Ibuprofen is an anti-inflammatory drug with a wide range of indications 

Ibuprofen is rightfully considered the most effective and common remedy for treating the symptoms of colds and acute respiratory viral infections. Some patients successfully relieve fever with its help and consider it an antipyretic, while others relieve serious pain of a chronic nature, for example, in the spine. The fact is that Ibuprofen has three properties at the same time: anti-inflammatory, analgesic and antipyretic.

Ibuprofen

Indications for use

Ibuprofen belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs) - derivatives of phenylpropionic acid. In the instructions for tablets and capsules for adults, we see primarily prescriptions related to the symptomatic treatment of diseases of the joints or spine (rheumatoid arthritis, osteoarthritis, bursitis, sciatica), the fight against pain from injuries, myalgia and neuritis. In children's forms, we find the following indications: sore throat, pain with otitis media, teething, reduction of fever during ARVI or influenza, relief of symptoms of fever during childhood infections and post-vaccination reactions.

Of course, the indications are not limited to those mentioned above. We list here the most common types of pathologies where Ibuprofen does an excellent job eliminating inflammation and pain:

• Pathologies of the musculoskeletal system, pain relief: ankylosing spondylitis, radiculitis, spinal osteochondrosis, exacerbation of gout, polyarthrosis, psoriatic arthritis, tendinitis, inflammation of soft tissues in injuries, back pain, joint pain, trauma, sprains, dislocations, myalgia of various types .
• Diseases of the peripheral nervous system: neuralgia and neuritis.
• Gynecology: primary dysmenorrhea, secondary dysmenorrhea, pain during painful menstruation, with adnexitis.
• Relief of various types of pain: toothache, headache, migraine, sore throat, ear pain with otitis media, muscle pain.
• Use as an antipyretic for fever, flu, ARVI and colds. Increased temperature in infectious and inflammatory diseases.
• Relief after vaccination, including against coronavirus.

The use of ibuprofen in neurological practice

IN

In the structure of neurological diseases, pain syndromes occupy an absolutely predominant place. Along with acute pain, chronic pain is just as common. The variety of causes and mechanisms of formation of various pain syndromes sometimes complicates the accuracy of diagnosis. In addition, it is well known that in the mechanisms of symptom formation and non-painful phenomena (vegetative, motor, etc.), pain is the factor that triggers a whole cascade of changes. In this regard, for both somatogenic and neurogenic pain, the role of symptomatic therapy remains relevant, i.e. impact on the actual pain sensations, especially since pain is the most common and maladaptive complaint.

In the treatment of both acute and chronic pain, traditional in practical medicine and in neurology, in particular, is the use of non-steroidal anti-inflammatory drugs (NSAIDs). The history of the use of NSAIDs dates back more than 140 years. To date, stable traditions and principles for evaluating and selecting the most effective drug have developed.

Pharmacological effects of NSAIDs

The main mechanisms of action of NSAIDs are associated with the suppression of the activity of the enzyme cyclooxygenase (COX), which plays a key role in the metabolism of arachidonic acid, which results in the formation of prostaglandins (PGs). This is the most well-known mechanism associated with the analgesic and anti-inflammatory effects of NSAIDs. However, there is also data on PG-independent mechanisms of the analgesic activity of NSAIDs, in particular those associated with the blockade of NMDA receptors (increased synthesis of kynurenic acid), which also provides a central antinociceptive effect. The latter circumstance is confirmed by the existence of a dissociation between the anti-inflammatory (COX-dependent) and analgesic effect of NSAIDs. In addition, most NSAIDs have antiplatelet effects to varying degrees, which are achieved by inhibiting the synthesis of thromboxane A2 in platelets. Other clinical effects of NSAIDs are also discussed. For example, their ability to suppress the growth of malignant tumors (in particular, the gastrointestinal tract, lungs and breast) due to the possible stimulation of apoptosis and, accordingly, cell proliferation induced by oncogenes. This allows us to consider drugs in this group as a potential factor in the prevention of malignant neoplasms. In addition, quite extensive clinical observations have accumulated showing that long-term use of NSAIDs for various indications significantly reduces the risk of developing dementia in older age (for example, Alzheimer's disease) by five times. This fact can also serve as a basis for the use of NSAIDs for the prevention of cognitive impairment in older people.

The main limitations of longer-term use of NSAIDs are associated with their characteristic effects on the gastrointestinal tract, primarily damage to the stomach and duodenum. All these various disorders in the upper gastrointestinal tract associated with taking NSAIDs are referred to as non-steroidal gastropathy. Their development is associated mainly with the predominant blockade of the COX-1 isoenzyme, which is responsible for the synthesis of PG and integrates the mechanisms of cytoprotection in the mucous membrane of the stomach and duodenum. The creation and subsequent introduction into practice of selective COX-2 inhibitors has opened up new prospects in terms of the safety of NSAID treatment.

One of the most studied are the clinical effects of ibuprofen ( Nurofen

). Special studies modeling the interaction of ibuprofen stereoisomers with the corresponding COXs have shown a high affinity for the active center of COX-2, which explains its low ulcerogenic activity and high degree of safety in over-the-counter doses.

The above-mentioned circumstance significantly changes the established opinion about the need to prescribe NSAIDs only in short courses (weeks), avoiding long-term continuous use. Clinical trials indicate that long-term (months) treatment with selective NSAIDs does not increase the risk of side effects.

In all cases, the choice of the optimal drug is based on the safety-efficacy ratio. Currently, more than 50 dosage forms of drugs from this group are known. Propionic acid derivatives have the most optimal combination of safety and effectiveness, which served as the basis for the release of over-the-counter dosage forms that are widely used throughout the world to relieve pain of various natures. In addition, taking into account the generally poor compatibility of NSAIDs with other drugs (beta blockers, ACE inhibitors, anticonvulsants, hypoglycemic drugs, acetylsalicylic acid, etc.), propionic acid derivatives are among the most “communicative” representatives that do not accumulate when metabolic disorders in elderly patients.

