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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A young man suffering from both cluster headache and epilepsy is reported. Since the age of 37 he had recurrent generalized tonic-clonic seizures; one year later cluster headache attacks began. Neurological examination, standard laboratory tests and CT-scan were normal. The EEG showed medium-voltage sharp waves, not blocking upon eye opening, over the right parieto-temporal region. Flunarizine was added to his phenytoin therapy; it controlled both paroxysmal disorders. After six months, flunarizine was discontinued and during a one year follow-up the patient remained symptom-free. This calcium channel blocker can be regarded as an ideal drug in patients suffering from both cluster headache and epilepsy; it controls this headache syndrome and is a useful add-on to standard anti-convulsant therapy.
Headache 1989 Jun
PMID:Cluster headache and intercalated seizures in a young man: therapeutic effectiveness of flunarizine. 275 46

Headache characteristics are described in 139 patients with chronic daily or almost daily headaches due to regular intake of analgesics and the short- and long-term results of drug withdrawal. Drug-induced headache was described as dull, diffuse, and band-like, and usually started in the early morning. The mean duration of the original headache (migraine or tension headache) was 25 years; regular intake of drugs and chronic daily headache had started 10 and 6 years prior to withdrawal therapy, respectively. Patients took an average of 34.6 tablets or analgesic suppositories or antimigraine drugs per week containing 5.8 different substances. The drugs most often used were caffeine (95%), ergotalkaloids (89%), barbiturates (64%), and spasmolytics, paracetamol, and pyrazolone derivates (45%-46%). A total of 103 patients (68 migraine, 35 tension or combination headache) were available for interviews at a mean time interval of 2.9 years after an inpatient drug withdrawal programme. Chronic headache had disappeared or was reduced by more than 50% in two-thirds of the patients. Positive predictors for successful treatment were migraine as primary headache, chronic headache lasting less than 10 years, and regular intake of ergotamine. Drug intake was significantly reduced and patients used single substances more often. Patients who originally suffered from migraine, superimposed on the daily headache, also experienced a significant improvement in the frequency of the migraines and their intensity. Migraine prophylaxis through beta-blocking agents and calcium channel antagonists was more efficient after drug-withdrawal therapy.
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PMID:Analgesic-induced chronic headache: long-term results of withdrawal therapy. 291 33

The pharmacokinetics and relative bioavailability of oral isradipine, a dihydropyridine calcium channel blocking agent, were determined in 42 normal male volunteers participating in two separate studies. Eighteen of the subjects received 2.5-, 5-, and 10-mg oral doses of isradipine solution (Study 1). The remaining 24 subjects received four 2.5-mg capsules, one 10-mg capsule, and 10 mg of isradipine as an oral solution (Study 2). Venous blood samples were obtained prior to and at frequent intervals after administration of each dose form. Plasma isradipine concentrations were measured by radioimmunoassay. No significant dose effect occurred with respect to any pharmacokinetic parameter except AUC and Cmax in Study 1. In Study 2, Cmax, tmax, and MRT were significantly different after the solution compared with the capsular formulations. The respective pharmacokinetic parameters (mean +/- SD) for the 10-mg solution and 10-mg capsule in Study 2 were time to maximum concentration, 0.40 +/- .28 and 1.57 +/- 0.44 hours; oral clearance, 284.9 +/- 105.3 and 317.0 +/- 138.4 L/hr; elimination half-life, 5.36 +/- 1.8 and 6.63 +/- 2.4 hrs, respectively. Headache, dizziness, and tachycardia were the most frequent adverse effects in both studies.
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PMID:The pharmacokinetics of oral isradipine in normal volunteers. 296 65

