Amitriptyline kaufen online

Whether speaking of migraines, tension-type headaches or other recurring head pains, it’s safe to say that the best headache attack is the one you don’t have. Even if you have found an effective treatment for resolving a headache that is already underway, there is nothing about today’s as-needed treatment that will keep next week’s attack from occurring.

Headache treatments come in two forms-abortive and preventive. The abortive form is familiar to most people. It means something you do to get rid of a headache that has already started. Usually it consists of an over-the-counter or prescription medication, but in some cases, a non-drug approach works. By contrast, a preventive treatment is something you do every day with the goal of keeping some future attacks from even starting. These, too, can involve drug and non-drug strategies.

Billions of dollars are spent each year on abortive remedies. For the most part, they are dollars well spent. And for people who have infrequent headaches that are rapidly and reliably resolved by an abortive treatment, a preventive treatment might be needless.

But if attacks are frequent, hard to resolve, interfere with usual activities-or side-effects from the abortive treatment interfere with usual activities-then a preventive treatment should be considered. Employing a preventive remedy does not preclude also using an abortive measure: each can be part of an integrated plan.

Before discussing specific treatments for specific headache types, let’s consider the impacts of recurring headaches. The more obvious impact is the sheer unpleasantness and suffering involved in an attack. However, another impact-though less obvious-is in its own way just as important. And that is the associated disability or loss of function that comes with an attack.

If a headache attack is severe, then whatever else was planned for that day goes out the window-it’s just not going to happen. If an attack is moderate in intensity, then usual activities might be possible, but occur more slowly, less efficiently, or require more effort to produce. This, too, represents headache-associated disability.

An increasing trend in the field of headache management is for practitioners to address their patients’ loss of function as well as their pain and suffering. Drs. Richard Lipton and Walter Stewart designed a questionnaire to estimate headache-associated disability, called the MIDAS (Migraine Disability Assessment) scale which can also be used for non-migraine headaches.

Measuring and then re-measuring MIDAS is one method for judging if a preventive treatment is effective. But to accurately detect the effectiveness (or lack of effectiveness) of a preventive headache treatment there should also be some sort of day-by-day recording system.

It might be as minimal as a check-mark on the calendar for each day with any symptoms. Another system is to summarize at the end of each day that one day’s headache-impact by selecting one of the following four descriptions-none, mild, moderate or severe. Numerically inclined people can assign scores of 0-3 to these choices and then run averages and other statistics for each calendar month.

For people with recurring or continuous pain there is a tendency to live moment-to-moment without a view of the longer-term pattern. A recording system helps capture the big picture. It would be a mistake to judge the effectiveness of any treatment by what happened with symptoms in just the last few days. Generally, a month or longer is required to judge fairly and accurately.

So now that we have decided to consider a preventive treatment for our headaches and have put in place a system for measuring the treatment’s outcome, what specific remedies are available?

It depends, of course, on the kind of headaches being treated. Let’s discuss two of the most common types-migraine and tension-type headaches.

For prevention of migraine, the best-studied and most effective drug treatments are available by prescription only in the U.S. These include propranolol (brand name Inderal), amitriptyline (Elavil), divalproex (Depakote) and topirimate (Topamax).

Riboflavin (vitamin B2) at 400 milligrams per day was shown in one controlled study to have migraine-preventing actions. (At this dose-far higher than what is needed to treat vitamin deficiency-riboflavin should be considered a drug rather than a vitamin.) The herb feverfew has also shown benefit in controlled trials, but it is important to remember that this, too, is a drug and can have side-effects. As is the case with other drugs, it should not be used during pregnancy.

Non-drug strategies of proven effectiveness in migraine prevention include therapist-supervised programs of stress management, relaxation, biofeedback and cognitive-behavioral therapy. Studies of acupuncture have shown mixed results. Also, avoiding individually determined triggers for attacks carries no risk and can reduce the attack rate.

For tension-type headaches amitripyline is the best-studied drug for prevention of attacks. Note that this drug is also a leading treatment for migraine, so people unlucky enough to have both kinds of headaches can obtain benefit from just one drug. Unfortunately, even at the low doses used for headache prevention, amitriptyline can cause daytime drowsiness (even when administered at bedtime) or annoying oral dryness. Because of this, substitution of a better-tolerated, though less-studied drug in amitriptyline’s family (tricyclic antidepressants) is sometimes required. Tizanidine (Zanaflex) has also shown benefit in controlled trials.