In this sense, ibuprofen is particularly well tolerated, which is traditionally considered the “gold standard” of safety, which is especially important in the treatment of chronic pain syndromes. Ibuprofen meets all the requirements for an “ideal” over-the-counter analgesic: its presence in dosage forms that are quickly absorbed in the stomach and intestines; rapid creation of peak plasma concentrations; relatively short half-life and at the same time long-lasting effect; minimal range of side effects with occasional and short-term use. The benefits of this drug have also been demonstrated by special studies. When comparing the three most widely used first-line analgesics in a large-scale study of PAIN, acetylsalicylic acid, ibuprofen and paracetamol, ibuprofen and paracetamol showed similar efficacy and similar tolerability at analgesic doses, which was clearly better than acetylsalicylic acid. At the same time, ibuprofen caused fewer adverse gastrointestinal events than paracetamol. These facts are very important from the point of view of choosing the most optimal NSAID for the treatment of pain syndromes. It should also take into account the fact that the main side effects of NSAIDs, including gastrointestinal ones, are dose-dependent. And pain relief involves using it in analgesic doses, which are lower than anti-inflammatory doses and, accordingly, less dangerous for the patient.

Clinical effects of ibuprofen

The range of indications for the clinical use of ibuprofen in neurological practice is quite wide. The most common indications for its use are all forms of acute and chronic pain syndromes. With a number of them, its effectiveness has been proven and well studied from the point of view of the objective laws of such treatment.

Ibuprofen is a first-category drug in the treatment of headaches of various origins: tension-type headaches (TTH), psychogenic cephalgia, headaches accompanying colds and flu, hangover headaches, migraine headaches, cervicogenic headaches, “abusive” headaches , as well as combined or combined headaches (migraine and tension-type headaches).

Among all forms of headaches in neurological practice, tension headaches are the most common - they make up 54% of all cephalgia. In the modern classification, tension headache is defined as a headache associated with tension in the pericranial muscles, occurring as a manifestation of increased anxiety, severe depressive disorders in response to the effects of acute and chronic emotional stress. Depending on the duration of pain episodes, two forms of TTH are distinguished: episodic (30 minutes - 2 hours, up to 15 days per month) and chronic (more than 15 days per month or 180 days per year). Clinically, TTH is characterized by monotonous, dull, squeezing, tightening, aching, usually bilateral pain without clear localization. This pain does not intensify with habitual, everyday physical activity and is often combined with other algic manifestations (cardialgia, abdominalgia, arthralgia). The episodic form of tension-type headache is most often associated with migraine, which is called combined or associated headache.

In the treatment of both episodic and chronic forms of tension-type headache, despite the variety of therapeutic approaches, relief of pain itself is traditional. Particularly targeted is the use of analgesics, in particular ibuprofen, in the episodic form of tension-type headache, as well as in the combination of tension-type headache and migraine, where ibuprofen is used both to relieve a painful episode and as a course therapy. Thus, special clinical studies of the effectiveness of Nurofen for the treatment of chronic forms of tension-type headache have shown that in a daily dose of 800 mg Nurofen for 14 days leads to an average reduction in pain intensity by three times (from 6.8 to 2.3 points on the visual analog scale ). At the same time, reliably significant changes in a number of objective characteristics were obtained. A decrease in the degree of negative impact of pain on life activity was obtained (according to the comprehensive pain questionnaire (CPI), especially on the pain intensity and interference scales, as well as a decrease in the initially high levels of depression in these patients. At the same time, when studying pain thresholds with an initially low level, it was shown reliably significant increase during therapy.

In practical neurology, drug-induced, so-called “overuse” headaches are currently becoming increasingly important. The main idea behind habitual pain is that regular or frequent use of analgesics, ergotamines, aspirin, barbiturates, benzodiazepines, and other compounds used to treat migraines and tension-type headaches can worsen existing headaches and cause additional headaches that their clinical features already differ from the original cephalgia. Basic criteria for diagnosing “overuse” headaches

include the following points: 1) headache develops 3 months after starting daily medication; 2) the minimum mandatory dose of the drug has been established; 3) the headache is chronic (at least 15 days per month); 4) the headache worsens sharply immediately after discontinuation of the drug; 5) headache goes away after 1 month. after drug withdrawal.

For such headaches, certain patterns are important. Firstly, the “abuse” factor is a non-specific phenomenon. There does not appear to be a single specific drug that is solely responsible for the development of certain headaches. The duration and dose of the drug used, as well as the fact of combining different forms, are of greater importance. Secondly, deprivation of a chronically used “abusive” drug completely relieves (in 75% of cases) the headache or transforms (in 25% of cases) it into its primary form.

The practical significance of this problem lies in the difficulties of diagnosis and, even more so, in fundamentally different methods of treatment, since the main principle of treatment for “overuse” headaches is the abolition of the usual analgesic. Typical withdrawal symptoms observed in the first 2–10 days include a sharp increase in headache, which is accompanied by a variety of autonomic disorders. Therefore, the main link in therapeutic tactics is the relief of “withdrawal headaches”. For this purpose, NSAIDs are most often used, since representatives of this class themselves are extremely rarely capable of causing abuse, so their role in the treatment of AHD at this stage can hardly be overestimated.

A special place in neurological practice is occupied by cervicogenic headaches (CHH), which are essentially multifactorial, i.e. Many different causes are involved in their symptom formation, primarily pathologies of the cervical spine (neuroreflex manifestations of degenerative-dystrophic disorders), traumatic brain injury (“whiplash” injury), myofascial pain syndromes. The Central City Hospital is distinguished by a fairly high representation in practice of both neurologists and doctors of other specialties. The actual pain syndrome in CDH can manifest itself both in the form of acute and relatively constant or recurrent pain. In their relief, a significant role is played by NSAIDs, in particular, ibuprofen, which can be used in larger than “analgesic” doses.

The use of NSAIDs is traditional in the treatment of migraine. The use of ibuprofen to relieve an attack of migraine cephalgia is quite effective in comparison with other anti-migraine drugs (ergotamines and triptans) and is the most affordable way in terms of price. At the same time, analysis of the clinical effects of ibuprofen allows us to distinguish two groups of changes. Firstly, the analgesic effect, which is achieved already at a dose of 200–400 mg: the intensity and duration of painful attacks is significantly reduced. In addition, the need for additional pain relief is reduced. Secondly, a statistically significant reduction in the severity of accompanying symptoms such as nausea, photopsia, photophobia and anxiety was shown.

