Maxalt Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

Rizatriptan is used to treat migraines. It helps to relieve headache, pain, and other migraine symptoms (including nausea, vomiting, sensitivity to light/sound). Prompt treatment helps you return to your normal routine and may decrease your need for other pain medications. Rizatriptan belongs to a class of drugs known as triptans. It affects a certain natural substance (serotonin) that causes narrowing of blood vessels in the brain. It may also relieve pain by affecting certain nerves in the brain.Rizatriptan does not prevent future migraines or lessen how often you get migraine attacks.

How to use Maxalt

Read the Patient Information Leaflet if available from your pharmacist before you start taking rizatriptan and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, at the first sign of a migraine. It may be taken with or without food, but may work faster when it is taken on an empty stomach. The dosage is based on your medical condition, age, response to treatment, and other drugs you may be taking. For children, the dosage is also based on weight. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

If there is no improvement in your symptoms, do not take more doses of this medication before talking to your doctor. If your symptoms are only partly relieved, or if your headache comes back, adults may take another dose at least 2 hours after the first dose. Children should not take more than one dose, or 5 milligrams in a 24-hour period. For adults, the US manufacturer recommends a maximum dose of 30 milligrams in a 24-hour period. The Canadian manufacturer recommends a maximum dose of 20 milligrams (for adults) in a 24-hour period.

If you have a higher risk for heart problems (see Precautions), your doctor may perform a heart exam before you start taking rizatriptan. He/she may also direct you to take your first dose of this medication in the office/clinic to monitor for serious side effects (such as chest pain). Talk to your doctor for details.

If you are using drugs for migraine attacks on 10 or more days each month, the drugs may actually make your headaches worse (medication overuse headache). Do not use medications more often or for longer than directed. Tell your doctor if you need to use this medication more often, or if the medication is not working as well, or if your headaches get worse.

Side Effects

Flushing, feelings of tingling/numbness/prickling/heat, tiredness, weakness, drowsiness, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if you have any serious side effects, including: blue fingers/toes/nails, cold hands/feet, hearing changes, mental/mood changes.

Rizatriptan can commonly cause chest/jaw/neck tightness, pain, or pressure that is usually not serious. However, these side effects are like symptoms of a heart attack, which may include chest/jaw/left arm pain, shortness of breath, or unusual sweating. Get medical help right away if these or other serious side effects occur, including: fast/irregular heartbeat, fainting, severe stomach/abdominal pain, bloody diarrhea, signs of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion).

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before using rizatriptan, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (for example, in your legs, arms/hands, or stomach), certain types of headaches (hemiplegic or basilar migraine), heart problems (such as chest pain, irregular heartbeat, previous heart attack), liver disease, seizure, stroke or “mini-stroke” (transient ischemic attack).

Certain conditions can increase your risk for heart problems. Tell your doctor if you have any of these conditions, including: high blood pressure, high cholesterol, diabetes, family history of heart disease, overweight, smoker, postmenopausal (women), age more than 40 years (men).

This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

The risk of heart disease, liver disease, and high blood pressure increases with age. Older adults may be more sensitive to the side effects of this drug, especially increased blood pressure and heart problems.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

If you also take any ergotamine medication (such as dihydroergotamine) or other “triptan” drugs (such as sumatriptan, zolmitriptan), you will need to separate your rizatriptan dose at least 24 hours apart from your dose of these other medications to lessen the chance of serious side effects.

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Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Do not share this medication with others.

Certain foods, beverages, or food additives (such as red wine, cheese, chocolate, monosodium glutamate) as well as lifestyle patterns such as irregular eating/sleeping habits or stress may bring on a migraine headache. Avoiding these “triggers” may help lessen migraine attacks. Consult your doctor for more details.

Lab and/or medical tests (such as blood pressure) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

Not applicable. (See How to Use section.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

Maxalt 10 mg tablet

Color: pale pinkShape: oblongImprint: MAXALT MRK 267

This medicine is a pale pink, oblong, tablet imprinted with “MAXALT” and “MRK 267”.