Non-drug strategies for tension-type headache have also been proved effective. These include similar behavioral interventions to those mentioned for migraine-stress management, relaxation, biofeedback and cognitive-behavioral therapy.

It would be wonderful if preventive treatments stopped headaches entirely. If they did, a measurement system would not be necessary. But a more realistic goal for preventive treatment is to reduce overall headache symptoms by at least half, or to an extent that an individual patient finds meaningful. When this occurs, a preventive approach can be a valuable addition to a program of headache management.

(C) 2005 by Gary Cordingley

Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher. For more health-related articles, see his website at: http://www.cordingleyneurology.com

Article Source:
http://EzineArticles.com/expert/Gary_Cordingley/6702

Whether speaking of migraines, tension-type headaches or other recurring head pains, it’s safe to say that the best headache attack is the one you don’t have. Even if you have found an effective treatment for resolving a headache that is already underway, there is nothing about today’s as-needed treatment that will keep next week’s attack from occurring.

Headache treatments come in two forms-abortive and preventive. The abortive form is familiar to most people. It means something you do to get rid of a headache that has already started. Usually it consists of an over-the-counter or prescription medication, but in some cases, a non-drug approach works. By contrast, a preventive treatment is something you do every day with the goal of keeping some future attacks from even starting. These, too, can involve drug and non-drug strategies.

Billions of dollars are spent each year on abortive remedies. For the most part, they are dollars well spent. And for people who have infrequent headaches that are rapidly and reliably resolved by an abortive treatment, a preventive treatment might be needless.

But if attacks are frequent, hard to resolve, interfere with usual activities-or side-effects from the abortive treatment interfere with usual activities-then a preventive treatment should be considered. Employing a preventive remedy does not preclude also using an abortive measure: each can be part of an integrated plan.

Before discussing specific treatments for specific headache types, let’s consider the impacts of recurring headaches. The more obvious impact is the sheer unpleasantness and suffering involved in an attack. However, another impact-though less obvious-is in its own way just as important. And that is the associated disability or loss of function that comes with an attack.

If a headache attack is severe, then whatever else was planned for that day goes out the window-it’s just not going to happen. If an attack is moderate in intensity, then usual activities might be possible, but occur more slowly, less efficiently, or require more effort to produce. This, too, represents headache-associated disability.

An increasing trend in the field of headache management is for practitioners to address their patients’ loss of function as well as their pain and suffering. Drs. Richard Lipton and Walter Stewart designed a questionnaire to estimate headache-associated disability, called the MIDAS (Migraine Disability Assessment) scale which can also be used for non-migraine headaches.

Measuring and then re-measuring MIDAS is one method for judging if a preventive treatment is effective. But to accurately detect the effectiveness (or lack of effectiveness) of a preventive headache treatment there should also be some sort of day-by-day recording system.

It might be as minimal as a check-mark on the calendar for each day with any symptoms. Another system is to summarize at the end of each day that one day’s headache-impact by selecting one of the following four descriptions-none, mild, moderate or severe. Numerically inclined people can assign scores of 0-3 to these choices and then run averages and other statistics for each calendar month.

For people with recurring or continuous pain there is a tendency to live moment-to-moment without a view of the longer-term pattern. A recording system helps capture the big picture. It would be a mistake to judge the effectiveness of any treatment by what happened with symptoms in just the last few days. Generally, a month or longer is required to judge fairly and accurately.

So now that we have decided to consider a preventive treatment for our headaches and have put in place a system for measuring the treatment’s outcome, what specific remedies are available?

It depends, of course, on the kind of headaches being treated. Let’s discuss two of the most common types-migraine and tension-type headaches.

For prevention of migraine, the best-studied and most effective drug treatments are available by prescription only in the U.S. These include propranolol (brand name Inderal), amitriptyline (Elavil), divalproex (Depakote) and topirimate (Topamax).

Riboflavin (vitamin B2) at 400 milligrams per day was shown in one controlled study to have migraine-preventing actions. (At this dose-far higher than what is needed to treat vitamin deficiency-riboflavin should be considered a drug rather than a vitamin.) The herb feverfew has also shown benefit in controlled trials, but it is important to remember that this, too, is a drug and can have side-effects. As is the case with other drugs, it should not be used during pregnancy.

