Does advil help nausea

Headaches and Nausea

Headaches, including migraines, affect millions of people. Unfortunately for some, migraine headaches can be accompanied by unpleasant symptoms such as nausea, adding to the challenge of this painful and often debilitating condition. Distinct from tension, sinus, and other types of headache, migraines are repetitive headaches that have specific accompanying symptoms, such as sensitivity to light or sound, changes in vision, nausea, and sometimes vomiting.

“There is a center in the brain which, if affected, can cause nausea and in some cases, vomiting,” says neurologist Mary Quiceno, MD, assistant professor at the University of Texas Southwestern Medical Center in Dallas. Neurologists specialize in treating migraines, among other conditions, and are familiar with the latest advances in medication and other therapies to get migraines under control.

Quiceno says nausea does not accompany a tension headache, so if you are nauseous and have a pounding headache, you are probably having a migraine. One survey of 500 people with frequent migraines found that more than 90 percent of them experienced nausea during an attack.

Treating Headache-Related Nausea

The good news is that headache nausea does respond to migraine treatment, says Dr. Quiceno. As a first step, you can try over-the-counter pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), and get rest. If that doesn’t work, there are a number of prescription medications that stop a migraine and its related symptoms.

When nausea and vomiting are problematic, your doctor may recommend a medication to control these symptoms specifically. These drugs are called anti-emetics or anti-nausea medications. However, these are not first-line treatments for headaches or even migraines with nausea, and are often reserved for patients who experience significant nausea or vomiting.

For patients who do use them,“research shows that anti-emetics can take care of both the headache and nausea,” says Quiceno. This is true for prochlorperazine (Compazine) and promethazine hydrochloride (Phenergan). In fact, some research has shown that anti-emetics may be more effective treatments for acute migraines than narcotic pain relievers. Other anti-emetics include chlorpromazine (Thorazine), trimethobenzamide hydrochloride (Tigan), and metoclopramide hydrocholoride (Reglan)

Anti-emetics do have side effects that include sleepiness and, for some people, tremors, so doctors prefer to try other remedies first.

When to Worry About Headache Nausea and Vomiting

You’re probably familiar with your headache pain pattern. Any time your headaches or migraines and related symptoms take on a new pattern, pay attention. “If there is a sudden increase in vomiting, that is a warning sign that something else may be going on,” says Quiceno. Contact your primary care doctor or neurologist for an evaluation.

You don’t have to live with pounding headaches or migraines and nausea. These symptoms can be managed with the help of your doctor and targeted medications.

Case Report: Woman With Headache Pain, Dizziness, and Nausea

CASE REPORT

A 33-year-old woman has been experiencing recurrent episodes of nausea, headaches, and dizziness for the past 8 months. She has come to the emergency department because she is concerned about her current episode, which is slightly different from her previous ones.

Her symptoms began in the early morning, waking her from sleep at around 5 AM. She had head pain, dizziness, and nausea—similar to the previous episodes—yet she has noticed flashing lights in front of her eyes. She also complains of tingling in both arms and hands, which had occurred with a few of her earlier bouts. She has been taking over-the-counter ibuprofen and acetaminophen all day long without improvement. She went to work as usual and has been trying to sleep since returning home from her job. However, she has been unable to sleep due to the pain.

She has been previously healthy. She has been taking oral contraceptives for birth control for the past 7 years. She has not recently had any changes to her oral contraceptive prescription. She has a normal menstrual cycle and has experienced monthly menstrual migraines for the past 5 years. They always improve with one or two doses of sumatriptan.

The recurrent headaches began about 8 months ago. They have been occurring about once a week and lasting between 24 to 48 hours. She has taken sumatriptan for her headaches, and, like her menstrual migraines, they improve with one or two doses.

She has a family history of inflammatory bowel disease, and when she began to experience intermittent abdominal discomfort a few years ago, she decided to become a vegetarian. She explains that she has been getting enough calories and protein intake since the switch in diet about a year ago.

Physical examination

The patient was afebrile, well-nourished, and healthy appearing. She had both a severe headache and nausea. She complained of dizziness, but the dizziness does not interfere with her ability to walk. She felt the urge to vomit several times during the evaluation, but instead of vomiting large amounts, she gags.

The skin appeared normal, with no bruises or rashes. Throat examination was normal, as was thyroid examination. The chest examination was normal, with clear breath sounds. Her cardiac examination reveals a regular heart rate and rhythm. Pulse were palpable and normal in bilateral upper and lower extremities. Her carotid arteries were normal with no bruits. Abdominal exam was normal, with no pain, tenderness or masses.

Neurological examination

The patient was alert and oriented x3. Her speech was normal. Extra ocular movements were intact with no nystagmus, and her vision was normal. Pupils were equal, round ,and reactive to light. She did not have ptosis or facial asymmetry. She had photophobia. Facial sensation and movements were normal bilaterally.

She had normal strength in the bilateral upper lower extremities. Reflexes were slightly brisk in bilateral upper and lower extremities, with no asymmetry. Sensation was normal in bilateral upper and lower extremities to touch, pinprick, vibration, and position sense. She had no ataxia or dysmetria in bilateral upper and lower extremities. Gait was normal and she could perform a Romberg test and heel to toe walking without any difficulty.

Diagnostic tests and diagnosis >

Why It’s So Hard to Cure Your Hangover, According to Experts

Ask 10 people how they cure a hangover, and you’ll likely get 10 different answers.

Some go for greasy food and hair of the dog; others swig Pedialyte or Gatorade; and a motivated few hit the gym to sweat it out. But do any of these hangover remedies actually work?

Probably not, says Dr. Ed Boyer, a medical toxicologist at Boston’s Brigham and Women’s Hospital. “I don’t think anybody can really tell you with a great degree of honesty what causes a hangover,” he says, adding that theories run the gamut from dehydration to electrolyte imbalance to a buildup of alcohol byproducts. “The bottom line is nobody knows for sure what causes it, so we don’t have a good cure.”

