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How to relieve bad headaches: The request could not be satisfied

Opioids and Migraine | American Headache Society

Opioids have utility in migraine treatment, but they are often overprescribed, which may be hurting patients. Stephen Silberstein, MD, FAHS says a lack of physician education is to blame

For certain groups of patients with migraine, like the elderly and pregnant women who often avoid triptans or nonsteroidal anti-inflammatory drugs (NSAIDs), opioid medications could potentially be used for occasional pain management. But in today’s treatment landscape where migraine-specific medications that target the source of a patient’s symptoms are effective and available, opioids continue to be prescribed at unnecessarily high rates, a practice that can have devastating effects on individuals, according to Stephen Silberstein, MD, FAAN, FACP, FAHS, director of the Headache Center at Jefferson University Hospital.

Migraine treatment in emergency departments

Opioids continue to be used in over 50 percent of emergency department migraine visits, according to a 2014 study published in Headache, even though medications that directly target migraine symptoms, like triptans, are also available, and may be more effective for many. Migraine patients are routinely prescribed OxyContin, Vicodin, Percocet and other opioid-based medications in an attempt to treat their headache pain, which some specialists say strays far from the best practices applied within the headache medicine field.

“The problem we have is that many physicians treat the symptoms, and not the disease,” Silberstein said. “So if you have a pain of any type, they’re treated with an opioid,” even though “evidence strongly suggests that opioids are not as effective as medicine like triptans.”

Opioids and migraine progression

The use of opioids in patients with migraine carries a high risk of medication overuse headache (MOH). Opioids can cause MOH when used more than ten times per month: if a high-frequency episodic or chronic migraine patient relies on opioids for pain relief, they can easily become dependent, leading to a complicated detoxification process that may aggravate their symptoms.

“Sometimes patients have to be admitted for detoxification,” Silberstein said. “Other times, they have to be slowly tapered off and carefully monitored, realizing that during the taper, their headaches could get worse.”

Routine use of opioids for migraine treatment often leads to more frequent and severe headaches, and detoxifying from opioid dependency isn’t always enough to undo that damage. For many patients, overuse of opioids can trigger the transition from episodic migraine to chronic migraine. That’s why it is crucial to ensure that both simple analgesics and triptans are contraindicated before considering prescribing an opioid medication. These acute medications treat the source of the pain, not just the pain itself, and are less likely to induce migraine progression.

“I think the problem we have with the opioid crisis is people looking at symptoms and not the disease,” Silberstein said. “Why are patients getting opioids? They’re getting opioids because pain became the vital sign, and people were treating the symptom and not the disease. We need to focus on what’s causing the pain, and treat that, not simply giving a palliative treatment for the pain.”

Opioids’ role in migraine treatment

The general criterion on opioid use for migraine is as a last resort. “I’m not saying opioids are always wrong and always evil,” Silberstein said, “But in patients that take opioid for the treatment of migraine, they frequently wind up with more frequent and more severe headaches, and the worst part is when you stop them, their headaches don’t always get better.”

Being proactive in your treatment regime can play a role in successful pain relief. Silberstein recommends patients develop an emergency department plan with their doctors so they are not given opioids unnecessarily or misjudged as “drug-seeking” and denied necessary care. A written note advising acute treatments like triptans or NSAIDs as the first line of defense can help bridge the communication gap between headache specialists and emergency department personnel.

“Good care gives good results,” Silberstein said. For many migraine patients, “opiates are a shortcut that results in bad care.”

Are there any circumstances where opioids should be used?

Evidence strongly suggests that opioids are not as effective as acute medications like triptans, but for certain patient groups they offer a necessary alternative option for pain relief. Patients with a history of cardiovascular disease are unable to take triptans or NSAIDs due to their side effects: for this reason, triptans and NSAIDs are contraindicated for the elderly due to their increased risk for cardiovascular disease. In those cases, opioids may be the only treatment option for relief from a severe headache.

Pregnant women who experience frequent migraine attacks will often abstain from acute medication during pregnancy, and may be prescribed opioids under the supervision of their physician to provide occasional symptom relief. Opioid use in pregnant women must be closely monitored, and infrequent, due to the risk of passing on an opioid dependency to their unborn child.

Stephen Silberstein, MD, FAHS is a member and past president of the American Headache Society, a professional society for doctors and other health care workers who specialize in studying and treating headache and migraine. The Society’s objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders, and to share and advance the work of its members. Learn more about the American Headache Society’s work and find out how you can become a member today.

 

Minen, M. T., Tanev, K. and Friedman, B. W. (2014), Evaluation and Treatment of Migraine in the Emergency Department: A Review. Headache: The Journal of Head and Face Pain, 54: 1131–1145. doi:10.1111/head.12399

Does Caffeine Trigger or Treat Headaches? • National Headache Foundation

24 Feb Does Caffeine Trigger or Treat Headaches?

Posted at 17:03h
in Headache Triggers
by headache

Caffeine is something that on average 90% of Americans enjoy, but it can also be a headache trigger or headache inhibitor. Caffeine is all around us,  and can be found in a number of beverages, chocolate and even in some popular over-the-counter and prescription pain relievers, but how is it affecting our heads?

The Buzz on Caffeine

Before a headache or migraine, blood vessels tend to enlarge, but caffeine has “vasoconstrictive” properties that cause the blood vessels to narrow and restrict blood flow, which can aid in head pain relief. When caffeine is added to the combination of acetaminophen and aspirin, the pain relieving effect is increased by 40%. If you feel a headache coming on, a cup of joe might lessen the severity of your symptoms.

On the other hand, though caffeine does not directly cause headache, too much of the substance can trigger “caffeine rebound.” A caffeine rebound headache occurs from withdrawals of caffeine after a sufferer continually consumes too much of it. Though the physical side effects can be severe, only 2% of the population suffers from caffeine rebound.

Although most headache sufferers can consume up to 200 mg. per day, the NHF advises patients with frequent headaches to avoid daily use. But this doesn’t mean you have to cut your caffeine off, try slowly decreasing your intake, and remember it’s always best to enjoy in moderation.

