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

Pramlintide is an analog of the human glucoregulatory hormone amylin. Previous studies have shown no clear evidence that pramlintide modifies the response to insulin-induced hypoglycemia; however, a detailed assessment of responses at hypoglycemic thresholds has not been conducted. To further test the effect of pramlintide on symptom, catecholamine, and glucagon responses, a 3-step hypoglycemic clamp was investigated in healthy volunteers. In a randomized, double-blind, placebo-controlled, crossover study, 18 healthy subjects without diabetes received subcutaneous premeal injections of either placebo or 60 microg pramlintide 3 times daily for 5 consecutive days. On day 6, subjects received study drug with breakfast and, after a 7-hour fast, were connected to a Biostator for a 3-step, 3-hour clamp experiment (insulin infusion rate: 1.0 mU/kg/min; blood glucose targets: 70, 55, and 45 mg/dL). An intravenous (IV) infusion of pramlintide (16 microg/h) or placebo was initiated at t = 60 minutes. At the end of each 60-minute clamp step, autonomic (sweating, palpitations, hunger, etc) and neuroglycopenic (confusion, headache, odd behavior, etc) symptoms were assessed using a validated visual analog scale questionnaire. Blood samples were collected at 30-minute intervals for measurement of plasma glucose, insulin, pramlintide, catecholamine, and glucagon concentrations. Intraindividual and group mean responses showed that autonomic symptoms and plasma catecholamine and glucagon concentrations increased progressively during the clamp, with no discernible differences between pramlintide and placebo treatments. Group means for catecholamines at 60 minutes were: epinephrine 233 +/- 42, 892 +/- 85, 2,340 +/- 302 and 202 +/- 25, 774 +/- 114, 2,751 +/- 404 pg/mL and norepinephrine 1,138 +/- 86, 1,236 +/- 77, 1,721 +/- 158 and 1,278 +/- 108, 1,259 +/- 109, 1,580 +/-136 pg/mL (+/- SEM) for placebo- and pramlintide-treated groups at 70, 55, and 45 mg/dL glucose, respectively. Group means for glucagon were 72 +/- 6.3, 98 +/- 11.1, 130 +/- 14.7 and 63 +/- 3.6, 92 +/- 9.4, 120 +/- 16.0 pmol/L (+/- SEM) for placebo- and pramlintide-treated groups at 70, 55, and 45 mg/dL glucose, respectively. These results showed that pramlintide did not impair the symptom, catecholamine, and glucagon responses to insulin-induced hypoglycemia in healthy subjects.
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PMID:Effect of pramlintide on symptom, catecholamine, and glucagon responses to hypoglycemia in healthy subjects. 1533 89

In childhood and adolescence, migraine is the main primary headache. This diagnosis is extensively underestimated and misdiagnosed in pediatric population. Lacks of specific biologic marker, specific investigation or brain imaging reduce these clinical entities too often to a psychological illness. Migraine is a severe headache evolving by stereotyped crises associated with marked digestive symptoms (nausea and vomiting); throbbing pain, sensitivity to sound, light are usual symptoms; the attack is sometimes preceded by a visual or sensory aura. During attacks, pain intensity is severe, most of children must lie down. Abdominal pain is frequently associated, rest brings relief and sleep ends often the attack. The prevalence of the migraine varies between 5% and 10% in childhood. At childhood, headache duration is quite often shorter than in adult population, it is more often frontal, bilateral (2/3 of cases) that one-sided. Migraine is a disabling illness: children with migraine lost more school days in a school year, than a matched control group. Migraine episodes are frequently triggered by several factors: emotional stress (school pressure, vexation, excitement: upset), hypoglycemia, lack of sleep or excess (week end migraine), sensorial stimulation (loud noise, bright light, strong odor, heat or cold...), sympathetic stimulation (sport, physical exercise). Attack treatments must be given at the early beginning of the crisis; oral dose of ibuprofen (10 mg/kg) is recommended. If the oral route is not available when nausea or vomiting occurs, the rectal or nasal routes have then to be used. Non pharmacological treatments (relaxation training, self hypnosis, biofeedback) have shown to have good efficacy as prophylactic measure. Daily prophylactic pharmacological treatments are prescribed in second line after failure of non-pharmacological treatment.
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PMID:[Migraine and headache in childhood]. 1588 59

