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Tension-type headache: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Combination analgesics, sedatives, and tranquillizer/analgesic combinations have been used in the treatment of acute TTH.112 A single-dose, placebo-controlled study found that adding a muscle relaxant to a compound analgesic was complementary.113 A comparison of meprobamate and aspirin with a butalbital-aspirin-phenacetin combination found them to be equally effective, but the later had significantly more CNS adverse events. A multicentre, double-blind, randomized clinical study found that a meprobamate/acetylsalicylic acid combination was significantly more effective than aspirin alone. The combination of analgesics with caffeine, sedatives, or tranquillizers may be more effective than simple analgesics or NSAIDs. Caffeine (130 or 200 mg) as an adjunct significantly increases the efficacy of simple analgesics and ibuprofen.114–115 Eight publications reported on ten separate controlled trials of butalbital-containing combination drugs to treat TTH.97,116–122 The butalbital-containing compounds have been shown to be efficacious in placebo-controlled trials among patients with ETTHs. Short-term adverse events appeared to be infrequent and mild.
Headache
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
Acute attack treatments for migraine can be usefully divided into disease non-specific treatments, analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), and disease specific treatments, ergot-related compounds and triptans (Table 10.4). It must be said at the outset that most acute attack medications seem to have a propensity to aggravate headache frequency and can induce a state of refractory daily or near-daily headache, Medication overuse headache (see below). Codeine-containing compound analgesics are a particularly pernicious problem when available in over-the-counter (OTC) preparations. One should advise patients with migraine who have two headache days a week or more to avoid their regular use. Probably about one-third of patients who stop taking regular analgesics will have substantial improvement in their headache with a reduction in frequency or severity. The other two-thirds will have little or no change in their headache frequency, but will still feel in some way better, especially if they have been using codeine regularly. It is crucial to emphasize to the patient that standard preventive medications will, in the main, simply not work in the presence of regular analgesic use. It is often a waste of time to start a preventive in migraine patients if they are using regular analgesics; the analgesic problem must be tackled first (see below).
Acute pain management in children
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
In comparison with adults, relatively few analgesics have a clearly established role in pediatric acute pain management. Detailed analgesic clinical pharmacology is discussed in Chapter 3, Clinical pharmacology: opioids; Chapter 4, Clinical pharmacology: traditional NSAIDs and selective COX-2 inhibitors; Chapter 5, Clinical pharmacology: paracetamol and compound analgesics; Chapter 6, Clinical pharmacology: other adjuvants; and Chapter 7, Clinical pharmacology: local anesthetics.
Comparison of therapeutic effects of continuous epidural nerve block combined with drugs on postherpetic neuralgia
Published in International Journal of Neuroscience, 2021
Xi’an Dong, Yuantao Liu, Qianqian Yang, Zhaobin Liu, Zipu Zhang
PHN is one of the most common complications of HZ, which seriously affects the quality of life of patients, including physical, psychological, life and social aspects [8]. The treatment of PHN aims to relieve or even eliminate pain and associated symptoms such as depression, insomnia, and dysfunction, so as to improve the quality of life of patients [9]. However, although there are many treatments for PHN, the curative effect is not ideal [10]. If PH is not properly and effectively treated, it will inevitably make the pain last for a long time and eventually develop into a refractory PHN. Continuous epidural block is a novel method to treat PHN, in which local anesthetics are directly injected into the spinal nerve to block the nerve conduction function, so as to achieve analgesia. At present, the mechanism of gabapentin has not been fully elucidated. It may be mainly combined with the voltage-gated calcium channel α2δ subunit, which can reduce the release of glutamate, norepinephrine and substance P [11], thus effectively control neuropathic pain. There may be many other mechanisms of action [12]: 1) inhibition of r-Amino acid (GABA) mediated afferent pathways, causing effects on the central nervous system (effective effects on the spinal cord and brain levels); 2) increase the synthesis of GABA, reduce the degradation of GABA; 3) N-formaldehyde-D-aspartate (NM-DA) receptor antagonism. However, gabapentin has a slower onset effect, and the dose required to reach the effective window of the drug action is larger, and the adverse reactions are more and more serious. For difficult-to-treat PHN, the treatment is often abandoned. Oxycodone-acetaminophen is a compound analgesic consisting of 5 mg oxycodone and 325 mg paracetamol. It is the combination or synergistic action of two drugs with different mechanisms of action to increase the analgesic effect. It can also reduce the total adverse reactions due to the reduction of the dosage of the two drugs and the non-overlapping of adverse reactions.