Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endogenous opioid peptides, by modulating the release of sympathetic transmitters, may play a role in the pathogenesis of migraine and related headaches which are considered hypernociceptive syndromes. Hypoendorphinaemia has been demonstrated in migraine attack. Captopril, a drug able to potentiate morphine analgesia in rats and inhibit enkephalinase in animals and in man, improves the clinical course of migraine. In the present research the cerebrospinal fluid and plasma beta-endorphin (beta-EP) levels have been evaluated following a single oral dose of captopril. The drug increased plasma beta-EP levels in migraine sufferers, and these data may be relevant in the mechanism of action of this drug in migraine and related headaches.
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PMID:Hypernociceptive syndromes and pharmacological inhibition of endogenous opioid degradation. 294 84

Two anaesthetic procedures that did not include nitrous oxide were compared in a randomised study of 50 patients for tympanoplasty and tympanoscopy: propofol given for induction and maintenance, and thiopentone-isoflurane given for induction and maintenance, respectively. Induction in the first group was with a bolus injection of propofol and the same agent was given for the duration of anaesthesia by continuous intravenous administration. Thiopentone was given until loss of the eyelash reflex and anaesthesia maintained with isoflurane 0.4-2.0%. Analgesia was achieved in both groups by fentanyl given intravenously and by local injection of mepivacaine with ornipressin. The two patient groups were analysed for age, sex and weight as well as for side effects during the induction, maintenance and recovery periods, such as coughing, vomiting, venous pain, spontaneous movements, singultus, headaches, dysrhythmias and psychic disorders possibly due to anaesthesia. Side effects were moderate in both groups. Recovery time was statistically significantly shorter in the propofol group and the patients in this group appeared to be much more aware after recovery than those in the thiopentone-isoflurane group.
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PMID:Recovery times and side effects after propofol infusion and after isoflurane during ear surgery with additional infiltration anaesthesia. 325 10

In a controlled study a single segment combined spinal epidural (CSE) block was compared with epidural block for cesarean section. Thirty healthy parturients were randomly divided into two groups. In both groups a T4 block was aimed at. Bupivacaine was used to provide analgesia in both groups. All patients receiving CSE block had good to excellent analgesia, while 11 patients (74%) receiving epidural block had similar pain relief. This was reflected in the requirement for additional analgesics, sedatives or N2O anesthesia. The muscular relaxation was also better following CSE block. The total dose of bupivacaine for a T4 block was three times larger in patients receiving only epidural block. The maternal and fetal blood bupivacaine levels were correspondingly about three times higher in the epidural group. Additionally, the incidence of maternal hypotension was higher in patients receiving epidural block. Apgar scores, blood gases and neurobehavioural evaluation did not show any differences between the two groups of neonates. No postspinal headache was noted. CSE block appears to combine the reliability of spinal block and the flexibility of epidural block while minimizing their drawbacks.
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PMID:Epidural versus combined spinal epidural block for cesarean section. 281 42

The care of burns to the head, face, and neck remains a challenge to the clinician. From 1978 to 1986, halo traction was used as an immobilizing device and as a protective frame for 31 patients with burns to the head (n = 8), face (n = 24), and neck (n = 28). The patients ranged in age from 8 months to 80 years (mean = 16 years) and had second- and third-degree burns covering a total body surface area of 8% to 75% (mean = 28%). The halo was used for an average of eight days (range one to 19 days) and served to immobilize and protect areas of fresh skin grafts, as well as to elevate and protect scalp donor sites (n = 10). Traction was initially used in patients who were confused and uncooperative, and in patients whose burns involved the neck to provide extension for prophylaxis against contractures. Treatment side effects included intermittent headache and backache, the latter occurring especially in the patients subjected to hyperextension. Eight patients (26%) complained of discomfort, which was reduced with adequate analgesia, sedation, and emotional support. The halo had to be removed from one patient after one day because of a loose pin, and in another patient after eight days because of the development of cellulitis at a pin site. Halo immobilization was used successfully to minimize graft loss in 30 of 31 patients.
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PMID:Halo immobilization in the treatment of burns to the head, face, and neck. 328 35

Seven therapy-resistant patients with cluster headache (six of whom were chronic) were treated by percutaneous retro-Gasserian glycerol injections under general anesthesia. In four of the patients immediate and complete relief of attacks was obtained. There was a close correlation between pain relief and the degree of ophthalmic sensory loss. Quantitative estimation of thresholds for thermal perception and pain showed a good correlation to clinically evaluated sensory loss. As the analgesia waned, headaches returned, and the glycerol injections had to be repeated. Two patients were still considerably improved after 5 1/2 and nearly 3 years, respectively. In the other patients the results were less satisfactory at long-term follow-up study. Pure glycerol is highly hypertonic, and the damage of the trigeminal nerve root may be due to this property.
Cephalalgia 1987 Mar
PMID:Retro-Gasserian glycerol injection in the treatment of chronic cluster headache. 349 42

