Stronger pain meds?

In my last post, I mentioned OTC pain killers not working for me. Katy and Jackie both mentioned "stronger" pain medication. Sounds like something to investigate, but I'm not sure what drugs belong in this category.

Can you guys give me some examples of what "stronger pain killers" I should ask my doctor about? Jackie mentioned T3's...which I assume means Tylenol 3 (with codeine)? I recall taking Tylenol 3's back in 1998 when my headaches started, but they had zero effect on me. What are the other options?

I also liked Katy's comment that chronic tension-type headache may well be as intense as transformed migraine. Since I've never experienced *migraine*, and its subsequent transformation into chronic daily headache (for the unfortunate ones), it's hard to say if what I feel is the same as what they feel. But from descriptions I've read of chronic daily headache that stems from migraine (and includes migraine episodes), it seems that I do experience a similar level of pain on a daily basis, fortunately without the migraine episodes.

All I know is my head aches badly. All the time.

Mine can go from moderate to severe over the course of a few minutes, and they're rarely "mild". Once or twice a month, I need to stay home in bed because they're so bad. Many other days a month, I function and work with a rather severe headache and wish I could be home in bed. My good fortune is that mine never evolve into full-on "migraine."

On another note, I have experienced migraine *auras*, but infrequently. On about 3 occasions over the past year or so, I've had visual auras in my right eye....holes in the field of vision, scintillating, zig-zagging lights, etc. They all passed within 20-30 minutes of starting and were replaced by a rather sharp pain over my right eye. But they never evolved into a migraine. On all occasions, I took ibuprofen (600mg or so) as soon as they started (as instructed by a fellow migraineur), so I may have curbed a migraine. But I really think I just don't have a migraine in me, thank God! They've had plenty of chances to come out! So I may just be someone who has chronic TTH and infrequent "aura without migraine". Yet another dimension to my headache personality.

I also frequently experience sharp pain over my right eye...again uncommon in TTH. But who knows?

It makes me wonder if a similar process is happening inside my head as in the heads of migraineurs. Some things are similar, but others aren't. I have intense muscle pain all the time in my neck and shoulders. Most migraineurs don't have this type of pain (although I've talked to people who have neck pain during a migraine episode, but not all the time).

There is great debate as to whether tension-type has the same modus operandi as migraine.

My neurologist thinks it doesn't.

He thinks that TTH stems from a muscular component outside the head which then manifests itself inside the head. This helps explain why Botox sometimes works to reduce headache by being injected in muscles of the neck and shoulders or why marcaine-like (muscle-freezing) medications may also work. The only problem is...they don't work all the time (and never for me). He believes the neck/shoulder muscle component drives the TTH. I often agree as Robax may work for me. And to answer Katy's question...Robax sometimes works to relax the muscles of my back and neck. With it, my headache subsides. The effect seems indirect (via the muscle relaxation). This also goes with the fact that if I sit improperly, pull a muscle in my back, work out with weights, or otherwise start "tightening up" my neck and shoulder muscles more than usual, I develop a killer headache. The muscles are triggering the headache. Or so it would seem.

But other neuro's think that TTH is just part of the spectrum of migraine. That it is the "same" mechanism, just a "lower level". This "lower level" insults me a little, but it's what they say, and I guess they are right if they mean a lower level than a full-blown migraine that sends you to the ER. In his book "Heal Your Headache," David Buchholz, a Johns Hopkins' neurologist, describes TTH as the same as migraine...but there is a line that gets crossed when you have full-blown migraine which isn't crossed with TTH. I seem to be hovering at or near this line, or often slightly above it, but not as far above it as during a *migraine*. All the same, just a different level.

Truly perplexing.

In the meantime, I'll have to investigate the stronger pain meds my fellow h/a sufferers are suggesting!