Non-drug strategies of proven effectiveness in migraine prevention include therapist-supervised programs of stress management, relaxation, biofeedback and cognitive-behavioral therapy. Studies of acupuncture have shown mixed results. Also, avoiding individually determined triggers for attacks carries no risk and can reduce the attack rate.

For tension-type headaches amitripyline is the best-studied drug for prevention of attacks. Note that this drug is also a leading treatment for migraine, so people unlucky enough to have both kinds of headaches can obtain benefit from just one drug. Unfortunately, even at the low doses used for headache prevention, amitriptyline can cause daytime drowsiness (even when administered at bedtime) or annoying oral dryness. Because of this, substitution of a better-tolerated, though less-studied drug in amitriptyline’s family (tricyclic antidepressants) is sometimes required. Tizanidine (Zanaflex) has also shown benefit in controlled trials.

Non-drug strategies for tension-type headache have also been proved effective. These include similar behavioral interventions to those mentioned for migraine-stress management, relaxation, biofeedback and cognitive-behavioral therapy.

It would be wonderful if preventive treatments stopped headaches entirely. If they did, a measurement system would not be necessary. But a more realistic goal for preventive treatment is to reduce overall headache symptoms by at least half, or to an extent that an individual patient finds meaningful. When this occurs, a preventive approach can be a valuable addition to a program of headache management.

(C) 2005 by Gary Cordingley

Anxiety in dogs can be just as complicated as it is with people. Actually, it can be tougher to deal with because dogs are not able to talk to you and tell you what’s wrong. From separation anxiety to sudden anxiety disorder the minds of our lovable companions can be a worrisome place. Toy breeds, such as Pugs, shadow us and rely on us heavily for emotional support therefore they are often susceptible to anxiety disorders.

We were recently introduced to an anxiety issue with our pug, Martini, which eventually became unbearable. Martini has always been very clingy when it comes to my wife and I. Separation anxiety is something that usually only worries us when we are away for vacations because one of us is home most of the day.

Martini’s situation became different when she developed sudden anxiety disorder. She would get in “real fights” with her Shih-Tzu sister, Bella, which would result in biting and sometimes blood. It would happen when Martini would get startled by unexpected sounds such as knocks on the door, dropped objects, loud storms, or dog barks. When this happened all of the sudden she would attack her sister violently! She would also get jealous if my wife was holding Bella and attack her sister then as well. Not only would Bella get injured but we would as well just being in the same proximity.

Martini’s emotional problem began to rule our home as my wife and I were walking on egg shells trying not to make sudden sounds, etc. It was no way to live. Finally, after the worst fight we had ever seen we decided it was time to take action. We decided to get with our Vet first and discuss our situation.

Dr. Wagner has been our well-respected Veterinarian for the past two years and has a Boston Terrier child of his own. He gave us several options and suggested that we put Martini on an anti-anxiety medication, Amitriptyline (10MG) and we now give it to her twice a day. Upon doing some research, I have found this medication works by increasing the levels of neurotransmitters and was once prescribed to humans. The neurotransmitter “serotonin” seems to be responsible for helping with anti-anxiety.

Another option our Vet gave us was the use of the Dog Appeasing Pheromone (D.A.P.) Spray. This clear odorless spray prevents fear or stress-related behavior in dogs by simulating the pheromones which a female dog secretes to comfort their offspring. 8-10 sprays liquid in the common area of the dogs does seem to help the situation but we use it sparingly as it is pricey.

Overall the situation in our household is night-and-day compared to what it used to be! Martini occasionally becomes startled, but when she does she does not attack – in fact we have not had one fight since. We do not know if she will always be on the medication, but the medication is a small price to pay for the peace, harmony and happiness of our pets. Our Pug will never be perfect, but that is part of the reason we love her so much!

Eric J Rankin – [http://prettypugs.com/]

Article Source:
http://EzineArticles.com/expert/Eric_Rankin/652389

Whether speaking of migraines, tension-type headaches or other recurring head pains, it’s safe to say that the best headache attack is the one you don’t have. Even if you have found an effective treatment for resolving a headache that is already underway, there is nothing about today’s as-needed treatment that will keep next week’s attack from occurring.