PRODUCT —MILLIGRAMS OF CAFFEINE (APPROXIMATE)

Coffee (5 oz. cup)

Drip, regular—106-164 mg Percolated, regular—93-134 mg Instant, regular—47-68 mg Decaffeinated—2-5 mg Espresso (1 oz. cup)—30-50 mg

Loose-leaf tea (imported, 5 oz. cup)

Black—25-110 mg

Oolong—12-55 mg

Green—8-36 mg

Tea (black tea assumed, 5 oz. cup)

Brewed, major U.S. brands

-1 minute brew—20-80 mg

-3 minute brew—21-33 mg

-5 minute brew—35-46 mg

Canned iced tea—39-50 mg

Iced tea (12 oz.)—67-76 mg

Instant tea—22-36 mg

Cocoa and chocolate

Cocoa beverage (mix, 6 oz. )—2-8 mg

Milk chocolate (1 oz.)—6 mg

Baking chocolate (1 oz.)—35 mg

Sweet chocolate (1 oz.)—20 mg

Ovaltine—0 mg

Postum—0 mg

Soft drinks

Mr. Pibb, diet (12 oz.)—57 mg

Mountain Dew (12 oz.)—54 mg

Coca-Cola, Diet Coke (12 oz.)—46 mg

Tab (12 oz.)—46 mg

Shasta Cola (12 oz.)—45 mg

Mr. Pibb (12 oz.)—44 mg

Dr. Pepper (12 oz.)—41 mg

Pepsi (12 oz.)—38 mg

Diet Pepsi (12 oz.)—36 mg

Diet Rite (12 oz.)—36 mg

Royal Crown Cola (12 oz.)—36 mg

Cragmont Cola—0 mg

7-Up—0 mg

Sprite—0 mg

Fanta—0 mg

Fresca—0 mg

Root beer—0 mg

Club soda—0 mg

Ginger ale—0 mg

Tonic water—0 mg

Orange soda—0 mg

Grape soda—0 mg

Sports/Energy drinks

AMP tall boy (16 oz.)—143 mg

Enviga (12 oz.)—100 mg

FIXX (20 oz.)—500 mg

Full Throttle (16 oz.)—144 mg

Full Throttle Fury (16 oz. )—144 mg

Monster Energy (16 oz.)—160 mg

No Name (formerly known as Cocaine) (8.4 oz.)—280 mg

Red Bull (8.3 oz.)—76 mg

Rockstar (16 oz.)—160 mg

SoBe Adrenaline Rush (16 oz.)—152 mg

SoBe No Fear (16 oz.)—174 mg

Vault (8 oz.)—47 mg

Food/Other products

Foosh energy mints (1 mint)—100 mg

Haagen-Dazs coffee ice cream (.5 cup)—30 mg

Hershey’s chocolate bar (1.55 oz.)—9 mg

Hershey’s special dark chocolate bar (1.45 oz.)—18 mg

Jolt caffeinated gum (1 stick)—33 mg

Non-prescription stimulants

Caffedrine capsules—200 mg

NoDoz tablets—200 mg

NoDoz maximum strength (1 tablet)—200 mg

Vivarian tablets—200 mg

Non-prescription pain relievers

Advil—0 mg

Anacin—32 mg

Bufferin—0 mg

Excedrin Migraine—65 mg

Excedrin Extra Strength (2 tablets)—130 mg

Midol—32 mg

Motrin—0 mg

Plain aspirin—0 mg

Tylenol—0 mg

Vanquish—33 mg

Diuretics

Aqua Ban—200 mg

Fluidex—0 mg

Permathene water off—200 mg

Pre-Mens Forte—100 mg

Cold Remedies

Actified—0 mg

Contac—0 mg

Comtrex—0 mg

Coryban-D. —30 mg

Dristan—16 mg

Neo-synephrine—15 mg

Sudafed—0 mg

Triaminicin—30 mg

Treating Migraines with Masturbation

New research in self-care suggests an unexpected way to ease headache pain

You might not look to your own hand for migraine relief, but research suggests, maybe you should; masturbation may be an effective treatment option for migraine sufferers. And while the news may shock some and make others blush, it is all very scientific.

At the University of Münster in Germany, Stefan Evers, MD, and colleagues performed the largest cohort study of its kind on this topic. The team sent a questionnaire to 600 unselected migraine patients to anonymously survey their experience with migraine pain intensity during sexual activity. Approximately 60% of the respondents who engaged in sexual activity during a migraine reported relief.

A professor of neurology and clinical neurophysiology and chair of the Headache Panel of the European Academy of Neurology, Dr. Evers discussed the study’s implications with Practical Pain Management. He believes that orgasm is a key factor in pain relief, due to the endorphins released during climax. It was unclear in his study whether sexual excitement leading up to orgasm had any positive effects on pain, but he did note that the movement of sex could worsen certain migraine symptoms such as sensitivity to touch and nausea. And while the neurologist does not routinely discuss his patients’ sex lives with them, if asked, he advises masturbation. Due to the nature of the survey-based study, biological imperatives for pain relief are unknown; Dr. Evers and his colleagues are careful to only speculate that the endorphins released during orgasm are the primary reason for the pain relief.

Meanwhile, at Rutgers University in New Jersey, researchers of a much smaller study have worked to demystify the relationship between orgasms and pain relief. Led by Nan Wise, PhD, a cognitive neuroscientist and psychology lecturer, researchers sought to explain why a woman’s pain tolerance could increase by up to 75% during orgasm. To find out, Dr. Wise turned to brain imaging.

A functional magnetic resonance imaging (fMRI) machine may not sound like the sexiest place to pleasure yourself, but that’s exactly what 10 women did while Dr. Nan Wise and colleagues at Rutgers monitored their brain activity. The images showed how orgasms engage an area of the brain called the dorsal raphe nucleus that releases serotonin, a powerful analgesic. Dr. Evers’ hypothesis wasn’t far off. While serotonin may act shorter than endorphins, they are both mechanisms of the reward system and function in similar directions.  In the Rutgers study, participants first orgasmed by self-stimulation and then from stimulation by a partner; both methods activated the dorsal raphe nucleus.

