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

Twenty-one patients with brucellosis wereinvestigated. Four patients with the classical manifestations of acute brucellosis presented no problems in diagnosis. The other 17 patients suffered from chronic disease and had no history of any acute episode of brucellosis. The most common symptoms in this group were tiredness, fatigue, depression, arthralgia and muscular pains. Abdominal pain and pain in the temperomandibular joints were marked in some patients. Most of these patients had been receiving psychiatric treatment. Clinical examination was largely negative, but lymphadenopathy was found in 9 cases. Brucella meningo-encephalitis was diagnosed in 7 patients who complained of severe headache. Problems in the diagnosis of chronic brucellosis with an insidious onset are discussed.
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PMID:Clinical aspects of chronic brucellosis. 81 22

We present a 66-year old woman suffering from a chronic disorder characterized by multiple paroxysmal symptoms precipitated by coughing. These included cephalalgia, syncope, binocular photopsia phenomena with blurred vision, and an "electric-like" paroxysmal tingling of the hands. In addition to a central spinal cord cavity and hindbrain herniation, magnetic resonance imaging showed multiple skeletal anomalies and the craniospinal junction which included a narrow clivo-axial angle, basilar impression of the skull and a tight foramen magnum. Resonance magnetic imaging showed a high-signal intensity lesion on T2-weighted images at the posterior medullo-spinal junction suggesting focal demyelination. We propose that paroxysmal symptoms induced by coughing in patients bearing hindbrain ectopia and skeletal anomalies at the foramen magnum region may involve different pathogenetic mechanisms, including ectopic axonal activity and ephaptic transmission at the sensory pathways. This caused a Lhermitte-like phenomenon precipitated by coughing, rather than by forward flexion of the neck. However, increased pressure at the posterior fossa presumably underlies all these phenomena, and may therefore be potentially relieved by suboccipital decompressive craniotomy.
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PMID:[Arnold-Chiari malformation with multiple paroxysmal manifestations induced by coughing]. 845 93

Poisoning is a significant problem in the elderly. The majority of poisonings in older people are unintentional and may result from dementia and confusion, improper use of the product, improper storage or mistaken identities. Depression is also common in the elderly and suicide attempts are more likely to be successful in this age group. The elderly patient's recuperative abilities may be inadequate as a result of numerous factors including impaired hepatic or renal function as well as chronic disease processes. General management of poisoning in the elderly parallels management of younger adults, but it is especially important to ascertain underlying medical conditions and concurrent medications. In most poisonings, activated charcoal and cathartic are sufficient. Haemodialysis or haemoperfusion may be required at lower plasma drug concentrations in elderly patients. While the specific indications for antidotes are the same for all age groups, dosage alterations and precautions may need to be considered in the elderly. Drugs most often implicated in poisonings in the elderly include psychotherapeutic drugs, cardiovascular drugs, analgesics and anti-inflammatory drugs, oral hypoglycaemics and theophylline. Cardiovascular and neurological toxicities occur with overdoses of neuroleptic drugs and, more frequently and severely, with cyclic antidepressants. Patients with pre-existing cardiovascular disease are at particular risk of worsening ischaemic heart disease and congestive heart failure. Benzodiazepines only appear to produce significant toxicity during long term administration or in combination with other CNS depressants. Digoxin can cause both chronic and acute intoxication, most seriously cardiac toxicity including severe ventricular arrhythmias, second or third degree heart block or severe refractory hyperkalaemia. Immune Fab antibody is indicated for the management of digoxin toxicity, although patients dependent on the inotropic effect of digoxin may develop heart failure after digoxin Fab antibody administration. Nitrates can cause toxicity including headache, vomiting, hypotension and tachycardia from excessive sublingual, transdermal or intravenous doses. Conduction disturbances and hypotension occur with overdoses of antihypertensive drugs; these effects are mild with angiotensin converting enzyme (ACE) inhibitors, occasionally severe with beta-blockers and of significant concern with calcium channel antagonists. The elderly commonly use aspirin and other salicylates, are more likely to develop chronic intoxications to these agents, and are more susceptible to severe complications such as pulmonary oedema. Salicylate poisoning, recognition of which is often delayed, should be considered in elderly patients with neurological abnormalities or breathing difficulties, especially in the setting of acid-base abnormalities. The clinical effects of NSAID overdose are mild and usually involve the central nervous system and gastrointestinal tract.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Poisoning in the elderly. Epidemiological, clinical and management considerations. 179 7

