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)

The oral contraceptive (OC) Stediril acts by inhibiting ovulation, rendering the endometrium inhospitable to implantation, and rendering the cervical mucus impermeable to sperm. The effectiveness of Stediril may be compromised by failure to follow the dosage schedule: 1 pill daily for 21 days followed by a pill-free interval of 7 days when withdrawal bleeding occurs. Stediril should be taken at a regular time each day. If pills are missed for more than 48 hours, efficacy cannot be guaranteed. If vomiting occurs within 4 hours of pill ingestion, the pill should be replaced. Certain drugs, such as Rifadine, may affect the action of Stediril. Stediril should only be prescribed after a complete medical history and examination, including responding to any questions the patient may have. At a 3-month follow-up visit the patient's tolerance to the drug should be assessed by absence of various symptoms: psychological problems such as nervousness and irritibality that resemble those of pregnancy; skin problems such as acne or changes of pigmentation; periods of nausea that diminish in frequency after a few weeks; weight gain; bleeding problems; or signs of thromboembolic risk, such as headaches, unusual visual disturbances, or hypertension, which require immediate cessation of OC use. Because Stediril constitutes a risk to the fetus in case of unplanned pregnancy, the preliminary gynecological examination is mandatory and the pill should only be prescribed to women able to comply with dosage requirements. The pill should be stopped 6 weeks-3 months before pregnancy to allow the endometrium to regenerate. The carcinogenic role of the pill is frequently discussed but not conclusively proven. Follow-up visits should occur 3 and 6 months after beginning use and every year thereafter.
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PMID:[Stediril]. 656 44

102 patients using Trinordiol, a triphasic oral contraceptive (OC) containing ethinyl estradiol and d-norgestrel, were followed for 932 cycles in a study of secondary effects. Follow-up visits were scheduled after 1,3, and 6 months and every 6 months thereafter. 26 patients discontinued use of the pills during the study after using them for a total of 159 cycles. 5 discontinued because of abdominal pain, 1 for breast tenderness, and 1 because of headaches or migraines. 7 discontinued because of metrorrhagia, 4 for weight gain, 3 for amenorrhea, 2 for nausea and vomiting, and 1 each for nervousness, water retention, acne, desire for pregnancy, leaving the country, hypertension, and unknown motivation. the average age of patients was 23.6 years, with a range from 14-48. 76% were aged 15-29 years. 52.9% were nulliparas. 58.8% were Belgian, 21.6% were from Mediterranean Europe, 10.8% were Moroccan, and 7.9% were from black Africa. Only 1 patient, a 37 year old, developed hypertension. 15 patients gained more than 2 kg and 17 lost more than 2 kg. 15.8% complained of spotting during the 1st cycle compared to 3.1% during the 6th cycle, 5.2% during cycle 7-12, and 9.1% during cycle 13-30. Among 35 patients who did not discontinue treatment, 7 complained of amenorrhea and 1 of scanty menstrual bleeding, 14 of pain including 7 cases of pelvic pain, 2 of dysmenorrhea, 3 of breast tenderness, and 2 of headaches, 15 of leukorrhea, 3 of nausea, 2 of dizziness, and 1 each of fatigue, acne, galactorrhea, and cutaneous pruritus. 1 case of myoma at the level of the uterine cornu was identified after 24 cycles of treatment. In all, 61 patients had some complaint, while 41 were totally satisfied. No patient became pregnant during the study.
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PMID:[Clinical study of the secondary effects associated with taking a triphasic anti-ovulatory contraceptive]. 670 4

75 patients with cluster headache (63 men and 12 women) and 939 with migraine headache were seen among 1260 new patients at the Princess Margaret Migraine Clinic of Charing Cross Hospital (London, England) over a 16-month period. 3 points of interest emerged from this analysis. The age of onset in women, unlike the men, appeared to be bimodal. Approximately half of the women developed the condition in early adult life, and the remainder at about the time of the menopause. These distributions were significantly different. This was not noted in Ekbom's earlier series nor in that of Pearce, although Ekbom did record a disproportionate number of old women at presentation. Atypical cases seemed more common among women and especially among those women who developed headaches later in life. There were no satisfactory criteria for the classification of less typical cases, e.g., patients with single weekly attacks typical in site and duration, or patients with bout up to 12 attacks daily but with long headache free intervals that would appear to exclude the diagnosis of chronic paroxysmal hemicrania. 6 of the 7 typical premenstrual cases had been on oral contraceptives (OCs), and 4 of these associated breaks from contraception with the start of clusters. They could not abort a cluster by immediately restarting OC. In 1 case there was a temporal association with a change from Ovulen 50 to Ovranette, and the headaches settled when she was changed back to Ovulen 50 3 months later. They recurred when she stopped the Ovulen 50 again after 4 months, and she conceived during the cluster, which ceased in the 4th week of pregnancy. She had another cluster, lasting 6 weeks, which started when she was 11 weeks pregnant but none later in the pregnancy. She had a further cluster 7 months postpartum, and hormonal treatment has been contraindicated by a postpartum thrombosis. The anecdotal nature of this observation cannot be denied, but a large scale trial is not feasible. Longterm OC use, possibly with a 50 mcg estrogen preparation, might be helpful in occasional patients. This phenomenon is the opposite of that found in migraine, emphasizing the distinction between the 2 conditions.
Cephalalgia 1982 Sep
PMID:Cluster headache in women. 715 Nov 51

