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Suggest the ideal dosage for Indomethacin taken for sensitive headache

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Posted on Sat, 28 May 2016
Question: Last September I was using the charcoal grill and inhaled a large amount of smoke into my sinuses. This brought back a symptom I had 7 years earlier after a severe sinus infection. The closest thing we could find to describe what I had was a cough headache. A drug called Indomethacin seemed to resolve my problem but it took many months to do so. It is now six months later any my daily headaches continue. So here it is seven years later and pretty much the same sysmptoms are present in addition to slight dizziness when I get up first thing in the morning.
Seven years ago i also had sinus surgery that did not resolve my issues, plus numerous MRI scans which showed nothing unusual.
On a scale of one -to-ten my daily pain is a two or three. Not dibilitating but very annoying. It seems as if the charcoal smoke may have permanently damaged the lining of my sinuses. The current 250 MG twice a day dosage of Indomethacin seems to abate much of the pain.
I've seen a Neurologist once, and the ENT doctor that did my sinus surgery. he tried tow rounds of antibiotics after taking two mucus samples but no positive outcome.
If I bend over or cough or sneeze I get a very strong sudden headache which diminishes in a few minutes, exactly like the first time I experienced this seven years ago.
I am re-establishing contact with my neurologist tomorrow as he requested I follow up with him if the medication does not abate the symptoms.
I am on Benazepril and Simvistaton for high blood pressure and high cholesterol
My occupation is a Fire Marshal/Building Code Official for the last 36 years.

doctor
Answered by Dr. Dariush Saghafi (2 hours later)
Brief Answer:
Indomethacin sensitive headaches

Detailed Answer:
Good day sir and thank you posing your question here on this network. I'm a headache specialist from XXXXXXX OH and am curious about the dose of your Indomethacin. Are you certain that it is 250 mg. TWICE daily? That's an ENORMOUS amount of medication and it would be even more impressive if you're not having any side effects to that dosage because the GI side effect profile in my experience of anything above 100 or 150mg. DAILY total dose can be debilitating. In many instances patients complain of changes in the color of their stools which generally indicates bleeding from the upper GI tract....so I just wanted to verify that dose with you. The more common dose would be something on the order of 25 mg. twice or 3x daily or in very aggressive cases maybe 50-75mg. 3x/day.

Secondly, if your headaches are responsive to indomethacin then, you may be suffering from what are lovingly referred to as TRIGEMINAL AUTONOMIC CEPHALGIAS or TAC's. Typically, these are indomethacin sensitive headaches and encompass a wide variety of headache types (cluster, hemicrania continua, jabs and jolts, and others). It's a shame that you had sinus surgery done for this because I am forever trying catch people before they go for these sorts of surgeries to warn them of the HIGH RATE of useless results they get since MIGRAINE types of headaches or in this case, probable TCA's can easily mimic sinus symptoms with the pain in the front of the face, pressure sensations, even upon bending over....but the truth is rounds of antibiotics, antihistamines, and even steroids do nothing for the headaches. Those are the BIG RED FLAGS that should STOP any ENT specialist from wanting to operate. Especially, if CT scans of the sinuses don't show anything significant which they generally don't.....Don't let anybody convince you that CHRONIC sinusitis causes any type of real problem because we don't believe it does in terms of headaches. Acute sinus infection, yes....but in those cases you will not only have congestion...but there will be drainage, usually a lot, usually purulent of a green, yellow, or brown nature.....Congestion or stuffiness in and of itself is not at all a sensitive parameter to diagnose sinusitis or headaches caused by sinusitis. Anyways, I guess it's too late in your case to give you that talk...the deed has been done.....now, you can be the disciple that goes forth and warns fellow headache sufferers that sinus headaches are indeed rare (estimated at less than 0.5% of all headache patients) though they are HIGHLY AND ERRONEOUSLY DIAGNOSED!

