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

BACKGROUND. Pneumocephalus developed in a 45-year-old woman after epidural anesthesia was performed to treat her low back pain. The cause was thought to be the loss of resistance to air technique. The clinical symptoms were immediate headache independent of posture, pallor, bradycardia, and hypotension. These symptoms disappeared during the first 24 hours with no neurologic sequelae. CONCLUSION. This case suggests that using the loss of resistance technique with saline versus air should prevent this complication, especially after unintentional dural puncture or when, in difficult placements, the technique is repeated frequently in the same patient.
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PMID:Pneumocephalus after accidental dural puncture during epidural anesthesia. 820 69

Open non comparative study for the evaluation of the efficacy and tolerability of the new piroxicam formulation, the Fast Dissolving Dosage Form tablets for sublingual administration in the treatment of primary dysmenorrhea. The 54 patients enrolled in the study have been treated with piroxicam sublingual tablets: 40 mg single daily dose for the first two days and 20 mg for the following three days for a total of 5 days of therapy to be repeated for two consecutive menstrual cycles. The drug efficacy was evaluated on the basis of variation of intensity in pain and associated symptoms, as cephalgia, nausea, vomiting, etc. The ability to perform normal daily activity has also been evaluated. The intensity of spontaneous pain in the first and second cycles showed a statistically significant improvement (p = 0.0001) only 15 minutes after drug administration. This improvement increased in the first and in the following days. The relief from pain was stronger in the second cycle, in fact none of the patients had to assume a further analgesic drug, as happened during the first cycle of therapy. As regards the symptoms associated to pain, as cephalgia and low back pain, they significatively decreased starting from the first cycle of treatment. The improvement became more marked during the second cycle of therapy. Local and systemic tolerability was good. Only 5 patients experienced systemic side effects in the first cycle, and 12 in the second cycle. Three patients experienced local side effects in the first cycle, and 1 in the second cycle. These effects were well tolerated and did not cause the treatment discontinuation. Moreover, most of the side effects occurred, as nausea and diarrhoea, are symptoms commonly associated to dysmenorrhea. In conclusion, piroxicam fast dissolving dosage form for sublingual administration, in the treatment of primary dysmenorrhea, showed its analgesic efficacy 15 minutes after the drug administration. It has also a good local and systemic tolerability.
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PMID:[Primary dysmenorrhea treated with sublingual piroxicam]. 841 45

In 184 adult patients with severe nonmalignant low back pain from postlaminectomy syndrome, temporary lumbar epidural catheters were infused with either 0.25% bupivacaine 92 mL, fentanyl 600 micrograms, and droperidol 5 mg (Group A), or 0.25% bupivacaine 92 mL, fentanyl 600 micrograms, and NaCl 0.9% 2 mL (Group B). Infusion rates ranged from 0.5 to 2 mL per hour, with an option for turning the infusion off when the patient had no pain and turning it on when the pain returned. Infusions were continued from 2 to 55 days, during which time the patient was at home. In Group A, only two patients had nausea without emesis, while in Group B, nausea occurred in 18 patients (P < 0.04) and four vomited (P < 0.05). The number of patients with headache, pruritus, somnolence, and/or numbness was minimal and without statistically significant group differences. During treatments, pain levels were 2 or less on a 10-cm visual analogue scale. Added to the epidural infusate, droperidol appears to significantly reduce nausea and vomiting in ambulatory patients receiving fentanyl and bupivacaine in extended epidural infusions. The possibility that droperidol potentiates analgesic effects could not be evaluated.
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PMID:Reduction of nausea and vomiting from epidural opioids by adding droperidol to the infusate in home-bound patients. 853 96

The family climate in 36 families, comprising 154 individuals, was investigated. The objective of this study was to compare families where the mother suffered from chronic headache to families with pain-free mothers and to those where the mother suffered from chronic low back pain. The Family Environment Scale (FES) was used to evaluate the family climate in these 3 groups as perceived by the members of the family. The results in sufficiently standardized groups show a significantly reduced intra-family openness (P < 0.0001) in families where the mother suffered from chronic headache. Both pain groups were less active in their leisure time than the pain-free families. Based on the findings of the present study, the impact of the psychosocial environment as a novel normative value for chronic pain syndromes is discussed in relation to the need for further research and treatment modalities.
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PMID:Differences in family functioning between patients with chronic headache and patients with chronic low back pain. 862 88