Maxalt 10 mg tablet

Color: pale pinkShape: oblongImprint: MAXALT MRK 267

This medicine is a pale pink, oblong, tablet imprinted with “MAXALT” and “MRK 267”.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Maxalt Dosage Guide – Drugs.com

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Generic name: rizatriptan benzoate 10mg
Dosage forms: tablet, oral, tablet, orally disintegrating
Drug class: Antimigraine agents

Medically reviewed by Drugs.com. Last updated on Jun 1, 2022.

​Although rizatriptan benzoate 5 mg tablets and orally disintegrating tablets are available in the marketplace, MAXALT Tablets and MAXALT-MLT Orally Disintegrating Tablets are no longer marketed in the 5 mg strength.

Dosing Information in Adults

The recommended starting dose of rizatriptan benzoate is either 5 mg or 10 mg for the acute treatment of migraines in adults. The 10-mg dose may provide a greater effect than the 5-mg dose, but may have a greater risk of adverse reactions [see Clinical Studies (14.1)].

Redosing in Adults

Although the effectiveness of a second dose or subsequent doses has not been established in placebo-controlled trials, if the migraine headache returns, a second dose may be administered 2 hours after the first dose. The maximum daily dose should not exceed 30 mg in any 24-hour period. The safety of treating, on average, more than four headaches in a 30-day period has not been established.

Dosing Information in Pediatric Patients (Age 6 to 17 Years)

Dosing in pediatric patients is based on the patient’s body weight. The recommended dose of rizatriptan benzoate is 5 mg in patients weighing less than 40 kg (88 lb), and 10 mg in patients weighing 40 kg (88 lb) or more.

The efficacy and safety of treatment with more than one dose of rizatriptan benzoate within 24 hours in pediatric patients 6 to 17 years of age have not been established.

Administration of MAXALT-MLT Orally Disintegrating Tablets

For MAXALT-MLT Orally Disintegrating Tablets, administration with liquid is not necessary. Orally disintegrating tablets are packaged in a blister within an outer aluminum pouch and patients should not remove the blister from the outer pouch until just prior to dosing. The blister pack should then be peeled open with dry hands and the orally disintegrating tablet placed on the tongue, where it will dissolve and be swallowed with the saliva.

Dosage Adjustment for Patients on Propranolol

Adult Patients

In adult patients taking propranolol, only the 5-mg dose of rizatriptan benzoate is recommended, up to a maximum of 3 doses in any 24-hour period (15 mg) [see Drug Interactions (7.1) and Clinical Pharmacology (12.3)].

Pediatric Patients

For pediatric patients weighing 40 kg (88 lb) or more, taking propranolol, only a single 5-mg dose of rizatriptan benzoate is recommended (maximum dose of 5 mg in a 24-hour period). Rizatriptan benzoate should not be prescribed to propranolol-treated pediatric patients who weigh less than 40 kg (88 lb) [see Drug Interactions (7.1) and Clinical Pharmacology (12.3)].

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causes, symptoms and treatments

Content

• 1 Tension headache
  • 1.1 Possible causes of tension headache
  • 1.2 Stress
  • 1.3 Poor posture 9 0008
  • 1.4 Sleep deprivation
  • 1.5 Sedentary lifestyle
  • 1.6 Symptoms tension-type headache
  • 1.7 Moderate pain in the temples and neck
  • 1.8 Compressive, pressing pain
  • 1.9 Worse on exertion
  • 1.10 Tension headache treatments
  • 1.11 Stress avoidance
  • 1.12 Regular exercise
  • 1.13 Use of warm compresses
  • 1.14 Related videos:

  90 005 1.15 Q&A:

  • • tension type pain?
    • 1.15.0.2 What symptoms accompany tension headache?
    • 1.15.0.3 How can tension headache be treated?

