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

Treatment with metoprolol (100 mg twice daily), nifedipine (10 mg 3 times daily) and both drugs combined were compared for effect on clinical variables, bicycle ergometer exercise tolerance and adverse effects in a randomized double-blind, crossover study in patients with stable effort angina (n = 62). Nitroglycerin consumption and anginal attack rate as recorded in patient diaries indicated a higher antianginal efficacy (p less than or equal to 0.001) with metoprolol and combination therapy than with nifedipine monotherapy. All exercise test variables showed a significantly higher antianginal efficacy with combination therapy than with nifedipine monotherapy (15 to 26%). The combination therapy was also better than metoprolol in all exercise variables (9 to 14%), except for onset and duration of chest pain. Furthermore, metoprolol showed a higher efficacy than nifedipine in all exercise variables (7 to 23%) except total exercise time. More adverse symptoms of peripheral vasodilation were reported for nifedipine than for metoprolol (tachycardia, flushing, headache, p less than or equal to 0.05). It is concluded that combined treatment with metoprolol and nifedipine increased antianginal efficacy compared with the monotherapies, without increasing adverse effects. In effort angina, metoprolol in these doses was more effective and better tolerated than nifedipine.
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PMID:Metoprolol, nifedipine, and the combination in stable effort angina pectoris. 308 64

Three hundred fifty patients in an observation unit attached to an emergency department received diagnostic workup of nine critical diagnostic syndromes (abdominal pain, flank pain, headache, possible cerebrovascular accident, chest pain, dizziness or syncope, head injury, seizure, multiple trauma). The decision to hospitalize for acute care after observation for 11.1 +/- 3.9 hours was examined. The objective diagnosis-related group (DRG) criteria for admission were compared retrospectively with the physician's clinical judgment of need for hospitalization. Clinical outcome was used to establish the correctness of the decision to hospitalize. Clinical judgment was compared with objective DRG criteria for reliability in predicting the presence of serious pathology necessitating acute care hospitalization; respective values were sensitivity, 100% vs 76%; specificity, 86% vs 80%; positive predictive value, 75% vs 62%; and negative predictive value, 100% vs 89%. The difference between the sensitivity of the two admission criteria was highly significant (P less than 10(-8); chi 2, 26.12). We conclude that the physician's clinical judgment outperforms DRG objective criteria in identifying which patients with critical diagnostic syndromes need acute care hospitalization for emergency medical or surgical therapy.
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PMID:Decision to hospitalize: objective diagnosis-related group criteria versus clinical judgment. 313 51

The authors present a retrospective study of 46 consecutive patients aged from 70 to 79 years (mean 73.3 +/- 2.5 years) with suspected coronary artery disease who, being unfit for exercise tests, were explored by myocardial scintigraphy with thallium 201 after coronary dilatation with intravenous dipyridamole. The examination was well tolerated by 30 patients. Such classical side-effects as chest pain, malaise, dizziness, headache, flushing, vomiting and transient arrhythmia or repolarization disorders were recorded, but they were not more frequent than in younger subjects. However, the occurrence of severe hypotensive malaise relieved by theophylline in two cases and of angina in about one third of patients with myocardial ischaemia means that the procedure must be performed under close supervision. A fall in blood pressure (-11 mmHg on average) and a rise in heart rate (+8 beats/min on average) were usual. Post-scintigraphy follow-up of patients over a mean period of 11.1 +/- 6.2 months showed that a reversible defect of thallium 201 uptake, due to redistribution, is a highly selective indicator of patients who are particularly exposed to a cardiac accident in the short--or mid-term. Only one out of 26 patients without reversible ischaemia (4 p. 100) subsequently presented with a major coronary event (unstable angina). In contrast, in the group of 20 patients with reversible ischaemia three required early myocardial revascularization; furthermore, five serious accidents (29 p. 100) occurred among the 17 patients who were left under medical treatment, including two sudden deaths, two cases of unstable angina and one case of myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Tolerance and prognostic value of Thallium 201 myocardial tomoscintigraphy with dipyridamole in the aged subject]. 314 28

The issues related to measuring pattern recognition are similar to measuring other clinical skills; how can testing time be used most efficiently to obtain reliable and valid scores? How should tests be constructed to obtain scores that validly reflect individual performance in making diagnoses? Generalizability analyses indicated that performance in one topic area does not predict performance in other areas very well. For example, students who were relatively expert in diagnosing patients with headaches tend not to be expert in diagnosing patients with chest pain, joint pain, etc. Therefore, to evaluate diagnostic pattern recognition skills in general, it is preferable to sample more presenting complaints with fewer items directed at each one, rather than to sample more items within a small number of presenting complaints. Approximately one hour of testing time would be required to generate a reasonably reliable score (ie, with a generalizability coefficient greater than 0.80). For diagnostic or remedial purposes, performance can be examined by content area to determine specific areas of weakness for individual students. The next phase of this study will be directed at determining whether there are benefits to using the current matching format with a relatively long list of response alternatives rather than a traditional multiple choice format with five choices. It is hypothesized that the shorter list differentially benefits the lower ability students and the more junior students. Efforts will also be directed to determining the applicability of the item format to other content areas such as diagnostic testing and therapy.
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PMID:Evaluating diagnostic pattern recognition: the psychometric characteristics of a new item format. 321 69

