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

Despite its efficacy in preventing rebleeding, the anticipated strong trend in favor of early intracranial surgery has not been achieved. Early intracranial operation remains a useful choice in the management of recent SAH in good-risk patients, but patients must be carefully selected on an individual basis. Many patients will undoubtedly benefit from early surgery but it is not a panacea. Further investigation of surgical treatment in combination with improved preoperative and postoperative medical therapy will be required to ameliorate the outcome of SAH. In particular, the prevention and treatment of cerebral infarction deserves attention. The results of the antifibrinolytic and timing of intracranial surgery studies point to the need for an effective prevention treatment regimen for vasospasm. Further studies about the efficacy of calcium channel blocking drugs in prevention of ischemia after SAH are needed among patients given antifibrinolytic drugs or having early operation. All the advances in treatment are predicated on prompt diagnosis of SAH in good-condition patients. The medical community needs to maintain a high degree of vigilance for the diagnosis of SAH in all patients complaining of a new, unusual or severe headache. Early referral to properly equipped and staffed medical facilities remains a keystone to effective treatment of SAH.
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PMID:Early management of the patient with recent aneurysmal subarachnoid hemorrhage. 381 Jul 3

Diltiazem is an orally and intravenously active calcium channel blocking agent shown to be an effective and well-tolerated treatment for stable angina and angina due to coronary artery spasm. Its efficacy in these diseases has generally been similar to that of nifedipine or verapamil - alternative calcium channel blockers with which diltiazem has many electrophysiological, haemodynamic, and antiarrhythmic similarities. The antianginal mechanism of diltiazem cannot be precisely described; however, it appears to increase myocardial oxygen supply and decrease myocardial oxygen demand, mainly by coronary artery dilatation and/or via both direct and indirect haemodynamic alterations. Diltiazem has also shown substantial efficacy in the treatment of unstable angina, hypertension, and supraventricular tachyarrhythmias, but further study is necessary before its place in the treatment of these diseases may be clearly established. Although headache due to peripheral vasodilatation and depression of atrioventricular nodal conduction may be troublesome, side effects occur in only 2 to 10% of patients receiving diltiazem and are generally minor in nature. Thus, diltiazem offers a worthwhile alternative to other agents currently available for the treatment of angina pectoris. Although the infrequency of serious side effects may offer an advantage, its relative place in therapy compared with that of other calcium channel blockers remains to be clarified.
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PMID:Diltiazem. A review of its pharmacological properties and therapeutic efficacy. 389 2

Nitrendipine (BAY e 5009) is a new calcium channel blocker with a marked effect on excitation-contraction coupling in different types of muscle cells. It has many similarities to the established agent, nifedipine. In the present study, nitrendipine was evaluated in a double-blind within-patient comparison. Twelve patients with essential hypertension were given nitrendipine 20 mg or 40 mg orally for three weeks following a 1-week placebo period. After a second 1-week placebo period, there was a crossover to the alternative dosage (20 or 40 mg respectively), and active therapy was again given for 3 weeks. Both doses of nitrendipine caused a significant and equal reduction of arterial pressure, which persisted for at least 24 hours. Only the highest dose caused an increase in heart rate. There were a few reports of headaches, flushing, and palpitation, particularly after the 40 mg dose. There was a significant correlation between the reduction of mean arterial pressure and the log plasma concentration (20 mg: r = -0.88, p less than 0.01; 40 mg: r = -0.94, p less than 0.001). There was a linear relationship between the area under the curve and the oral dose, indicating that liver enzyme saturation had not occurred. There was no accumulation of nitrendipine in plasma during 3 weeks of treatment.
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PMID:Pharmacokinetic and pharmacodynamic parameters in patients treated with nitrendipine. 634 73