Tension headache: main causes, symptoms and treatments. Learn how to deal with bad feelings and prevent them from happening.

Headache is a common problem that we face in everyday life. However, a headache characterized by constant aching discomfort and tension can seriously impair the quality of life and the ability to perform daily tasks.

Tension headache causes:

1. Stress and emotional tension are a common cause of headaches. Depression, nervous tension, conflicts at work or in personal life – all this can cause increased tension in the neck and shoulder muscles, which leads to headaches.

2. Incorrect posture and sedentary work – Prolonged exposure to incorrect posture and insufficient physical activity can cause increased tension in the neck muscles and headache.

3. Eye fatigue – prolonged use of a computer or reading in poor lighting can cause eye strain and headaches.

Tension headache symptoms:

1. An unpleasant feeling of pressure, aching or tightness in the forehead, occiput or temples.

2. Feeling of fatigue and tension in the neck and shoulders.

3. Pain may be intermittent or constant, and may also be aggravated by increased physical or emotional stress.

Treatments for tension headaches:

1. Relaxation and rest – Regular breaks in work, short sleep or meditation can help relieve tension and reduce headaches.

2. Physical activity – sports, exercise and stretching will help relieve muscle tension and prevent headaches.

3. Stress avoidance – developing stress management mechanisms and finding ways to relax will help reduce the frequency and intensity of headaches.

Tension headache should not be neglected, because its timely treatment and prevention can significantly improve the quality of your life.

Possible causes of tension-type headache

Tension-type headache can be caused by incorrect posture when working at a computer or sitting in an incorrect posture. If the neck and head are in the wrong position, the muscles are loaded, which can cause a headache.

One cause of tension-type headache may be lack of physical activity. With a sedentary lifestyle, blood circulation worsens, which leads to muscle tension and headaches.

Stress and emotional tension can also cause tension headaches. When stressed, muscles tighten and more energy is expended, which can lead to headaches.

Poor indoor lighting can be another cause of tension headaches. When working in low light, the eyes strain, which leads to a headache.

An unhealthy diet can also cause a tension headache. Deficiencies in certain vitamins and minerals can lead to muscle cramps, which in turn causes headaches.

Stress

Stress is one of the main causes of tension headaches. Under the influence of stress, the body experiences increased tension, which can lead to unusual sensations in the head and the appearance of pain. Often stress is the result of problems at work, failures or conflicts in your personal life.

What are the symptoms of stress? Usually this is constant fatigue, irritability, decreased concentration and memory problems. You may also experience pain in the head and neck. If you have these symptoms, you may be suffering from the effects of stress.

Fortunately, there are special treatments that can help you cope with stress and headaches. One of the most popular methods is relaxation: it can be meditation, deep breathing, yoga, or other techniques that help reduce tension and restore emotional balance.

In addition to relaxation, it is recommended to pay attention to your lifestyle and make adjustments to reduce the impact of stress. Try to find time for rest and relaxation, indulge in your favorite hobbies, lead an active lifestyle and watch your diet. In addition, it is useful to seek the help of a specialist who will help to understand your situation and offer individual recommendations and treatments.

Do not forget that health is the most valuable wealth, so if you have a headache or other symptoms of stress, do not leave them unattended. Use all available means to deal with stress and take care of your physical and emotional well-being. Only then can you enjoy life to the fullest and get rid of tension headaches.

Poor posture

Poor posture can lead to many health problems, including tension headaches.

The causes of poor posture can be varied, including prolonged sitting in an incorrect position, slouching and being inactive.

Symptoms of poor posture include pain in the neck, back and head, as well as a feeling of tension and fatigue in these areas.

If necessary, special corrective devices such as lumbar pillows or orthopedic mattresses can be used.

Seek immediate medical attention if headache persists or is accompanied by other symptoms such as nausea or dizziness.

Sleep deprivation

Sleep deprivation is a common problem in modern society that seriously affects our health and overall well-being. Lack of sleep can cause a tension-type headache, also known as spanglossia.

