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

User compliance is not a problem for the recently approved subdermal, longterm contraceptive delivery system, Norplant. It delivers 50-80 mcg of levonorgestrel/day during the 1st year and 30-35 mcg for years 2-5. The levonorgestrel is encased in 6 36 mm x 2.4 mm capsules which are placed in the upper arm in 5-10 minutes using local anesthesia. Since the implants systemically release levonorgestrel, the shock to the liver experienced in oral contraceptive (OC) users does not occur. Levonorgestrel prevents pregnancy by decreasing luteinizing hormone and follicle stimulating hormone which prevents ovulation, reducing the rate of ovum transfer in the tube, making the endometrium incompatible for implantation, and making the cervical mucus too thick and scanty for sperms to migrate if ovulation does occur. 1-year pregnancy rates for Norplant users are much lower than for women who use other contraceptives (0.6/100 users vs. 2.3/100 for OC users and 2.4/100 for IUD users). The ectopic pregnancy rate is also low (1.47/1000 Norplant users). The 1-year continuation rate is 80% compared with 50% for OC users. Fertility returns within 3 months for 50% of users and within 1 year for 80%. Because Norplant does not adversely affect lipid metabolism there is no increase in the risk of atherogenesis. Menstrual irregularities are the leading side effect of Norplant. The irregular cycles tend to occur during the 1st 3-6 months after insertion. Other side effects include headaches, acne, breast discharge, weight gain, and transient ovarian cysts. Contraindications are abnormal uterine bleeding, possible pregnancy, active liver disease, and women taking phenytoin. The cost for the initial exam and insertion of the Norplant capsules is $500 at Planned parenthood of the Rocky Mountains in Colorado (mean=$8.30/month vs. $13/month for 5 years of taking OCs). Due to the possibility of exploitation of women and involuntary infertility, nurse practitioners must thoroughly explain the system to each patient and answer all questions so the patient can give informed consent.
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PMID:New concepts in contraception: Norplant subdermal implant. 156 6

A lack of uniform methodology used by different authors in the assessment of different puncture techniques in spinal anesthesia formed the basis of the current study, which compared under randomized conditions the incidence of post spinal headache after a median or paramedian (lateral) approach. MATERIALS AND METHODS. Two hundred and fifty ASA physical status II and III patients, aged 50-85 years, scheduled for transurethral prostate surgery under spinal anesthesia were investigated. The patients were comparable with regard to weight and height (Table 1). No premedication was given and, 30 min prior to surgery, all patients received normal saline 400-500 ml i.v. The patients were randomly divided into two groups of 125 patients each to receive 4 ml 0.5% bupivacaine in 5% glucose (specific gravity 1.017 at 20 degrees C) using the median or paramedian (lateral) approach according to the following scheme (Table 2): I: 4 ml 0.5% bupivacaine/median approach; II: 4 ml 0.5% bupivacaine/paramedian approach. The study was carried out in a double-blind fashion. Neither the patient nor the investigator evaluating the post spinal headache was aware of which technique had been used. Lumbar puncture was performed by a midline approach at the L3-4 interspace using a 25-gauge (Whitacre) spinal needle with the patient in the sitting position group I. The bevel of the spinal needle was directly laterally, so that the dural fibers that run longitudinally were spread rather than transected. When using the paramedian approach (group II), patients were placed in the flexed lateral decubitus position and the spinal needle inserted 1 cm medial and 1 cm lateral and caudad to the lowest part of the posterior superior iliac spine and then directed medially and cephalad at an angle of 55 degrees into the subarachnoid space. Postoperatively, patients were allowed to move as soon as possible; no prophylactic bed rest was ordered. Starting from the 1st postoperative day, patients were evaluated by an independent observer and asked whether they were suffering from any problems concerning anesthesia. Typical post-puncture headache was defined as invariably bifrontal and occipital, frequently involving the neck and upper shoulders, and being aggravated by the upright position. Statistical analysis of the data was performed using the Mann-Whitney rank-sum test for unpaired samples. A P value of less than 0.05 was considered statistically significant. RESULTS. Twenty-six of 250 patients (10.4%) developed post spinal headaches. Comparing both groups, 11/125 (8.8%) patients in the median group (group I) versus 15/125 (12%) in the paramedian group (group II) had typical post-puncture headaches. Within the group of patients aged 50-60 years, the paramedian approach (group II) showed a significantly higher headache rate compared with group I (P less than 0.05). Neurologic sequelae were not observed; 6 patients received epidural injections of autologous blood while the rest of the patients suffering from post spinal headache were treated conservatively with bed rest, analgesics, and fluids. CONCLUSIONS. The results indicate that the incidence of post spinal headache is higher in younger patients when using the paramedian (lateral) approach. However, our findings suggest that the choice of lumbar puncture technique--median or paramedian--is of little importance in regard to post-puncture headache in elderly patients. The paramedian approach is especially useful when degenerative changes are encountered in the interspinous structures in elderly patients, when an ideal position is difficult to achieve.
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PMID:[Post spinal headache. Its incidence following the median and paramedian techniques]. 157 Aug 86

