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

Prescription of oral contraceptives is reviewed by giving practical tips on the absolute contraindications, timing of the first dose, dose of estrogen, choice of type of progestin, reasons for changing the combination, and a list of benefits of oral contraceptives. The major risk in taking orals is cardiovascular disease, but actual risks are clustered in subsets of women. Those at high risk are women over 45, smokers over 35, and smokers of any age with cardiovascular risk factors. Generally women should start with a 30 or 35 mcg estrogen combined pill, and perhaps consider taking a higher estrogen dose if they experience breakthrough bleeding or amenorrhea. The 1st cycle can be started at any time up to 6 days after Cycle Day 1 or after spontaneous or induced abortion. Women taking bromocriptine should also begin contraception soon after delivery. Signs of potential major complications are abdominal pain, chest pain or dyspnea, headache or neurologic symptoms, visual or speech problems, or leg pain or weakness. Benefits of oral contraception include menstrual regulation, decreased menstrual flow, prevention of functional ovarian cysts, protection against ovarian and endometrial cancer by half, against benign breast disease, and possibly against pelvic inflammatory disease.
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PMID:Oral contraceptives. Who, which, when, and why? 362 38

Cocainization of the sphenopalatine fossa region has been shown to abort acute cluster headaches rapidly. Whether this response occurs by sympathomimetic action or via local anesthetic effect has been unknown. In this study, lidocaine hydrochloride was given as a therapeutic abortive agent to patients with cluster headache to elucidate cocaine's mechanism of action in relieving symptoms and to search for a safe, nonaddicting agent for self-administration. Using a 4% lidocaine solution applied to the sphenopalatine fossa, four of five patients obtained rapid relief of nitrate-induced cluster headaches and associated signs. Lidocaine was also effective in relieving spontaneous attacks. These results indicated that anesthetic rather than sympathomimetic effects are responsible for cocaine-medicated abortion of cluster headache, that transmission of pain in cluster headache likely occurs via the sphenopalatine fossa, and that topical lidocaine is effective in rapidly aborting acute cluster headache.
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PMID:Cluster headache. Local anesthetic abortive agents. 399 68

The article reports upon the characteristics of 300 abortion applicants in Arkansas manifesting significant stress from unwanted pregnancy between May 1, 1970 and June 30, 1971. The sample is limited by the fact that all of these women had been willing to seek medical aid. Patients ranged from ages 13-47, 131 of them ages 17-21. 35% had had some college education; another 29% were high school graduates. 50.6%, 20.6%, and 27.3% were single, divorced, and married, respectively. 59.6% of the patients were primiparas. 18.3%, 9.6%, and 12.3% were classified as being neurotic, having psychophysiologic tendencies (gastrointestinal problems, obesity, chronic headaches), and having sociopathic features (passive-aggressive, frankly rebellious, delinquent, antisocial, alcoholic), respectively. 12 women had noticeable schizoid features; 4 women had mildly active schizophrenia. Fathers of the women were usually blue-collar workers (55.3%) or white-collar workers (24.6%). The most frequent ordinal sibling position among the women was oldest child (38%). Parental instability (1 or both parents lost through death, divorce, father usually away working, chronic alcoholism, etc.) was reported by 39.6% of the patients. Patients' attitudes toward the unwanted pregnancy included dislike of inexpediency of the situation (82.6%), self-depreciation (55.6%), and aversion (28.6%). Precipitated psychiatric disorders were for the greatest part mild. Manifesting symptoms included depression (66.7%), anxiety (21%), and mixed anxiety and depression (12.2%). Suicidal threats and gestures were made by 22 and 8 patients, respectively. In summary, the study reveals a group of predominantly Caucasian women from unstable, middle-class urban families who were going through an adjustment reaction to adolescence or adult life.
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PMID:Abortion applicants in Arkansas. 426 12

424 pregnant women seeking termination of 2nd trimester pregnancy had either PGF2alpha (290 women) or PGE2 (134 women) administration. Oxytocin was concomitantly administered as an intravenous infusion to 185 women. The patients were divided into 11 groups based on PG (prostaglandin) type and dose, route of PG administration, and oxytocin infusion (Table 1). Vital signs were monitored hourly and blood samples collected from most patients for analysis of erythrocyte sedimentation rate, hemoglobin, blood leukocytes, and glutamic oxaloacetic transaminase before induction, at or immediately after abortion, and 24-48 hours after abortion. Side effects reported included diarrhea, vomiting, headache, and vasovagal symptoms. Complications included bleeding of 500 ml or more; pelvic infection and cervical rupture. Intraamniotic administration of 50 mg PGF2a either alone or with supplemental intravenous oxytocin, and intraamniotic use of 10 mg of PGE2 supplemented with oxytocin provided the best results in terms of success rate (100%) and shortest induction-abortion interval (14.1 to 16.2 hours). Extraamniotic administration had success rates ranging from 83% to 90%, depending on frequency of PG application. Intravenous PG administration was associated with low efficacy and high frequency of side effects.
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PMID:Prostaglandin induction of 424 midtrimester abortions. 445 74

