What are tension headaches?

Also known as muscle contraction or chronic daily headache, this is the most common variety of headache. Most people will have suffered from tension headaches at some point in their lives and never seek medical assistance but for a small minority of patients the condition is severe, long-standing and may be difficult to treat.

What causes tension headaches and who is at risk?

It was long believed that tension headaches were due to overcontraction of the muscles covering the scalp and back of the neck. However, all types of chronic (prolonged) headache may give rise to increased muscle tension and individuals with tension headaches often describe the continuous squeezing discomfort even when completely relaxed.

Despite this condition being one of the most common to affect humans, surprisingly little is understood of the exact mechanisms giving rise to the symptoms.

It is not uncommon for tension headaches and migraine (another type of headache described in a separate factsheet) to occur in the same individual, often with the migraine attack subsiding and evolving into a tension headache.

Tension headaches are undoubtedly more common in people suffering from anxiety and depression and effective treatment of these conditions may result in improvement of the headache. As tension headaches can last for a long time, this often arouses the suspicion in the sufferer and his or her doctor that a brain tumour could be the cause of symptoms.

What are the common symptoms and complications of tension headaches?

This headache usually affects both sides of the head, often involving the back of the head and neck but also frequently the sides and front of the head. Commonly, the entire head is affected in a diffuse manner. The pain is described as a dull, aching or squeezing but others often describe sensations such as fullness, tightness or pressure. Sometimes there may be the sensation that the head is surrounded by a band or being compressed in a vice. The onset of the attack is usually more gradual than in migraine and the duration of the attack may range from hours to years. Frequently the sufferer will claim the pain is present every day without a break, although the intensity may vary considerably during this time. Sleep is not usually affected, although the headache is often present on waking or soon after.

Tension headaches rarely begin during childhood or adolescence but more commonly during middle age. They are more common in women than men.

What is the treatment for tension headaches?

One particularly useful drug for treating tension headache is amitriptyline; this is taken at night before going to bed. Treatment is commenced at a low dose and gradually built up over a period of weeks to minimise problematic side effects which may include morning drowsiness. However, this side effect usually improves within a few days to weeks when the headaches should be improving. Amitriptyline is also an effective antidepressant and may helpfully improve the anxiety commonly associated with tension headaches.

Complementary therapy

Acupuncture, the Alexander technique, reflexology and relaxation exercises linked to visualisation with feedback may all be helpful at reducing stress and the chronic anxiety often associated with tension headache.

Identifying particular causes of stress and making appropriate changes in lifestyle (eg taking up regular exercise) may also prove effective.



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Tramadol is a narcotic-like drug used to soothe from moderate to severe body pains. It works in similar ways as morphine and can be addictive. Thus, there is a tendency of the drug being abused. It is available in both original and generic forms and is administered as tablets, capsules or in liquid forms.

Dosage

The recommended dose for extended release tablets is 100mg per day which can be increased by 100mg every five days but not to exceed 300mg per day.  These tablets should be swallowed whole and should NEVER be crushed or chewed.

The immediate release tablets should be taken every 4 to 6 hours with the maximum dosage of 400mg per day. The patient is advised to start of by taking 25mg daily which is then increased to 50mg every three days. It can be taken with a glass full of water or with food.

If you miss a dose, take it as soon as you remember. However, DO NOT take a double dose. In case of an overdose, seek medical help immediately. Never stop medication suddenly as it causes unpleasant withdrawal symptoms.



Points to Note Before Taking Tramadol

•    You should not take this drug if you are an addict, was an addict or have recently used any of the following: alcohol, stress and depression relievers, medication for mental illnesses, sedatives or tranquilizers and any narcotic pain medicine.

•    Inform your physician if you are suffering from kidney, liver or stomach diseases and if you have a history of depression, suicidal attempts or mental illness.

•    The drug can produce an allergic effect hence the need to let the doctor know if you are allergic to any medicine.

•    It’s not recommended for pregnant and lactating mothers not unless directed by a doctor.



Side Effects

The more serious adverse effects are: convulsions, difficulty in breathing accompanied by weak pulses and red blistering and peeling of the skin. The less serious effects are: nausea, blurred vision, insomnia, dizziness and drowsiness as well as loss of appetite.

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Generic Name: tramadol (TRAM a dol)

Brand Names: Ultram, Ultram ER

What is tramadol?

Tramadol is a narcotic-like pain reliever.

Tramadol is used to treat moderate to severe pain. Tramadol extended-release is used to treat moderate to severe chronic pain when treatment is needed around the clock.

Tramadol may also be used for other purposes not listed in this medication guide.

