DR SAMBO URGES INCREASED COMMUNITY ENGAGEMENT FOR MALARIA PREVENTION AND CONTROL

Brazzaville, 25 April 2010 – WHO Regional Director for Africa, Dr Luis Sambo, on Sunday made a passionate appeal for increased engagement of communities to support ongoing malaria prevention and control efforts, and its eventual elimination as a major public health problem in the African Region.
“I call upon every African community to assume leadership in the fight against malaria … each one of us has a role to play in this drive… communities must act to protect themselves from malaria”, the Regional Director said in his message to mark World Malaria Day, ob-served on 25 April since 2008.

Dr Sambo stated that particular attention needed to be focused on communities where chil-dren, women and people living with HIV/AIDS were especially vulnerable. He also called for increased emphasis to be placed on the day-to-day involvement of families, school chil-dren, teachers, youths, women, men and civil society organizations.

On the role of the larger society in the anti-malaria fight, he said: “Politicians, parliamen-tarians, governments, the private sector, civil society, faith-based organizations and the mass media must engage to support community-based interventions. Calling for advocacy at all levels, the Regional Director added: “We need engagement of champions from all walks of life including the arts, culture and sports arenas to disseminate positive messages to combat malaria”.

Dr Sambo outlined six action points that should underpin community engagement in the fight against the disease. These are: ensuring community ownership and participation including contribution to human and financial resources and strengthening of alliances to fight malaria; building upon local knowledge and experiences, especially in environmental protection and management for disease prevention; involving all families and community leaders in local development initiatives; focusing on prevention while establishing enabling conditions for prompt referral of febrile cases to district health facilities by caregivers at household level; working with and supporting community health workers, and strengthen-ing capacity for monitoring service accessibility, quality and uptake at community level.


Dr Sambo pledged that, WHO, for its part, would continue to provide guidance on appro-priate malaria control policies and interventions, and intensify technical support to countries in partnership with multilateral and bilateral organizations as well as other members of the international health and development community.

Malaria exerts a disproportionate burden on the African Region which accounts for 85% of malaria cases and 90% of malaria deaths worldwide. Still, significant progress has been made in delivering life-saving malaria nets and treatments over the last few years, but the coverage of malaria programme needs to be stepped up drastically in order to meet the Millennium Development Goals.

Arthritis

Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions involving damage to the joints of the body.

There are over 100 different forms of arthritis[1]. The most common form, osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Other arthritis forms are rheumatoid arthritis, psoriatic arthritis, and autoimmune diseases in which the body attacks itself. Septic arthritis is caused by joint infection.

The major complaint by individuals who have arthritis is pain. Pain is often a constant and daily feature of the disease. The pain may be localized to the back, neck, hip, knee or feet. The pain from arthritis occurs due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of joint, muscles strains caused by forceful movements against stiff, painful joints and fatigue. The most important factor in treatment is to understand the disorder and find ways to overcome the obstacles which prevent physical exercise.

Epidemiology
Arthritis is a disease of the elderly, but children can also be affected by the disease. More than 70% of individuals in North America affected by arthritis are over the age of 65. Arthritis is more common in women than men at all ages and affects all races, ethnic groups and cultures. An estimated 46 million individuals in USA have arthritis and the numbers continue to increase each year. Close to one million individuals are admitted to hospitals each year because of their arthritis.

History and physical examination
All arthritides feature pain. Pain patterns may differ depending on the arthritides and the location. Rheumatoid arthritis is generally worse in the morning and associated with stiffness; in the early stages, patients often have no symptoms after a morning shower. In the aged and children, pain might not be the main presenting feature; the aged patient simply moves less, the infantile patient refuses to use the affected limb.

Elements of the history of the disorder guide diagnosis. Important features are speed and time of onset, pattern of joint involvement, symmetry of symptoms, early morning stiffness, tenderness, gelling or locking with inactivity, aggravating and relieving factors, and other systemic symptoms. Physical examination may confirm the diagnosis, or may indicate systemic disease. Radiographs are often used to follow progression or assess severity in a more quantitative manner.

