after indomethacin treatment for headaches what to do next

Alternative treatments tried after the discontinuation of indomethacin included: gabapentin (Neurontin), melatonin, verapamil, topiramate (Topamax), celecoxib (Celebrex), and onabotulinumtoxinA (Botox).

Full Answer

What is the best medication for chronic headaches?

What are the treatments for chronic tension headache?

• Painkillers. You may well be used to taking painkillers such as paracetamol, aspirin, ibuprofen, etc. ...
• Treating the cause: diary. ...
• Stress and depression. ...
• Regular exercise. ...
• Physiotherapy. ...
• Acupuncture. ...
• Cognitive behavioural therapy (CBT) CBT can be a helpful add-on in the treatment of chronic daily headache. ...
• Preventative medication. ...

What conditions does indomethacin treat?

What Conditions does INDOMETHACIN Treat?

• acute inflammation of the joints due to gout attack
• joint damage causing pain and loss of function
• acute shoulder pain due to inflammation of shoulder joint
• acute pain
• ankylosing spondylitis, a rheumatic disease causing pain and stiffness in backbone
• acute shoulder pain due to tendonitis
• rheumatoid arthritis
• non-radiographic axial spondyloarthritis

Can tramadol be used to treat a headache?

Tramadol/APAP reduces the severity of pain, photophobia, and phonophobia associated with migraine headache, but does not reduce migraine-associated nausea. Tramadol/APAP might be an appropriate option for the management of moderate-to-severe migraine headache.

Is Indomethacin effective in cluster headache?

“Prescribed 50mg indomethacin daily for Cluster Headaches along with 180mg Verapamil. While the Verapamil dosage seemed completely ineffective, the Indomethacin was almost completely successful at eliminating onset of headaches (nominally 4-5 times per day).

What happens when you stop taking indomethacin?

If you stop taking it: If you don't take your medication, your pain and swelling may get worse. If you take too much: If you take too much indomethacin, you may experience side effects like nausea, vomiting, very bad headaches, confusion, and convulsions.

How long does indomethacin take to work for headaches?

The response to indomethacin is prompt. Most patients report complete relief of headache within 24 h. After one week, if the patient is asymptomatic, the dose should be decreased to the minimum effective dose at which the patient remains pain-free.

Can you get rebound headaches from indomethacin?

Simple analgesics: Common medications such as aspirin, acetaminophen, NSAIDS (ibuprofen, naproxen, indomethacin,) may contribute to rebound headaches especially when the patient exceeds the recommended daily dosages. These medications cause MOH when used 15 or more days per month.

How long should you take indomethacin?

Adults—75 to 150 milligrams (mg) per day, divided into three or four equal doses, and taken for 1 to 2 weeks as determined by your doctor....DosingAdults—50 milligrams (mg) three times a day. ... Children 15 years of age and older—Dose is based on body weight and must be determined by your doctor.More items...•

What type of headache responds to indomethacin?

Traditionally, indomethacin-responsive headaches include a subset of trigeminal autonomic cephalalgias (paroxysmal hemicrania and hemicrania continua), Valsalva-induced headaches (cough headache, exercise headache, and sex headache), primary stabbing headache, and hypnic headache.

Why do I have a permanent headache?

True (primary) chronic daily headaches don't have an identifiable underlying cause. Conditions that might cause nonprimary chronic daily headaches include: Inflammation or other problems with the blood vessels in and around the brain, including stroke. Infections, such as meningitis.

Why won't my headache go away after taking medicine?

Taking OTC pain relievers too often, or at a higher dose than advised, could cause more problems. Once the drug wears off, withdrawal symptoms start. This leads to more head pain and the need for more medicine. Doctors call this a rebound headache.

How long does it take to stop rebound headaches?

Rebound headaches will often resolve to 'normal' headaches within two months of stopping the overused medication. Therefore, withdrawal from these medications is the usual treatment for medication overuse headaches.

How do I know if it's a rebound headache?

Symptoms. Rebound headaches can cause a dull, persistent, tension-type headache that happens either daily or nearly every day. The pain is usually worse in the morning.

Does indomethacin help with headaches?

Indomethacin may also be helpful in headache related to physical stress or exertional headache. It has been shown to be effective in migraine both for prevention of migraine as well as treating the acute migraine attack.

What can I take instead of indomethacin?

Naproxen.Indocin.Ibuprofen.Methylprednisolone.Advil.Aleve.

Can I take paracetamol and indomethacin together?