Another aspect of the clinical use of ibuprofen for migraine is course treatment. In a special study of the effect of Nurofen in over-the-counter doses of 800 mg per day in patients with frequent migraines for 10 days, a statistically significant reduction of 40% in the frequency of migraine attacks and three times the intensity of headaches was demonstrated. The duration of the attack showed the greatest dynamics. Data obtained using a comprehensive pain questionnaire recorded an improvement in many objective indicators: a decrease in the level of pain intensity, a decrease in interference, i.e. the impact of pain on various areas of life, an increase in the indicator of support for a significant person, an increase in the indicator of life control. According to psychometric testing, after a course of treatment with Nurofen, a decrease in indicators of reactive anxiety and depression was obtained. Of particular interest were the results of a study of the dynamics of spectral analysis of heart rhythm during therapy with Nurofen. A decrease in the overall heart rate variability was obtained due to a decrease in the power of all spectrum peaks. At the same time, the initial differences with healthy subjects in these indicators were leveled out. This generally allows us to talk about the influence of Nurofen on the initial sympathoadrenal activation in these patients.

There is a clear, natural connection between the exacerbation of migraine cephalgia and the menstrual cycle (in 60% of cases). And in 14–20% it is possible to identify strictly menstrual or catamenial migraine. This is a form of migraine when migraine attacks strictly depend on the menstrual cycle - they occur only during or immediately before menstruation and do not occur outside of this state. In the treatment of menstrual migraine, a special role is given to preventive therapy, in which the use of NSAIDs is key.

A special place in the clinical practice of neurologists is occupied by the treatment of patients with chronic muscle pain. Among all forms of myalgia, perhaps the most common is fibromyalgia (FM). Its representation in the population is about 7%. There are quite a lot of these patients in the practice of not only neurologists, but also general practitioners, rheumatologists, surgeons, etc. FM was traditionally previously considered in the context of rheumatic problems. Although in the last two decades most researchers have recognized the predominantly non-rheumatic, non-inflammatory nature of this disease, the use of NSAIDs remains relevant in its treatment. This is primarily due to their proven effectiveness in this disease.

Pain is the main manifestation of FM and the most common reason for visits to specialists. Pain in FM can be characterized as generalized and chronic. One of its characteristic features is a pronounced dissociation between the fairly low intensity of pain and the level of experience of this pain. The main reason for limitations in everyday and professional activities is precisely the presence of pain. The only specific sign of fibromyalgic pain is the presence of characteristic pain points, which have a number of features: 1) palpation reveals the phenomenon of reproducibility of spontaneous pain; 2) pain points are located in strictly defined anatomical zones; 3) there is a direct correlation between the severity of the patient’s condition and the number of these pain points.

Difficulties in the clinical analysis of FM patients are associated with the pronounced clinical polymorphism of this disease. Along with pain, sleep disturbances, depression and other emotional disorders, asthenia, and morning stiffness are obligatory for this phenomenon. FM is characterized by the presence of various comorbid disorders, the spectrum of which is quite wide. Among them, the leaders are primarily various algic phenomena (headaches, arthralgia, tunnel neuropathies, myofascial pain), as well as psychovegetative disorders (panic attacks, hyperventilation syndrome).

The complexity of the clinical symptom formation of FM also determines the complexity of the treatment used. In the general range of therapeutic measures, the use of NSAIDs occupies a strong leading position. Since treatment of chronic myalgia must be long-term, preference is given to the safest representatives. The effectiveness of ibuprofen has been proven by clinical practice of its use in patients with FM. The clinical analgesic effect is also confirmed by objective data - at a dose of 800 mg per day for 14 days, 70% of patients experience a decrease in the intensity of pain and the duration of pain episodes. The objective nature of the antinociceptive effect of the drug is confirmed by a significant increase in pain thresholds. To a large extent, its clinical effect is associated with the impact on the intensity of concomitant pain syndromes - tension-type headache, arthralgia, where the intensity and frequency of pain episodes also decreased. Despite the lack of a direct effect on the psychological characteristics of patients with chronic pain, such therapy significantly improves their quality of life. Providing a persistent and pronounced analgesic effect in most cases is an obligatory component in the treatment of these patients. Therefore, the inclusion of ibuprofen in the complex therapy of patients with FM is undoubtedly justified.

It is necessary to emphasize the features of the course and, accordingly, treatment of chronic forms of pain syndromes. In neurological practice, regardless of the form of chronic pain syndrome, they are all characterized by the presence of comorbidities, i.e. highly associated disorders at the clinical level. Among them, along with psychovegetative and psychosomatic ones, various algic disorders occupy a predominant position. The peculiarity of therapy in these cases involves taking into account the possible impact on comorbid, in this case, painful clinical manifestations. The use of Nurofen for this purpose demonstrates its high effectiveness. At the same time, its obvious participation in the reduction of other phenomena accompanying pain manifestations: emotional-affective, autonomic, motor, cognitive is practically important.

Another pattern in the treatment of chronic pain syndromes is the use of NSAIDs in complex treatment - along with psychotropic (usually antidepressants) and other drugs.
Nurofen's good sociability in these cases makes it the drug of choice. Literature:
1. Ananyeva L.P. Consilium medicum.2002, vol. 4, no. 8. p. 416–25.

2. Korotkova S.B. Journal of Neurology and Psychiatry. Korsakova, 1998, No. 4, pp. 40–4.

3. Nasonov E.L., Nasonova V.A. Consilium medicum, 2000. vol. 2, no. 12, p. 509–13.

4. Tabeeva G.R. Treatment of nervous diseases. 2000, vol. 1, no. 2, pp. 20–2

5. Tabeeva G.R. Russian medical journal. 2003, vol. 11, no. 10 (182), pp. 586–9.

What forms does Ibuprofen come in?

