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

In general, Adie's syndrome does not represent a serious diagnostic problem. In cases of cerebrospinal syphilis the Argyll-Robertson phenomenon or even absolute pupillary rigidity will be observed. Positive syphilis reactions will clarify these cases. The erroneous diagnosis of brain tumour may arise because of anisocoria. However, if pupillotonia can be ascertained by means of conjunctival instillation of drugs no further invasive diagnostics will be necessary. In some cases of Adie's syndrome concomitant emotional instability may be present. This dysautonomic reaction type of personality will hardly ever be confounded with the psychological disturbances encountered in brain tumours. Therapy is restricted to symptomatic measures. Pupillotonia can be influenced by strychnine and thymoxamine. Headache and facial neuralgia respond to the usual therapeutic schemes. Sweating disorder cannot be influenced. Neuropharmacological treatment may become necessary in periods of acute emotional disturbance.
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PMID:[Differential diagnosis and therapy in Adie's syndrome]. 91 9

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

A survey was carried out on 711 medical students from both the medical school and the Kenya Medical Training Centre on headaches using a closed ended questionnaire. Six hundred and twenty five (88%) of the students reported to have at least one episode of headache in the last six months. Two hundred and forty (33.8%) of these were classified as migraine using the International Headache Society case definition. Seventy (29%) had migraine with aura, the rest being migraine without aura. The mean age was 22.7 +/- 5 years with a male to female ratio of 1:1.3. The majority of the respondents (43%) had an average of two to three headache episodes per month. The major triggering factors for the headache were physical activities, emotional disturbance and studying, each occurring in 21% of the student respondents. It was reported by 43.6% of the respondents that there was a member of their nucleus family with a similar headache. Only 40% of the respondents had sought medical attention for their headache in the last one year. The main reason for not seeking medical services was self medication in 56% of those who did not attend medical services. Only 27 (11%) of the respondents were currently on medication which consisted of simple analgesics and antimalarials. There were only two students who were on specific drugs for migraine. The majority of the respondents continued to be inadequately treated despite the development of wide range of effective treatment.
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PMID:Migraine headaches in a group of medical students at the Kenyatta National Hospital, Nairobi. 899 Dec 41

There may be a population of patients subject to frequent headache and in whom optimal analgesic effect is obtained only by frequent but controlled use of opiate drugs and in whom adverse drug effects are minimal. It is emphasized again that the reality is that there are currently a large amount of opioids being prescribed for headache patients because of patients' demands. One of the major considerations for physicians prescribing such treatment is familiarity with the legal guidelines. The federal law requires physicians to register if they are to maintain or detoxify with opioids addicts defined as "any individual who habitually uses any narcotic drug so as to endanger the public morals, health, safety, or welfare, or is so far addicted to the use of narcotic drugs as to have lost the power of self-control with reference to his addiction." A subsequent regulation, however, stated that the law was not intended to impose any limitation on prescription of narcotics for intractable pain. There are also many different state regulations covering, for example, limitations on amounts to be prescribed and reporting of patients who are habitual narcotic users. Obviously, headache patients who request liberal amounts of opioids must be screened. There has been considerable recent effort to provide guidelines regarding which patients with nonmalignant pain might be poor candidates for opioid treatment by reason of both probable treatment failure and risk of drug overuse. Many of these guidelines are not relevant to headache patients in whom pain is rarely continuous and rarely demands scheduled analgesia, as is often the case with pain of other types. There is general agreement that any previous history of any type of substance abuse is an important indicator of danger of recurrence of such behavior. Evaluation of psychological state and personality structure is of great importance. The more evidence of emotional disturbance, the greater the danger both of poor results and of drug abuse. In the chronic daily headache population, treatment failure has been found to correlate with abnormalities on the Minnesota Multiphasic Personality Inventory (MMPI). It is possible that formal psychological testing prior to the prescription of opioid drugs will prove of value in identifying those headache patients at greatest risk for drug abuse. The importance of making opioid treatment part of a multifaceted pain program has been emphasized. Portenoy emphasizes the need for (1) careful discussion with the patient (and often family) of the potential side effects of the drugs, and (2) scrupulous monitoring of adherence to the appropriate dosage and maintenance of prescription by a single physician. The more psychological disturbance evidenced by the patient, the more the risk with failure of drug treatment and of drug abuse. Finally, the analgesic needs of the patient with frequent migraine are different from those of the patient with tension-type headache. Migraine infrequently occurs more than two or three times a week for any period and usually responds to ergotamine, dihydroergotamine, sumatriptan, or a phenothiazine. Addition of codeine or oxycodone for the occasional intractable attack may be needed. When demands in a migraine patient for opioids in amounts greater than 10 to 15 tablets per month occur, there is obvious cause for concern. The opioid agonist-antagonist butorphanol, now available in nasal inhalation form, is alleged to have low abuse potential because it tends to produce dysphoria (an unpleasant emotional state) rather than the euphoria of other opioids. It is therefore unscheduled. The drug, however, does have abuse potential, and the limits needed to be placed on its use are still uncertain. Markley recently recommended a restriction to not more than two bottles (30 treatments) per month. The population with frequent tension-type headaches presents the major problem. Large numbers of these patients use drugs--often in combination
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PMID:Opioids in headache treatment. Is there a role? 905 6

