Pain Relief Resources

How to treat Pain, Headache, and Muscle Relaxant

What is a headache?

Headache is defined as pain in the head that is located above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Headache, like chest pain or dizziness, has many causes.

What are the causes of headaches?

There are two types of headaches: primary headaches and secondary headaches. Primary headaches are not associated with (caused by) other diseases. Examples of primary headaches are migraine headaches, tension headaches, and cluster headaches. Secondary headaches are caused by associated disease. The associated disease may be minor or serious and life threatening.

How common are primary and secondary headaches?

Tension headaches are the most common type of primary headache; as many as 90% of adults have had or will have tension headaches. Tension headaches are more common among women than men.

Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. An estimated 6% of men and up to 18% of women will experience a migraine headache.

In the United States, migraine headaches often go undiagnosed or are misdiagnosed as tension or sinus headaches. As a result, many migraine sufferers do not receive effective treatment.

Cluster headaches are a rare type primary headache, affecting 0.1% of the population. An estimated 85% of cluster headache sufferers are men. The average age of cluster headache sufferers is 28-30 years, although headaches may begin in childhood.

Secondary headaches have diverse causes, ranging from serious and life threatening conditions such as brain tumors, strokes, meningitis, and subarachnoid hemorrhages to less serious but common conditions such as withdrawal from caffeine and discontinuation of analgesics.

Many people suffer from "mixed" headache disorders in which tension headaches or secondary headaches trigger migraine headaches.

What is the treatment for tension headaches?

Individuals with occasional tension headaches or mild migraine headaches that do not interfere with daily activities usually medicate themselves with over-the-counter (OTC, non-prescription) pain relievers (analgesics). Many OTC analgesics are available. OTC analgesics have been shown to be safe and effective for short-term relief of headache (as well as muscle aches, pains, menstrual cramps, and fever) when used according to the instructions on their labels.

There are two major classes of OTC analgesics: acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs). The two types of NSAIDs are aspirin and non-aspirin. Examples of non-aspirin NSAIDs are ibuprofen (Advil, Nuprin, Motrin IB, and Medipren) and naproxen (Aleve). Some NSAIDs are available by prescription only. Prescription NSAIDs are usually prescribed to treat arthritis and other inflammatory conditions such as bursitis, tendonitis, etc. The difference between OTC and prescription NSAIDs may only be the amount of the active ingredient contained in each pill. For example, OTC naproxen (Aleve) contains 220 mg of naproxen per pill, whereas prescription naproxen (Naprosyn) contains 375 or 500 mg of naproxen per pill.

Acetaminophen reduces pain and fever by acting on pain centers in the brain. Acetaminophen is well tolerated and generally is considered easier on the stomach than NSAIDs. However, acetaminophen can cause severe liver damage in high (toxic) doses or if used on a regular basis over extended periods of time. In individuals who regularly consume moderate or large amounts of alcohol, acetaminophen can cause serious damage to the liver in lower doses that usually are not toxic. Acetaminophen also can damage the kidneys when taken in large doses. Therefore, acetaminophen should not be taken more frequently or in larger doses than recommended on the label.

NSAIDs relieve pain by reducing the inflammation that causes the pain (They are called non-steroidal anti-inflammatory drugs or NSAIDs because they are different from corticosteroids such as prednisone, prednisolone, and cortisone which also reduce inflammation). Corticosteroids, though valuable in reducing inflammation, have predictable and potentially serious side effects, especially when used long-term. NSAIDs do not have the same side effects that corticosteroids have.

Aspirin, Aleve, Motrin, and Advil all are NSAIDs and are similarly effective in relieving pain and fever. The main difference between aspirin and non-aspirin NSAIDs is their effect on platelets. Platelets are small particles in the blood that cause blood clots to form. Aspirin prevents the platelets from forming blood clots. Therefore, aspirin can increase bleeding by preventing blood from clotting though it also can be used therapeutically to prevent clots from causing heart attacks and strokes. The non-aspirin NSAIDs also have anti-platelet effects, but their anti-platelet action does not last as long as aspirin.

Aspirin, acetaminophen, and caffeine also are available combined in OTC analgesics for the treatment of headaches. Examples of such combination analgesics are Pain-aid, Excedrin, Fioricet, and Fiorinal.

Finding an effective analgesic or analgesic combination often is a process of trial and error because individuals respond differently to different analgesics. In general, a person should use the analgesic that has worked in the past. This will increase the likelihood that an analgesic will be effective and decrease the risk of side effects.

There are several precautions that should be observed with OTC analgesics:

• Children and teenagers should not use aspirin for the treatment of headaches, other pain, or fever, because of the risk of developing Reye's Syndrome, a life-threatening neurological disease that can lead to coma and even death.
• Patients with balance disorders or hearing difficulties should avoid using aspirin because aspirin may aggravate these conditions.
• Patients taking blood thinners such as warfarin (Coumadin) should not take aspirin and non-aspirin NSAIDs without a doctor's supervision because they add further to the risk of bleeding that is caused by the blood thinner.
• Patients with active ulcers of the stomach and duodenum should not take aspirin and non-aspirin NSAIDs because they can increase the risk of bleeding from the ulcer and impair healing of the ulcer.
• Patients with advanced liver disease should not take aspirin and non-aspirin NSAIDs because they may impair kidney function. Deterioration of kidney function in these patients can lead to rapid and life-threatening deterioration of their liver disease.
• Patients should not overuse OTC or prescription analgesics. Overuse of analgesics can lead to the development of tolerance (increasing ineffectiveness of the analgesic) and rebound headaches (return of the headache as soon as the effect of the analgesic wears off, usually in the early morning hours). Thus, overuse of analgesics can lead to a vicious cycle of more and more analgesics for headaches that respond less and less to treatment and occur more frequently.