“Nothing treats the entire hangover,” agrees Dr. David Aizenberg, an associate professor of clinical medicine at Penn Medicine. Hangovers affect nearly every organ system in your body, from your gastrointestinal tract to your brain to your heart. So there’s no “magic cure where one remedy will get rid of every single hangover symptom,” Aizenberg says. (Except, of course, drinking in moderation to avoid a hangover in the first place.)

That said, Aizenberg says certain remedies may improve certain symptoms. Here are the hangover cures that might have you feeling better, and the ones that are just myths.

Drinking water before bed

Hydration can reduce dehydration and the resulting headaches and dizziness, Aizenberg says, but doctors aren’t sure whether chugging water before bed will make any difference in the morning.

That’s because heavy drinking throws off the body’s levels of antidiuretic hormone, which typically regulates your water balance.

“That’s why a lot of people pee a lot when they’re drinking, because that regulatory system is going haywire,” Aizenberg explains. “It’s unclear whether after drinking, before drinking or when people have a hangover” is the best strategy, he says.

Drinking Pedialyte or Gatorade

Pedialyte has a cult following for its alleged hangover-busting abilities, and while it may reduce symptoms such as nausea, vomiting and dehydration, Aizenberg says it’s not any different from other electrolyte-rich beverages, which help the body recoup lost nutrients such as calcium, potassium and sodium.

“There’s no magic about Pedialyte. It’s just all the electrolytes that potentially were lost during and after the drinking period,” Aizenberg says.

Gatorade, which also contains electrolytes, likely does the same thing, though Aizenberg recommends watering it down since it’s high in sugar.

Sweating it out

Exercise may make you feel better, Boyer says, simply “because you’re out doing something.”

While that may be true, Aizenberg urges drinkers to remember that coordination, higher-level thinking and other key processes are thrown off by a hangover — so use caution if you decide to exercise, or complete other physically or mentally taxing tasks, the day after a bender.

Hair of the dog

If a Bloody Mary at brunch has you feeling better, Aizenberg says that may be a red flag.

“We consider that a sign of addiction,” he says. “Some people say it does make them feel better, but if that’s the case, there could be a little bit of actual alcohol withdrawal going on.”

Eating greasy food

Greasy food won’t “soak up” alcohol, Aizenberg says, but it might help you feel better.

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“By the time people are eating their greasy foods, none of the actual alcohol is left in the body; it’s all of the byproducts that are in the blood,” he says. Still, Aizenberg says getting something in your stomach may ease nausea and vomiting.

But healthy food, he notes, would work just as well, and quite possibly even better. “If the stomach is irritated, eating more bland foods that aren’t going to cause a lot of acid reflux would actually be better,” Aizenberg says.

Using IV bags

A number of startups now offer on-demand IV services that promise to bust hangover symptoms ranging from headaches to upset stomaches. But Aizenberg says to think twice before forking over the cash for your own personal fluid drip.

“I have no idea if it makes people feel better faster,” Aizenberg says. “It’s not all that comfortable to have an IV. It can bruise you up and you’re paying all that money. There’s also an IV fluid shortage because of the hurricanes, so these are precious resources I would hate to waste on that type of thing.”

Taking painkillers before bed

Some people swear they can prevent headaches by popping a few Advil before they drift off to sleep — but since ibuprofen only lasts four to six hours, Aizenberg says its painkilling effects likely won’t last until you wake up. Plus, the pills can make acid reflux worse, he says.

Consuming red ginseng

Recent research has shown that red ginseng, a root native to Korea, can clear alcohol byproducts from the blood, though Aizenberg says it’s less clear exactly what that means for your hangover symptoms.

The bottom line

Prevention, by way of drinking responsibly, is the only way to truly “treat” a hangover. While some strategies may help with isolated symptoms including nausea, vomiting and headaches, a breakfast sandwich or bottle of Gatorade isn’t going to wipe out a hangover entirely — and you may have the placebo effect to thank for any relief you do feel, Boyer says. As long as your preferred concoction is safe, though, that’s likely not a problem.

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Write to Jamie Ducharme at [email protected]

Headache Medications

Headache pain may need to be managed with medications. Medications used to treat headache pain can be grouped into three different types:

  • Symptomatic relief
  • Abortive therapy
  • Preventive therapy

Each type of medication is most effective when used in combination with other recommendations, such as dietary modifications, lifestyle changes (at least 7-8 hours of sleep and adequate hydration , exercise and relaxation therapy).

Symptomatic relief

This group of medications is given for the relief of symptoms associated with headache. This includes the pain associated with headaches or the nausea and vomiting associated with migraine headaches. Many of the medications are available over-the-counter (without a prescription). Other medications require a prescription from your doctor. When taking these medications, avoid caffeine-containing foods and beverages and medications. Medications containing barbiturates (butalbital) or narcotics (codeine) should be avoided if possible. The use of aspirin should be avoided in children. Many of the medications listed for symptomatic relief are not recommended for use in young children (see end of document for discussion of ‘off-label’ use.

