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

What is pain? Pain is an uncomfortable feeling that tells you something may be wrong in your body. Pain is your body's way of sending a warning to your brain. Your spinal cord and nerves provide the pathway for messages to travel to and from your brain and the other parts of your body. Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells, most sense pain and the fewest sense cold. When there is an injury to your body--in this case surgery--these tiny cells send messages along nerves into your spinal cord and then up to your brain. Pain medicine blocks these messages or reduces their effect on your brain. Sometimes pain may be just a nuisance, like a mild headache. At other times, such as after an operation, pain that doesn't go away--even after you take pain medicine--may be a signal that there is a problem. After your operation, your nurses and doctors will ask you about your pain because they want you to be comfortable, but also because they want to know if something is wrong. Be sure to tell your doctors and nurses when you have pain.
Decubitus 1992 Nov
PMID:Pain control after surgery: a patient's guide, Agency for Health Care Policy and Research. 148 16

A lack of uniform methodology used by different authors in the assessment of different puncture techniques in spinal anesthesia formed the basis of the current study, which compared under randomized conditions the incidence of post spinal headache after a median or paramedian (lateral) approach. MATERIALS AND METHODS. Two hundred and fifty ASA physical status II and III patients, aged 50-85 years, scheduled for transurethral prostate surgery under spinal anesthesia were investigated. The patients were comparable with regard to weight and height (Table 1). No premedication was given and, 30 min prior to surgery, all patients received normal saline 400-500 ml i.v. The patients were randomly divided into two groups of 125 patients each to receive 4 ml 0.5% bupivacaine in 5% glucose (specific gravity 1.017 at 20 degrees C) using the median or paramedian (lateral) approach according to the following scheme (Table 2): I: 4 ml 0.5% bupivacaine/median approach; II: 4 ml 0.5% bupivacaine/paramedian approach. The study was carried out in a double-blind fashion. Neither the patient nor the investigator evaluating the post spinal headache was aware of which technique had been used. Lumbar puncture was performed by a midline approach at the L3-4 interspace using a 25-gauge (Whitacre) spinal needle with the patient in the sitting position group I. The bevel of the spinal needle was directly laterally, so that the dural fibers that run longitudinally were spread rather than transected. When using the paramedian approach (group II), patients were placed in the flexed lateral decubitus position and the spinal needle inserted 1 cm medial and 1 cm lateral and caudad to the lowest part of the posterior superior iliac spine and then directed medially and cephalad at an angle of 55 degrees into the subarachnoid space. Postoperatively, patients were allowed to move as soon as possible; no prophylactic bed rest was ordered. Starting from the 1st postoperative day, patients were evaluated by an independent observer and asked whether they were suffering from any problems concerning anesthesia. Typical post-puncture headache was defined as invariably bifrontal and occipital, frequently involving the neck and upper shoulders, and being aggravated by the upright position. Statistical analysis of the data was performed using the Mann-Whitney rank-sum test for unpaired samples. A P value of less than 0.05 was considered statistically significant. RESULTS. Twenty-six of 250 patients (10.4%) developed post spinal headaches. Comparing both groups, 11/125 (8.8%) patients in the median group (group I) versus 15/125 (12%) in the paramedian group (group II) had typical post-puncture headaches. Within the group of patients aged 50-60 years, the paramedian approach (group II) showed a significantly higher headache rate compared with group I (P less than 0.05). Neurologic sequelae were not observed; 6 patients received epidural injections of autologous blood while the rest of the patients suffering from post spinal headache were treated conservatively with bed rest, analgesics, and fluids. CONCLUSIONS. The results indicate that the incidence of post spinal headache is higher in younger patients when using the paramedian (lateral) approach. However, our findings suggest that the choice of lumbar puncture technique--median or paramedian--is of little importance in regard to post-puncture headache in elderly patients. The paramedian approach is especially useful when degenerative changes are encountered in the interspinous structures in elderly patients, when an ideal position is difficult to achieve.
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PMID:[Post spinal headache. Its incidence following the median and paramedian techniques]. 157 Aug 86

Fifty-six adult patients who developed post-lumbar puncture headache (PLPH) were treated with epidural Dextran 40 after various therapeutic measures, such as rest, intravenous fluids, narcotic as well as non-narcotic analgesics, epidural injection of saline, oral steroids, acupuncture, and applications of blood patch at the puncture site, had proven unsatisfactory. An average of 20 ml dextran was injected epidurally over a period of 120 seconds with patients in the sitting or lateral decubitus position. Relief of headache was accomplished in all patients after periods ranging from 15 minutes to 24 hours. Follow-up 6 months to 1 year revealed no recurrence of the headache. Burning sensation at the injection site and dysesthesia at the time of injection were noted in 3.5% and 7.1% of patients, respectively.
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PMID:Relief of post-lumbar puncture headache with epidural dextran 40: a preliminary report. 248 80