Dentists are trained to provide treatment for patients with straightforward problems that respond to routine therapy and do not recur. However, patients may present to dentists and complain solely of physical symptoms such as toothache, headache, and facial pain: only after much inappropriate treatment these symptoms are revealed to be due to emotional disturbance. The dentist may spend hours investigating such patients, in some of whom dental pathology may be present, but the symptoms and ensuing disability cannot be satisfactorily explained as a result. There are other patients who are preoccupied by physical symptoms or by their appearance. In others, anxiety may manifest itself as a phobia, or a dysmorphic concern about certain aspects of their appearance. This article reviews the role of liaison psychiatry and psychology in dentistry.
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PMID:Liaison psychiatry and psychology in dentistry. 939 63

Previous epidemiological and clinical studies of humans exposed to polychlorinated biphenyls (PCBs) indicate that the majority of patients have neurological complaints (e.g., headache, vertigo, paresthesias, poor memory and concentration, fatigue, depression). Since only a small minority of PCB-exposed patients demonstrate abnormalities on objective neurological measures (e.g., CT-scans, EEC, nerve conduction velocity), it is particularly unfortunate that objective neuropsychological data has not been published to substantiate patient complaints. The present study provides neuropsychological test data on two patients exposed to PCBs. In both cases, PCB exposure is documented by an analysis of PCB levels in the patients' work environments. Despite the absence of abnormalities on CT-scans and EEC, both patients displayed a variety of cognitive deficits and emotional disturbance. Serial assessment of one patient with high blood levels of PCBs revealed a dementia (sharing certain features with Alzheimer's disease) and an organic affective syndrome. Assessment of a second patient exposed to PCBs (but with no detectable blood levels of PCBs) suggested that his cognitive impairments were not due to PCB exposure. The present study provides data which points to the importance and sensitivity of neuropsychological examination in cases of PCB-exposure.
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PMID:Dementia as a neuropsychological consequence of chronic occupational exposure to polychlorinated biphenyls (PCBs). 1458 22

The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF) was administered to 251 National Guard soldiers who had recently returned from deployment to Iraq. Soldiers were also administered questionnaires to identify posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). On the basis of responses to the screening instruments, the National Guard soldiers who produced a valid MMPI-2 RF were classified into four groups: 21 soldiers who screened positive for PTSD only, 33 soldiers who screened positive for mTBI only, 9 soldiers who screened positive for both conditions, and 166 soldiers who did not screen positive for either condition. Results showed that the MMPI-2 RF was able to differentiate across the groups with the MMPI-2 RF specific problem scale Anxiety adding incrementally to MMPI-2 Restructured Clinical scales in predicting PTSD. Both MMPI-2 RC1 (Somatic Complaints) and MMPI-2 RF head pain complaints predicted mTBI screen but did not add incrementally to each other. Of note, all of the MMPI-2 RF validity scales associated with overreporting, including Symptom Validity-Revised (FBS-r), were not significantly elevated in the mTBI group. These findings support the use of the MMPI-2 RF in assessing PTSD in non-treatment-seeking veterans. This further suggests that a positive screen for mTBI alone is not associated with significant emotional disturbance.
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PMID:The Minnesota Multiphasic Personality Inventory-2 Restructured Form in National Guard soldiers screening positive for posttraumatic stress disorder and mild traumatic brain injury. 2138 45

