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

The clinical and therapeutic aspects in 26 patients with cluster headache are reported. The patient's age ranged between 14 and 60 years old (average 31.5 years); 22 were male and 4 female. The patients constituted a consecutive series of typical cases (only one was a chronic cluster) with regular headache attacks; in 69.2 per cent of the cases there were associated symptoms and signs (ipsilateral lacrimation, stuffiness of the ipsilateral nostril and Horner's syndrome). In seven patients the cluster was induced by alcohol ingestion (during an active cluster period) and a cluster attack was reproduced by isosorbitol dinitrate (vasodilator drug) in one patient. All patients received orally either methysergide maleate, prednisone or both. The first drug used, in 20 patients, was methysergide maleate in a dosage of 3--6 mg daily over a four weeks period. Eight patients received prednisone only, which presented side-effects or no improvement with methysergide, in a dosage of 40--60 mg daily and tapered off over a period of four weeks. Methysergide maleate and prednisone were given to 11 patients in association, because of moderate effect of the first drug. The clinical effect of the treatment was judged according to the following three categories: freedom from the attacks; slight improvement of the attacks; no improvement of the attacks. In 57.6 per cent of the cases (15 patients) there was freedom of the attacks, in 30.7 per cent of the cases (8 patients) there was a slight improvement and in 3 patients there was no improvement.
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PMID:[Cluster headache: clinical and therapeutic aspects in 26 cases]. 746 27

The recent publication of drug formularies by third-party payers has serious implications for the practice of medicine. These formularies list the medications for which the consumer can be reimbursed by the third-party payer. The most restrictive of the five formularies I have received lists only two agents for the treatment of migraine headaches: Cafergot (at an incorrect dose of 1/100 mg) and Ergotrate which is no longer available. The most liberal of the formularies lists analgesics, Cafergot, Midrin, and Imitrex for the treatment of acute attacks, and as prophylactic agents, Inderal, Sansert, and analgesics (known to cause rebound headaches when used in this fashion in migraine patients). Abortive agents of proven value, such as DHE-45 and NSAIDs, and preventative medications, such as calcium channel blockers, tricyclic antidepressants, serotonin reuptake inhibitors, methylergonovine, and divalproex sodium, are not available. No one could quarrel with a goal of developing a cost-effective formulary. However, the authors of these formularies have clearly demonstrated their inability to provide even a current, accurate, and adequate formulary by existent standards of care in the treatment of migraine headache. While it is easy to criticize these formularies, it is more difficult to develop a comprehensive list that would satisfy the practitioners' need to provide relief for their patients with a minimum of side effects, and the needs of third-party payers (presumed) to provide quality care at the most economical level.
Headache 1995 Apr
PMID:Toward a standard drug formulary for the treatment of headache. 777 80