The efficacy of intravaginal administration of prostaglandin F2 alpha (PGF2alpha) in induction of abortion was determined in a clinical trial of 16 gravidas aged 21-38, parity 0-4, between the 6th-11th weeks of pregnancy. PGF2alpha tablet (50 mg) was inserted into the posterior fornix of the vagina and repeated at 1-2 hour intervals; dose range varied from 50-250 mg. Slight to severe labor-like pain was felt by all patients in the lower abdominal region 20 minutes-4 hours after PGF2alpha administration. Vaginal bleeding occurred within 30 minutes-8 hours. In all but 1 case, the fetus and the villi were expelled broken into small pieces. All 16 patients aborted, 7 completely and 9 incompletely. This form of administration is deemed efficacious as 3 patients aborted completely within 5 hours and 4 aborted completely between 15-18 hours. Bleeding in most cases occurred following the onset of abdominal pain, 30 minutes-8 hours after treatment. In another clinical trial, the efficacy of intravaginal administration of PGF2alpha in inducing menstruation was tested in 10 volunteers aged 31-40. Either 50 or 25 mg PGF2alpha tablets were used. The patients recorded their basal body temperature (BBT) every morning. Menstruation was successfully induced in 6 of 10 patients. 6 patients treated 2-3 days before the expected date of menstruation had menstrual-like bleeding 1-9 hours after PGF2alpha administration. 3 patients treated 5, 7, and 13 days (a day before BBT shift) before the expected date of menstruation did not have vaginal bleeding. 1 patient, with monophasic BBT who was treated 3 days before the expected menstruation, did not have menstrual bleeding. Amount of induced flow was more or less the same in most patients; duration of flow was normal in all cases. The mechanism of action of PG in menstruation induction is not known. The authors speculate that PGF2alpha mechanically stimulates separation of the superficial endometrium from the remainder of the uterine wall when the endometrium is in the premenstrual state. Side effects noted were nausea, diarrhea, pyrexia, slight flushing of the face, and headache.
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PMID:The induction of abortion and menstruation by the intravaginal administration of prostaglandin F 2a . 470 6

Diethylstilbestrol (DES) is a nonsteroidal synthetic estrogen. It has been approved as a "morning-after" contraceptive. It is thought to interfere with the implantation of the fertilized ovum. Among 5593 women treated with DES or other estrogens, 26 pregnancies have been reported. Most of these patients reported midcycle exposures. Of 92 patients with adenocarcinoma of the vagina or cervix, prenatal histories of 66 were obtained. The mothers of 49 of them had taken DES or related nonsteroidal estrogens during pregnancy. In 1 case the mother had received only 1.5 mg daily. Another mother was treated for only 5 days during the first trimester. There is no evidence that the use of DES increases the risk of cancer in the mother. The Food and Drug Administration has approved the use of DES as an emergency treatment only. Early therapeutic abortion is recommended when this use of DES fails, because of the possibility of a teratogenic effect. The recommended oral dosage is 25 mg twice daily for 5 consecutive days, begun within 72 hours after sexual exposure. Severe nausea and vomiting may occur. Headaches and menstrual irregularities have also been reported.
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PMID:Diethylstilbestrol as a "morning after" contraceptive. 474 Feb 92

The use of intraamniotic injection of hypertonic solutions for termination of pregnancy during the second trimester has been generally adopted. Because of side effects in such treatment with other agents, it was decided to use intraamniotic instillation of urea solution (Urevert) to induce midtrimester therapeutic abortion in 38 patients. The method was successful in 35 patients (92%) with a mean injection/abortion interval of 26.1 hours, shorter than that with the use of hypertonic saline or hypertonic glucose solutions. The side effects of headache, nausea, and vomiting were mild, and an endometritis in 1 patient responded well to antibiotic treatment. Intravenous oxytocin drip was necessary in patients with hypotonic contractions or in those who failed to react within 36 hours after injection. In 3 cases of missed labor, the urea solution injected induced labor within 5-8 hours, with no side effects. The mean in-patient hospital time was 4.3 days.
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PMID:Termination of midtrimester pregnancy by intramniotic injection of urea. 482 62