A 54-year-old, previously healthy female experienced headache, nausea and vomiting, and consulted our hospital regarding her symptoms. Her cerebrospinal fluid (CSF) showed leukocytosis with polymorphonucleosis and hypoglycemia, thus she was diagnosed with bacterial. She admitted to our hospital and combination therapy of ampicillin and cefotaxime was started. CSF and blood cultures was negative. On the third hospital day, despite a decrease in her CSF cell count, her consciousness level decreased and neck stiffness worsened. On the seventh hospital day, the CSF cell count increased again, and we changed antibiotics to panipenem/betamipron (PAPM/BP) at 4 g/day. On the tenth hospital day, the CSF cell count decreased, but by the twelfth hospital day her consciousness had deteriorated to a drowsy state. Brain CT and MRI revealed multiple brain abscesses and hydrocephalus. We increased the dose of PAPM/BP up to 8 g/day, and her neurological, CSF and brain MRI findings subsequently improved. The patient was discharged from our hospital on the sixty-ninth hospital day. As the frequency of beta-lactamase-producing bacteria is currently increasing, carbapenems should be considered as first choice of antibiotics for the initial treatment of multiple brain abscess.
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PMID:[A case of multiple brain abscess effectively markedly responded to high dose panipenem/betamipron administration]. 1594 5

In childhood and adolescence, migraine is the main primary headache. This diagnosis is largely underestimated and misdiagnosed in the pediatric population. Because of the lack of specific biologic markers, specific investigation tools or brain imaging techniques, these clinical entities are too often considered to be a psychological illness. Migraine is a severe headache evolving by stereotyped attacks associated with marked digestive symptoms (nausea and vomiting); throbbing pain and sensitivity to sound or light are common symptoms; the attack is sometimes preceded by a visual or sensory aura. During attacks, pain intensity is severe; most of the children have to lie down. Abdominal pain is frequently associated, rest brings relief and sleep often ends the attack. The prevalence of migraine varies between 5 percent and 10 percent in childhood. In children, the duration of the headache is quite often shorter than in adults; it is more often frontal and bilateral (2/3 of cases) than one-sided. Migraine is a disabling illness: children with migraine miss more school days in a school year than their matched controls. Migraine episodes are frequently triggered by several factors: emotional stress (school pressure, vexation, excitement: upset), hypoglycemia, lack of sleep or excess (week end migraine), sensorial stimulation (loud noise, bright light, strong odor, heat or cold...), sympathetic stimulation (sports, physical exercise). Treatment must be given early at onset of attacks; oral ibuprofen (10 mg/kg) is recommended. If the oral route in not available because of nausea or vomiting, the rectal or nasal routes can be used. Triptan can be prescribed (body weight above 30 kg) when NSAID (prescribed at right dose and time) fail to abort the attack. Non-drug treatments (relaxation training, self hypnosis, biofeedback) have shown to have good efficacy as prophylactic measures. Daily prophylactic drug treatments are prescribed in second line after failure of non-drug treatment.
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PMID:[Migraine in childhood]. 1614 60

Headache in children and adolescent represents one of the most frequent and potentially severe pathological conditions, requiring a paediatric consult. The purpose of the study was to establish the headache prevalence from the total paediatric consultations in ambulatory practice as well as to establish the main etiological causes of the headache. The study, including 400 children and adolescents (M/F ratio=150/250, U/R ratio=290/110) with headache selected from 3100 cases between 2003 and 2004, in two practices (one general paediatric office and one paediatric neuropsychiatry office) from the Outpatient Clinic of the "Sf. Spiridon" Hospital of Iasi, has shown a prevalence of headache of 12.9%, the most affected age group being that of 5-12 years (52.5%). The etiologic study proved a high frequency of trauma 46.25%, ophthalmologic diseases 13.28%, psychogenic headache 10.75%, migraine 10%, general causes (infections, anaemia, hypoglycaemia) 9%, ENT causes 6.25%, intracranial causes 0.75%. The study confirms the necessity of a multidisciplinary approach, most causes being benign and the prognosis favourable in most cases.
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PMID:[Headache in children and adolescent in ambulatory practice]. 1660 79

