I was going to try to post this last night, 15 Feb, as it was happening, but one of my 'triggers' is talking about my Anxiety so I had to avoid it and take breaks.
I have been off Arcoxia (arthritis anti-inflammatory) as part of a yearly regimen. This has made my neck very painful with referred pain in both arms.
Last evening my pain and eyes started making my head feel like an Anxiety Attack was imminent. Sweating, waves of 'greying out' - and then tightening chest pains with radiating pain down my left arm. It was SO bad I messaged my Ex to warn her I might need her. I never do this.
The pain in my chest made me more anxious, increasing adrenaline which increased the pain. I cannot take Anxiety meds because of my heart problems, GTN spray starts my TN and Cluster Headaches. Breathing techniques simply made me aware of how shallow my breathing was. I could, and did, take my heart meds and Arcoxia a couple of hours early. My Anxiety levels were feeding off my fears of my physical condition all this time. My breathing was becoming more ragged, sweating of forehead more profuse.
The meds eased the pains in my chest and neck, after a while my eyesight cleared enough to log on and distract myself reading Posts, although I was up until the early hours, too anxious to sleep.
Today my heart feels as though it's been kicked by a small horse, so the Anxiety Attack trigger WAS a physical event - microvascular in nature I expect - and my mind is 'frazzled' and on edge.
This just goes to show that Anxiety/Panic attacks can have physical AND mental triggers. Remember, if you present with chest/arm pains call Emergency - better safe than sorry. I know I didn't, but I have had a heart attack, suffer Coronary Ischaemia and Microvascular Disease and have medication in-house. If my meds hadn't worked, I would have called.

Dave.

Gosh, I'm sorry about your awful night.

My daughter gets chest pains when her anxiety is bad. The only thing that stops that is usually her beta blocker Propranolol. It works on the physical symptoms of anxiety. Doesn't help the reasons why a person gets anxious in the first place.

Lots of people on TBI/PCS get anxiety after their accidents and head injuries too. For people like myself who had anxiety prior to a head injury, life can get very complicated because of the fear of being hurt again. Anyway... long story.

I hope you're able to get some rest today.
take care there Dave.

Ah, propranolol - I miss it, used to pop it like Smarties, especially when I was working. Even 2 years ago I was on beta-blockers, but my new heart meds stop me using them. Now I only have my mind and meditation techniques to help cope.
I wrote the above to try to let others see the savage circle of an Anxiety Attack.

Dave.

I am curious, Dave. What meds do you take now for your heart?

MrsD,
Diltiazem. Tildiem Retard (Calcium Channel Blocker) 90mg x2 a day.
Atorvastatin 40mg x1 a day
GTN Spray as needed. Needed for the mild/moderate chest pain 2-3 times a week, but avoid taking it because it is an INSTANT trigger for Cluster Headaches.
Prescribed Isosorbide Mononitrate, don't take for same reason as GTN spray.

I had more pain, but less Anxiety when I was on beta-blockers.
Oh, BP has gone up from 95/70 to 130/90 in 2 years since med change. It has always been naturally low.

Dave.

Thanks for that information.

I have a few comments.

1) nitrate based drugs typically cause headache in most people when used sporatically or just started up. It can take about a week on regular dosing for the side effect headache to stop. A tolerance to it develops with regular use. Some medical schools even have students use a nitro sublingual as a demonstration to illustrate this headache. The basic problem with nitrates over time is that the tolerance extends to the vasodilation effects, and those wane away, and usefulness is lost.

You could try a cold pack on the back of your neck to minimize the headache effects of the nitro on your brain.

2) I have to wonder how much tea and/or coffee you drink daily.
Too much caffeine in some people triggers headache, in the offtimes like the evening and night when the caffeine is no longer present. These are called caffeine withdrawal headaches.
As we age, it seems caffeine can become an enemy even in small amounts. I've seen many people develop anxiety and or insomnia from modest amounts of tea. Others can drink expresso at bedtime like my MIL used to do! Caffeine can make anxiety much worse, and give symptoms of chest pressure. Stopping caffeine is difficult...and should be done with a taper.

Also tea contains polyphenols which dilate blood vessels. These can be a headache trigger for some people.