Lacidipine is an orally administered calcium channel blocker of the dihydropyridine class, which shows selectivity for vascular smooth muscle over cardiac tissue and has a long duration of action. In studies using ambulatory blood pressure monitoring, lacidipine 2 to 8mg administered once daily in the morning reduced blood pressure over 24 hours, with the reductions being greater during the day than at night in some studies. 77 to 87% of patients with mild to moderate hypertension had their blood pressure controlled by treatment with lacidipine 2 to 8 mg/day for 1 to 4 months in dose-finding studies. When administered once daily, lacidipine 4 to 6 mg was equivalent in antihypertensive efficacy to hydrochlorothiazide 25 to 50 mg/day, atenolol 50 to 100 mg/day, and the prototype calcium channel blocker nifedipine 20 to 40 mg twice daily (sustained-release formulation). The adverse effects of lacidipine are those common to other dihydropyridine calcium channel blockers, and include headache, flushing, ankle oedema, dizziness and palpitations. The long term effects of lacidipine on cardiovascular morbidity and mortality, and possible additional clinical benefits in terms of its antiatherosclerotic effects, are under investigation; the outcome of these studies will be important in defining the future role of this agent in the treatment of hypertension. Thus, available evidence suggests lacidipine provides a further alternative to the dihydropyridine calcium channel blockers currently available for the treatment of essential hypertension.
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PMID:Lacidipine. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential in the treatment of hypertension. 752 28

Hypertension in a patient with acute spinal cord injury is commonly caused by autonomic dysreflexia, which is a syndrome of paroxysmal hypertension associated with headaches, relative bradycardia and vasomotor instability secondary to sympathetic overactivity. Life-threatening complications such as seizures and intracerebral haemorrhage are largely preventable. We report both acute and chronic forms of autonomic dysreflexia due to underlying urinary and faecal impaction in a 33-year-old female with traumatic C4 quadriplegia. She was successfully managed with a combination of physical and pharmacological measures including calcium channel and sympathetic blockers.
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PMID:Paroxysmal hypertension in a C4 spinal cord injury--a case report. 757 37

Levels of sex hormones fluctuate throughout the female life cycle, and these fluctuations may trigger, intensify, or alleviate migraine. Drugs can be used both preventively and therapeutically to combat the headache that results in some women from such fluctuations. Effective prophylactic agents include beta blockers, antidepressants, calcium channel blockers, and hormones. Nonsteroidal anti-inflammatory drugs, ergotamine and its derivatives, and narcotics are among the abortive therapy options. Pharmacologic management of migraine in pregnant women must be conservative because of the risks of injury and dependence to the fetus and newborn.
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PMID:Migraine and women. The link between headache and hormones. 771 87

The recent publication of drug formularies by third-party payers has serious implications for the practice of medicine. These formularies list the medications for which the consumer can be reimbursed by the third-party payer. The most restrictive of the five formularies I have received lists only two agents for the treatment of migraine headaches: Cafergot (at an incorrect dose of 1/100 mg) and Ergotrate which is no longer available. The most liberal of the formularies lists analgesics, Cafergot, Midrin, and Imitrex for the treatment of acute attacks, and as prophylactic agents, Inderal, Sansert, and analgesics (known to cause rebound headaches when used in this fashion in migraine patients). Abortive agents of proven value, such as DHE-45 and NSAIDs, and preventative medications, such as calcium channel blockers, tricyclic antidepressants, serotonin reuptake inhibitors, methylergonovine, and divalproex sodium, are not available. No one could quarrel with a goal of developing a cost-effective formulary. However, the authors of these formularies have clearly demonstrated their inability to provide even a current, accurate, and adequate formulary by existent standards of care in the treatment of migraine headache. While it is easy to criticize these formularies, it is more difficult to develop a comprehensive list that would satisfy the practitioners' need to provide relief for their patients with a minimum of side effects, and the needs of third-party payers (presumed) to provide quality care at the most economical level.
Headache 1995 Apr
PMID:Toward a standard drug formulary for the treatment of headache. 777 80