The diagnosis and surgical management of insulinomas associated with multiple endocrine neoplasia type 1 (MEN1) pose additional problems in children because of the long-term risk of recurrence of other pancreatic and non-pancreatic tumors. We report a diagnostic confirmation by laparoscopic ultrasound of an insulinoma and its successful removal by laparoscopic enucleation in an 8- year-old boy who was admitted to our hospital with a history of recurrent episodes of absences, headache, and visual and auditive disturbances diagnosed as hyperinsulinism-related hypoglycemia. Magnetic resonance imaging of the pancreas showed a small contrast-enhancing lesion in the body of the pancreas, suspected for insulinoma. MEN1 was genetically proven by direct DNA testing. A pancreatic tumor can arise before the age of 10 in patients with MEN1 and can be surgically treated by a laparoscopical approach.
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PMID:Laparoscopic management of insulinoma in a child with multiple endocrine neoplasia type 1. 1679 55

Insulin-secreting pancreatic tumors and insulin-like growth hormone-secreting non-islet cell tumors can cause hypoglycemia. However, insulin-releasing paraganglioma or pheochromocytoma has almost never been reported. A 67-year-old female patient was admitted to our hospital because of headache, palpitation, perspiration, faintness, frequent sense of hunger and absent-mindedness. These intermittent symptoms had begun approximately a year before admission. On physical examination, she had high blood pressure of 150/90 mm Hg. Hormonal studies demonstrated increased urinary norepinephrine levels, and hyperinsulinemic hypoglycemia was confirmed while the patient was symptomatic. Abdominal MRI revealed a retroperitoneal mass measuring 4.5 cm in the pancreatic region. She was treated with an alpha-blocking agent to control blood pressure preceding the removal of the mass. Histopathological diagnosis was paraganglioma, and immunohistochemically insulin staining in the neoplastic cells was demonstrated. Her blood pressure normalized and hypoglycemia relieved after the operation. The patient did not have recurrence of hypoglycemia after a year of follow-up. Paraganglioma is a rare tumor of the neural crest, and co-secretion of insulin and catecholamines has been reported only by a single case report in the literature. The present patient is another case with this co-secretion.
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PMID:Hypoglycemia due to ectopic release of insulin from a paraganglioma. 1728 22

We describe an unusual cause of severe hypoglycaemia, secondary to hypopituitarism as a result of antepartum pituitary failure, in a pregnant patient with type 1 diabetes mellitus (T1DM). Antepartum pituitary failure is a very rare condition, which has been reported only in a very small number of pregnant patients with diabetes and presents with an acute onset headache and a sub-arachnoid haemorrhage-like picture. It is a potentially fatal condition to the mother and the child if not recognised and treated. Our case report highlights the importance of thinking about hypopituitarism, as a cause of recurrent hypoglycaemia in pregnant patients with T1DM as missing the diagnosis could be fatal to the mother and child.
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PMID:An unusual cause of severe hypoglycaemia in type 1 diabetes mellitus. Antepartum pituitary failure: a case report and literature review. 1731 75

Headache is a common disorder in the general population. It is often highly debilitating for the people affected and highly costly to society. Although we know much about primary headaches, little is known about secondary headaches which, however,are a frequent occurrence in the general population. A study conducted on Denmark's general population found a lifetime prevalence rate of 22% for headache forms attributed to disorder of homeostasis, including fasting headache.The purpose of this review was to analyze literature data on fasting headache, in order to evaluate its possible pathophysiological mechanisms and to suggest therapeutic strategies.We considered only English-language articles published in scientific journals and searched for these articles on PubMed using "headache," "fasting," "Yom Kippur," "Ramadan," "hypoglycemia,"and "caffeine withdrawal" as key words, with no limitations to the year of publication. In most cases, fasting headache has the same clinical features as tension-type headache and the probability of onset increases directly with the duration of fasting.Hypoglycemia and caffeine withdrawal have been especially implicated as causative factors, but much remains to be understood about this topic.
Headache 2009 May
PMID:Fasting headache: a review of the literature and new hypotheses. 1947 50

We reported a 32-year-old male with a sellar solitary fibrous tumor who presented with headache and affliction in the left eye. Serum biochemical examination revealed hypoglycemia. The tumor was assumed to be a nonfunctional pituitary adenoma preoperatively. A subtotal resection of the tumor was performed. Immunohistochemically, atypical solitary fibrous tumor was established. The residual tumor had no progression or distant metastasis at a 44-month follow-up after gamma-knife stereoradiotherapy.
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PMID:A primary atypical solitary fibrous tumor of the sella mimicking nonfunctional pituitary adenoma: a case report. 2022 65


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