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

Among the 185 retinoblastoma patients seen at the Lausanne Retinoblastoma Clinic from 1963-1993, 24 (14%) first presented with another sign than classical leukocoria (60.5%) or strabismus (21.5%). Most of these atypical signs were related to inflammatory complications of unrecognized retinoblastoma; they consisted of low vision (1.5%), hypopyon (2%), ocular redness and pain (1.5%), ocular redness and buphtalmia (1.5%), as well as photophobia and headaches (1.5%). The presence of unexplained chronic ocular signs during childhood should always raise the possibility of an underlying retinal malignancy.
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PMID:[Unusual presentation of retinoblastoma]. 805 60

Intracranial tumors affecting the visual system are a source of malpractice claims involving optometrists. Signs and symptoms of disease, such as papilledema, optic atrophy, decreased visual acuity, headache, loss of visual field, acute onset incomitant strabismus, and gradually worsening coordination, should prompt optometrists to rule out the possibility of an underlying intracranial lesion. Appropriate optometric and medical evaluation should be provided. Co-management of care with other health care practitioners should be scrupulously coordinated and documented.
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PMID:Brain tumors, malpractice, and optometry. 819 45

A recent double-masked placebo-controlled trial has confirmed that some children experience a reduction in symptoms of eyestrain and headache when they read through individually prescribed coloured filters and has shown that this benefit cannot be solely attributed to a placebo effect. People who are helped by coloured filters in this way have been described as having "Meares-Irlen syndrome'. We investigated the mechanism of this benefit by studying the optometric and visual perceptual characteristics of the children in the double-masked study. This population had normal refractive errors and heterophorias (none of the subjects had strabismus). They demonstrated slightly, but significantly, reduced amplitudes of accommodation and vergence and poor stereo-acuity. However, these factors seemed to be correlates of Meares-Irlen syndrome rather than the underlying cause. Pattern glare, a sensitivity to striped patterns (e.g. lines of text), was prevalent in our sample and was significantly associated with the subjects' symptoms. The spatial contrast sensitivity function was normal.
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PMID:A preliminary investigation into the aetiology of Meares-Irlen syndrome. 879 97

Two cases of eosinophilic meningitis who presented with headache and strabismus are reported. Pertinent physical examination revealed unilateral horizontal conjugate gaze palsy with absence of doll's eye maneuver and hemiparesis. The etiologic agent of eosinophilic meningitis is presumed to be Angiostrongylus cantonensis and the infected location that produce horizontal conjugate gaze palsy was a pontine lesion.
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PMID:Horizontal conjugate gaze palsy in eosinophilic meningitis. 1077 76

