Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aggressive dual antiplatelet therapy is associated not only with more bleeding, impaired wound healing, and potentially more solid cancer rates but it also causes higher infection risks including sepsis, and systemic inflammatory response syndrome (SIRS). This may be especially true considering the alarming off-label use of prasugrel. A 65-year-old white male patient with a history of myocardial infarction treated with percutaneous coronary intervention and implantation of 2 bare metal stents, was treated with off-label clopidogrel for 4 years, including a double daily dose (150 mg) for the initial 13 months. Still on clopidogrel, the patient was hospitalized with suspected pneumonia. A diagnostic cardiac catheterization revealed a 60%-70% blockage of the mid left anterior descending, but there was no need for coronary intervention. At discharge, clopidogrel 75 mg/d was switched over to off-label prasugrel 10 mg/d on top of aspirin (81 mg/d). On day 3 after prasugrel was given, a football-sized bruise appeared on the patient's lower right abdomen, but computed tomography results were unremarkable. On day 6 after administration of prasugrel, the patient became dizzy, disoriented, confused, experienced difficulty breathing, severe headache, weakness, intensive petechial rash covering the entire body, and breathing difficulty requiring ventilation. Within 24 hours, the patient was unable to correctly identify his age; his eyes were pale in color to almost colorless and when hearing a sound he would turn his entire head toward the sound and he appeared to be blind. His lungs, liver, and kidneys began to show signs of failure over the next 5-9 days. Sixteen days after the administration of the first prasugrel dose, the patient died of sepsis complicated with SIRS. Aggressive off-label use of clopidogrel (double dose for 13 months, and >4 years overall duration), followed by off-label switchover to the highest daily dose (10 mg) prasugrel may trigger sepsis and fatal SIRS. The mechanism responsible for such harmful association is probably indirect, and involves the weakening of platelet-neutrophil-endothelial crosstalk necessary to combat infections, and/or keep inflammation from spreading.
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PMID:Fatal sepsis and systemic inflammatory response syndrome after off-label prasugrel: a case report. 2366 86

Mood and pain are interrelated to each other in a mutual and complex manner. Patient populations in headache clinics exhibit more emotional disturbance than general practice patients. Nonetheless, the degree of psychological illness among headache patients is less than maybe found in psychiatric outpatients. However, it is a fact that several psychiatric disorders appear to be comorbid with primary headache syndromes such as migraine. Still, prospective standardized studies are sparse. We aimed to investigate whether migraine per se or specific migraine characteristics are associated to depression and anxiety. In a single center study (Department of Neurology of the University of Athens) migraineurs were asked for several headache features such as pain intensity, attack frequency, average attack duration, prodromal symptoms and the presence of aura. We assessed 50 consecutive headache patients who were referred to our headache outpatient clinic. Patients diagnosed with non-migraine syndromes, mixed non-migraine and migraine syndromes, or patients with previously diagnosed systemic disease known to precipitate psychiatric disorders (such as systemic lupus erythematodes) were excluded from the study. Furthermore, we did not include any subjects who were already on antidepressive or other psychiatric medication. Twenty four patients met the inclusion criteria. The data were then correlated with scores obtained by the Beck Depression Inventory and the Hamilton's scales for Depression and Anxiety. Our results showed an increased frequency of mild and moderate depression compared to what was expected from the normal population which is in line with past observations on headache patients. In an analogous manner, mild and moderate anxiety appeared more frequently among migraineurs than healthy subjects. However, we did not find any significant relation between depression or anxiety and parameters such as pain intensity, monthly attack frequency, attack duration, presence or absence of aura, appearance of pre-ictal prodromal symptoms and migraine career duration (age of assessment minus age of migraine onset). These findings suggest that migraine, although often comorbid with depression and anxiety, has no specific headache characteristics causally related to mood abnormalities. Larger samples will be required in future studies to address the question of a link between more specific mood and mental disturbances with primary headache syndromes.
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PMID:Relationship of intensity and special characteristics of migraine to depressive and anxious features. 2418 86

Emerging data suggest that traumatic brain injury (TBI) is a disease process with considerable long-range morbidities requiring lifelong monitoring and treatment. Multiple chronic morbidities develop across the life span after TBI, including mental health disorders, headaches, seizures, and neuroendocrine imbalances as well as chronic diseases. Still, there has been limited focus on effective guides and strategies for helping persons with TBI meet their chronic health needs as they live with the consequences of TBI. The advanced practice nurse is well positioned to participate collaboratively in practices that promote health screening and chronic disease management after TBI to ameliorate distress and enhance quality of life as persons with TBI live with lifelong consequences.
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PMID:Chronic morbidities after traumatic brain injury: an update for the advanced practice nurse. 2467 Apr 34

