Patient Headache Resources

Appendices

General Information

When you’re ready to get pregnant …

Congratulations on your decision to have a baby. The best time to prepare for your pregnancy is before you become pregnant. This is the ideal time to make decisions about safer headache treatments.

The good news is that most women experience headache improvement with pregnancy:

• Headaches improve for about four in every five women by the third trimester.

• Headaches often don’t improve until the early second trimester.

• Even if your headaches improve, you may still continue to have some troublesome headaches that will need treatment.

• Safer and effective treatments are available when trying to get pregnant and after you have become pregnant.

Before you start trying to get pregnant, you should talk to your doctor about your headache treatment. You will need to:

• Learn safe and effective non-drug treatments that you can use to control headaches throughout your pregnancy and after delivery.

• Make sure the headache medications you are using are safe for you to take when trying to get pregnant and throughout pregnancy. This reduces risks to the baby if you become pregnant while taking the medications.

• Try to get your headache pattern under as good control as possible before becoming pregnant.

• Talk to your doctor before using any non-prescription medications and supplements to make sure they are safe during pregnancy.

Often, medication choices need to change with pregnancy to make sure you minimize risks to your baby.

Remember, there are many safer and effective non-drug and drug treatments for you to use throughout your pregnancy. Making treatment changes before you become pregnant is the best way to provide the safest treatments for your developing baby.

Now that you’re pregnant …

Congratulations on becoming pregnant!

As soon as you know that you’re pregnant, make an appointment to talk to your doctor about your headaches. You will need to learn:

• Safe and effective non-drug treatments to control your headaches;

• Which medications you can safely take for pain and nausea;

• Which medications you can safely take to prevent headaches if this becomes necessary;

• What to do if your headaches get worse.

Let your doctor know:

• What your current headache pattern is like;

• If there has been any recent change in your headaches;

• If you are having any other medical problems besides headaches;

• What over-the-counter medications you are taking;

• What supplements, vitamins, minerals, and herbs you are taking;

• What prescription medications you are taking and who prescribed them.

Know that you are not expected to suffer with your headaches during pregnancy. Headaches improve for four in every five women, so the odds are good that your headaches will get better.

General recommendations for pregnant patients who have headaches:

• Quit smoking.

• Eat regular meals and snacks—don’t skip meals, especially breakfast.

• Get a good night’s sleep every night.

• Learn effective relaxation techniques.

• Learn headache-relieving neck stretching exercises.

• Don’t use over-the-counter, herbal, or supplement remedies without first discussing them with your healthcare provider.

• Use safe and effective therapies to treat and relieve nausea.

• Develop a plan for treating severe headaches with your doctor. Make sure you know which treatments to try first.

• Talk to your doctor about prevention therapy if you are having frequent severe headaches.

Effectively treating your headaches will allow you to better enjoy your pregnancy.

Even if your headaches aren’t a problem during pregnancy, talk to your doctor about safer treatment options that can be used if you decide to breastfeed your baby. Most women experience a return of their previous headaches after delivery. Fortunately, breastfeeding often delays the return of headaches. There are more headache treatment options available when you’re breastfeeding compared to during pregnancy. Some medications should be avoided during breastfeeding. Work with your provider to develop a safe, effective treatment plan.

After you’ve delivered …

Congratulations on your new arrival! An exciting new chapter in your life has begun!

While four out of five women note improvement in their headache pattern by the third trimester, headaches usually return after delivery. Headaches may return after your baby is born because of changes in:

• Hormone levels;

• Your sleep pattern;

• Stress associated with the new arrival and changing routines.

All of these factors can contribute to the return of the headaches.

After your baby is born, your headaches can affect both you and your ability to interact with your baby—so there are now even more reasons to effectively control your headaches. Medications you use for your headaches can also affect the baby if you are nursing, so talk to your healthcare provider about which medications can be safely used when nursing. Fortunately, many effective headache treatments can be used while breastfeeding.

The decision to breastfeed your infant is an important one. There are many health benefits for the breastfed newborn, as well as the breastfeeding mother:

• Benefits for the baby from breastfeeding:

  • Ideal nutrition;

  • Gives baby important hormones and immune factors;

  • Reduces infant infections;

  • Promotes bonding with mom.