Headache treatments come in two forms-abortive and preventive. The abortive form is familiar to most people. It means something you do to get rid of a headache that has already started. Usually it consists of an over-the-counter or prescription medication, but in some cases, a non-drug approach works. By contrast, a preventive treatment is something you do every day with the goal of keeping some future attacks from even starting. These, too, can involve drug and non-drug strategies.

Billions of dollars are spent each year on abortive remedies. For the most part, they are dollars well spent. And for people who have infrequent headaches that are rapidly and reliably resolved by an abortive treatment, a preventive treatment might be needless.

But if attacks are frequent, hard to resolve, interfere with usual activities-or side-effects from the abortive treatment interfere with usual activities-then a preventive treatment should be considered. Employing a preventive remedy does not preclude also using an abortive measure: each can be part of an integrated plan.

Before discussing specific treatments for specific headache types, let’s consider the impacts of recurring headaches. The more obvious impact is the sheer unpleasantness and suffering involved in an attack. However, another impact-though less obvious-is in its own way just as important. And that is the associated disability or loss of function that comes with an attack.

If a headache attack is severe, then whatever else was planned for that day goes out the window-it’s just not going to happen. If an attack is moderate in intensity, then usual activities might be possible, but occur more slowly, less efficiently, or require more effort to produce. This, too, represents headache-associated disability.

An increasing trend in the field of headache management is for practitioners to address their patients’ loss of function as well as their pain and suffering. Drs. Richard Lipton and Walter Stewart designed a questionnaire to estimate headache-associated disability, called the MIDAS (Migraine Disability Assessment) scale which can also be used for non-migraine headaches.

Measuring and then re-measuring MIDAS is one method for judging if a preventive treatment is effective. But to accurately detect the effectiveness (or lack of effectiveness) of a preventive headache treatment there should also be some sort of day-by-day recording system.

It might be as minimal as a check-mark on the calendar for each day with any symptoms. Another system is to summarize at the end of each day that one day’s headache-impact by selecting one of the following four descriptions-none, mild, moderate or severe. Numerically inclined people can assign scores of 0-3 to these choices and then run averages and other statistics for each calendar month.

For people with recurring or continuous pain there is a tendency to live moment-to-moment without a view of the longer-term pattern. A recording system helps capture the big picture. It would be a mistake to judge the effectiveness of any treatment by what happened with symptoms in just the last few days. Generally, a month or longer is required to judge fairly and accurately.

So now that we have decided to consider a preventive treatment for our headaches and have put in place a system for measuring the treatment’s outcome, what specific remedies are available?

It depends, of course, on the kind of headaches being treated. Let’s discuss two of the most common types-migraine and tension-type headaches.

For prevention of migraine, the best-studied and most effective drug treatments are available by prescription only in the U.S. These include propranolol (brand name Inderal), amitriptyline (Elavil), divalproex (Depakote) and topirimate (Topamax).

Riboflavin (vitamin B2) at 400 milligrams per day was shown in one controlled study to have migraine-preventing actions. (At this dose-far higher than what is needed to treat vitamin deficiency-riboflavin should be considered a drug rather than a vitamin.) The herb feverfew has also shown benefit in controlled trials, but it is important to remember that this, too, is a drug and can have side-effects. As is the case with other drugs, it should not be used during pregnancy.

Non-drug strategies of proven effectiveness in migraine prevention include therapist-supervised programs of stress management, relaxation, biofeedback and cognitive-behavioral therapy. Studies of acupuncture have shown mixed results. Also, avoiding individually determined triggers for attacks carries no risk and can reduce the attack rate.

For tension-type headaches amitripyline is the best-studied drug for prevention of attacks. Note that this drug is also a leading treatment for migraine, so people unlucky enough to have both kinds of headaches can obtain benefit from just one drug. Unfortunately, even at the low doses used for headache prevention, amitriptyline can cause daytime drowsiness (even when administered at bedtime) or annoying oral dryness. Because of this, substitution of a better-tolerated, though less-studied drug in amitriptyline’s family (tricyclic antidepressants) is sometimes required. Tizanidine (Zanaflex) has also shown benefit in controlled trials.

Non-drug strategies for tension-type headache have also been proved effective. These include similar behavioral interventions to those mentioned for migraine-stress management, relaxation, biofeedback and cognitive-behavioral therapy.

