indomethacin

5 February 2018

Diagnosing: Sudden Sharp Pain in Head

Every once in a while we look at specific symptoms and possible diagnoses. Today, that sudden, sharp pain in head will be our focus.

Sudden sharp pain in head Sudden, sharp pain sometimes has a direct trigger or cause. For example, if you go out in cold weather, or even dive into cold water, you may end up with a stabbing headache. Normally these don’t last long.

Headaches during airplane travel may also have a sudden, stabbing quality.

Sudden sharp pain in the head may also be caused by an actual disease or organic dysfunction. It’s important to see a doctor if this is a kind of headache you haven’t experienced before.

Some people experience headaches that feel like sudden stabs, or several sudden stabs, lasting for only a few seconds. The location of the stabbing changes. This is called primary stabbing headache.

This type of headache is difficult to treat, because it’s so brief. However, if it’s a constant problem, medication such as indomethacin may be prescribed.

If the pain tends to always be in the same place, and you also have migraine pain that tends to be in the same place, they may be related. Or, it could be a sign of a problem with the nerves in that location.

But there are other headaches that may cause this type of pain. Pain from trigeminal neuralgia is often described as being like “an electric shock”, and may be triggered by a touch to the face. There are also other types of neuralgia (neuralgia refers to pain along the path of a nerve, and may have various causes. See this article: nerve pain in head).

As you might guess by now, the location of the pain is very important for getting a proper diagnosis and treatment. If you experience sudden sharp pain in the head, take note – where was it? Is it always in the same place?

If the pain is sudden, but lasts a few minutes instead of a few seconds, the diagnosis will also be different. SUNCT is an example of this type of headache.

There are various medication that can be used for these types of headaches, but it very much depends on frequency and diagnosis. If this headache is new to you, do see a doctor right away to rule out the most urgent concerns that need to be treated immediately.

17 September 2015

Headache Waking You Up? Could Be Hypnic Headache.

James Discoveries & Stats, Medications, Treatments 0

You’ve noticed it’s starting to happen on a regular basis. All of a sudden, you wake up with a headache.

You didn’t have the headache when you went to sleep. Where did it come from? It may just be mild, but it could be severe – you might even feel sick.

Hypnic Headache - waking you up? Now that you’re awake, the headache lasts for a few minutes – but could even last up to four hours.

And it’s happening several times a week now – twice a week, maybe four times, or even every night.

It’s possible that you have a rare kind of primary headache known as hypnic headache.

But don’t jump to conclusions too quickly. This headache, sometimes known as the “alarm clock headache”, really is quite rare. It tends to happen in people over the age of 50, and it can easily be misdiagnosed.

The reason is that there are many other reasons why you may wake up with a headache. Sleep apnea is a common trigger of certain headaches, for example.

If you wake up feeling restless, it probably isn’t hypnic headache. A hypnic headache generally won’t last for more than 4 hours. And it will wake you up quite often – more than twice a week, often every day.

If you suspect you have hypnic headache, your doctor will want to ask some questions to try to find an underlying cause. Chances are she will give you a different diagnosis. Like I said, it’s rare.

However, if you are diagnosed with hypnic headache, there are some excellent treatments.

A recent study suggested that lithium is the best treatment for these types of headaches. Oddly enough, caffeine consumption upon waking is the second-best treatment. Melatonin or indomethacin may also be tried if these are not effective.

For more information about hypnic headache, check the links below:

Lithium, caffeine effective for hypnic headache treatment
Hypnic Headache (The Migraine Trust)
Hypnic headache (International Headache Society)

20 August 2015

Are we ruling out hemicrania continua too soon?

James Information, Medications, Tips 3

You’ve had a headache for weeks – then months – it may get better or worse, but it rarely (if ever) goes away completely.

It’s a one-sided headache, and some strange symptoms go along with it. Flushing or sweating in the face, congestion, watery eyes, feeling restless. A sensitivity to light or noise.

Are we missing hemicrania continua? Part of the problem is that sometimes the symptoms play tricks on you. They may look a lot like migraine symptoms. Or they may not look like hemicrania continua (HC) symptoms – for example, a key diagnostic criteria, that HC is pain on one side of the head, seems to be almost always but not always the reality.

But there is another concern that neurologist Dr. Randolph W. Evans has. In his recent article Migraine Mimics, he suggests that some doctors may not be using the typical HC treatment properly.

HC is one headache condition that is diagnosed by treatment. It always responds to indomethacin. When the patient takes indomethacin, the headaches go away, and the diagnosis of hemicrania continua is confirmed.

But there is a catch. How much indomethacin should the patient take, and for how long? Could it be that some doctors are not raising the dosage high enough?