Tension-type headache is characterized by heaviness in the head, constricting pain, a feeling of pressure or tension in the temples or occiput. It often feels like a rubber band around the skull.

Sleep deprivation can be caused by a variety of factors, including stress, work and school responsibilities, being too active, disrupting your daily routine, using electronic devices before bed, and other habits that interfere with normal sleep.

To combat sleep deprivation, it is recommended to maintain a regular sleep schedule, create a cozy and quiet environment in the bedroom, avoid caffeinated drinks and alcohol before bed, and practice relaxation methods such as meditation or yoga.

Neglecting sleep deprivation can lead to serious health problems, so getting enough sleep and rest is important.

Sedentary lifestyle

Nowadays, more and more people suffer from tension headaches, and one of the main reasons for this is a sedentary lifestyle.

Sitting at a computer or in front of a TV sets tense muscles in the neck, shoulders and back, which in turn can cause headaches. In addition, the lack of physical activity affects the general condition of the body, provokes diseases and affects the psychological state of a person.

In addition to headaches, a sedentary lifestyle is also associated with cardiovascular problems, metabolic disorders and excess weight. Lack of physical activity leads to a decrease in muscle tone, weakness and deterioration of well-being.

To avoid the problems associated with a sedentary lifestyle, regular exercise, outdoor walks and an active lifestyle are recommended. In addition, it is useful to perform a set of exercises for the neck and back in order to prevent the accumulation of tension in these areas.

Taking care of your health and exercising regularly is the key to avoiding tension headaches and overall well-being.

Tension headache symptoms

Tension headache is one of the most common types of headache. Its symptoms vary, but it is usually characterized by moderate or mild intensity and a pressing sensation around the head.

The main symptoms of tension headache include:

1. Unpleasant sensation of pressure or tightness in forehead, temple, neck and occiput.
2. Hangover sensation, as if the head were being pulled together with a rubber band.
3. Increased pain during physical activity or stressful situations.
4. Episodic or prolonged prolonged action of headache.

Unlike migraine, tension-type headache is usually not accompanied by photophobia, nausea or vomiting, and does not worsen with physical activity. If you experience these symptoms, it is recommended that you see a doctor for diagnosis and appropriate treatment.

Moderate pain in the temples and neck

Do you often experience moderate pain in the temples and neck? This may be due to a tension-type headache. This condition often occurs as a result of poor posture, a long time in a static position, or excessive tension in the muscles of the neck and head.

One of the treatments for moderate pain in the temples and neck area is massage. Massage will help improve blood circulation, relieve tension and allow you to relax. Specialists guarantee a professional approach to massage sessions and maximum relief of your discomfort.

It is important to remember that moderate pain in the temples and neck can be a symptom of other diseases, so it is important to pay attention to all accompanying symptoms and visit a doctor to get the correct diagnosis and prescribe the necessary treatment.

Constricting, pressing pain

Do you often suffer from headaches that feel like constricting, pressing pain? It can be a tension-type headache, one of the most common conditions that people experience in various situations. It can be caused by stress, fatigue, poor posture, or staying in one position for a long time.

Tension-type headache is characterized by unpleasant symptoms: pressure and constriction in the forehead, temples or around the head. It can be both paroxysmal and permanently low. Often accompanied by a sensation of limited movement of the head and neck muscles, as well as a feeling of fatigue and irritability.

Don’t put off taking care of your health until later! The specialists of our clinic offer effective methods for the treatment of tension-type headache. We will conduct a detailed examination to determine the cause of your condition and develop an individual treatment program that includes physiotherapy, massage and lifestyle recommendations.

Be aware that a headache can affect your performance and quality of life. Contact us right now and get rid of this unpleasant symptomatology! We guarantee a professional approach, individual attention and results!

Worse with exercise

Tension-type headache may be aggravated by exercise. This is due to an increase in muscle tension in the shoulders and neck, which leads to compression and irritation of the nerve endings.