Edema due to increased capillary permeability (ICP) may be diffuse or localized. Local edemas (Quincke edema, angioneurotic edema) are most often allergic or very rarely due to a defect in C1-inhibitor. Generalized edemas due to ICP share the following clinical features: Fluid retention (subcutaneous edema and diffused swelling) is predominant in lower limbs; it is worsened by orthostatism and warmth and alleviated by decubitus and cold, with important weight variations between morning and evening. It is associated with enhanced thirst, hypotension, oliguria, headaches and blood volume reduction; secondary hyperaldosteronism is the main mechanism. These troubles are due to ICP, associated with lymphatic drainage abnormalities; ICP is measured by the isotopic Landis Test. This abnormality is present in several diseases. Idiopathic orthostatic edema (IOE) is frequent and often unrecognized, occurring mainly in women, often associated with luteal insufficiency. Iatrogenic complications (diuretic and laxative abuses) are frequently superimposed. ICP may be corrected by vitamins P (rutin, anthocyanosides, diosmin, Ginkgo biloba extracts...) Cyclic shock due to ICP is rare. It is characterized by cyclic edema and shock with hypovolemia, hypoproteinemia; the mechanism of shock is a severe loss of fluid and protein from the vascular bed. It is often associated with monoclonal gammapathy and complement activation. In our personal case, the trouble in CP was present all along the disease with permanent edema and low blood pressure (especially in orthostatism). Vit "P" and Ginkgo biloba extracts were able to partially improve CP and the clinical troubles. However, in spite of this treatment a fatal shock occurred after ten years follow-up. Episodic angioedema associated with eosinophilia was first described by Gleich.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Edematous syndromes caused by capillary hyperpermeability. Diffuse angioedema]. 277 97

Reproductive care of women with spinal cord damage demands knowledge of such women's reproductive potential and the specific complications to which these women are prone during pregnancy and childbirth, especially autonomic hyperreflexia. Fertility in cord-damaged women of reproductive age is generally undiminished as are libido, ability to have intercourse, and ability to bear children. Frequent complications of cord-damaged pregnant women include urinary tract infection, anemia, pressure sores, sepsis, unattended birth, and autonomic hyperreflexia. Autonomic hyperreflexia or autonomic dysreflexia occurs during labor in up to two thirds of women with cord lesions above T-6. Autonomic hyperreflexia results from noxious stimuli including distention of the bladder, cervix, or rectum, which evokes mass triggering of sympathetic and parasympathetic afferents that are uninhibited by supraspinal centers below the cord lesion. Autonomic hyperreflexia manifests itself with sudden onset of marked hypertension and headache during uterine contractions, as well as bradycardia or tachycardia, various cardiac dysrhythmias, and marked diaphoresis with piloerection and flushing above the level of the cord lesion. We describe the second reported occurrence of intraventricular hemorrhage due to autonomic hyperreflexia during labor and detail recommendations for anticipating and mitigating this potentially lethal complication of parturition in cord-damaged women. Pregnancy and parturition are best carried out with informed cooperation of the patient and of obstetric, cord rehabilitation, anesthetic, and nursing personnel.
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PMID:Autonomic hyperreflexia: a mortal danger for spinal cord-damaged women in labor. 397 Jan 1

Autonomic dysreflexia, a syndrome sometimes occurring in spinal cord injured (SCI) individuals, may be life-threatening. It involves, in varying degrees, hypertension, diaphoresis, headache, bradycardia, anxiety, and flushing and is believed due to unrestricted sympathetic activity below the level of the lesion in individuals with injuries above T4-6. The most frequent causes of the syndrome are urinary infections, rectal impaction, bladder distention, and decubitus ulcers. To our knowledge, medication has seldom been described as causal agent. We report here on an autonomic dysreflexic syndrome following use of an isometheptene combination (Midrin), to treat migraine. The individual involved is a C4-quadriplegic man with a long history of migraines. He was given a standard initial adult dose of the medication. Over a one-hour period, he was initially relieved of the headache, but then noted a new more severe headache, diaphoresis, and flushing. His vital signs showed progressive BP elevation to 210/130 and a relative bradycardia. Treatment over the next three hours was limited to elevation of the head of the bed and observation, during which his vital signs returned to baseline and he became asymptomatic. This experience reinforces the belief that sympathomimetic drugs in general, and isometheptene in particular, should be used in caution in patients with high-level SCI.
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PMID:Autonomic dysreflexia due to medication: misadventure in the use of an isometheptene combination to treat migraine. 403 34