It would be wonderful if preventive treatments stopped headaches entirely. If they did, a measurement system would not be necessary. But a more realistic goal for preventive treatment is to reduce overall headache symptoms by at least half, or to an extent that an individual patient finds meaningful. When this occurs, a preventive approach can be a valuable addition to a program of headache management.

(C) 2005 by Gary Cordingley

Anxiety in dogs can be just as complicated as it is with people. Actually, it can be tougher to deal with because dogs are not able to talk to you and tell you what’s wrong. From separation anxiety to sudden anxiety disorder the minds of our lovable companions can be a worrisome place. Toy breeds, such as Pugs, shadow us and rely on us heavily for emotional support therefore they are often susceptible to anxiety disorders.

We were recently introduced to an anxiety issue with our pug, Martini, which eventually became unbearable. Martini has always been very clingy when it comes to my wife and I. Separation anxiety is something that usually only worries us when we are away for vacations because one of us is home most of the day.

Martini’s situation became different when she developed sudden anxiety disorder. She would get in “real fights” with her Shih-Tzu sister, Bella, which would result in biting and sometimes blood. It would happen when Martini would get startled by unexpected sounds such as knocks on the door, dropped objects, loud storms, or dog barks. When this happened all of the sudden she would attack her sister violently! She would also get jealous if my wife was holding Bella and attack her sister then as well. Not only would Bella get injured but we would as well just being in the same proximity.

Martini’s emotional problem began to rule our home as my wife and I were walking on egg shells trying not to make sudden sounds, etc. It was no way to live. Finally, after the worst fight we had ever seen we decided it was time to take action. We decided to get with our Vet first and discuss our situation.

Dr. Wagner has been our well-respected Veterinarian for the past two years and has a Boston Terrier child of his own. He gave us several options and suggested that we put Martini on an anti-anxiety medication, Amitriptyline (10MG) and we now give it to her twice a day. Upon doing some research, I have found this medication works by increasing the levels of neurotransmitters and was once prescribed to humans. The neurotransmitter “serotonin” seems to be responsible for helping with anti-anxiety.

Another option our Vet gave us was the use of the Dog Appeasing Pheromone (D.A.P.) Spray. This clear odorless spray prevents fear or stress-related behavior in dogs by simulating the pheromones which a female dog secretes to comfort their offspring. 8-10 sprays liquid in the common area of the dogs does seem to help the situation but we use it sparingly as it is pricey.

Overall the situation in our household is night-and-day compared to what it used to be! Martini occasionally becomes startled, but when she does she does not attack – in fact we have not had one fight since. We do not know if she will always be on the medication, but the medication is a small price to pay for the peace, harmony and happiness of our pets. Our Pug will never be perfect, but that is part of the reason we love her so much!

Although only one drug has been FDA approved specifically for interstitial cystitis, Elmiron, treating interstitial cystitis has always been a “brand off” approach. “Brand off” is where drugs not specifically designed for the illness or disease are used because of their side effects. For example, interstitial cystitis patients are given anti-anxiety drugs, antidepressants, antispasmodics, pain medication, and even some antiseizure medication.

Elavil is the brand name for the drug amitriptyline. The other brand name for the drug is Endep . It is given to mental health patients to elevate mood by increasing the neurotransmitters in the brain. Typically, this drug is prescribed for more than one reason to interstitial cystitis sufferers. It is available in tablet form in the dosages of 10mg, 25 mg, 50mg, 75mg, 100mg and in 150mg.

Sleep Effects

Elavil tends to make one drowsy after taking, and therefore is typically prescribed to be taken at night before bed. For this reason it is given to interstitial cystitis sufferers to help them sleep through the night without having to wake up to go to the bathroom multiple times. Also, even if one doesn’t typically get up at night, it will still give them a better night sleep and will help them feel better throughout the day because they were able to rest. According to Dr. Robert Moore (Director of Advanced Pelvic Surgery and Co-Director of Urogynecology at Atlanta Urogynecology Associates, a “low dose helps to elevate the patient’s pain threshold, i.e. the level that the pain fibers fire at in the spinal cord. These nerves are super sensitive and fire very easily at very low input levels; Elavil helps to elevate these levels so they don’t fire so easily at low levels.”

