The Role of NSAID’s & Triptans in Headaches02/03/2021 2021-03-02 13:57
The Role of NSAID’s & Triptans in Headaches
The Role of NSAID’s & Triptans in Headaches
Headaches are divided into two major categories by the International Headache Society: primary headache and secondary headache.
A primary headache consists of:
⦁ tension-type headaches
⦁ cluster headaches
Typically, tension-type headaches, generally on both sides of the brain, cause mild to moderate pain. A squeezing or tightening pressure is present. It is not pulsating, and nausea does not accompany it. With regular physical exercise, the headache does not get worse.
Typical migraine headaches are throbbing or pulsating and are also associated with nausea and vision changes. While many migraine headaches are intense, migraines are not always severe headaches, and some migraine episodes may be relatively mild. Many people who have migraines endure frequent attacks over several years of headaches.
Very frequent headaches are cluster headaches. Typically, the pain begins around one eye, then spreads to nearby areas of the face. The length of each headache is about half an hour to three hours. Over 24 hours, episodes can happen many times (in clusters). This occurs regularly, lasting from weeks to months. Cluster headaches in men are much more likely to occur than in women.
For secondary headache, there are several possible causes, such as:
- injury or trauma to the neck or head
- Disorders of the blood vessels, such as an aneurysm of the brain, tearing of the carotid artery, or inflammation (temporal arteries)
- infection, such as meningitis or encephalitis
- Drugs or medication may be the direct cause of headaches. For instance, headache can be the side effect of many blood pressure medicine, including nifedipine.
- Withdrawal headache: This type of headache occurs when a substance or medication is suddenly stopped. Examples include caffeine withdrawal headache or headache after abruptly stopping long-term use of pain relievers.
Why do we get headaches?
Owing to a complex combination of genetics, defects in the brain, defective or overactive pain receptors, environmental stimuli, and a neurological state called sensitization, people get headaches. It is suspected that the most common type of headache, called a tension-type headache, results from the activation of muscle pain receptors and connective tissue called fascia.
A combination of signals between your brain, blood vessels, and surrounding nerves produces the discomfort you experience during a headache. In your blood vessels and head muscles, involved nerves turn on and transmit pain signals to your brain. But how these signals get switched on in the first place isn’t clear.
Prevalent headache causes include:
- An illness. Infections, colds, and fevers can include this. With conditions such as sinusitis (inflammation of the sinuses), a throat infection, or an ear infection, headaches are also common. In certain situations, a blow to the head or, sometimes, a symptom of a more serious medical condition may result in headaches.
- Stress. Emotional stress and depression and the intake of alcohol, missing meals, sleep pattern changes, and taking too much medicine can cause a headache. Other factors due to poor posture include neck or back strain.
- Your surroundings, including secondhand cigarette smoke, allergens, and some foods, strong smells from household chemicals or perfumes may initiate headache. Other potential causes include tension, traffic, noise, lighting, and weather changes.
- In genetics. Headaches tend to run in families, especially migraine headaches. Most kids and teens (90%) who have migraines have other family members who get them. There is a 70 percent risk their child will also have them because both parents have a migraines history. The risk decreases to 25 percent -50 percent if only one parent has a history of these headaches.
Doctors don’t know what’s causing migraines. One theory suggests that an issue with nerve cell electrical charges triggers a series of changes that cause migraines. In adults, too much physical activity can even cause migraines.
What are the signs of headache?
As the name sounds, headache is defined as pain in the head. The type, place, and severity of pain, however, are highly variable. Even without a headache, there may be profound signs of a migraine. An individual may have multiple causes for headaches simultaneously. Both migraine and tension-type headaches are typical for a person to experience. And the symptoms of migraine headaches and tension-type headaches may overlap.
For instance, bright lights or noisy noises can make all types of headaches worse. Migraine headaches tend to throb in general. Tension-type headaches are more likely to cause persistent pain. But the pain may be steady or throbbing or can alternate between the two, either from a migraine or a tension-type headache.
Headache effects go beyond the pain in the head. For certain persons, these other signs cause the most pain and anxiety, such as nausea, visual changes, or sensitivity to light. While specific symptoms vary from one type of headache to another type of headache, often making it difficult for a firm diagnosis, others may be more distinctive in that regard.
Secondary headaches are called headaches that result from an underlying medical condition. Since they may have a variety of associated symptoms, all of which depend on the primary diagnosis, it is better to investigate the symptoms of primary headaches, those that arise on their own.
How to analyse headaches?
Headache diagnosis takes into account various factors, including when episodes arise, what symptoms you encounter, how they react to medications you have tried, your overall health profile, and more. Your doctor will work to determine what kind of headache you are having or, if a headache is not at the root of your discomfort, what other condition might be causing your symptoms by doing a thorough history and physical evaluation, and maybe some testing.
Your doctor will conduct a physical exam to look at your blood pressure and cardiorespiratory processes in detail. A neurological review will test your sensory responses, muscle and nerve activity, and coordination and balance.
Your personal and family medical history, any drugs you take, and any lifestyle patterns will be recorded by your healthcare provider (e.g., caffeine intake, alcohol use, smoking).
Your provider will probably first ask you some detailed questions about your headache while treating you.
These questions include as follows:
- Location of the pain
- Onset: was it a gradual start or sudden.
- Duration: How long does the pain last? Does the pain come and go?
- Character: Describing the type of pain ( sharp ? or aching? )
- Severity: How bad is it? One being the lowest and ten being the highest?
- Radiation: Does the pain go or move or radiate anywhere?