Important information about tramadol

You should not take tramadol if you have ever been addicted to drugs or alcohol.

Seizures (convulsions) have occurred in some people taking tramadol. You may be more likely to have a seizure while taking tramadol if you have a history of seizures or head injury, a metabolic disorder, or if you are taking certain medicines such as antidepressants, muscle relaxers, or medicine for nausea and vomiting.

Take tramadol exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Do not take more than 300 milligrams of tramadol in one day.

Seek emergency medical attention if you think you have used too much of this medicine. A tramadol overdose can be fatal. Overdose symptoms of a tramadol overdose may include drowsiness, shallow breathing, slow heartbeat, extreme weakness, cold or clammy skin, feeling light-headed, fainting, or coma. Tramadol may be habit-forming and should be used only by the person it was prescribed for. Tramadol should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Tramadol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Do not stop using tramadol suddenly, or you could have unpleasant withdrawal symptoms such as anxiety, sweating, nausea, diarrhea, tremors, chills, hallucinations, trouble sleeping, or breathing problems. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Do not crush the tramadol tablet. This medicine is for oral (by mouth) use only. Powder from a crushed tablet should not be inhaled or diluted with liquid and injected into the body. Using this medicine by inhalation or injection can cause life-threatening side effects, overdose, or death.

Before taking tramadol

You should not take tramadol if you have ever been addicted to drugs or alcohol, if you are currently intoxicated (drunk), or if you have recently used any of the following drugs:





alcohol;





narcotic pain medicine;





sedatives or tranquilizers (such as Valium);





medicine for depression or anxiety;





medicine for mental illness (such as bipolar disorder, schizophrenia); or





street drugs.





Seizures have occurred in some people taking tramadol. Your risk of a seizure may be higher if you have any of these conditions:





a history of drug or alcohol addiction;





a history of epilepsy or other seizure disorder;





a history of head injury;





a metabolic disorder; or





if you are also taking an antidepressant, muscle relaxer, or medicine for nausea and vomiting.





Talk with your doctor about your individual risk of having a seizure while taking tramadol.

Before taking tramadol, tell your doctor if you are allergic to any drugs, or if you have:





kidney disease;





liver disease;





a stomach disorder; or





a history of depression, mental illness, or suicide attempt.





If you have any of these conditions, you may need a dose adjustment or special tests to safely take tramadol.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tramadol may also cause serious or fatal side effects in a newborn if the mother uses the medication during pregnancy or labor. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Tramadol can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Tramadol should not be given to a child younger than 18 years of age.

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The pathophysiology of dental pain is a complex central and peripheral nervous system process, and the use of combination analgesics that act at multiple pain sites can improve dental pain relief. In general, for the treatment of mild to moderate dental pain, the most appropriate options are:

• Acetaminophen (Tylenol), 650mg every 4-6 hour as needed for dental pain; • Non-steroidal anti-inflammatory drugs, or NSAIDs (Advil, Motrin, Aleve), 400mg every 4-6 hours as needed for dental pain; and • COX-2-selective inhibitors, celecoxib (Celebrex) and rofecoxib (Vioxx), 25-50mg per day as needed for dental pain.

Acetaminophen: Acetic acid and p-aminophenol, or APAP—commonly known as acetaminophen—is classified as a nonnarcotic pain reliever. Dentists generally use it for mild to moderate dental pain. It acts as both anti-pain and anti-fever. It has rapid painkiller action. Acetaminophen, unlike nonsteroidal anti-inflammatory drugs, or NSAIDs, has little anti-inflammatory action. It generally is safe for acute dental pain. At very high single doses it causes liver damages.

Acetaminophen’s dose of 500-650 milligrams is good dental pain-reliever. However, such relief is brief, peaking one hour after administration. Significantly more dental pain relief can be provided by acetaminophen’s dose of 1,000 mg. At this dosage, the maximal efficacy of acetaminophen is achieved and last up to four hours after administration. There is no more oral pain relief in dose higher than 1000 mg. Because of this “ceiling-dose” effect, acetaminophen is good shot-term reliever for mild dental pain.

NSAIDs: NSAIDs have been the traditional treatment for moderate dental pain and inflammation. NSAIDs such as ibuprofen, ketorolac, flurbiprofen, ketoprofen, diclofenac, aspirin and aspirin derivatives diminish local dental pain. Long-term use of NSAIDs, however, can gastrointestinal distress, bleeding, kidney damages, and cardiovascular problems. Also, NSAIDs have been shown to interact with several high blood pressure drugs, which may compromise blood pressure control. The most common short-term side effects of NSAID usage are upset stomach, diarrhea and abdominal pain.