In a prospective study lumbar iohexol myelography was performed in 107 consecutive patients, randomised for lumbar puncture with a Quincke or Whitacre spinal needle. All patients answered a questionnaire about possible side effects. Data from 100 patients (58 men, 42 women) were evaluated. In the Quincke group (n = 53), 23 (43%) reported no side effects. In the 30 patients who reported various side effects, post-dural puncture headache (PDPH) occurred in 22 (42%), of whom 9 had mild, 6 moderate and 7 (13%) severe cephalalgia, 18 (34%) reported increased low back pain/sciatica, 5 nausea and 7 dizziness. In the Whitacre group (n = 47), 33 (70%) had no side effects. PDPH was reported by 9 patients (19%), of whom 2 had mild, 6 moderate and only 1 (2%) severe cephalalgia, 4 (9%) reported increased low back pain/sciatica, 5 nausea and 4 dizziness. The conclusion drawn from this study is that lumbar myelography performed with the Whitacre spinal needle reduces postspinal side effects.
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PMID:Use of a 22-gauge Whitacre needle to reduce the incidence of side effects after lumbar myelography: a prospective randomised study comparing Whitacre and Quincke spinal needles. 879 76

A comparison of a 25 G with a 29 G Quincke needle was performed in paediatric day case surgery. Sixty healthy children aged 1 year to 13 years were randomly allocated to have spinal anaesthesia with either 25 G or 29 G Quincke needle without an introducer needle. There was a failure rate of 10% with the 29 G spinal needle compared with 0% with the 25 G needle. The time needed to perform dural puncture was shorter using 25 G than 29 G needle, 22 (+/- 31)(SD) vs 59 (+/- 63) s. The time taken for cerebrospinal fluid to appear at the needle hub was also longer, 4 (+/- 3) vs 8 (+/- 5) s. The number of puncture attempts was similar, 1.2 (+/- 0.6) vs 1.4 (+/- 0.8), with 25 G and 29 G needle. Low back pain, 5 vs1, and nonpositional headache, 2 vs 4, after 25 G and 29 G needles, respectively, were the most frequent postoperative complaints. Mild postdural puncture headache occurred in one eight year old male patient in the 25 G group. In conclusion, lumbar puncture without introducer needle was possible with both needles. The puncture characteristics favoured the 25 G needle. A shorter needle could partly alleviate the difficulties with the 29 G needle.
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PMID:Comparison of 25 G and 29 G Quincke spinal needles in paediatric day case surgery. A prospective randomized study of the puncture characteristics, success rate and postoperative complaints. 884 76

202 children aged 2 months to 17 years, undergoing elective paediatric operations below the umbilicus, were allocated randomly to receive either spinal (SA) or epidural anaesthesia (EA). SA was more efficacious since 8 children of 102 needed supplementation with general anaesthesia, in contrast to EA where 24 children of 100 were supplemented with general anaesthesia and 6 with fentanyl. The haemodynamic stability was maintained during EA, whereas during SA 6 patients were given medication to increase heart rate/blood pressure. EA provided longer pain relief than SA in the recovery room. The incidence of postoperative side effects was similarly low following SA and EA. Complaints after discharge were also similar. General weakness (7% vs 8% after SA and EA, respectively), low back pain (6% vs 6%), headache (7% vs 4%), fever (6% vs 4%) and positional headache (PDPH) (5% vs 3%) were the most frequent side effects. PDPH was only observed following SA in children aged 11 years or older. Following EA, PDPH was also observed in the younger age group after accidental dural puncture. In conclusion, we prefer SA for minor paediatric operations due to its high efficacy.
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PMID:Comparison of spinal anaesthesia with epidural anaesthesia in paediatric surgery. 884 88