A case of a young women with paroxysmal nocturnal hemoglobin (PNH) who developed thrombosis of the cerebral veins after beginning a regimen of oral contraceptives is presented. She was 24 years old and presented with a 3-week history of frontal headache, neck stiffness, paraesthesiae of both arms, and weakness of the left leg. She had begun use of Microgynon 2 months before presentation, but had discontinued use when symptoms began. Hematological studies showed a shortened partial thromboplastin time, high fibrinogen and factor VIII levels, and prlonged euglobulin clot lysis time. Though this patient had a history of coagulation difficulties, it was not until after taking the estrogen-containing contraceptive preparation that PNH developed. The mechanism of thrombosis may be related to the liberation of thromboplastic material from hemolysed erythrocytes and to interaction between complement-sensitive platelets and complement components in plasma. It is suggested that the estrogen augmented the previously existing thrombotic condition in this patient, and that administration of estrogen-containing preparations should not occur in women with thrombotic disorders.
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PMID:Cerebral vein thrombosis and the contraceptive pill in paroxysmal nocturnal haemoglobinuria. 744 35

In the US, the 90% of women, at risk of pregnancy, who use contraceptives account for 47% of all unplanned pregnancies. Thus, if women using no contraceptives or using user-dependent methods were to switch to long-acting hormonal contraceptives like Norplant or injectables, unplanned pregnancy rates would drop. Norplant was approved for use in the US in 1992. The device consists of six rods that release levonorgestrel over a period of five years to suppress the luteinizing hormone surge responsible for ovulation and thicken cervical mucus to prevent sperm penetration. Norplant is highly effective, results in few metabolic changes in users, and can be used by lactating mothers. Side effects (most prevalent in the first six months) include abnormal bleeding, weight gain, depression, and headaches. Adolescents studied reported overall satisfaction with the method. Difficulties with removal can be minimized if the implants are inserted properly. The injectable use of depot medroxyprogesterone acetate (DMPA) was approved in the US in 1992. Contraceptive plasma levels are reached within 24 hours of the injection and are maintained for 14 weeks. DMPA inhibits ovulation and is highly effective when administered once every three months. DMPA is associated with a longer delay in return to fertility than other methods. The side effects of DMPA are similar to those seen in Norplant users. Concern about changes in bone density are currently being investigated. DMPA users have increased low-density lipoprotein cholesterol levels and decreased high-density lipoprotein cholesterol levels as compared to IUD users. DMPA (unlike Norplant) can be used effectively in women using anticonvulsant medications or antibiotics. It is also safe during lactation. Research into hormonal methods is being concentrated on the development of a two-rod and one-rod Norplant delivery system, on biodegradable delivery systems, and on various injectable formulations, including once-a-month estrogen/progesterone combination methods.
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PMID:New contraceptives in the 1990s. 758 38

Questionnaires completed by 107 adolescents (average age, 16.5 years) recruited from Florida clinics indicated substantial interest in Norplant contraceptive implants, especially among those with a previous pregnancy. Included in the sample were 28 adolescents 13-20 years of age who were caring for one or more children. 40 (55%) of the adolescents with a history of sexual activity acknowledged having intercourse in the past year without use of contraception. Overall, 56% had heard of Norplant prior to the survey; the mass media was the primary knowledge source. 70% of those without children and 79% of adolescent mothers stated that they were interested in the method; moreover, 73% of nulliparous women and 89% of mothers thought Norplant would be superior to oral contraceptive use. Convenience and effectiveness were the most frequently cited positive aspects of Norplant. On the other hand, significant percentages of adolescents expressed concern about Norplant-related side effects: acne (87%), headache (83%), weight change (71%), and menstrual irregularities (71%). The main predictor of interest in Norplant was number of pregnancies; the 12 adolescents who had two or more previous pregnancies expressed the highest degree of interest. Early age at menarche (12.5 years and under) and a high number of sexual partners (4.5 and above) were also positively associated with interest in Norplant. Thus, adolescents who are most at risk of an unintended pregnancy are also the subgroup most receptive to Norplant use.
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PMID:Adolescent girls' attitudes toward contraceptive subdermal implants. 766 85

This prospective study of 122 Black and Hispanic inner-city adolescent Norplant users recruited from a teen clinic in Rochester, New York, was the first to include a two-year follow-up period. The study period extended from June 1, 1991, to June 30, 1993. The mean age of Norplant acceptors was 17.4 years; 76% had a parity of at least one. Recorded was a one-year retention rate of 71% and a two-year rate of 62%. The greatest number of removals occurred in the first three months after insertion. There was no association between Norplant retention and age, weight, race, parity, or school status. The only significant predictor of Norplant continuation was a history of at least one induced abortion. The reasons most frequently cited by the 30 adolescents who discontinued Norplant were headache, fatigue, hair loss, nausea, weight changes, breast symptoms, and appetite changes. Menstruation irregularities were reported only by terminators in the 3-6 month use interval. Considering the high continuation rates recorded in this survey and the method's proven effectiveness, Norplant has the potential to widen substantially the birth interval between adolescent pregnancies.
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PMID:Contraceptive implant use among inner city teens. 766 90

