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Query: UMLS:C0018681 (headache)
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Two train conductors had chest tightness, painful breathing, muscle cramps, and nausea after fighting a fire in a battery box under a passenger coach. Shortly thereafter, they became anosmic and had excessive fatigue, persistent headaches, sleep disturbances, irritability, unstable moods, and hypertension. Urinary cadmium and nickel levels were elevated. Neurobehavioral testing showed, in comparison to referents, prolonged reaction times, abnormal balance, prolonged blink reflex latency, severely constricted visual fields, and decreased vibration sense. Test scores showed that immediate verbal and visual recall were normal but delayed recall was reduced. Scores on overlearned information were normal. Tests measuring dexterity, coordination, decision making, and peripheral sensation and discrimination revealed abnormalities. Repeat testing 6 and 12 months after exposure showed persistent abnormalities. Cadmium and vinyl chloride are the most plausible causes of the neurotoxicity, but fumes from the fire may have contained other neurotoxic chemicals.
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PMID:Persistent neurotoxicity from a battery fire: is cadmium the culprit? 868 56

Our purpose in conducting this descriptive study was to assess the health-related concerns and experiences of a sample of employed perimenopausal women in Alexandria, Egypt. In addition, we explored their help-seeking behavior and their perception of symptoms. We interviewed two hundred working women ages 40-60 years, 42% of whom were nurses, using a semistructured interview form as well as Koos's list of symptoms. The commonly mentioned concerns, in order of frequency, were chronic headaches, chronic fatigue, transportation and phone communication problems, financial problems, job dissatisfaction, backaches, hypertension, kidney disease and gall bladder disease, gastritis/indigestion, menstrual disturbances, arthritis, AIDS, and hepatitis B. With respect to the problems experienced by the women in the past 6 months, there was a high self-reported prevalence of headaches, fatigue, transportation and communication problems, backaches, job dissatisfaction, dissatisfaction with health insurance, financial problems, menstrual disturbances, gastritis/indigestion, gall bladder disease, anxiety, disturbed sleep, and hypertension. Women attempted to manage their problems mainly by taking over-the-counter drugs and self-prescribing (75.5%), doing nothing or using traditional remedies (56.5%), and going to a doctor or health insurance office (40%). Symptoms perceived by the majority of the women as not needing medical attention included loss of appetite, persistent backache, bleeding gums, chronic fatigue, persistent headaches, and loss of weight. The influence of education and occupation on women's perceptions and practices is discussed.
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PMID:Health-related concerns and experiences of employed perimenopausal women in Alexandria, Egypt. 885 19

Beside well-established clinical benefits, the current doses of oestrogens may induce clinical side-effects leading to non-compliance and loss of efficacy. During a normal menstrual cycle the incidence of any cyclic discomfort is consistently reported to be lowest during the mild-follicular phase when plasma E2 remains between 60 and 150 pg/ml. The incidence of pregnancy-like symptoms such as bloating, breast tenderness and mood swings tends to increase in mid-luteal phase when E2 increases upto 150 pg/ml. On the other hand incidence of asthenia, sleep disturbances, depressive mood, headaches and migraines increase during perimenstrual days when E2 drops to 40 pg/ml or below. Accordingly experimental and human studies in castrated animals and postmenopausal women suggest that plasma E2 around 100 pg/ml is optimal for treatment of hot flushes, prevention of bone loss and cardiovascular protection. Due to large interindividual variation in estrogen clearance rate, it is unlikely that any standardized unique dose of oral or non-oral formulations will reproduce the optimal levels in all postmenopausal users. Efforts for individual titration are mandatory to improve compliance and actual efficacy on a long term. Because older postmenopausal women tend to have a better clinical tolerance to low E2 levels, objective markers of efficacy should also be identified when the aim of HRT is the prevention of osteoporosis or vascular diseases. In addition clinical and metabolic side-effects related to added progestins can be substantially reduced by the use of lower dose inducing amenorrhea and by progesterone instead of synthetic steroids.
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PMID:Hormone replacement therapy: clinical benefits and side-effects. 886 37