In pharmacies you can find four dosage forms of the drug:

• If there are no contraindications related to the gastrointestinal tract, then people usually choose tablets or capsules.
• In cases where there is a stomach disease in the acute stage or the patient for some reason cannot swallow a tablet, suppositories are prescribed.
• Syrups are prescribed to infants. Most pediatricians prefer to reduce fever using Ibuprofen rather than Paracetamol, since the former acts faster and longer, and also has a lower safety profile due to the absence of toxic metabolites.
• For pain in the joints, muscles, back, and injuries, the ointment is ideal.

Use during pregnancy and breastfeeding

It is not advisable to take ibuprofen and certain medications while pregnant. Although fever and pain pose a threat, the corresponding signs require quick elimination.

Ibuprofen, as recommended by your doctor, can be taken in the 2nd trimester; you should not be treated with it if there are contraindications. The medicine is contraindicated in the first or third trimester of pregnancy.

When breastfeeding, the medicine also quickly eliminates fever and eliminates pain. However, it can pass into breast milk and cause some harm to the baby, although there will be no serious health hazard. If there is an urgent need to take medication, the tablet should be taken after feeding. The concentration of the active substance in milk reaches a large amount 2 hours after administration, and then begins to rapidly decrease.

Instructions for taking Ibuprofen for adults and children.

• A single dosage for an adult is 200 mg; in case of severe pain, you can take 400 mg, the dosage frequency is 3-4 times a day, but not more than 1200 mg per day.
• A single dose for a child over 6 years old is 200 mg, can be taken 3-4 times a day. The maximum dosage for children per day differs by age as follows: for children 12-17 years old - 1000 mg; for children aged 6 to 12 years - 800 mg.

Ibuprofen Welfarm for adults

How many days can you take Ibuprofen?

The drug is taken for 2-3 days; if the patient’s condition does not improve or becomes worse, it is necessary to stop taking it and consult a doctor.

When is it appointed?

Ibuprofen is to some extent a harmless drug, but if there are contraindications noted in the instructions, you should stop using the medicine. The opposite can lead to dire consequences. In addition, you cannot take an increased dose of medication, as there is a serious danger to life and health.

Benefits for headaches

Ibuprofen will be a good help when you suffer from excruciating headaches. In particular, it is prescribed for migraines, characterized by prolonged pain. In this situation, the drug should be used as soon as possible after the onset of migraine symptoms. If your health does not improve, repeat taking the medicine after 5 hours. This treatment regimen is very effective and most often leads to a positive result.

When nervous tension occurs, “discomfort” occurs; in this situation, an Ibuprofen tablet will help.

Ibuprofen for toothache and menstruation

The medicine is a pathognomonic drug. If there is no way to get an appointment with a dentist, you can take an Ibuprofen tablet to relieve toothache. You should not take more than 6 tablets of the drug per day, the treatment course is a maximum of 5 days.

Ibuprofen will be useful after implant placement and tooth extraction; it will help relieve pain.

During menstruation, many women experience pain; to relieve it, it is advisable to take Ibuprofen. However, you should beware of overdose. The first dosage should be 400 mg; if the discomfort does not go away, after a few hours you will have to repeat the medication.

Treatment in this case should not exceed 3 days; if a positive result is not noted, consult a doctor.

Ibuprofen for colds

Each property of the drug is very effective for various types of colds. After taking Ibuprofen, the fever quickly passes, pain decreases, due to which the patient’s condition quickly returns to normal.

To treat colds, tablets can be prescribed to persons over 12 years of age. The doctor may prescribe a different dosage than indicated in the instructions. Of course, Ibuprofen alone is not enough to get rid of a cold, but its anti-inflammatory properties help enhance the effects of other medications. Thanks to all this, recovery is accelerated.

Ibuprofen for fever

With many illnesses, people's body temperature rises; Ibuprofen will help reduce it. The pharmaceutical is prescribed as part of a complex therapeutic course for various diseases:

• Cold
• Injuries
• ENT diseases
• Viral, bacterial infections
• Joint and muscle pain

Ibuprofen for children

Ibuprofen in the form of syrup for children is used from the age of 3 months and can begin to act within 15 minutes. The tablets take effect within 30 minutes.

How to use baby syrups?

Children's syrups are usually made using fruit fillings and therefore children take them with pleasure. For the little ones there is a measuring syringe complete with syrup, where 1 ml contains a certain dose of Ibuprofen.

It is necessary to follow the manufacturer's instructions, the maximum daily dosage for a child is 30 mg per 1 kg of body weight, the interval between doses is from 6 to 8 hours. As we noted earlier, the duration of treatment should not exceed 3 days. Syrups are popular and therefore they are often designed for use up to 12 years, although tablets can also be used from 6 years.

The dose of syrup for a child can be determined from the table.

Child's age	Body weight in kg	Dosage	Maximum dose per day
3-6 months	5kg-7.6kg	50 mg up to 3 times a day	150 mg
6-12 months	7.7-9 kg	50 mg up to 3-4 times a day	200 mg
1-3 years	10-16 kg	100 mg up to 3 times a day	300 mg
4-6 years	17-20 kg	150 mg up to 3 times a day	450 mg

New opportunities in the treatment of headaches in general medical practice

Headache (HE) is the most common complaint in medical practice among patients with a wide variety of diseases. It should be noted that out of fifty different diseases, headache can be the leading (and sometimes the only) complaint. HD is widespread, occurring, according to various sources, in 50–85% of residents of different ages, and its occurrence and development can be determined by both somatic and mental factors. Up to 50% of all consumers resort to self-medication for headaches [1].

All this makes us consider the problem of diagnosing and treating hypertension as a general medical, interdisciplinary task that deserves the attention of doctors of all specialties, a task, primarily for specialists in general medical practice.

The frequency and intensity of headaches are variable, usually distinguished:

• rare (no more than 1 time per month/12 times per year) - 60% of cases;
• episodic (several times a month) - 37% of cases;
• daily (or almost daily) - 2-3% of cases of headache sufferers.