Medical histories of 436 patients treated with Ovulen after childbirth or an abortion were examined in order to collect a sample of women who had taken the orals for 6-12 cycles. A group of 70 patients was thus formed. The following parameters were investigated: weight variation; blood pressure; nausea and vomiting; varicosities; variation in menstrual flow and length of period; breast-related side effects; jaundice; psychic alteration, i.e., nervousness, anxiety, or depression; changes in libido; headaches; skin changes; and pregnancy. Results are presented both in graph and table form. Weight change was found to tend more to loss than to gain. No statistically significant changes in blood pressure were observed. Nausea and associated symptoms tended to disappear after the 9th cycle. Edema was present in only 6% of all cycles. The most common side effect was varicosities, present in 25% of the sample, but in no instance did thrombosis occur nor was varicosity a cause for discontinuation in any case. Breast-related side effects were more common at the outset. No jaundice was observed. Psychic alterations were not common and were mostly insignificant and tended to occur more frequently at the outset. 12% of the sample had headaches from the beginning of treatment up until the 8th month, after which they began to disappear. Only 1 patient had chloasma and then only during the 1st 2 cycles. There was a marked tendency toward menorrhagia which was thought to be beneficial due to the prevalence of anemia in the group. Changes in libido were minimal and tended to disappear after the 8th cycle. None of the patients became pregnant.
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PMID:[Secondary effects of ethynodiol diacetate plus mestranol]. 535 18

The safety, efficacy, and acceptability of menstrual regulation with prostaglandin (PG) El vaginal suppositories was investagated in 534 women whose menses was delayed up to 8 weeks from the last menstrual period. 5 suppositories, each containing 1 mg of 16,16 dimethyl-trans-delta 2 PG El methyl ester, were inserted high in the vagina at 3 hour intervals. The success of treatment was assessed by 2 alternate criteria: 1) induction of bleeding, or 2) induction of bleeding and no surgical intervention. The success rate was 98.9% according to the 1st criterion and 86% according to the 2nd criterion. The mean duration of bleeding after treatment was 6.7 days. 47.9% of women experienced moderate bleeding and 43.8% reported heavy bleeding following treatment. Surgical intervention (curettage or vacuum aspiration) was required in 74 of the 528 bleeding cases and in 1 of the 6 nonbleeding cases with positive signs of pregnancy. The surgical intervention was performed because bleeding was considered to be either excessive or prolonged. Side effects tended to manifest themselves between the 1st and 2nd administration of suppositories. Abdominal cramps occurred in 66% of subjects; other side effects were minimal, including vomiting (2.8%), headache (5.8%), nausea (7.8%), and diarrhea (8.8%). These findings suggest that menstrual regulation with PGE1 suppositories is a safe method with the advantages of ease of administration, reversibility, a high success rate, acceptable bleeding duration, only mild side effects, and induction of menses without the need for surgical intervention. The simplicity of vaginal administration offers potential for self-treatment. Use of this method of menstrual regulation could be especially advantageious in countries with restrictive abortion laws. Single administration of a suppository, or parenteral administration, could improve the acceptability of this method.
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PMID:Menstrual regulation with prostaglandin (Pg ONO 802) in Indonesia. 615 28

Although no postcoital method has been developed for safe and effective regular use, postcoital contraception is being offered in Canada and Western Europe on an emergency basis to people who experience such problems as a burst condom. It is little known in the US, however. The 1st commercial version of a postcoital method recently became available to women in England. A former postcoital contraceptive was diethylstilbestrol (DES) which has been linked to cancer in the daughters of women who had taken the drug to prevent miscarriage. A new postcoital contraceptive regime was developed by Albert Yuzpe and consists of 4 ordinary contraceptive pills combining estrogen and progestin to be taken over a 12-hour period. In the US, this is the formulaion of birth control pill marketed under the trade name Ovral by Wyeth Laboratories. England and Germany are the only countries in which the Yuzpe method is officially approved for use as an emergency postocital contraceptive, but the method is used to some degree in most European countries, being well-known in France and Denmark. The most frequent side-effect reported by Yuzpe is vomiting experienced by 29% of women; another 22% felt nauseated. Other side effects, e.g. headache, were infrequent. The findings of the Pregnancy Advisory Service and the Brook Advisory Centre in Britain are reported. Overall very few side effects were found. Postcoital contraceptive treatment may cause the length of the cycle in which it occurs to be irregular. Treatment before day 15 has been found to shorten the cycle, whereas treatment after day 15 lengthens it. The majority of women who become pregnant due to treatment failure tend to seek an abortion. Ectopic pregnancy incidence may also be a result of treatment failure. In 1981, the International Planned Parenthood Federation (IPPF) issued a statement endorsing the use of postcoital contraceptives. Reasons for using them include rape, problems with barrier methods, ineffective use of the pill and IUD expulsion. No drug company in the US has expressed interest in getting FDA approval to market a postcoital contraceptive, partly because its usage might not be widespread. Opposition to approval from groups who believe life begins at conception and consequently that postcoital contraceptives are an abortifacient is expected.
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PMID:Contraception--the morning after. 651 38


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