Individuals with multiple chemical sensitivity (MCS) report decreased attention/concentration, memory loss, disorientation, confusion, fatigue, depression, irritability, decreased libido, sleep disturbances, headaches, and weakness. These neurobehavioral symptoms represent possible alterations in the central nervous system (CNS). The evaluation of neurobehavioral functioning using neuropsychological techniques provides an indirect method for determining the integrity of the CNS. However, caution must be used in interpreting neuropsychological test results, since this technique is extremely sensitive but is not specific. Clinically significant aberrant test performance may be noted after chemical exposure as well as with other diseases of the CNS. In addition, neuropsychiatric conditions such as anxiety and depression are often manifested as cognitive difficulties that are similar in pattern to the cognitive dysfunction caused by toxic chemicals. Herein, limitations and cautions in the interpretations of neuropsychological test results are discussed.
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PMID:Neuropsychological evaluation for detecting alterations in the central nervous system after chemical exposure. 892 55

Although a relationship between headache and sleep disturbances has been reported in adults, only few data have been available in children. Accordingly, we performed a survey to determine the prevalence of sleep disturbances in children with migraine and tension-type headache. A questionnaire of history and clinical data and of sleep disturbances was given to parents of 283 headache subjects (164 with migraine and 119 with tension-type headache). Results were compared to a normative group comparable for age and sex of 893 normal healthy subjects. Migraine subjects showed a higher prevalence of sleep disturbances during infancy as well as 3-month colic. In both headache groups, more parents had sleep disturbances and there was a higher occurrence of co-sleeping and napping. A high frequency of sleep disturbances involving sleep quality, night awakenings, nocturnal symptoms and daytime sleepiness was reported in headache children. No statistical differences were found in the prevalence of sleep disturbances between migraine and tension-type headache. However, the migraine group tended to have "disturbed sleep" more often with increased prevalence of nocturnal symptoms such as sleep breathing disorders and parasomnias. Our results give further support to an association between sleep and migraine that may have a common intrinsic origin.
Cephalalgia 1997 Jun
PMID:Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study. 920 68

Dentistry uses a variety of different polymer materials. Dental polymer materials are based on methacrylate, its polymer, and polyelectrolytes. The setting of restorative materials and adhesives is initiated chemically by mixing two components or by light. In both cases, polymerisation is incomplete and monomers, not reacted, release. Studies have documented that monomers may cause a wide range of adverse health effects such as irritation to skin, eyes or mucous membranes, allergic dermatitis, asthma, parenthesise in the fingers, and disturbances from central nervous system such as; headache, pain in the extremities, nausea, loss of appetite, fatigue, sleep disturbances, irritability, loss of memory and changes in blood parameters. Dental personnel are occupationally exposed when handling the non reacted monomers. The use of gloves do not give enough protection as monomers, released from the material, easily penetrate all gloves used in dentistry. Face masks do not prevent inhalation of monomers. Ordinary glasses do not protect the eyes against vapor from monomers. The result from this study demonstrate the need for the development of ergonomic procedures and practices for safe handling of such materials in dental clinics.
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PMID:Use of polymer materials in dental clinics, case study. 941 12

We retrospectively reviewed 17 polysomnograms (PSG) in symptomatic amyotrophic lateral sclerosis (ALS) patients to assess the type and frequency of sleep disordered events and correlated these findings with pulmonary function tests (PFTs), presenting complaints, presence of bulbar dysfunction, and response to bi-level positive airway pressure (PAP) treatment. PSG revealed abnormalities in 16 patients. Complaints of orthopnea, daytime sleepiness (but not morning headaches) and a low negative inspiratory force (NIF) correlated with sleep disruption. However, neither the forced vital capacity (FVC) nor the NIF reliably predicted any specific PSG finding. Twelve of 13 patients treated with bi-level PAP responded favorably. Since the response to bi-level PAP is frequently gratifying, PSG should strongly be considered in ALS patients with suspected sleep disturbances.
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PMID:Polysomnographic studies in amyotrophic lateral sclerosis. 941 51