In order to study the prevalence and frequency of hypertension, 578 adolescents aged 14–17 years (average age 16.1 years) were studied who underwent a routine medical examination in the 2014–2015 academic year in a large urban clinic in the metropolis with the involvement of specialized specialists (girls accounted for 55.7% , boys - 44.3%).

All patients were asked to answer four questions:

1) Have you experienced headache at least once in your life? 2) If yes, how often (several times in life, several times a year, several times a month, almost daily)? 3) Have you consulted a doctor about hypertension? 4) Do you use any painkillers to relieve headaches (no, several times a year, several times a month, constantly when headaches occur).

The survey results were as follows: 496 adolescents (85.8%) reported that they had experienced headache at least once in their life. 82 respondents (14.2%) denied the occurrence of hypertension during their lifetime.

Of the subgroup of adolescents familiar with the phenomena of headache (496 cases - 100%), 40.7% (202 cases) of those examined reported that they had experienced headache several times in their lives; 28.6% (142 cases) - several times a year; 29.5% (146 cases) - several times a month and 1.2% (6 cases) - almost daily. Among this subgroup of adolescents, 11.7% (58 cases) reported that they had previously consulted a doctor about hypertension. In order to relieve the headache that occurred, 58.1% (288 cases) took painkillers, 14.1% (70 cases) did this several times a year, 34.1% (169 cases) took several times a month, and 9.9 % (49 cases) used drugs continuously during each headache attack.

Thus, despite their young age, adolescents (more than 4/5) are already familiar with the phenomena of hypertension. A third of these patients experience headaches several times a month or more often.

In order to establish the cause of headache, 168 patients (112 women and 57 men), whose average age was 38.7 years, were examined, who complained of headache to the advisory center of the city neurological hospital of a large regional city for outpatient care during 2014 and the first half of 2015 gg. As a result of the examination, it was found that the most common cause, noted in almost half of the examined (47% - 79 cases), was tension headaches (TTH), migraine cephalgia was recorded half as often (21.4% - 36 cases), characteristically, that migraine was always more pronounced, was much more difficult for the patient to tolerate, and was perceived and assessed by him as a “severe headache.” In the remaining patients (31.6% - 53 cases), headache was regarded as symptomatic, several patients were referred for further examination to clarify the diagnosis.

Thus, due to the fairly high probability of occurrence of tension-type headaches and migraine attacks in the population, attention should be focused on them when choosing treatment tactics.

It should be noted that the diagnosis between primary and secondary headaches is of fundamental importance for the choice of therapy (Fig. 1).

Tension headache

A tension headache occurs at least once in every person’s life. There is an episodic form of TTH - it can last from several hours to 7-15 days - and a chronic form of TTH - recorded up to 180 days a year. One of the most common causes of tension-type headache is the so-called “office syndrome” (this is facilitated by: incorrect posture during prolonged work at the computer, stress, sleep disturbance, lack of rest, etc.) [2]. Researchers attribute particular importance to the “muscle factor” in the occurrence of tension-type headaches, since incorrect posture that accompanies stress can cause muscle tension [2–4]. Because as a result of prolonged muscle tension, pressure points, or “trigger points,” are formed in the muscles, leading to the local synthesis of inflammatory mediators - prostaglandins. In turn, peripheral nerve endings become more sensitive to pain impulses, and increasing pain signals lead to the perception of these processes in the form of referred tension headache [2, 4–5].

TTH usually has a painful “aching” character, covers the entire head, and is sometimes accompanied by a feeling of nausea, dizziness and/or other signs of emotional disorders (increased irritability, decreased mood, fatigue, poor sleep, severe autonomic disorders, etc.).

Diagnostic criteria:

1. Localization: diffuse, bilateral with severity in the occipital-parietal or parietal-frontal regions.
2. Character: monotonous, squeezing (like a “helmet”, “helmet”, “hoop”), practically never pulsating.
3. Intensity: moderate, less often intense, usually does not increase with physical activity.
4. Accompanying symptoms: soreness of the pericranial muscles and muscles of the collar zone, neck, shoulder girdle and loss of appetite (often), nausea, photo- or phonophobia (rarely).
5. Combination with other algic syndromes (cardialgia, abdominalgia, dorsalgia, etc.) and psychovegetative syndrome, with a predominance of emotional disorders of a depressive or anxiety-depressive nature.

Migraine

Migraine is a periodically recurring paroxysmal condition, manifested by attacks of intense headache of a pulsating nature, in one (rarely in both) half of the head (mainly in the frontal-temporal-parietal-orbital region) in combination with other non-painful manifestations (nausea and/or vomiting, intolerance bright lights, loud noises, emotional disturbances, aura symptoms, drowsiness and lethargy after an attack). The possible duration of an attack is from 1–2 to 72 hours.

There are migraine without aura (simple migraine) and migraine with aura (classic). An aura is a complex of neurological symptoms that occurs immediately before or at the very beginning of a migraine headache.

Auras are distinguished: ophthalmic - with visual disturbances (zigzags, sparks, flickering spiral-like contour); hemiparesthetic - paresthesia or a feeling of numbness that occurs locally and slowly spreads to half the body; paralytic - in the form of unilateral weakness in the limbs; aphasic - in the form of speech disorders, etc. It should be remembered that migraine can have complications: status migraine (duration of attack more than 72 hours) and migraine stroke.

Diagnostic criteria

Migraine without aura

1. Headache has at least two of the above symptoms (unilateral localization; pulsating nature; moderate or significant intensity of headache, reducing the patient’s activity; headache worsening during monotonous work or walking).
2. At least five “attacks” of headache, with each duration (without treatment or with unsuccessful treatment) from 4 to 72 hours.
3. The presence of at least one of the accompanying symptoms (nausea, vomiting, sensitivity to light and/or sound).

Migraine with aura

1. GB has a minimum of 2 attacks (meeting the criteria for “Migraine without aura”).
2. Migraine attacks have: complete reversibility of one or more aura symptoms; none of the aura symptoms last more than 60 minutes; the duration of the “light” interval between the aura and the onset of headache is less than 60 minutes.