Chronic fatigue syndrome (CFS) is an illness which may be mild or completely disabling. Clients who return with recurring non-related symptoms and no specific diagnosis may suffer from CFS. The symptoms of CFS are numerous and varied, including fatigue, malaise, myalgias, difficulty concentrating, headaches and sore throat. Patient complaints seem out of proportion to the physical findings, which may be normal. There is no cure for this chronic disease. Therapy is primarily symptomatic. The role of the health care provider is to recognize this confusing disorder and help the patient and family cope with its many effects.
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PMID:Chronic fatigue syndrome--a diagnosis for consideration. 283 May 63

This pilot study was designed to investigate the relationship between perceived stress, self-esteem and "functional" pain in young adolescents with and without chronic disease. Twenty children with chronic disease and 15 without who were seen in a pediatric outpatient clinic completed a symptom survey, the Piers-Harris Self-Concept Survey, and Lewis's Feel-Bad Scale. Adolescents with significant self-reported complaints of abdominal pain, chest pain, and headaches (without documented organic cause) scored higher on the Feel-Bad scale (p less than 0.002) and lower on the self-concept scale (p less than 0.02) than those without functional complaints. Patients with chronic disease scored higher on the self-esteem measure (61 +/- 14 versus 48 +/- 14, p less than 0.01) and lower on the stress measure (80 +/- 40 versus 120 +/- 54, p less than 0.02) than those without a chronic disease. These findings of lower stress and higher self-esteem in adolescents with chronic illness were unexpected. Possible explanations are discussed.
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PMID:Self-esteem and perceived stress in young adolescents with chronic disease. Unexpected findings. 370 Jan 94

One hundred and three patients referred to a neurological outpatient clinic were examined to assess the relationship between persistent headache, not due to significant physical illness, and emotional disturbance. Overall, the patients showed slightly more evidence of emotional disturbance than a general practice population but less than psychiatric outpatients. Thus, with cut-off points of 4/5 and 9/10 on the General Health Questionnaire (GHQ 28) the whole group had 52% or 20% of psychiatric 'cases' respectively. On the Crown-Crisp Experiential Index the 70 females had mean total scores of 37.19 +/- 11.11 and the 33 males had scores of 31.79 +/- 11.36. In addition the childhood experiences measured by the Parental Bonding Instrument appeared to be normal. Seven patients had significant depressive illness, according to the Levine-Pilowsky Depression Questionnaire. Statistically significant differences in psychological state did not emerge between the diagnoses of cluster headache, classical migraine, common migraine, tension headache or combined headache. However, negative correlations were found between the duration of illness and measures of anxiety. It is concluded that although the emotional state contributes to the development of pain and headache in some patients, there are others in whom comparable headaches are unlikely to be due to emotional factors. Selection effects are held to be important and some of the emotional changes will vary at different phases of a chronic disorder. A new symptom may initially cause anxiety but when a condition persists some patients will be increasingly concerned or depressed whilst others develop tolerance for the situation.
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PMID:Psychological normality and abnormality in persistent headache patients. 405 27

This presentation summarises the opinions concerning chronic pain after mild cervical trauma without neurological and radiological findings. Clinicians are often surprised by the disabling character of the pain, despite the lack of severe lesions. The initial lesions lead in some cases to chronic headache having different features associated with cervical pain, but in our opinion this pain does not have a disabling nature. When the disabling character is present, we postulated that it is associated with other psychological, social and professional factors. In fact, the pathogenesis of this chronic disorder is multifactorial. Its treatment doesn't lead to healing but to better management of patient life with chronic pain.
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PMID:[Chronic pain sequelae after trauma of the cervical spine]. 798 42

