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

This letter is in reply to a previous article of April 30 asking if oral contraceptives cause disease of the uterine arteries. The writer has found that changes in the small vessels of the endometrium are an early effect of taking oral contraceptives. Proliferation of endometrial arterioles has been related to headache and migraine incidence. Distended sinusoids have accompanied tiredness and dilated leg veins. Stromal condensation around sinusoids has been found with leg cramps. These changes have preceded thrombosis. It is thought that oral contraceptives cause generalized vascular overactivity. Symptoms are usually rapidly reversible on discontinuing the therapy. At an acute migraine clinic, oral contraceptives and smoking have been important contributing factors in patients requiring emergency treatment. Oral contraceptives are thought to be a more potent cause of bascular disease than smoking.
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PMID:Oral contraceptives and the uterine vessels. 87 84

The efficacy of the repetitive intravenous dihydroergotamine (DHE) inpatient protocol for refractory headache is well established. We conducted a retrospective and prospective study of long-term headache patients at our clinic to evaluate this regimen in an outpatient setting. Treatment consisted of oral metoclopramide and four doses of DHE, with the total dose equaling 4 mg., administered over two days. Patients were followed for up to 10 weeks while they continued to receive prophylactic medication. Responsiveness was rated in terms of decreased frequency or severity of headache: excellent (75% to 100%), moderate (50-75%), mild (25-50%), and none (0-25%). In the retrospective study, 69% (43/62) of patients with chronic daily muscle-contraction-type headache and severe migraine had an excellent response at two days. An excellent or moderate response was sustained over three weeks in 65% (32/49) of the study group (13 patients were dropped from the study for failing to comply with record keeping requirements). At the 6- and 10-week follow-up evaluations, the majority of patients (76% and 70%, respectively) reported mild or no relief. Among patients with refractory daily headache or frequent severe migraine studied prospectively, 80% (28/35) reported an excellent response at two days. After six weeks, 66% (23/35) showed excellent or moderate relief. For both groups combined, 73% (71/97) of patients showed an excellent response to DHE at two days, with 43% (33/77) sustaining excellent or moderate relief at six weeks. Side effects, including nausea, leg cramps, facial flushing, increased blood pressure, diarrhea, burning at the injection site, and tightness in the throat and/or chest, were generally mild and transient.(ABSTRACT TRUNCATED AT 250 WORDS)
Headache 1992 Oct
PMID:Outpatient repetitive intravenous dihydroergotamine. 144 90

We analyzed retrospectively the data for 300 patients with refractory headache who were treated with dihydroergotamine (DHE) at the Comprehensive Headache Center at Germantown Hospital. The patients had either chronic daily headache (with drug rebound -216, without rebound -42), short-duration headache (18), or cluster headache (24). Treatment consisted of withdrawal of overused medications (usually analgesics and ergots), repetitive IV administration of DHE, and use of metoclopramide and prophylactic medications, together with educational and psychological support. Overall, 91% (range, 86% to 100%) of the patients became headache-free, usually within 2 to 3 days. The average duration of hospitalization was 7.4 days. Side effects, reported in 157 (52%) of the patients, consisted primarily of nausea (32%), tightness and burning (8%), leg cramps (7%), vomiting (6%), and increased blood pressure (5%). The side effects generally resolved spontaneously or with adjustment of the DHE dose and/or adjunct medication, and necessitated withdrawal of therapy in only 2 patients (1 with drug-related claudication; 1 with somatic complaints of uncertain origin). We conclude that a regimen of repetitive intravenous DHE and metoclopramide can provide rapid relief of chronic intractable headache, and can ameliorate the effects of analgesic and ergot withdrawal in patients with chronic daily headache and rebound associated with overuse of these drugs.
Headache 1990 May
PMID:Repetitive intravenous DHE in the treatment of refractory headache. 237 Jan 32