Treatment of headache

In the treatment of hypertension, various types of medications are used, the most frequently used of which are the most accessible to patients - simple (non-narcotic) analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). From the group of NSAIDs, ibuprofen is most often used in the treatment of hypertension, and from the group of non-narcotic analgesics - paracetamol.

General criteria for choosing NSAIDs in the treatment of hypertension are: rapid action (complete cessation of headache); effectiveness (no recurrence of headache); safety and good tolerability. It was the selection criteria that formed the current recommendations for choosing NSAIDs in the treatment of hypertension: it is more effective to use analgesics at the beginning of an episode of headache, using fast-acting forms of analgesics; and also use the maximum initial dosage in order to prevent relapse and repeated use for the prevention of abuse headaches, it is necessary to limit the doses of analgesics containing barbiturates - up to 4 times a month, simple analgesics and NSAIDs - up to 15 doses per month, and also limit drugs with caffeine content, avoid drugs containing metamizole sodium) [6–7].

Treatment of tension-type headache

When treating TTH, it should be remembered that the source of TTH is the release of prostaglandins, key mediators of inflammation. Therefore, the choice of drug for the treatment of tension-type headache is aimed at its cause, at suppressing the synthesis of prostaglandins. Based on the mechanism of action, NSAIDs are the first choice drugs for the treatment of TTH [4, 14–16].

Thus, when studying the comparative effectiveness of treating TTH with drugs, ibuprofen proved its effectiveness on a par with other NSAIDs (Diclofenac, Naproxen, Ketoprofen); it was proven [17–18] that ibuprofen brings significant relief in TTH within 30 minutes after its administration to a larger number of patients (20% of cases) than paracetamol (12.5% ​​of cases). And it is ibuprofen that provides complete relief of TTH 3 hours after its administration in the majority of patients (75%), compared with paracetamol (32%) [19].

The new original drug Nurofen Express forte is presented in a unique format (capsules with a liquid center), thanks to which the drug has high absorption, and its maximum concentration in the blood (Tmax) is achieved in 30–40 minutes. The enhanced formula contains ibuprofen - 400 mg and targets the source of pain. Currently, the drug Nurofen Express forte is considered the best drug in the Nurofen “line”; it is recommended for use from the age of 12, which is important, given the frequency of headaches in adolescence.

Nurofen Express forte 400 mg begins to eliminate headaches after 15 minutes [20], and its fast-acting form and dosage of 400 mg has the highest efficacy rate, since the earliest achievement of a high concentration of ibuprofen in the blood leads to faster pain relief [21].

Nurofen Express forte (400 mg) has a more pronounced analgesic effect than 1 gram of paracetamol [22–23], or a low dose of ibuprofen (200 mg) compared to an average dose of acetylsalicylic acid (500 mg) [24].

When comparing the risks of adverse events, as well as toxicity in the gastrointestinal tract, Nurofen Express forte with other drugs that aggressively affect the gastrointestinal mucosa (piroxicam, ketoprofen, indomethacin, diclofenac, naproxen, acetylsalicylic acid), showed a high safety profile, accordingly, the lowest risk for undesirable consequences [25–26].

Thus, the drug Nurofen Express forte meets all the criteria for choosing an NSAID: namely “Fast” (begins to act after 15 minutes); “Effectiveness” (contains an effective dose of 400 mg of ibuprofen in one capsule with a liquid center); “Safety” (has the most favorable safety profile among NSAIDs). Nurofen Express forte, according to European standards, can be recommended as the first choice drug for headaches [14–15, 27–30].

Migraine treatment

Migraine, although it ranks second in prevalence, is, however, more pronounced in terms of severity of manifestation and subjectively difficult to tolerate for headache sufferers.

During clinical studies, it was noted that the optimal result in relieving hypertension is achieved by a combination of ibuprofen and paracetamol, which is widely used and considered safe in appropriate doses [8–9]. It is important to note that pharmacokinetic interactions between ibuprofen and paracetamol have not been documented, and no additive effects have been observed from the combined use of these two drugs [10–11].

Ibuprofen and paracetamol are reasonably considered to be relatively safe with a proven analgesic effect, which allows their use in multicomponent analgesics [9, 12–13]. At the same time, a combined drug of ibuprofen and paracetamol allows not only to use the advantages of the two drugs, but also to avoid the disadvantages and dangers of independent combined prescription of NSAIDs [10–11].

In this regard, the drug Nurofen MultiSymptom is interesting, which relatively recently appeared in the Nurofen “line” and is positioned as a “special remedy for migraines”, since its high effectiveness (in terms of the speed of onset of therapeutic effects and elimination of the severity of headache symptoms) is associated with a successful combination of its constituents components: ibuprofen - 400 mg and paracetamol - 325 mg. These components affect the central and peripheral mechanisms of pain syndrome formation and have a rapid, pronounced analgesic effect [9, 12], since it is the combination of ibuprofen and paracetamol that provides a higher analgesic effect due to the combined inhibition of COX types 1–2, which is noticeably superior in effectiveness NSAID monotherapy. The results of randomized, double-blind, placebo-controlled studies for the treatment of acute pain give grounds to conclude that the drug is superior in analgesic efficacy, duration of action and time of development of analgesia to its individual ingredients and placebo [9, 12–13]. It is worth noting that both components of the drug Nurofen MultiSymptom are recommended by the European Neurological Federation and the American Society for the Study of Hypertension as the drugs of choice for the relief of migraine attacks; in addition, studies show that repeated use of the drug is required much less frequently, and the rate of recurrence of a migraine attack is significantly lower [9 , 12–13].

It should also be understood that in relieving hypertension, the use of any drug is more effective if treatment is started earlier (for migraine with aura - at the stage of aura appearance, for simple migraine - from the moment the headache appears), at the height of the attack - most medications are ineffective.

Thus, the attention of doctors should be focused on the use of drugs in the most favorable period, from the point of view of prognosis. It is during this period that non-narcotic analgesics and non-steroidal anti-inflammatory drugs are effective in many patients with rare migraine attacks.

Despite the fact that the use of triptans is currently considered one of the promising areas in the treatment of migraine, it is difficult to use these drugs in general medical practice (especially in underexamined patients). In most cases, one should resort to a stratified approach “from simple to more complex”; this gives every reason to use an effective combination of NSAIDs and analgesics for migraine headaches (Fig. 2).