While evidence of primary ankle (kaki) osteoarthritis has been discovered in dinosaurs, the first known traces of human arthritis date back as far as 4500 BC. In early reports, arthritis was frequently referred to as the most common ailment of prehistoric peoples.[3] It was noted in skeletal remains of Native Americans found in Tennessee and parts of what is now Olathe, Kansas. Evidence of arthritis has been found throughout history, from Ötzi, a mummy (circa 3000 BC) found along the border of modern Italy and Austria, to the Egyptian mummies circa 2590 BC [4]

In 1715 William Musgrave published the second edition of his most important medical work De arthritide symptomatica which concerned arthritis and its effects.

for more info visit http://en.wikipedia.org/wiki/Arthritis

Alzheimer's disease

Alzheimer's disease (AD), also called Alzheimer disease, Senile Dementia of the Alzheimer Type (SDAT) or simply Alzheimer's, is the most common form of dementia. This incurable, degenerative, and terminal disease was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906 and was named after him.[1] Generally, it is diagnosed in people over 65 years of age,[2] although the less-prevalent early-onset Alzheimer's can occur much earlier. In 2006, there were 26.6 million sufferers worldwide. Alzheimers is predicted to affect 1 in 85 people globally by 2050.[3]

Although the course of Alzheimer's disease is unique for every individual, there are many common symptoms.[4] The earliest observable symptoms are often mistakenly thought to be 'age-related' concerns, or manifestations of stress.[5] In the early stages, the most commonly recognised symptom is memory loss, such as difficulty in remembering recently learned facts. When a doctor or physician has been notified, and AD is suspected, the diagnosis is usually confirmed with behavioural assessments and cognitive tests, often followed by a brain scan if available.[6]

As the disease advances, symptoms include confusion, irritability and aggression, mood swings, language breakdown, long-term memory loss, and the general withdrawal of the sufferer as their senses decline.[5][7] Gradually, bodily functions are lost, ultimately leading to death.[8] Individual prognosis is difficult to assess, as the duration of the disease varies. AD develops for an indeterminate period of time before becoming fully apparent, and it can progress undiagnosed for years. The mean life expectancy following diagnosis is approximately seven years.[9] Fewer than three percent of individuals live more than fourteen years after diagnosis.[10]

The cause and progression of Alzheimer's disease are not well understood. Research indicates that the disease is associated with plaques and tangles in the brain.[11] Currently used treatments offer a small symptomatic benefit; no treatments to delay or halt the progression of the disease are as yet available. As of 2008, more than 500 clinical trials have been conducted for identification of a possible treatment for AD, but it is unknown if any of the tested intervention strategies will show promising results.[12] A number of non-invasive, life-style habits have been suggested for the prevention of Alzheimer's disease, but there is a lack of adequate evidence for a link between these recommendations and reduced degeneration. Mental stimulation, exercise, and a balanced diet are suggested, as both a possible prevention and a sensible way of managing the disease.[13]

Because AD cannot be cured and is degenerative, management of patients is essential. The role of the main caregiver is often taken by the spouse or a close relative.[14] Alzheimer's disease is known for placing a great burden on caregivers; the pressures can be wide-ranging, involving social, psychological, physical, and economic elements of the caregiver's life.[15][16][17] In developed countries, AD is one of the most costly diseases to society.

for more visit http://en.wikipedia.org/wiki/Alzheimer%27s_disease

Condom

A condom (pronounced /ˈkɒndəm/ (US) or /ˈkɒndɒm/ (UK)) is a barrier device most commonly used during sexual intercourse to reduce the likelihood of pregnancy and spreading sexually transmitted diseases (STDs—such as gonorrhea, syphilis, and HIV). It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner. Because condoms are waterproof, elastic, and durable, they are also used in a variety of secondary applications. These include collection of semen for use in infertility treatment as well as non-sexual uses such as creating waterproof microphones and protecting rifle barrels from clogging.

In the modern age, condoms are most often made from latex, but some are made from other materials such as polyurethane, polyisoprene, or lamb intestine. A female condom is also available, most often made of polyurethane. As a method of birth control, male condoms have the advantage of being inexpensive, easy to use, having few side effects, and of offering protection against sexually transmitted diseases. With proper knowledge and application technique—and use at every act of intercourse—women whose partners use male condoms experience a 2% per-year pregnancy rate.

