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abdominal migraine-a type of migraine that mostly affects young children and involves moderate to severe abdominal pain, with little or no headache.

arteriovenous malformation-a tangle of veins and arteries that can disrupt the normal flow of blood and is frequently associated with episodic headache.

aura-a warning of a migraine headache. Usually visual, it may appear as flashing lights, zigzag lines, or a temporary loss of vision, along with numbness or trouble speaking.

autonomic-occurring involuntary. Autonomic nervous system dysfunction is frequently associated with various types of migraine.

basilar-type migraine-a type of migraine, occurring primarily in young women, causing symptoms of abnormal brain stem functioning such as double vision, loss of peripheral vision, numbness, imbalance, or loss of consciousness.

benign intracranial hypertension-increased pressure within the brain that causes severe headaches. It can be caused by clotting in the major cerebral veins or from certain medications (including some antibiotics, human growth hormone replacement, and vitamin A and related compounds).

biofeedback-a process that increases an individual’s voluntary control of physiologic states such as blood pressure and pain response.

cephalgia-head pain.

cervical arterial dissection-a tear in an artery wall that can lead to stroke or transient ischemic attacks.

cervicogenic headache-a type of headache caused by structural irregularities in either the neck or head.

chronic headache-headache that occurs 15 or more days a month over a 3-month period.

cluster headache-sudden, extremely painful headaches that occur in a closely grouped pattern several times a day and at the same times over a period of weeks.

computed tomography (CT)-a type of diagnostic imaging that uses X-rays and computer technology to produce two-dimensional images of organs, bones, and tissues.

cortical spreading depression-a wave of increased brain activity that slowly spreads from the back toward the front of the brain’s surface and may be the basis for migraine aura.

epidural hematoma-bleeding between the brain’s protective coating and the skull.

episodic-comes and goes.

ergot derivative drugs-drugs that bind to the neurotransmitter serotonin and help to decrease the transmission of pain messages along nerve fibers.

hemicrania continua-one-sided headaches that are chronic or continuous and respond to indomethacin treatment.

hemiplegic migraine-a type of migraine causing temporary paralysis on one side of the body.

hypnic headache-a rare form of headache that awakens individuals at night (also called “alarm-clock headache”).

ice cream headache-a painful headache brought on by changes in blood flow that result from a sudden chilling of the roof of the mouth.

ischemic stroke-stroke caused by a clot that blocks blood flow to the brain.

medication overuse headache-caused by the overuse of drugs (more than 3 times weekly) to treat headache. While the medication may help to relieve the headaches temporarily, over time the underlying headache becomes worse and occurs more frequently, creating a vicious cycle of medication use and head pain. The pain improves when the medication is stopped.

meninges-the three layers of membrane that cover the brain and spinal cord.

menstrually-related migraine-a migraine that affects women around the time of their period.

migraine-headaches that are usually pulsing or throbbing and occur on one or both sides of the head. They are moderate to severe in intensity, associated with nausea, vomiting, sensitivity to light and noise, and worsen with routine physical activity.

new daily persistent headache-a type of treatment-resistant chronic headache marked by daily pain that can last for years.

neurotransmitters-chemicals in the brain that helps nerve cells communicate with each other.

nociceptors-nerve fiber endings that receive and transmit pain signals.

ophthalmoplegic migraine-an uncommon form of migraine featuring a droopy eyelid, large pupil, and double vision that may last for weeks after the headache pain is gone.

paroxysmal hemicrania-a rare form of headache that usually begins in adulthood and is marked by one-sided attacks that typically occur 5 to 40 times a day.

postdrome-the period following the headache.

premonitory-meaning before. Some individuals with migraine experience premonitory symptoms up to 24 hours prior to headache pain.

primary exertional headache-headache brought on by fits of coughing or sneezing, or by intense physical activity such as running or lifting.

primary headaches-headaches that occurs on their own with no detectable underlying cause, such as migraine, tension-type headache, and the trigeminal autonomic cephalgias.

