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

Sixteen Indian neurologists saw 1,850 patients over a sample 6-day working week. The average daily workload comprised 19 patients including 11 new cases. Epilepsy (27.0%), headache (19.0%) and cerebrovascular disorders (7.8%) were the commonest problems. Only 2.5% fell in the ICD-9-CM categories 780-799 consisting of symptoms, signs and ill-defined conditions. In 43% it was felt that the neurologic consult was not necessary. In the Indian setting this would suggest that emphasis should be on neurologic education of primary care physicians and internists for the appropriate utilization of limited resources.
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PMID:Practice patterns in neurology in India. 3134 24

Hydrocephalic women with cerebrospinal fluid shunts are now surviving to reproductive age. Twenty-one pregnancies in 18 patients with shunts, including 11 from the present series and 10 from previous series, were analyzed for neurological, obstetrical, and perinatal outcome. Fourteen women had preexisting shunts, and 4 had the onset of symptomatic hydrocephalus and the placement of shunts during pregnancy. Neurological complications occurred in 13 of 17 (76%) pregnancies in patients with preexisting shunts, including symptoms of increased intracranial pressure (ICP) in 10 of 17 (59%) pregnancies, exacerbation of seizure disorder in 2 of 17 (12%) pregnancies, and severe headaches without increased ICD in 1 patient. In 7 of 11 (66%) of the symptomatic patients, symptoms spontaneously resolved postpartum. Four of 17 (23%) of these pregnancies were associated with shunt obstruction requiring antepartum or postpartum surgery. Four patients had a primary shunt placement, and one had a shunt revision during pregnancy without complications. There were no unusual obstetrical or perinatal complications in the series. The clinical management of pregnant patients with hydrocephalus should include preconception counseling and magnetic resonance imaging, as well as the use of serial antenatal magnetic resonance images, ICP monitoring, or the judicious use of radioisotope studies of shunt patency if signs of increased ICP appear. A cesarean section is recommended for the delivery of the neurologically unstable patient. For asymptomatic mothers, a vaginal delivery with a shortened second stage and prophylactic antibiotics are advised.
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PMID:Pregnancy in patients with cerebrospinal fluid shunts: report of a series and review of the literature. 161 9

A new international headache classification has improved possibilities for uniformity of diagnosis throughout the world, because it gives operational diagnostic criteria for all headache disorders. The classification was an initiative of the International Headache Society, but has been supported by the Research Group on Headache and Migraine of the World Federation of Neurology and the main diagnosis entities have been used in the new International Classification of Diseases (ICD 10) by the WHO. Vascular mechanism of headache is only known in migraine. During attacks of migraine with aura pathognomonic changes in regional cerebral blood flow (rCBF) have gradually been characterized. The attack begins with occipito-parietal rCBF decrease which slowly spreads to involve a greater or smaller parts of one cerebral hemisphere. In the area of hypoperfusion the normal functional activation is abolished and response to altered PaCO2 is diminished. The autoregulation, however, seems to be preserved. Whether the area of hypoperfusion is actually ischemic is still uncertain. Later in the attack rCBF normalizes and then changes to become increased in the previously hypoperfused focus. Hyperperfusion persists for one to several hours. Headache begins during hypoperfusion and does not change with the later occurrence of hyperperfusion which may even outlast the headache. There is a strong correlation between the site of rCBF changes, the site of origin of aura symptoms and the laterality of headache. It is proposed that liberation of neurotransmitters sensitizes local nociceptors and thereby induces headache.
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PMID:[Headache diagnosis and vascular pathophysiology]. 198 92

155 people who had left East-Germany and sought psychiatric help within six weeks after their arrival in West Berlin, were examined. History, living situation and psychopathological symptoms were studied. The disorders were diagnosed according to ICD-9 and DSM-III-R. 85% of the patients reported that they had already suffered from similar complaints in East Germany. 50% stated they have had symptoms before they had made the decision to leave. On average, that decision had been taken 22 months before the actual leaving. Most often patients complained about sleep disturbance, nervousness, and headaches. According to ICD-9, 55% of the disorders were classified as reactive and 39% as neurotic or personality disorders. The most frequent diagnoses according to DSM-III-R were adjustment disorders (41%), major depression (21%), anxiety disorders (16%), and dysthymia (14%). Regardless of diagnosis most patients were found to have symptoms of anxiety and depression associated with vegetative complaints. There were no clear relationships between psychopathological symptoms and data of history or present living situation.
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PMID:[Psychiatric disorders in immigrants. I. History, symptoms and diagnostic classification]. 226 61