Intraocular pressure (IOP) was measured by Goldmann's or Schiotz's method in 46 nephrotic children, who were treated with betamethasone, and in 40 age-matched normal controls at the Taipei Municipal Chung-Hsin Hospital, from July 1, 1987 to June 30, 1990. We found the difference in mean IOP between patients treated at the end of a full-dose course of betamethasone and normal controls or patients before treatment, was statistically significant. This difference was also found between the measurement of IOP at the end of a full-dose course of betamethasone, and after stopping betamethasone therapy two to four weeks later. Although six of all patients had high IOP and suffered from headache or ocular pain, clinically, at the end of full-dose betamethasone therapy, the symptoms disappeared quickly after tapering or stopping of the drug. Therefore, we believe it is very safe to treat the nephrotic syndrome with betamethasone. On the other hand, these observations indicate that corticosteroid is a causative factor in increasing IOP. Susceptibility to full-dose betamethasone is firmly recognized, and patients need to be monitored on an individual basis. Nephrotic syndrome is a chronic disease which often requires long-term corticosteroid treatment. Children with the syndrome are at risk of developing steroid-induced increasing IOP. Careful ophthalmological examination of nephrotic children, as well as other pediatric patients who received corticosteroid therapy, is highly recommended.
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PMID:The effect of betamethasone on intraocular pressure in nephrotic children. 804 2

The existence of a physiopathologic connection between nose and middle ear is widely accepted so that chronic purulent middle ear effusion (CPMEE) could be expected to be usually associated with nasal chronic disease or impaired function. Nevertheless such association is less frequently observed in clinical practice than one could expect, possibly because of inadequate nasal function evaluation. Thirty-five patients affected by CPMEE were included in this study in order to assess the incidence of nasal disorders. E.N.T. clinical history was obtained and E.N.T. physical examination, nasal endoscopy by fiber optics, anterior rhino-rheo-manometry, non-specific nasal provocation test with histamine, mucociliary transport test, and allergic skin tests were performed. In the clinical history assessment 26 patients were affected by chronic rhinopathies, 16 by chronic pharyngitis, and 20 by frequent headache. At rhinoscopy we registered nasal septum deviation in 24 cases and mean and inferior turbinates hypertrophy in 31 cases. CPMEE and nasal septum deviation or turbinates hypertrophy were more frequently ipsilateral (p < .001 and p < .05, respectively). Total nasal resistance was 0.99 +/- 0.49; it was abnormally high in 11 subjects bilaterally and in 4 subjects monolaterally and increased significantly in 32 patients following nasal provocation test. Mucociliary transport time was longer in CPMEE subjects than in 10 healthy subjects (18 +/- 5 vs 13 +/- 4 min; p < .05). Finally 10 patients presented positive skin tests. On the whole, 96% of non allergic patients included in this study showed signs of non-specific nasal hypersensitivity which could theoretically cause purulent middle ear effusion to chronicize. Indeed recurrent histamine release in response to specific and/or aspecific stimuli could cause the obstruction of the Eustachian tube and consequently inadequate middle ear ventilation.
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PMID:Nasal hypersensitivity in purulent middle ear effusion. 915 Aug 39

Migraine, a chronic disorder characterized by episodes of headache, has a profound effect on the well-being and general functioning of its victims, not only during the acute attacks, but also in terms of impairment of school achievement, work performance, and family/social relationships. Despite staggering social and economic costs, it remains under-diagnosed and under-treated worldwide. Migraine has been labeled a "woman's disease" because it is three times more common in women than men, the attacks tend to be more severe and disabling among women and, in some women, they seem to be modulated by such hormonal "milestones" as menarche, menstruation, pregnancy and menopause. After a brief review of the diagnosis of migraine, this article will examine the nuances responsible for that label and their implications for treatment.
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PMID:Migraine: a "woman's disease?". 1006 7


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