• Benefits for the mother from breastfeeding:

  • Delays return of headaches;

  • Helps improve needed weight loss after delivery;

  • Reduces the risk for developing breast and ovarian cancer;

  • Reduces the risk for developing rheumatoid arthritis;

  • Promotes bonding with baby.

If you decide to nurse your baby:

• Arrange an office visit with your healthcare provider soon after delivery to develop a safe, effective treatment plan.

• Review non-drug approaches to treat headaches.

• Keep track of your headaches using a headache diary.

• Learn how and when to safely store breast milk in case you need to supplement feedings.

• Talk to your provider about safe and effective contraceptive methods that can be used when breastfeeding.

Daily Headache Diary Name: ____________________________ First day of diary (Sunday) ____/____/_______

Day	Migraine Severity				Treatments
	None	Mild	Moderate	Severe	Medications	Non-medications
Sunday   Morning   Noon   Evening   Bedtime
Monday   Morning   Noon   Evening   Bedtime
Tuesday  Morning   Noon   Evening   Bedtime
Wednesday   Morning   Noon   Evening   Bedtime
Thursday   Morning   Noon   Evening   Bedtime
Friday   Morning   Noon   Evening   Bedtime
Saturday   Morning   Noon   Evening   Bedtime

1. Instructions: record headache severity every day, four times daily. Also record all treatment you used each day.

Headache Treatment

Now that I’m trying to get pregnant, what can I do when I get a headache?

Acute migraine medications are used to treat severe migraine episodes. Regularly using acute medications more than two days per week can worsen your headaches and result in medication overuse or rebound headaches. Let your doctor know if you are using or need to use acute medication more than two days per week.

When you get a migraine, remember the following principles:

• Start with non-drug treatments.

• Don’t take medication for mild headaches.

  • When you take a medication, use only medications recommended by your doctor and use the recommended dose.

• If nausea occurs with your migraine, ask your doctor for recommendations to treat and reduce nausea.

When you get a mild migraine:

• Apply heat or ice (whichever you find more soothing) for 20 minutes to your temples or neck.

• Begin relaxation techniques: deep breathing, imagery, or biofeedback.

• Use acupressure techniques (described in What non-drug treatments are effective for treating headaches ? handout).

• Include positive messages about good expectations.

• Do oscillatory movements (described in Headache-reducing exercises handout).

• Perform exercises that stretch your painful area. Be sure to stretch slowly, and only to the point of first feeling a stretching sensation.

• Use distraction techniques.

• Don’t give up—combining and repeating these techniques is usually helpful.

When you get a moderate migraine:

• Use those techniques for mild migraine.

• If non-drug treatments haven’t worked, use acetaminophen.

• Treat nausea with non-drug therapies and, if necessary, medications (See What can I do if I'm feeling nauseated during my pregnancy handout.)

When you get a severe migraine:

• Use the tools for mild plus moderate migraine.

• If acetaminophen and non-drug treatments haven’t worked, talk to your doctor about other treatments, such as benadryl, lidocaine nasal spray, or a mild narcotic.

• If possible, going to sleep can turn off a severe migraine.

Keep track of your headaches in diaries and bring completed diaries to your next visit to see how well your treatment is working. Mark when you get a headache, how bad it was on a 1–10 scale, whether you had significant nausea with it, and how well your treatments worked.

Do not use any additional over-the-counter, supplement, or prescription drugs without first talking with your healthcare provider.

What non-drug treatments are effective for treating headaches?

Non-drug acute headache treatments are designed to block pain messages by sending other signals through the nerves and spinal cord. It’s hard for your brain to focus on one thing when it’s bombarded with lots of other signals. Pain management techniques are designed to overload brain circuits, blocking transmission of migraine signals. This is similar to having difficulty balancing your checkbook when the television’s blaring, the phone is ringing, and toddlers are running through the house. When your brain is occupied with relaxation techniques, moving joints and muscles, or focusing on other activities, it’s harder for the brain to have enough excess capacity to also transmit pain messages.

Try to combine several of the following techniques together to maximize the headache relief benefit. Don’t be discouraged if these techniques don’t always work. Try to use them before your migraine becomes severe. You can also use these in conjunction with doctor-approved migraine medications.