During exercise, especially when exercising intensely or lifting heavy weights, the muscles in the head and neck work more actively, which can cause or worsen headaches.

To prevent headaches from worsening during exercise, it is recommended to warm up and stretch the muscles of the neck and shoulder girdle before training. It is also helpful to avoid sudden movements and switch attention to other muscle groups during training.

Tension headache treatments

Tension headache is a common disorder that can lead to significant discomfort and quality of life. However, there are various treatments that help deal with this problem.

To begin with, it is important to pay attention to the factors that can cause a tension-type headache. These include stress, fatigue, poor posture or posture when sitting, eye strain from working at a computer, and contraction of the muscles in the neck and shoulders. Therefore, one of the main methods of treatment is the elimination or minimization of these factors.

One effective method is the medical approach, which includes the use of drugs. Analgesics such as paracetamol or ibuprofen are often recommended for tension headaches. In some cases, stronger medications such as migraines or triptans may be prescribed.

In addition to medication, there are also alternative treatments for tension headache. One of them is physical activity and exercise. Regular exercise helps relieve muscle tension, improve blood circulation, and relieve stress, which can reduce the frequency and intensity of headaches.

Another alternative method is psychological counseling. Tension headache can be associated with low mood and stress, so psychological support and advice can be helpful in treating this condition.

In general, the treatment of tension headache requires an integrated approach. A combination of medical, physical and psychological methods can help manage this problem and improve the quality of life.

Stress avoidance

Long periods of tension and stress can lead to tension headaches. To prevent this unpleasant problem from occurring, it is important to learn how to effectively avoid stressful situations.

Organize the right daily routine. Regular sleep and rest will help to strengthen your mental stability and reduce the risk of developing stress. Try to go to bed and get up at the same time every day.

Exercise or exercise. Regular exercise helps to relieve accumulated tension and negative emotions. Choose the exercises you enjoy and do them at least 3-4 times a week.

Learn to relax. Meditation, yoga, breathing exercises and other relaxation techniques can help reduce stress and tension. Take some time each day to practice these methods.

Set priorities and plan your time. Overloading with chores and urgent tasks can cause stress. Break down your tasks into smaller parts, set priorities, and schedule time so that you can complete everything in stages.

Limit your caffeine and alcohol intake. Avoiding excessive consumption of caffeine and alcohol will help to avoid additional stress and possible complications associated with tension-type headache.

Keep in touch with loved ones. Associating with people you love and trust will help you cope with stress and negative emotions. Don’t be afraid to share your concerns and seek support from loved ones.

By following these simple guidelines, you can reduce your risk of tension headaches and manage stress more effectively.

Regular exercise

Regular exercise is one effective way to relieve the tension and fatigue that causes headaches. Physical activity can improve blood circulation and metabolism in the body, which has a beneficial effect on preventing headaches.

Most experts recommend physical activity at least three times a week for 30-60 minutes. Exercise can range from outdoor activities to running, swimming, or going to the gym.

Special attention should be paid to stretching and strengthening the muscles of the neck and back. This will relieve the accumulated tension and improve the flexibility of the spine. Stretching can be done with simple exercises such as forward, backward, and sideways head tilts, as well as gentle head turns.

Regular and consistent exercise will help you reduce your risk of headaches and greatly improve your quality of life.

Using warm compresses

One effective way to relieve tension headaches is to use warm compresses. This simple and affordable method helps relieve tension in the muscles of the head and neck, improve blood circulation and relax.

To use warm compresses, you can use hot water, a heating pad or special gel pads. It is necessary to apply a warm compress to the back of the head or other areas of the neck and head where pain is felt, and leave for 10-15 minutes. Heat helps to dilate blood vessels and relieve tension, and also improves overall well-being.

It is important to remember that the use of warm compresses should be used with caution and only after consulting a doctor, especially if you have contraindications such as fever, dilated blood vessels, inflammation or other diseases.

