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Neuralgia Pain selecting Carbamazepine / Migraine selecting NSAIDs, Triptans / Tension Headache selecting NSAIDs, Acetaminophen

  • Writer: Mayta
    Mayta
  • Mar 9, 2024
  • 2 min read

Condition

Treatment

Prophylaxis

Migraine

NSAIDs, Triptans

Propranolol

Tension Headache

NSAIDs, Acetaminophen

Amitriptyline

Neuralgia Pain

Carbamazepine

Gabapentin, Pregabalin

Migraine Management

1. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

  • Indication: Effective for mild to moderate migraine attacks.

  • Common choices: Ibuprofen (400-600 mg orally, every 4-6 hours as needed) and Naproxen (500 mg initially, followed by 250 mg every 6-8 hours as needed).

  • Note: Use at the onset of migraine symptoms for best effectiveness.

2. Acetaminophen

  • Indication: An alternative for patients who cannot take NSAIDs, for mild to moderate migraine.

  • Dosage: 500-1000 mg orally every 4-6 hours as needed, not exceeding 3,000 mg per day to avoid liver damage.

3. Triptans

  • Indication: First-line treatment for moderate to severe migraine attacks or for those not responding to NSAIDs.

  • Common choices: Sumatriptan (25-100 mg orally once, may repeat after 2 hours if needed, max 200 mg/day), Zolmitriptan (2.5-5 mg orally, may repeat after 2 hours if needed, max 10 mg/day).

  • Note: Contraindicated in patients with cardiovascular diseases.

Tension Headache Management

1. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

  • Indication: Effective for mild to moderate migraine attacks.

  • Common choices: Ibuprofen (400-600 mg orally, every 4-6 hours as needed) and Naproxen (500 mg initially, followed by 250 mg every 6-8 hours as needed).

  • Note: Use at the onset of migraine symptoms for best effectiveness.

2. Acetaminophen

  • Indication: An alternative for patients who cannot take NSAIDs, for mild to moderate migraine.

  • Dosage: 500-1000 mg orally every 4-6 hours as needed, not exceeding 3,000 mg per day to avoid liver damage.

Neuralgia Pain Management

Carbamazepine

  • Indication: First-line treatment for trigeminal neuralgia.

  • Dosage: Starting at 100 mg twice a day orally, gradually increasing to a maintenance dose of 400-800 mg/day divided into 2-4 doses. The maximum dose can go up to 1,200 mg/day based on response and tolerability.

  • Note: Monitor for side effects like dizziness, drowsiness, and blood dyscrasias.

Additional Treatment Options

For Migraine

  • Prophylactic treatment: Considered for patients with frequent, long-lasting, or particularly severe migraine attacks. Beta-blockers (e.g., propranolol), calcium channel blockers (e.g., verapamil), and antiepileptic drugs (e.g., topiramate) are options.

  • CGRP antagonists: Erenumab, Galcanezumab, and Fremanezumab for preventive treatment.

For Tension Headache

  • Muscle relaxants: Occasionally used for managing chronic tension headaches.

  • Antidepressants: Amitriptyline for prevention in chronic cases.

For Neuralgia Pain

  • Other anticonvulsants: Pregabalin and gabapentin may be considered if carbamazepine is not effective or not tolerated.

  • Surgical intervention: In cases of trigeminal neuralgia not responsive to medical therapy, microvascular decompression or other surgical procedures might be indicated.

Remember, the choice of medication and dosage should be individualized, considering the patient's medical history, comorbidities, and potential drug interactions. Regular follow-up is crucial to assess efficacy and adjust the treatment plan as needed.

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Post: Blog2_Post

Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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