It is known that significant disadvantages of triptan therapy are:

• Possibility of prescribing only with a confirmed diagnosis of migraine;
• contraindication for use during aura and more often than 9 days a month;
• ability to cause dependence;
• prescription dispensation.

In studies where ibuprofen 400 mg was used to treat migraine, it reduced nausea and vomiting, this is likely due to ibuprofen's ability to reduce platelet aggregation or prostaglandin synthesis, both of which are involved in the development of migraine symptoms [31].

conclusions

1. HD occurs quite often in the population, regardless of gender and age.
2. Among primary headaches, tension headache is the leader, and migraine is the second most common headache.
3. The new drug Nurofen Express forte can be considered as the first choice drug for tension-type headache, which has a highly effective, rapidly onset (begins to act within 15 minutes) effect with a proven most favorable safety profile among NSAIDs, and the use of which is an ideal solution for tension-type headache.
4. The new drug Nurofen MultiSymptom contains a combination of ibuprofen and paracetamol in doses that reliably relieve a migraine attack faster and more effectively compared to the individual components of the drug [9, 12, 13], which makes it possible to talk about an effective solution to the problem of migraine, and the components contained in it (ibuprofen and paracetamol) correspond to a high level of evidence of effectiveness and are recommended as the drugs of choice for the treatment of migraine.

Literature

1. World Health Organization. Atlas of headache disorders and resources in the world 2011. A collaborative project of World Health Organization and Lifting The Burden, 2011. Available at: https://www.who.int/mental_health/management/atlas_headache_disorders/en/. Accessed May 2014.
2. Bendtsen L., Fernández-de-las-Peñas C. // Curr Pain Headache Rep. 2011; 15: 451–458.
3. Abboud J. et al. Cephalalgia. 2013. Fernández-de-la-Peñas C. et al. Cephalalgia. 2007.
4. Fernández de las Peñas C. et al. // Cephalalgia. 2007; 27: 383–393.
5. Jensen R. // Cephalalgia. 1999; 19: 602–621.
6. Bendtsen L., Evers S., Linde M. et al. EFNS guideline on the treatment of tension-type headache 2010.
7. Sarchielli P. et al. // J Headache Pain. 2012.
8. Moore RA, Derry CJ, Derry S., Straube S., McQuay HJ A conservative method of testing whether combination analgesics produce additive or synergistic effects using evidence from acute pain and migraine // European Journal of Pain. 2012; 16(4):585–591.
9. Derry CJ, Derry S., Moore RA Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain // Cochrane Database Syst Rev. 2013, Jun 24; 6.
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11. Frank de Vries et al. // Br J Clin Pharmacol. 2010, 70: 3, 429–438, 4291.
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13. Nikoda V.V., Mayachkin R.B. // Therapeutic archive. 2005, November.
14. Steiner T. et al. // J Headache Pain. 2007; 8:S 1–47.
15. Bendtsen L. et al. // Eur J Neurol. 2010; 17: 1318–1325.
16. Burian M. et al. // Pharmacol Ther. 2005; 107:139–154.
17. Kubitzek F. et al. // Eur J Pain. 2003; 7: 155–162.
18. Lange R. et al. // Drugs Exp Clin Res. 1995.
19. Packman B. et al. // J Headache. 2000; 40:561–567.
20. Schachtel B. Thoden W. // Headache. 1988; 28:471–474.
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24. Nebe J. Heier M., Diener HC // Cephalalgia. 1995.
25. Henry D. et al. // Int J Clin Pract Suppl. 2003; 135:43–49.
26. Fries JT et al. // Arthritis Rheum. 1991, Nov; 34(11):1353–1360.
27. British Association for the Study of Headache (BASH). Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type headache, cluster headache and medication-overuse headache. 3rd edition (1st revision). 2010.
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29. NICE. Headaches — diagnosis and management of headaches in young people and adults. NICE clinical guideline 150. Issued September 2012.
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31. Pearce, Franketal - 1983.

V. G. Moskvichev*, Candidate of Medical Sciences Yu. G. Petrova**, Candidate of Medical Sciences R. M. Mamin***

* GBUZ PKB No. 4 named after. P. B. Gannushkina DZM, Moscow ** State Budgetary Healthcare Institution JSC City Clinical Hospital No. 5, Astrakhan *** State Budgetary Educational Institution of Higher Professional Education of the State Medical University "MSCh", Astrakhan

Contact Information

Ibuprofen ointment 5%

The drug is widely used as an external agent. Ointments and gels are produced in pure form or with the addition of cooling agents.

The ointment helps with arthritis, sprains, pain from damaged ligaments, back pain, sports injuries, and neuralgia.

How to use Ibuprofen ointment?

Usually the ointment is prescribed to adults and children over 14 years of age.

The dosage depends on the manufacturing company. A gel from 4 to 10 cm approximately contains 50 – 125 mg of the drug and this is a single dose. The product should be gently rubbed into the skin. Reapply no earlier than after 4 hours. The maximum daily dose is 500 mg.

Ibuprofen ointment

Side effect

• Like all medications, Ibuprofen can cause allergic reactions: skin itching, urticaria, Quincke's edema, anaphylactic reactions, incl. anaphylactic shock. In this case, you should stop taking the drug and consult a doctor.
• The following side effects may be observed on the part of the digestive system: pancreatitis, nausea, vomiting, erosive and ulcerative lesions of the gastrointestinal tract, stomach and abdominal pain, stomatitis, liver dysfunction, hepatitis.
• Genitourinary system: polyuria, renal dysfunction, renal failure, edema, cystitis, nephrotic syndrome, interstitial nephritis.
• Nervous system and sensory organs: irritation and dry eyes, ringing in the ears, hallucinations, psychomotor agitation, confusion, headaches, anxiety, irritability.
• Respiratory system: allergic rhinitis, bronchospasm, shortness of breath.
• Cardiovascular system: agranulocytosis, leukopenia, increased pulse, hypertension, heart failure.