Pain Effects

Elavil will give a slight boost to treating and dealing with pain. It isn’t a pain medication, but it does “take an edge off”. This makes living with interstitial cystitis a bit easier. Its sedative effects help with the pain of the bladder. It raises your pain threshold so that lower level pain isn’t felt as much, and you are much more able to cope.

Warnings

There are many drug interactions with Elavil. If you are taking an MAOI (monoamine oxidase inhibiting drugs) you may get a high fever, convulse, or even die while on Elavil / Endep.

If you have seizures or are at risk for having a seizure, you should not take this drug.

You should not take Epinephrine (what is known as an Epipen, given to those with severe allergic reactions) while on this drug as it raises your chance of severe high blood pressure. If you have risk factors for allergies severe enough that you carry an Epipen you need to let your doctor know prior to filling this drug prescription.

Tina Samuels has written health and wellness articles for 15 yrs. She runs the Chronic Pain Today weblog at [http://chronicpain.today.com]

Article Source:
http://EzineArticles.com/expert/Tina_Samuels/218785

Whether speaking of migraines, tension-type headaches or other recurring head pains, it’s safe to say that the best headache attack is the one you don’t have. Even if you have found an effective treatment for resolving a headache that is already underway, there is nothing about today’s as-needed treatment that will keep next week’s attack from occurring.

Headache treatments come in two forms-abortive and preventive. The abortive form is familiar to most people. It means something you do to get rid of a headache that has already started. Usually it consists of an over-the-counter or prescription medication, but in some cases, a non-drug approach works. By contrast, a preventive treatment is something you do every day with the goal of keeping some future attacks from even starting. These, too, can involve drug and non-drug strategies.

Billions of dollars are spent each year on abortive remedies. For the most part, they are dollars well spent. And for people who have infrequent headaches that are rapidly and reliably resolved by an abortive treatment, a preventive treatment might be needless.

But if attacks are frequent, hard to resolve, interfere with usual activities-or side-effects from the abortive treatment interfere with usual activities-then a preventive treatment should be considered. Employing a preventive remedy does not preclude also using an abortive measure: each can be part of an integrated plan.

Before discussing specific treatments for specific headache types, let’s consider the impacts of recurring headaches. The more obvious impact is the sheer unpleasantness and suffering involved in an attack. However, another impact-though less obvious-is in its own way just as important. And that is the associated disability or loss of function that comes with an attack.

If a headache attack is severe, then whatever else was planned for that day goes out the window-it’s just not going to happen. If an attack is moderate in intensity, then usual activities might be possible, but occur more slowly, less efficiently, or require more effort to produce. This, too, represents headache-associated disability.

An increasing trend in the field of headache management is for practitioners to address their patients’ loss of function as well as their pain and suffering. Drs. Richard Lipton and Walter Stewart designed a questionnaire to estimate headache-associated disability, called the MIDAS (Migraine Disability Assessment) scale which can also be used for non-migraine headaches.

Measuring and then re-measuring MIDAS is one method for judging if a preventive treatment is effective. But to accurately detect the effectiveness (or lack of effectiveness) of a preventive headache treatment there should also be some sort of day-by-day recording system.

It might be as minimal as a check-mark on the calendar for each day with any symptoms. Another system is to summarize at the end of each day that one day’s headache-impact by selecting one of the following four descriptions-none, mild, moderate or severe. Numerically inclined people can assign scores of 0-3 to these choices and then run averages and other statistics for each calendar month.

For people with recurring or continuous pain there is a tendency to live moment-to-moment without a view of the longer-term pattern. A recording system helps capture the big picture. It would be a mistake to judge the effectiveness of any treatment by what happened with symptoms in just the last few days. Generally, a month or longer is required to judge fairly and accurately.

So now that we have decided to consider a preventive treatment for our headaches and have put in place a system for measuring the treatment’s outcome, what specific remedies are available?

It depends, of course, on the kind of headaches being treated. Let’s discuss two of the most common types-migraine and tension-type headaches.

For prevention of migraine, the best-studied and most effective drug treatments are available by prescription only in the U.S. These include propranolol (brand name Inderal), amitriptyline (Elavil), divalproex (Depakote) and topirimate (Topamax).