Dr. Evans mentions one case in which a woman had tried indomethacin for five months – surely a long enough trial. The problem was, the dosage was too low.

Missing a diagnosis by a few milligrams is pretty frustrating, especially considering that it’s not unusual for a patient to go through several doctors and wait 5-10 years for a proper diagnosis.

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID), and doctors are right to start on a low dose. Side effects can include abdominal pain, nausea, and diarrhea to name a few.

Dr. Evans suggests that doses as low as 25-50mg a day can be effective for some patients. Some patients may go up to a high dose, but be able to taper off down to about 60mg.

One specific suggestion is to try going from 75mg to 150mg to 225mg, trying each dosage for 5 days. Patients will often split the daily dose throughout the day.

Although the usual recommendation is to try up to 225mg (for example, 75mg 3x daily), there are some reports of patients responding to 300mg/day.

Because indomethacin can help us get a clear diagnosis, even if the patient can’t continue taking it, doctors should be cautioned not to stop raising the dose too soon. If the patient is able to get rid of the headache, but can’t tolerate the medication, there are other options to try.

Hemicrania continua is so often misdiagnosed, it may be more common than we think. This may be a simple way to catch cases and provide better treatment.

13 October 2014

Stabbing Headache – Could it be MS?

James Discoveries & Stats 0

Although most autoimmune disorders are chronic, patients have a number of reasons for wanting to diagnose them early. First and most importantly, there is the concern that these disorders are degenerative – they get worse as time goes by, in a way which may not be reversible.

Of course there’s also the matter of the symptoms themselves. The sooner you can get them under control, the sooner the patient can have a life with less disability.

And this is what makes some recent research into primary stabbing headache particularly interesting.

Stabbing headache is characterized as jolts of headache pain (often in the face or around they eye) that usually last for two or three seconds. It may just happen once, or it could happen many times a day.

Many migraine patients have the occasional stabbing headache. Treatment often involves a non-steroidal anti-inflammatory drug, such as indomethacin.

Primary stabbing headache is not caused by a known underlying disorder (by definition). However, a study published in 2012 following 26 patients with stabbing headache found that over half of the patients also had an autoimmune disorder (Stabbing headache in patients with autoimmune disorders.).

This would include not only multiple sclerosis but also lupus, autoimmune vasculitis, and Sjogren’s syndrome.

Could the damage done by these diseases actually bring on the stabbing pain?

A more recent study found that a flare-up of multiple sclerosis (MS) could bring on the stabbing pain, and that treating the MS would also alleviate the head pain (Stabbing headache as a sign of relapses in multiple sclerosis.).

Could this type of pain be an early sign of an autoimmune disease? At the very least, it could be a sign that a flare-up needs to be treated. If doctors are aware of the connection between stabbing headache and autoimmune disorders, they may be able to ask the right questions to get patients treatment faster.

10 June 2014

Hemicrania Continua: Is Melatonin an Alternative to Indomethacin?

James Discoveries & Stats, Medications, Treatments 8

If you’ve never heard of hemicrania continua, you’re already lost. If you have hemicrania continua, you know exactly what I’m talking about.

Briefly, for the fortunate ones who don’t have this condition, hemicrania continua is a constant one-sided headache which is often accompanied by watery eyes and congestion. It’s often misdiagnosed as migraine or sinus headache. For more quick info, see Hemicrania Continua Facts.

There are some unique things about this condition. For example, the headache is always one-sided. And although it may wax and wane, the headache is always there.

But for our purposes, the important thing is that it it treated with indomethacin, a non-steroidal anti-inflammatory drug (NSAID) (similar to ibuprofen). And this treatment always works. Well, mostly.

Although hemicrania continua always responds to indomethacin, dosages may vary and its effectiveness may change over time.

But there’s a worse problem – side effects. Stomach problems, ringing in the ears – and even more headaches, to name a few of the more common issues.

So although patients are encouraged to periodically try to lower the dosage (once they’re stabalized), the possibility of new treatments is very attractive.

Melatonin is one of the main alternative treatments for hemicrania continua. There are few other treatments, and even melatonin has been studied very little. This is mainly because this is such a rare disorder.

However, more and more patients are trying melatonin as a safer alternative to indomethacin. Some patients start taking melatonin and are able to phase out indomethacin use. The melatonin may be taken during the day (it’s usually taken before bed as a sleeping aid).

Researchers at the University College London Medical School are encouraging doctors to take this treatment more seriously, after describing the case of another patient who found relief with melatonin.

Melatonin is inexpensive and widely available. Although it’s considered generally safe, do talk to your doctor if you plan to take it for more than a few days.