Headache Treatment

First line:

  • NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (nurofen), ketoprofen (ketonal), indomethacin and other or selective COX-2 blockers and coxibs (celecoxib, etherokoksib);
  • Antipyretics / analgesics such as metamizol (analgin) or paracetamol (usual dose of 1 gram).

I prefer to prescribe paracetamol initially, it helps a lot with a dose of 1 gram. Ketorol is very good for anesthesia, but I never prescribe it myself, and in every possible way I avoid it because of gastrotoxicity: it can cause stomach and duodenal ulcers.

Paracetamol is the safest drug at the moment, 1 gram 4 times a day is considered a safe dose. Instead of ibuprofen, I would recommend Coxibs, they have less effect on the stomach, but they also act on the kidneys, however, you can also take it for a long time with the protection of the stomach (taken after eating, diet + proton pump blockers), for life take.

In general, the NSAIDs will soon disappear anyway, when celecoxib generics appear. (original – a little expensive: 400-1200 rubles per pack).

Second line:

stronger painkillers in paracetamol / codeine, paracetamol / tramadol combinations.

The third line:

add antidepressants, but this is for chronic tension headaches. In our country, a very strange and extremely wrong attitude to antidepressants. I just recently returned from Austria from schooling for pain treatment, where a German pain treatment specialist said that 100% of patients undergo a psychiatric examination as part of monitoring depression.

The pain itself is a vile thing, except for masochists no one really loves it, but here it is for a long time, and even forever climbs into your life. Either pain provokes and supports depression, or initially hidden depression provokes and supports pain. The connection is proven, it is and something must be done with it. In this context, the appointment of antidepressants is justified and necessary.

The task of antidepressants is to reduce the number of attacks in combination therapy (I always emphasize this because with one pill you will not remove complex pain), ideally, to zero. And I immediately explain: we do not treat depression as antidepressants as such, we remove the depressive component of chronic pain. Often, patients refuse to take antidepressants, saying why they are to me, I’m not depressed. We have to explain that depression is a serious disease that has different manifestations. One person walks into depression after a couple of years of illness, and someone with mild depression marines himself for years without even thinking that the daily negative that supposedly falls on him is a manifestation of this mild form of depression, if it is without pain.

And if with pain, then the life of an ordinary person and the life of a person with chronic pain, or rather a person who did not have pain and then it arose and was chronized – these are two different lives. For example, you often ask a patient about his past – to the pain and he tells about himself as another person: “I traveled / worked / loved to do (insert the missed), but now I can’t because of the pain.” And this is one of the origins of the depressive component.

Ideally, of course, a psychiatrist needs to be examined in order to professionally confirm the depressive component and how pronounced it is, which in patients with chronic pain is close to 100%.

It is worth noting that with an unsystematic constant intake of drugs, a drug-induced headache may develop. That is, the pain is no longer associated with the original problem of a headache, but with the immediate administration of an anesthetic. This usually develops after 3 months of systemic intake and it is very difficult to distinguish tension headache or migraine from drug-induced headache.

To avoid this, the rule is simple: no more than two drugs per day, no more than two times a week.

Tablets are nice, but you have to understand that a headache is not a cause but a consequence.

So we recommend changing your lifestyle:

  • Regular physical activity / sports (if you don’t work out at the gym, even just walk at least 2 hours a day. Do not stand on the escalator, but go. Do not wait for the elevator, but go up the stairs. Good weather? Walk a couple of subway stations on foot and etc);
  • Refusal of smoking and a large amount of coffee;
  • Normal lifestyle: sleep mode (too much sleep – bad, too little – bad, 6–9 hours – normal), regular meals (usually often fractionally 4–5 times a day in small portions, hunger – a rather serious stress provoker) and so on.
  • Various meditation techniques, cognitive-behavioral techniques, consultation of a psychiatrist and a psychotherapist for the selection and change of attitude to stress and increasing stress tolerance. After all, it’s important not only that we experience pain, it’s important how we perceive it and how much we are able to control it, but not it.