Over-the-Counter Medications for Symptomatic Relief

Non-steroidal anti-inflammatories

  • Generic Name:aspirin*
    • Brand Name: Bayer® , Bufferin®, Ecotrin®
    • Symptoms Relieved: Relief of fever and pain
    • Precautions and possible side effects: Do not use in children under 14 years of age due to the potential for Reye’s syndrome. Side effects may include: heartburn, gastrointestinal (GI) bleeding, bronchospasm or constriction that causes narrowing of the airways, anaphylaxis and peptic ulcer
  • Generic Name: acetaminophen, paracetamol
    • Brand Name: Tylenol®
    • Symptoms Relieved: Relief of fever and pain
    • Precautions and possible side effects: Few side effects, if taken as directed, although they may include changes in blood counts and liver function
  • Generic Name: ibuprofen (NSAID)**
    • Brand Name: Advil®, Motrin IB®, Nuprin®
    • Symptoms Relieved: Relief of fever, pain, and inflammation
    • Precautions and possible side effects: Side effects may include GI upset, GI bleeding, nausea, vomiting, rash and changes in liver function
  • Generic Name: naproxen sodium (NSAID)**
    • Brand Name: Aleve®
    • Symptoms Relieved: Headache pain relief
    • Precautions and possible side effects: Side effects may include GI upset, GI bleeding, nausea, vomiting, rash and changes in liver function

*Not recommended in pediatric patients **= nonsteroidal inflammatory drugs

Prescription Medications for Symptomatic Relief

  • Generic Name: Antiemetics promethazine HCI (available in tablet, syrup, injection or suppository forms)
    • Brand Name: Phenergan®
    • Symptoms Relieved: Nausea, vomiting
    • Precautions and Possible Side Effects: Confusion, drowsiness, dizziness, GI upset, excitability, nightmares, uncontrollable muscle movements, and lip smacking or chewing movements
  • Generic Name: chlorpromazine (available in suppository form)
    • Brand Name: Thorazine®
    • Symptoms Relieved: Nausea, vomiting
    • Precautions and Possible Side Effects: Confusion, drowsiness, dizziness, GI upset, excitability, nightmares, uncontrollable muscle movements, and lip smacking or chewing movements
  • Generic Name: prochlorperazine (available in suppository form)
    • Brand Name: Compazine®
    • Symptoms Relieved: Nausea, vomiting
    • Precautions and Possible Side Effects: Confusion, drowsiness, dizziness, GI upset, excitability, nightmares, uncontrollable muscle movements, and lip smacking or chewing
  • Generic Name: trimethobenzamide HCI (available in capsule injection, syrup, or suppository form)
    • Brand Name: Tigran®
    • Symptoms Relieved: Nausea, vomiting
    • Precautions and Possible Side Effects: Hypotension, blurred vision, drowsiness, dizziness, disorientation, uncontrollable muscle movements, and lip smacking or chewing
  • Generic Name: metoclopramide HCI (available in syrup, tablet, or injection form)
    • Brand Name: Reglan®
    • Symptoms Relieved: Nausea, vomiting
    • Precautions and Possible Side Effects: Uncontrollable muscle movements, lip smacking or chewing movements, sensitivity to sunlight, aching of lower legs, diarrhea
  • Generic Name: ondansetron HCI (available in solution, tablets/disintegrating tablets, injection)
    • Brand Name: Zofran
    • Symptoms Relieved: Nausea, Vomiting
    • Precautions and Possible Side Effects: Diarrhea, dizziness, headache, constipation, malaise/fatigue, fever
  • Generic Name: Antihistamines cyproheptadine HCI (available in syrup or tablet form)
    • Brand Name: Periactin®
    • Symptoms Relieved: May induce sleep, may shorten migraine attack
    • Precautions and Possible Side Effects: Weight gain, drowsiness (also used as preventive therapy)
  • Generic Name: diphenhydramine HCI (available in tablets, liquids, liquid-gels)
    • Brand Name: Benadryl® (over-the-counter)
    • Symptoms Relieved: Nausea, vomiting
    • Precautions and Possible Side Effects: Sleepiness, dizziness, disturbed coordination, and behavioral changes

NOTE: For people using symptomatic relief more than twice a week, daily preventive therapy may be considered by your doctor. In addition, appropriate non-medicinal therapy, such as exercise, biofeedback, adequate sleep (at least 8 hours/night), adequate hydration (6 to 8 glasses of water/day), and diet can be used to decrease the frequency of headache attacks, eliminating the need for frequent pain medicines.

Abortive Therapy

These medications are used early in a migraine headache to stop the process that causes the headache pain. In this way, they help minimize the symptoms of headache, such as nausea/vomiting and sound and light sensitivity. These medications are most effective if used at the first sign of a migraine. Some medications should not be used during a migraine aura; please follow the instructions of your doctor.

When headaches—and especially migraine headaches last longer than 24 hours and other medications have been unsuccessful in managing the attacks, medication administered in an “infusion suite” can be considered. An infusion suite is a designated set of rooms at a hospital or clinic that are monitored by a nurse and where intravenous drugs are administered. The intravenous drugs are usually able to end the migraine attack. Patients’ length of stay at the infusion suite can range from several hours to all day.

Use of abortive therapies has not been approved for children (see end of document for discussion of ‘off-label’ use).

Medications for Abortive Therapy

  • Generic Name: Ergot, dihydroergotamine, mesylate
    • Brand Name: DHE-45®, Injection Migranal® intranasal
    • Possible Side Effects: Nausea, numbness of fingers and toes
  • Generic Name: Triptans, Sumatriptan succinate*, zolmitriptan*, rizatriptan*, naratriptan HCI†, almotriptan malate*$, frovatriptan succinate†, eletriptan hydrobromide*
    • Brand Name: Imitrex® injection, oral or intranasal; Zomig®, oral or Intranasal; Maxalt® oral; Amerge®oral; Axert® oral; Frova® oral; Relpax ®oral
    • Possible Side Effects: Side effects for all the Triptans are similar This class of drugs is well tolerated, but side effects may include: Nausea, headache, sleepiness, dry mouth, dizziness, fatigue, headache, hot/cold sensations, chest pain, flushing, sense of tightness around chest and or throat, numbness

*short acting †= long-acting $ = FDA approved for teens ages 12 to 18

Overmedicating and Rebound Headache

People who are prone to having headaches may develop a pattern of daily or almost-daily headaches. In some people, migraine-type headache attacks may become so frequent that they finally blend together with no clear-cut beginning or end. In both of these cases, the development of more severe or frequent headaches may actually be caused from taking headache relief medications too frequently. Daily or almost daily use of over-the-counter medications such as aspirin, acetaminophen, ibuprofen, narcotics, barbiturates and caffeine-containing medications; or prescription medications such as the triptans, appears to interfere with the brain centers that regulate the flow of pain messages to the nervous system and may make your headache worse. In addition, overmedicating interferes with the effectiveness of prescribed preventive medications.

