Tension-type headaches are the kind of migraine. To chronic sufferers (frequent pain for more than six months) tension-type headaches can be disabling and cause the overuse of pain medicines.  About 3 percent of women and 1.5 percent of men in the general population experience chronic tension-type headaches in a given year.

Anti-depressants are the primary drug therapy for chronic headaches.  Behavioral therapies such as relaxation and stress management, though less studied, are also used to manage the associated pain.  Recent research, however, has cast doubt on the effectiveness of both these treatments.

In a new study, Kenneth A. Holroyd, PhD of Ohio University and colleagues set out to determine the combined and separate effects of anti-depressant medication (AM) and stress management therapy (SMT) on headaches. The medications used were one of two possible tricycline-type anti-depressants, amitriptyline hydrochloride or nortriptyline.

From 1995 to 1998, 203 volunteers were recruited to the study.  All participants, between 18 and 65 years old, had been diagnosed with chronic tension-type headaches.  For one month these patients kept a diary listing headache intensity and pain medications taken.  Headache intensities were ranked 4 times per day on a 0-10 scale.

Once baselines were established, the subjects were randomly divided into 4 groups.  Fifty-three patients were assigned to get AM, which consisted of either amitriptyline hcl (up to 100mg per day) or nortriptyline (up to 75 mg per day).  Another group of 48 patients received inactive placebo pills.  Forty-nine subjects received SMT, which consisted of relaxation and cognitive coping exercises, and the placebo pills.  The remaining 53 patients received both SMT and AM.  Subjects continued to keep a their daily diaries for an eight month treatment phase along with periodic clinical visits.

The researchers compared the intensity and frequency of headaches and the number of times patients took pain medications among the 4 treatment groups.

By the end of the 8 month evaluation period, all three active treatments, but not the placebo, yielded similar improvements in reducing headache intensity and frequency and pain medication use.  These improvements were more rapid in the AM and combined therapy groups than the SMT group.

A greater proportion of subjects in the AM plus SMT group (64 percent) showed clinically significant (greater than 50 percent) reductions in migraine scores compared with the AM only group (38 percent) and SMT only group (35 percent).

Eighty percent of the subjects who took AM reported adverse side effects, compared to 30 percent who took the placebo pills.  The only side effects reported by more than 10 percent of either treatment group were dry mouth and drowsiness.

Suggested dosage regimen
1. A typical prescription calls for 1/2 to 2 tablets at 50 mg each, used each 4-6 hours as needed for pain. To begin with, you may be given a lower dose. Then your doctor may increase the dose gradually. This will give your body a chance to become accustomed to tramadol so that you can avoid side effects. Never take more than 400 mg of tramadol within a 24 hour period.

Side effects
2. You could feel lightheaded or drowsy after taking tramadol. As you initially begin using this drug, you might experience nausea or vomiting episodes. You might get relief by lying down, or by working your way up from a smaller dose.

Seizures
3. Seizures can be caused by taking tramadol. Although unusual, people who have experienced drug or alcohol addiction or have a history of head trauma or seizure disorder may experience seizures. Antidepressant drugs or sedatives used in conjunction with Tramadol can lead to a greater likelihood of seizure.

Interactions with other drugs
4. Do not consume alcohol or take any sort of CNS depressant or sedative while using tramadol without prescription. This includes other types of pain medications, sleeping pills and allergy medications. When used in combination with these drugs, tramadol will intensify the effect. The higher the dose, the more dangerous these side effects will be.

Patients who aren’t advised to use tramadol
5. Tramadol may be addictive, so anyone who has ever abused substances is not advised to take it. If you are experiencing suicidal thoughts, do not use tramadol. If you are taking anti-depressants such as MAO inhibitors, be extremely cautious. Tramadol should not be taken by pregnant women. It has been known to cause stillbirth, miscarriages, infant withdrawal symptoms and seizures in the newborn baby. Tramadol can enter into a nursing mother’s milk supply, so it is not advised for these patients.

