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

In a cross-sectional study of 4558 Australians, it was found that the proportion of subjects reporting indigestion, palpitations, tremor, headache and insomnia increased significantly with mean caffeine intake. A multiple logistic regression model was used to show that the association between the prevalence of these symptoms and usual daily caffeine consumption remained significant in both males and females for palpitations, tremor, headache and insomnia after controlling for the potential confounding factors of age, adiposity, smoking, alcohol intake and occupation. Adiposity was strongly correlated with the prevalence of indigestion and the apparent association between caffeine and indigestion disappeared when adiposity was controlled for. According to the logistic model, the relative risk of experiencing symptoms for people consuming 240 mg of caffeine (approximately 4-5 cups of coffee or tea) per day (the population average) compared with caffeine abstainers is 1.6 for palpitations, 1.3 for tremor, 1.3 for headache, and 1.4 for insomnia in males and 1.7, 1.5, 1.2 and 1.4 respectively for females. Further logistic regression analysis indicated that the associations found between caffeine intake and symptoms did not depend on the source of caffeine. In general, coffee consumption has no significant effect over and above that attributable to its caffeine content. If these associations are causal, then approximately one quarter of the reported prevalence of palpitations, tremor, headache and insomnia is attributable to caffeine consumption in this study population.
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PMID:A study of caffeine consumption and symptoms; indigestion, palpitations, tremor, headache and insomnia. 387 38

The efficacy of safety of naproxen sodium and ergotamine tartrate were compared for the treatment of acute migraine attack in a randomized, parallel trial with 114 participating patients. At the start of symptoms, patients took either three tablets of naproxen sodium (275 mg each) or one of an ergotamine combination (containing 2 mg ergotamine tartrate, 91.5 mg caffeine, and 50 mg cyclizine chlorhydrate). Patients were followed for three months or until six attacks were monitored, whichever came first. Both medications substantially shortened the duration of migraine attacks and reduced the severity of symptoms. When the test medications were taken within 2 h of onset of attack, naproxen sodium was statistically significantly more effective than the ergotamine combination in reducing the severity of headache pain, nausea, and lightheadedness. The ergotamine combination was associated with significantly more vomiting, need for rescue medication, and side effects than was naproxen sodium. Four patients required discontinuation of the ergotamine combination and one of naproxen sodium. Both patients and investigators rated tolerance for naproxen sodium as superior to tolerance for the ergotamine combination. Naproxen sodium seems to be an effective and safe treatment for migraine attacks.
Cephalalgia 1985 Jun
PMID:Acute migraine attack therapy: comparison of naproxen sodium and an ergotamine tartrate compound. 392 22

Fifty-two patients, most of whom had had daily headaches for years, were examined and treated. Among them there were 40 who originally had migraine, the others had vasomotor or post-contusional headaches. Average duration of the migraine was 21 years, of chronic headache 7.6 years. All patients had been taking analgesics of a mixed type regularly and for a long time, on average 35.6 tablets or suppositories weekly. All patients had taken more than three different drugs. After an observation period of 3-6 months for grading the headaches and registering the amount of drug intake, all patients were admitted to hospital when all analgesics were at once discontinued. Changing degrees of withdrawal symptoms were the rule: increased headaches, nausea, vomiting, tachycardia, sweating, sleep disorders, and in some also hallucinations and cerebral episodes. At the end of the hospital stay chronic headache had completely disappeared or markedly improved in 77% of patients. Even after an average of 16 months of subsequent observation, chronic headache continued to be significantly improved in 70% of patients. There was a significant reduction in frequency and intensity of attacks in the patients with originally typical migraine. Regular intake of analgesics of the mixed type induces chronic headaches. These are most commonly caused by ergotamine tartrate and aminophenol derivatives, while psychological and physical dependence on anti-migraine drugs is initiated and maintained by additional barbiturates, caffeine and codeine.
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PMID:[Chronic analgesic-induced headache]. 614 24

Thirty clinical studies involving more than 10,000 patients conducted during the last 20 years have been analyzed to assess the value of caffeine as an analgesic adjuvant. Although most studies included patients with postpartum uterine cramping or episiotomy pain, some involved patients with pain from oral surgery or headache. In 21 of 26 studies, the relative potency estimates of an analgesic with caffeine to an analgesic without caffeine is greater than one. The pooled relative potency estimates in each of several major categories of combination analgesics are significantly greater than one. The overall pooled relative potency estimate is 1.41, with 95% confidence limits of 1.23 to 1.63; that is, to obtain the same amount of response from an analgesic without caffeine requires a dose that is approximately 40% greater than one with caffeine.
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PMID:Caffeine as an analgesic adjuvant. 636 75

