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

Chronic headaches in a shunt-dependent patient with small ventricles has long been treated with little or no regard to intracranial pressure. In this study, pressure monitoring on 12 such patients demonstrated that they fell into three distinct categories: 3 had headaches caused by intracranial hypertension, 2 had headaches from hypotension, and 7 showed no relation of symptoms to pressure. As therapeutic procedures for treating these three categories are entirely different and sometimes opposing, it is clear that intracranial pressure monitoring is essential to successful management of this complaint.
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PMID:Chronic headache associated with a functioning shunt: usefulness of pressure monitoring. 199 84

Many conditions in clinical neurology may be responsive to pyridoxine as a therapeutic agent. The current difficulty is in trying to isolate the conditions that are most likely to respond. Treating seizures is a major part of a neurologic practice. Our current therapeutic agents are only partially successful and limited by multiple side effects. One problem is that patients often have to take these agents for an entire lifetime, further raising the risk of toxicity. If pyridoxine supplementation can improve the efficacy of currently used medications, it will be gladly accepted into our therapeutic arsenal. Headache, chronic pain, and depression all appear to run together in many of our patients. The observations that serotonin deficiency is a common thread between them and that pyridoxine can raise serotonin levels open a wide range of therapeutic options. Small studies have been carried out with mixed success. Comparison with amitriptyline in the treatment of headache appears to show about equal efficacy, although side effects would be expected to be more of a problem with the amitriptyline. Behavioral disorders are relatively common and continue to be a major problem, disrupting the lives of the patients and their families. Current treatments are not acceptable to most people because of the risk of side effects with long-term usage. If, as Dr. Feingold suggests, many of these problems are caused by "toxic" exposures to chemicals that are pyridoxine antagonists, supplementation at early ages may reduce the incidence of hyperactivity and aggressive behavior. This raises the question of safety. Is pyridoxine safe for long-term use in large segments of the population, including children? The studies on children with Down's syndrome and autism, utilizing much higher doses than are used for other therapeutic purposes, seem to indicate relative safety if carefully monitored. Studies involving large population groups with carpal tunnel syndrome, all adults, using 100-150 mg/day have shown minimal or no toxicity in five- to 10-year studies. Women self-medicating for PMS taking 500 to 5000 mg/day have shown peripheral neuropathy within one to three years. It would appear from this retrospective analysis that pyridoxine is safe at doses of 100 mg/day or less in adults. In children there is not enough data to make any sort of suggestion. Because the major neurologic complication is a peripheral neuropathy and the causes of this condition are myriad, pyridoxine may cause neuropathy only in patients with a pre-existing susceptibility to this condition.
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PMID:Vitamin B6 in clinical neurology. 216 44

Chronic headaches are difficult problems to manage effectively. A select group of six patients with headache symptoms (throbbing headaches, located in the frontal or occipital areas; aggravated by ambulation and relieved by recumbency) resembling post-dural puncture headache received epidural blood patches using autologous blood for their chronic headaches. Five of the six patients obtained effective and sustained pain relief. All of the patients had received placebo injections with normal saline in the paraspinous muscles, without effect. The mechanism of action of the blood patch in these patients is unclear. It is possible that the headache may have been caused by a low pressure cerebrospinal fluid state, due to an unknown anatomical or physiological defect of the ventriculo-spinal system. Further studies are needed to evaluate this treatment modality.
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PMID:Use of epidural blood patch in treating chronic headache: report of six cases. 360 61

Chronic headaches are relatively common in children and adolescents. The majority of these are benign and do not reflect organic pathology. Diagnosis can usually be made by careful history and physical examination, and extensive laboratory investigations are rarely required. Most children can be managed with reassurance, simple analgesics, and mild sedation. For more severe cases, particularly of migraine, effective pharmacologic agents are available. The prognosis is favorable. Very few of these children go on to develop significant intracranial pathology, and the majority will remit spontaneously. A significant number, however, do have chronic headaches in adult life.
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PMID:The diagnosis and management of headaches in childhood. 703 73

Chronic headaches due to intracranial hypo- or hypertension (IHS codes 7.2 and 7.1) may be difficult to diagnose. In this article, we review their principal clinical characteristics, etiologies and therapies. Intracranial hypotension may be caused by CSF linkage, e.g. after lumbar puncture. It may also be "idiopathic" in which case a CSF leak, usually at the spinal level, may be difficult to demonstrate. Postural headache is the clinical hallmark of intracranial hypotension. The diagnosis is confirmed by leptomeningeal enhancement on MRI scans. The headache of benign intracranial hypertension may be aggravated by the supine position and accompanied by transient visual obscurations and tinnitus. Papillary edema supports the diagnosis but may be absent in some cases. Increased opening pressure of the CSF will confirm the diagnosis. Etiologies such as cerebral venous thrombosis, have to be excluded by adequate imaging methods. In both hypo- and hypertension syndromes, various therapeutic strategies have been proposed.
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PMID:[Benign intracranial hypo- and hypertension]. 1054 94