We have evaluated the effect of withdrawal of antihypertensive drugs on the frequency of symptoms over a 2-week period in 11,710 hypertensive patients. Previously untreated patients complained most frequently of headache, dizziness and chest pain, whereas most other symptoms occurred more often in previously treated patients. With the exception of headache, which rose in frequency, most symptoms showed a significant reduction following therapy withdrawal. The burden of symptoms reported by treated hypertensive patients is probably the result of a combination of their disease, drug-related adverse effects and inappropriate use of drugs in certain patient groups.
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PMID:Symptoms in hypertensive patients: the effect of treatment withdrawal. 324 Dec 71

Many childhood and adolescent stress-related symptoms have a psychophysiological component that involves muscular tension and/or autonomic nervous system dysfunction. Examples of this include recurrent headache, chest pain, abdominal pain, syncope, and dizziness. After a careful medical and psychosocial evaluation, the clinician may identify many patients who are appropriate for the application of stress reduction techniques such as progressive muscular relaxation, meditation, biofeedback, and relaxation/mental imagery (self-hypnosis). This review describes these techniques and their application with selected children and adolescents.
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PMID:Stress management techniques in childhood and adolescence. Relaxation training, meditation, hypnosis, and biofeedback: appropriate clinical applications. 331 33

Persons with Q fever usually present with severe retrobulbar headache, a fever to 104 degrees F or higher with shaking chills, general malaise, myalgia, chest pain, and sometimes pneumonia and hepatitis. Cattle, sheep, goats, and ticks are the primary reservoirs of the etiologic agent, Coxiella burnetii. Humans are usually infected by inhaling infectious aerosols. Because C. burnetii can survive for long periods in the environment, it poses a continuing health hazard once it is disseminated. Q fever usually occurs sporadically, but large outbreaks are frequently observed throughout the world, particularly among abattoir workers and personnel working in research centers. Q fever endocarditis follows a chronic course and is frequently fatal. Tests for antibodies to C. burnetii are required for confirmation of the diagnosis. Tetracyclines remain the mainstay of treatment for acute Q fever, and tetracyclines in combination with other antibiotics have been advocated for patients with Q fever endocarditis. Vaccines for Q fever have been proven effective in clinical trials.
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PMID:Q fever: current concepts. 331 37

A survey concerning common pain conditions and psychological distress was carried out among a probability sample of the adult enrollees of a large health maintenance organization in Seattle. The prevalence of pain in the prior six months was 41% for back pain; 26% for headache; 17% for abdominal pain; 12% for chest pain; and 12% for facial pain. Headache, abdominal and facial pain were less prevalent among older persons and more prevalent among females. We examined the temporal dimensions of these pain conditions, as well as intensity, treatment seeking, and activity limitation. The pain conditions were typically long standing, recurrent, of mild to moderate intensity, and usually did not limit activities. However, depending on the pain condition, 9-40% reported one or more days in the prior six months when they were unable to carry out their usual activities due to the pain problem. On average, persons with a pain condition had higher levels of anxiety, depression, and non-pain somatic symptoms as measured by the scales of the Symptom Checklist (SCL); poorer self-rating of health status; and more family stress compared to persons without a pain condition. Of these alternative measures of distress, the SCL somatization scale had the strongest independent association with pain. The increments in measures of anxiety, depression, and family stress with the presence of pain were greatest among persons with higher levels of non-pain somatic symptoms.
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PMID:An epidemiologic comparison of pain complaints. 336 55

A 79-year-old woman was admitted to hospital complaining of chest pain, increasing weakness, anorexia, hoarseness, headache and discomfort in the throat and jaws while eating. Physical examination, chest x-rays, serial electrocardiograms and cardiac enzymes were unremarkable. After admission she developed weakness and numbness in the left leg with urinary retention, decreased sensation to touch, weakness, increased tone, absent deep tendon reflexes and a positive Babinski sign on the left. Zeta sedimentation rate was markedly elevated at 0.63. Computerized tomographic head scan, myelography, echocardiography, barium swallow and meal, immunoglobulins, electrophoresis and other laboratory investigations were unremarkable. Repeat sedimentation rate was still markedly elevated three weeks later. A temporal artery biopsy confirmed the diagnosis of temporal or giant cell arteritis. Prednisone, 60 mg daily, was started.
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PMID:Acute chest pain in an elderly woman. 337 98

Since oral contraceptives (OCs) are the method chosen by an estimated 10 million US women, health care providers must be informed about the pill's mechanism of action, its warning signs and contraindications, and its interaction with other drugs and vitamins. Although nearly 60 OC brands are currently available, there are only 2 basic types: the mini-pill, which contains progesterone only, and the combination OC, which adds estrogen. Combination OCs are further divided into monophasic, biphasic, and triphasic preparations. OC use is contraindicated in women with a history of phlebitis, stroke, coronary artery disease, liver tumors, or breast cancer. Warning signs that patients should be instructed to report include acute abdominal pain, chest pain, headaches, and severe leg pain. The effectiveness of OCs is decreased by drugs such as ampicillin, penicillin V, tetracycline, rifampin, barbiturates, and some antiepileptics. On the other hand, OCs decrease the effects of insulin and oral hypoglycemics, oral anticoagulants, and guanethidine. In addition, OCs can increase the risk of certain nutritional deficiencies, primarily of folic acid and vitamins C, B2, B6, and B12.
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PMID:The pill, the patient, and you. 338 42


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