Riboflavin (vitamin B2) at 400 milligrams per day was shown in one controlled study to have migraine-preventing actions. (At this dose-far higher than what is needed to treat vitamin deficiency-riboflavin should be considered a drug rather than a vitamin.) The herb feverfew has also shown benefit in controlled trials, but it is important to remember that this, too, is a drug and can have side-effects. As is the case with other drugs, it should not be used during pregnancy.

Non-drug strategies of proven effectiveness in migraine prevention include therapist-supervised programs of stress management, relaxation, biofeedback and cognitive-behavioral therapy. Studies of acupuncture have shown mixed results. Also, avoiding individually determined triggers for attacks carries no risk and can reduce the attack rate.

For tension-type headaches amitripyline is the best-studied drug for prevention of attacks. Note that this drug is also a leading treatment for migraine, so people unlucky enough to have both kinds of headaches can obtain benefit from just one drug. Unfortunately, even at the low doses used for headache prevention, amitriptyline can cause daytime drowsiness (even when administered at bedtime) or annoying oral dryness. Because of this, substitution of a better-tolerated, though less-studied drug in amitriptyline’s family (tricyclic antidepressants) is sometimes required. Tizanidine (Zanaflex) has also shown benefit in controlled trials.

Non-drug strategies for tension-type headache have also been proved effective. These include similar behavioral interventions to those mentioned for migraine-stress management, relaxation, biofeedback and cognitive-behavioral therapy.

It would be wonderful if preventive treatments stopped headaches entirely. If they did, a measurement system would not be necessary. But a more realistic goal for preventive treatment is to reduce overall headache symptoms by at least half, or to an extent that an individual patient finds meaningful. When this occurs, a preventive approach can be a valuable addition to a program of headache management.

(C) 2005 by Gary Cordingley

Anxiety in dogs can be just as complicated as it is with people. Actually, it can be tougher to deal with because dogs are not able to talk to you and tell you what’s wrong. From separation anxiety to sudden anxiety disorder the minds of our lovable companions can be a worrisome place. Toy breeds, such as Pugs, shadow us and rely on us heavily for emotional support therefore they are often susceptible to anxiety disorders.

We were recently introduced to an anxiety issue with our pug, Martini, which eventually became unbearable. Martini has always been very clingy when it comes to my wife and I. Separation anxiety is something that usually only worries us when we are away for vacations because one of us is home most of the day.

Martini’s situation became different when she developed sudden anxiety disorder. She would get in “real fights” with her Shih-Tzu sister, Bella, which would result in biting and sometimes blood. It would happen when Martini would get startled by unexpected sounds such as knocks on the door, dropped objects, loud storms, or dog barks. When this happened all of the sudden she would attack her sister violently! She would also get jealous if my wife was holding Bella and attack her sister then as well. Not only would Bella get injured but we would as well just being in the same proximity.

Martini’s emotional problem began to rule our home as my wife and I were walking on egg shells trying not to make sudden sounds, etc. It was no way to live. Finally, after the worst fight we had ever seen we decided it was time to take action. We decided to get with our Vet first and discuss our situation.

Dr. Wagner has been our well-respected Veterinarian for the past two years and has a Boston Terrier child of his own. He gave us several options and suggested that we put Martini on an anti-anxiety medication, Amitriptyline (10MG) and we now give it to her twice a day. Upon doing some research, I have found this medication works by increasing the levels of neurotransmitters and was once prescribed to humans. The neurotransmitter “serotonin” seems to be responsible for helping with anti-anxiety.

Another option our Vet gave us was the use of the Dog Appeasing Pheromone (D.A.P.) Spray. This clear odorless spray prevents fear or stress-related behavior in dogs by simulating the pheromones which a female dog secretes to comfort their offspring. 8-10 sprays liquid in the common area of the dogs does seem to help the situation but we use it sparingly as it is pricey.

Overall the situation in our household is night-and-day compared to what it used to be! Martini occasionally becomes startled, but when she does she does not attack – in fact we have not had one fight since. We do not know if she will always be on the medication, but the medication is a small price to pay for the peace, harmony and happiness of our pets. Our Pug will never be perfect, but that is part of the reason we love her so much!

Although only one drug has been FDA approved specifically for interstitial cystitis, Elmiron, treating interstitial cystitis has always been a “brand off” approach. “Brand off” is where drugs not specifically designed for the illness or disease are used because of their side effects. For example, interstitial cystitis patients are given anti-anxiety drugs, antidepressants, antispasmodics, pain medication, and even some antiseizure medication.