To determine the range of neurologic complications in children with systemic cancer, we evaluated prospectively all of the neurologic consultations requested by the pediatric department of Memorial Sloan-Kettering Cancer Center from October 1997 until January 2001. Demographic data, main complaints, diagnosis, cancer status, etiology, and neuroradiologic studies were reviewed for the 528 consultations. Headache was the most frequent complaint (18.3%), followed by altered mental status (8.4%) and back pain (7.1%). Many children with these complaints had underlying structural disorders despite a normal neurologic examination. The symptoms varied with the underlying cancer and tumor status. Headaches were more common in patients with hematologic cancers, and back pain was more common in patients with solid tumors. Chronic headaches were frequent in patients in remission. Iatrogenic complications, particularly related to chemotherapy, constituted the largest etiologic group (27.7%). A high percentage of neuroradiologic studies were abnormal, and 63% of the magnetic resonance imagine studies were diagnostic. The broad spectrum of conditions underlying the neurologic complaints of children with systemic cancer illustrates the complexity of problems presented by these patients and requires a thorough knowledge of pediatric cancer, its effects on the nervous system, and the complications of its treatment from the neurology consultant.
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PMID:The spectrum of neurologic disease in children with systemic cancer. 1158 78

Headache is a recurrent somatic complaint in childhood and adolescence. In recent decades headache prevalence has increased while the age of onset has decreased. In most cases headache can be categorized as migraine or tension-type headache without significant organic pathology, i.e. head trauma, structural lesion, etc. Diagnosis according to the criteria of the International Headache Society is based on subjective reports by patients and their parents. The basic tools of clinical assessment are history, physical examination and a headache diary. Laboratory tests, including electroencephalography and imaging studies should not, as a rule, be undertaken routinely. Pathophysiological models with an impact on therapeutic interventions will be discussed. Childhood headache is often treated inappropriately in daily practice despite the availability of various options (including environmental, drug, and psychological therapy). Psychological therapy (relaxation training, biofeedback, stress management, etc.) as well as medication can be applied for prophylaxis. Minimal therapeutic interventions have been shown to be equally effective in a remarkable number of patients. Chronic Headache shows relevant comorbidity with anxiety and depression and is associated with somatization and school disorders. A careful investigation and an adequate therapy of eventual psychiatric comorbidity is therefore strongly recommended.
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PMID:[Headache in children: also a problem for child and adolescent psychiatry? Pathogenesis, comorbidity, therapy]. 1247 19

Chronic headaches have increasingly become a focus within the field of head pain. The biological and physiopathological origins of chronic headaches probably reside in receptor physiology, but it is also probable that the initiation and sustaining dynamics of this pathological condition involve several other factors. Not all, but most patients with frequent headache eventually overuse their medications, and when this happens (approximately 1%), the diagnosis of medication-overuse headache is clinically important, because patients rarely respond to preventive medications while overusing acute medications. Properly treating medication overuse and preventing relapse require recognition of the different factors that contribute to its development and perpetuation, including some behaviours and psychological elements that are important in sustaining the overuse of medication. The problems concerning the diagnosis, classification and clinical aspects of chronic headaches are mentioned. Also the different therapeutical approaches, pharmacological and non-pharmacological, initial outcomes and long-term durability of treatment are discussed.
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PMID:Chronic headaches: pharmacological and non-pharmacological treatment. 1668 25

Chronic headaches are difficult to treat and represent the biggest challenge in headache centres. Mirtazapine has a prophylactic and ibuprofen an acute effect in tension-type headache. Combination therapy may increase efficacy and lower side effects. We aimed to evaluate the prophylactic effect of a combination of low-dose mirtazapine and ibuprofen in chronic tension-type headache. Ninety-three patients were included in the double-blind, placebo-controlled, parallel trial. Following a 4-week run-in period they were randomized to four groups for treatment with a combination of mirtazapine 4.5 mg and ibuprofen 400 mg, placebo, mirtazapine 4.5 mg or ibuprofen 400 mg daily for 8 weeks. Eighty-four patients completed the study. The primary efficacy parameter, change in area under the headache curve from run-in to the last 4 weeks of treatment, did not differ between combination therapy (190) and placebo (219), P = 0.85. Explanatory analyses revealed worsening of headache already in the third week of treatment with ibuprofen alone. In conclusion, the combination of low-dose mirtazapine and ibuprofen is not effective for the treatment of chronic tension-type headache. Moreover, the study suggests that daily intake of ibuprofen worsens headache already after few weeks in chronic tension-type headache.
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PMID:Combination of low-dose mirtazapine and ibuprofen for prophylaxis of chronic tension-type headache. 1725 Jul 28

Chronic headaches have increasingly become a focus within the field of head pain. Most patients with frequent headache eventually overuse their medications, and when it happens, the diagnosis of medication-overuse headache is clinically important, because patients rarely respond to preventive medications whilst overusing acute medications. Properly treating medication overuse and preventing relapse require recognition of the different factors that contribute to its development and perpetuation, including some behaviours and psychological elements that are important in sustaining the overuse of medication. The different therapeutical approaches, pharmacological and nonpharmacological, initial outcomes and long-term durability of treatment are discussed.
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PMID:Chronic headaches: pharmacological and non-pharmacological treatment. 1750 60


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