Classification, epidemiology, pathophysiology, and therapy of migraine, cluster, and muscle-contraction (tension) headaches are reviewed. Migraine headache is related to vasomotor changes and is often preceded or accompanied by neurologic symptoms, nausea, and vomiting. Ergot alkaloids are used in acute migraine episodes; products containing caffeine are sometimes used for synergy. Other agents including antiemetic and sedative drugs and a combination product containing isometheptene mucate , dichloralphenazone , and acetaminophen have been used. Methysergide is the drug of choice for migraine prophylaxis. Of all patients with cluster headache, 90% experience episodes that occur in series separated by intervals as short as one week or as long as 25 years, and the remaining 10% have chronic headache. Pain is unilateral, nausea and vomiting are rare, and there is no aura. Pathophysiology is thought to be similar to that of migraine. Supportive treatment includes drug therapy to improve sleep and avoidance of alcohol and vasodilating agents. Aerosol ergot preparations may be effective for treatment of acute episodes . Prednisone has been used both as an abortive agent and for prophylaxis, while ergotamine, methysergide, and lithium have been tried prophylactically. Chronic tension headache is a constant, tight, pressing, or bandlike sensation in the frontal, temporal, or occipital area that occurs daily. The deep, steady ache differs from the throbbing sensation of vascular headache. Constant overcontraction of scalp muscles may be a cause. Heat, massage, and stretching are used to alleviate excess muscle contraction. Tension headache has been treated with analgesics, nonsteroidal anti-inflammatory agents, muscle relaxants, and amitriptyline. Drug treatment of headache must be based on headache type and tailored to individual response. Bio-feedback may be useful in some patients when combined with drugs.
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PMID:Classification, mechanisms, and management of headache. 637

Tolfenamic acid is a fenamate which inhibits prostaglandin (PG) biosynthesis and may act as a PG antagonist as well. Caffeine and metoclopramide are used in combination with analgesics and ergotamine in the treatment of migraine attacks, but controlled clinical studies on fixed combinations with analgesics are rare. The effects of orally given tolfenamic acid (200 mg), caffeine (100 mg), metoclopramide (10 mg), tolfenamic acid + caffeine (200 mg + 100 mg), tolfenamic acid + metoclopramide (200 mg + 10 mg) and placebo were studied in 49 migraine patients (3 men, 46 women) in a double-blind randomized cross-over study comprising 482 migraine attacks. The patients were allowed to take either one or two capsules of each preparation for an attack. Additional drugs were allowed after 3 h. Parameters characterizing the effects and side-effects of the drugs were registered. Tolfenamic acid and its combinations were found to be effective in the treatment of acute migraine, but caffeine and metoclopramide alone did not differ from placebo. Combination with metoclopramide was better than tolfenamic acid alone as judged by the smaller dose needed and the intensity of attack. Between tolfenamic acid alone and its caffeine combination there were no statistically significant differences.
Cephalalgia 1984 Dec
PMID:Tolfenamic acid, metoclopramide, caffeine and their combinations in the treatment of migraine attacks. 639 43

The main treatment of the acute migraine attack remains sleep, sedation, an anti-nauseant and analgesics, and in some patients 1 or 2 mg of ergotamine tartrate. Drugs containing large amounts of caffeine should not be used. Absorption of drugs may be impaired in a migraine attack. Metoclopramide is probably the anti-emetic of choice because it is an effective anti-nauseant and promotes normal gastrointestinal activity. Domperidone has a similar action but is said not to go through the blood-brain barrier, so is less likely to cause extrapyramidal reactions. All drugs, including analgesics such as aspirin and paracetamol, are best given in a soluble or effervescent form. Where vomiting occurs early in the attack, suppositories may be indicated. Ergotamine tartrate is necessary in about one third of attacks and is best given by suppository or by inhalation. Doses higher than 2 mg per attack or 6 mg in one week may cause toxic symptoms, the early signs of which are headache, nausea, vomiting and a feeling of not being very well. The non-drug treatments of an acute attack include pressing on the temporal artery, hot and cold compresses and relaxation.
Cephalalgia 1983 Mar
PMID:Treatment of the acute migraine attack--current status. 640 72

Hypertension, severe headache, and grand mal seizures developed in a 13-year-old girl after ingestion of one nonprescription diet pill containing phenylpropanolamine and caffeine. This case is at least the sixth report of seizures with phenylpropanolamine use in children or adolescents. Phenylpropanolamine ingestion must be included in the differential diagnosis of young patients, particularly adolescents, in whom acute neurological symptoms develop.
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PMID:Phenylpropanolamine-associated CNS complications in children and adolescents. 642 18

Psychotropic substances combined with simple analgesics are a common pharmacologic denominator in the dependency complex. More than 95 percent of patients studied took preparations containing barbiturates; the remaining few subjects used analgesics combined with caffeine. Dependence on compound analgesic preparations usually develops in patients with headaches--migraine, tension headaches, and other complex forms--since ergotamine-containing preparations are generally effective only at the onset of an attack, and prophylactic administration is, therefore, common. Once dependence has developed, reduction or discontinuation of the medication is typically followed after one or two days by an increase in the intensity of the pain. This may cause the patient to revert to these preparations in an attempt to reduce pain and may lead to an unfortunate vicious cycle. Therefore, cessation of psychotropic analgesic combinations is essential in the treatment of chronic pain.
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PMID:Effects and risks of psychotropic and analgesic combinations. 665 May 31

Tolfenamic acid is a potent inhibitor of prostaglandin biosynthesis, which has been proved effective in the treatment of acute migraine attacks. The usefulness of caffeine, metoclopramide and pyridoxine as adjuncts to tolfenamic acid was tested in acute migraine attacks in ten patients. A combination of tolfenamic acid (200 mg) with either caffeine (100 mg), metoclopramide (10 mg) or pyridoxine (300 mg) was given twice to each patient in random order. Thus 60 attacks were treated. The tolfenamic acid-caffeine combination proved the most effective as judged by duration and intensity of attacks, working ability, vigilance, and overall evaluation of the drugs by the patients. Metoclopramide was somewhat better than pyridoxine as an additive.
Cephalalgia 1982 Dec
PMID:Tolfenamic acid and caffeine: a useful combination in migraine. 698 58


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