We present an unusual case of postoperative headache in a child after an epidural block. A seven-year-old girl (ASA 1) was scheduled to undergo a urological procedure under general anaesthesia combined with an epidural technique for intra- and postoperative analgesia. Although there was no evidence of dural puncture when the block was performed, the patient developed a headache postoperatively. The headache, which was accompanied by neck pain, appeared in the sitting or standing position and was relieved by decubitus. According to the mother, her child had never complained of those symptoms in the past. After independent evaluation by an anaesthetist and a neurologist, a postdural puncture headache (PDPH) was considered the most likely diagnosis. As oral analgesics failed to provide relief, and epidural blood patch (EBP) using 10 ml autologous blood was performed under light sedation. This was followed by resolution of the symptoms. Epidural injections of opioids and local anaesthetics are becoming increasingly popular for pain management in children. This implies that there may be an increasing number of unintentional dural punctures that may result in more PDPHs in children. Epidural blood patches are effective in treating PDPHs in adults but their use has been reported very rarely in children. Resolution of the patient's symptoms following EBP supported the diagnosis while illustrating that EBP can be useful in the treatment of PDPH in children.
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PMID:Epidural blood patch in a seven-year-old child. 755 1

Spinal anesthesia in day-care surgery is still controversial because of the possibility of postdural puncture headache (PDPH). The use of the Sprotte needle with a conical tip that spreads the dural fibers may reduce the incidence of PDPH. The aim of this study was to compare the 22-gauge and 25-gauge Sprotte needles with respect to PDPH and postoperative complaints in out-patients undergoing arthroscopy. The rate of spinal anesthesia failure and the feasibility of unilateral spinal anesthesia when using a low dose of anesthesia was also verified. For this randomized, prospective study, 234 patients undergoing elective arthroscopy were chosen. Patients were allocated randomly to have spinal anesthesia with either a 22-gauge or 25-gauge Sprotte needle. Dural puncture was performed with the patient in a lateral flexed decubitus position. After the injection of anesthetic solution (0.5-1.2 mL of 1% bupivacaine in 8% glucose) patients remained in the lateral decubitus position for 30 min. The time to regression of analgesia, time of micturition, and all postoperative complaints were recorded. The most frequent side effect was backache (10.2%) with a more frequent incidence in the group using the 22-gauge needle (14.5% and 5.9%, respectively). PDPH was recorded in only one patient (0.8%) in the group using the 22-gauge needle. The failure rate was 0.8%. Unilateral anesthesia was achieved in 88% of 213 patients. Our data indicate that the use of spinal block is a suitable technique in the ambulatory setting, with a low rate of unplanned hospital admission.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Spinal anesthesia in outpatient knee surgery: 22-gauge versus 25-gauge Sprotte needle. 759 86

Thirty patients presenting with post-dural puncture headache (PDPH) were prospectively studied to determine the influence of the duration of the decubitus position after epidural blood patch on the efficacy of treatment. All patients received 12 ml of autologous blood. They were randomly distributed into three groups of ten patients. Patients in Group 1 were maintained in a decubitus position for 30 min after the epidural injection of autologous blood in the epidural space. Patients in Group 2 were maintained for 60 min in decubitus and patients in Group 3 for 120 min. Post-dural puncture headache was evaluated using a visual analogue scale before the epidural blood patch, at the time of initially adopting a standing position after the blood patch, and 24 hr later. The severity of PDPH in the three groups was reduced at the time of initially adopting a standing position and after 24 hr, in comparison with preblood patch VAS (P < 0.001). Patients in Group 3 presented less severe PDPH than patients in Group 1 at the time of initially standing up and 24 hr later (P < 0.05). We conclude that epidural blood patch was effective in treating PDPH but that the maintenance of a decubitus position for at least one hour and preferably for two hours after the blood patch was more effective than maintenance for 30 min.
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PMID:Duration of decubitus position after epidural blood patch. 811 39

In order to evaluate the possibility of using a selective subarachnoid anesthesia in ambulatory surgery we studied its feasibility with a Sprotte needle 24 G in 103 patients (range 15-67 years) undergoing a knee joint arthroscopy. The subarachnoid anesthesia was achieved with Sprotte needle 24 G with introducer with patient on lateral decubitus. Hyperbaric bupivacaine 1% (0.05 mg/cm height) was used in order to obtain a selective homolateral metameric anesthesia between L1 and S3. The numbers of attempts were 1.29 (range 1-4). We involved the homolateral determatomeres in 94% of our attempts, adding a weak anesthetic action on contralateral ones. In the remaining 6% of the patients the anesthesia was bilateral and extending in an overlying manner. Anesthesia was adequate for the time needed to perform all the surgical procedures. Nevertheless in 3 patients the tourniquet was painful. We registered systemic hypotension only in 2% of the patients (a reduced systolic pressure value > 30%). No cases of postdural puncture headache were registered. Non postural atypical headache was seem in 3.9% of the patients. Urinary retention necessitating catheterization was noted only in 3 cases. A weak backache was revealed in 8.8%. When interviewed after surgery, 98% of our patients fulfilled the technique. In spite of technical difficulties that the use of the Sprotte needle may present, the selective subarachnoid anesthesia may be a safe alternative to the other anesthetic procedures for ambulatory surgery of the legs.
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PMID:[Subarachnoid anesthesia with Sprotte 24-G needle in ambulatory surgery]. 835 63


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