primary stabbing headache-also called “ice pick headache” or “jabs and jolts” headache for its extremely intense pain that develops suddenly and generally lasts 1 to 10 seconds.

retinal migraine-a type of migraine that is characterized by attacks of visual loss or disturbances in one eye.

reversible vasoconstriction syndrome-a narrowing of the arteries in the brain that can cause sudden, “thunderclap” headache that may be brought on by bleeding in or around the brain.

secondary headaches-headaches that are caused by an underlying condition or disease.

serotonin-a neurotransmitter present throughout the body and brain that plays an important role in headache and migraine, mood disorders, regulating body temperature, sleep, vomiting, sexuality, and appetite.

status migrainosus-migraine lasting more than 72 hours.

subdural hematoma-bleeding between the brain and its protective membrane covering.

SUNCT (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing)-a rare form of headache marked by brief recurrent bursts of moderate to severe burning, stabbing, or throbbing pain, usually on one side of the head and around the eye or temple, accompanied by symptoms including watery, reddish eyes, and runny nose.

tension-type headache-a primary headache that is band-like or squeezing and does not worsen with routine activity. It may be brought on by stress.

transient ischemic attack-a strokes that last only a few minutes but signals a subsequent and more severe stroke.

trigger-something that brings about a disease or condition.

triptans-a family of drugs used to treat migraines and cluster headaches by preventing or stopping nerve tissue inflammation and resulting changes in blood vessels.

vascular-refers to blood vessels or the flow of blood.

venous sinus thrombosis-a form of stroke caused by a clot that blocks blood flow in the brain’s veins.

Arachnoiditis is a condition in which one of the three membranes covering the brain and spinal cord, called the arachnoid membrane, becomes inflamed. A number of causes, including infection or trauma, can result in inflammation of this membrane. Arachnoiditis can produce disabling, progressive, and even permanent pain.

Arthritis. Millions of Americans suffer from arthritic conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and gout. These disorders are characterized by joint pain in the extremities. Many other inflammatory diseases affect the body’s soft tissues, including tendonitis and bursitis.

Back pain has become the high price paid by our modern lifestyle and is a startlingly common cause of disability for many Americans, including both active and inactive people. Back pain that spreads to the leg is called sciatica and is a very common condition (see below).

 Another common type of back pain is associated with the discs of the spine, the soft, spongy padding between the vertebrae (bones) that form the spine. Discs protect the spine by absorbing shock, but they tend to degenerate over time and may sometimes rupture.

Spondylolisthesis is a back condition that occurs when one vertebra extends over another, causing pressure on nerves and therefore pain. Also, damage to nerve roots is a serious condition, called

radiculopathy, that can be extremely painful. Treatment for a damaged disc includes drugs such as painkillers, muscle relaxants, and steroids; exercise or rest, depending on the patient’s condition; adequate support, such as a brace or better mattress and physical therapy. In some cases, surgery may be required to remove the damaged portion of the disc and return it to its previous condition, especially when it is pressing a nerve root. Surgical procedures include discectomy, laminectomy, or spinal fusion.

Burn pain can be profound and poses an extreme challenge to the medical community. First-degree burns are the least severe; with third-degree burns, the skin is lost. Depending on the injury, pain accompanying burns can be excruciating, and even after the wound has healed patients may have chronic pain at the burn site.

Central pain syndrome-see “Trauma” below.

Cancer pain can accompany the growth of a tumor, the treatment of cancer, or chronic problems related to cancer’s permanent effects on the body. Fortunately, most cancer pain can be treated to help minimize discomfort and stress to the patient.

Headaches affect millions of Americans. The three most common types of chronic headache are migraines, cluster headaches, and tension headaches. Each comes with its own telltale brand of pain.

• Migraines are characterized by throbbing pain and sometimes by other symptoms, such as nausea and visual disturbances. Migraines are more frequent in women than men. Stress can trigger a migraine headache, and migraines can also put the sufferer at risk for stroke.
• Cluster headaches are characterized by excruciating, piercing pain on one side of the head; they occur more frequently in men than women.
• Tension headaches are often described as a tight band around the head.