Related videos:

Q&A:

What causes a tension headache?

Tension headache can be caused by various factors such as stress, fatigue, poor posture, prolonged sitting in one position, lack of sleep and other external and internal causes that lead to neck and head muscle tension.

What symptoms accompany tension headache?

Symptoms of tension-type headache may include a feeling of fatigue and unpleasant tension in the head and neck, unsteadiness, slight dizziness, difficulty concentrating, irritability, loss of appetite, sleep disturbance and increased sensitivity to light and sound.

How can tension headache be treated?

Tension headaches can be treated with a variety of therapies, such as psychotherapy, meditation, relaxation exercises, physical activity, massage, heat or cold, pain medication (if needed), and lifestyle changes to address the cause of the headache. .

Hypnic headache. What is Hypnic Headache?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Hypnic headache is a distinct form of primary chronic cephalalgia that occurs during sleep in patients aged 50 and older. A distinctive feature of the disease is the absence of similar attacks in the waking state. This variant of cephalalgia is diagnosed taking into account clinical features after the exclusion of organic brain damage using instrumental studies (Echo-EG, MRI, ultrasound). The main pharmaceuticals used in the treatment of hypnic headache are lithium salts, sleeping pills, caffeine, indomethacin, melatonin.

ICD-10

R51 Headache

• Causes of HGB
• Symptoms of HGB
• Complications
• Diagnostics
• HGB treatment
• Prognosis and prevention
• Prices for treatment

General

Headache (cephalgia) is one of the most common complaints among patients of various age categories. At a young age, primary cephalalgias (tension headache, migraine) predominate, in the elderly, secondary pains are more often observed due to various intracranial pathologies (tumors, cerebrovascular diseases, arachnoiditis, etc. ). The only variant of primary cephalalgia that occurs exclusively in the older age group is hypnic headache (HGB). The peak incidence occurs at the age of 50-60 years, women get sick more often than men. The prevalence of pathology is at the level of 1.1%. Due to the peculiarities of its occurrence in the literature on neurology and among patients, hypnic cephalgia has received the synonymous name “alarm clock” headache.

Hypnic headache

Causes of HGB

The provoking etiofactors are unknown. Most researchers suggest that the disease is based on a specific disorder in the regulation of circadian rhythms. Cephalgic paroxysms occur during sleep accompanied by rapid movements of the eyeballs (REM sleep phase). Since the regulation of the alternation of sleep-wake cycles is carried out by the suprachiasmatic hypothalamic nucleus, its dysfunction is considered the pathogenetic basis of hypnic seizures. A likely explanation is the change in the relationship of the suprachiasmatic nucleus with the noceptive structures of the brain responsible for pain sensations.

Symptoms of HGB

Hypnic cephalgia develops paroxysmal at night. The patient wakes up with a headache, cannot fall asleep until the attack ends. In 10% of cases, patients note that paroxysms can also occur during daytime sleep. The pain is usually dull and moderate. Complaints of intense pain syndrome are presented by 20% of patients. The hypnic form of cephalgia is diffuse in nature, in 60% of cases it covers both halves of the head. Sometimes migraine-like symptoms are observed: nausea, increased susceptibility to light and sounds, but phono- and photophobia do not reach significant severity.

The minimum duration of cephalgic paroxysm is 15 minutes, the maximum is 3 hours. On average, a headache lasts 0.5-1 hour. The number of attacks varies from 1 episode per week to 6 during the night, the hypnic attack begins 2-6 hours after falling asleep. After its completion, patients are able to fall asleep again. HGB has a long chronic course. Appearing once, paroxysms accompany the patient until the end of life.

Complications

Hypnic cephalgia is a relatively benign pathology that is not accompanied by serious complications. Frequent hypnotic attacks that occur several times a night negatively affect the patient’s quality of life. This course of HGB can lead to sleep deprivation. Shortened to 4-5 hours of sleep adversely affects the ability to work, provokes problems with concentration, daytime sleepiness, increased emotional lability, irritability, memory impairment for current events. Sleep deprivation increases the risk of developing diabetes, obesity, stomach ulcers, and fibromyalgia.