Cold & Heat Application
If you injure yourself, immediately apply a cold pack to the affected area to decrease swelling, which will eliminate much of the pain. The cold pack can consist of a frozen bag of veggies or crushed ice in a plastic bag. While elevating the injured area, apply cold for 15 to 20 minutes at a time, and repeat until the swelling subsides. Once the swelling is gone, stop using the cold packs. You can switch to a heat pack if it feels good. Also use moist (not dry) heat for general muscle aches in your neck and lower back, since it increases blood flow to an area.

Stress Reduction
As John M. Stamatos, M.D., points out in his book Painbuster, one of the most common underlying causes of pain is stress. Once the physical pain is removed, you can learn stress management tools as a way to prevent pain. Such techniques include counseling, meditation and yoga, as well as biofeedback, a technique that enables a person to measure the levels of tension and relaxation he/she is feeling.

“Biofeedback helps you control pain by making you aware of subtle changes in your body and how to move your body in healthy ways,” explains Stamatos. It can be particularly helpful in dealing with chronic muscle spasms, which are most often associated with stress.

Correct Body Mechanics
Take a hard look at how you sit, stand, walk, and sleep. Many of us are triggering pain simply by the way we move and hold our bodies. If you suspect this may be your problem, learn proper posture to improve your spine health. Scrutinize your workplace for ways to achieve proper ergonomics. Dr. Stamatos says a chair with adjustable armrests that rise to your elbows is best. Make sure it offers lumbar support and lets you sit so your feet rest flat on floor. Computer monitors should be two to six inches below eye level. Your desk should be an inch or two lower than your elbows so that your wrists lean down, which will help prevent carpal tunnel syndrome.

TENS
TENS or Transcutaneous electrical nerve stimulation is very effective on muscle spasms, as well as nerve pain. It forces a spasm to relax by over-stimulating it with mild electrical impulses. A safe method of pain relief, TENS does not have side effects and can be self-administered using a small, battery-operated unit. Make sure to talk to your doctor about whether this is a viable option for you.

Massage therapy
“Massage increases blood flow to an injured area, relieves stiffness and swelling, relaxes tense muscles, and increases the levels of natural endorphins,” says Dr. Stamatos. There are a variety of massage techniques so you will want to find one that works best for you. Examples include Swedish massage, Shiatsu, Rolfing, and Reflexology.

Ultrasound
Ultrasound treatments increase blood flow to parts of the body that normal massage cannot reach. It uses sound waves to warm muscles, even those deep down. A physical therapist can provide more information.

Physical therapy
Physical therapy, as defined by Dr. Stamatos, is any supervised exercise program that returns the body to its normal condition, whatever it was like before the pain began. It can be initiated once the pain is eliminated.

“If you’re still in pain, physical therapy will not help,” says Stamatos. “Doing any exercise while still in pain is counterproductive — it will actually do more harm than good.”

Physical therapy for pain management has three components: flexibility and function, strengthening, and conditioning. Exercises that target these three areas of physical fitness will help the body fully recover from a pain syndrome.

Out came Amanda Marie after 9 minutes of pushing. That was it! The doc was very impressed and wished he had more pushers like me, LOL!

She weighed in at 7 pounds, 15 ounces and was 20 inches long. Her head was 36 cm and her chest was 35 centimeters which amazes me since we only dilate to 10 cm – ouch!

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We went home and I was starting to get contractions but nothing with a regular pattern and then they would stop and come back. I finally got to sleep knowing that I would be induced at 6:30 in the morning. I woke up in a lot of pain and when I went to the bathroom, there was bloody show. I was excited that I was going into labor on my own before I had to be induced. Well morning time came and I was still getting the contractions but nothing regular, so at 6 am I was off to the hospital for the induction. I was so scared and nervous I have never went passed my due date before and was never induced so I did not know what to expect.

I got all set up and they put the monitors on the and started the IV with the pitocin around 8:30 am. When the doctor came in, I was doing very well. I was staying focused and breathing and said that I will probably not take any drugs. When the doctor came in about an hour or two later and asked how I was, I said that I was doing good, it was not that bad. Well this….person….said “Well then you definitely are not in enough pain” and broke my water. She was very rough about it and jacked the pitocin all the way up saying now I should feel real pain. How mean was that? Thank goodness she was not the one who delivered my precious girl.