Rebound headaches may result from taking prescription or nonprescription pain relievers more than two days a week. If prescription or nonprescription abortives are overused, the headaches may rebound as the last dose wears off, leading you to take more and more medication and actually aggravate the pain. When the medications are no longer taken, headache pain will likely improve over a period of 6 to 12 weeks.

Preventive therapy

These medications are taken daily to prevent headaches. Some of these medications are used for other medical conditions and were accidentally discovered to help headache. While none of these medications cures headache, preventive medications may reduce the frequency, duration and severity of headache attacks.

The medications listed include both over-the-counter and prescription drugs. These drugs are not habit-forming, but any medication can cause unwanted side effects. Your doctor will work with you to carefully regulate the dosage so that side effects are minimized and headache relief is maximized.

To be effective, all preventive medications must be taken one or more times every day. It may be necessary to change the medications and modify their dosages in order to discover which medication or combination of medications, at which dosages, work best to reduce the frequency and severity of your headache pain.

While these medications are being used, carefully recording your headache frequency and severity on a daily basis will help your doctor judge how the medications are working. Most of these medications require days to weeks of daily use before they become fully effective in preventing headaches. A trial of about 8 weeks is recommended before the effectiveness of a medication can be judged by your doctor.

Once good headache control has been achieved and maintained for 6 months or a year, it may be possible to taper and stop these medications. In other cases, it may be necessary to take the medications for a longer period of time.

Preventive therapies have not been approved for use in children. (see end of document for discussion of ‘off label’ use).

Headache Checklist of Management Suggestions

  • Educate yourself and your family. Read about your type of headache and its treatment.
  • Maintain a headache diary
  • Ask your doctor for written instructions about what to do when you have a headache
  • Limit your use of over-the-counter and prescription abortive medications to two days per week. Excessive use can actually increase headaches
  • Follow a regular schedule:
    • Don’t skip meals, especially breakfast
    • Get eight hours of sleep nightly
    • Exercise 30 minutes/day
    • Drink 6-8 glasses of water/day
    • Learn to identify and avoid headache “triggers.” Common triggers include caffeinated foods and beverages (teas, chocolate, colas, coffee), nitrates (luncheon meats, sausage/hot dogs, pepperoni) tyramine (aged cheeses, pizza) Doritos® Ramen® noodles, other “junk” foods, and Asian foods containing MSG.
  • Daily school attendance IS A MUST
  • Initiate non-drug measures at the earliest onset of your headache
    • Seek rest in a cool, dark, quiet comfortable location
    • Use relaxation strategies and other methods to reduce stress
    • Apply a cold compress
  • Don’t wait! Take the maximum allowable dosage of recommended medications(s) at the first sign of a severe headache
  • Take prescribed medications regularly, as directed, and maintain regular follow-up visits.
  • Call your doctor when problems arise

Medications for Preventive Therapy

  • Generic Name: amitriptyline HCI
    • Brand Name: Elavil®
    • Possible Major Side Effects: Fatigue, dry mouth, weight gain, and constipation
    • Instructions When Used for Headaches: Frequently started at low dosages and slowly increased to a therapeutic level taken nightly, EKG optional
  • Generic Name: Antihistamines cyproheptadine HCI (available in syrup or tablet form)
    • Brand Name: Periactin®
    • Possible Major Side Effects: May induce sleep or may shorten migraine attack, weight gain, drowsiness
    • Instructions When Used for Headaches: Usually started at low dosages and slowly increased; often taken at bedtime
  • Generic Name: Selective Serotonin Receptor Inhibitors (SSRI)* fluoxetine HCI
    • Brand Name: Prozac®
    • Possible Major Side Effects: Nausea, dry mouth, increased appetite, agitation
    • Instructions When Used for Headaches: Usually started at low dosages and slowly increased; usually taken in the a.m.
  • Generic Name: Beta Blockers atenolol, Propranolol HCI
    • Brand Name: Tenormin®, Inderal®
    • Possible Major Side Effects: Fatigue, depression, weight gain, faintness and diarrhea, memory disturbance, decreased performance in athletes
    • Instructions When Used for Headaches: Depending on the form may be one to three times a day
  • Generic Name: Calcium Channel Blockers, verapamil, flunarizine
    • Brand Name: Calan®, Isoptin®, Sibelium®
    • Possible Major Side Effects: Constipation, dizziness; hair loss
    • Instructions When Used for Headaches: Frequently started at low dosages and slowly increased. Taken twice a day. Usually the first dose is in the a.m.
  • Generic Name: Anticonvulsants valproic acid
    • Brand Name: Depakote®
    • Possible Major Side Effects: Nausea, drowsiness, weight gain, tremors, and rare liver failure; may cause birth defects
    • Instructions When Used for Headaches: Frequently started at low dosages and slowly increased. Periodic blood tests required
  • Generic Name: topiramate
    • Brand Name: Topamax®
    • Possible Major Side Effects: Rare: glaucoma, kidney stone at higher doses (>150 mg): weight loss, word-finding difficulties
    • Instructions When Used for Headaches: Usually started at low dosages and slowly increased; may be taken two to three times/daily
  • Generic Name: gabapentin
    • Brand Name: Neurontin®
    • Possible Major Side Effects: Generally well tolerated
    • Instructions When Used for Headaches: Usually started at low dosages and slowly increased, maybe taken two to three times/daily

Important Note About ‘Off-Label’ Prescribing

Many of the medications listed in this handout have not been approved by the Food and Drug Administration (FDA) for use in children and adolescents with headaches. When a doctor chooses to prescribe a drug for a medical condition or for a certain patient type (eg, children) for which it has not received FDA approval, this practice is called ‘off-label’ prescribing. This is a common practice in the field of medicine. It is one of the ways by which new and important uses are found for already approved drugs. Many times, positive findings lead to formal clinical trials of the drug for new conditions other than what the drug was first approved for.