Causes of drug-induced migraine

Medicinal migraine occurs when painkillers are abused, explains neurologist at the Headache and Autonomic Disorders Clinic, Academician Alexander Vein, Associate Professor of the Department of Nervous Diseases of Moscow State Medical University. THEM. Sechenova Nina Latysheva. Taking analgesics more than twice a week is addictive. The lifespan of the tablet is reduced. A person takes analgesics more often and becomes dependent.

Symptoms of headaches from the reverse effect of analgesics were described by a group of Russian scientists from the Moscow Federal State Budgetary Institution "Scientific Center of Neurology" and the Federal State Budgetary Educational Institution of Higher Education "Moscow State Medical and Dental University named after. A.I. Evdokimov." This pain is daily and varies in intensity. Pain increases with physical or emotional stress and discontinuation of medications.

It is not always easy to identify the causes of migraine, and sometimes it is impossible without a full examination.

Doctors at Germany's Essen University Hospital have described drug overuse as a global problem, with up to 4% of people overusing analgesics and other drugs to treat migraines and 1% of people in Europe, North America and Asia experiencing medication-induced headaches.

In Russia, patients also face headaches due to medications. German scientists from the University of Bochum, the Norwegian University of Science and Technology and the Russian Academy of Sciences examined 2,725 adults in 35 cities and nine villages in Russia. 213 (10.5%) respondents reported headaches 15 times a month or more often, 145 of them (68.1%) abused medications.

Scientists from the American Academy of Neurology have found out how long it takes to get used to drugs. The shortest period was for triptans - 1.7 years, for ergot - 2.7 years, for analgesics - 4.8 years. Patients who overused ergots and analgesics reported daily tension-type headaches (TTH), and patients who took triptans described migraine-like headaches or an increase in migraine attacks.

Be careful, some drugs are addictive.

Contraindications:

• Hypersensitivity to the components of the drug.
• Bleeding disorders, hemophilia.
• Hematopoietic disorders.
• Erosive and ulcerative lesions of the gastrointestinal tract in the acute stage, bleeding in the gastrointestinal tract.
• Kidney or liver failure.
• Severe heart failure.
• The period after coronary artery bypass surgery.
• “Aspirin triad” (aspirin intolerance, nasal polyps and bronchial asthma).
• Diseases of the optic nerve.
• Caution should be exercised when taking other NSAIDs.
• Simultaneous use of medication and alcoholic beverages is not recommended.

Ibuprofen CAPS - analgesic and antipyretic agent

Undesirable effects can be minimized by using a low effective dose for the short time needed to control symptoms.

The drug is prescribed with caution to elderly patients, as they are more likely to experience adverse side reactions to NSAIDs, mainly gastrointestinal bleeding and perforation, which can lead to a sharp deterioration of the condition.

Respiratory system:

Caution should be exercised when using the drug in patients with bronchial asthma and other obstructive pulmonary diseases due to the risk of bronchospasm.

Other NSAIDs:

The simultaneous use of Ibuprofen CAPS and other NSAIDs, including selective cyclooxygenase-2 inhibitors, should be avoided.

Systemic lupus erythematosus, as well as mixed connective tissue diseases, increase the risk of aseptic meningitis.

Kidneys:

The drug is used with caution in case of renal failure, because Renal function may deteriorate.

Liver:

The drug should be used with caution in cases of liver dysfunction.

Cardiovascular and cerebrovascular effects:

The drug is prescribed with caution to patients with heart failure, arterial hypertension, and bleeding disorders.

Clinical trials and epidemiological data suggest that ibuprofen, especially at high doses (2400 mg daily) and long-term treatment, may be associated with a small increased risk of arterial thrombotic complications (eg, myocardial infarction or stroke). In general, epidemiological studies do not suggest that low doses of ibuprofen (eg, ≤1200 mg daily) are associated with an increased risk of myocardial infarction.

Female fertility disorders:

There is limited evidence that drugs that inhibit cyclooxygenase/prostaglandin synthesis may impair female fertility by affecting ovulation. This phenomenon is reversible when the drug is discontinued.

Gastrointestinal tract:

Patients with diseases of the gastrointestinal tract (ulcerative colitis, Crohn's disease) should be prescribed NSAIDs with caution due to a possible exacerbation of these diseases.

Patients with a history of gastrointestinal toxicity, especially the elderly, should report any unusual abdominal symptom (especially gastrointestinal bleeding), especially if the symptom is observed during the initial phase of taking the drug.

If patients develop gastrointestinal bleeding while taking the drug, the drug should be stopped immediately.

Caution should be exercised in patients receiving concomitant medications that may increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin reuptake inhibitors, or antiplatelet agents such as aspirin.

Dermatological:

Serious skin reactions, some fatal, including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs. Ibuprofen CAPS should be discontinued at the first appearance of skin rash, mucosal lesions, or any other signs of hypersensitivity.

special instructions

• Ibuprofen is prescribed in a short course - three days. If therapy lasts 10 days or more, you should consult a doctor.
• Elderly patients need to carefully monitor the tolerability of the drug, as they are more likely to experience side effects.
• May temporarily reduce female reproductive function (the effect disappears after discontinuation).
• It may affect the ability to drive vehicles, so if the patient notices lethargy or drowsiness, he should refrain from driving vehicles and other activities where reaction speed is required.

Ibuprofen for children

Interaction with other drugs

Ibuprofen was created back in 1953 and is therefore well studied. Here we will briefly list its interactions with common drugs - this is mainly a group of cardiovascular drugs, some antibiotics. A complete list of drug interactions should be read in the instructions for the drug.

• Reduces the effect of ACE inhibitors, beta-blockers and some diuretics, such as furosemide.
• The effect may be enhanced when taken with anticoagulants.
• The activity of amlodipine decreases.
• Caution should be used when taking warfarin, methotrexate and lithium together.
• Interactions have been noted with cardiac glycosides, quinolone antibiotics, ethanol, barbiturates, rifampicin, phenylbutazone, cyclosporine, mifepristone, tacrolimus, zidovudine, cefoperazone, cefotetan, valproic acid.