Q. I've been titrating my dose of Prozac to a moderately high level. Although I am stable at my present dosage, I have, and continue to have fairly severe headaches; they are a low grade ache most of the day.

I've been taking Aspirin, Aleve, and presently on high Ibuprofen dosage---to no avail. What is a good treatment for these headaches and what causes them? Looking for a treatment that won't interact with the Prozac but provides relief. Both recommendations for an OTC and prescription remedy would be appreciated.

  A. I really am at a loss as to what is causing the headaches. If they predated the Prozac, higher dosages of Prozac may help. 80 mg was the dose where we began to see efficacy in our trials. If this is not effective, you might want to discuss another SRI, Effexor, or Serzone with your doctor.

If the headaches came about or worsened after the Prozac, it may be contributing to them. We do no know why, but this happens. If you stay on the Prozac, and the Prozac is causing the headaches, they sometimes goes away, and sometimes do not.

I am not a headache specialist, but other methods of treating headaches include Inderal LA (propranolol), Depakote (250 mg twice daily works for migraine prophylaxis), and low dose tricyclics. Discuss it with your doctor to determine the cause, and base your treatment on the cause. I know this is vague, but depending on what causes the headaches, the treatments usually are totally different.