- Exacerbating or alleviating factors: What makes the pain worse or better?
- Associations: Are there other s/sx associated with your headache? (e.g., nausea, vomiting, visual changes)
Your healthcare professional will determine based on this data whether or not your headache is a form of primary headache condition or maybe because of something else.
Labs and tests
There are no laboratory tests to identify primary headache conditions that are specific. To determine your general health, you should have blood and urine tests and rule out the causes of secondary headaches, such as infection, dehydration, diabetes, and thyroid disorders.
If a brain or spinal cord infection is suspected, your doctor can use a spinal tap to check the fluid’s pressure and test it for infectious agents. If the signs of epilepsy follow the headaches, an electroencephalogram (EEG) may be carried out.
Your doctor – order imaging tests, although they are not a regular part of a headache workup if you have symptoms that point to a systemic cause of your headaches. If you have headaches nearly every day or your doctor suspects you may have sinus issues, this may be prescribed.
X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) may involve imaging procedures.
Determining Headache Type
Some distinct features of the three major types of headache, kind of tension, cluster, and migraine help doctors decide precisely what sort of primary headache problem is at play, one of which is suspected.
Your doctor will decide whether the headache may be an infectious cause. You may have a headache for several forms of infection like bacterial, fungal, or parasitic infections. Condition of the brain or spinal cord is of particular concern.
A brain stroke, hemorrhage, or blood clot is a severe disorder that can present with a headache, and if present, the doctor may want to ensure that one is not overlooked. These complications can occur in high blood pressure or recent trauma.
A structural cause of a headache, such as a tumor, abscess, or fluid build-up in the brain, may be present. The effect of taking pain medication too much may also be a reason for the headache.
How can I get rid of my headache?
Over-the-counter pain relievers are easy, affordable, and relatively safe for infrequent headaches. Aspirin, acetaminophen (Tylenol), ibuprofen ), and naproxen (Aleve) are instances. With mixed pain relievers that include caffeine, some individuals get more pain relief. To be more effective, when the headache begins, a pain relief medication should be taken immediately.
It is best to restrict the use of any over-the-counter pain reliever to no more than two or three days a week. If painkillers are used more often than that, there may be “rebound” headaches on days when drugs are not taken.
There are several prescription medications available for migraines:
- Isometheptene (Midrin and other brand names)
- Triptans, such as sumatriptan (Imitrex), zolmitriptan (Zomig), naratriptan (Amerge), and rizatriptan (Maxalt)
- Ergotamines, such as dihydroergotamine (Ergomar) and sublingual ergotamine (Migranal).
Besides, anti-nausea medication or suppository can also be taken by people who experience nausea with migraines (with or without vomiting).
It is more difficult to treat common episodic and chronic headaches. When pain relievers are stopped, rebound headaches are common. A safer way is to avoid the headache before it begins than take pain relievers after the headache is present. Some drugs, such as naproxen (Naprosyn, Aleve, generic versions) and amitriptyline (Elavil, generic versions). That can break the cycle of chronic headaches.
Some people without treatment can treat their headaches. An ice pack or heating pad may be applied to any close areas of your neck and shoulders. You should try massaging the region as well.
When to see a doctor?
People who have some warning signs should immediately see a doctor. The appearance of a warning sign may indicate that, as for the following, the headaches may be due to a severe disorder:
- High fever and stiff neck with headache: meningitis, a life-threatening fluid-filled space infection between the tissues surrounding the brain and spinal cord (meninges)
- Thunderclap headache: subarachnoid hemorrhage, often due to a ruptured aneurysm (bleeding inside the meninges)
- Tenderness in the temple, particularly in older people who have lost weight and have muscle aches: giant cell arteritis
- Headaches in people with cancer or a compromised immune system (due to a condition or medication)
- Red eyes and halos around lights: This can be due to glaucoma, which leads to irreversible loss of vision if left untreated.
They should call their doctor if individuals with none of the above symptoms or characteristics begin to have headaches that are different from any they have had before or if their usual headaches become unusually severe. The doctor might ask them to come for an evaluation, depending on their other symptoms.
Healthy Lifestyle Habits to avoid a headache
For headache management, lifestyle habits that enhance your overall health and well-being can be helpful.
- Eat a balanced diet. Consume a diet that is rich in fruits, vegetables, whole grains, and lean proteins. Speak to your doctor before taking a particular diet if you think specific foods, drinks, or ingredients cause your headaches.
- Keep your meals daily. A headache may be caused by going too long without eating (fasting) and getting low blood sugar (hypoglycemia). It helps you control your blood sugar levels by eating meals and snacks at about the same time of day.
- Remain hydrated. If they are dehydrated, even individuals that don’t usually get headaches can get one. The standard aim is to drink eight glasses of water a day, but a refillable water bottle works too.
- Moderate the consumption of caffeine and alcohol. Headaches may be caused by beverages containing caffeine and alcohol. Overdoing may also contribute to dehydration, which can lead to headaches.
- Get active in daily exercise. Choose a physical activity that you enjoy. Try outdoor dance, golf, or cycling if you don’t like going to the gym. Improving circulation and pumping out endorphins may help relieve the pain by combating stress and tension.
- Stick to a timetable for sleep. Headaches may result from sleep disturbances or low-quality sleep. Both sleep deprivation and oversleeping may be headache causes, according to the American Migraine Foundation.
- Regularly visit the primary care physician. Your overall well-being is encouraged by keeping updated on vaccines and other preventive care initiatives. Daily check-ups also allow you to chat about your headaches and discuss the options for treating them with your doctor.