The effects of a new dihydropyridine calcium channel blocker, amlodipine, on blood pressure (BP) and renal function were studied in spontaneously hypertensive rats (SHR). These effects were compared with those of an angiotensin-converting enzyme (ACE) inhibitor, enalapril. In addition, the effects of amlodipine on BP and renal function were studied in hypertensive patients with renal impairment. In five of six nephrectomised salt-loaded SHR, increases in BP, urinary excretion of protein and serum creatinine were attenuated by the administration of 2 mg/kg/day of amlodipine. The progression of renal histological damage was also markedly decreased. The protective effects of amlodipine against renal damage were similar to those of enalapril. However, the mechanisms of action of these two agents seem to differ as, unlike enalapril, amlodipine did not significantly dilate the efferent arteriole in hydronephrotic perfused rat kidney. In a clinical study, 2.5-5 mg/day of amlodipine was administered once a day for 8-10 weeks to 39 hypertensive patients with renal impairment (serum creatinine > or = 1.5 mg/dl to < 5 mg/dl) or renal parenchymal disease (serum creatinine < 5 mg/dl). A significant reduction in BP (reduction of mean BP > or = 13 mm Hg) was observed in 28 patients (80%). Headache was experienced as a side-effect in one of 35 patients (2.9%). With respect to the influence of amlodipine on renal function, mean values of blood urea nitrogen and serum creatinine were unchanged for the total group whereas a slight elevation of serum creatinine was observed in four of 35 patients (11.4%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal effects of amlodipine. 778 8

Moyamoya disease is a cerebrovascular disease characterized radiologically by progressive narrowing and occlusion of the arteries contributing to the circle of Willis and its branches. There is formation of an exuberant collateral network of blood vessels at the base of the brain, which is thought to arise in response to chronic ischemia. Clinically, the course is variable, with patients having repeated transient ischemic attacks, strokes, migraine, and seizures. Effective treatment is not available. The etiology and pathophysiology of moyamoya disease are largely unknown. Two patients with arteriographically proven moyamoya disease were identified. Both patients were symptomatic before age 5 years. Despite successful encephaloduroarteriosynangiosis revascularization procedures, they continued to experience an inexorable downhill course. A calcium channel blocker (nicardipine HCl) was introduced in order to prevent further symptoms. After the introduction of nicardipine, no further strokes occurred in either patient. There were no further episodes of transient ischemic attacks, seizures, or headache in one patient and decreased frequency in the other. In patients with moyamoya disease, nicardipine may have a beneficial effect on cerebral hemodynamics and may prevent ischemic sequelae by optimizing existing collateral circulation.
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PMID:Use of a calcium channel blocker (nicardipine HCl) in the treatment of childhood moyamoya disease. 782 27

This is the first report of long-term use (one year) of isradipine, a new dihydropyridine calcium channel blocker, in the treatment of elderly patients with essential hypertension. Patients completing a three month, double-blind, multicentre study comparing isradipine to hydrochlorothiazide (HCTZ) were eligible to enroll in this open-label, continuation study. At initial baseline, patients were at least 60 years of age and had DBP from 95 mmHg to 120 mmHg. Patients were titrated when necessary every two weeks with isradipine, 5 mg to 15 mg once daily or 2.5 mg to 10 mg twice daily, to maintain sitting DBP < or = 90 mmHg. HCTZ, 12.5 mg to 50 mg once daily, could be added for better BP control. A total of 136 patients completed the one year, open-label phase. One hundred and fourteen patients (84%) received isradipine as monotherapy (mean dose, 9.7 mg/day); 22 received concomitant HCTZ therapy at one year. Reduction in DBP was significant and similar among all age groups and races (mean change of -19 mmHg). Reduction in SBP was similar among all age groups. Ninety-four per cent of those receiving isradipine monotherapy achieved BP control during the last four months of treatment. Twenty-six patients (16%) withdrew from the study: 11 (7%) had adverse reactions (one with headache, two with pedal oedema, eight with other problems); 11 (7%) had nondrug-related problems; and in four (2%), the drugs were ineffective. Based on these observations, isradipine is a well-tolerated, safe and effective agent for long-term BP control in elderly patients with essential hypertension.
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PMID:One year experience of elderly hypertensive patients with isradipine therapy. 788 90


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