A region of the brain called the nucleus cuneiformis was also activated during orgasm. The nucleus cuneiformis is part of the brainstem thought to help control pain through thought. In essence, during climax, neurologists saw increased brain activity in regions promoting an analgesic reaction and a pain management response. This neurological activation could explain why participants in the Münster University study reported migraine relief during and after orgasm.

Perhaps the most promising news from these studies is the absence of side effects. For those who suffer from migraines, pain is only a fraction of the problem. In addition to symptoms such as light sensitivity and nausea, patients can experience years of troubleshooting treatments that may involve preventive and abortive pills, vitamins, botox or acupuncture, and more. And in some cases, they are left with Medication Overuse Headache, and feel more helpless. Masturbation, on the other hand, is fairly harmless. The only potential pitfall that Dr. Evers observed was what he called “the opposite phenomenon,” that is, headaches caused by sexual activity, also known as coital cephalalgia. Dr. Evers noted that, “this headache is different from migraines, is treated differently, and has nothing to do with the migraine attack.” Sexual headaches are more common in men, and are most typically short in duration. Migraine patients tend to experience this headache more often than other people, albeit it separately from a migraine attack.

As regards gender, while the majority of migraine sufferers are women, pleasure may be an optimal treatment for pain among both genders. Even though only a minority of respondents in the Münster study were men, the benefits were equally reported for both men and women. Orgasm releases many of the same chemicals in men as in women: endorphins, serotonin, and dopamine. Low dopamine levels often correspond with migraine symptoms, so the surge in this neurotransmitter further explains migraine relief post orgasm.  

So next time a migraine strikes, consider self-care via masturbation. Pleasuring yourself may turn out to be one of your greatest tools for pain relief.

Updated on: 05/08/18

6 Medications That Can Make a Migraine Worse

Nonprescription Treatment Options for Migraine

US Pharm. 2016;41(1):31-34.

Migraine headache is a common, debilitating condition affecting nearly 1 out of 7 Americans annually.1 This condition affects more women than men, and prevalence is highest during peak productive years, between the ages of 25 and 55 years.2 Migraine accounts for the majority of the 5 million headache visits to U.S. emergency departments annually.3 It has a major impact on quality of life; more than 90% of migraine sufferers find it difficult to work or function normally during an attack, accounting for more than 150 million missed worked days, with an annual cost to employers exceeding $14 billion.4,5 In addition, migraine headache is ranked as the sixth highest cause of disability worldwide.6

Pharmacists are in a unique position to help care for patients suffering from migraines. They are often the first healthcare professionals that patients will encounter when seeking relief for their migraine; as many as 57% of patients self-medicate with OTC products. 7 It is important for pharmacists to understand when and how to use OTC products for the management of migraines as well as when patients require referral to their healthcare provider.

Pathophysiology

We have come a long way in our understanding of migraine. Descriptions of headaches date back to roughly 3000 BC. At that time, it was thought that migraines were due to malevolent beings inside the head with treatments consisting of incantations and application of substances to the head to drive out these spirits and demons.8 Although we obviously know that this is no longer the case, the exact pathophysiology of migraine is still unclear. In the past century, there have been two theories that have dominated thought. In the 1940s, the vascular theory was introduced by Harold Wolff, MD. Migraine attacks were caused by the dilation of intracranial blood vessels, while the aura associated with migraines resulted from vasoconstriction of blood vessels. 9 However, there have been regional blood and imaging studies that do not support this theory in its entirety. The more accepted theory now is that migraines are caused by a neuronal dysfunction characterized by paroxysmal symptoms; migraine attacks are triggered by excessive neocortical cellular excitability.9

It is believed that migraine headaches are dependent upon activation and sensitization of the central trigeminal system.10 Migraine pain begins with the activation of trigeminal nerve fibers surrounding blood vessels.11 This activation triggers the release of vasoactive and proinflammatory neuropeptides, contributing to increased blood flow and plasma extravasation, eventually causing perivascular inflammation.11 It is this inflammation that sensitizes the trigeminal nerve cells to nonspecific stimuli, increasing pain perception. This trigeminal hyperexcitability, known as central sensitization, results in allodynia and the prolongation of a migraine attack. 12

The migraine aura is thought to be a result of neuronal excitation and suppression that spreads throughout the gray matter of the brain, also known as cortical spreading depression (CSD). This phenomenon can also activate the trigeminal nociception and trigger headache mechanisms.10 The idea of CSD is generally now accepted as the biological basis of most types of migraines.10 Migraine without aura may be due to the occurrence of CSD in areas of the brain where tissue polarization is not consciously perceived.10

Triggers

There are several triggers that have been identified that can increase a patient’s risk of experiencing a migraine. Triggers differ for everyone, and it is important for patients to understand what events or stimuli precipitate an attack. Triggers for migraine may be related to foods, environmental stimuli, and behavioral-psychological factors (TABLE 1).13

There appears to be a genetic component to migraines. If one parent suffers from migraines, there is a 40% chance that the child will also suffer. If both parents are afflicted, this chance increases to 90%.5


Clinical Presentation

Migraines are associated with varying symptoms and differ between individuals and attacks.13,14 Untreated migraines can last from 4 to 72 hours. Headache pain is usually described as moderate to severe, throbbing, unilateral, and retro-orbital in location. Patients may also experience nausea, vomiting, malaise, photophobia, phonophobia, irritability, and/or neck pain. In general, migraine headaches can be classified as migraine with aura and migraine without aura. About 25% of patients will experience aura. Auras can occur prior to or during a migraine attack and are most commonly visual, often characterized by flickering lights or loss of vision.13,14

Patient Assessment

A four-question algorithm has been developed to assist pharmacists when assessing a patient seeking treatment for headache15:

1. What percentage of your headaches prohibit you from performing your daily tasks and/or are accompanied by vomiting?

2. How many days per month are you completely headache free?

3. What are the symptoms of your attacks?

4. What OTC products have you tried in the past, and how have they worked?

If patients indicate that more than half of their headaches are disabling or that more than 20% of their migraines are accompanied by vomiting, they are poor candidates for OTC therapy and should be referred to their primary healthcare provider. A patient who spends fewer than 15 days a month head-ache free should also be referred.