So after that I just lost it. I lost my focus and concentration and could not handle the pain of the contractions anymore which were coming like every 2 minutes and lasting 1 1/2 minutes since she jacked up the pitocin. So in came my savior the anesthesiologist LOL! I had asked for an epidural but he gave me a new kind of drug. It was a one time spinal shot that worked wonders. t numbed me from the waist down and I could not feel a thing. It didn’t even feel like I was pregnant I was so comfy and was able to rest since I was up the whole night before. This shot would last for 5 hours before I needed anything else and the doctor said he guaranteed me that I would deliver my baby within 2 hours after having this cheap drug, because it relaxes you so much.

When looking at methods for treating arthritis pain, it is important to remember that you should talk with your health care provider about the pain you’re experiencing and also about any pain relief methods that you use.

The pain relief methods discussed below are temporary, designed to be helpful when joints hurt more than usual. This may be after completing an exercise program, after a strenuous day or during stressful times. Not all of the methods described below will work for you – it’s important to experiment to find out what works best.

Heat and cold treatments. Heat and cold treatments are among the most common types of temporary pain relief. At home, heat can be used in the form of heat packs, warm baths or showers, warm towels applied to the affected area, etc. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), heat treatment can be used for 15 to 20 minutes, three times a day. Heat treatments work because they help to relax muscles and reduce sensitivity to pain.

For some people, or for some types of pain, cold treatments may be more effective in providing relief. Cold compresses or ice packs can help to reduce swelling. When using ice packs, never put ice directly on your skin. Always wrap it in a towel or washcloth first. If you don’t have a cold compress, try using a bag of frozen vegetables (many people find that frozen peas are particularly helpful because you can shape the bag around the swollen joint).

Relaxation therapy. Relaxation therapy can help to reduce pain by relaxing tension in the muscles. Your doctor or local Arthritis Foundation can provide information about relaxation therapy. In some forms, relaxation therapy can involve a focused effort to relax tension in each muscle. In other forms, it may involve massage or therapies.

Sleep. Sleep is often overlooked in dealing with pain. A lack of quality sleep can lead to fatigue, and make you more sensitive to pain. Try to relax before bed by taking a warm bath or reading a book. If you are having trouble sleeping due to arthritis pain, consult your health care provider for treatment options.

TENS. If your pain is not relieved by any of the above methods, you may want to talk with your doctor about TENS, or transcutaneous electrical nerve stimulation. In TENS therapy, a device is used to deliver an electrical current under the skin. TENS machines can be adjusted throughout the day as needed for pain relief. Many TENS machines are expensive, though lest costly versions are available and effective.

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Pain Relief and Management

The decision to use pain relief during labor is one based on many factors: Your goals for childbirth, previous birth experiences, presence or absence of complications, and your own body’s comfort level with pain. You may also find that whether to use pain relief is a decision you’ll make once labor begins, especially if this is the first time you have gone through it.

If you want to avoid taking medication during your labor and delivery, but want to have access to it in case you change your mind, you should plan on delivering your baby in a hospital setting. Certified nurse midwives (CNMs) who deliver babies in hospitals can order pain medication just as doctors can, but licensed midwives who deliver babies at home or in birthing centers cannot. Be aware of this while making your pain relief decisions.

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The Indian snakeroot belonging to the dogbane family, Apocynaceae, is obtained from Rauvolfia serpentina. It has been used in indigenous medicine for treating mental illness and insomnia. Its usefulness in modern medicine to treat hypertension and psychiatric disorders came to light with the isolation of the active principle reserpine. In a way it heralded the era of modern day antipsychotic agents. Also from the same family, the Madagascar periwinkle, which belongs to the species Catharanthus roseus, was investigated as a potential anti-diabetic agent. The plant extracts had some blood-sugar-reducing activity but also produced leucopenia, or an abnormally low number of white blood cells, in laboratory animals. Further investigation revealed that the active principles vinblastine and vincristine were useful in treating Hodgkin’s disease and childhood leukemia, respectively. In recent years, several semi-synthetic derivatives of these compounds have come on the market as anticancer agents.