Indomethacin+Paracetamol is used for pain relief. Indomethacin + Paracetamol is a combination of two medicines: Indomethacin and Paracetamol. These medicines work by blocking the action of chemical messengers responsible for pain, fever and inflammation (redness and swelling).

What are the side effects of indomethacin?

Downsides. If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include: Indigestion, heartburn, and very occasionally, stomach ulceration and bleeding.

How does Indomethacin work?

Indomethacin works by blocking the effects of the enzymes cyclooxygenase (COX)-1 and COX-2. This prevents prostaglandin synthesis (prostaglandins elevate body temperature and make nerve endings more sensitive to pain transmission). Indomethacin belongs to a group of medicines known as NSAIDs (nonsteroidal anti-inflammatory drugs).

How long does it take for indomethacin to be absorbed?

Peak levels are reached 2 hours after administration, and 90% of a dose is absorbed within 4 hours of administration. Indomethacin is approximately 10 times as potent as aspirin. 7. Interactions.

What medications interact with indomethacin?

Common medications that may interact with indomethacin include: ACE inhibitors or ARBs, such as captopril, enalapril, or losartan. antibiotics, such as ciprofloxacin or vancomycin. anticoagulants (blood thinners) such as apixaban, dabigatran, fondaparinux, heparin, or warfarin.

Can Indomethacin cause stomach pain?

People of an older age, taking other medicines that affect the stomach, or who drink more than 3 glasses of alcohol per day may be more at risk. Indomethacin is considered to carry a high risk for stomach-related side effects compared with other NSAIDs. A headache is also a common side effect.

Is Indomethacin a cardiovascular drug?

The risk may be higher in patients with pre-existing cardiovascular conditions and with higher dosages. Indomethacin is considered to carry a high risk for cardiovascular-related side effects compared with other NSAIDs.

Is indomethacin a first line drug?

NSAIDs (including indomethacin) are considered first-line options for mild-to-moderate acute pain because at correct dosages they are effective, do not cause dependence, and are readily available at a low cost. Available as immediate-release capsules, suspension, extended-release capsules, and suppository form.

How often does paroxysmal hemicrania occur?

Symptoms of paroxysmal hemicrania are similar to those of cluster headaches: the pain is very severe, very brief (lasting a few minutes) and occurs anywhere from a few times to a few hundred times a day. The pain is always one-sided, localized to the eye and it is often accompanied by tearing, nasal congestion, and redness of the eye. ...

Is Indomethacin a NSAID?

Indomethacin belongs to the category of NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, naproxen, and other. Indomethacin is somewhat unique in the way it works and it is often stronger, however it also causes more gastrointestinal side effects than other NSAIDs.

Does indomethacin cause headaches?

Indomethacin-responsive headaches. Chronic and episodic paroxysmal hemicrania and hemicrania continua are rare types of headaches that have one common feature – they respond very well to indomethacin (Indocin). The diagnosis is actually based not only on clinical features but also on the response to indomethacin.

When was indomethacin first used?

Indomethacin has been used for the treatment of headache disorders since the 1960's, shortly after it was introduced as a treatment for pain and joint swelling in rheumatologic conditions.

Is indomethacin good for headaches?

These disorders have been better characterized over the past decade and classified into primary headache disorders of paroxysmal hemicrania (PH) and hemicrania continua (HC). Since the current ICHD-3 beta requires response to indomethacin as a diagnostic criterion, studies on alternative treatments in HC and PH generally occur in patients with intolerance to its gastro-intestinal side effects rather than loss of analgesia effectiveness. More rarely, the development of new headaches have been reported in chronic indomethacin use. In these settings, other classes of medications such as selective cyclooxygenase-2 inhibitors (celecoxib), anti-epileptic agents (topiramate), calcium channel blockers (verapamil, flunarizine), melatonin, and local nerve blocks with anesthetic and steroids have been shown to be effective in case reports and series. We review the literature and provide our clinical recommendations on alternative therapies for the "indomethacin-responsive headaches".

Abstract

Indomethacin is a nonsteroidal anti-inflammatory drug whose mechanism of action in certain types of headache disorders remains unknown. The so-called indomethacin-responsive headache disorders consist of a group of conditions with a very different presentation that have a particularly good response to indomethacin.

BACKGROUND

Indomethacin-sensitive headache disorders are a group of rare conditions, for which understanding of the underlying neurobiology is limited.

METHODS

We used the PubMed and Cochrane databases in September 2020 to perform a narrative literature review and searched for the following keywords: “Indomethacin-responsive headaches,” “Indomethacin-sensitive headaches,” “Indomethacin pharmacology,” “Indomethacin AND intracranial pressure,” “Indomethacin AND prostaglandins,” and “Nitric oxide AND Indomethacin.” Articles addressing pharmacology, clinical trials, and observational studies were included.