Head and facial pain can be agonizing, whether it results from dental problems or from disorders such as cranial neuralgia, in which one of the nerves in the face, head, or neck is inflamed. Another condition, trigeminal neuralgia (also called tic douloureux), affects the largest of the cranial nerves and is characterized by a stabbing, shooting pain.

Muscle pain can range from an aching muscle, spasm, or strain, to the severe spasticity that accompanies paralysis. Another disabling syndrome is fibromyalgia, a disorder characterized by fatigue, stiffness, joint tenderness, and widespread muscle pain. Polymyositis, dermatomyositis, and inclusion body myositis are painful disorders characterized by muscle inflammation. They may be caused by infection or autoimmune dysfunction and are sometimes associated with connective tissue disorders, such as lupus and rheumatoid arthritis.

Myofascial pain syndromes affect sensitive areas known as trigger points, located within the body’s muscles. Myofascial pain syndromes are sometimes misdiagnosed and can be debilitating. Fibromyalgia is a type of myofascial pain syndrome.

Neuropathic pain is a type of pain that can result from injury to nerves, either in the peripheral or central nervous system. Neuropathic pain can occur in any part of the body and is frequently described as a hot, burning sensation, which can be devastating to the affected individual. It can result from diseases that affect nerves (such as diabetes) or from trauma, or, because chemotherapy drugs can affect nerves, it can be a consequence of cancer treatment. Among the many neuropathic pain conditions are diabetic neuropathy (which results from nerve damage secondary to vascular problems that occur with diabetes); reflex sympathetic dystrophy syndrome (see below), which can follow injury; phantom limb and post-amputation pain, which can result from the surgical removal of a limb; postherpetic neuralgia, which can occur after an outbreak of shingles; and central pain syndrome, which can result from trauma to the brain or spinal cord.

Reflex sympathetic dystrophy syndrome, or RSDS, is accompanied by burning pain and hypersensitivity to temperature. Often triggered by trauma or nerve damage, RSDS causes the skin of the affected area to become characteristically shiny. In recent years, RSDS has come to be called complex regional pain syndrome (CRPS); in the past it was often called causalgia.

Repetitive stress injuries are muscular conditions that result from repeated motions performed in the course of normal work or other daily activities. They include:

• writer’s cramp, which affects musicians and writers and others,
• compression or entrapment neuropathies, including carpal tunnel syndrome, caused by chronic overextension of the wrist and
• tendonitis or tenosynovitis, affecting one or more tendons.

Sciatica is a painful condition caused by pressure on the sciatic nerve, the main nerve that branches off the spinal cord and continues down into the thighs, legs, ankles, and feet. Sciatica is characterized by pain in the buttocks and can be caused by a number of factors. Exertion, obesity, and poor posture can all cause pressure on the sciatic nerve. One common cause of sciatica is a herniated disc.

Shingles and other painful disorders affect the skin. Pain is a common symptom of many skin disorders, even the most common rashes. One of the most vexing neurological disorders is shingles or herpes zoster, an infection that often causes agonizing pain resistant to treatment. Prompt treatment with antiviral agents is important to arrest the infection, which if prolonged can result in an associated condition known as postherpetic neuralgia. Other painful disorders affecting the skin include:

• vasculitis, or inflammation of blood vessels;
• other infections, including herpes simplex;
• skin tumors and cysts, and
• tumors associated with neurofibromatosis, a neurogenetic disorder.

Sports injuries are common. Sprains, strains, bruises, dislocations, and fractures are all well-known words in the language of sports. Pain is another. In extreme cases, sports injuries can take the form of costly and painful spinal cord and head injuries, which cause severe suffering and disability.

Spinal stenosis refers to a narrowing of the canal surrounding the spinal cord. The condition occurs naturally with aging. Spinal stenosis causes weakness in the legs and leg pain usually felt while the person is standing up and often relieved by sitting down.