In a multicenter, randomized, double-blind, cross-over study in the Netherlands, the effectiveness of (prism-)glasses prescribed by the Measurement and Correction Method of H.-J. Haase (MKH) was compared to that of glasses prescribed by conventional orthoptic examination. Nine pairs of MKH-optometrists and orthoptists recruited patients who primarily presented with asthenopia, and each prescribed the patient (prism-)glasses. A questionnaire for asthenopia was developed that rated headache and tired eyes as 0-7 days per week and none-light-medium-severe, respectively. Light sensitivity, problems with focusing, near-work problems and burning eyes were each rated as: never-occasionally-often-always. A patient was eligible if he scored 'medium', 'often' or '5 days a week' twice; or 'medium' (etc.) once and 'light' (etc.) twice. Controls, in contrast to the patients, typically answered 'none' or 'never' to half of the complaints, but 37% of them would have passed the admission criteria. Among other criteria were: 18 to 40 years of age, horizontal angle < 4 degrees, vertical < 1.7 degrees, acuity > or = 0.8, stereopsis threshold disparity < 120". Seventy-two patients fulfilled all criteria and returned sufficient questionnaires. They wore the first glasses for six weeks, were without glasses for two weeks, and then wore the second glasses for six weeks. At the start, halfway and at the end of each 6-week period, questionnaires were filled out; 97% were returned. Only 19 of the orthoptists' glasses contained prisms (14 horizontal, 5 vertical; horizontal average of all glasses 0.49 PD, vertical 0.05 PD). Five of the orthoptists' glasses were plano. All MKH glasses contained prisms, 53 of 72 both horizontal and vertical, 18 only horizontal and one only vertical (horizontal average of all glasses 2.83 PD, vertical 0.79 PD). The starting levels of complaints were high and both glasses improved complaints dramatically. The starting levels were lower, but not significantly, in the second 6-week period and improvement was less outspoken. Because of these differences, the two periods had to be evaluated separately. The primary outcome of the study was defined as the difference between the effect of the MKH glasses and that of the orthoptists' glasses in the first and second 6-week periods. For problems with focusing, in the first 6-week period, and for tired eyes, in the second 6-week period, the difference exceeded the difference that had been defined as clinically significant (one day per week less headache or half the distance light-medium or half the distance occasionally-often), but it did not reach statistical significance. The statistical power was approximately 0.7 for demonstrating this clinically significant difference. Statistical significance was not reached in multivariate repeated measure ANOVA either. Forty-four patients preferred to keep the MKH glasses, 25 the orthoptists' glasses, including one plano. It is striking that 25% of the patients did not prefer the glasses that, according to the questionnaire, improved their complaints the most. A year after the study, the questionnaire was sent again to all patients: The levels of complaints after a year were similar to those at the end of the second 6-week period, whether they had preferred the MKH or the orthoptists' glasses, and were similar to the levels in controls. The most conspicuous finding was that both glasses improved the complaints dramatically. Apart from the prisms, other reasons could be: spherical and cylindrical correction, improved wearing comfort of the frame, placebo effect, Hawthorne effect and regression to the mean.
Strabismus 2001 Mar
PMID:Preliminary report: prescription of prism-glasses by the Measurement and Correction Method of H.-J. Haase or by conventional orthoptic examination: a multicenter, randomized, double-blind, cross-over study. 1126 97

Unlike heterotropia (= manifest strabismus), heterophoria (= latent strabismus) is not a primarily existing condition but is a reaction to an interruption of the sensory-motor feedback control system. The reaction consists of a deviation from the orthovergence position. Binocular vision causes a continuous calibration of the vergence position. This "orthophorisation" explains that in most persons, heterophoria differs only slightly from zero. Nevertheless, a small heterophoria is common (70-80% of the population). The need to compensate for heterophoria by sensory-motor fusion can cause asthenopic complaints, such as headaches with prolonged reading. Since a variety of other defects can lead to similar symptoms, a causal relationship with heterophoria can be assumed only after a thorough differential diagnosis. Prism spectacles or eye muscle surgery for heterophoria should be recommended only after prism trials in free space, which include yoked prisms as a placebo control. Heterophoria should be distinguished from "Winkelfehlsichtigkeit", which is a deviation from orthoposition that results from the "measuring and correcting methodology after H.-J. Haase" (MKH) and is based on the idea that fixation disparity, a minute deviation from orthovergence position, indicates an inability to overcome a larger "vergence angle at rest". Objective recordings have, however, revealed that the subjective tests with stereo cues applied in the MKH can mislead to the assumption of a fixation disparity although both eyes are aligned exactly to the fixation point. A trial conducted in the Netherlands concerning the therapy of asthenopic complaints showed no statistically significant advantage of prism spectacles determined with the MKH over conventional spectacles.
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PMID:[Prism correction in heterophoria]. 1184 Jul 87

Optometrists frequently encounter patients with migraine and patients and practitioners sometimes suspect that visual stimuli or visual anomalies trigger headaches. There is a lack of evidence-based research on the issue, however. Some patients with migraine may be hypersensitive to visual stimuli, and it has been suggested that individually prescribed coloured filters might be an effective treatment to reduce symptoms from such stimuli. A recent randomised controlled trial showed such a treatment to be effective and the present paper reports on the optometric characteristics of the patients in this study. Twenty-one patients with neurologically diagnosed migraine were compared with 11 controls. No significant differences were found between the two groups with respect to refractive error, ocular pathology, colour vision, contrast sensitivity, accommodative function, strabismus and hyperphoria. The migraine group tended to be a little more exophoric, but by most criteria they were able to compensate for their exophoria as well as the control group. The migraine group were more prone to pattern glare than the controls (p = 0.004). The effects of precision tinted and control tinted lenses were investigated. The only variable to show a consistent and marked improvement with tinted lenses was pattern glare. The most likely mechanism for the benefit from individually prescribed coloured filters in migraine is the alleviation of cortical hyperexcitability (Wilkins et al. 1994) and associated pattern glare.
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PMID:Optometric function in visually sensitive migraine before and after treatment with tinted spectacles. 1201 87