• Apply heat or ice (whichever you find more soothing) for 20 minutes to your temples or neck.

• Begin relaxation techniques: deep breathing, imagery, or biofeedback. Ask your provider if he/she can recommend a local expert who specializes in teaching these techniques.

• Include positive messages about good expectations.

• Do oscillatory movements (described in Headache-reducing exercises handout).

• Perform exercises that stretch your painful area. Be sure to stretch slowly, and only to the point of first feeling a stretching sensation.

• Use distraction techniques.

• Try acupuncture.

• If other treatments aren’t helping, some people find their headache goes away after a nap. See if sleep can turn off your headache.

Relaxation and biofeedback

• Progressive muscle relaxation involves alternatively contracting and relaxing muscles throughout your body. Close your eyes and practice first tensing and then relaxing individual muscles in different parts of your body, starting at your feet and moving toward your neck and face. Hold the tension for 10–15 seconds, and then release it. Tense and release the muscles in your legs, then abdomen, then arms, then shoulders, then neck, then jaw, then eyes, then forehead. Focus on the sensations of the muscles when they are no longer tensed. When you are familiar with this exercise, you will begin to recognize when your muscles are abnormally tensed, even if you don’t feel “stressed.” For example, you may notice jaw and neck tension when sitting in traffic or waiting in a line at the store. Once you feel this tension, work to release it.

• Cue-controlled relaxation uses a combination of deep breathing and repetition of the word “relax.” Begin this exercise with a slow, deep, abdominal breath. Place your hand over your abdomen to ensure that it is moving in and out with each breath. After inhaling, hold for 5–10 seconds, then exhale, slowly repeating the word “relax.” Repeat. After you are comfortable with this technique, you should be able to close your eyes and take a deep breath as above before confronting stressful situations, like a doctor’s visit, meeting with the boss, or discussion with your spouse. This will relax your system to reduce the impact of the stressful situations on your pain-provoking physiology and headaches.

Cognitive restructuring

• Replace negative, catastrophic thinking with positive, helpful messages:

  • Instead of thinking, “My day is ruined now,” tell yourself, “This migraine will become more manageable soon.”

  • Instead of, “Nothing ever gets rid of my migraine,” tell yourself, “If I use my acute migraine treatments, the pain will improve soon.”

  • Instead of, “Life’s not fair. Why me?” remind yourself, “I have good tools to help control my migraine.”

Distraction

• Many people suggest lying down in a quiet room when a migraine starts. While this may be necessary when the pain is very severe, you want to try to distract your brain by increasing pleasant stimulation when a migraine starts. When your migraine is still mild-to-moderate, try going for a walk outside, singing to the radio, taking a bike ride, hitting a few golf balls in the backyard, tossing the ball to your dog, or some other pleasurable activity. Avoid activities that are frustrating, require substantial mental exertion, or don’t require active engagement (like television viewing).

Heat, ice, and neck stretches

• Apply heat or ice (whichever you find more soothing) for 20 minutes to the neck and shoulders.

• Positional distraction: Place a 1- to 2-inch high stack of books on the floor. Lie on the floor, with the back of your head resting on the books. The edge of the books should be near the middle of your head, so that your neck is free. Relax so that your head moves up from your neck.

• Trigger point compression: You may notice certain spots on your neck muscles that aggravate your pain when you press them. These are called trigger points. Apply pressure to any trigger points with your fingers and hold for 12–60 seconds. Release the pressure, and proceed with your usual stretching exercises. Some physical therapists recommend a Theracane (www.theracane.com) to help apply pressure to hard-to-reach trigger points.

• Oscillatory movements: perform slow, gentle, rhythmic, side-to-side movements of the neck. Face forward and turn your head 1–2 inches, turning away from the painful side. Return to facing forward. Repeat at a rate of about one turn per second, for a total of 30 seconds. Rest for 30 seconds; then repeat until no further relief is noted. Now turn your head toward the painful side and back, as above.

• Perform neck stretches (described in Headache-reducing exercises handout).

Acupressure

• Find a depression in the middle of your neck between the neck muscles and move up within this depression to where the neck meets the skull. Rub the area where the neck muscles attach to the skull firmly for 2–3 minutes with deep circular movements.