The thing to do at this point is to discover EXACTLY what type of headache you are having. If they are clearly TAC's secondary to trigeminal nerve sensory damage from the smoke inhalation then, you could raise the dose of the indomethacin...I'm assuming it is NOT 250 mg. TWICE daily and something on the order of 25 mg. instead which means I might suggest a 3x/day regimen or a slightly higher unit dose such as 37.5mg. if the 25's are scored....or if not just use 50mg. tablets and then, combine with 25's so you get a bit of a higher total daily dose. You should also keep a headache diary accurately as this will help not only your neurologist but you in terms of looking for other things about your headaches that may be contributory such as triggers and other factors that could be related to the headaches (sleep deprivation, stress, etc. etc.).

I might even check to see if you are magnesium deficient as I've found that some of my TAC patients have magnesium deficiencies which when corrected can give very good results to overall control of headaches and auras if any exist (most TAC types do not have aura associated).

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. If so, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: www.bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

Many thanks for using this service to ask your questions. Be well.

This consult request has taken a total of 48 minutes of time to read, research, and respond.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (19 minutes later)
Dr. Saghafi,
I should have looked at the bottle before I wrote. I was taking a 10 MG dose of Indomethacin three times daily, the new dose is 25 MG twice daily. And as to the sinus surgery the outcome of that was wonderful even though it did not resolve my headaches. I've had one sinus blocked since I was born and the surgery allows me to fully nose breathe again.

I'll touch base with my neurologist tomorrow. Thank you for your expert opinion. XXXXXXX
doctor
Answered by Dr. Dariush Saghafi (10 minutes later)
Brief Answer:
Sinus surgeries are clearly useful for many reasons

Detailed Answer:
Thanks for that clarification on your sinus surgery.

I'm glad to hear that the surgery worked out for you in clearing a problem you'd had from childhood. Of course, there are many other reasons people get surgeries on their sinuses. I was thinking that the only reason you had gotten the procedure was for headache relief which is something I run into all the time...obviously, not the case here....would've been nice for it to have worked as well for your headaches as it did for your congestion but unfortunately, it didn't.

I'm also happy to hear about the dose for your indomethacin being what I thought...otherwise, I'd been racing to find a way of getting the lining of your gut tested to find out whether or not you may be some type of genetically linked half brother to Superman or something! LOL.....

Please keep me in the loop with further updates as well as what your neurologist's thoughts might be once he's had a chance to examine you and assess the types of headaches you may be having these days.

This consult request has taken a total of 57 minutes of time to read, research, and respond.

All the best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (4 hours later)
Doc,
While I wish I had an iron stomach I do not. Early in my days of self-employment I suffered from duodenal ulcers. That was in my twenties. Have not had any issues since and that has been almost 40 years ago. Superman I'm not but in my profession someone has called me Dr. CodeHead more than once because of the thousands of pages of building codes they think I've memorized. It's a mixed bag out there how people view building inspectors but at the end of the day "If we do our jobs nothing happens". Buildings don't collapse, lives aren't lost, and I can sleep well at night (well almost sleep well except for these nuisance headaches :-))
You are providing a great service and have given me some good insight as to questions I can ask when I meet our local neurologist.
Thanks again sir! XXXXXXX
doctor
Answered by Dr. Dariush Saghafi (28 hours later)
Brief Answer:
Many thanks for your service

Detailed Answer:
Very appreciative of the very important and hard work you and your colleagues do day in and day out.

I think we all take your line of work very much for granted, unfortunately, because it's just so easy for everyone to climb to the top of a giant skyscraper...or any building for that matter and simply expect it to be in tip top shape, floors, walls, beams, elevators, stairwells, bannisters, railings, plate glass.....just incredible how much has to be AFTER THE FACT and throughout the life of the building while human beings choose to venture into the edifice....just amazing.

Please feel free to stay in touch and let me know how things work out with your neurologist. Allow me one more bit of advice with respect to your neurologist. If for some reason he/she is unable to get those bothersome symptoms to COMPLETELY be vanquished then, you may consider a HEADACHE SPECIALIST. We are trained in a slightly different approach to headache patients than even general or even subspecialty trained neurologists. One major thing that a good headache specialist teaches their patients how to use are headache diaries or logs that closely monitor, follow, and document the most salient features and characteristics of headaches and their associated symptoms.