Condoms have been used for at least 400 years. Since the nineteenth century, they have been one of the most popular methods of contraception in the world. While widely accepted in modern times, condoms have generated some controversy, primarily over what role they should play in sex education classes.

History

Before the 19th century

Whether condoms were used in ancient civilizations is debated by archaeologists and historians.[1]:11 In ancient Egypt, Greece, and Rome, pregnancy prevention was generally seen as a woman's responsibility, and the only well documented contraception methods were female-controlled devices.[1]:17,23 In Asia before the fifteenth century, some use of glans condoms (devices covering only the head of the penis) is recorded. Condoms seem to have been used for contraception, and to have been known only by members of the upper classes. In China, glans condoms may have been made of oiled silk paper, or of lamb intestines. In Japan, they were made of tortoise shell or animal horn.[1]:60-1

In 16th century Italy, Gabriele Falloppio wrote a treatise on syphilis.[1]:51,54-5 The earliest documented strain of syphilis, first appearing in a 1490s outbreak, caused severe symptoms and often death within a few months of contracting the disease.[2][3] Falloppio's treatise is the earliest uncontested description of condom use: it describes linen sheaths soaked in a chemical solution and allowed to dry before use. The cloths he described were sized to cover the glans of the penis, and were held on with a ribbon.[1]:51,54-5[4] Falloppio claimed that an experimental trial of the linen sheath demonstrated protection against syphilis.[5]

After this, the use of penis coverings to protect from disease is described in a wide variety of literature throughout Europe. The first indication that these devices were used for birth control, rather than disease prevention, is the 1605 theological publication De iustitia et iure (On justice and law) by Catholic theologian Leonardus Lessius, who condemned them as immoral.[1]:56 In 1666, the English Birth Rate Commission attributed a recent downward fertility rate to use of "condons", the first documented use of that word (or any similar spelling).

For more, Visit http://en.wikipedia.org/wiki/Condom

Religious views on female genital cutting

Religious views on female genital cutting have often been highly critical, although the medical phenomenon appears to be concentrated in Islamic areas, and not in Jewish or Christian regions. Evidence suggests that female genital cutting might be a cultural relic from pre-monotheistic African tribal religions, given that the practice is mentioned as far back as 163 BC. Muslim scholars have often been divided on whether it should be considered as a non-religious traditional custom, or whether it should be specifically condemned by religious authorities.

Girls in Ancient Egypt

The traditional cultural practice of FGC predates both Islam and Christianity. A Greek papyrus from 163 B.C. mentions girls in Egypt undergoing circumcision and it is widely accepted to have originated in Egypt and the Nile valley at the time of the Pharaohs. Evidence from mummies have shown both Type I and Type III FGC present.[1] (Note that the earliest evidence of male circumcision is also from Ancient Egypt.) Amnesty International says that the prevalence of the practice of FGC is unknown, and that the procedure is now only practiced by some Muslims and Animists.[2]

The U.S. Department of Health and Human Services states that the custom of FGC "cuts across religions and is practiced by Muslims, Christians, Jews and followers of indigenous religions."

Traditional African cleanliness

Medical justifications offered by cultural tradition are regarded by scientists and doctors as unsubstantiated. Some African societies consider FGC part of maintaining cleanliness as it removes secreting parts of the genitalia. Vaginal secretions, in reality, play a critical part in maintaining female health. Some Bambara and Dogon believe that babies die if they touch the clitoris during birth.[4] In some areas of Africa, there exists the belief that a newborn child has elements of both sexes. In the male body the foreskin of the penis is considered to be the female element. In the female body the clitoris is considered to be the male element. Hence when the adolescent is reaching puberty, these elements are removed to make the indication of sex clearer.[4]

In years past, western doctors advocating or performing these procedures sometimes claimed that girls of all ages would otherwise engage in excessive masturbation and be "polluted" by the activity, which was referred to as "self-abuse".[5]

C.F. McDonald wrote in a 1958 paper titled "Circumcision of the Female"[6] "If the male needs circumcision for cleanliness and hygiene, why not the female? I have operated on perhaps 40 patients who needed this attention." The author describes symptoms as "irritation, scratching, irritability, masturbation, frequency and urgency," and in adults, smegmaliths causing "dyspareunia and frigidity." The author then reported that a two-year-old was no longer masturbating so frequently after the procedure. Of adult women, the author stated that "for the first time in their lives, sex ambition became normally satisfied." Justification of the procedure on hygienic grounds, or to reduce masturbation, has since declined. The view that masturbation is a cause of mental and physical illness has dissipated since the mid-20th century.[7]