OTC Treatments

Acetaminophen: Although not FDA approved for migraine treatment, acetaminophen has been shown to be effective for the treatment of mild-to-moderate migraines.16 Acetaminophen 1,000 mg was found to be highly effective in relieving pain, functional disability, photophobia, and phonophobia in patients with nonincapacitating migraine. 17 Patients should be advised not to exceed more than 4,000 mg in 24 hours due to risk of hepatotoxicity; however, this dose may be too much for certain patients, such as those who drink more than three alcoholic beverages per day and those on warfarin.18 Patients should also be alerted to the fact that various products contain acetaminophen and should not be used in combination.18

Aspirin: Aspirin is an agent that has anti-inflammatory properties and may be beneficial in migraine treatment. High-dose aspirin (900-1,000 mg) has been established as an effective treatment option for acute migraine.16,19 Aspirin should be used with caution in patients with a history of peptic ulcer disease and those taking warfarin. When used in high doses, the development of tinnitus may be indicative of aspirin overdose.20

Ibuprofen: Nonsteroidal anti-inflammatory drugs (NSAIDs) in general are a good starting point for acute migraines that are mild to moderate in severity, although they may be effective in patients with more severe migraines if they have experienced adequate relief in the past. 16 Several clinical studies have demonstrated the efficacy of ibuprofen in the management of migraine, with doses ranging from 200 to 1,200 mg.21-24 Both the 200- and 400-mg doses have been proven to provide clinical benefit 2 hours post administration. Various measures of pain relief and symptom improvement scores were utilized within these studies. Studies demonstrated a trend in improvement with increasing ibuprofen doses, but statistical significance was not achieved.

Ibuprofen is available in a variety of dosage forms and numerous brand names, one of which is FDA approved for the management of migraines, Advil Migraine (solubilized ibuprofen 200 mg capsules). Formulations that provide more rapid dissolution of the dosage form are associated with a faster onset of symptom relief.16 The short half-life of ibuprofen may require that multiple doses be used to prevent recurrence of symptoms.16 These products carry a risk of gastro-intestinal (GI) bleeding. Patients who are 60 years of age or older, have a history of stomach ulcers, are on anticoagulants, or drink more than three alcoholic beverages a day have an increased risk.

Combination Products: The first OTC product to gain FDA approval for the treatment of migraine was the combination of acetaminophen, aspirin, and caffeine (AAC), which is available as Excedrin Migraine (acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg). The combination of these agents has been shown to be more effective than any one of the components alone in comparable doses.25 In a landmark study comparing AAC (n = 602) to placebo (n = 618), 59% of the AAC-treated patients experienced adequate pain relief in 2 hours compared with 33% with placebo.26,27 A further analysis of 172 of these patients who had severe or incapacitating disability showed that 40% of the AAC users had mild or no pain at 2 hours versus 20% for placebo.27

The effectiveness of a combination AAC product was compared with ibuprofen and placebo in the treatment of migraine in over 1,500 patients who had similar demographic profiles, migraine histories, and baseline symptom profiles. 28 Patients were randomized to receive 2 tablet doses of each of the treatment regimens. Both active treatment regimens provided better relief in relieving pain and associated symptoms than placebo. However, the combination of AAC provided more rapid and superior pain relief compared with ibuprofen.

If patients use a combination product for their migraines, it is important to educate them about the caffeine content. There is as much caffeine in this product as there is in a cup of coffee; they should limit their caffeine intake while taking this product.

Conclusion

When confronted with a patient seeking advice for migraine pain, it is important for the pharmacist to adequately assess the patient to determine whether he or she is a candidate for self-treatment or in need of a referral. Both Advil Migraine and Excedrin Migraine received FDA approval for the treatment of migraines and are viable options. Other options, including acetaminophen and aspirin, do not have FDA approval for migraine but are considered effective for the management of mild-to-moderate migraines. Patients should take the product at the earliest signs of a migraine and to treat a minimum of three attacks. An agent is considered a therapeutic failure when the patient does not have relief in at least two of the three treated attacks. At this point, an alternate OTC agent should be tried or the patient should be referred to his or her healthcare provider.

It is very important to educate patients on the importance of limiting the use of OTC analgesics to no more than 2 days per week.29 Overuse of analgesics, including nonprescription products, can lead to medication overuse headache. If the headache worsens in severity or is not relieved with OTC agents, further evaluation is warranted.

PATIENT INFORMATION

What Can I Take for My Migraine?

 

Types

There are two major types of migraine headaches—migraine with aura and migraine without aura. The aura may start 20 minutes to 1 hour before the actual onset of symptoms. It can include seeing flashing lights/dots, tingling in the arm, or difficulty speaking.

Triggers

Many things can trigger a migraine, such as hormonal changes, certain foods or smells, hunger, and tension relief after stressful events. Keeping a headache diary can help you identify your triggers. Some food triggers may include chocolate, hard cheeses, red wine, or food and drinks that contain caffeine, gluten, nitrates, monosodium glutamate (MSG), or artificial sweeteners. Other common headache triggers include stress, skipping meals or not eating enough, too little or too much caffeine, over- or undersleeping, and drinking alcohol.

Treatment

Patients with a migraine often try to avoid lights, sounds, and smells due to increased sensitivity. Some people feel better if they lie down in a cool, dark, quiet room. Apply ice to decrease painuse an ice pack or put crushed ice in a plastic bag. Cover the ice pack with a towel, and place it on your head where it hurts for 15 to 20 minutes every hour.

Some people need to take medications to help relieve their symptoms. This can include OTC and prescription drugs.

