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

This paper reports the phenomenon of dependence to a somatostatin octapeptide analog used for the treatment of acromegaly and severe headache. The mechanism of this dependence is still unknown, but could be based on the interaction of the somatostatin analog with opioid receptors. Analgesia may be at least partially supported by the opioid modulation of pain transmission, but also by general "appetitive" behavioral activation due to the effect of somatostatin on its receptors.
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PMID:The development of dependence to an octapeptide somatostatin analog: contribution to the study of somatostatin analgesia. 254 10

In this study we have examined the results of salmon calcitonin treatment on migraine pain. The mechanism by which calcitonin induces analgesia is still not understood. We observed the effect of a 5-day treatment with salmon calcitonin (IM 100 IU/day) on circulating levels of beta-endorphin, ACTH, and cortisol in 20 patients with migraine during the headache-free period. All 3 hormones were increased after the calcitonin administration and the maximum increase was obtained in beta-endorphin levels. There were significant statistical correlations between beta-endorphin, ACTH, and cortisol levels determined before and after calcitonin treatment.
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PMID:Treatment of migraine with salmon calcitonin: effects on plasma beta-endorphin, ACTH and cortisol levels. 256 Apr 8

In this report we describe a patient who developed severe headache following uneventful continuous epidural analgesia for labour and delivery. Initially it was thought that she had a spinal headache. However, with the aid of Magnetic Resonance Imaging the diagnosis of cerebral venous thrombosis was later established. The entity of cerebral venous thrombosis, its manifestation, pathology, diagnosis and treatment are discussed.
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PMID:Postpartum headache following regional analgesia; a symptom of cerebral venous thrombosis. 258 69

To study the effect of needle bevel direction on the incidence and severity of headache following inadvertent dural puncture occurring during the identification of the epidural space, the authors randomly assigned obstetric anesthesia residents to identify epidural space with the bevel of the epidural needle oriented either parallel or perpendicular to the longitudinal dural fibers. If dural puncture occurred, an observer unaware of the needle bevel direction, daily assessed the presence and severity of any subsequent headache. Of the 1,558 women who received epidural analgesia during this study, 41 women suffered dural puncture, 20 with the needle bevel oriented perpendicular to the longitudinal dural fibers and 21 with the needle bevel inserted parallel to the dural fibers (NS). Fourteen of 20 women in the group in which the needle bevel was perpendicular to dural fibers developed a moderate to severe headache, whereas only five of 21 in the group in which the needle bevel was parallel to dural fibers did so (P less than 0.005). Similarly, we administered a therapeutic blood patch to ten of 20 women in the perpendicular group but to only four of 21 in the parallel group (P less than 0.05). Thus, identifying the epidural space with the needle bevel oriented parallel to the longitudinal dural fibers limits the size of the subsequent dural tear and, therefore, lowers the incidence of headache should dural perforation occur.
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PMID:Needle bevel direction and headache after inadvertent dural puncture. 280 29

The side-effects of two opioid agonist-antagonists, nalbuphine and pentazocine, were assessed when used for patient-controlled postoperative analgesia. Forty ASA I or II patients scheduled for upper abdominal surgery were randomly allocated to two equal groups. The anaesthetic technique was the same for all the patients: premedication with atropine and diazepam, induction with thiopentone and suxamethonium and maintenance with fentanyl, pancuronium, nitrous oxide and halothane. Patient-controlled computer assisted analgesia (On-Demand Analgesia Computer) was started in the recovery room at least 2 h after the last administration of fentanyl. The parameters used were: a routine hourly dose (the half of that received during the previous hour), with on demand delivery of nalbuphine (15 micrograms.kg-1) or pentazocine (45 micrograms.kg-1) aliquots respectively, with a refractory period between two demands of 4 min and a total hourly maximum dose of 16 mg and 48 mg respectively. The following parameters were measured before the start of self-administration, and every hour afterwards for 24 h: systolic (Pasys) and diastolic blood pressures, heart rate, pressure-rate product (PRP), respiratory rate, end-tidal CO2 and pain (by way of a three point scale). Analgesia was assessed on a four-point scale every 6 h. The total doses of nalbuphine and pentazocine administered were 94 +/- 43 mg and 251 +/- 150 mg respectively. The only parameters significantly different between the two groups were Pasys and PRP, being higher in the pentazocine group. There were no significant differences in the side-effects (drowsiness, nausea, vomiting, headache, amnesia, logorrhoea and urine retention). All patients in both groups were satisfied with this technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparison of nalbuphine and pentazocine in the treatment of postoperative pain by self-administration]. 266 Jun 40

In two randomised, double-blind studies of elderly patients with a mean age of 68.9 (range 21-88) years and young patients, mean age 29.4 (range 20-40) years, the effect of needle size on the incidence of postspinal headache was compared. The two needle groups, 20- and 25-gauge, were comparable in both studies with regard to number, sex, age and type of surgery. The incidence of postspinal headache in young patients was 27.6% when a 20-gauge needle was used and 12.6% with a 25-gauge needle. There was no significant difference in either the incidence of headache in the elderly patients (10.8% and 7.8%, respectively) or between the sexes. It is concluded that it does not matter if a 20- or a 25-gauge needle is used for spinal analgesia in elderly patients with regard to postspinal headache, but if spinal analgesia is indicated in young patients a fine needle is preferred.
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PMID:Postspinal headache in young and elderly patients. Two randomised, double-blind studies that compare 20- and 25-gauge needles. 240 Apr 34