Many of the drugs prescribed to help prevent head pain disorders are prescribed in this off-label fashion. Please check with your doctor regarding other medications not mentioned in this handout or if you have any concerns or questions.

Other notes

Pain medications that are least likely to be habit-forming should be tried first. In general, narcotic analgesics are not used in children and adolescents or adults. In all but the most severe headaches, the lowest strength dose should be tried first. Caution should always be used when taking “stronger” medications, because the more frequently the medication is taken, the greater the possibility that they could become harmful and less effective.

Guidelines for Use of Over-the-Counter (OTC) Pain Relievers

Nonprescription pain relievers have been demonstrated to be safe when used as directed. In addition, keep the following precautions in mind:

  • Know the active ingredients in each product. Be sure to read the entire label.
  • Do not exceed the recommended dosage for age on the package—including for a single dose, for total daily dosage, and total weekly dosage.
  • Carefully consider how you use pain relievers and all medications; it is easy to over-medicate.
  • Check with your doctor before taking products containing aspirin, ibuprofen or naproxen sodium if:
  • Children should not use over-the-counter medications that contain aspirin and/or caffeine.
  • Children and teenagers should not be given aspirin, as aspirin has been associated with a rare but serious liver and brain disorder called Reye’s syndrome.
  • Avoid combination medications containing caffeine, barbiturates and narcotics.

Adapted from the American Council for Headache Education

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With the holidays comes more drinking—and hangovers. If you ask around, you’ll be buried in folk remedies for hangovers. But here’s what’s actually been studied and what actually works compared to doing nothing (or taking a placebo).

What causes a hangover?

Hangovers are NOT caused by an electrolyte imbalance, lactate, ketones or (this will surprise you) dehydration. While dehydration can have an effect, there are other factors at play.

A hangover—characterized by headache, nausea, diarrhea, loss of appetite, tremulousness and fatigue—can make you miserable even more than 24 hours after your blood alcohol concentration returns to zero. Weird, right? So, what causes a hangover? Inflammation.

Hangovers are an immune response. Newer studies have helped us see that hangovers are more severe when immune activity is high. This is key to hangover symptoms and where we’ll start with treatments that work.

1) NSAIDs

The best studies on treating hangover symptoms look at anti-inflammatory medications like the over-the-counter NSAIDs, ibuprofen (Advil, Motrin) and naproxen (Aleve). Two tablets (200-400 mg) with water before you get into bed will help reduce hangover severity.

Remember, acetaminophen (Tylenol) is not an anti-inflammatory and won’t help nearly as much.

2) Treatments for upset stomach

After reducing overall inflammation with NSAIDs, you may still need to control symptoms like nausea and upset stomach. Ondansetron (Zofran) helps quite a bit for nausea. And Pepcid, Zantac or Alka-Seltzer may help with some of the sour stomach you feel the next day.

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3) Prickly pear extract

Prickly pear extract, which comes as a supplement, has actually been studied (on medical students, which is funny) with results published in a scientific journal—and it works! Taking it two hours before drinking can decrease the severity of hangovers by 50% in some cases. Prickly pear extract likely works as an anti-inflammatory. You can buy the capsules online, but remember, supplements aren’t regulated so you have to hope you get the actual product.

4) Liv.52

A study on the herbal supplement, Liv.52, has been published in which taking the supplement helped for hangover symptoms. Liv.52 comes in a capsule that contains a mixture of several herbs, and like prickly pear extract, is not tested for safety, so you have to take a leap of faith on this. I’d go the NSAID route first.

5) Vitamin B6

Many incorrectly think of vitamin B12 as a remedy for hangover. Studies only show positive results for vitamin-b6. Here is how you take it: 400 mg of vitamin B6 when you start drinking, 400 mg three hours later, and 400 mg at the end of the night (good luck with remembering that).

6) Sleep

Poor sleep and sleep deprivation can affect your hangover. In fact, how bad a hangover gets is directly related to how long and how well you sleep, not how much alcohol you consume (what?!). Sleeping off a hangover is a successful remedy. Don’t drink heavily on a night before you have to get up early to walk the dog, catch a plane, go to work, or know you are going to be sleeping on a friend’s uncomfortable couch. You get the idea.

7) Avoiding dark liquors

Avoid dark liquors to prevent severe hangovers. Dark liquors like red wine, brandy, whiskey, and bourbon, give you worse hangovers than clear liquors like vodka. Dark liquors contain congeners, which give these drinks their flavor and color but also increase your risk for a hangover. More congeners = more hangover. Mixing orange juice in with your liquor drinking can lessen the effect of congeners.

8) Avoiding aggravating activities

You’ll want to pay attention to what you do right before you drink and while you’re drinking to prevent a hangover later. Remember to eat. Don’t do strenuous activities while drinking (like participate in a beach volleyball tournament). And smoking while drinking can worsen hangover symptoms.

9) Hydrating

Hydration will help, but not completely relieve, hangover symptoms.

– – –

Dr O.

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  • Ibuprofen

    Ibuprofen is a painkiller available over the counter without a prescription.

    It’s one of a group of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) and can be used to:

    • ease mild to moderate pain – such as toothache , migraine and period pain
    • control a high temperature (fever) – for example, when someone has the flu (influenza)
    • ease pain and inflammation (redness and swelling) caused by conditions that affect the joints, bones and muscles – such as rheumatoid arthritis](https://www.your.md/condition/rheumatoid-arthritis) and (https://www.your.md/condition/angina) , heart attacks , or mild or moderate [heart failure
    • had a stroke

    Ibuprofen and pregnancy

    Ideally, pregnant women shouldn’t take ibuprofen unless a doctor recommends and prescribes it.