• Find a depression at each temple, immediately behind your eyebrows. Rub firmly and deeply for 1 minute.

• Find a depression between your eyebrows. Rub firmly and deeply for 1 minute.

• Find the muscle that lies in the web between your thumb and index finger by compressing this area with the thumb and index finger from your other hand. Deeply and firmly make circular motions over this area for 5 minutes. Repeat with your other hand.

Sleep

• Going to bed with a migraine should be reserved for severe episodes associated with nausea that prevents physical activity.

• Sleep can effectively shut off serotonin-activated pain pathways. Some people find a 1-hour nap effectively relieves their migraine. Unless your headache is severe, avoid bed unless you also experience fairly prompt headache relief from brief sleep.

Practicing relaxation techniques

Relaxation techniques are very effective for controlling chronic headaches. These techniques have been shown to be very effective during pregnancy and while nursing. Interestingly, headache reduction from relaxation techniques is just as good as that from typical headache medications. The good news is you don’t have to worry about medication exposure with relaxation.

You may be planning to learn breathing techniques, like Lamaze, to help control your pain when your baby is delivered. You will learn these skills months before you will actually use them to control pain at the time of delivery. No one can learn these techniques once they’re in the middle of having contractions. Similarly, you have to first practice headache-relieving relaxation techniques when you don’t have a bad headache. You should practice these skills several times daily until you feel you have developed a good ability to achieve a relaxed state. Then you can use them effectively to help control headache pain when a headache first begins.

Relaxation techniques work by getting your brain to turn on pain-relieving centers. Relaxation techniques release the same brain chemicals that control headaches when you take headache medications. This is why these techniques are so helpful. So it’s not a matter of “chilling out” or “letting things roll off of your back.” Relaxation techniques are really a way to tap into your body’s natural pain-relieving pathways.

Tips for performing relaxation techniques

• Relaxation techniques should be learned while sitting in a comfortable chair, with arms and legs uncrossed, feet flat on the floor, and eyes closed.

• Each practice session should last for about 15–20 uninterrupted minutes.

• Once you have regularly practiced and mastered these techniques, you will be able to use them whenever you feel yourself starting to tense or in anticipation of stress.

• Several effective techniques are progressive muscle relaxation, cue-controlled relaxation, and thermal biofeedback. Each is described below.

Progressive muscle relaxation

Progressive muscle relaxation involves alternately contracting and relaxing muscles throughout your body.

• Close your eyes and practice first tensing and then relaxing individual muscles in different parts of your body, starting at your feet and moving toward your neck and face.

• Hold the tension for 10–15 seconds, and then release it.

• Tense and release the muscles in your legs, then abdomen, then arms, then shoulders, then neck, then jaw, then eyes, then forehead.

• Focus on how the muscles feel when they are no longer tensed.

• When you are familiar with this exercise, you will begin to recognize when your muscles are unusually tense, even if you don’t feel “stressed.” For example, you may notice jaw and neck tightness when sitting in traffic or waiting in a line at the store. Once you feel this tightness, work to relax it as you do during your quiet training sessions.

Cue-controlled relaxation

Cue-controlled relaxation uses a combination of deep breathing and repetition of the word “relax.”

• Begin this exercise with a slow, deep, abdominal breath.

• Place your hand over your abdomen to make sure that it is moving in and out with each breath. After breathing in, hold your breath for 5–10 seconds, then breathe out, slowly repeating the word “relax.” Repeat.

• After you are comfortable with this method, you should be able to close your eyes and take a deep breath as above before dealing with stressful situations, like a doctor’s visit, a meeting with the boss, or a discussion with your spouse. This will relax your system and reduce the effect of the stressful situation on your pain-provoking mechanisms and headaches.

Thermal biofeedback

Place a handheld thermometer on your finger and measure the temperature.

• Focus on raising your finger temperature by 2–3 degrees Fahrenheit (probably to about 96 degrees) while practicing relaxation techniques.

• Some people find that it’s difficult to “feel” relaxed. Using biofeedback can help show you when you are getting relaxed. If you are turning on and turning off the right pathways in your brain and nervous system, this will result in a feeling of calm, higher skin temperatures, and, most importantly, the blocking of pain messages.