Elavil is the brand name for the drug amitriptyline. The other brand name for the drug is Endep . It is given to mental health patients to elevate mood by increasing the neurotransmitters in the brain. Typically, this drug is prescribed for more than one reason to interstitial cystitis sufferers. It is available in tablet form in the dosages of 10mg, 25 mg, 50mg, 75mg, 100mg and in 150mg.

Sleep Effects

Elavil tends to make one drowsy after taking, and therefore is typically prescribed to be taken at night before bed. For this reason it is given to interstitial cystitis sufferers to help them sleep through the night without having to wake up to go to the bathroom multiple times. Also, even if one doesn’t typically get up at night, it will still give them a better night sleep and will help them feel better throughout the day because they were able to rest. According to Dr. Robert Moore (Director of Advanced Pelvic Surgery and Co-Director of Urogynecology at Atlanta Urogynecology Associates, a “low dose helps to elevate the patient’s pain threshold, i.e. the level that the pain fibers fire at in the spinal cord. These nerves are super sensitive and fire very easily at very low input levels; Elavil helps to elevate these levels so they don’t fire so easily at low levels.”

Pain Effects

Elavil will give a slight boost to treating and dealing with pain. It isn’t a pain medication, but it does “take an edge off”. This makes living with interstitial cystitis a bit easier. Its sedative effects help with the pain of the bladder. It raises your pain threshold so that lower level pain isn’t felt as much, and you are much more able to cope.

Warnings

There are many drug interactions with Elavil. If you are taking an MAOI (monoamine oxidase inhibiting drugs) you may get a high fever, convulse, or even die while on Elavil / Endep.

If you have seizures or are at risk for having a seizure, you should not take this drug.

You should not take Epinephrine (what is known as an Epipen, given to those with severe allergic reactions) while on this drug as it raises your chance of severe high blood pressure. If you have risk factors for allergies severe enough that you carry an Epipen you need to let your doctor know prior to filling this drug prescription.

DRUGS belonging to the selective serotonin reuptake inhibitor (SSRI) family are undoubtedly the safest anti-depressants in the US market today. They act faster, have milder and more manageable side-effects, and have negligible drug-drug and drug-food interactions if taken in strict compliance with the physician’s instructions. Examples of SRI drugs are Lexapro, Celexa, Paxil, Zoloft among others. Nevertheless, it might be that your physician has prescribed you a non-SSRI drug. Whatever the category the prescribed drug may belong to – it could be a tricyclic antidepressant such as amitriptyline or butriptyline — there can be only one reason: pain.

Yes, SSRIs are very effective in the treatment of depression and anxiety disorders, but not pain. In many cases, depression and anxiety stem from acute body pain, and the treatment of such depression largely lies in the treatment of pain. Also, the patient’s capacity to withstand pain through the pain-healing process lies in his or her state of mind. So, there’s a two-way relationship between acute pain and mental depression.

With the above in perspective, it should now be noted that SSRIs are ‘pure anti-depressants’. They have no direct analgesic effect. On the other hand, TCA has both anti-depressant and analgesic effect. The two groups of drugs act in the following ways:

SSRIs’ direct action is only on serotonin, which is the mood-influencing chemical in the brain cells.
TCAs act on both serotonin and endorphin (the body’s natural analgesic that resides in the brain).
TCAs are therefore dual-action drugs, but very risky. They can lead to very serious complications in case of overdose. They have very serious drug-drug and drug-alcohol interactions, which can give rise to new medical conditions altogether. Excessive overdose of a TCA drug can also kill (which is why physicians usually start treatment with sub-therapeutic doses of a TCA and then gradually increase it to the therapeutic level, which varies from patient to patient). The duration of treatment with any TCA is therefore long. SSRIs, on the other hand, usually pose none of these problems except when taken in flagrant deviation of the physician’s prescription.

Therefore, though SSRIs are the safest anti-depressants around today, the older TCA group of drugs have retained their relevance in depression-cum-pain cases, which usually require hospitalization. So, if your physician has prescribed you a TCA, you should know that your root problem lies in the condition that is causing you physical pain, and not your depression. Once the physical pain is healed and if your depression remains, an SSRI might be the next drug you are on.

Leave a Reply

Your email address will not be published. Required fields are marked *