Nifedipine, the dihydropyridine calcium channel antagonist prototype, is characterized by wide variability of its hepatic first-pass metabolism and individual response. This could be due to a new genetic polymorphism of drug metabolism, and this hypothesis was investigated in a randomized and cross-over population study in normal volunteers (n = 80). The kinetics and effects of an oral dose of nifedipine (10 mg) and (+/-)-nicardipine (20 mg), a second generation derivative with presumed different biotransformation routes, were evaluated at 0, 1, 2 and 3 h. The two drugs displayed a similar pharmacodynamic profile in terms of heart rate and blood pressure. The observed frequency distributions showed no asymmetry or bimodality suggesting polymorphism. The frequency of headaches and flushes were 21/80 and 19/80 respectively for nifedipine and (+/-)-nicardipine. At the doses administered nifedipine and (+/-)-nicardipine show the same efficacy. This study does not confirm the presence of polymorphism in the response to these dihydropyridines.
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PMID:[Absence of polymorphism in individual response to the dihydropyridines nifedipine and (+/-)-nicardipine]. 322 86

To assess the safety of the calcium channel blocker nitrendipine, data from 61 clinical studies conducted in the United States and involving 1,245 patients were reviewed. The drug appeared to be tolerated in the majority of patients and the dropout rate was low. The most common side effects associated with nitrendipine administration were headache and edema. Most side effects were mild and were tolerated or disappeared with continued therapy. No serious adverse biochemical, hemodynamic, renal, or humoral effects of nitrendipine were apparent. Nitrendipine produced a prompt, smooth, and sustained reduction in systolic and diastolic blood pressures in both the supine and standing positions. The blood pressure response was maintained for six months to one year with no evidence of resistance or tachyphylaxis. Sex and race had no influence on the antihypertensive effect of nitrendipine, but patients sixty years of age and older appeared to respond better to the drug than younger patients.
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PMID:The safety of nitrendipine in the treatment of essential hypertension--a review of 61 clinical studies. 327 92

Calcium channel blocking drugs are a chemically heterogenous group, so it might be expected that their effects on vascular smooth muscle, cardiac contractility, and conduction tissue may differ. However, the majority of adverse reactions are predictable from their pharmacological actions and may be conveniently grouped in the following categories: 1) vasodilatation, 2) negative inotropic effects, 3) conduction disturbances, 4) gastrointestinal effects, 5) metabolic effects, and 6) drug interactions. Vasodilatory symptoms, namely, dizziness, headaches, flushing sensation, and palpitation, are more likely with nifedipine. Peripheral edema is also common with nifedipine, but the mechanism is uncertain. For a given degree of vasodilation, the greatest negative inotropic effect is seen with verapamil first, diltiazem second, and nifedipine last. Calcium channel blocking drugs are contraindicated in hypertensive patients with second and third degree heart block, sick sinus syndrome, and severe heart failure. Verapamil and diltiazem have a significant effect on cardiac conduction, whereas nifedipine, in therapeutic doses, does not. Local gastrointestinal symptoms, such as nausea and constipation, are common with verapamil. None of the calcium channel blocking drugs have been reported to adversely affect lipid or protein metabolism. However, nifedipine, verapamil, and diltiazem in high doses may inhibit liberation of insulin. The significance of this finding needs to be explored further in hypertensive diabetics. Serum digoxin levels have been shown to increase after administration of verapamil and nifedipine, but there is no evidence that this change has any clinical relevance.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Side effects of calcium channel blockers. 328 Apr 92

Fifteen patients with Raynaud's phenomenon [systemic lupus erythematosus (6), progressive systemic sclerosis (8) and rheumatoid arthritis (1)] and 12 patients with Raynaud's disease participated in a parallel, 4-week/arm, double blind, crossover study of nicardipine, an experimental calcium channel blocker. Nicardipine significantly improved pain (p = 0.03), decreased number of Raynaud's attacks (p less than 0.03), and was preferred over placebo (p less than 0.05) in the patients with Raynaud's disease, but showed an effect only in the number of attacks (p = 0.049) among the group with Raynaud's phenomenon. Plethysmography showed no drug effects. One patient discontinued the trial after developing headaches while taking placebo. Nonlimiting toxicity occurred more commonly with drug than placebo (15 vs 9 times, p less than 0.05). Our study demonstrated that nicardipine improves symptoms in Raynaud's disease, but is not effective in Raynaud's phenomenon.
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PMID:Nicardipine for the treatment of Raynaud's phenomena: a double blind crossover trial of a new calcium entry blocker. 331 3