Clitorecdomy in its less invasive form, removal of the prepuce alone, is also called a hoodectomy. It is often an elective surgery undertaken by mature consenting adults. Some doctors[8] and other advocators[9] believe that the hoodectomy form of FGC can help to increase and improve sexual sensitivity and sexual pleasure in cases where the hood of the clitoris is too tight. A study done in 1959 by Rathmann et al. states that 87.5% of women saw an improvement in sexual pleasure following a hoodectomy FGC,[10] with 75% in a study by Knowles et al.

for more visit http://en.wikipedia.org/wiki/Religious_views_on_female_genital_cutting

As Parkinson's disease is a chronic disorder, Treatment of Parkinson's Disease requires broad-based management including patient and family education, support group services, general wellness maintenance, exercise, and nutrition. At present, there is no cure for PD, but medications or surgery can provide relief from the symptoms.

While many medications treat Parkinson's, none actually reverse the effects of the disease or cure it. People with Parkinson's therefore often must take a variety of medications to manage the disease's symptoms.[1] The Parkinson's Disease Foundation (PDF) has a chart on its website that provides details about Parkinson's medications.

Several medications currently in development seek to better address motor fluctuations and nonmotor symptoms of Parkinson's Disease. However, none are yet on the market with specific approval to treat Parkinson's.

Levodopa

The most widely used form of treatment is L-dopa in various forms. L-dopa is transformed into dopamine in the dopaminergic neurons by L-aromatic amino acid decarboxylase (often known by its former name dopa-decarboxylase). However, only 1-5% of L-DOPA enters the dopaminergic neurons. The remaining L-DOPA is often metabolised to dopamine elsewhere, causing a wide variety of side effects. Due to feedback inhibition, L-dopa results in a reduction in the endogenous formation of L-dopa, and so eventually becomes counterproductive.

Carbidopa and Benserazide are dopa decarboxylase inhibitors. They help to prevent the metabolism of L-dopa before it reaches the dopaminergic neurons and are general given as combination preparations of carbidopa/levodopa (co-careldopa BAN) co-careldopa combined L-dopa and carbidopa in fixed ratios in such branded products of Sinemet and Parcopa and Benserazide/levodopa (co-beneldopa BAN) as Madopar. There are also controlled release versions of Sinemet and Madopar that spread out the effect of the L-dopa. Duodopa is a combination of levodopa and carbidopa, dispersed as a viscous gel. Using a patient-operated portable pump, the drug is continuously delivered via a tube directly into the upper small intestine, where it is rapidly absorbed.

Talcopone inhibits the COMT enzyme, thereby prolonging the effects of L-dopa, and so has been used to complement L-dopa. However, due to its side effects, such as possible liver failure is limited in its availability. A similar drug, entacapone, has similar efficacy and has not been shown to cause significant alterations of liver function. Stalevo[3] contains Levodopa, Carbidopa and Entacapone.

Mucuna pruriens, is a natural source of therapeutic quantities of L-dopa.
Dopamine agonists

The dopamine-agonists bromocriptine (Parlodel), pergolide (Permax), pramipexole (Mirapex), ropinirole (Requip), cabergoline (Cabaser), apomorphine (Apokyn), and lisuride (Revanil), are moderately effective. These have their own side effects including those listed above in addition to somnolence, hallucinations and /or insomnia. Dopamine agonists initially act by stimulating some of the dopamine receptors. However, they cause the dopamine receptors to become progressively less sensitive, thereby eventually increasing the symptoms.
[edit] MAO-B inhibitors