In the last century, important compounds were also discovered and isolated from the animal kingdom. When minute amounts of hormones were isolated from glands of domesticated animals, their potential as useful medicinal agents became apparent but the cost of isolating larger amounts was phenomenally high. This led to a search for similar compounds in the plant kingdom. The search led to precursors such diosgenin found in certain yams belonging to the genus Dioscorea. Diosgenin and other steroidal compounds from plants are now used as starting materials in the production of hormone derivatives including the birth control pill.

Interesting and useful natural compounds have also been obtained from microbial sources. The drug LSD (lysergic acid diethylamide) is chemically related to useful medicinal agents found in the fungus ergot. A series of compounds found in ergot have been used to treat migraine headaches, help contract the uterus at term, stop postpartum hemorrhage and treat Parkinson’s disease among others. Other fungi and bacteria have helped produce a variety of antibiotics to treat infectious diseases. A category of soil bacteria, Actinomycetes, has provided us with more commercially useful antibiotics than any other group of microorganism.

Natural compounds such as morphine and codeine are obtained from opium. Synthetic compounds such as methadone with analgesic properties are often prepared using morphine as a prototype. Often, the synthetic or semi-synthetic derivatives have a better pharmacological profile and are more potent. Oxymorphone a semi-synthetic derivative of morphine is several times more active than the parent compound in relieving pain. The antibiotic erythromycin isolated from the cultures of Saccharopolyspora erythreus is labile but its semi-synthetic derivative clarithromycin is stable and active against a larger number of pathogens. Tinkering with the natural compounds has other advantages; a natural compound is more difficult to patent than a synthetic or semi-synthetic compound. In addition royalties from the patents help pay for further research and development of useful drugs.

Future of natural product research: In the last few years, microbial metabolites have become the mainstay of pharmaceutical natural product research. If microbial products are so good, why should we study plants? Literature research suggests that as a rule, microbes and plants don’t produce the same kinds of pharmacologically active compounds. Products from plants and microbes complement each other and provide a greater variety of chemically diverse compounds necessary for pharmacological research. Also, with the rapid rate of habitat destruction and species extinction we are witnessing at the moment, we are faced with, in essence, a now-or-never situation. Besides, with the acculturation of indigenous people, the knowledge of plant medicine they have derived over millennia is disappearing even faster than the plants themselves. The study of traditional medicine often referred to as ethnopharmacology has provided us with new drugs time and again. The new anti-malarial, artemisinin, was isolated recently from Artemisia annua an herb used in traditional Chinese medicine for over a thousand years.

Biotechnology is also an up-and-coming field. It involves technological application that uses biological systems, living organisms, or derivatives thereof, to make and modify products or processes for specific use. As natural resources start to dwindle, man will have to use cells of living organisms or enzymes from cells to produce products of medicinal value. Products from plant cell cultures is no longer is no longer a dream, it is reality. For example, the Japanese have commercially produced a red cosmetic dye, shikonin, from the plant cell cultures of Lithospermum erythrorhizon and berberine, an anti-microbial astringent, from the cultures of Coptis japonica. In recent years, combinatorial chemistry has provided a powerful synthetic tool in which huge numbers of structurally related compounds are produced for biological testing. Natural products are also amenable to combinatorial approaches by genetic manipulation of systems responsible for biosynthesis of promising natural drugs. Genetic engineering and combinatorial technologies together may represent one of the most promising future areas of pharmacognostic research.

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History of natural products in medicine: In his quest for survival, man sampled nature’s bounty by foraging for food and medicine. Organisms such as plants that were pleasant to the taste were used as food; those with unpleasant taste or effect were avoided, while the poisonous and venomous organisms were used against enemies; others that produced physiological effects such as healing, defecation, relief from pain, perspiration or hallucination were saved for medical purposes and divination. Thus by trial and error over a period of several millennia, humans learned the art of healing both the body and mind.