OTC Pain Medications: Aspirin used alone or in combination with acetaminophen plus caffeine may help your headache pain. Anti-inflammatory drugs such as ibuprofen or naproxen can also be used. You may need to try several different products to see which ones work best for you. Your doctor will want you to use the least amount of medication to treat your migraines. Aspirin, ibuprofen, or naproxen should be taken with food to reduce the chance of stomach upset. Alcohol should be avoided while taking these medications. Read the label on the package to ensure you do not take too much medication in a 24-hour period.

Prescription Drugs: Your doctor may prescribe a triptan (e.g., sumatriptan [Imitrex]) for your migraines. Triptans work on the cause of the migraine. They usually help the other symptoms that come with the headache, too. Triptans can be very effective but are not right for everyone. If you have heart disease or severe high blood pressure, these medications should be avoided.

Prevention

To help prevent migraines in the future, you can refer to your diary. In it, write down every time you have a headache and what you ate and did before it started. That way you can find out if there is anything you should avoid eating or doing. Also note what medications you took for the migraine and whether or not they helped. You should bring your diary with you to the doctor’s office.

Remember, if you have questions, Consult Your Pharmacist.

REFERENCES

1. Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache J Head Face Pain. 2015;55(1):21-34.
2. Lipton RB, Stewart WF, Scher AI. Epidemiology and economic impact of migraine. Curr Med Res Opin. 2001;17(suppl 1):s4-s12.
3. Minen MT, Tanev K, Friedman BW. Evaluation and treatment of migraine in the emergency department: a review. Headache. 2014;54(7):1131-1145.
4. Goldberg LD. The cost of migraine and its treatment. Am J Manag Care. 2005;11(suppl 2):S62-S67.
5. Migraine Research Foundation. Migraine fact sheet. www.migraineresearchfoundation.org/fact-sheet.html. Accessed November 30, 2015.
6. Steiner TJ, Birbeck GL, Jensen RH, et al. Headache disorders are third cause of disability worldwide. J Headache Pain. 2015;16:58.
7. Lipton RB, Diamond S, Reed M, et al. Migraine diagnosis and treatment: results from the American Migraine Study II. Headache. 2001;41(7):638-645.
8. Villalón CM, Centurión D, Valdivia LF, et al. Migraine: pathophysiology, pharmacology, treatment and future trends. Curr Vasc Pharmacol. 2003;1(1):71-84.
9. Reddy DS. The pathophysiological and pharmacological basis of current drug treatment of migraine headache. Expert Rev Clin Pharmacol. 2013;6(3):271-288.
10. Pietrobon D, Moskowitz MA. Pathophysiology of migraine. Annu Rev Physiol. 2013;75(1):365-391.
11. Schürks M, Diener HC. Migraine, allodynia, and implications for treatment. Eur J Neurol. 2008;15(12):1279-1285.
12. Dodick D, Silberstein S. Central sensitization theory of migraine: clinical implications. Headache J Head Face Pain. 2006;46(suppl 4):S182-S191.
13. Ross LA, Ross BS. Chapter 35. Headache. In: Chisholm MA, Wells BG, Schwinghammer TL, et al, eds. Pharmacotherapy: Principles and Practice. 3rd ed. New York, NY: The McGraw-Hill Companies; 2013:621-632.
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15. Wenzel RG, Sarvis CA, Krause ML. Over-the-counter drugs for acute migraine attacks: literature review and recommendations. Pharmacotherapy. 2003;23(4):494-505.
16. Becker WJ. Acute migraine treatment in adults. Headache J Head Face Pain. 2015;55(6):778-793.
17. Lipton RB, Baggish JS, Stewart WF, et al. Efficacy and safety of acetaminophen in the treatment of migraine: results of a randomized, double-blind, placebo-controlled, population-based study. Arch Intern Med. 2000;160(22):3486-3492.
18. Tylenol. McNeil-PPC, Inc. www.tylenol.com/products/headache-muscle. Accessed November 30, 2015.
19. Ingledue VF, Mounsey A. PURLs: treating migraine: the case for aspirin. J Fam Pract. 2014;63(2):94-96.
20. Bayer safety coated aspirin. Comprehensive prescribing information. Morristown, NJ: Bayer Corporation. www.fda.gov/ohrms/dockets/ac/03/briefing/4012B1_03_Appd%201-Professional%20Labeling.pdf. Accessed November 30, 2015.
21. Nebe J, Heier M, Diener HC. Low-dose ibuprofen in self-medication of mild to moderate headache: a comparison with acetylsalicylic acid and placebo. Cephalalgia Int J Headache. 1995;15(6):531-535.
22. Kloster R, Nestvold K, Vilming ST. A double-blind study of ibuprofen versus placebo in the treatment of acute migraine attacks. Cephalalgia Int J Headache. 1992;12(3):169-171; discussion 128.
23. Codispoti JR, Prior MJ, Fu M, et al. Efficacy of nonprescription doses of ibuprofen for treating migraine headache. a randomized controlled trial. Headache. 2001;41(7):665-679.
24. Sandrini G, Franchini S, Lanfranchi S, et al. Effectiveness of ibuprofen-arginine in the treatment of acute migraine attacks. Int J Clin Pharmacol Res. 1998;18(3):145-150.
25. Diener HC, Pfaffenrath V, Pageler L, et al. The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Cephalalgia Int J Headache. 2005;25(10):776-787.
26. Lipton RB, Stewart WF, Ryan RE, et al. Efficacy and safety of acetaminophen, aspirin, and caffeine in alleviating migraine headache pain: three double-blind, randomized, placebo-controlled trials. Arch Neurol. 1998;55(2):210-217.
27. Goldstein J, Hoffman HD, Armellino JJ, et al. Treatment of severe, disabling migraine attacks in an over-the-counter population of migraine sufferers: results from three randomized, placebo-controlled studies of the combination of acetaminophen, aspirin, and caffeine. Cephalalgia Int J Headache. 1999;19(7):684-691.
28. Goldstein J, Silberstein SD, Saper JR, et al. Acetaminophen, aspirin, and caffeine in combination versus ibuprofen for acute migraine: results from a multicenter, double-blind, randomized, parallel-group, single-dose, placebo-controlled study. Headache. 2006;46(3):444-453.
29. Matchar DB, Young WB, Rosenberg JH, et al. Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting: Pharmacological Management of Acute Attacks. Minneapolis, MN: American Academy of Neurology; 2012. http://tools.aan.com/professionals/practice/pdfs/gl0087.pdf. Accessed November 30, 2015.

