OTC


Headache [Show Notes]

5 Types of Headaches

Tension Headache

They come on if you’re stressed or having to hold your body in an uncomfortable or unnatural position.  Neck and shoulder tension can cause the headache to hurt in the back of your head (and can radiate to your eyes due to the location of the optic area of the brain).  Intense facial expressions (including crying) can hurt in the front or sides of your head.  Obsessive personality types are more prone to tension headaches.  OTC pain meds help turn off pain receptors.  Using a warm compress to loosen and soften muscles and then doing stretches can relax the muscles and relieve tension.  Some people find that ice packs can help because the cold decreases the inflammation in the area that is tense and painful.

Cluster Headaches

They happen in groups or cycles. Mild to moderate pain.  One-sided headache accompanied by watery eyes, sinus pressure, and runny nose on that same side.  Don’t be fooled into thinking that it’s a sinus headache.  The pain from cluster headaches will make you restless – “If I can just stay busy, I won’t think about the pain and will be ok”.  This type of headache can be treated with OTC medications.

Sinus Headache

Your sinuses (tunnels in your head and face bones) are lined with mucous membranes.  They can become inflamed if they are fighting off a virus (cold), infected by bacteria (sinus infection), or from overproduction due to a severe allergy attack.  The inflammation, in itself, can cause pain.  But if they swell shut and the air inside can’t even out pressure with the outside (just like your ears when you change altitude), it can cause pain. Antihistamines and decongestants can help, and again, OTC pain relievers.

Rebound Headache

If you use a medication for a prolonged period of time, your body chemistry will adjust to it always being there.  So, if you stop taking it, your body notices the gap and responds by sending pain signals.  This happens with headache medications as well as other pain medications.  Can be an indication of medication overuse. 

Migraine

These must meet a specific set of criteria to be diagnosed.  And because they are most affected by brain chemistry, OTC medications rarely work, thus require prescription medications. 

Diagnosis criteria

  • 5 or more debilitating episodes
  • An episode lasts 4-72 hrs
  • At least 2 of the following:
    • one-sided
    • throbbing (feel the pulse or heartbeat)
    • Moderate to severe
    • Interferes or prohibits daily activity
    • Daily activity makes it worse
    • Sensitivity to light and/or sound
  • With or without aura (visual disturbances – halo, floaters; hand numbness)

A deeper look

If your brain knows something is going on, it may preemptively redirect blood and nutrients to the vital organs and thus your extremities get neglected.

Still not 100% sure what causes migraines, Neurologists can do brain scans to look for patterns in electrical signals and misfirings. So far, we know it has something to do with neurotransmitters.

Hormones can affect the brain chemistry so strongly, that each menstrual cycle can come with migraine.  Pregnancy hormones can cause migraines – either temporarily or permanently.  

Serotonin, which is your “happy” chemical, is produced when your eyes are stimulated by sunlight.  If it gets out of balance, the brain responds.  

Treatment Options

  • Triptans (a class of medications used to treat migraines) affect serotonin levels to try and rebalance it.
  • OTC and home remedies don’t work for true migraines.
  • Some people do get relief with ice packs.  Ice reduces any inflammation, and also numbs the nerves so they don’t feel as much pain.  **Ice must be used conservatively because too much ice contact can damage the skin**
  • Other people find that warm compresses hurts because the muscles around the painful area get tense and the warmth can help them relax.

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Music Credit: “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/


APAP vs NSAIDs

FAQ

What’s the difference between acetaminophen (Tylenol) and ibuprofen (Advil/Motrin)?

APAP

Acetaminophen (A-SEET-a-men-o-fin, APAP) is in a class all by itself and science isn’t 100% sure how it works. There is a suspicion that there is an enzyme in the inflammation cascade that is only found in the central nervous system, and that enzyme is inhibited by APAP. But because it’s central, this is why APAP works on pain and fever but not swelling. APAP is metabolized by the liver, and that metabolism pathway produces a very toxic by-product if it gets into a traffic jam. This is why APAP dosing limits have been adjusted, and APAP overdoses are so dangerous, even if one does not have liver disease or consume alcohol.
Podcast Episode: Too Much Acetaminophen

NSAIDs

Ibuprofen is in a class many call NSAIDs (non-steroidal anti-inflammatory drugs – because the other medications used to treat inflammation are steroids). NSAIDs, including ibuprofen work on a specific enzyme step in the inflammation process that result in pain, swelling, and fever. That is why joint and muscle injuries respond well to NSAIDs. It is also why the inflammatory response due to viral or bacterial infections are subdued easily by NSAIDs. NSAIDs are metabolized and processed through the kidneys. An overdose can lead to kidney damage, as well as kidney disease can be worsened if these medications are used.  Aspirin is also a NSAID, as well as naproxen.

Bottom Line

In my personal experience, APAP works well on fever and overall body aches (think the flu). Ibuprofen and naproxen work well on injured joints and muscles, as well as sore throat symptoms due to viral infections.  Aspirin doesn’t get recommended for the same things as NSAIDs, mostly because it has such a big reputation as a blood thinner.