Pain and discomfort in everyday life are often treated with over-the-counter (OTC) analgesic medications. These drugs are remarkably safe, but serious side effects can occur. Up to 70% of the population in Western countries uses analgesics regularly, primarily for headaches, other specific pains and febrile illness. It is not known whether the patterns of use are consistent with good pain management practices. OTC analgesics are also widely used to treat dysphoric mood states and sleep disturbances, and high levels of OTC analgesic medication use are associated with psychiatric illness, particularly depressive symptoms, and the use of alcohol, nicotine and caffeine. More than 4 g per day of acetylsalicylic acid (ASA) or acetaminophen over long periods is considered abuse. People using excessive amounts of OTC analgesics may need more effective treatments for chronic pain, depression or dysthymia. The possibility that these drugs have subtle reinforcing properties needs to be investigated. Certainly phenacetin, which was taken off the market in the 1970s, had intoxicating effects. A better understanding of patterns of use is needed to determine the extent of problem use of OTC analgesics, and whether health could be improved by educating people about the appropriate use of these drugs.
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PMID:Use and abuse of over-the-counter analgesic agents. 950 57

Motor vehicle accidents (MVAs), even those of a nonserious nature, appear to increase the risk of severe psychiatric morbidity in survivors. The present review examines the evidence indicating the levels of psychiatric morbidity in MVA survivors. Although no consistent profile has emerged, the most commonly reported symptoms are depression, anxiety, irritability, driving phobia, anger, sleep disturbances, and headache, with rates of posttraumatic stress disorder (PTSD) across studies of 0% to 100%. Variability in the type and severity of psychiatric outcomes may be due, in part, to methodological inadequacies in many studies, particularly the use of biased population samples, inclusion of subjects exposed to varied types of accidents, an absence of a clear definition of PTSD, a reliance on clinical judgment rather than the use of objective psychometric measures, the failure to include ratings of injury severity, and the absence of assessments for past exposure to traumatic events or preexisting posttraumatic reactions. The most important concern relates to the use of nonrepresentative samples, usually patients referred for medicolegal assessment in whom issues of compensation are of central importance. Gender and age differences distinguish the compensation group from the general population of MVA survivors, who therefore may also differ in the vulnerability to posttraumatic morbidity. It is argued that more systematic research on unselected subject samples is critical to establish epidemiological data on the true nature and extent of psychiatric morbidity following MVAs.
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PMID:Psychiatric morbidity following motor vehicle accidents: a review of methodological issues. 960 76

Toxic or environmental exposures have been suggested as a possible cause of symptoms reported by Gulf War veterans. To further explore this hypothesis, we analyzed findings in 18,495 military personnel evaluated in the Department of Defense Comprehensive Clinical Evaluation Program. The program was established in 1994 to evaluate Persian Gulf veterans eligible for Department of Defense medical care who had health concerns after service in the Persian Gulf during Operation Desert Shield/Desert Storm. The evaluation included a structured clinical assessment, a physician-administered symptom checklist, and a patient questionnaire addressing self-reported exposures, combat experiences, and work loss. Among 18,495 patients examined, the most common symptoms were joint pain, fatigue, headache, memory or concentration difficulties, sleep disturbances, and rash. Symptom onset was often delayed, with two-thirds of symptoms not developing until after individuals returned from the Gulf War and 40% of symptoms having a latency period exceeding one year. There was no association between individual symptoms and patient demographics, specific self-reported exposures, or types of combat experience. Increased symptom counts were associated with work loss, the number of self-reported exposures, the number of types of combat experience, and certain ICD-9 diagnostic categories, particularly psychological disorders. Prolonged latency of symptom onset and the lack of association with any self-reported exposures makes illness related to toxic exposure less likely.
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PMID:Symptoms in 18,495 Persian Gulf War veterans. Latency of onset and lack of association with self-reported exposures. 1057 Apr 96


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