    It’s best to tell your doctor, pharmacist or health visitor about any medicines you’re taking.

    Paracetamol is recommended as an alternative to ease short-term pain or reduce a high temperature.

    Ibuprofen and breastfeeding

    Ibuprofen appears in breast milk in small amounts, so it’s unlikely to cause any harm to your baby while you’re breastfeeding.

    Ibuprofen and children

    Ibuprofen may be given to children aged three months or over who weigh at least 5kg (11lbs) to relieve pain, inflammation or fever.

    Your doctor or another healthcare professional may recommend ibuprofen for younger children in certain cases – for example, this may be to control a fever after a vaccination if paracetamol is unsuitable.

    If your baby or child has a high temperature that doesn’t get better or they continue to experience pain, speak to your doctor.

    How to take ibuprofen

    Make sure you use ibuprofen as directed on the label or leaflet, or as instructed by a health professional.

    How much you can take depends on your age, the type of ibuprofen you’re taking and how strong it is.

    For example:

    • adults – can usually take one or two 200mg tablets every four to six hours, but shouldn’t take more than 1,200mg (six 200mg) tablets in the space of 24 hours
    • children under 16 – may need to take a lower dose depending on their age; check the packet or leaflet, or ask a pharmacist or doctor for advice

    The painkilling effect of ibuprofen begins soon after a dose is taken, but the anti-inflammatory effect can sometimes take up to three weeks to get the best results.

    Ibuprofen shouldn’t be used to treat conditions that are mainly related to inflammation.

    Don’t take more than the recommended dose if it isn’t relieving your symptoms.

    Adults can take paracetamol at the same time as ibuprofen if necessary, but this isn’t recommended for children. For more details, see Can I take paracetamol and ibuprofen together?.

    Contact your doctor if your symptoms get worse or last more than three days despite taking ibuprofen.

    Interactions with medicines, food and alcohol

    Ibuprofen can react unpredictably with certain other medicines. This can affect how well either medicine works and increase the risk of side effects.

    Check the leaflet that comes with your medicine to see if it can be taken with ibuprofen. Ask your doctor or local pharmacist if you’re not sure.

    As ibuprofen is a type of NSAID, you shouldn’t take more than one of these at a time or you’ll have an increased risk of side effects.

    NSAIDs can also interact with many other medicines, including:

    • some types of antidepressants – used to treat depression
    • beta-blockers – used to treat high blood pressure (hypertension)
    • diuretics – which reduce the amount of fluid in your body

    Read more about medicines that interact with NSAIDs .

    Ibuprofen can also interact with ginkgo biloba, a controversial dietary supplement some people claim can treat memory problems and dementia.

    There are no known problems caused by taking ibuprofen with any specific foods or by drinking a moderate amount of alcohol.

    Side effects of ibuprofen

    Ibuprofen can cause a number of side effects. You should take the lowest possible dose for the shortest possible time needed to control your symptoms.

    See the patient information leaflet that comes with your medicine for a full list of side effects.

    Common side effects of ibuprofen include:

    • nausea or vomiting
    • constipation or diarrhoea
    • indigestion (dyspepsia) or abdominal pain

    Less common side effects include:

    • headache or dizziness
    • bloating (fluid retention)
    • raised blood pressure
    • inflammation of the stomach (gastritis)
    • a stomach ulcer
    • allergic reactions – such as a rash
    • worsening of asthma symptoms by causing narrowing of the airways (bronchospasm)
    • kidney failure
    • black stools and blood in your vomit – this can indicate bleeding in your stomach

    If you feel unwell after taking ibuprofen or have concerns, speak to your doctor or pharmacist, or call NHS 111.

    You can also report suspected side effects using the Yellow Card Scheme in the UK.

    High doses

    Taking high doses of ibuprofen over long periods of time can increase your risk of:

    • stroke – when the blood supply to the brain is disturbed
    • heart attacks – when the blood supply to the heart is blocked

    In women, long-term use of ibuprofen might be associated with reduced fertility. This is usually reversible when you stop taking ibuprofen.

    Overdoses of ibuprofen

    Taking too much ibuprofen, known as an overdose, can be very dangerous.

    If you’ve taken more than the recommended maximum dose, go to your nearest emergency department as soon as possible.

    It can be helpful to take any remaining medicine and the box or leaflet with you to the emergency department if you can.

    Some people feel sick, vomit, have abdominal pain or ringing in their ears (tinnitus) after taking too much ibuprofen, but often there are no symptoms at first. Go to the emergency department even if you’re feeling well.

    Fever A fever is when you have a high body temperature of 38C (100.4F) or over.

    Inflammation Inflammation is the body’s response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

    PMC

    Discussion

    Abdominal migraine falls under the subcategory of childhood periodic syndromes in the ICHD-II (1) and is classified as a childhood functional gastrointestinal disorder in the Rome III critera (2). Both of these have established diagnostic criteria for the disorder. Both consider abdominal migraine to be a childhood disorder with the average age of onset at 8 years and a relatively high prevalence rate between 1% and 4% of children (3). It has a relatively good prognosis because most patients with childhood onset of abdominal migraine go into spontaneous remission by the time they reach adulthood. However, although abdominal pain goes into remission, it shifts to a conventional migraine headache in many cases. Dignan et al. observed patients with abdominal migraine for 10 years and reported that it shifted to migraine headache in 70% of them (4). Although this disease is referred to as “abdominal migraine,” the headache is absent or mild in most cases (5). It is considered to be a migraine-related disorder for the following reasons: 1) a notable family history of migraine, 2) in many cases, the disorder shifts to migraine headache after reaching adulthood, 3) predominance in women, 4) a relatively clearly-defined beginning and end of symptoms, and 5) in many cases, migraine medication is effective. Abdominal pain occurs in a poorly localized central abdominal area (6) and is often accompanied by concomitant symptoms such as nausea and vomiting, which are observed in cases of conventional migraine headaches. However, it is rarely associated with prodromal symptoms, scintillating scotoma, or sensitivity to light or sound.