This investigation searched for the relationship between amount of nearwork, asthenopic symptoms and visual function, in a group of office workers engaged in telemarketing. Phoria, monocular accommodative facility with +/- 2 lens flippers and near point of convergence were measured in 100 office workers (mean age 21 +/- 2.6 years) whose uncorrected visual acuity was 20/30 or better. Daily hours of reading hard-copy and of computer use, and the level of asthenopic symptoms, were measured using a questionnaire. In this sample, telemarketers were involved 5.84 +/- 2.02 daily hours in computer use, and 2.87 +/- 2.13 daily hours in reading. The following asthenopic symptoms were present twice or more times in a week: headaches 16%, pain in the eyes 17%, red eyes 18%, blurred vision 10%, double vision 3%, burning eyes 19% and watery eyes 19%. An association was found between the amount of hours using computers and red eyes (chi 2 = 4.4, p = 0.0359) or blurred vision (chi 2 = 8.35, p = 0.0038). And also between deficit of convergence and headaches (chi 2 = 4.3313, p = 0.0374) or red eyes (chi 2 = 3.6416, p = 0.0564). No other associations could be found between the accommodative facility test results, the near point phoria, and the amount of nearwork or the asthenopic symptoms. In conclusion, computer use in telemarketing is associated with few asthenopic symptoms. Near point of convergence should be routinely measured, as it is associated with some asthenopic symptoms.
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PMID:[Visual function study in work with computer]. 1203 35

Botulinum toxin is a dreaded biological toxin elaborated by Clostridium botulinum. The action of this toxin is to cause paralysis of both voluntary and involuntary muscles. The unique property of paralysing capability of muscles has been used for the benefit of human beings. Dr Allan Scot, an ophthalmologist, first used the toxin in a patient with squint in 1981 and since then the botulinum toxin is being used in various disorders characterised by muscle overactivity such as spasticity in both children and adult, dystonic conditions such as blepharospasm, cervical dystonia, spasmodic dysphonia, writer's cramp, etc, hemifacial spasm and headache. Its main action is at the terminal nerve endings of myoneural junction and it prevents release of acetylcholine from vesicles thus causing chemical denervation. Its action persists for 3 to 4 months on an average. Its side effects such as drooping, diplopia, dysphagia, depending on the sites of injection, are few and usually transient. Generalised anaphylaxis is almost unknown. Now botulinum toxin is being used in non-neurological conditions where muscles are under spasmodic state such as achalasia cardia, anal fissure, spasm of urethral sphincter, etc. Because of wider safety range and fewer complications, botulinum toxin has been an important therapeutic armamentarium in different branches of medicine and surgery.
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PMID:Botulinum toxin: a dreaded toxin for use in human being. 1245 15

Botulinum toxin, the most potent known biological neurotoxin, holds great promise in the therapy of many diseases. It has been used effectively to treat strabismus, dystonias and other movement disorders, and spasticity. However, a number of potential new therapeutic indications have emerged and attracted a considerable amount of interest from the scientific community. These emerging indications included treatment for conditions associated with pain (e.g. headaches, myofascial pain, chronic low back pain), hypersecretion of glands (e.g. hyperhidrosis, sialorrhea, intrinsic rhinitis), and excessive or dyssynergic muscle contraction, and for cosmesis (e.g. myokymia, bruxism, anal fissure). There is a need for more controlled clinical trials, dose-ranging studies to determine optimal treatment, validated clinical scales and studies developed to assess the value of electromyographic guidance and skill of investigators on the outcome of treatment for some of these diseases. The long-term cost effectiveness of treatment and immunoresistance from repeated injections are also important clinical issues to address.
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PMID:Emerging therapeutic applications of botulinum toxin. 1260 5


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