Surgical pain may require regional or general anesthesia during the procedure and medications to control discomfort following the operation. Control of pain associated with surgery includes presurgical preparation and careful monitoring of the patient during and after the procedure.

Temporomandibular disorders are conditions in which the temporomandibular joint (the jaw) is damaged and/or the muscles used for chewing and talking become stressed, causing pain. The condition may be the result of a number of factors, such as an injury to the jaw or joint misalignment, and may give rise to a variety of symptoms, most commonly pain in the jaw, face, and/or neck muscles. Physicians reach a diagnosis by listening to the patient’s description of the symptoms and by performing a simple examination of the facial muscles and the temporomandibular joint.

Trauma can occur after injuries in the home, at the workplace, during sports activities, or on the road. Any of these injuries can result in severe disability and pain. Some patients who have had an injury to the spinal cord experience intense pain ranging from tingling to burning and, commonly, both. Such patients are sensitive to hot and cold temperatures and touch. For these individuals, a touch can be perceived as intense burning, indicating abnormal signals relayed to and from the brain. This condition is called central pain syndrome or, if the damage is in the thalamus (the brain’s center for processing bodily sensations), thalamic pain syndrome. It affects as many as 100,000 Americans with multiple sclerosis, Parkinson’s disease, amputated limbs, spinal cord injuries, and stroke. Their pain is severe and is extremely difficult to treat effectively. A variety of medications, including analgesics, antidepressants, anticonvulsants, and electrical stimulation, are options available to central pain patients.

Vascular disease or injury-such as vasculitis or inflammation of blood vessels, coronary artery disease, and circulatory problems-all have the potential to cause pain. Vascular pain affects millions of Americans and occurs when communication between blood vessels and nerves is interrupted. Ruptures, spasms, constriction, or obstruction of blood vessels, as well as a condition called ischemia in which blood supply to organs, tissues, or limbs is cut off, can also result in pain.

Acute Pain – The normal, predicted physiological response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, and acute illness. It is generally time-limited and is responsive to Opioid therapy, among other therapies. eg, you hurt yourself with a knife, or by a stove;

Chronic Pain – A pain state which is persistent and in which the cause of the pain cannot always be removed or is difficult to treat. Chronic Pain may be associated with  a long term incurable or intractable medical condition or disease.

By specific pain receptors, pain can divided into Nociceptive Pain and Non Nociceptive Pain

If you according to the pain stimulus, duration, and features, there are also several types of pains:

• Gnawing pain. Continuous with constant intensity. It generally worsens with movement.
• Throbbing pain. This is typical of migraine pain. It is caused by dilation and constriction of the cerebral blood vessels.
• Stabbing pain. Intense and severe. It is caused by mechanical stimuli.
• Burning pain. A constant, burning feeling, like, for example, the type of pain caused by heartburn.
• Pressing pain. Caused by constriction of the blood vessels or muscles.

The Gate Control Theory was initially proposed in 1965 by Melzack and Wall based on the fact that small diameter nerve fibres carry pain stimuli through a ‘gate mechanism’ but larger diameter nerve fibres going through the same gate can inhibit the transmission of the smaller nerves carrying the pain signal.

Chemicals released as a response to the pain stimuli also influence whether the gate is open or closed for the brain to receive the pain signal. This lead to the theory that the pain signals can be interfered with by stimulating the periphery of the pain site, the appropriate signal-carrying nerves at the spinal cord, or particular corresponding areas in the brain stem or cerebral cortex. Complementary Therapists need to concern themselves with the first 2 options in order to effectively modify the pain signal.

It is generally recognised that the ‘Pain gate’ can be shut by stimulating nerves responsible for carrying the touch signal (mechaoreceptors) which enables the relief of pain through massage techniques, rubbing, and also the application of wheat bags and ice packs.