    In the present case, the pain experienced by this patient met the diagnostic criteria for abdominal migraine listed in both the ICHD-II and the Rome III criteria. However, a careful workup through the differential diagnosis was required because the duration of the interval between attacks was atypical, there have been few reports on this disorder occurring in adults (7-13), and it is a functional disorder.

    Many patients who complain of epigastric symptoms during outpatient exams and who cannot be diagnosed by imaging tests are treated for FD. The present case was also treated for FD, but showed no signs of improvement. Using the Rome III criteria (14), except for the fact that the abdominal pain lasted for a short time, the patient’s symptoms were consistent with epigastric pain syndrome (EPS). However, we believe that a diagnosis of abdominal migraine was accurate because 1) the abdominal pain was intense enough to significantly hinder the patient’s daily living activities, 2) the appearance and disappearance of symptoms was clearly delineated, and 3) proton pump inhibitors were completely ineffective, whereas migraine medication was effective. In addition, postprandial distress syndrome (PDS) was ruled out because there was little relationship between food and the patient’s symptoms. By using the Rome III criteria, many patients who complain of abdominal pain are ultimately diagnosed with FD, but some of these patients have refractory disorders, and they may be suffering from abdominal migraine. IBS was also ruled out because it has little relationship to constipation and abdominal pain.

    In addition to FD and IBS, some diseases cause epigastric pain and are difficult to diagnose using imaging tests. Eosinophilic gastroenteritis is distinguished by the fact that it causes paroxysmal abdominal pain; however, in the present case, because there was no elevation in the eosinophil levels in the peripheral blood and random biopsies performed during upper and lower endoscopies did not indicate eosinophil infiltration, it did not satisfy the diagnostic criteria (15) for eosinophilic gastroenteritis and was thus ruled out. In addition, eosinophilic gastroenteritis was ruled out because there was no history of allergic disease and CT did not indicate ascites or thickening of the intestinal tract walls. Chronic pancreatitis was ruled out because the patient had no history of alcohol consumption, i.e., neither abdominal ultrasound nor CT indicated calcification of the pancreas, irregular margins, or pancreatic duct enlargement. Moreover, chronic pancreatitis rarely presents with a paroxysmal onset of symptoms. Because the serum amylase levels were slightly elevated but lipase levels were within normal range, we believed it was a case of nonspecific elevation. Psychiatric disorders that may be accompanied by abdominal pain include some pain-related disorders such as depression and somatoform disorder. Consultation of the diagnostic standards for these disorders (DSM-IV) (16) indicated that because the patient did not exhibit a depressed mood or a loss of interest or happiness, depression could be ruled out. Because psychological factors are not related to pain onset, nausea, or continuous symptoms, pain disorder was also ruled out.

    As there is no evidence-based treatment for abdominal migraine, current treatments are based on experience and consist of medication therapy and the improvement of activities of daily living. Improving the activities of daily living consists of receiving adequate sleep and avoiding stress, maintaining an adequate hydration level, and avoiding foods that contain vasoactive amines (e.g., cheese and wine). Medication therapy includes ibuprofen, acetaminophen, and other analgesics, which can be highly effective if taken soon after the onset of pain. In addition, triptans (17) and ergotamines (18) have been reported to be effective, and Roberts et al. reported that the effectiveness of triptans can be used in the differential diagnosis of abdominal migraine (7). When accompanied by nausea and vomiting, antiemetics (8) are used. Prophylactics include beta-blockers (propranolol), antiallergic agents (cyproheptadine), and pizotifen, which have been used experimentally (6,19). Research has indicated that the antiepileptic drugs valproic acid (20) and topiramate are also effective. When a calcium blocker (lomerizine), the cost of which is covered by national health insurance in Japan, was administered to the present patient, the patient experienced a marked improvement in her symptoms. Thus, this drug can be expected to be used for the treatment of abdominal migraine. However, as none of these drugs are used for the treatment of other gastrointestinal disorders, to make an accurate diagnosis, we must keep abdominal migraine in mind and provide appropriate medications.

    A MEDLINE search of previous reports on abdominal migraine over the last 10 years using the key words “abdominal migraine” and “adult” revealed seven reports (total of ten cases) on adults (7-13). A summary of the 11 cases of adult abdominal migraine (ten cases plus the present case) is shown in Table 2. Four cases were men and seven were women. Five cases were aged in their twenties, two cases were in their thirties, one case was in his forties, and three cases, including the present case, were in their fifties. Except for the present case, there was a period of 1-15 years between the onset of symptoms and the diagnosis, and in five of the ten cases, the onset of abdominal pain occurred when the patient had not yet reached adulthood. Thus, six cases were adult-onset, including the present case. Although there are very few studies on adult-onset abdominal migraine, Long et al. reported that detailed interviews of 85 patients with abdominal pain (median age, 37.6 years; age range, 13 to 72 years) whose pain could not be attributed to functional disorders revealed that 19 had a disease history implicating abdominal migraine and six presented the classical symptoms of abdominal migraine (21). Lundberg et al. reported that 12% of patients with migraine headache experience repeated intermittent abdominal pain, whereas only 1% of patients with muscle contraction headache experience abdominal pain (22). One of the main reasons why there have been such few reports on adult-onset abdominal migraine is because the disease is not widely known, indicating that the number of reports on proactive suspicion of the disease may increase in the future. The present patient occasionally experienced headache in addition to abdominal pain, and five of the other ten cases also reported concomitant headache (Table 2). The reason why abdominal migraine in adults is rarely accompanied by headache remains to be elucidated, which will be addressed through the study of additional cases in the future. Because abdominal pain is severe in cases of abdominal migraine, concomitant headache may be masked. Thus, when we meet a possible case of abdominal migraine, a careful interview process is required to determine the presence of concomitant headache.