Selegiline (Eldepryl) and rasagiline (Azilect) reduce the symptoms by inhibiting monoamine oxidase-B (MAO-B), which inhibits the breakdown of dopamine secreted by the dopaminergic neurons. By-products of selegiline include amphetamine and methamphetamine, which can cause side effects such as insomnia. Use of L-dopa in conjunction with selegiline has increased mortality rates that have not been effectively explained. Another side effect of the combination can be stomatitis. One report raised concern about increased mortality when MAO-B inhibitors were combined with L-dopa [4]; however subsequent studies have not confirmed this finding[5]. Unlike other non selective monoamine oxidase inhibitors, tyramine-containing foods do not cause a hypertensive crisis.

for more, visit http://en.wikipedia.org/wiki/Treatments_of_Parkinson%27s_Disease

Diabetes mellitus

Diabetes is a chronic disease with no cure as of 2010[update]. It is associated with an impaired glucose cycle, altering metabolism. Management of this disease may include carefully managing diet, exercising, taking oral diabetes medication, using some form of insulin, maintaining proper circulation in extremities and may be further complicated by other external factors such as stress, illness, menses, injection site scarring, and other physiological factors unique to individual patients.
The primary issue requiring management is the glucose cycle, whereby glucose in the bloodstream is made available to cells in the body, a process dependent upon the twin cycles of glucose entering the bloodstream, and insulin allowing appropriate uptake into the cells of the body. Both aspects can require management.
for more info, visit http://en.wikipedia.org/wiki/Diabetes_management

Key facts about urbanization and health

Urbanization: a challenge for public health

Urbanization is associated with many health challenges related to water, environment, violence and injury, noncommunicable diseases (NCDs) and their risk factors like tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol as well as the risks associated with disease outbreaks.

Virtually all population growth over the next 30 years will be in urban areas.

The rapid increase of people living in cities will be among the most important global health issues of the 21st century. Over half the world’s population now live in cities. By 2030, six out of every 10 people will be city dwellers, rising to seven out of every 10 people by 2050. In many cases, especially in the developing world, the speed of urbanization has outpaced the ability of governments to build essential infrastructure. Unplanned urbanization can intensify an existing humanitarian crisis and has consequences for the health security and safety of all citizens in cities.

The urban poor suffer disproportionately from a wide range of diseases and other health problems.
Health data is usually aggregated to provide an average of all urban residents - blurring differences between the rich and the poor. It thus masks the health conditions of the urban poor. More than one billion people – one third of the urban population – live in urban slums. World Bank estimates that by 2035, cities will become the predominant sites of poverty. Health problems of the urban poor include an increased risk for violence, chronic disease, and for some communicable diseases such as tuberculosis and HIV/AIDS.

The major drivers of health in urban settings are beyond the health sector.

Urbanization is not inherently positive or negative. Underlying drivers – also referred to as social determinants – converge in urban settings which strongly influence health status and other outcomes. These determinants include physical infrastructure, access to social and health services, local governance, and the distribution of income and educational opportunities. Communicable diseases such as HIV/AIDS and tuberculosis, chronic diseases such as heart disease and diabetes, mental disorders, and deaths due to violence and road traffic injuries are all driven by these underlying social determinants.

Actions and solutions exist to tackle the root causes of urban health challenges.

Urban planning can promote healthy behaviours and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks. Building inclusive cities that are accessible and age-friendly will benefit all urban residents. Such actions do not necessarily require additional funding, but commitment to redirect resources to priority interventions, thereby achieving greater efficiency.

Build partnerships with multiple sectors of society to make cities healthier.

Health is a human right for all citizens. It is the role and responsibility of individuals, civil society, and governments to uphold this principle. Platforms where municipalities, civil society and individuals come together must be encouraged to protect the right to health of current and future generations of urban dwellers. By bringing multiple sectors of society together to actively engage in developing policies, more sustainable health outcomes will be achieved. We are at a clear turning point in which we are moving towards an increasingly urbanized world and with it, the need to embrace the consequences this can have for health – both the benefits and the challenges. Rather than look back fifty years from now at what could have been done, we can take action now to ensure that growing cities are healthy cities.