Mood and pain are interrelated to each other in a mutual and complex manner. Patient populations in headache clinics exhibit more emotional disturbance than general practice patients. Nonetheless, the degree of psychological illness among headache patients is less than maybe found in psychiatric outpatients. However, it is a fact that several psychiatric disorders appear to be comorbid with primary headache syndromes such as migraine. Still, prospective standardized studies are sparse. We aimed to investigate whether migraine per se or specific migraine characteristics are associated to depression and anxiety. In a single center study (Department of Neurology of the University of Athens) migraineurs were asked for several headache features such as pain intensity, attack frequency, average attack duration, prodromal symptoms and the presence of aura. We assessed 50 consecutive headache patients who were referred to our headache outpatient clinic. Patients diagnosed with non-migraine syndromes, mixed non-migraine and migraine syndromes, or patients with previously diagnosed systemic disease known to precipitate psychiatric disorders (such as systemic lupus erythematodes) were excluded from the study. Furthermore, we did not include any subjects who were already on antidepressive or other psychiatric medication. Twenty four patients met the inclusion criteria. The data were then correlated with scores obtained by the Beck Depression Inventory and the Hamilton's scales for Depression and Anxiety. Our results showed an increased frequency of mild and moderate depression compared to what was expected from the normal population which is in line with past observations on headache patients. In an analogous manner, mild and moderate anxiety appeared more frequently among migraineurs than healthy subjects. However, we did not find any significant relation between depression or anxiety and parameters such as pain intensity, monthly attack frequency, attack duration, presence or absence of aura, appearance of pre-ictal prodromal symptoms and migraine career duration (age of assessment minus age of migraine onset). These findings suggest that migraine, although often comorbid with depression and anxiety, has no specific headache characteristics causally related to mood abnormalities. Larger samples will be required in future studies to address the question of a link between more specific mood and mental disturbances with primary headache syndromes.
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PMID:Relationship of intensity and special characteristics of migraine to depressive and anxious features. 2418 86

This study investigated the degree of brain functional impairment in persistent somatoform pain disorder (PSPD) by examining changes in the patterns of brain functional hubs. Resting-state functional magnetic resonance imaging was performed in 21 PSPD patients with headache as the main symptom and 17 sex- and age-matched healthy controls. Degree centrality (DC) analysis as well as the connectivity among these hubs by functional connectivity (FC) analysis and Granger causality analysis (GCA) were performed to characterize abnormal brain networks in PSPD (Gaussian random field corrected: P < 0.001, Z > 3.09). The relationships between DC and connectivity and clinical parameters were also examined. DC values in the bilateral inferior occipital gyrus (IOG), bilateral calcarine fissure (CAL), and left paracentral lobule (PCL) and FC values of right IOG-left CAL, right IOG-right CAL, right IOG-left IOG, left CAL-right CAL, left CAL-left IOG, left CAL-left PCL, right CAL-left PCL, and left IOG-left PCL were lower in PSPD patients as compared to controls. A negative causal effect from the left CAL to the left paracentral lobule and a positive effect from the right CAL to the right IOG were observed in PSPD patients. Abnormal DC, FC, and signed-path coefficients in PSPD patients were negatively correlated with self-rating anxiety and depression scale scores. These results indicate that altered functional hubs and connectivity patterns in the somatosensory cortex may reflect emotional disturbance in PSPD patients.
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PMID:Altered Brain Functional Hubs and Connectivity Underlie Persistent Somatoform Pain Disorder. 3111 77

On the base of the idea of traditional Chinese medicine as "disease prevention", the mode and the protocol of the moxibustion intervention for the group under quarantine after close contact with coronavirus disease 2019 (COVID-19) were explored. The group under quarantine after close contact with COVID-19 was taken as the subjects. By the non-contact physician-patient communication network platform co-developed by China Association of Acupuncture-Moxibustion, Hunan Provincial Association of Acupuncture-Moxibustion, Data Center of China Academy of Chinese Medical Sciences and Yuge Medicine Company, an exploratory randomized controlled trial was designed. A total of 100 cases were included and randomized into a moxibustion group and a conventional intervention group, 50 cases in each one. In the moxibustion group, moxibustion intervention was used. In the conventional intervention group, the conventional observation was adopted without moxibusiton intervention applied. The outcomes included the symptoms changes, e.g. anxiety, emotional disturbance, fatigue, headache and diarrhea, as well as whether quarantine release and the case confirmed or not, etc. The results were evaluated before intervention, in 14 days of intervention and 2 weeks after intervention separately. In this research, on the base of internet plus technology and with the internet communication platform adopted, through mobile phone WeChat App, it was to implement the subject screen, the random allocation and the instruction of moxibustion intervention as well as the quality control of patient's diary and data collection. It is anticipated that the significance and the implementation mode of moxibustion intervention can be assessed preliminarily for the group under quarantine after close contact with COVID-19.
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PMID:[Significance and operation mode of moxibustion intervention for the group under quarantine after close contact with COVID-19]. 3239 50


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