Increasing recognition of the importance of calcium in the pathogenesis of cardiovascular disease has stimulated research into the use of calcium channel blocking agents for treatment of a variety of cardiovascular diseases. The favorable efficacy and tolerability profiles of these agents make them attractive therapeutic modalities. Clinical applications of calcium channel blockers parallel their tissue selectivity. In contrast to verapamil and diltiazem, which are roughly equipotent in their actions on the heart and vascular smooth muscle, the dihydropyridine calcium channel blockers are a group of potent peripheral vasodilator agents that exert minimal electrophysiologic effects on cardiac nodal or conduction tissue. As the first dihydropyridine available for use in the United States, nifedipine controls angina and hypertension with minimal depression of cardiac function. Additional members of this group of calcium channel blockers have been studied for a variety of indications for which they may offer advantages over current therapy. Once or twice daily dosage possible with nitrendipine and nisoldipine offers a convenient administration schedule, which encourages patient compliance in long-term therapy of hypertension. The coronary vasodilating properties of nisoldipine have led to the investigation of this agent for use in angina. Selectivity for the cerebrovascular bed makes nimodipine potentially useful in the treatment of subarachnoid hemorrhage, migraine headache, dementia, and stroke. In general, the dihydropyridine calcium channel blockers are usually well tolerated, with headache, facial flushing, palpitations, edema, nausea, anorexia, and dizziness being the more common adverse effects.
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PMID:Differential effects of 1,4-dihydropyridine calcium channel blockers: therapeutic implications. 332 59

Irrespective of their mechanism of action, which so far has not been clarified, calcium channel blockers (CCBs) have a documented prophylactic effect on classical and common migraine, as well as on cluster headache. The drugs may reduce migraine prodromes, the frequency of migraine attacks, and also decrease the severity and possibly the duration of these attacks. Notably, their optimum effect is often seen after more than 2 months of treatment. Side effects seem to be few and mild. Whether or not there are differences in therapeutic efficacy between different CCBs is presently unclear. As comparisons with other alternatives of treatment are sparse, the place of CCBs in migraine therapy remains to be established.
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PMID:Migraine treatment with calcium channel blockers. 352 Nov 94

A comparative, double-blind, placebo-controlled, double-dummy, randomized, crossover trial was performed in 32 hypertensive patients (initial blood pressure [BP] 165/105 +/- 3/2 mm Hg), most of them obese women, to evaluate the antihypertensive efficacy and tolerability of the new calcium channel blocking drug nisoldipine, 10 mg once or twice daily, over 6 weeks compared with the diuretic hydrochlorothiazide-amiloride (hydrochlorothiazide, 25 mg, in combination with amiloride, 2.5 mg once or twice daily). Adequate 24-hour control of BP (supine diastolic BP less than 90 mm Hg) was achieved in 15 of 32 patients (47%) with monotherapy by 1 agent and in 23 of 32 patients (72%) when including those who responded to either agent. Both nisoldipine and the diuretic had a flat dose-response curve. The larger dose of diuretic yielded lower systolic and exercise BP values (erect and supine) than high-dose nisoldipine (p less than 0.05), with less headache (p less than 0.05). In the other 9 patients who did not respond, the combination of nisoldipine 10 mg plus hydrochlorothiazide (25 mg)-amiloride (2.5 mg) was administered and yielded a response in 8 patients (overall response including monotherapy 96%). Ten patients were given nisoldipine for an additional period of 6 months, and they required an average dose of 33 mg/day for BP control. In both the 6-week and 6-month studies, nisoldipine monotherapy caused frequent subjective adverse effects. In contrast, in the 6-week study the combination of low-dose nisoldipine and low-dose diuretic gave good BP control with no adverse effects.
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PMID:Monotherapy with the calcium channel antagonist nisoldipine for systemic hypertension and comparison with diuretic drugs. 366 39


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