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.