• An inexpensive finger thermometer and biofeedback audiotape may be obtained from Primary Care Network (1-800-769-7565).

Stress management

Stress is consistently reported as the #1 trigger for both migraine and tension-type headaches, acting as a trigger for about 75% of headache sufferers. Remember that everyone experiences stress symptoms, with our bodies reacting in different ways to stress. Some people become loud and boisterous, others quiet and reserved. Other people experience chest pain, rapid breathing, stomach aches, or diarrhea. Typically, people notice that stress causes their usual health symptoms to be aggravated. Stress can cause people with heart disease to experience chest pain, people with Parkinson’s disease more tremors, people with epilepsy a higher risk of seizures, and headache sufferers headaches.

Stress management does not mean ignoring or eliminating stressful situations from our lives. Indeed, every life is full of stresses related to school, work, family, health issues, etc. In fact, driving to your doctor’s office may be stressful because of traffic and concerns about making it to the appointment on time. Your doctor would not suggest that you “eliminate” the stress of your appointment. And no one could imagine that having a new baby in the house won’t be stressful!

While it is not usually possible to change whatever is producing the stress response, we can change our response to the stress. Stress management teaches your body to react to stresses in different ways that do not result in the release of pain-provoking chemicals and tightening muscles. So, when you’re stuck in aggravating city traffic on your way to your appointment, instead of experiencing a flare in temper, clenching your teeth, and tightening the muscles in your neck, you can repeat soothing thoughts (“I will make my appointment. I am a responsible person.”) or listen to music, while practicing relaxation techniques (such as slow, deep breathing). These same strategies can be used before attending a meeting with one’s boss or a child’s teacher, before beginning a discussion about family issues with your spouse or child, or when waiting in a long line at the grocery store.

Try these stress management techniques:

• Learn good time management: schedule a reasonable amount of activities, chores, or goals for each day. Overloading your schedule will inevitably result in a stress response.

  • Write down which activities must be completed each day, and delegate chores among members of your household.

  • Accept that life won’t be perfect. It’s more important to have a relaxed home than a spotless house.

  • Don’t be afraid to say no. You can’t volunteer for every worthwhile cause and your kids don’t need to participate in every possible after-school activity. Prioritize what’s important for you and your family.

  • Schedule down time every day for reading, reflection, or a fun family activity.

• Identify your stress buttons. Learn what events typically make you feel stressed. You might be stressed after meeting with your boss, helping with a school project, or talking with your mother-in-law.

  • Anticipate when your stress buttons will be pushed, and practice relaxation techniques beforehand.

  • Stretch muscles when they first become tense.

  • Provide positive encouraging messages to yourself before the beginning of a stressful activity to reduce your stress response.

• Practice daily stress-busting:

  • Recognize and accept stressful events you can’t control (e.g., the weather or other people’s attitudes and behavior).

  • Plan for stress by recognizing when stressful events are likely to occur.

  • Practice relaxation techniques and cognitive restructuring.

  • Ask for help from others—you don’t have to do everything yourself!

  • Do aerobic exercise every day.

  • Consider learning and practicing yoga, Tai Chi, and/or mindfulness meditation.

  • Eat regularly.

  • Get plenty of sleep.

  • Sing and find humor in your day.

Most people notice stress symptoms when they come upon new environments and situations. Take time to spot situations that are usually stress-provoking for you. When you feel your jaw or hands clench or notice you are beginning to sweat before certain situations, make a mental note that these events are stressful for you. For some people, events like taking a test in school or giving a speech or a business presentation may be where they feel stress. For others, minor events, like making a phone call, driving in traffic, or meeting a school teacher may be stress-provoking. Understanding your body’s response to stress lets you understand how and when to best use relaxation techniques and stress management.

Headache-reducing exercises

Helpful exercises for headache typically include both aerobic and stretching exercises.

Aerobic exercise

In general, low–impact physical activity and exercise should be maintained during uncomplicated pregnancies. Aerobic exercises are typically performed daily, beginning at a low level, then increasing as tolerated. Walking, swimming, and bicycling are all good aerobic exercises. A walking program often begins at about 1/8 to ¼ mile per day, increased by 1/8 to ¼ mile each week until achieving a target of 1–2 miles per day. You should always discuss plans for any exercise program with your obstetrician. In general, low–impact activities performed routinely before pregnancy can be continued.

