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

This work is an attempt to find an answer to the question: once arrived at the diagnostic identification of a certain type of idiopathic headache, which treatment should be followed? On the basis of recent researches and experience acquired during ten years' activity of our Headache Unit, a diagnostic identification can be made for migraine (in all its types and evolution stages), cluster headache, tension headache and pure psycogenic headache. Among the most widely used drugs, positive pharmacological results were obtained with: cyproheptadine, pizotifen, cinnarizine, lysergic acid derivatives, histamine, reserpine, clonidine and a barbituric acid derivative. The therapeutic cycles were standardized, for each drug, in the way of administration, dosage and total duration of the treatment. A comparison between the data obtained and the pre-therapeutic situation was made. When repeated, the most efficacious therapeutic cycle was evaluated. According to Pearson's dispersion index, each group of patients improved respresents 16.68% of the expected total results (frequency of attacks reduced to 50%, 25% and 0%): for cyproheptadine, pizotifen, methysergide, histamine, clonidine and allil-propyl-malonylurea, the "p" is less than 0.001; for cinnarizine, less than 0.02. This "a posteriori" analysis does not take into account the placebo control, the "anticipation effect", and the "carry over effect". It cannot therefore be a comparison of efficacy among the various drugs. An evaluation based on "among patients" and "inside patient" method by means of the cross over system, can instead give some useful suggestion about which treatment is to be recommended to patients suffering from recurrent headaches. With regard to migraine sufferers: cinnarizine, cyproheptadine, clonidine, histamine, pizotifen und reserpine. For cluster headaches: cinnarizine, cyproheptadine, clonidine, histamine and reserpine. For tension headaches: cyproheptadine. For pure psychogenic headache: allyl-propyl-malonylurea. For migraine attacks or parossystic crises in the course of ondulating or continuous headaches, positive therapeutic results, statistically significant, were obtained with an association of indomethacin, caffeine and prochlorperazine.
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PMID:[Therapeutic possibilities in idiopathic headaches. Analysis of about 1000 cases]. 93 45

The author describes a case in which different types of headaches occurred in life. In childhood the patient had typical attacks of ophthalmic migraine, at the age of 45 years classical Horton's neuralgia developed lasting 5 months, occurring 3-4 times daily and 2-3 times in night time. The pains were intense, their location was always identical and their duration was 15-20 min. It seemed at the time of observation that they represented a form intermediate between that described by Ekbom and Olivarius and that reported by Sjaastad and Dale. After treatment with Indomethacin immediate improvement was obtained with disappearance of pains.
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PMID:[Chronic Horton's neuralgia treated successfully with indomethacin]. 95 89

Therapeutic electric stimulation in cases of chronic headaches was carried out in 150 patients. Migraine was diagnosed in 40 cases, common vasomotor headache in 63, cervical migraine in 24, Horton's neuralgia in 5 and complex headaches in 18 cases. The results are reported here, which were best in the cervical migraine syndrome, while in the typical migraine they were the least successful.
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PMID:Electric stimulation in chronic headaches. 102 76

Nineteen patients obstinate with cluster headaches whose pain was not mitigated by standard treatment (Methysergide, caffeine, ergotamine preparation, phenobarbital and analgesics) underwent a double blind control study with single crossover for the evaluation of prednisone therapy. Compared to placebo, a single oral dose of prednisone in 17 cases produced sustained improvement. Maintenance administration of prednisone was also effective in decreasing the frequency of attacks; however a single dose of the steroid when headaches began was effective.
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PMID:The treatment of cluster headaches with prednisone. 109 22

Thirty-three patients have been treated by acupuncture since July 8, 1974, using body loci, ear points and electrical stimulation. Of the 33 cases, 18 were female and 15 were male, ranging in age from 25 to 77 years. Sixteen patients suffered from migraines, 12 from tension headaches, 2 from cluster headaches, 1 from vascular headaches, and for 2 patients the etiology was uncertain. The duration of the headaches ranged from 3 months to 40 years. The patients received from 3 to 16 treatments. Of the 33 cases, 5 patients had only 3 treatments and 10 patients had 5 or less treatments. Eighteen patients had good results, i.e., no headache at all. Twelve patients had fair results, that is they sometimes had headaches, but they could be controlled with a few repetitions of treatment or by analgesics at a lesser dosage than they were taking at the beginning of treatments. Three patients had no response at all or poor results; however, these discontinued treatment before the author could evaluate whether they were actual absolute no-response cases. Of the 33 patients, 2 patients had a good response after only 2 treatments; 4 had a good response after 10 treatments. However, most of the patients had a good response after 6-8 treatments. A course of treatment usually requires 10 to 14 visits befor definite evaluation of the results can be made. It was observed that patients with fair or particularly poor results usually discontinued treatment too early and/or had concomitant conditions as well. Even though a longer period of time for follow-up is necessary before drawing any conclusions, results have already shown that acupuncture, perhaps, can be a valuable form of treatment for headaches.
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PMID:The treatment of headaches employing acupuncture. 112 34