Brofaromine (CGP 11 305 A), a new reversible and selective MAO-A inhibitor, was studied in two multicentre, (Trial A and Trial B) double-blind, dose-finding trials in a total of 124 depressed in-patients. Doses of 25, 50 and 75 mg bid were compared, to determine which was the most effective. The duration of the trials was four weeks. The comparative drugs were nomifensine (100 mg/day) and tranylcypromine (20 mg/day). The majority of patients in the Trial A was classified as "endogenous" depression. Diagnosis of depression was based on DSM-III or ICD-9 criteria. Conversely, most of the patients in Trial B were "non-endogenous" depressives. In "endogenous" depression, a statistically significant linear dose-response relationship was found in all the efficacy variables assessed. The most effective dose was 150 mg/day. This dose gave a mean drop of 25.3 +/- 11.9 (S.D.) points in the total Hamilton Depression Rating Scale (HAMD) scores and provided successful treatment in 83% of the patients treated, success being defined as a drop of at least 50% in the initial HAMD score at the end of the trial period. In "non-endogenous" depression, no statistical difference was found between the four treatment groups in any of the efficacy variables assessed. Response rate in all brofaromine groups averaged 59% (tranylcypromine group 60%). Tolerability was good in 90% or more of the brofaromine patients in both trials, regardless of the dose administered. The side effects reported most frequently were sleep disturbances, nausea, and headaches.
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PMID:Therapeutic and side-effect profile of a selective and reversible MAO-A inhibitor, brofaromine. Results of dose-finding trials in depressed patients. 267 40

Our multidimensional classification of headache uses on the one hand the phenomenological main criteria. Id est: attack-featured headaches versus the more permanent headaches. On the other hand the main etiological factors have to be traced: heredity, vasomotor-dysfunction, disturbances of cervical spine, metabolic disturbances, psychodynamics. As the majority of 90% chronical headaches have a multifactorial etiology, these factors have to be taken into consideration one by one. Usually more than one is to be found. Such differential diagnosis forms already a clear way into differentiated therapy. Our classification is conform to patient and to daily medical practice, easy to execute and, last not least, has a statistically proven small inter-examiner variation. The nowadays discussed IHS-classification we see contrarely to ours and to the demands of a good classification. Same counts for the classification that is put on by the ICD-9. First is to big, second is to small to be useful. Moreover, both show quite a number of clearly definable faults, which are opposite to clinical reality.
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PMID:[Headache: classification/nomenclature]. 805 18

A random sample of 14,917 new enrollees in a state-wide health maintenance organization was selected as part of a study of the effectiveness of medical self-care brochures. Medical ICD-9 codes related to each of the conditions described in the brochures were examined for the intervention group (N = 7439) and controls (N = 7478). Significantly less utilization was found for visits due to colds in the month following brochure distribution (P < .01). While not statistically significant, trends in the expected direction of less utilization for earaches and less total medical charges for the intervention group were also found. No significant differences were found related to headache and backache symptoms, although a greater proportion of the intervention group reported backache symptoms. Utilization related to sore throats and fever was significantly (P < .001) higher in the intervention group. These findings suggest that a minimal intervention such as brochure distribution can have a favorable, albeit minimal, impact on medical services utilization. Self-care education may also play a role in increasing utilization for certain types of health conditions.
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PMID:The effect of self-care brochures on use of medical services. 848 22

