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

In the last decade, world literature abounds in reports of harmful side effects which develop with the use of oral contraceptives including visual problems such as partial and total clotting in the retinal veins, infections, blood in the retina, and dilated veins signalling imminent stroke. 2 particular cases treated at the Opthalmological Clinic of the Academy of Medicine in Lodz deserve consideration. M.W., a 19 year old student who had had measles and scarlet fever in childhood, reported increasing visual problems. Due to irregular menstrual periods, she had been taking the contraceptive Angravid, consisting of 1 mg ethynodiol acetate, a synthetic progestogen and .05 mg mestranol, a synthetic estrogen. After a complete examination retrobulbar neuritis with the presence of papilloedema in the eye fundus of local origin was diagnosed. She was treated for general and local infection and for the prevention of clotting. After a month all symptoms regressed. H.U., a 30 year old stomatologist, reported to the clinic, complaining of sudden and periodic visual disturbances occurring in both eyes, accompanied by severe headache pains. In childhood she had had measles and whooping cough, later frequent bouts of flu and angina. She had given birth 3 times, each a natural delivery with healthy children. Recently she had been taking the oral contraceptive femigen, consisting of 2 mg chloromadinon acetate and .05 mg mestranol. After a complete series of skull and brain tests, papilloedema with the pseudotumor syndrome cerebri was diagnosed. Intensive treatment for edema produced visible improvement and the patient was discharged.
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PMID:[Ophthalmological complications after oral contraceptives (author's transl)]. 67 30

The Collaborative Study Group for the Study of Stroke in Young Women studied 598 women from age 15 to 44 years with cerebrovascular disease. They found that the use of oral contraceptives was significantly more prevalent in women who had suffered a thrombotic stroke than in women who had not had strokes. The risk of thrombotic stroke was estimated to be nine times greater in users of oral contraceptives than in nonusers. We report a case in which a previously healthy man who was using an oral contraceptive drug developed middle cerebral artery occlusion. In the absence of other predisposing factors in this case, it appears that the cerebrovascular occlusion was related to estrogen administration. The occurrence of persistent severe headaches in patients using estrogenic hormones may be a clue to impending cerebrovascular occlusion.
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PMID:Cerebrovascular occlusion in a transsexual man taking mestranol. 71 32

The hypertensive encephalopathy is a syndrome consisting of a sudden elevation of arterial pressure usually preceded by severe headache and followed by convulsions, coma or a variety of transitory cerebral phenomena. The syndrome may complicate acute glomerulonephritis, toxemia of pregnancy and essential or malignant hypertension. Two syndromes must be differentiated from true hypertensive encephalopathy: 1. acute anxiety state with labile hypertension and 2. acute pulmonary edema due to hypertensive heart disease. At least in patients with acute anxiety states, the use of antihypertensive agents is usually not indicated. Since encephalopathy is always accompanied by increased vascular resistance and since clinical experience has demonstrated clearing of the sensorium, cessation of convulsions and release of vasoconstriction following reduction of blood pressure, the primary aim of therapy should be prompt lowering of arterial pressure. The two agents of choice are diazoxide and sodium nitroprusside. Stroke is differentiated from encephalopathy by the persistence of lateralizing signs. The aggressiveness of antihypertensive therapy in this situation depends on the severity of the hypertensive process. Rapid reduction of blood pressure is indicated in patients found to have accelerated hypertension while a more gradual lowering of pressure appears warranted for patients with chronic arterial hypertension and evidence of generalized arteriosclerosis.
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PMID:Management of hypertensive encephalopathy. 72 Oct 56

Carotid endarterectomy has become a widely used approach to the treatment of cerebrovascular disease. In spite of increasing experience, a significant and varied morbidity remains attached to the procedure. A poorly recognized complication is postoperative headache. In a series of 57 endarterectomies in 50 patients, 24 patients experienced postoperative headaches encompassing the entire spectrum of vascular headaches: nonspecific diffuse headaches, severe hemicranias, cluster headaches occurring early and delayed, chronic paroxysmal hemicranias, carotidynia, and Eagle's syndrome. Five patients had hemicranias, and all were homolateral to the endarterectomy. Therefore, we hypothesize that the spontaneously occurring hemicranias, the counterparts of postsurgical headache syndromes, also may be due to some overt or occult injury or disease of the carotid vessels or carotid sheaths in the regions from the carotid bifurcation to the base of the skull.
Stroke
PMID:Cluster headache, hemicrania, and other head pains: morbidity of carotid endarterectomy. 74 85