Bumetanide was compared with furosemide in a total of 43 outpatients with edema due to renal disease, selected from three clinics following a uniform protocol. By random selection, 31 patients received 1 to 10 mg/day bumetanide, and 12 received 40 to 400 mg/day furosemide for at least six months. The patients were evaluated clinically, by standard laboratory tests, as well as by ECG, audiometry, eye examination, and mammary examination. Pooled statistical analysis of the results was done. Edema, body weight, and abdominal girth were reduced during both treatments. There was no significant difference in the mean response to the two diuretic agents by the two sided probability test in the other parameters studied, e.g., supine and standing blood pressure and pulse, serum electrolytes (sodium, potassium, chloride), and uric acid. There were no differences in liver function tests, hematology, or chest x-ray, and no remarkable effects on hearing. Gynecomastia improved in some patients while being treated with bumetanide after spironolactone was discontinued. Adverse reactions in patients on bumetanide which were considered possibly or probably related to the drug were muscle cramps (two patients); and vertigo, headache, muscle pain, urticaria, chest pain, arthritis, dehydration, postural hypotension, and leg cramps (one each). Laboratory abnormalities in both groups were generally those that could be attributed to the pharmacologic action of the diuretics or due to the patients' underlying disease states. No drug-related adverse effects were noted in ECG, ophthalmologic examinations, or chest x-rays. Two patients in the furosemide group had a probably or possibly drug-related loss of hearing sensitivity. In summary, bumetanide appeared to be as safe and as efficacious as furosemide in controlling edema and hypertension in patients with renal disease.
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PMID:Long-term bumetanide treatment of patients with edema due to renal disease. Cooperative studies. 704 Apr 92

Medroxyprogesterone acetate (MP) and norethindrone enanthate (NET) are used as depot preparations. Intramuscular injections of 150 mg MP are given every 12 weeks, and NET is administered in 200 mg dosages every 8 weeks for the first 4 intervals and every 12 weeks thereafter. These preparations prevent conception by inhibiting gonadotropin secretion (preventing ovulation), by making the cervical secretions impenetrable to sperm, and by affecting the endometrium to prevent nidation. The Pearl Index for these preparations when properly administered is less than 1. The most common side effect of using these preparations is menstrual irregularities; 71% of MP users and 47% of NET users never experience even 1 normal menstrual cycle per year. 35% of MP users and 9% of NET users do not experience a menstrual bleeding between the injections. Headache, depression, and leg cramps are other side effects of these preparations. Normal menstruation is observed about 8 months after discontinuing MP use and 3-6 months after NET use. These preparations do not affect lactation.
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PMID:[Depot gestagens as contraceptives]. 738 96

In a large, double-blind, multicentre study, 269 patients with confirmed endometriosis were randomly allocated to receive either danazol (200 mg twice daily; n = 137) or gestrinone (2.5 mg twice weekly; n = 132) for 6 months. The two groups were comparable in terms of the staging of endometriosis by the American Fertility Society (1979) score. After the sixth month of treatment, repeat laparoscopy was performed. Clinical assessment, haematological and biochemical investigations were carried out during the 6 months of treatment and for a further 12 months' follow-up and are compared between the two groups. A total of 15 patients from the gestrinone group, including four patients with hirsutism, and 17 patients from the danazol group, including six patients with headache, withdrew because of adverse symptoms. An additional 22 patients, including 10 from the gestrinone group and 12 from the danazol group withdrew because of lack of efficacy, pregnancy, elevated hepatic function tests or for reasons unrelated to the trial. Total American Fertility Society scoring showed an improvement of 73.3% in 101 patients receiving gestrinone and 72.7% in 99 patients receiving danazol. The results showed a significant reduction in the severity of dysmenorrhoea by the third month in the danazol group and at 6 months in both groups. There was a significant (P < 0.001) increase in weight observed in both groups during treatment. Overall, the tolerability of danazol and gestrinone was good; however, significantly more patients with gestrinone complained of hirsutism while significantly more with danazol complained of leg cramps. During the 12 months of follow-up, mild, moderate or severe degrees of lower abdominal pain, dysmenorrhoea and deep dyspareunia all fluctuated, with no statistically significant increase in frequency in either group.
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PMID:Updating the clinical experience in endometriosis--the European perspective. 757 49

The frequency and severity of physical and emotional menstrual symptoms were investigated with a cross-sectional study of 502 women not seeking treatment for menstrual symptoms. The most frequent symptoms were abdominal bloating, backache, headache, constipation, low abdominal pain, fatigue and symptoms related to depression. Some symptoms increased during the late luteal phase, and others were related to the women's life-style. Lack of schooling and living in rural areas were associated with headache, backache, sadness, insecurity, restlessness and weakness. Women from urban areas with more schooling had more breast tenderness, abdominal pain, irritability, depression, aggressiveness and increased sexual desire. Younger women had increased appetite, lack of concentration, insecurity, desire to be alone, weakness and dissatisfaction with their looks. Heavier women had more leg cramps, swollen feet, lack of coordination and polydipsia. Menstrual symptoms seem to be determined by the interplay of the menstrual cycle with biologic factors and life-style.
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PMID:Association of physical and emotional symptoms with the menstrual cycle and life-style. 833 24