Cluster headache is frequently characterized by pain localized to the orbital area. There is often associated ipsilateral oculosympathetic paresis with varying degrees of blepharoptosis and miosis. The ophthalmologist is often confronted with such cases; however, the atypical presentations and the subtle clinical findings may obscure the diagnosis. As cluster headache is a benign condition, accurate recognition is essential to spare the patient potentially harmful diagnostic studies.
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PMID:Ophthalmic presentations of cluster headache. 116 26

The role of serotonin in the pathogenesis of migraine is discussed, and the chemistry, pharmacology, pharmacokinetics, efficacy, adverse effects, and dosage and administration of sumatriptan are reviewed. Sumatriptan, which is structurally related to the neurotransmitter serotonin, is a serotonin type-1-like-receptor agonist that has a selective but heterogeneous effect on the carotid arterial system. Sumatriptan has a rapid onset of action and a large volume of distribution. Its subcutaneous bioavailability approaches 100%, and its mean terminal half-life is two hours. Studies have shown that both subcutaneous sumatriptan and oral sumatriptan are superior to placebo in relieving migraine and cluster headaches. Studies comparing oral sumatriptan with either ergotamine tartrate plus caffeine (Cafergot) or aspirin plus metoclopramide indicated that sumatriptan relieved headache more quickly and effectively; however, the dosages of these other agents may have been suboptimal. Sumatriptan is generally well tolerated by patients, and most dose-related effects are mild and transient. The most common adverse effect is pain at the injection site. No drug interactions have been identified so far. Subcutaneous sumatriptan 6 mg and oral sumatriptan 100 mg seem to offer the best benefit-to-risk ratio, although dosage and administration information is limited. Subcutaneous and oral sumatriptan are effective in aborting moderate to severe migraine and cluster headaches and their associated symtpoms. However, more studies are necessary to compare sumatriptan's efficacy with that of other treatments before it can be recommended as first-line therapy for migraine.
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PMID:Sumatriptan: a new drug for vascular headache. 838 41

Cluster headache is a disorder of unknown origin. Some studies have focused their attention on neuroendocrine derangement, others on immunity. To probe central alterations in cluster headache (CH), immune parameters were investigated in cluster headache patients in comparison to low back pain patients and healthy controls. Increases in peripheral blood monocytes found in remission cluster headache patients may be attributable to chronic central nervous system (hypothalamic?) noradrenergic dysfunction or altered beta-endorphin. Alterations in NK+, CD3+ and CD4+ levels found in cluster period cluster headache and low back pain patients are probably pain or stress-related.
Cephalalgia 1992 Aug
PMID:Immunological alterations in cluster headache during remission and cluster period. Comparison with low back pain patients. 138 94

Cluster headaches are rare in childhood. We identified 35 patients with cluster headaches starting at or before 18 years of age, including 7 patients with onset prior to age 10. All patients met the criteria of the International Headache Society for episodic or chronic cluster headaches. Patients experienced cluster headaches for as long as 20 years before seeking medical attention and required many medical contacts to establish the correct diagnosis. The clinical features of cluster headaches during childhood were similar to those which typically occur in adult life. Cluster headache patterns changed over 18 years of follow up. The frequency and duration of cluster periods increased in 14 subjects. The frequency of single headache attacks during cluster periods also increased in a similar number of subjects. We conclude that cluster headaches starting in childhood or adolescence closely resemble the adult form of the disease. In many patients, the frequency and duration of cluster periods and the frequency of the individual headache episodes increased over time. Cluster headache represent a treatable under-recognized cause of severe headaches in childhood and adolescence.
Headache 1992 Jun
PMID:Childhood onset cluster headaches. 139 46

Patients (299) with various types of headaches (migraines, cluster headaches, and so-called idiopathic headaches) were operated on between 1973 and 1991. Septal correction, resection of the middle concha, ethmoidectomy, and sphenoidectomy on the corresponding headache side or occasionally on both sides were carried out. Most patients (235; 78.5%) were totally asymptomatic postoperatively; 34 (11.5%) had a sensation of pressure in the head on rare occasions but no further migraines, and 30 (11%) continued to experience headaches that occurred only rarely and were mild and of short duration.
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PMID:Pathogenesis and surgical treatment of migraine and neurovascular headaches with rhinogenic trigger. 146 19


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