Stretching exercises

Stretching exercises should be relaxing. They should be done daily, with each session lasting about 25 minutes. Stretches should result in a normal sensation of stretching, but not pain. Hold the stretch for 5 seconds, relax for 5–10 seconds, and then repeat each stretch about 3–5 times.

Several specific exercises are described below. You may perform several repetitions of each exercise during every exercise session, or vary stretches between exercise sessions.

• Neck range of motion: bend your chin to your chest, then rotate chin to each shoulder, then tip your ear toward your shoulder, then pull in your chin to make a double chin.

• Shoulder shrugs: sit/stand up straight and raise your shoulders straight up. Lower and relax. Then raise shoulders up and forward. Lower and relax. Then raise shoulders up and back.

• Suboccipital range of motion: place a rolled or folded towel behind your neck and gently pull down. Tilt your chin to your chest. Look up at the ceiling. Tilt your ear toward your shoulder.

• Neck stretches: tilt your ear to the shoulder on the same side. Then tilt your chin forward and toward the opposite breast. Gently press with your hand at the end of the stretch to feel the stretch.

• Neck isometrics: place your palm on your forehead and press your head against it, keeping your palm stationary. Don’t let your head or hand move. Repeat with your hand on each side of your head.

• Head lift: place folded hands behind your neck at the base of your head. Pull elbows forward and up to achieve the sensation of lifting the head up slightly from the neck.

• Turtle: with head looking forward, push the chin forward, away from the neck. When the head is forward, turn about 1 inch to each side and up.

Schedule twice-daily stretching sessions, each lasting about 15 minutes. Stretching in the morning and before bed can help relieve stress before starting the day and aid with relaxation before sleep. Alternatively, you might include stretching exercises when watching your favorite daily television programs.

The stretching exercises that are particularly soothing for you can also be performed when you feel the beginning of a headache or muscle tension throughout the day. Many stretching exercises can be performed while standing or sitting and can act as stress-releasers when sitting in a long meeting or in the car, waiting in line at the store, or standing in the shower.

Acute headache relief techniques

Acute headache relief techniques can be used when a headache has already occurred, to help minimize pain. These may be used in conjunction with applying heat or ice (whichever you find more soothing) for 20 minutes to the neck and shoulders.

Three helpful techniques are described below:

• Oscillatory movements: small, rhythmic, side-to-side head movements, turning the head through about 25% of its full range of motion. Starting with your head facing forward, first turn your head away from the painful side and back. Repeat at a rate of about 1 per second, for a total of 30 seconds. Rest for 30 seconds; then repeat until no further relief is noted. Then switch to turning the head toward the painful side, and proceed as above.

• Positional distraction: Place books on the floor in a stack that is about 1–2 inches high. Lie down on the floor, with the back of your head resting on the books. The edge of the books should be near the middle of your head, so that your neck is free. Relax so that your head moves up from your neck.

• Trigger-point compression: during a headache, you may notice certain spots on your muscles that aggravate the head pain when you press them. These are called trigger points. If you identify trigger points, apply pressure to them with your fingers and hold for 12–60 seconds. Release the pressure, and proceed with your usual stretching exercises.

Nausea Treatment

What can I do if I’m feeling nauseated during my pregnancy?

• Fluids will be better tolerated if they are cold, clear, and carbonated, and consumed in small amounts between meals. Options include ginger ale or lemon-lime soda, clear broth, juice diluted with water, gelatin, electrolyte drinks (e.g., Gatorade and Pedialyte), and popsicles.

• When nausea has improved, move on to the “BRAT” diet: Bananas, Rice, Applesauce, and Toast. Eat only small portions.

• Choose salty over sweet foods.

• Avoid hot, spicy, fried, greasy, or high-fat food.

• If food odors make you nauseated, use prepared or frozen foods or let someone else do the cooking. Another trick is to use a nose clip to minimize the odors.

• Eat in a cool, well-ventilated room, away from where the food was prepared.

• Eat slowly.

• Supplements containing iron can increase nausea and may need to be temporarily reduced.

• An empty stomach may aggravate nausea, so eat snacks frequently and as soon as you feel hungry.

