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

Optimal therapy for pyelonephritis requires the immediate administration of an effective broad-spectrum antibiotic. Because conventional oral antibiotics such as the sulfonamides and the aminopenicillins are limited by the development of resistant bacteria associated with this common disease, the therapeutic effectiveness of a new oral carbacephem antibiotic was investigated. Two double-blind, randomized clinical trials of loracarbef (LY163892) were conducted. A total of 245 patients (greater than or equal to 18 years old) with uncomplicated pyelonephritis were enrolled in parallel studies. One study compared loracarbef with cefaclor; the other compared loracarbef with norfloxacin. In the combined patient population, 119 patients were treated with loracarbef (400 mg twice daily), 43 with cefaclor (500 mg three times daily), and 83 with norfloxacin (400 mg twice daily). All treatment regimens continued for greater than or equal to 14 days. A total of 68 patients in the loracarbef group, 25 in the cefaclor group, and 43 in the norfloxacin group qualified for efficacy analysis. Escherichia coli was the causative pathogen in 85.0% of these patients. Successful posttherapy clinical and bacteriologic responses were similar for all three study drugs: 94.1 and 86.8%, 96.0 and 80.0%, 97.7 and 88.4% for loracarbef, cefaclor, and norfloxacin, respectively. Late posttherapy clinical responses were 87.4, 83.3, and 91.7% for the loracarbef, cefaclor, and norfloxacin groups, respectively. Bacteriologic responses for the three groups were 79.6, 60.0, and 88.9%. The most frequent adverse effects (headache, diarrhea, and nausea) were experienced by three patients (2.5%) in the loracarbef group; headaches were noted in two (4.7%) cefaclor patients, diarrhea was noted in three (7.0%) patients in the cefaclor group, and nausea was noted in four (9.3%). Gastrointestinal events were noted in four patients (4.8%) in the norfloxacin group. The data demonstrate that loracarbef is comparable in efficacy and safety to both cefaclor and norfloxacin as oral therapy for uncomplicated pyelonephritis.
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PMID:Loracarbef (LY163892) versus cefaclor and norfloxacin in the treatment of uncomplicated pyelonephritis. 162 52

Since 1978, the authors have observed 7 cases of dissecting aneurysm in the internal carotid artery. Symptoms were severe headache and subsequent neurologic deficit in young persons (3 women, 4 men; mean age 35 years). The underlying pathology was spontaneous dissection of the cervical internal carotid artery, with surgical confirmation in 3 cases and typical angiographic patterns in all cases. Spontaneous dissection of the cervical internal carotid artery is being increasingly recognized as a cause of cerebral ischemia in young adults. Moreover this clinicopathologic event is more common than had previously been supposed. The etiology remains unclear, except in 15% of cases in which dystrophy of the media (Marfan's syndrome) is in cause. No history of cervical trauma can be found. Typical clinical features consist in ipsilateral headache preceding an abrupt neurologic deficit in a 40-year-old person. An incomplete Horner syndrome (oculosympathetic paresis without facial anhidrosis) associated with facial pain and numbness is pathognomonic, but the majority of dissections are less typical. The typical angiographic pattern is an elongated regular stenosis of the high cervical internal carotid artery, 2 cm above the non-involved bulbus ("string sign"). The dissection may modify to a tapered occlusion above the point of origin of the internal carotid artery. The natural course is spontaneous resolution of the stricture, without relapse. Optimal management is non-operative since medical treatment has proved to be efficient. These cases confirm the benign course and overall good prognosis of spontaneous dissections of the internal carotid artery which are not as rare as the scarcity of reports might indicate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spontaneous dissection of the internal carotid artery. Apropos of 7 cases and a review of the literature]. 217 45