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How Chiropractors Can Help Relieve Headaches: McGowan Medical Centers: Chiropractors

Most people experience headache pain at some point in their lives. Headaches can range from a mild, dull ache, to severe, throbbing pain accompanied by nausea. The location of the headache and the kind of pain you’re feeling are a good indication of the type of headache you have.

Tension headaches are the most common type and appear as pain almost anywhere in the head, scalp, or neck. As tension headaches are often due to a combination of stress and back or neck strain, chiropractic care has been proven to help provide relief for these headaches.

Some people suffer from migraines — throbbing headaches that can cause debilitating pain, nausea, and sensitivity to the surrounding environment. Migraines are often chronic, and the pain can last anywhere from a few hours to a few days.

When you feel a headache developing, your first thought might be to take an over-the-counter pain reliever. But have you considered a more natural alternative to treat headache pain? Research shows that chiropractic care, without medication, can be an effective treatment for a variety of headaches.

Here at McGowan Medical Centers, Drs. McGowan and Dr. Jenkins are experts in applying chiropractic techniques to alleviate headache pain. We’ll work with you to understand the cause of your headaches and find a chiropractic routine that helps keep you pain free.

Chiropractic adjustments for headache pain

According to the American Chiropractic Association, spinal manipulation is an effective headache treatment option for many sufferers. Chiropractic adjustment can improve acute and chronic neck pain, which can reduce the number of headaches you’ll experience — whether you suffer from migraines, tension headaches, or something other kind.

Using targeted methodology, we adjust the alignment of your spine to improve spinal function and alleviate stress on the nervous system. This allows your body to function more normally and reduces risk of stress and tension building until headache pain develops.

Seeing one of our chiropractors can help counteract the stress you face in daily life. Whether you spend long hours driving or you work an office job, stress can manifest in many ways that lead to headache pain.

When you come to McGowan Medical Centers for your headaches, we can also give you tips on posture, exercises, and relaxation techniques. Evaluating all possible causes of your headache pain helps us address the pain more effectively.

Lifestyle modifications to help prevent headaches

Our team believes in a multifaceted approach to headache treatment, which includes understanding your triggers. We’ll work to understand your unique situation to help you find the root cause of your headaches.

Some common causes of headache pain are:

  • Stress
  • Long hours at a computer or looking at your phone
  • Certain foods
  • Your environment (noise, light, etc.)
  • Insomnia

When we determine that certain foods or environmental triggers seem to bring on your headaches, we can help you make small changes in your lifestyle to ward off these triggers.

Tension headaches can often be attributed to spending a long time in one position. Looking down at your phone or working at a computer can build muscle tension in your neck causing “tech neck” and making you more susceptible to headaches.

Prolonged periods in the same position can irritate joints and create muscle tension in your upper back as well. In addition to your recommended chiropractic care plan, our team often suggests that you take a break every 30-60 minutes to move around, change positions, and help ward off pain.

Overall, lifestyle tweaks paired with chiropractic adjustments can make a big difference to help relieve your chronic headache pain.

The next time you suffer from a headache, think twice about taking a pain reliever. Instead, call our office in Jacksonville, Florida, or request an appointment with our convenient online booking tool.

90,000 All severity of headache – EMC

Unfortunately, many people believe that a person who has a headache does not experience serious suffering – it’s just a little pain that probably happens to every person.
In some cases, headaches do not really cause serious distress, but they are often very intense (especially migraines). If a person has never experienced a severe headache, then he will not be able to objectively assess the degree of suffering of those who have migraine attacks or severe episodes of tension headache.In the same way, people who have only had bruises in their limbs will not be able to understand what a victim with a bone fracture feels like.

Unfortunately, many of those who suffer from headaches tend to trust the opinion of others, especially if this is the opinion of loved ones and people who are authoritative for them, rather than their own feelings. As a result, additional discomfort arises, since the person feels that he is exaggerating his own suffering.

Sometimes a headache isn’t just an excuse to take time off from work or spend the day in bed.


In many cases, headaches, especially migraines and cluster headaches, are really maladaptive. Migraines can be accompanied by nausea, vomiting, dizziness, visual impairment, and increased sensitivity to light and sound. If, while experiencing a migraine, the responsible employee continues to work, then very often the work he has done has to be redone, since during the attacks the concentration of attention is reduced and memory is impaired, as a result of which errors often occur.

Those who have experienced cluster headaches (more often men suffer from them) say that the pain is worse than with the worst torture. Sometimes people literally bang their heads against the wall to stop the torture. In addition, if a man or woman is under the pressure of the so-called social roles (“mother / father”, “businessman”, “superman”), then he / she may feel guilty for not being able to fully devote himself to work or parenting because of such a “trifle” as a headache. It is also widely believed that if a migraine or tension headache is diagnosed, one should simply accept this fact and learn to live with it, since no cure has yet been invented for this ailment.

In fact, there are a myriad of medicinal and non-medicinal therapies that can prevent or at least significantly alleviate headaches. Unfortunately, not all doctors are aware of the latest advances in headache treatment. Many doctors are still convinced that it is impossible to help such patients.Hence the lack of proper attention to the problem. “Calm down! You have nothing serious! I also often have a headache, all from stress,” – you can often hear the doctor’s conclusion.

Indeed, nothing can cure a man or woman if he / she is predisposed to headaches (although many people have spontaneous remissions with age, i.e. the disappearance of the headache). At the same time, there are many ways to reduce the frequency, duration and intensity of headaches, as well as reduce its consequences. None of the headache sufferers should resign themselves to the problem without a murmur! It is solvable, you just need to find a good doctor and, together with him, choose the right treatment.

