mild headache I hoped was not CH. It was, and they are getting worse each day.

I have looked at the Kip scale and thought other people might be interested in the scale I have used in recording my headaches. The scale my headache clinic suggested was simply - mild, moderate severe - I wanted something more extensive and measurable. Comparison with Kip is not easy but I could not sleep with anything above A)

A) very mild, no treatment necessary

B) no treatment other than oxygen and lying down

C) eye running, nose blocked, sweating - severe pain

D) eye almost closed, profuse sweating (irrespective of temperature), involuntary hyperventilation even on oxygen

E) unendurable pain, teeth ache, unable to supress groaning, think I might be dying, hope I am

I have recorded all my headaches since 1991, recording:
the date, time, duration and severity of each headache
remedial action e.g. oxygen, ergotamine, imigran
dates and doses of preventitive medicines, e.g. prednisolone, methysergide, verapamil

As far as helping with the headaches themselves, my first line treatment has been oxygen. At 4 litres per minute (7 is the ideal, but not possible with the regulators our National Health Service provides) it would often abort the headache and usually avert the worst, provided that I was able to use it AT THE FIRST SIGN OF THE HEADACHE. They come on so quickly that 5 - 10 minutes delay is too long. O2 has the advantage that you can use it all the time. A cylinder (1400 litres?) would last 3 - 10 days and I was prescribed two at a time. For any headache B) or above I would use it throughout - setting an alarm for every 20 minutes to avoid wastage when I fell asleep as the headache passed.

The second line of attack is ergotamine - tablets take too long - you need an inhaler. You will need 2-3 puffs and you are are limited to 6 puffs a day, 15 in a week, Again, most of the time I have used it, it has worked . Used for C)/D) headaches only.

The third line is sumatriptan (Imigran is the trade name in UK). This needs to be injected, again the tablets are too slow. I have only been prescribed two at a time- so I have kept them for the very worst headaches. I have been frightened that they would cease to become effective if over-used and that, if used on headaches which are just awful, I might not have any for the killer.
Some people do not like the idea of injecting themselves but
a) Imigran comes with a spring-loaded "pen" which makes it easy.
b) When you get a very bad one, not liking the idea of injecting is not going to be an issue.

My experience was that nothing worked all the time, no painkillers have any effect at all, but that the above strategy helped me cope with headaches whose intensity varied from bad to ........ If I had to choose one of the above it would be oxygen. The occasions when I did not have it handy showed me how effective it was at keeping the killers at bay - without it they were all C) and up.

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