• Keep dry crackers by your bedside. Eat a few crackers in the morning before rising and then sit upright in bed for a few minutes before getting up. This will often minimize the feeling of nausea that occurs with an empty stomach.

Additional Headache Resources

Where can I find reliable online information about migraine and other headaches?

Some of the best sites for getting reliable and up-to-date information on migraine and other headaches are managed by national headache foundations:

• American Council for Headache Education at http://www.achenet.org

• American Headache Society at http://www.ahsnet.org/resources/patient.php

• National Headache Foundation at http://www.headaches.org

These sites provide information on testing, diaries, diets, and treatment, as well as specialized topics like migraines in kids, pregnant women, and people with fibromyalgia.

The following sites provide specific information about the safety of medications during pregnancy and breastfeeding:

• The Hospital for Sick Children of the University of Toronto at http://www.motherisk.com

• King’s College London at http://www.safefetus.com/

• Thomas W. Hale, RPh, PhD, Professor of Pediatrics at Texas Tech University at http://neonatal.ttuhsc.edu/lact/

Where can I learn more about managing headaches?

There are many excellent books that describe effective ways to manage your headache. You may wish to take advantage of information in some of the books listed below:

• • General information

  • – Bernstein C, McArdle E. 2008. The migraine brain. Your breakthrough guide to fewer headaches, better health. Glencoe, IL: Free Press.

  • – Foster CA. 2007. Migraine. Your questions answered. New York, NY: DK Publishing.

  • – Roberts T. 2005. Living well with migraine disease and headaches: You’re your doctor doesn’t tell you … that you need to know. New York, NY: Harper Collins.

  • – Kenefick K. 2006. Migraines be gone: 7 simple steps to eliminating your migraines forever. Crestone, CO: Roots and Wings Publishing.

  • – Marcus DA. 2006. 10 simple solutions to migraine. Oakland, CA: New Harbinger.

  • – Blumenthal M, Brinckmann J, Wollschlaeger B. 2003. The ABC clinical guide to herbs. New York, NY: Thieme.

• • Safety of medications and supplements during pregnancy and nursing

  • – Briggs GG, Freeman RK, Yaffe SJ. 2008. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk, 8 ^th edition. Portland, OR: Lippincott Williams & Wilkins.

  • – Hale TW. 2008. Medications and mothers’ milk: a manual of lactational pharmacology. Amarillo, TX: Pharmasoft Medical Publishing.

  • – Humphrey S. 2003. The nursing mother’s herbal. Fairview Press.

  • – Rubin SH. 2008. The ABCs of breastfeeding: everything a mom needs to know for a happy nursing experience. New York, NY: AMACOM.

• • Guides to learning non-drug treatments

  • – Davis M, Eshelman ER, McKay M. 2000. The relaxation & stress reduction workbook. Oakland, CA: Raincoast Books.

  • – Delaune V. 2008. Trigger point therapy for headaches & migraines: your self-treatment workbook for pain relief. Oakland, CA: Raincoast Books.

  • – Rossman M. Headache relief: guided imagery exercises to soothe, relax and heal (guided self-healing practices). Sounds True, 2004. [Audio CD]

  • – Sharpe M. 2001. The migraine cookbook: more than 100 healthy and delicious recipes for migraine sufferers. New York, NY: Marlowe & Co.

  • – Magee E. 2005. Tell me what to eat if I have headaches and migraine. Franklin Lakes, NJ: The Career Press.

  • – Van Houten P. 2003. Yoga therapy for headache relief. Nevada City, CA: Crystal Clarity Publishers.

• • Helping your child with headaches

  • – Zeltzer LK, Schlank CB. 2005. Conquering your child’s chronic pain: a pediatrician’s guide for reclaiming a normal childhood. New York, NY: HarperCollins.

  • – Diamond S, Diamond A. 2001. Headache and your child: the complete guide to understanding and treating migraine and other headaches in children and adolescents. New York, NY: Fireside.

  • – Culbert T, Kajander R. 2007. Be the boss of your pain: self-care for kids. Minneapolis, MN: Free Spirit Publishing.

  • – Ricker J. 2006. The headache detective: mom, my head hurts. Massillon, OH: Thomas and Clayton Publishing.