You may also choose to download a FREE IPHONE app (if you've got an iphone) called MIGRAINE BUDDY. I would highly recommend you look that app up and combine that with a standard and conventional HEADACHE DIARY which I can share with you. It is surprising just how valuable such tools are and how much good they do at solving peoples' problems without really getting terribly personal or invasive.

Cheers! Keep me in the loop if possible!


Please keep me in the loop with further updates as well as what your neurologist's thoughts might be once he's had a chance to examine you and assess the types of headaches you may be having these days.

This consult request has taken a total of 69 minutes of time to read, research, and respond.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2473 Questions

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Suggest the ideal dosage for Indomethacin taken for sensitive headache

Brief Answer: Indomethacin sensitive headaches Detailed Answer: Good day sir and thank you posing your question here on this network. I'm a headache specialist from XXXXXXX OH and am curious about the dose of your Indomethacin. Are you certain that it is 250 mg. TWICE daily? That's an ENORMOUS amount of medication and it would be even more impressive if you're not having any side effects to that dosage because the GI side effect profile in my experience of anything above 100 or 150mg. DAILY total dose can be debilitating. In many instances patients complain of changes in the color of their stools which generally indicates bleeding from the upper GI tract....so I just wanted to verify that dose with you. The more common dose would be something on the order of 25 mg. twice or 3x daily or in very aggressive cases maybe 50-75mg. 3x/day. Secondly, if your headaches are responsive to indomethacin then, you may be suffering from what are lovingly referred to as TRIGEMINAL AUTONOMIC CEPHALGIAS or TAC's. Typically, these are indomethacin sensitive headaches and encompass a wide variety of headache types (cluster, hemicrania continua, jabs and jolts, and others). It's a shame that you had sinus surgery done for this because I am forever trying catch people before they go for these sorts of surgeries to warn them of the HIGH RATE of useless results they get since MIGRAINE types of headaches or in this case, probable TCA's can easily mimic sinus symptoms with the pain in the front of the face, pressure sensations, even upon bending over....but the truth is rounds of antibiotics, antihistamines, and even steroids do nothing for the headaches. Those are the BIG RED FLAGS that should STOP any ENT specialist from wanting to operate. Especially, if CT scans of the sinuses don't show anything significant which they generally don't.....Don't let anybody convince you that CHRONIC sinusitis causes any type of real problem because we don't believe it does in terms of headaches. Acute sinus infection, yes....but in those cases you will not only have congestion...but there will be drainage, usually a lot, usually purulent of a green, yellow, or brown nature.....Congestion or stuffiness in and of itself is not at all a sensitive parameter to diagnose sinusitis or headaches caused by sinusitis. Anyways, I guess it's too late in your case to give you that talk...the deed has been done.....now, you can be the disciple that goes forth and warns fellow headache sufferers that sinus headaches are indeed rare (estimated at less than 0.5% of all headache patients) though they are HIGHLY AND ERRONEOUSLY DIAGNOSED! The thing to do at this point is to discover EXACTLY what type of headache you are having. If they are clearly TAC's secondary to trigeminal nerve sensory damage from the smoke inhalation then, you could raise the dose of the indomethacin...I'm assuming it is NOT 250 mg. TWICE daily and something on the order of 25 mg. instead which means I might suggest a 3x/day regimen or a slightly higher unit dose such as 37.5mg. if the 25's are scored....or if not just use 50mg. tablets and then, combine with 25's so you get a bit of a higher total daily dose. You should also keep a headache diary accurately as this will help not only your neurologist but you in terms of looking for other things about your headaches that may be contributory such as triggers and other factors that could be related to the headaches (sleep deprivation, stress, etc. etc.). I might even check to see if you are magnesium deficient as I've found that some of my TAC patients have magnesium deficiencies which when corrected can give very good results to overall control of headaches and auras if any exist (most TAC types do not have aura associated). I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. If so, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response. Write to me any time at: www.bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered. Many thanks for using this service to ask your questions. Be well. This consult request has taken a total of 48 minutes of time to read, research, and respond.