Diagnostics

Since hypnic headache is a rare pathology, many practicing neurologists and therapists are not sufficiently informed about the criteria for its diagnosis. A characteristic feature of older patients is the presence of a burdened premorbid background (arterial hypertension, coronary heart disease, chronic gastrointestinal pathology). As a result, hypnic paroxysms are attributed to nocturnal attacks of hypertension, manifestations of abuse headache, symptoms of impaired venous outflow from the cranial cavity (venous DEP).

Diagnosis of HGB allows a thorough study of clinical symptoms, the exclusion of any intracranial organic pathology that can provoke such cephalalgia. Diagnostic criteria were developed in 2003. According to the International Classification of Headaches, there are four signs of the hypnotic form of the disease. There is a dull headache that occurs only during sleep, leading to awakening. Cephalgic attacks are characterized by at least two of the following signs: they debut at the age of over 50 years, appear more than 15 times within a month, and last more than 15 minutes. Headache is not accompanied by autonomic symptoms. There are no other causes of cephalgic paroxysms.

In order to confirm the latter criterion, instrumental examinations are carried out to identify sleep disorders, organic cerebral pathology. According to indications, consultations of a cardiologist, vertebrologist, somnologist are appointed. The list of required examinations includes:

• Echoencephalography. With the help of a special ECHO-EG, intracranial pressure is measured. Research is necessary to exclude intracranial hypertension.
• Assessment of cerebral circulation. It is carried out using ultrasound of the vessels of the head and neck, duplex scanning. In many patients, due to age, various hemodynamic abnormalities are recorded. In the absence of headache during the waking period, their presence does not exclude the diagnosis of HGB.
• Polysomnography. Performed in conjunction with the consultation of a somnologist. Polysomnography makes it possible to exclude various somnological disorders: sleep apnea syndrome, nocturnal seizures, parasomnias.
• Tomography. MRI of the brain visualizes morphological changes in cerebral tissues. Allows you to diagnose brain tumors, cysts, inflammatory foci, to detect the area of ​​a stroke, lacunar infarcts.

Differential diagnosis of HGB is carried out with nocturnal paroxysms of migraine, cluster headache, venous form of discirculatory encephalopathy. Migraine is characterized by the presence of daytime attacks along with nighttime ones. Beam cephalgia is distinguished by the vegetative coloring of paroxysms, high intensity of pain, psychomotor agitation of the patient. Venous DEP occurs with a predominance of night and morning cephalgic paroxysms. The test with a tilt of the head helps to carry out differential diagnosis.

HGB treatment

A single method for the treatment of hypnic cephalgia has not been developed. Clinical studies of the effectiveness of pharmaceuticals used in the treatment of HGB have not been conducted. The main means used in therapy are:

• Lithium preparations (lithium carbonate). They act on the noceptive system, increase the night production of melatonin. Appointed for the night.
• Hypnotics (zopiclone). The positive effect of drugs is associated with a regulatory effect on the structure of sleep, an increase in the awakening threshold. Atypical benzodiazepines (clonazepam) have a similar effect.
• Other pharmaceuticals. The literature describes successful attempts at treatment with indomethacin, verapamil, gabapentin, prednisolone. The effectiveness of taking caffeine and melatonin preparations before bedtime has been noted.

Prognosis and prevention

The hypnic form of headache is characterized by a benign chronic course. Therapeutic measures can reduce the likelihood of another nocturnal paroxysm, but do not lead to recovery. After manifestation, the disease continues throughout the life of the patient. Preventive measures have not been developed, since the etiofactors provoking the disease are unknown.

You can share your medical history, what helped you in the treatment of hypnic headache.

Sources

1. Differential diagnosis of hypnic headache.