Despite the widespread use of non-steroidal anti-inflammatory drugs (NSAIDs), the current number of reported cases of poisoning is small. However, with the introduction of 'over-the-counter' preparations of NSAIDs in some countries (e.g. ibuprofen in the UK and USA) an increased incidence of acute poisoning from this group of drugs can be expected. Conventionally, NSAIDs are divided into the following groups based on their chemical structure: arylpropionic acids, indole and indene acetic acids, heteroarylacetic acids, fenamates, phenylacetic acids, pyrazolones and oxicams. Unless NSAIDs are ingested in substantial overdose, acute poisoning with these agents does not usually result in significant morbidity or mortality. In most cases the clinical features are mild and confined to the gastrointestinal and central nervous systems, though acute renal failure, hepatic dysfunction, respiratory depression, coma, convulsions, cardiovascular collapse and cardiac arrest may complicate severe poisoning. Arylpropionic acid derivatives were thought initially to have a low order of toxicity in overdose but, in addition to anticipated gastrointestinal symptoms, headache, tinnitus, hyperventilation, sinus tachycardia, hypoprothrombinaemia, haematuria, proteinuria and acute renal failure have been described. In addition, drowsiness, coma, nystagmus, diplopia, hypothermia, hypotension, respiratory depression and cardiac arrest have been reported in severe cases of poisoning. Oxyphenbutazone and phenylbutazone are considerably more toxic in overdose. Complications of severe poisoning include coma, convulsions, hepatic dysfunction, acute renal failure, sodium and water retention, haematuria, cardiovascular collapse, respiratory alkalosis, metabolic acidosis, hypoprothrombinaemia and thrombocytopenia. In contrast, indomethacin appears to be much less toxic. In addition to gastrointestinal symptoms, indomethacin taken in overdose induces headache, tinnitus, dizziness, lethargy, drowsiness, confusion, disorientation and restlessness. Only 1 case of acute sulindac poisoning has been reported in the literature. A 16-year-old boy was admitted with hypokalaemia (2.2 mmol/L), transient granulocytosis and 'scanty' haematemesis after ingesting 12 g sulindac. No case of acute tolmetin poisoning have been reported. The fenamates (flufenamic acid, meclofenamic acid, mefenamic acid, tolfenamic acid) are, with the exception of mefenamic acid, not as widely prescribed as other groups of NSAIDs. In overdose, mefenamic acid may result in nausea, vomiting, diarrhoea, muscle twitching, convulsions and coma.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acute poisoning due to non-steroidal anti-inflammatory drugs. Clinical features and management. 353 13

Brain abscess is a formidable diagnostic and therapeutic problem with mortality ranging from 35% to 65%. It may occur at any age, and there is a male:female ratio of 2:1. Brain abscess arises from a contiguous focus of infection, direct implantation due to trauma, or hematogenous spread from a remote site. The commonest organisms isolated from brain abscess include streptococci, Staphylococcus aureus, Bacteroides species, and Enterobacteriaceae. Brain abscess frequently produces headache, vomiting, focal neurologic signs, and depressed level of consciousness. Fever and leukocytosis often are absent. Diagnosis is suggested by computerized tomography, but most cases require surgical confirmation. Optimal management consists of intensive antibiotic therapy. Aggressive surgical treatment is required in cases not responding to antimicrobial therapy. Long-term neurologic deficit occurs in up to 60% of cases.
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PMID:Brain abscess: recent experience at a community hospital. 400 2

Thirty-nine patients with esthesioneuroblastoma are reviewed. The presentation of the tumor, symptomatology, investigation, and treatment are discussed. A recommended treatment regimen is outlined. Histologic typing is valueless in predicting tumor behavior. An illustrative and difficult case of recurrent base of skull esthesioneuroblastoma is presented. The resection performed is described, and the problem of extradural oropharyngeal communication is discussed. The solution was to use a temporalis and galeal frontalis flap. Reconstruction was with an external and intraoral prosthesis. Optimal treatment in a fresh lesion is radical surgery with or without radiation therapy. Esthesioneuroblastoma is a rare and often misdiagnosed malignant tumor of the olfactory epithelium. Originally described by Bergen et al. in 1924 as "esthesioneuroepithelioma olfactif," it was introduced into the North American literature by Schall and Lineback in 1951. Since then, fewer than 200 cases have been collected. The various terms used to describe it--olfactory esthesioneuroblastoma, esthesioneurocytoma, and olfactory neuroblastoma--all denote origin from the neural crest. The sensory nerves of smell are short bundles of fibers that originate in the olfactory bulb and pass through the cribriform plate to the olfactory area of the nasal mucosa. This mucosa is located in the most superior part of both nasal fossae. Thus the usual primary sites of occurrence include the superior nasal cavity or nasal septum, and turbinates, the ethmoid, or the cribriform plate, although an extranasal site of origin has been suggested. Symptoms are usually progressive and range from nasal obstruction or epistaxis to diplopia, ocular pain, and headaches in the more advanced disease state.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Esthesioneuroblastoma: treatment of skull-base recurrence. 402 92

Optimal migraine therapy begins with an accurate diagnosis and knowledge of the symptoms that the patient finds most disturbing. Pharmacologic treatment of migraine may be acute (abortive, symptomatic) or preventive (prophylactic); both approaches are frequently required in patients with frequent, severe headaches. Drugs for acute care consist of analgesics, antiemetics, anxiolytics, nonsteroidal anti-inflammatory drugs, ergots, steroids, major tranquilizers, narcotics, and selective serotonin agonists. Preventive agents include beta-blockers, calcium channel blockers, antidepressants, serotonin antagonists, and anticonvulsants. The choice of a preventive drug depends on side effect profiles and comorbid conditions. Behavioral interventions, such as biofeedback and relaxation techniques, are an important complement to pharmacologic therapy; however, drugs are the mainstay of migraine therapy. To ensure that therapy achieves optimal results, the individual patient's preferred approach to this debilitating problem must be considered carefully.
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PMID:Overview of diagnosis and treatment of migraine. 796 47