The anesthetic effect of 2 ml of 5% lidocaine in 7.5% glucose (LG) or 5% meperidine in water were evaluated and compared in 40 ASA class 1 or 2 patients. Patients were randomly assigned to one of the two groups (20 patients in each) according to the anesthetic agent, which was injected into the lumbar subarachnoid space in the sitting position. The patients remained sitting for 5 min before being placed in the supine position. Times of onset of sensory and complete motor blockade were significantly more rapid with LG. The extent of maximum cephalad spread of analgesia and the time to maximum height of analgesia in the two groups were not different. Duration of analgesia at the T-7 (48.96 +/- 6.64 min with LG, 44.74 +/- 6.14 min with meperidine; means +/- SEM) and L-1 (94.37 +/- 7.42 min with LG, 76.19 +/- 5.64 min with meperidine) dermatomes was not different in the two groups but was statistically longer at the T-10 dermatome with LG (66.83 +/- 6.72 min) than with meperidine (46.66 +/- 6.26 min). The duration of complete motor blockade was also significantly longer with LG (66.44 +/- 7.05 min) than with meperidine (42.67 +/- 4.47 min). Complications in both groups included decrease in blood pressure and nausea and vomiting intraoperatively, and urinary retention, nausea and vomiting, and mild headache postoperatively. Complications that occurred only in the meperidine group were intraoperative drowsiness, respiratory depression, bronchospasm, and itching. The frequency of complications was greater wit meperidine.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Meperidine as a spinal anesthetic agent: a comparison with lidocaine-glucose. 354 85

Equal volumes (2.5 ml, 12.5 mg) of plain 0.5% bupivacaine (glucose-free) and hyperbaric 0.5% bupivacaine (in 8% glucose) were compared in a randomized double-blind study of 40 patients undergoing Caesarean section under subarachnoid anaesthesia. There were no differences in the rate of onset, maximum spread, number of patients with high cervical levels, duration of anaesthesia or incidence of post-spinal headaches between the two solutions. The median maximum cephalad levels of analgesia were (hyperbaric) T1 (range C1-T4), and (plain) T2 (range C1-T4). Thirteen patients in the hyperbaric group and 10 in the isobaric group required i.v. ephedrine to treat hypotension. Nine patients (23%) developed a post-spinal headache, and three were treated with an extradural blood patch.
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PMID:Subarachnoid analgesia for caesarean section. A double-blind comparison of plain and hyperbaric 0.5% bupivacaine. 354 93

Two isobaric spinal anesthetic solutions (bupivacaine 0.5%/20 mg without epinephrine and tetracaine 0.5%/15 mg with 0.2 mg epinephrine) were compared in a double-blind study of 60 patients. Patients were injected while in the lateral recumbent position and were immediately turned supine and horizontal. Up to 30 min after injection, no differences were found between the groups regarding segmental level of analgesia, changes in heart rate, and onset to or maximum decrease in mean arterial pressure (MAP). No correlation was found between maximum decrease in MAP and level of analgesia. At time of maximum decrease in MAP (tetracaine group - 16.7 +/- 12.8% (mean + SEM), bupivacaine group -19.4 + 14.8%) the level of analgesia was significantly higher in the tetracaine group (T5-6) than in the bupivacaine group (T7-8). Hypotension occurred in five patients in the bupivacaine group and in six in the tetracaine group. Two patients in the tetracaine group (but none in the bupivacaine group) had bradycardia. Hypotension together with bradycardia was observed in one patient in the tetracaine group but in no patient in the bupivacaine group. Two patients in each group developed postlumbar puncture headache. The authors conclude that the choice of local anesthetic agent, by itself, is not the sole cause of hypotension seen with spinal anesthesia.
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PMID:Hypotension in spinal anesthesia: a comparison of isobaric tetracaine with epinephrine and isobaric bupivacaine without epinephrine. 357 65

Nociceptive flexion reflexes, RIII reflex in particular, have been demonstrated to be a useful tool for pain research in humans, since the threshold of RIII reflex is that of pain. In this study a reduction of RIII reflex threshold, strictly related to the severity of the disease, is described in migraine with interval headache (MIH), that is considered a severe and evolutive form of common migraine (CM). These abnormalities were not found in CM or in other chronic pain conditions, i.e. chronic tensive headache (CTH), suggesting that this electrophysiological parameter may be useful in the clinical assessment of primary headache. Moreover, the administration of amitriptyline, a drug producing analgesia mainly by blocking serotonin uptake, was able to markedly increase the RIII reflex threshold in MIH. This fact supports the hypothesis that an impairment of serotoninergic antinociceptive system may exist in this type of headache. A significant correlation between percentage increase in RIII reflex threshold and reduction of PTI was also observed after amitriptyline treatment, indicating that pain reflex may be used for predicting treatment response in migraine.
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PMID:Pain reflexes in the clinical assessment of migraine syndromes. 360 72

A survey of the recognition and management of 21 unintentional dural punctures that occurred in a series of 3500 obstetric epidurals is presented. In seven cases, dural puncture was not recognised at the time of occurrence and two patients may have subsequently received mixed epidural and subarachnoid analgesia. In two patients with dural puncture in whom air had been used to locate the epidural space, cerebrospinal fluid did not drip from the hub of the needle. A test dose did not reveal incorrect catheter placement in seven patients. The provision of an epidural infusion of Hartmann's solution for 24 hours, together with bed rest, appeared to delay the onset of dural puncture headache rather than prevent it entirely. Blood patching was required only in five of the 21 patients but was entirely successful. The implications of these observations in relationship to obstetric epidural practice are discussed.
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PMID:Unintentional dural puncture. A survey of recognition and management. 368 97


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