In recent scientific studies, it has been shown that people with headaches have a significantly reduced quality of life. The negative impact of headache is not limited to the short period of the attack itself. People suffering from this ailment, to a greater extent than other chronic disorders (diabetes mellitus, arthritis, depression, back pain), have a reduced satisfaction with family, professional and social aspects of life.EMC neurologists are ready to help cope with headaches by finding out the cause of their occurrence and choosing the appropriate treatment.

There are contraindications. Read the instructions for ILT and consult with a specialist.

One of 7 ways to help relieve headaches

We all experience headaches from time to time. So how do you deal with it?

Naturally, it is very important to determine the causes of headache and not to self-medicate, but to consult a specialist. But if the pain in the head needs to be removed quickly, then you can use one of the tips given by the site bienhealth.com .

Quick Ways to Relieve Headaches:

1. Take an over-the-counter pain reliever. Most pain relievers take about 30 minutes to work, so the medication should be taken as soon as you feel the first signs of a headache.

2. Drink plenty of water . Dehydration can cause headaches, especially after vomiting or drinking a lot of alcohol.As soon as you feel pain approaching, drink a full glass of water, and then drink water often, but in small sips throughout the day. Gradually, the pain will subside.

It is also necessary to refrain from coffee, alcohol, sugary drinks – they also cause dehydration. Plain water is the best solution for headaches.

3. Find a quiet and dark place to rest. if possible, you should lie down and relax for at least half an hour. Close the curtains, turn off the lights, and focus on your breathing.

Take care of peace and quiet. In the event that you have to rest with other people, do not be lazy to explain to them that you have a headache, and ask them to leave you alone and not to disturb for a while.

Adjust the room temperature. Some people can only relax in a cool room, others prefer to relax under a large blanket and near a heater. When you go to rest, try several temperature settings to find the best one for you.
Try to avoid tension headache (stress-related headache). Make sure the bed or sofa is comfortable enough and your head is in a position that does not strain your neck muscles.

4. Use cold compresses. A soft and cold compress applied to the forehead helps the blood vessels to constrict, which will greatly relieve headaches. This technique is quite effective if the pain is concentrated in the temples or sinuses.
Dampen a cloth with cold water and place it on your forehead.Once the compress is warm, refrigerate it again.

Preparing the compressor e ss lasts e d e . Place wet compress in a plastic bag and place in freezer for 30 minutes. After that, put a compress on your forehead, the effect of such a compress will last for a longer time, especially since the plastic bag will save your skin from icy moisture.

5. Massage the scalp, neck and earlobes. Gentle massage will not only help distract yourself from pain, but also improve blood circulation and relieve tension.The easiest way is to gently press down on your temples with your fingers and massage slowly in a circular motion. However, you can use more advanced techniques:

Head massage. Take a shower and pamper yourself with a scalp massage, all you need to do is make the movements as if you were shampooing your hair. Alternatively, you can dab coconut or argan oil on your fingers and rub it into your scalp.

Take e two t e balls and put e in the sock. Lie on a flat surface, placing these two balls just below the base of the skull – on the occipital bone, relax. First of all, you may feel pressure on your sinuses or even a little discomfort, but these sensations will quickly pass. This method is especially effective for sinus headache (headache in the paranasal sinuses).

If possible, your loved ones can massage your neck and back. Just a few movements made by a loving person will bring the desired relaxation and stress relief.Particular attention should be paid to the back of the head.

Massaging the bridge of the nose is effective for sinus pain and migraine.

You can forcefully massage the biologically active points, which are located in the place where the bones of the thumb and index fingers meet (the second metacarpal bone). It is best if someone else helps you with the massage, so both hands can be massaged at the same time. However, if you do this on your own, then you need to massage the points alternately for 5 minutes each.

6. Enjoy sex. Love making not only relieves stress and normalizes blood pressure, it also stimulates the production of the hormone oxytocin, which in turn promotes the release of endorphins, the body’s natural pain relievers.

7. Practice relaxation techniques. All over the world, people use many tricks to avoid pain. When the headache reaches its climax, don’t worry about learning new techniques – just try not to leave your comfort zone.However, the following techniques can be used at almost any time:

  • Meditation.
  • Deep breathing.
  • Visualization.
  • Listening to binaural beats.

As a reminder, experts suggested how to quickly recognize the cause of morning headache and eliminate it.

Read also:

How to relieve migraine headache?

How to relieve migraine headache?

Headache is one of the most common complaints in the practice of a therapist and neuropathologist.Unfortunately, most people do not pay attention to headache that occurs sporadically, and the doctor is usually consulted only when the pain is particularly persistent or severe, or when the attacks become more frequent and stronger, or when the nature of the pain changes. If the pain is recurrent or chronic, then in most cases either migraine or psychogenic headache is detected.

Migraine is a disease in the form of recurrent, regular or episodic attacks of severe headache, often in one half of the head, not associated with blood pressure, muscle tension or cervical osteochondrosis.

How to relieve migraine headache?

The main symptoms of migraine are periodic attacks of intense throbbing headache. More often, a severe headache is felt in one side of the head. Other symptoms of migraine are dizziness, nausea, vomiting, poor tolerance to bright light, loud sounds, increased fatigue, lethargy, drowsiness. In addition, when diagnosed with migraine, symptoms may be supplemented by impaired vision and smell.

The main and most characteristic symptom of migraine is severe headache.From the point of view of traditional Chinese medicine, migraine headache occurs mainly due to nervous stress, depression, the need to solve difficult problems, as well as due to sudden fluctuations in the weather and lack of sleep. The hereditary factor is also of great importance.

Migraine headache usually affects one half of the head, but can spread to both halves, as well as one or both eyes, upper jaw and neck. A migraine attack usually lasts from several tens of minutes to several hours.

How to relieve migraine headache?

How to relieve a migraine headache:

There are several main points, with the next and correct pressing of which the headache decreases, and after 30 minutes it disappears completely. These points are located on the neck, shoulders, at the base of the skull, on the feet and on the bridge of the nose. The Chinese teaching says: any headaches are signals that speak not only of the physical poor state of the body, but of the spiritual and emotional problems of the individual.

Therefore, traditional Chinese medicine acupressure will help determine the real cause of frequent headaches.