Although headache is among the most common pain complaints seen by physicians, the measurement of health-related quality of life (HRQoL) in headache patients is in its earliest stages. Two types of questionnaire have been used to measure HRQoL in headache sufferers: general and disease-specific instruments. General quality-of-life (QoL) instruments use scales to assess QoL with respect to a number of activities within physical, social, psychological, and behavioral life domains. Disease-specific instruments reflect particular limitations or restrictions associated with specific disease states. These instruments are designed to be most sensitive in determining the effects of treatment or the longitudinal course of disease. Data from the Medical Outcomes Study Short Form (SF)-20 and SF-36 generic QoL instruments demonstrated that chronic headache disorders were associated with significant limitations in all eight health domains of patient wellbeing and functioning. The SF-20 outcomes profiles for each of the common benign headache disorders (migraine, tension-type headache, mixed headache, and cluster headache) appear to be unique for the specific headache diagnosis. The SF-20 and SF-36 were also used to compare headache disorders with other chronic illnesses. Chronic headache disorders, including migraine, were found to cause significantly more impairment of function than diabetes, hypertension, osteoarthritis, and low back pain. Preliminary studies of QoL during pharmacologic therapy have suggested that disease specific instruments may be more sensitive than generic instruments for evaluating the longitudinal impact of treatment. Generic QoL instruments, such as the SF-20 or SF-36, may be more useful to define populations being studied than to measure changes in the population over time. The publication of headache-specific QoL instruments, which have been widely used in clinical trials and have been validated, is awaited. Until such time, the SF-36 will remain the standard measure of QoL in headache.
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PMID:Evolution of the measurement of quality of life in migraine. 907 Dec 64

Patients suffering from vascular disease are often a challenge for the acute pain service. Ischaemia, impaired wound healing, stump and phantom limb pain often require a complex analgesic regimen. Invasive measures such as spinal or epidural catheters can be very helpful but carry the risk of infection, as shown by this case report. A 53-year-old woman with a ten-year history of diabetes developed arterial vascular disease. Her right lower leg had been amputated two years previously. She was now admitted with necroses of the left forefoot. A bypass operation was performed under general anaesthesia. Because of intractable ischaemic pain, she was provided with an epidural catheter by the acute pain service. The bypass occluded, however, and a few days later her left lower leg also had to be amputated, this operation being performed under epidural anaesthesia with bupivacaine. The catheter was subsequently used for postoperative pain control and as a means to prevent phantom limb pain. When signs of superficial catheter infection were noticed days later, the catheter was immediately removed. Intractable pain then developed in the left leg which could not be sufficiently controlled with opioids and NSAIDs, and so a second epidural catheter was inserted one segment rostrally. Several days later the infected vascular prosthesis had to be removed followed by amputation of the thigh, this operation also being performed in epidural anaesthesia. Eleven days after insertion of the first epidural catheter, the patient complained of low back pain and headache. Examination by a neurologist revealed no signs of intraspinal infection. The second epidural catheter dislocated at this point in time and it was decided to introduce a third one, this being the only means to treat the otherwise intractable stump pain. Ten days later meningism, Kernig's sign and leucocytosis developed. NMR tomography detected intraspinal fluid in the epidural space at the dorsal border of the spinal canal. A hemilaminectomy was performed. The spinal epidural space showed signs of inflammation of the adipose tissue, but no pus. A little necrotic material and residues of an old haematoma were removed and the epidural space was lavaged. Specimens taken from the epidural material revealed colonisation with staphylococcus epidermidis, which was sensitive to the broad spectrum antibiotics formerly given to the patient to treat the infection in the left stump. By the next day, all signs of epiduritis had disappeared and the patient recovered completely.
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PMID:[Epiduritis after long-term pain therapy with an epidural catheter--review of the literature with a current case report]. 932 67

This article reviews historical aspects and the following complications of lumbar puncture: cerebral and spinal herniation, postdural puncture headache, cranial neuropathies, nerve root irritation, low back pain, stylet associated problems, infections, and bleeding complications. The incidence of postdural puncture headache can be greatly reduced by pointing the face of the bevel in the direction of the patient's side, replacing the stylet and rotating the needle 90;dg before withdrawing the needle, and using the Sprotte atraumatic needle, especially in high risk patients.
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PMID:Complications of lumbar puncture. 942 42


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