What are prophylactic medications for migraine headaches?

Prophylactic medications are medications taken daily to reduce the frequency and duration of migraine headaches. They are not taken once a headache has begun. There are several classes of prophylactic medications: beta blockers, calcium-channel blockers, tricyclic antidepressants, antiserotonin agents and anticonvulsants. Medications with the longest history of use are propranolol (Inderal), a beta blocker, and amitriptyline (Elavil), an antidepressant. When choosing a prophylactic medication for a patient the doctor must take into account the drug side effects, drug-drug interactions, and co-existing conditions such as diabetes, heart disease, and high blood pressure.

Beta-blockers are a class of drugs that block the effects of beta-adrenergic substances such as adrenaline (epinephrine). By blocking the effects of adrenaline, beta-blockers relieve stress on the heart by slowing the rate at which the heart beats. Beta-blockers have been used to treat high blood pressure, angina, certain types or tremors, stage fright, and abnormally fast heart beats (palpitations). They also have become important drugs for improving survival after heart attacks. Beta-blockers have been used for many years to prevent migraine headaches.

It is not known how beta-blockers prevent migraine headaches. It may be by decreasing prostaglandin production, though it also may be through their effect on serotonin or a direct effect on arteries. The beta-blockers used in preventing migraine headaches include propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol (Corgard), and timolol (Blocadren).

Beta-blockers generally are well tolerated. They can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema. In patients with who already have slow heart rates (bradycardias) and heart block (defects in electrical conduction within the heart), beta-blockers can cause dangerously slow heartbeats. Beta-blockers can aggravate symptoms of heart failure. Other side effects include drowsiness, diarrhea, constipation, fatigue, decrease in endurance, insomnia, nausea, depression, dreaming, memory loss, impotence.

What is the proper way to use preventive medications?

Doctors familiar with the treatment of migraine headaches should prescribe preventive medications.

Decisions about which preventive medication to use are based on the side effects of the medication and the medical conditions that the patient may have.

Propranolol (Inderal) often is used first, provided that the patient does not have asthma, COPD or heart disease. Amitriptyline (Elavil) also is used commonly.

Preventive medications are begun at low doses and gradually increased to higher doses if needed. This minimizes side effects from the medications. Preventive medications are to be taken daily for months to years. When they are stopped, the dose needs to be gradually reduced rather than abruptly stopped. Abruptly stopping preventive medications can lead to headaches.

In some instances, more than one drug may be needed. Non-medication and behavioral therapies also may be needed.

Muscle relaxant
Generic (Brand name)	Formulations Usual Dose & Notes
Carisoprodol (Soma)	Tab: 350 mg Dose: 350 mg tid Metabolized to meprobamate, has been frequently associated with drug-seeking behavior and dependency. Abrupt cessation may produce withdrawal symptoms
Soma compound	Carisoprodol 200 mg + aspirin 325 mg tab Dose: 1-2 tab qid
Soma compound w codeine	Carisoprodol 200 mg + aspirin 325 mg + codeine 16 mg Dose: 1 - 2 tab q6
Cyclobenzaprine (Flexeril)	tab: 10 mg Dose: 10 mg tid Use with caution in patients with urinary retention and closed-angle glaucoma
Chlorzoxazone (Parafon forte, Paraflex )	Caplet: 500 mg Dose: 500 mg tid to qid
Metaxolone (Skelaxin)	Tab: 400 mg Dose: 800 mg tid to qid May cause hemolytic anemia and elevated hepatic serum transaminases
Methocarbamol (Robaxin)	tab: 500, 750 mg Dose: 750 to 1500 tid
Methocarbamol  (Robaxisal)	tab: Methocarbamol 400 mg + aspirin 325 mg Dose: 2 tab q6
Orphenadrine (Norflex)	Ext release tab: 100 mg dose: 1 tab bid Use with caution in patients with urinary retention and closed-angle glaucoma
Orphenadrine (Norgesic)	Orphenadrine 25 mg + aspirin 385 mg + caffeine 60 mg dose: 1-2 tab tid Caution: see Orphenadrine
Orphenadrine (Norgesic forte)	Orphenadrine 50 mg + aspirin 770 mg + caffeine 60 mg dose: 1 tab tid Caution: see Orphenadrine

Pain is one of the most common reasons for visiting a physician. Although there are a wide range of treatments now available, new approaches are being investigated. At Beth Israel Medical Center's Department of Pain Medicine and Palliative Care, studies are currently recruiting patients with some types of chronic pain, neuropathic pain, pain due to cancer, and low back pain.

Neuropathic pain includes many conditions caused by injury to nerves. The discomfort experienced by patients with this type of pain can be severe, long-lasting, and not easily treated by current analgesics.

Online Prescription service.

Several drugs can be bought by online drugstores. such as Fioricet, tramadol, butalbital and Carisoprodol. For the same drugs, Online drug store sell much cheaper than street pharmacy because they donot need renting fee, and storage, transportation fee.

There are lot of online health resources about pain, pain types, pain medication, pain treatment, we just listed several about them Here. Tramadol-Usadruglist, Tramadol Ultracet Are very good health pain resources.

Legitimate pharmacy sites on the Internet provide consumers with a convenient, private, way to obtain needed medications, sometimes at more affordable prices. The elderly and persons in remote areas can avoid the inconvenience of traveling to a store to purchase medications. Many reputable Internet pharmacies allow patients to consult with a licensed pharmacist from the privacy of their home. Moreover, Internet pharmacies can provide customers with written product information and references to other sources of information like the traditional storefront pharmacy. Finally, the increasing use of computer technology to transmit prescriptions from doctors to pharmacies is likely to reduce prescription errors. links

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