To know how to relieve a headache, you must first identify the cause of the headache.

How to relieve migraine headache?

The main reasons may be as follows:

● Curvature of the spine. Headache occurs when the cervical vertebrae are fixed in the wrong position due to constant tension in the muscles of the back and neck.They can cause headaches by pinching the cervical nerve. In case of very severe pain, a doctor’s consultation is necessary. Any slight curvature of the spine and associated headaches can be relieved by applying pressure to the V10 point (tien chu). This point is located in the upper part of the neck on the muscles of the belt, about one centimeter on either side of the spinal column. You need to lie on your back. Press and hold the V10 points, easily supporting your neck muscles. Breathe deeply. Affect the points for 3 minutes.Then you should stretch your arms along the body, close your eyes, and lie down for five minutes in a relaxed state.

● Intestinal stagnation. In the front of the head, the headache is often accompanied by constipation. To relieve headaches in the front of the head and relieve constipation, use the G14 point, which is located between the index and thumbs. By acting for 2 minutes on the points of each of the hands, you can reduce and then relieve the headache. Abdominal massage also relieves headaches and constipation.When massaging the abdomen, you need to press on the acupressure points located in a circle, at a distance of 7.5 cm from the navel. Massage movements should be carried out following the hands of the clock.

● When the headache is associated with congestion of mucus in the sinuses. How to relieve a headache in this case? To relieve pain and clear the sinuses, you should massage point V2, then point E3, and then point F3 (tsuan-chu, ju-liao, and tai chun).

How to relieve migraine headache?

● Active points for relieving headaches

• Gate of consciousness (VB 20) feng chi

Point position: under the base of the skull in the grooves between the two vertical muscles of the neck.

Effects on the body: helps with arthritis, headaches (including migraines), dizziness, tension in the neck and pain in it, neuromotor disorders of coordination of movements, tension in the eyes and increased irritability.

• Wind lock (VG 16) feng fu

Point position: above the spine, in the recess below the base of the skull.

Effect on the body: relieves pain in the ears, eyes, nose and throat, helps with nervous disorders, headaches, dizziness and tension in the neck.

• Drilling bamboo (V 2) tsuan-chu

Point position: in the depressions at the junction of the nose bridge and the eyebrow line.

Effects on the body: relieves pain in the eyes, headaches, eye fatigue, helps with hay fever and pain in the nasal cavity.

• Point of the third eye (VG 24.5) yin-tan

Point position: directly between the eyebrows, in the depression at the junction of the nose bridge and the frontal bones.

Effect on the body: balances the work of the pituitary gland, helps with hay fever, headaches, indigestion, tension in the eyes, relieves pain in peptic ulcer disease.

• Facial beauty (E3) ju-liao

Point position: below on the cheekbone, on the line of the pupil.

Effects on the body: relieves pressure in the eyes and their fatigue, helps with a runny nose, blood congestion in the head, tension in the eyes and toothache.

• Entering the valley (GI 4) he-gu

Caution: Pregnant women are prohibited from using this point before childbirth. Exposure to the point can cause premature birth.

Position: On the bulge between the index and thumb, at the top of the muscle that protrudes when the thumb and index finger join.

Action: Relieves pain in the front of the head, toothache, shoulder pain and pain during childbirth.

• More onslaught (F 3) tai chun

Point position: the point is located on the top of the foot, in the cavity between the big and second toes.

Action: relieves pain in feet, headaches, helps with allergies, tension in the eyes, arthritis in a state of a hangover.

• Above tears (VB 41) tszu lin chi

Position: in the upper part of the foot, about 2. 5 cm above the depression between the fourth and fifth toes, between the bones.

Action: helps with headaches, relieves arthritis pain throughout the body, edema and sciatica, pain in the side.

It is not necessary to use all the points at once, you can select and work out one or two points. Impact on them will also bring significant relief.

90,000 Migraine and breastfeeding, headache during lactation: treatment by professionals

The period of breastfeeding begins after childbirth. At this time, the woman’s body is under serious stress, hormonal changes take place.This circumstance can both reduce migraines during breastfeeding and increase the number of attacks and their intensity. There are many more options for treating headaches and migraines while breastfeeding than during pregnancy. Some drugs are completely safe during lactation, such as paracetamol and ibuprofen. When taking these medications, you do not need to observe the specific feeding times. However, if you are taking any other pain relievers, it is best to take them immediately after feeding. Thus, ensuring their lowest concentration in milk by the time of the next feeding. If your migraine is hardly “mild,” then you don’t need to endure severe pain while breastfeeding. It can even be harmful! In this case, consultation with a headache specialist is necessary. Together with the doctor, you will select the optimal treatment. Even if you have to take drugs prohibited during lactation, there is a way out. For example, you will need to stock up on milk in advance when you are not on medication and use it on the day you are taking illicit drugs.

Treatment of migraine during lactation

The most common and optimal prescription for the treatment of migraine during lactation is:

  • Ibuprofen: 1 or 2 tablets (total dose 400-600 mg).
  • Paracetamol: 1 tablet, but not more than 6 tablets per day.
  • You can try taking a homeopathic medicine – Spigelon: 1 tablet 3 times a day up to 6 tablets in a migraine attack.

Aspirin and caffeinated preparations are not recommended. All ergotamine preparations are prohibited. The antiemetic drug metoclopramide (cerucal, raglan) should also not be taken.

Particular attention in the treatment of migraines and headaches, both during pregnancy and during breastfeeding, should be given to relaxation techniques such as: biofeedback therapy, light head and neck massage, acupuncture. An optimally selected complex of treatment will keep the headache and migraine under control.

triptans during pregnancy and breastfeeding

There is no final conclusion about the safety of taking triptans for migraine during breastfeeding (lactation).The instructions for use of triptans read: “Breastfeeding should be avoided for 24 hours after taking sumatriptan.” However, respected foreign sources already write about the absence of the effect of sumatriptan on the child, since it penetrates into milk in very small doses. For relpax, no new data has yet been accumulated, and the instructions for use recommend that you stop breastfeeding within 24 hours after taking the pill.