SOURCE: WHO

MIGRAINE AURA

Migraine aura
An estimated 20% of migraine headaches are associated with an aura. Usually, the aura precedes the headache, although occasionally it may occur simultaneously with the headache. The most common auras are:
1. flashing, brightly colored lights in a zigzag pattern (referred to as fortification spectra), usually starting in the middle of the visual field and progressing outward; and

2. a hole (scotoma) in the visual field, also known as a blind spot.
Some elderly migraine sufferers may experience only the visual aura without the headache. A less common aura consists of pins-and-needles sensations in the hand and the arm on one side of the body or pins-and-needles sensations around the mouth and the nose on the same side. Other auras include auditory (hearing) hallucinations and abnormal tastes and smells.
For approximately 24 hours after a migraine attack, the migraine sufferer may feel drained of energy and may experience a low-grade headache along with sensitivity to light and sound. Unfortunately, some sufferers may have recurrences of the headache during this period.

What are some variants of migraine headaches?
Complicated migraines are migraines that are accompanied by neurological dysfunction. The part of the body that is affected by the dysfunction is determined by the part of the brain that is responsible for the headache.
Vertebrobasilar migraines are characterized by dysfunction of the brainstem (the lower part of the brain that is responsible for automatic activities like consciousness and balance).

The symptoms of vertebrobasilar migraines include:

fainting as an aura, vertigo (dizziness in which the environment seems to be spinning), and double vision.
Hemiplegic migraines are characterized by:

paralysis or weakness of one side of the body, mimicking a stroke.
The paralysis or weakness is usually temporary, but sometimes it can last for days.

Retinal, or ocular, migraines are rare attacks characterized by repeated instances of scotomata (blind spots) or blindness on one side, lasting less than an hour, that can be associated with headache. Irreversible vision loss can be a complication of this rare form of migraine.

How is a migraine headache diagnosed?
Migraine headaches are usually diagnosed when the symptoms described previously are present. Migraine generally begins in childhood to early adulthood. While migraines can first occur in an individual beyond the age of fifty, advancing age makes other types of headaches more likely. A family history usually is present, suggesting a genetic predisposition in migraine sufferers. The examination of individuals with migraine attacks usually is normal.

Patients with the first headache ever, worst headache ever, a significant change in the characteristics of headache or an association of the headache with nervous system symptoms, like visual or hearing or sensory loss, may require additional tests to exclude diseases other than migraine. The tests may include blood testing, brain scanning (either CT or MRI), and a spinal tap.

How are migraine headaches treated?

Treatment includes therapies that may or may not involve medications.

Non-medication therapies for migraine

Therapy that does not involve medications can provide symptomatic and preventative therapy.

Using ice, biofeedback, and relaxation techniques may be helpful in stopping an attack once it has started.

Sleep may be the best medicine if it is possible.
Preventing migraine takes motivation for the patient to make some life changes. Patients are educated as to triggering factors that can be avoided. These triggers include:

smoking, and
avoiding certain foods especially those high in tyramine such as sharp cheeses or those containing sulphites (wines) or nitrates (nuts, pressed meats).
Generally, leading a healthy life-style with good nutrition, an adequate intake of fluids, sufficient sleep and exercise may be useful. Acupuncture has been suggested to be a useful therapy.

Medication for migraine
Individuals with occasional mild migraine headaches that do not interfere with daily activities usually medicate themselves with over-the-counter (OTC or non-prescription) pain relievers (analgesics). Many OTC analgesics are available. OTC analgesics have been shown to be safe and effective for short-term relief of headache (as well as muscle aches, pains, menstrual cramps , and fever) when used according to the instructions on their labels.
There are two major classes of OTC analgesics:

acetaminophen (Tylenol), and
non-steroidal anti-inflammatory drugs (NSAIDs).

Acetaminophen
Acetaminophen reduces pain and fever by acting on pain centers in the brain. Acetaminophen is well tolerated and generally is considered easier on the stomach than NSAIDs. However, acetaminophen can cause severe liver damage in high (toxic) doses or if used on a regular basis over extended periods of time. In individuals who regularly consume moderate or large amounts of alcohol, acetaminophen can cause serious damage to the liver in lower doses that usually are not toxic. Acetaminophen also can damage the kidneys when taken in large doses. Therefore, acetaminophen should not be taken more frequently or in larger doses than recommended on the package label.

NSAIDS

NSAIDS

The two types of NSAIDs are
1) aspirin and
2) non-aspirin.