Ten HTLV-I-associated myelopathy (HAM) patients (four men and six women aged 38 to 58 years) with Expanded Disability Status Scale (EDSS) scores ranging from 4.0 to 8.5 entered an open-label zidovudine study. A high-dosage induction (2 g/d for 4 weeks) was followed by 1 g/d for 20 weeks. Five patients were natives of the Caribbean island Hispaniola, and one each was from Colombia, Cuba, El Salvador, Jamaica, and the United States; all were positive by polymerase chain reaction, and nine had positive Western immunoblots for HTLV-I. Side effects included anxiety, insomnia, gastric upset, anorexia, and loss of taste. Preexisting leg cramps were increased in two and headaches in one. Hemoglobin decreased from a mean of 13.5 to 11.8 g/dl and the hematocrit from 40.7% to 34.9% at 8 weeks, and then stabilized. Neutropenia appeared regularly but did not necessitate drug withdrawal. Mean EDSS scores changed little for the group as a whole, but the seven ambulatory patients improved objectively, with their scores dropping from 5.5 to 4.0 and none worsening. Timed gait improved by at least 50%. Following withdrawal, four of the five who had improved regressed. Zidovudine appears to be safe in subjects with HAM who have no other major health problems and should be investigated further.
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PMID:High-dose zidovudine induction in HTLV-I-associated myelopathy: safety and possible efficacy. 841 77

Side effects associated with administration of repetitive intravenous dihydroergotamine (DHE) were prospectively studied in 72 patients with chronic daily headache who were hospitalized in a dedicated inpatient headache treatment program. All patients received 11 consecutive doses of DHE, starting with 0.25 mg and increasing by 0.25 mg up to a maximum dose of 1.25 mg, depending on side effects and/or headache relief. The adverse events were recorded after each dose administered. The great majority of patients (91.6%) reported at least one side effect. The most common were: nausea (72.2%), increase in previous headache (47.2%), lightheadedness (33.3%), "new" headache (27.8%), and leg cramps (23.6%). The overall number of side effect complaints did not increase proportionally with the strength of the dose of DHE administered. These complaints declined from the earlier to the later doses of DHE, except for leg cramps, which were more common with the later doses. Side effects determined the strength of subsequent doses of DHE in only 18.1% of patients. Only four patients had to have a decrease in dosage and none required termination of DHE due to side effects. Although repetitive intravenous DHE causes frequent side effects, they are usually mild and transient and decrease with subsequent doses, even at higher doses.
Headache 1996 May
PMID:Early and transient side effects of repetitive intravenous dihydroergotamine. 868 69

We reviewed data on 171 patients with refractory headache treated by continuous intravenous dihydroergotamine mesylate (i.v. DHE 45) and repetitive i.v. DHE and compared the efficacy of continuous i.v. DHE to repetitive i.v. DHE. One hundred (58.5%) patients had refractory chronic daily headache. Seventy-one (42%) had drug rebound headache. One hundred thirty-eight (81%) had refractory migraine without aura, and 28 (16%) had migraine with aura. Treatment consisted of either continuous i.v. DHE by infusion pump or repetitive i.v. DHE and withdrawal of excessively used analgesics, analgesic narcotics, ergotamines, or benzodiazepines. Eighty-nine (92.5%) patients treated with continuous i.v. DHE became headache-free; the majority, 62 (64.5%), within 3 days. Sixty-five (86.5%) patients treated by repetitive i.v. DHE became headache-free, 50 (66.5%) within three days. The average hospital stay for both treatment groups was 4 days. Twelve (12.5%) of the continuous group and 12 (16%) of the repetitive group were headache-free within 24 hours. The average length of time to become headache-free was similar for the two groups, 3.06 days for continuous i.v. DHE and 2.94 days for repetitive i.v. DHE. The most common side effect was nausea, followed by diarrhea, vomiting, and leg cramps. We conclude that DHE can be accurately and easily administered by continuous i.v. infusion pump, and that continuous i.v. DHE is a safe and efficacious mode of treatment producing results similar to repetitive i.v. DHE.
Headache 1997 Mar
PMID:Continuous intravenous dihydroergotamine in the treatment of intractable headache. 910 Mar 96


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