NSAIDs generally require a higher dose to achieve maximum anti-inflammatory and anti-pain effect. Dosage of 800 mg three times per day may be needed for dental pain. The FDA-recommended daily dose is 2,400 mg. Studies has indicated that no more dental pain reliever is achieved with higher-than-the-recommended dosage. Comparing to acetaminophen, NSAID’s are better pain killer, but they act slower and last about the same time (about 4 hours).

COX-2 NSAIDs: COX-2 NSAIDs were developed to limit NSAID’s adverse effects. The two COX-2-selective inhibitors, celecoxib (Celebrex) and rofecoxib (Vioxx) are characterized by the following:

• less risk of GI ulceration than nonselective NSAIDs; • similar types of other GI side effects, such as abdominal pain, dyspepsia, diarrhea and nausea; • lack of effect on platelet function, unlike nonselective NSAIDs; • renal toxicity similar to that of other NSAIDS; • generally long duration of action, with once-daily administration for rofecoxib and once- or twice-daily administration for celecoxib.

However, while COX-2 therapy may reduce the risk of GI ulcerations, recent evidence indicates that COX-2 therapy may not reduce the risk of cardiovascular complications (heart attacks). This is the reason why Vioxx is currently taken off the US market.



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Migraine headaches are severe headaches that often begin in one area of the head and then spread to other ears. When a migraine strikes, it may seem like the worst pain in the world and you would do anything to stop it. The good thing regarding a migraine is that it is transient, that is the pain will go away after sometime.

A variety of headache closely related to the migraine is the cluster headache. The truth is almost everyone has had a headache at one point in his or her life. How bad are your headaches? Is it just a normal headache or it is a migraine headache? Read on to find out more.

The most important symptom you will probably have with your migraine headache is pain, and as you know, the pain can be very severe and last many hours. The exact cycle of events taking place in our brains during a migraine attack is still not fully understood. Approximately 25% of women and 8% of men suffer from migraine at some time in their lives. A migraine may remain at a “static” level that is tolerable, as long as the patient is not physically active, such as sitting at the office, or reading at home.

Migraine triggers are numerous and varied and occur in combinations peculiar to a individual. Triggers can be divided into different groups, including emotional triggers, stress, environmental, chemical, food and beverage. Migraine headache resulted from the expansion (or dilation) of blood vessels in the brain and scalp. Insufficient sleep, anxiety, problems, and worries give rise to the migraine headache. Staying up late or drinking too much coffee will bring on a headache every time. There are many possible triggers for migraines and they differ from one migraine sufferer to another. Stress, insomnia, over sleeping, and hunger may also trigger migraines.

What causes migraines is still somewhat of a mystery. Some even go to say that a migraine maybe caused by the end of a stressful situation. You may find it hard to avoid them, but for some people, environmental changes can trigger a migraine. Although the cause of migraine headaches is often undetermined, we do know that they present in different ways, and may involve different areas of the head and/or neck area.

Treatments of Migraine Headache

There are a lot of things you can do for yourself to help treat each of your migraine headaches. Some people find that by falling asleep, they can actually reduce the attack. Before you consider any treatment for your headaches, it is important that you make sure your diagnosis is indeed migraine

Crucial to the appropriate treatment of headache is the proper diagnosis of its type, and migraine headache is a particularly common form of recurring headache. Individuals with mild and infrequent migraine headaches that do not cause disability may require only OTC analgesics. Knowing what triggers attacks is a major step towards preventing them. People can avoid exacerbating aspects of Migraine by paying more attention to the triggering cause of the pain.

One of the most important aspects of headache treatment is your own control over your headache, and control starts with identifying your own triggers, and learning to avoid them. How migraine headaches are treated is usually determined by the frequency of the headaches. If the pain is severe, which it frequently is during a full-blown migraine attack, then you may need medication. Virtually all migraine therapies are designed to eliminate, or at least reduce, pain.

There are other alternative treatment options for migraine headaches. Some people put fingertip pressure on one of your temporal arteries, which are arteries you can feel on either side of your head near your temples. Other non-medication treatments include relaxation training; thermal or electromyographic (EMG) biofeedback, which is electrical activity recorded from small sensors attached to the scalp, mixed with relaxation training; and cognitive-behavioral treatments. Try putting a cold damp cloth on your forehead or temple (on the side that is painful), or deploy a frozen bag of peas wrapped in a small towel, as cold compresses can sometimes help with the pain.

Given so much options of treatments, there is no need to endure the pain. The good thing about a migraine is that it usually stops as people get older.



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