This study examines the sensitivity and specificity of a self-report screen for the diagnosis of migraine according to the IHS criteria in a sample of 1049 employees of the French National Railways. The diagnosis of migraine derived from the self-report instrument was compared to an unstructured diagnostic interview conducted by a neurologist specialized in the diagnosis and treatment of headache. The sensitivity of the diagnostic screen was poor, but the specificity was excellent. Optimal cut-off points for the questionnaire were determined by the Receiver Operator Characteristics (ROC) method. Assessment of the specific IHS criteria for migraine revealed that the following criteria failed to discriminate subjects with migraine from non-cases: "aggravation by physical activity" and "photophobia and phonophobia". Implications of the findings for modification of the IHS criteria were discussed.
Cephalalgia 1993 Apr
PMID:Diagnostic screen for assessment of the IHS criteria for migraine by general practitioners. 850 Jan 49

Seventeen idiopathic parkinsonian patients ranging between 47 and 75 years of age were included in this study to investigate the effect and tolerance of lisuride on PD. The duration of this simple clinical study, which had no control group was 12 weeks. There was 50% relief in disability scores and ADL in 13 patients in the first group in the combined therapy for 12 weeks with lisuride added to L-DOPA plus benserazide (p < 0.01). Optimal lisuride doses added to L-DOPA plus benserazide varied between 0.1 and 0.8 mg (mean 0.5 +/- 0.2 mg). With the addition of lisuride to treatment, the L-DOPA plus benserazide dose was reduced in 6 of 13 by 38%. Monotherapy with lisuride resulted in 56% to 57% improvement in disability scores and 47% in relief in ADL. Dry mouth, nausea, weakness, postural hypotension, and headache were the most frequently encountered side effects of lisuride. These adverse effects disappeared in 3 or 4 days, depending on a slight decrease and following increase in the dose of lisuride and/or the development of tolerance. Not only will such a combined therapy contribute to the reduction of the end-of-dose inadequacies, on-off phenomena, wearing off, peak-dose dyskinesias, and similar motor fluctuations, it may also play a prophylactic role in their prevention or delay.
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PMID:A study on the effect and tolerance of lisuride on Parkinson's disease. 861 74

Ergotamine tartrate (ET) and dihydroergotamine (DHE) are effective therapies for migraine and cluster headache. Optimal management with these agents must take several factors into account, including headache type and severity, associated symptoms, side effect potential, choice of dosage forms, and appropriate dosing. Oral ET is most appropriate for slowly evolving migraine without early onset nausea and/or vomiting, or for treatment of cluster headaches. Delivery of ET via rectal suppository (available only in combination with caffeine) is the most effective form, especially for patients with severe, rapid onset migraine accompanied by nausea and/or vomiting. Dihydroergotamine offers numerous benefits compared to ET, including a lower incidence of nausea and vomiting and headache recurrence, and a lack of rebound headache. Dihydroergotamine can be administered at any time during a migraine attack, including the aura. Intravenous administration provides rapid peak plasma levels and is the most effective form when a rapid effect is desired or for patients with intractable severe headache (status migrainosus, transformed migraine, rebound headache) and cluster headache. Intramuscular administration is effective for moderate to severe migraine with or without nausea and vomiting in the clinic. Intranasal delivery of DHE has shown significant promise for effective and convenient therapy in acute migraine and may be especially useful in the presence of nausea and/or vomiting. When used appropriately, DHE and ET provide clinicians with highly effective therapeutic options in a range of useful dosage forms for patients with migraine or cluster headaches.
Headache 1997
PMID:Dosing and administration of ergotamine tartrate and dihydroergotamine. 900 71

Nine-hundred-and-twenty-two hypertensive patients were included in a substudy to the Hypertension Optimal Treatment study, which aimed to investigate the impact on quality of life of lowering the pressure and of intensified therapy. Seven-hundred-and-eighty-one patients completed both baseline and follow-up questionnaires (intention-to-treat population), while 610 patients were included in a per protocol analysis. Patients were randomized to three diastolic BP levels (DBPs), i.e. < or =90 mmHg, < or =85 mmHg and < or =80 mmHg. Two self-administered validated questionnaires, the Psychological General Well-Being index and the Subjective Symptoms Assessment Profile (SSA-P) were completed at baseline and after 6 months. The lower the DBP achieved, the greater the improvement in well-being (p < 0.05). The increase in well-being from baseline to 6 months was significant in target groups < or =80 mmHg (p < 0.01) and < or =85 mmHg (p < 0.05). The SSA-P domains, cardiac symptoms and dizziness improved in all groups but the sex life score deteriorated in the < or =80 and < or =85 mmHg groups in male patients. In all target groups, headaches were reduced (p < 0.001), while swollen ankles (p < 0.001) and dry cough in the < or =80 mmHg group (p < 0.001) increased. Although more intensive antihypertensive therapy is associated with a slight increase in subjective symptoms, it is nonetheless still associated with improvements in patients' well-being.
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PMID:Does lowering the blood pressure improve the mood? Quality-of-life results from the Hypertension Optimal Treatment (HOT) study. 949 56


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