The Gate can also be shut by stimulating the release of endogenous opioids which are opioid (pain-relieving) type chemicals released by the body in response to pain stimuli. Acupuncture and electrical analgesia (TENS) is thought to stimulate their release as a response to stimulation, the opioids then inhibiting the transmission of pain signals in the substantia gelatinosa part of the spinal cord – what is often referred to as the spinal root part of the nerve.

Rubbing an injured area often helps to relieve the pain. Rubbing stimulates vibration receptors, sending signals to the dorsal horn via large diameter A-beta fibres
These vibration signals enter the dorsal horn computer at the same time as the small diameter C fibre pain signals from the injured area
If the vibration signals are of the correct magnitude, they prevent further onward transmission i.e. closing the gate on pain.
Pain relieving treatment modalities like TENS, Pain Gone Pen, acupuncture and heat produce pain control by a similar mechanism. TENS stimulates the A-beta fibres, and acupuncture stimulates the A-delta fibres.

Before taking carisoprodol, tell your doctor or pharmacist if you are allergic to it; or to meprobamate, tybamate, or mebutamate; or if you have any other allergies. Also tell your doctor if you have ever had an unusual reaction to carisoprodol or any of the medications listed above.

This medication should not be used if you have a certain medical condition. Before using this medication, tell your doctor if you have: acute intermittent porphyria.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, liver problems, history of regular alcohol/drug abuse, asthma, seizure disorder.

To reduce dizziness and lightheadedness, get up slowly when rising from a seated or lying position.

This drug may make you dizzy or drowsy; use caution engaging in activities requiring alertness such as driving, swimming or using machinery. Avoid alcoholic beverages.

This medication is not recommended for use during pregnancy. It may rarely harm an unborn baby. Consult your doctor for more details and to discuss reliable forms of birth control. If you become pregnant while taking this medication, tell your doctor immediately.

This medication passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Do not take Carisoprodol if you have acute intermittent porphyria. Before taking Carisoprodol, tell your doctor if you have kidney or liver disease. You may need a lower dose or special monitoring during your therapy. It is not known whether Carisoprodol will harm an unborn baby. Do not take Carisoprodol without first talking to your doctor if you are pregnant. It is also not known whether Carisoprodol passes into breast milk. Do not take Carisoprodol without first talking to your doctor if you are breast-feeding a baby. Carisoprodol is not approved for use in children younger than 12 years of age.

PRECAUTIONS
Sedation
SOMA may have sedative properties (in the low back pain trials, 13% to 17% of patients who received SOMA experienced sedation compared to 6% of patients who received placebo) [see ADVERSE REACTIONS] and may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a motor vehicle or operating machinery.

Since the sedative effects of SOMA and other CNS depressants (e.g., alcohol, benzodiazepines, opioids, tricyclic antidepressants) may be additive, appropriate caution should be exercised with patients who take more than one of these CNS depressants simultaneously.

Drug Dependence, Withdrawal, and Abuse
In the postmarketing experience with SOMA, cases of dependence, withdrawal, and abuse have been reported with prolonged use. Most cases of dependence, withdrawal, and abuse occurred in patients who have had a history of addiction or who used SOMA in combination with other drugs with abuse potential. Withdrawal symptoms have been reported following abrupt cessation after prolonged use. To reduce the chance of SOMA dependence, withdrawal, or abuse, SOMA should be used with caution in addiction-prone patients and in patients taking other CNS depressants including alcohol, and SOMA should be not be used more than two to three weeks for the relief of acute musculoskeletal discomfort.

One of the metabolites of SOMA, meprobamate (a controlled substance), may cause dependence [see CLINICAL PHARMACOLOGY].

Seizures
There have been postmarketing reports of seizures in patients who received SOMA. Most of these cases have occurred in the setting of multiple drug overdoses (including drugs of abuse, illegal drugs, and alcohol) [see OVERDOSAGE].

NonClinical Toxicology
Carcinogenesis, Mutagenesis, Impairment of Fertility
Long term studies in animals have not been performed to evaluate the carcinogenic potential of carisoprodol.

