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Headache/Migraine - Treatments

Headaches can often be self-treated by resting, regular sleeping, taking a bath or massaging the forehead, scalp, or temples to relieve the pain. Tension headaches can be eased by physical stretching and relaxing your head and neck muscles. For migraine headache, medical diagnosis is required before self-treatment can be recommended. You may apply an ice bag to the forehead or temple areas to ease pain associated with migraine attack. People with sinus headache can often be treated by taking decongestants and over-the-counter analgesics to relive the pain. However, you should take special attention or consult a doctor before trying to self-treat your headache if you are one of the following situations:
- Severe head pain or pain that persists for 10 days with or without treatment
- Last trimester of pregnancy
- Less than 8 years of age
- High fever or sign of serious infection
- History of liver disease or consumption of more than 3 alcoholic beverages per day
- Headache associated with underlying pathology ( ex. sinus headache)
- Symptoms consistent with migraine

Nutritional strategies:
- Dietary restriction of foods that trigger headaches ( foods with vasoactive substances such as nitrites, tyramine, caffeine, chocolate)
- Avoid starvation and hypoglycemia ( low blood glucose)
- Magnesium supplementation

Pharmacologic therapy:
- Headaches are commonly treated analgesia, NSAIDs, and other anti-inflammatory drugs to relieve pains associated with muscle ache, common cold, and menstrual cramps.

Over-the counter medications:
Acetaminophen: analgesic and antipyretic agent, but not anti-inflammatory; clinically proven to be effective in reliving mild-to moderate pain associated with headache, common cold, muscular aches, and menstrual cramps
- Adult Dosage (Maximum Daily Dosage): 325-1000mg every 4-6 hours (4000mg)
- Potential risk and interaction: increased risk of hepatotoxicity with doses exceeding 4g/day; symptoms of acetaminophen intoxication can include vomiting, nausea, abdominal pain, confusion, and drowsiness. Concurrent use of alcohol will increase the risk of hepatotoxicity.
- Preventive measures: Avoid alcohol intake if possible when taking acetaminophen
- Side effects: Dizziness, drowsiness; dry mouth, nausea; nervousness, sleep disturbance. Seek medical attention right away if any of these severe allergic reactions occur when using Acetaminophen which includes rash, hives, itching, difficulty breathing and urinating, constipation, swelling, tremors, high blood pressure, chest pain etc.

Ibuprofen has analgesic, antipyretic, and anti-inflammatory effects that are useful in treating mild-to-moderate pain. Ibuprofen is commonly used in both adults and children by reducing inflammation and pain in the body.  Onset of action for pain relief is 30 minutes and the time for peak effect for fever is 2 to 4 hours.
- Adult dosage: 200-400mg every 4-6 hours (1200mg)
- Potential risk / interaction: drug interaction with aspirin in which it decreases the antiplatelet effect of aspirin
- Preventive measures: Aspirin should be taken at least 30 minutes before or 8 hours after taking ibuprofen.
- Side effects: Anxiety, heartburn, constipation, drowsiness, nausea, nervousness, sleep disturbance, abdominal pain, swelling, vomiting, and diarrhea

Naproxen sodium has analgesic, antipyretic, and anti-inflammatory effects that are useful in treating mild-to-moderate pain. Onset of pain relief can begin within 30 minutes in patients taking naproxen sodium.
- Usual adult dosage: 220mg every 8-12 hours (660mg)
- Side effects: similar to ibuprofen which include stomach upset, mild heartburn, constipation, bloating, skin itching or rash, ringing in the ears, diarrhea, blurred vision etc.

Aspirin works by reducing the sensitivity of the pain receptors that are responsible for the stimulation of pain at sites of inflammation and trauma.
- Usual adult dosage: 650-1000mg every 4-8 hours (4000mg)
- Potential risks: salicylate intoxication occurs when taking salicylate 90-100mg/kg/day for at least 2 days. Symptoms include lethargy, nauseam dehydration, hemorrhage, pulmonary edema, hyperventilation, mental confusion, convulsion, and coma.
- Side effects: epigastric discomfort, nausea and vomiting, and other GI problems

Important information: If you are taking aspirin to prevent heart attack or stroke, avoid also taking ibuprofen as it will reduce the beneficial effect of aspirin in protecting the heart (drug-drug interaction).

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