We measured the cerebral blood flow (CBF) of 16 patients by the xenon-133 intracarotid method before and after the intramuscular injection of ergotamine tartrate. The regional and hemispheric CBF was unaltered, even in 3 migraneurs in who ergotamine relieved the headache. Ergotamine tartrate in therapeutic doses has no effect on the cerebral circulation.
Stroke
PMID:Ergotamine and cerebral blood flow. 74 94

Headache may be the presenting symptom of many diseases in the elderly. Some headaches are caused by significant intracranial disease, and the patient's age and general cardiologic and respiratory status may not allow investigation or neurosurgical management. Conditions that demand urgent neurosurgical attention are subarachnoid hemorrhage, pituitary apoplexy, subdural hematoma, and meningioma. Cranial arteritis, too, should be remembered as a possible medical cause of headache in the elderly.
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PMID:Differentiating causes of headache. 88 44

The authors report a case of pituitary apoplexy occurring several hours after carotid angiography. The event was associated with stupor, focal headache, and left hemiparesis. Repeat angiography demonstrated intracranial occlusion of the right internal carotid artery. At surgery, a hemorrhagic pituitary adenoma was found to be compressing the internal carotid artery, and the removal of the tumor resulted in restoration of flow. The mechanism, presenting symptoms and signs, and treatment of pituitary apoplexy causing compression of a major vessel are discussed.
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PMID:Pituitary apoplexy producing internal carotid artery occlusion. Case report. 90 13

The management of pituitary apoplexy with reference to both diagnosis and operative sequelae remains a major challenge. Acute onset of retro-orbital headache in association with visual loss and ophthalmoplegia are the cardinal symptoms; however, obtundation and signs of subarachnoid hemorrhage also may be present. Good quality plain skull radiographs and complete angiography prove sufficient for preoperative radiographic studies. Preoperative endocrine preparation focuses on supplemental glucocorticoids since these patients must be presumed deficient in cortisol reserve. Residual visual deficit appears to be more a function of the extent of damage at the time of ictus rather than rapidity of decompression. Our experience indicates that transsphenoidal decompression in appropriate cases offers an ideal opportunity to minimize mortality and morbidity. The acute onset of severe retro-orbital headache in association with stupor and ocular palsies would alert most physicians to the potential diagnosis of spontaneous subarachnoid hemorrhage. The association of complex ophthalmoplegias and visual defects in this constellation of symptoms should, in addition, alert one to the possibility of an acute intrasellar or parassellar expansile process. During the past two years, we have had the opportunity to care for 8 such patients with confirmed diagnoses of acute hemorrhagic infarction of the pituitary enabling us to formulate diagnostic and therapeutic schemata with reference to management of this problem.
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PMID:Pituitary apoplexy, therapeutic assessment. 103 16

A case of acromegaly complicated by pituitary apoplexy is described. The pituitary apoplexy occurred while the patient was under investigation in a metabolic ward permitting full assessment of pituitary function both before and immediately after the event. This demonstrated a remarkably selective reduction in the plasma growth hormone concentration with preservation of other pituitary function excluding mild diabetes insipidus. The plasma growth hormone fell from values greater than 120 ng/ml to less than 4 ng/ml. The brisk inappropriate release of growth hormone observed on stimulation with thyrotrophic hormone releasing hormone, associated with a severe headache and the onset of pituitary apoplexy two days later raised the possibility of provocative tests of pituitary function precipitating pituitary apoplexy.
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PMID:Regression of acromegaly following pituitary apoplexy. 105 79

The differentiation of migraine headache, preceded by visual aura, from cerebral arteriovenous malformation (AVM) is often regarded as difficult. A study of 26 patients with occipital lobe AVM revealed two distinct syndromes in 18 patients--occipital epilepsy and occipital apoplexy. Occipital epilepsy is characterized either by elementary visual phenomena, such as brief flashes of light, or by dimming of a homonymous field. Occipital apoplexy results from hemorrhage and hematoma formation within the occipital lobe and is characterized by sudden headache and homonymous visual field loss. We conclude that patients harboring occipital AVMs may, indeed, have visual phenomena and headache that should not be confused with migraine because either a history of generalized seizure or bruits on examination will probably be present.
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PMID:Occipital lobe arteriovenous malformations. Clinical and radiologic features in 26 cases with comments on differentiation from migraine. 111 66


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