SOMA was not formally evaluated for genotoxicity. In published studies, carisoprodol was mutagenic in the in vitro mouse lymphoma cell assay in the absence of metabolizing enzymes, but was not mutagenic in the presence of metabolizing enzymes. Carisoprodol was clastogenic in the in vitro chromosomal aberration assay using Chinese hamster ovary cells with or without the presence of metabolizing enzymes. Other types of genotoxic tests resulted in negative findings. Carisoprodol was not mutagenic in the Ames reverse mutation assay using S. typhimurium strains with or without metabolizing enzymes, and was not clastogenic in an in vivo mouse micronucleus assay of circulating blood cells.

SOMA was not formally evaluated for effects on fertility. Published reproductive studies of carisoprodol in mice found no alteration in fertility although an alteration in reproductive cycles characterized by a greater time spent in estrus was observed at a carisoprodol dose of 1200 mg/kg/day. In a 13-week toxicology study that did not determine fertility, mouse testes weight and sperm motility were reduced at a dose of 1200 mg/kg/day. In both studies, the no effect level was 750 mg/kg/day, corresponding to approximately 2.6 times the human equivalent dosage of 350 mg four times a day, based on a body surface area comparison. The significance of these findings for human fertility is not known.

Use In Specific Population
Pregnancy: Pregnancy Category C.
There are no data on the use of SOMA during human pregnancy. Animal studies indicate that carisoprodol crosses the placenta and results in adverse effects on fetal growth and postnatal survival. The primary metabolite of carisoprodol, meprobamate, is an approved anxiolytic. Retrospective, post-marketing studies do not show a consistent association between maternal use of meprobamate and an increased risk for particular congenital malformations.

Teratogenic effects: Animal studies have not adequately evaluated the teratogenic effects of carisoprodol. There was no increase in the incidence of congenital malformations noted in reproductive studies in rats, rabbits, and mice treated with meprobamate. Retrospective, post-marketing studies of meprobamate during human pregnancy were equivocal for demonstrating an increased risk of congenital malformations following first trimester exposure. Across studies that indicated an increased risk, the types of malformations were inconsistent.

Nonteratogenic effects: In animal studies, carisoprodol reduced fetal weights, postnatal weight gain, and postnatal survival at maternal doses equivalent to 1-1.5 times the human dose (based on a body surface area comparison). Rats exposed to meprobamate in-utero showed behavioral alterations that persisted into adulthood. For children exposed to meprobamate in-utero, one study found no adverse effects on mental or motor development or IQ scores. SOMA should be used during pregnancy only if the potential benefit justifies the risk to the fetus.

Possible Carisoprodol Side Effects
Carisoprodol may cause dizziness, vertigo, ataxia, tremor, agitation, irritability, headache, depressive reactions, syncope, and insomnia. Allergic or idiosyncratic reactions occasionally develop. They are usually seen within the period of the first to fourth dose in patients having had no previous contact with the drug. Skin rash, erythema multiforme, pruritus, eosinophilia, and fixed drug eruption with cross reaction to meprobamate have been reported with Carisoprodol. Severe reactions have been manifested by asthmatic episodes, fever, weakness, dizziness, angioneurotic edema, smarting eyes, hypotension, and anaphylactoid shock.

SIDE EFFECTS:
Dizziness, drowsiness, headache, unusually fast heartbeat, low blood pressure, or face flushing may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Sometimes carisoprodol may cause a very rare but serious reaction (idiosyncratic) that occurs within minutes or hours of the first dose of this medication. Seek immediate medical attention and do not take more of the medication if you experience: extreme weakness, inability to move your legs/arms, shaky/unsteady movement, pain in your joints, vision changes (double vision, inability to see), widened pupils, mental/mood changes (e.g., agitation, restlessness, unexplained mood swings, confusion).

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching, swelling, severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Contact your doctor for medical advice about side effects. The following numbers do not provide medical advice, but in the US you may report side effects to the Food and Drug Administration (FDA) at 1-800-FDA-1088. In Canada, you may call Health Canada at 1-866-234-2345.