PHARMACOKINETICS

Indomethacin was, along with aspirin, one of the compounds used by John Vane to discover nonsteroidal anti-inflammatory drugs’ (NSAIDs) essential activity as a prostaglandin inhibitor in 1971, 3 which subsequently led to him winning the Nobel Prize in Physiology or Medicine in 1982, 4 shared with Bergström and Samuelsson for their work with prostaglandins.

PHARMACODYNAMICS

Adverse events can be present in more than 30% of patients, and the majority of them are within the gastrointestinal spectrum.

MECHANISM OF ACTION

The unique effect of indomethacin on certain headache disorders is unknown and may not be the same for each disorder. Aside from the well-known inhibition of cyclooxygenase, in other activities, such as reduction of cerebral blood flow (CBF), the inhibition of nitric oxide (NO) pathways or attenuation of oxidative stress 24 may be important.

REGULATION OF INTRACRANIAL PRESSURE AND CEREBRAL BLOOD FLOW

The regulation of intracranial pressure may play an important part in the action of indomethacin on traumatic brain injury, as well as cough, exertional, or sexual headaches, when a peak in intracranial pressure is proposed as the underlying pathophysiology. 33

What is HC headache?

"Hemicrania continua (HC) is a primary headache disorder which responds absolutely to therapeutic doses of indomethacin. Unfortunately, approximately a fourth of patients develop adverse effects leading to discontinuation of the drug, and no other treatments have been proven to be consistently effective."#N#1

Can you take indomethacin with comorbid conditions?

Because of the potential side effects and various contraindications some due to comorbid conditions, many people cannot take indomethacin. This is an issue that has needed to be studied for quite some time. The results of this study are promising.

Is hemicrania continua easy to treat?

In a way, it would seem that hemicrania continua should be easy to treat given that one of the criteria for diagnosing it is that it responds to indomethacin. However, to the extreme frustration of both patients and their doctors, it's not that simple.

Is indomethacin effective for HC?

Study Conclusion: "Indomethacin is the most effective treatment for HC. Adverse effects and comorbidities which preclude the use of indomethacin often make the treatment of HC challenging. In clinical practice, alternative treatments have not been consistently effective or tolerated.

Is onabotulinumtoxina good for migraines?

Although reading the potential side effects of onabotulinumtoxinA can look somewhat alarming, it's important to note that its side effects profile is actually quite favorable when compared to that of many other treatments used for migraine and headache prevention. Hopefully, larger studies will be undertaken soon.

What is the rating of Indomethacin IV?

Also known as: Indocin, Tivorbex, Indocin SR, Indocin IV. Indomethacin has an average rating of 8.5 out of 10 from a total of 15 ratings for the treatment of Cluster Headaches. 80% of users who reviewed this medication reported a positive effect, while 0% reported a negative effect. Filter by condition.

Does indomethacin make you tired?

Indomethacin has side effects: tired, grumpy, mean, and hard on my kidneys, so I don’t take it during the day when I can manage the pain with ice, only just before bed so I don’t wake up in excruciating pain.

Can I take indomethacin for pain?

Yes No. “ Indomethacin is very effective for pain management, I can take as little as 5 mg to get relief (I buy empty capsules and divide the dosage), up to 25 mg if the pain is severe. I also manage the pain very well with ice (Bed Buddy wrapped around my head and stronger), and some pain distraction techniques.

When to take preventive medicine for headaches?

If your exercise headaches are frequent or unpredictable, you might need to take the preventive medicine every day.

What is the best medication for headaches after exercise?

If no underlying structural or vascular problem is causing your exercise headaches, your doctor may recommend medications to take regularly to help prevent the headaches. Indomethacin (Indocin, Tivorbex), an anti-inflammatory drug, is commonly prescribed.

What age do you get a headache?

Your headaches strike suddenly, like a thunderclap. You're older than age 40. You have other signs and symptoms, such as nausea, vomiting or vision disturbances. In these cases, different types of imaging tests can help your doctor verify that you have the harmless variety of exercise headache, rather than the type caused by a structural ...

When to use spinal tap for headache?

This test can show fresh or recent bleeding into or around the brain and is often used if your headache occurred less than 48 hours beforehand. Sometimes a spinal tap (lumbar puncture) is needed as well, especially if the headache started abruptly and very recently and brain imaging appears normal.

What to do when you have a pre-appointment?

When you make the appointment, ask if there's anything you need to do in advance, such as restricting your diet. Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

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