Post-dural puncture headache (PDPH) is a significant and well-known complication of procedures that perforate the dura mater, e.g., clinical spinal anaesthesia (SpA). The exact mechanisms leading to PDPH are still not completely understood, although several factors, particularly the patient's age, modulate the incidence. In young patients (20-30 years) previous studies reported high occurrences of PDPH in 6%-16% of cases [5, 8], decreasing the value and acceptance of SpA in this patient group. This study was undertaken to reevaluate under reproducible study conditions the incidence of PDPH and other side effects due to SpA in a larger and more homogeneous patient group. METHODS. Two hundred and two male patients between 19 and 30 years of age were included in this study. The standard anaesthetic technique consisted of oral premedication (1 mg flunitrazepam), preanaesthetic intravenous hydration with at least 0.5 l Ringer's lactate, monitoring of vital signs, and a standard lumbar puncture (lateral position, L2/3 or L3/4 interspace, 25-gauge spinal needle, parallel bevel direction). Anaesthesia was achieved using 12.5 mg hyperbaric 0.5% bupivacaine. Anaesthetic level, onset, and duration (pinprick method) and intraoperative events were recorded. Patients were randomly immobilised for either 6 or 24 h postoperatively. Patients were visited on the 2nd, 4th, and 7th postoperative day to ascertain the occurrence of PDPH and further anaesthesia-related complications. RESULTS. The 202 patients studied had homogeneous demographic characteristics (Table 1). During surgery (average duration: 36 min +/- 18; 10-100 min) with satisfactory anaesthetic levels 1 patient demonstrated a high spinal block (T1). Intraoperatively, a significant decrease in blood pressure was noted in 5 patients (2.5%) and bradycardia in 24 (11.9%). Ten minutes after local anaesthetic instillation the sensory block reached an average level of T10 and had ascended to T8 after 25 minutes (start of surgery). During the three postanaesthetic visits PHPD was present in 7 cases (3.5%); 3 other patients had non-PDPH "tension" headaches (1.5%). All PDPHs occurred on the first 2 postoperative days with a maximum duration of 4 days (1 patient). Treatment consisted of bed rest, hydration, and/or oral analgesics. No patient developed any neurologic sequelae. Moderate back pain (12.4%) and urinary retention (2.5%) were the other postoperative complications. The duration of prophylactic postoperative immobilisation had no obvious impact on PDPH occurrence. Our patients' acceptance of SpA was very high; 98.5% of them would favour SpA for future surgery. DISCUSSION. In contrast to previous studies reporting a high incidence of PDPH (6%-16%) in young adults, we found, in a stringent investigation of a large number of comparable patients in a defined age group, a PDPH rate of 3.5% and a few other minor side effects together with good anaesthetic quality, intraoperative stability, and excellent patient acceptance. Although future studies are needed to further minimise SpA complications, we found SpA a safe anaesthetic technique in our well-defined patient group.
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PMID:[The incidence of post spinal headache in a group of young patients]. 157 Aug 87

Seven hundred thirty ambulatory surgery patients, randomly assigned to receive spinal anesthesia with a 26- or 27-G needle, were studied for the incidence of post-dural puncture headache (PDPH), postoperative back pain, and patient acceptance. The incidence of PDPH following the use of 26- and 27-G needles was 9.6% and 1.5%, respectively (P less than 0.05). The incidence of PDPH was 5.7% among men and 13.4% among women following the use of 26-G needles (P less than 0.05), whereas no difference between men and women was noted after the use of 27-G needles. Of the patients who were 40 yr of age or younger, the overall incidence of PDPH was 11.9%, with a 7.5% incidence among men and a 16.4% among women following the use of 26-G needles (P less than 0.05) and a 1.8% incidence of PDPH following the use of 27-G needles, with no statistical difference between genders. Postoperative back pain was experienced in 18.3% of the patients in the 26-G group and 20.2% in the 27-G group (difference not significant). Favorable acceptance of spinal anesthesia was reported in 89.4% of patients in the 26-G group and 98.2% in the 27-G group (P less than 0.01). Results from this study demonstrate that, in patients who received spinal anesthesia for ambulatory surgery, the use of 27-G needles resulted in a significantly lower incidence of PDPH and greater patient acceptance compared with the use of 26-G needles. The incidence of postoperative back pain was not significantly different between the two groups.
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PMID:Comparison of 26- and 27-G needles for spinal anesthesia for ambulatory surgery patients. 157 41