Pain catastrophizing (PC) has been related to pain levels in both patients experiencing acute or chronic pain and in healthy volunteers exposed to experimental pain. Still, it is unclear whether high levels of pain catastrophizing lead to high levels of pain or vice versa. We therefore tested whether levels of pain catastrophizing could be increased and decreased in the same participant through hypnotic suggestions and whether the altered level of situation-specific pain catastrophizing was related to increased and decreased pain levels, respectively. Using the spontaneous pain of 22 patients with chronic tension-type headache and experimentally induced pain in 22 healthy volunteers, participants were tested in 3 randomized sessions where they received 3 types of hypnotic suggestions: Negative (based on the 13 items in the Pain Catastrophizing Scale), Positive (coping-oriented reversion of the Pain Catastrophizing Scale), and Neutral (neutral sentence) hypnotic suggestions. The hypnotic suggestions significantly increased and decreased situation-specific PC in both patients and healthy volunteers (P < 0.001). Also, the levels of pain intensity and pain unpleasantness were significantly altered in both patients and healthy volunteers (P < 0.001). Furthermore, regression analyses showed that changes in pain catastrophizing predicted changes in pain in patients (R = 0.204-0.304; P < 0.045) and in healthy volunteers (R = 0.328-0.252; P < 0.018). This is the first study to successfully manipulate PC in positive and negative directions in both patients with chronic pain and healthy volunteers and to show that these manipulations significantly influence pain levels. These findings may have important theoretical and clinical implications.
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PMID:Experimental manipulations of pain catastrophizing influence pain levels in patients with chronic pain and healthy volunteers. 2687 34

Botulinum toxin serotype A (BoNT/A) was originally used in neurology for the treatment of dystonia and blepharospasms, but is now clinically used worldwide for the treatment of chronic migraine. Still, the possible mode of action of BoNT/A in migraine is not fully known. However, the mode of action of BoNT/A has been investigated in experimental pain as well as migraine models, which may elucidate the underlying mechanisms in migraine. The aim of this study was to review studies on the possible mode of action of BoNT/A in relation to chronic migraine treatment. Observations suggest that the mode of action of BoNT/A may not be limited to the injection site, but also includes anatomically connected sites due to axonal transport. The mechanisms behind the effect of BoNT/A in chronic migraine may also include modulation of neurotransmitter release, changes in surface expression of receptors and cytokines as well as enhancement of opioidergic transmission. Clinical and experimental studies with botulinum toxin in the last decade have advanced our understanding of headache and other pain states. More research into botulinum toxin as treatment for headache is warranted as it can be an attractive alternative for patients who do not respond positively to other drugs.
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PMID:Botulinum toxin: A review of the mode of action in migraine. 2988 65

The literature examining primary headache, including migraine, in adolescents, has pointed out the key role played by a wide range of psychiatric disorders in reducing the patients' quality of life. Moreover, pioneering studies showed that preexisting personality characteristics, specific emotion regulation styles and psychological-psychiatric difficulties are likely to increase the risk of the onset, maintenance, and outcome of headache. Still personality issues in migraine have been poorly studied, in particular in children and adolescents. This study aims, therefore, to investigate the specific characteristics of personality, and in particular emotion regulation and coping strategies, in adolescent with migraine, comparing them with age-matched patients with idiopathic epilepsy and healthy adolescents. 52 adolescents (age: 11-17) were assessed using a multi-method test battery, which included a self-report questionnaire (the youth self-report), a proxy-report (child behavior checklist) along with a projective personality test, the Rorschach Test, administered and scored according to the Exner comprehensive system. The results showed specific personality characteristics in adolescents with migraine, revealing a marked difficulty in modulating and regulating affections through thoughts and reflections, resorting instead to impulsive acts and maladaptive coping strategies, thus revealing a vague and immature perception of reality. Differently from adolescents belonging to the general population, but similarly to patients with epilepsy, adolescents with migraine perceive a high situational stress, probably related to the condition of suffering from chronic disease. They have, therefore, a lower self-consideration and self-esteem along with a poorer insight regarding themselves as well as the relations with others. In line with previous findings, these preliminary results suggest the need for further research on ample samples, using also standardized projective test in order to better understand the pathogenesis of psychological difficulties in patients with migraine. As a clinical implication, the results seem to indicate that providing a psychological integrated approach can play a pivotal role in the assessment and treatment of adolescent with migraine, in order to improve the outcome and the quality of life of the young patients.
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PMID:Rorschach Evaluation of Personality and Emotional Characteristics in Adolescents With Migraine Versus Epilepsy and Controls. 2961 59

We report a case of silicone-induced Still's-like inflammatory syndrome diagnosed after extensive investigation in the department of internal medicine of a secondary hospital. A 45-year-old female healthcare specialist presented with fever, headache, sore throat, myalgia and fatigue. A history of breast augmentation surgery in 2007 was confirmed. Physical examination of the patient was normal while laboratory tests showed a very high white blood cell count. The patient was admitted to hospital due to suspected infection and further laboratory tests were carried out. Inflammatory markers were persistently high despite empirical treatment with doxycycline for possible infection by Rickettsia/Coxiella. As the fever did not resolve and the patient had not improved after more than 3 weeks, the case was investigated as fever of unknown origin. Eventually, the existence of liver granulomas as well as the presence of anti-silicone antibodies confirmed the diagnosis of silicone-induced Still's-like inflammatory syndrome. In conclusion, this case supports a linkage between silicone breast implants and autoimmune connective tissue diseases.
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PMID:Still's-like Disease Induced by Breast Implants in a Middle-Aged Female Health Professional. 3075 5


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