Examples of non-aspirin NSAIDs are ibuprofen (Advil, Nuprin, Motrin IB, and Medipren) and naproxen (Aleve). Some NSAIDs are available by prescription only. Prescription NSAIDs are usually prescribed to treat arthritis and other inflammatory conditions such as bursitis, tendonitis, etc. The difference between OTC and prescription NSAIDs usually is the amount of the active ingredient contained in each pill. For example, OTC naproxen (Aleve) contains 220 mg of naproxen per pill, whereas prescription naproxen (Naprosyn) contains 375 or 500 mg of naproxen per pill.

NSAIDs relieve pain by reducing the inflammation that causes the pain (they are called nonsteroidal antiinflammatory drugs or NSAIDs because they are different from corticosteroids such as prednisone, prednisolone, and cortisone which also reduce inflammation). Corticosteroids, though valuable in reducing inflammation, have predictable and potentially serious side effects, especially when used long-term. Their full effects also require hours or days. NSAIDs do not have the same side effects that corticosteroids have and their onset of action is faster.
Aspirin, Aleve, Motrin, and Advil all are NSAIDs and are similarly effective in relieving pain and fever. The main difference between aspirin and non-aspirin NSAIDs is their effect on platelets, the small particles in blood that cause blood clots to form. Aspirin prevents the platelets from forming blood clots. Therefore, aspirin can increase bleeding by preventing blood from clotting though it also can be used therapeutically to prevent clots from causing heart attacks and strokes. The non-aspirin NSAIDs also have antiplatelet effects, but their antiplatelet action does not last as long as aspirin, i.e. hours rather than days.
Aspirin, acetaminophen, and caffeine also are available combined in OTC analgesics for the treatment of headaches including migraine. Examples of such combination analgesics are Pain-aid, Excedrin, Fioricet, and Fiorinal.
Finding an effective analgesic or analgesic combination often is a process of trial and error because individuals respond differently to different analgesics. In general, a person should use the analgesic that has worked in the past. This will increase the likelihood that an analgesic will be effective and decrease the risk of side effects.

There are several precautions that should be observed with OTC analgesics:
a. Children and teenagers should not use aspirin for the treatment of headaches, other pain, or fever, because of the risk of developing Reye's Syndrome, a life-threatening neurological disease that can lead to coma and even death.
b. People with balance disorders or hearing difficulties should avoid using aspirin because aspirin may aggravate these conditions.
c. People taking blood thinners such as warfarin (Coumadin) should not take aspirin and non-aspirin NSAIDs without a doctor's supervision because they add further to the risk of bleeding that is caused by the blood thinner.
d. People with active ulcers of the stomach and duodenum should not take aspirin and non-aspirin NSAIDs because they can increase the risk of bleeding from the ulcer and impair healing of the ulcer.
e. People with advanced liver disease should not take aspirin and non-aspirin NSAIDs because they may impair kidney function. Deterioration of kidney function in these patients can lead to failure of the kidneys.
f. OTC or prescription analgesics should not be overused. Overuse of analgesics can lead to the development of tolerance (increasing ineffectiveness of the analgesic) and rebound headaches (return of the headache as soon as the effect of the analgesic wears off, usually in the early morning hours). Thus, overuse of analgesics can lead to a vicious cycle of more and more analgesics for headaches that respond less and less to treatment.

What is the treatment for moderate to severe migraine headaches?

Migraine-specific abortive medications usually are necessary for moderate to severe migraine headaches. The abortive medications for moderate or severe migraine headaches are different than OTC analgesics. Instead of relieving pain, they abort headaches by counteracting the cause of the headache, dilation of the temporal arteries. In fact, they cause narrowing of the arteries. Examples of migraine-specific abortive medications are the triptans and ergot preparations.

Triptans
The triptans attach to serotonin receptors on the blood vessels and nerves that surround them, constrict the blood vessels, and reduce the inflammation. This stops the headache. The triptan with the longest history of use is sumatriptan (Imitrex). Sumatriptan is available in the US as an injection, oral tablet, and nasal inhaler. Zolmitriptan (Zomig) and rizatriptan (Maxalt) are newer triptans that are available as oral tablets and as tablets that melt in the mouth. Naratriptan (Amerge), almotriptan (Axert) and frovatriptan (Frovalan) are available only as oral tablets.