Interest in the use of continuous spinal anaesthesia (CSA) has recently increased because of the availability of new, extremely thin catheters. In this study the use of 32-gauge (G) catheters was compared with 22-G catheters in operations on the lower limb and for the administration of intrathecal morphine in the postoperative period in 42 elderly patients. CSA succeeded in 34 cases and 8 patients were anaesthetised with a single-shot spinal method. No general anaesthesia was needed. Technical problems with the subarachnoid puncture with the 19-G needle caused two failures in the 22-G group. In a group of 20 patients, there were five failures with the 32-G catheter, as opposed to one failure with the 22-G catheter in a group of 20 patients. Associated with morphine injection through the 32-G catheter, the syringe or connector was inadvertently disconnected in four cases and a tear of the catheter wall was observed in one case. Such problems did not occur with the 22-G catheter. Postdural puncture headache did not occur, and there was no difference in the incidence of patient-reported postoperative complications between the two groups. It is concluded that both the insertion and maintenance of the thin (32-G) subarachnoid catheters are associated with more technical problems than the 22-G catheter.
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PMID:Technical problems associated with the use of 32-gauge and 22-gauge spinal catheters. 159 33

BACKGROUND. Dural puncture secondary to spinal anesthesia or unintentional dural puncture during attempted epidural anesthesia can lead to headaches complicated by bilateral subdural hematomas. Routine computed tomography scan may not elucidate bilateral subdural hematomas in the isodense phase. CONCLUSION. Computed tomography scans with contrast media or magnetic resonance imaging may be necessary to diagnose bilateral subdural hematomas.
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PMID:Bilateral subdural hematomas after dural puncture: delayed diagnosis after false negative computed tomography scan without contrast. 159 97

From March 1, 1990 to August 31, 1991, there were four hundred and forty eight female patients undergoing major lower abdominal obstetric and gynecologic operations in our hospital. The most frequently performed operation in our series was Cesarean section (80.8%). Besides, there were operations for ectopic pregnancy, ovarian cyst, fallopian tube problems and abdominal total hysterectomy as well as radical hysterectomy for cervical cancer. Most of the operations were done under spinal anesthesia (91.3%). The rest were performed under epidural anesthesia (2.2%), general anesthesia (4.9%) or a combined anesthetic technique (1.3%). On one occasion, a Cesarean section was done during cardio-pulmonary resuscitation in the emergency room. Another parturient developed cardiac arrest during spinal anesthesia for Cesarean section with successful resuscitation. Otherwise, only minor complications such as post dural puncture headache (6.4%), nausea and vomiting (13.51%) and hypotension (38.2%) were found. All complications responded to conservative therapy that no prolonged hospitalization or unacceptable Apgar score in the newborns was noted. In addition, intra-operative blood transfusion was a rare occurrence. Thus, spinal anesthesia is a safe, effective, simple and inexpensive anesthetic method for major obstetric and gynecologic operations particularly in a rural hospital.
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PMID:Evaluation of anesthesia for obstetric and gynecologic intra-abdominal pelvic surgery in a rural hospital. 160 17

We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5%), cranial nerve compression (87.5%), decreased visual acuity (20%), ruptured aneurysm (15%) and 5% were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia: a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria included xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their aneurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permanent and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated.
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PMID:Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects, cerebral monitoring, and results. 163 Jun 21

Application of a solution of 1-glutamine, 75 mM, to the pia-arachnoid surface of the dorsolateral neocortex of rabbits under dial-urethane anaesthesia was found to reversibly render the tissue insusceptible to spreading depression. It is suggested that this amide may play a part in the opposition normally offered by the tissue to undergo spreading depression. Some evidence is adduced which seems to support this suggestion.
Cephalalgia 1991 Sep
PMID:A note on the action of glutamine on cortical spreading depression. 174 76

A retrospective study was undertaken in patients who received spinal anesthesia in past two years in order to find out the incidence of post-spinal headache. There were 3729 cases, 1997 males and 1732 females. Seventy-two patients were noted to have post-spinal headache of whom twelve were male and sixty were female. The overall incidence was 1.93%. Incidence was 0.6% and 3.5% in male and female groups respectively. With respect to the type of surgical procedures in female group, patients undergoing Cesarean section had a higher incidence than those who received other surgical procedures, being 4.8% and 1.5% respectively. In conclusion, female patients were noted to have higher incidence of post-spinal headache, particularly in patients undergoing Cesarean section.
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PMID:Incidence of post-dural puncture headache with 25-gauge Quincke spinal needle. 175 45


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