Focus group discussions were utilized to increase understanding of the factors associated with Norplant discontinuation among young, low-income women and identify counseling needs. The 15 participants--all of whom had requested Norplant removal after at least two months of use--were drawn from health clinics in three South Carolina cities. Group participants were 18-26 years old; the mean duration of Norplant use was 13.8 months. Norplant's convenience, effectiveness, long-term duration, and low cost were cited as the major advantages of the method, while prolonged bleeding, headaches, weight gain, hair loss, and mood swings were identified as the worst side effects. These side effects were the reason for requesting early Norplant removal. Although participants had been exposed to a combination of educational methods before Norplant insertion, they noted that the possibility of adverse side effects was minimized. Others felt they had been pressured to agree to Norplant insertion while still in the hospital following a delivery. The majority reported that medical staff responded negatively to their request for removal and were unsympathetic about Norplant-related side effects. As a result, these women developed a mistrust of the medical system. Since young, low-income women comprise a major target population for Norplant use, it is important to develop a counseling protocol that prepares them for side effects and suggests various coping strategies.
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PMID:A qualitative study of the perceptions of dissatisfied Norplant users. 773 Jul 70

During the period of March-October 1993 Norplant was implanted in 58 women who appeared at first, third, and sixth monthly control examinations at the OB/GYN Service, US Army Hospital, Berlin, Germany. The six rods were inserted under local anesthesia within 4-5 minutes. The average age was 24.6 years, and they were counseled individually after watching a video film about the procedure. One month after the implantation the skin appeared normal without hematoma or infection. Only 2 women had a regular menstrual cycle in the course of six months, but no pregnancy occurred. 27 women (46.5%) reported at least one side effect. Most frequent was weight gain (21 cases, or 36.2%); other side effects were headache (8 cases, or 13.2%), loss of hair (5 cases, or 8.6%), mood changes (5 cases, or 8.6%), fatigue (2 cases, or 3.4%), decreased libido (1 case, or 1.7%), and nausea (1 case, or 1.7%). In women aged 20 years or younger fewer problems occurred than in older women (p 0.025). 54 women had also used oral contraceptives. 25 of these (46.3%) had side effects, i.e., headache, migraine, or nausea. There was an association between the side effects of Norplant and those of oral contraceptives (p 0.025). At the end of the study 86.2% of women (50) reported to be satisfied with Norplant, 10.3% of women (6) said they were not satisfied, and 3.4% of women (2) were undecided. Norplant was removed in 6 cases because of side effects. Among these were 3 women with heavy hair loss, 2 with mood changes, and 1 with increasing headaches. Almost 90% of the women accepted Norplant. It is very important to instruct women in detail about the action of Norplant and counsel them in order to reduce the rate of removals.
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PMID:[Norplant and its side effects]. 779 68

During June 1992-February 1993, physicians in Charlotte, North Carolina, randomly assigned 250 women who had delivered vaginally at the Carolinas Medical Center to receive the contraceptive implant Norplant either before being discharged from the hospital on postpartum day 1, 2, or 3 or 4-6 weeks later at the scheduled postpartum follow-up visit. They wanted to ascertain whether insertion of Norplant in the immediate postpartum period was safe and well-tolerated. 26 women were lost to follow-up. 11 of these women were in the delayed insertion group, so they did not receive Norplant or an alternative contraceptive method, placing them at risk of pregnancy. Another 34 women in the same group returned for their follow-up visit but did not receive Norplant. The mean interval from delivery to insertion stood at 1.7 days for the immediate insertion group and 34.3 days for the delayed insertion group. No one in either group experienced acute postpartum hemorrhage. The immediate insertion group had much more bleeding and spotting than did the delayed insertion group (17 vs. 13.6 days, p 0.01, and 11.1 vs. 8.8 days, p = 0.03, respectively; 28.2 vs. 22.4 days for both spotting and bleeding, p 0.01). Since hemoglobin values of the two groups did not differ (12.9 vs. 12.7), the increased bleeding was not clinically significant. Women in the immediate insertion group were more likely than those in the delayed insertion group to have headaches on at least seven days between insertion and study follow-up (15.1% vs. 2.8%; p 0.01). They also were more likely to have acne during at least three days (18.9% vs. 6.4%; p 0.01). They were just as likely as the delayed insertion group to report nausea, hair loss, and hirsutism. 40% of the women in both groups had sexual intercourse before their 4-6 week follow-up visit. These findings show that Norplant can be safe and well-tolerated if inserted in the immediate postpartum period.
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PMID:Use of Norplant contraceptive implants in the immediate postpartum period: safety and tolerance. 784 30


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