3) Theanine is for some an effective antianxiety agent and OTC.
http://www.lef.org/Magazine/2007/8/r...nxiety/Page-02

4) The Cox-2 inhibitor you are using IS an NSAID. All NSAIDs block Cox-2, but there are some who favor the Cox-2 enzyme more than others. Cox-1 is a homeostatic system and blocking it causes gastrointestinal bleeding and other problems. Cox-2 is mostly inflammatory, except for prostacyclin which is useful for dilating blood vessels. So the Cox-2 special NSAIDs are very bad for the heart. Other NSAIDs like ibuprofen and naproxen are mixed and therefore a little less heart damaging, but they still have potential to do so.

5) one good thing you can try for improving blood flow to your heart is fish oil (or the new krill oil). Omega-3's improve circulation and reduce inflammation (may help your arthritis issues). 3 a day of fish oil, or 2 a day of krill oil with food may be helpful for you.

6) you need your B12 measured. Low B12, along with low folic acid and low B6, leads to elevated homocysteine. This homocysteine causes inflammation inside blood vessels and leads to blockages there. May people end up here on NT with stubborn symptoms of all sorts, and many find they are low in B12 when tested. Also Vit D... so have the D measured too. Low D may lead to more chronic pain and when fixed, people often find their pain levels reduced.

7) and lastly... neurologists now are finding people with head pain, may have MOH... medication overuse headache. The brain cells actually change with chronic pain medications and this lowers the threshold for headache pain. The solution is to keep medication for use infrequently. Where I live there is a tertiary headache clinic run by neurologists where pain meds are only given up to twice a week. Many of the people going to that clinic are taken off pain medication at the start of their evaluation and treatment.

MrsD, thank you so much for such a comprehensive answer.
As to your points, in Number:

2. I drink no coffee, have maybe 1 or 2 weak teas morning and lunch time. Fresh coffee used to be my weakness in the early '80's, drinking 8-10 cups a day. After '83 I found it massively increased my Anxiety levels, I haven't touched it since.

3. Talking of Anxiety, Theanine is something I will definitely look in to. I am increasingly in need of help.

4. Thanks for that clarification, I was first diagnosed/prescribed during my 'Don't know, don't care, dead inside Citalopram' years. I have filed that self-misinformation ever since. So - Cox-1 inhibitors like Ibuprofen do not work on me.

5/6. I eat a fair amount of oily fish - far more than most people, though probably still not enough. All my vegetables are steamed, fruit not enough. My drinks of choice are plenty of water and fortified A, C, E, carrot and acerola juice.
Blood tests during my Annual Review often show B6/B12 slightly low for which I am prescribed high dose supplements for 6 weeks, then tested again. Levels sustain/taper off over the next 9 months. There is a contra-indication that, for the life of me, I cannot remember that my GP will not allow permanent supplement use.
Folic acid and vitamin D (surprisingly) are good.

1/7. Headaches. These are not MOH, or Nitrate headaches. My suffering precedes my use of any pain meds. I suffered for 9 years, having up to 8 attacks a day with no respite, thinking they were just part of the Chronic Neuropathic Facial Pain/Parasthesia and TN I have on the left side of my head/face.
It was only when I mentioned their intensity to my Neurologist - a white hot railroad spike boring into my brain behind my temple/left eye - that he matched more symptoms - sweating, eye watering, blocked and runny nose, (eventually) contracted pupil , length of attack - that he diagnosed Chronic Cluster Headaches.
Throughout the years, through all my different treatments and meds, and every year at this time when I cut out my pain meds to properly gauge my level of pain, ensure I'm not addicted to anything and to identify possible masked problems, the Cluster Headaches have been my miserable companion.
The Topiramate HAS cut the number of attacks, standing now at about 14 a week. And it seems that Lidocaine and/or Ketamine dulls their intensity a little.

Dave.

If you take B12 as a supplement, be sure to take it on an empty stomach. Presence of food can negate any absorption.

There we go, I have never been advised to do that, and all my supplements are dispensed at my Surgery in plain brown bottles with no paperwork.
Thanks for the info, I'm sure my bloods will show a need in March/April.

Dave.