During a 24-month period, 205 consecutive new referrals to Muhimbili psychiatric unit were studied. Their socio-demographic characteristics, sources of referral, types of treatment received before referral and the nature of their clinical problems were identified. Their neuropsychiatric disorders were classified according to ICD-10. The ratio of males to females was found to be 1.6:1. The average age was 29.3 years. 23.4% of adult patients were unemployed, two fifths of all patients were single and 70% of all subjects had less than eight years of formal education. Whereas 42.9% of all referrals were from other departments of Muhimbili hospital, the remaining were largely from parastatal dispensaries, district and regional hospitals within Dar es Salaam city. At least a fifth of all patients had consulted traditional healers prior to referral and antimalarials had been given inappropriately to 34 patients with mental problems. Mental disorders consisted of functional psychosis, 36.6% of which three quarters were schizophrenia, neurosis (19.5%), seizures (16.6%), substance abuse (8.8%), organic mental disorders (5.3%), headache (4.9%), sexual dysfunction (2.9%). The rest had conduct disorders and pseudocyesis. Seventeen percent of all cases had concomitant physical disorders. Most patients had delayed to seek medical help.
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PMID:Nature of referrals to the psychiatric unit at Muhimbili Medical Centre, Dar es Salaam. 868 72

Secondary side-effects often occur in women undergoing hormonal stimulation treatment with clomiphene citrate. In general 10.4% of women experience hot flushing, 5.5% have complaints caused by enlargement of the ovaries and 3.5% experience central nervous symptoms (nervousness, sleeplessness, headaches, visual disturbances, vertigo). During ovarian stimulation with clomiphene citrate for in-vitro fertilization, a 32 year old patient developed psychotic symptoms, commencing 3 days after initiation of treatment. Hospitalization in the psychiatric ward became necessary when severe formal and rational thought disturbances arose together with perceptory and sensory delusions. Under neuroleptic treatment the symptoms improved. Nevertheless, follow-up psychiatric care on an outpatient basis was deemed necessary. The infertility treatment was continued with human menopausal gonadotrophin stimulation. Psychiatric instability occurred neither at this point nor during the 2 year follow-up observation period. Both an exogenous psychosis (ICD F23.9) as well as the exacerbation of an endogenous psychosis (ICD F29) may be considered for the differential diagnosis. The stimulation with clomiphene citrate in connection with the physical and psychic stress of the infertility therapy can be regarded as the trigger factor. For patients with evidence of psychiatric illness in their case history, ovulation-inducing substances such as clomiphene citrate should be implemented with particular care.
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PMID:Clomiphene citrate as a possible cause of a psychotic reaction during infertility treatment. 915 29

One hundred and seven adult outpatients with Leriche stage II peripheral occlusive arterial disease took part in this open, controlled trial. Patients were randomly treated over a six-month period either with sulodexide capsules containing 250 lipoproteinlipase releasing units (LRU, two capsules twice daily for 176 days on average: 56 patients), or with pentoxifylline 400 mg tablets (one tablet three times a day for 180 days on average: 51 patients). The incidences of diabetes, hyperlipoproteinaemias, smoking habit and other risk factors were the same in the two groups. The drugs' efficacies were evaluated by monitoring, at the start of treatment and every month during it, the Winsor Index and the walking distance, both prior to (initial claudication distance-IDC) and after (absolute claudication distance-ACD) the symptom's onset. Compliance with treatment and occurrence of adverse events were constantly monitored; systemic tolerability was evaluated through the use of routine haematological and haematochemical tests. Both treatments brought about a progressive increase in the claudication-free walking distance, statistically significant versus baseline from the second month (ACD, sulodexide group) and third month (ACD and ICD, pentoxifilline and sulodexide groups). At the end of treatment, the absolute increase of ACD was significantly greater in sulodexide-treated patients (p < 0.01) with respect to the pentoxifylline-treated group. In both groups the Doppler test evidenced a good improvement in local arterial haemodynamics. In the sulodexide group, 3.6% of patients developed nausea, dyspepsia and other minor gastrointestinal phenomena. In the pentoxifylline group 17.6% of patients complained of gastroenteric disorders (nausea, vomiting, dyspepsia), or of headache and dizziness. In one patient of this latter group insomnia was also present. Systemic tolerance of both drugs was consistently good.
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PMID:Controlled clinical trial on the efficacy and safety of oral sulodexide in patients with peripheral occlusive arterial disease. 932 92


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