The traditional systems of medicine probably started over 5000 years ago. According to legend, the Chinese emperor Shen Nung put together Pen Tsao, an herbal compound, which included over 300 plant remedies. During that period in India, the indigenous medicine Ayurveda, which means the knowledge of life, was established; and starting at the same time and later, the Sumerians developed a system of cuneiform writing which helped them record prescriptions on clay tablets.

Traditional European medicine started back with the Egyptian and Babylonian-Assyrian medicine. Illness believed to be caused by bad spirits or a form of divine punishment, could be cured through exorcism and penance. The Egyptian ideology was recorded in Ebers Papyrus. It describes over 700 formulations with drugs derived from animal, mineral and plant sources, with plant drugs predominating.

The Egyptian and Assyrian culture was adopted by the Greeks and subsequently by the Romans. They derived their herbal knowledge from the civilizations referred earlier. Their contributions along with those before them are recorded by Dioscorides in De Materia Medica and in the 37-volume natural history written by Pliny the Elder. These early works are know to us through translations into Arabic by Razes and Avicenna and subsequently translated into Latin and the European languages by Christian monks. This knowledge was further nurtured and passed on to future generations by monks who studied medicinal plants and established medicinal plant gardens across Europe.

In the 9th century, apothecary shops opened in Bagdad (now Iraq) and by the 13th century London became the hub of trade in herbs and spices. Adulteration of herbs was common in this trade and establishment of proper standards and quality control was absent. In the 18th century, Linnaeus, a physician, introduced the binomial system of plant nomenclature, which helped authenticate and identify plants. This was followed by the publication of pharmacopeias across Europe and the United States. These compendia established and clearly defined the method of identification and standard of quality for each of the drugs from natural or synthetic sources.

Relatively recent trends to replace crude plant drugs with their biologically active compounds started in the 18th century with the pioneering work of Carl Scheele, who isolated organic acids from plants. This discovery was followed by several similar ones with Friedrich Serturner’s success in isolating morphine from opium and Pierre Pelletier and Joseph Caventou isolating quinine from the cinchona bark. These achievements initiated the field of phytochemistry. A recent study showed that among prescription drugs marketed between 1983 and 1994, 44% were either of natural origin or derived semi-synthetically from natural substances.

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What are cluster headaches?
These types of headaches usually occur at night and will awaken you from sleep because they are so intense. They can occur every night for several weeks or months. That is why they are called cluster headaches, because they are a group of headaches, not just one. Once they stop, they may not return for a long time, and it may even be several years before they return, if ever.

What causes normal headaches?

* Stress
* Not enough sleep or too much sleep
* A noisy environment
* Over eating or over drinking.
* Sinus problems, which are known as sinus headaches.

What is a migraine?
When you have a migraine headache, you have periodic headaches along with other symptoms such as nausea and sometimes vomiting. They will sometimes cause blurred vision and many people see spots before their eyes before the onset of a migraine. If you have a migraine headache you will be completely disabled until it is over. Modern medicine has made migraines much easier to deal with today. Many people take medication at the onset of the headache to help reduce the intense pain.

Two causes of normal headache pain:

* Strain on scalp, facial and neck muscles usually brought on by tension and stress.
* Swelling of blood vessels in the head.

Headaches can be brought on by an emotional crisis in your life or by something simple such as doing too much paperwork while hunched over in a studying position, or computer work which causes strain on the eyes. If you consume too much alcohol you’ll wake up with a “morning-after” headache or hangover. This is probably due to a widening of the blood vessels in the brain. Alcohol is a vasodilator, which dilates blood vessels in the body.

Treatment:
If you have tension headaches you’ll need to take a mild pain reliever and, if possible, try to lie down and close your eyes. If you are at home, take a warm bath to get your muscles to relax. Massage the muscles of your head, face and shoulders. If your headache continues for several days and gets more intense, contact your physician immediately. If you cannot get an appointment right away and the pain is becomes unbearable, go to the emergency room. For a serious headache, it is always better to seek treatment as soon as possible.