    Table 2.

    Case Reports of Abdominal Migraine in Adult.

    Reference number Age Sex Time from onset to diagnosis personal history of migraine Family history of migraine Headache Treatment (abortive) Treatment (prophylaxis)
    7 48 F 2 years Yes Yes Yes (partly) rizatriptan topiramate
    24 F 5 years None noted None noted No topiramate
    8 30 F 15 years None noted None noted No ketprofen metoclopramide
    9 20 M 10 years No Yes Yes (partly) eletriptan Valproate
    10 32 F 5-6 years None noted Yes No topiramate
    11 23 F 7 years No Yes Yes pizotifen
    12 22 M 4 years No Yes No sumatriptan topiramate verapamil
    13 52 M 3 years Yes None noted None noted eletriptan prochlorperazine
    56 M 16 months Yes None noted Yes propranolol venlafaxine nebivolol amitriptyline
    27 F 3 years No Yes Yes eletriptan topiramate
    This case 52 F 1 month Yes Yes Yes (partly) loxoprofen lomerizine

    Moskowitz’s trigeminovascular theory (23) is the strongest contender for an explanation of the onset mechanism underlying migraine headache. It proposes that pain transmission is activated via vasodilation of the carotid and cranial blood vessels due to the action of serotonin, and this then causes headache. Internal serotonin is present in the brain and blood platelets, however, because >90% of internal serotonin is present in the enterochromaffin cells and most serotonin receptors are also located in the enteric canal, it is thought that the pathological characteristics of abdominal migraine include the same abnormal serotonin dynamics as those observed in migraine headache (24). In addition, from an anatomic point of view, it is believed that both central nervous system disorders and peripheral neuropathy (hypersensitivity of visceral nerves) are involved (24).

    The present case had a history of migraine headache and was known to have experienced the sporadic onset of headaches, which were treated with single doses of NSAIDs. In general, most abdominal migraine experienced by patients during childhood shifted to migraine headache after the patient reached adulthood (1), however, the present case presented a typical migraine headache that shifted to abdominal migraine during middle age. The present case had a history of infectious enteritis 3 months prior to the onset of abdominal migraine. Although the mechanism of adult-onset abdominal migraine remains unclear, it was possible that infectious enteritis accelerated the hypersensitivity of the visceral nerves in the enteric canal, and as a result, caused adult-onset abdominal migraine. We would like to conduct future epidemiological research to determine whether the present case followed an extremely rare course or there are possibly many adult patients with abdominal migraine who remain undiagnosed.

    Because the onset of migraine headache is considered most common between 20 and 40 years of age, it is important to question middle-aged or older patients undergoing examination for idiopathic abdominal pain about their history of migraine headache. Furthermore, many patients do not consider it important to mention headaches during history-taking. If a physician asks open-ended questions about the patients’ medical history, patients may not mention migraine headaches. Therefore, it is important to use close-ended questions such as “Have you ever been told that you have a migraine headache?” or “Are you prone to headaches?”

    We herein reported our experience of a middle-aged woman with abdominal migraine. Although there are many reports on abdominal migraine in children, the possibility of this disease must also be considered in adults whose abdominal pain cannot be attributed to any other disease, especially when the patient has a history of migraine headache.

    Fever, headaches and tummy aches

    Children can run, jump and play for hours and may not share complaints – particularly when their tummies, heads or knees hurt – until after the fun is over.

    One of the first things I like to know when ascertaining the seriousness of a child’s condition is whether the child is playing, smiling eating or drinking. If a complaint is brought up regularly, interferes with a play or a child really cries, parents should consult a physician.

    High Fever

    New parents might find the recommendations for when to seek treatment for a fever daunting, but it gets easier with time.

    Children who are 3 months or older with fevers of 102 degrees Fahrenheit or higher that don’t respond to fever-reducing medicine should see a doctor.

    Fevers up to 101 can often by managed with fever-reducing medicine, fluids and rest. However, if your child also has a harsh cough – which may indicate croup – you need to consult a doctor.

    For infants 3 months and younger, any fever is serious and parents should see a physician’s help immediately. For children older than 3 months, a high fever combined with symptoms such as lethargy, changes in fluid and/or difficulty breathing require prompt medical attention.

    Tummy Aches

    If your child has a stomachache, there are three red flags that may warn parents of a serious illness such as appendicitis:

    1. Your child has a tummy ache and a fever.
    2. Your child can point with one finger to where it hurts.
    3. Your child has been vomiting.

    Children don’t need to have all three symptoms for parents to see help because any one of these symptoms can indicate that appendicitis might be a possible diagnosis. Parents should also not wait too long. If symptoms worsen in six to eight hours, consult a doctor.

    My Head Hurts

    Headaches and even migraines can occur in children as young as 3 years of age. Parents can give their child a nonsteroidal anti-inflammatory medicine, such as ibuprofen, or eliminate headache pain caused by hunger, fatigue or dehydration with food, rest or fluids.

    Talk to your pediatrician about his or her treatment recommendations, particularly if you’ve never treated your child’s headache before.

    If headaches occur at the same time each day, parents should consult their pediatrician. Headaches can occur with the flu or fever, but we become concerned if a headache is serious enough to make a child cry, interferes with play or is so bad the child is vomiting.

    Related Topics:

    • 7 mistakes parents make when treating their child’s fever
    • Oh No! My Child Has A Stomach Bug!
    • 5 winter health myths debunked
    • 7 days of diarrhea
    • Febrile seizures: 13 facts every parent should know

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