Traditionally, triptans were prescribed for moderate or severe migraines after OTC analgesics and other simple measures failed. Newer studies suggest that triptans can be used as the first treatment for patients with migraines that are causing disability. (Significant disability is defined as more than 10 days of at least 50% disability during a three-month period.). Triptans should be used early after the migraine begins, before the onset of pain or when the pain is mild. Using a triptan early in an attack increases its effectiveness, reduces side effects, and decreases the chance of recurrence of another headache during the following 24 hours. Used early, triptans can be expected to abort more than 80% of migraine headaches within two hours.

The U.S. Food and Drug Administration (FDA) has issued a warning about taking triptans together with medications of the SSRI (selective serotonin reuptake inhibitor) or SNRI (selective serotonin/norepinephrine reuptake inhibitor) classes. Taking these medicines together can cause a serious condition called serotonin syndrome.

Side effects of triptans

The most common side effects of triptans are facial flushing, tingling of the skin, and a sense of tightness around the chest and throat. Other less common side effects include drowsiness, fatigue, and dizziness. These side effects are short-lived and are not considered serious.

The most serious side effects of triptans are heart attacks and strokes. Triptans are effective in migraine headaches because they narrow arteries in the head; however, they also can narrow arteries in the heart. In individuals without existing carotid or coronary artery disease, the narrowing caused by triptans usually does not cause problems. However, persons whose carotid and coronary arteries are narrowed by atherosclerosis or who suffer from intermittent spasm of the coronary arteries (a condition called Prinzmetal's or variant angina), the narrowing caused by triptans can further reduce the flow of blood through the arteries and have been reported to cause heart attacks and strokes. Therefore, triptans should not be used by those who have had heart attacks and strokes, or those who have symptoms of atherosclerosis such as angina, transient ischemic attack (TIAs), and intermittent claudication.

Healthy adults may have atherosclerosis and narrowing of the coronary arteries that are "silent", that is, without past strokes, transient ischemic attacks, heart attacks, or angina. Therefore, before prescribing a triptan, a doctor should evaluate patients for possible atherosclerosis if they have one or more risk factors for developing atherosclerosis. These risk factors include cigarette smoking, diabetes mellitus, high blood pressure, high levels of LDL ("bad") cholesterol in the blood, obesity, male and over 40 years of age, female and postmenopausal, or a family member(s) who has had heart attacks at an early age. Some patients who are at risk should receive their first dose of a triptan in the doctor's office while being monitored with an electrocardiogram (EKG).
Triptans can interact with other drugs. For example, there have been rare reports of triptans causing a "serotonin syndrome" when given together with a selective serotonin reuptake inhibitor. Selective serotonin reuptake inhibitors (SSRIs) are a class of medications widely used to treat depression. The symptoms of serotonin syndrome include confusion, fever, tremor, high blood pressure, diarrhea, and sweating. Certain triptans such as sumatriptan, zolmitriptan, and rizatriptan can interact with monoamine oxidase inhibitors. Propranolol (Inderal) can raise rizatriptan blood levels. Cimetidine (Tagamet) can increase zolmitriptan blood levels.
Triptans should not be used in pregnant women and are not generally used in young children.

Ergots
Ergots, like triptans, are medications that abort migraine headaches. These may be combined with caffeine and/or other pain relief medications in combination products. Examples of ergots include ergotamine preparations (Ergomar, Wigraine, and Cafergot) and dihydroergotamine preparations (Migranal, DHE-45). Ergots, like triptans, cause constriction of blood vessels, but ergots tend to cause more constriction of vessels in the heart and other parts of the body than the triptans, and their effects on the heart are more prolonged than those of the triptans. Therefore, they are not as safe as the triptans. The ergots also are more prone to cause nausea and vomiting than the triptans. The ergots can cause prolonged contraction of the uterus and miscarriages in pregnant women.

Midrin
Midrin is used to abort migraine and tension headaches. It is a combination of isometheptene (a blood vessel constrictor), acetaminophen (a pain reliever), and dichloralphenazone (a mild sedative). It is most effective if used early during a headache; however, because of its potent blood vessel constricting effect, it should not be used in persons with high blood pressure, kidney disease, glaucoma, atherosclerosis, liver disease, or taking monoamine oxidase inhibitors.