Naloxone per se causes no pain in normal man, indicating that opioidergic antinociceptive systems are not tonically active, but this might not be the case in chronic pain conditions. The present investigation tested the hypothesis that pain in chronic headache is the result of insufficiently attenuated nociceptive impulses. Forty-seven patients suffering from chronic tension headache entered the present double-blind cross-over trial of naloxone 4 mg i.v. versus saline. Adverse effects were negligible. Patients scored headache pain on a 100 mm visual analog scale and change in headache on a 5-point verbal rating scale after 5, 15, 30, 60 and 90 min. Mean arterial blood pressure decreased 4.2 mm Hg (P less than 0.05) after naloxone compared to saline, but naloxone had no effect on headache (P = 0.96). A bimodal distribution of acute pain patients into placebo responders and non-responders has been reported, but our chronic pain patients showed a homogeneous placebo response. Review of the literature indicates that acute clinical pain and stimulation-induced analgesia in experimental pain has a naloxone-responsive component. Chronic pain does not appear to be influenced by naloxone in moderate doses.
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PMID:Naloxone in moderate dose does not aggravate chronic tension headache. 268 74

The use of subarachnoid anesthesia in Cesarean section in spite of its long history only now gains popularity. It is due to better knowledge of physiology and anatomy of a pregnant woman an the use of new local anesthetics and better needles for spinal anesthesia in clinical practice. Analgesia comprising segments Th4-S5 of the spinal cord provides painless operation and good muscle relaxation. In spinal anesthesia, unless there is arterial hypotension, intervillous flow increases. It is very important to prevent the syndrome of inferior caval vein by means of sloping the operating table by 15-20 degrees to the left, proper hydrating the patient, putting a wedge under the right hip, shifting the uterus to the left or putting the patient on right or left side. Analgesia consists in administering a local anesthetic into subarachnoid space. In this kind of analgesia the time elapse between the incision of skin and that of uterus muscle does not have a significant influence on the condition of newborns, which is contrary to general anesthesia. The time elapse between the incision of uterus muscle and extracting the fetus is a very significant factor both in spinal and general analgesia. The course of analgesia is very much influenced by preventing hypotension. It is done by fast infusion of 1500-2000 ml of electrolyte fluids within about 20 min., and the use of ephedrine. The prophylaxis of headaches consists in the use of very thin needles in spinal anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Subarachnoid anesthesia in cesarean section]. 269 61

A transdermal formulation of fentanyl (TTS-fentanyl, Alza Corp., Palo Alto, CA) was evaluated in 13 surgical patients after an abdominal operation. An intraoperative dose of fentanyl (100-200 micrograms i.v.) was administered at the same time as the TTS-fentanyl systems (50-125 micrograms/h) were applied to the antero-lateral chest wall. The TTS-fentanyl systems remained in situ for 24 h and were then removed and a second lot of systems were applied to the contra-lateral chest wall. There was a mean (S.D.) delay time of 12.7 (9.6) h before minimum effective blood fentanyl concentrations (MEC) were obtained from the systems and pseudo-steady state was reached between 36 and 48 h. There was a decay time of 16.1 (7.1) h after the systems were removed for the blood fentanyl concentration to decrease to less than the mean MEC for the control of postoperative pain. There was marked variability between patients in the actual hourly fentanyl dose rate determined from the residual amount of fentanyl remaining in the system and the duration of application. Significantly more supplementary pethidine was administered for inadequate postoperative analgesia between 0 and 12 h compared to the 12-24, 24-36 and 36-48 h periods; this was consistent with the observed delay time. Three patients required a reduction in the hourly fentanyl dose rate because of bradypnoea while 1 patient required an increase in dose because of inadequate pain relief. Nausea was the most frequently reported side effect (85% of patients) while bradypnoea, drowsiness, unpleasant dreams and headache were also reported. These effects were due to the combined effects of a sustained blood fentanyl concentration and the intermittent supplementary pethidine doses. Side effects due to the topical formulation were transient and included erythema (8 patients) and a minor rash (2 patients) in the area occluded by the systems. The TTS-fentanyl systems provided a significant contribution to postoperative pain control but, at the TTS dose rates used, supplementary doses of pethidine were required by all patients probably to control 'incident' pain.
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PMID:The transdermal administration of fentanyl in the treatment of postoperative pain: pharmacokinetics and pharmacodynamic effects. 274 92

The obstetrical anaesthesia experience of the Winnipeg Women's Hospital from 1975 to 1983 was reviewed (n = 22,925 infants). Use of narcotics in labour for analgesia decreased from 38.7 to 18.3 per cent of the deliveries. For analgesia during spontaneous vaginal deliveries, epidural anaesthesia increased from 6.0 to 24.0 per cent, inhalational analgesia decreased from 53.7 to 3.2 per cent while "no anaesthetic intervention" rose from 40.3 to 72.8 per cent. Use of epidural anaesthesia for Caesarean section increased from 58.7 to 82.6 per cent. The most common acute complications of anaesthesia were hypotension and inadvertent dural puncture during epidural catheterization. The incidence of hypotension decreased from 28.3 to 17.4 per cent during the nine-year period. Dural puncture decreased from 4.7 to 1.1 per cent of all epidural administrations. Postpartum complaints (that were thought to be related to anaesthesia) were mainly headache, back pain and sore throat. The incidence of these complaints also decreased over the study period.
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PMID:Obstetrical anaesthesia at Winnipeg Women's Hospital 1975-83: anaesthetic techniques and complications. 288 48


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