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

Food and symptom diaries were used to identify problem foods for each of 164 patients with chronic medical problems such as headache, fatigue, congestion, abdominal pain, and sinus problems. A statistical analysis related the total load of 90 biologic families, as well as caffeine, alcohol, and lactose, to changes in symptom intensity during a 2-week diary. The results helped 75% of the patients when used as a guide for elimination diets. Open challenges confirmed 47% of the identified food components. This study required a database and software to estimate recipe components for an average of 243 foods per patient. The analysis of each patient's diary produces a main report that lists suspect food components for each symptom. The report lists components in decreasing order of statistical confidence and gives lag times between food ingestion and symptom change. This report also shows that initial direction of the symptom change as a direct or masking effect. Foods that appear "safe" or unrelated to the symptoms are also listed. A second report lists the patient's food sources for each of the suspected food components. The report shows the percentage contribution of source foods and is useful for patient education and the design of elimination diets.
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PMID:Identification of problem foods using food and symptom diaries. 787 Apr 42

This paper discusses alternative statistical models for the analysis of six crossover studies to determine whether better relief of tension headache occurs from treatment with an analgesic plus caffeine (C) than with the analgesic alone (A) or with placebo (P). Each patient in these crossover studies randomly received a pair of distinct medications in such a way as to treat the first two of four headaches with the initial medication in the pair and to treat the third and fourth headaches with the last medication in the pair. In order to have greater power for the C versus A comparison, three times as many patients were randomly assigned to the A:C and C:A sequence groups as to the A:P, C:P, P:A, and P:C sequence groups. An issue of statistical interest for these crossover studies is the extent to which the possibility of unequal carryover effects of the three medications influences the roles of alternative models for data analysis and the interpretation of results. When carryover effects for all three medications are equal, univariate analysis of variance for the difference scores between the average response for the first two headaches and the average response for the third and fourth headaches for each patient provides nearly the same power for pairwise treatment comparisons as more comprehensive multivariate methods for all four headaches. However, for comparisons concerning carryover effects and for treatment comparisons with adjustment for carryover effects, multivariate methods encompassing all four headaches jointly can provide greater power than univariate analysis for difference scores, particularly when there is low intraclass correlation for responses within the same patient. Another noteworthy role for multivariate methods in situations with potentially unequal carryover effects is their capacity to clarify whether multiple types of carryover effects occur across the second, third, and fourth headaches in the respective sequence groups. Multivariate models with alternative specifications of carryover effects are fit to the data from the six crossover studies to compare C, A, and P by weighted least squares. The role of potential variation among centers is addressed in these analyses by the use of stratified proportional means over centers, means of center means, and means ignoring centers. The primary focus of attention in the respective analyses is the evaluation of treatment comparisons with and without adjustment for potential differences among carryover effects of the treatments.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Evaluation of alternative statistical models for crossover studies to demonstrate caffeine adjuvancy in the treatment of tension headache. 788 52

Six randomized, double-blind, two-period crossover studies, conducted under similar protocols, compared the efficacy of two analgesic combinations containing caffeine with an acetaminophen 1000 mg control and with a placebo in outpatients with episodic tension-type headaches. In four studies, comprising 1900 patients, the caffeine-containing analgesic consisted of a combination of 500 mg acetaminophen, 500 mg aspirin, and 130 mg caffeine (APAP/ASA/CAF). In two studies, comprising 911 patients, the caffeine-containing analgesic consisted of a combination of 1000 mg acetaminophen and 130 mg caffeine (APAP/CAF). Patients self-medicated for moderate or severe headache pain, and with a self-rating record they rated their pain and its relief hourly for 4 hours. In all six studies, the caffeine-containing analgesics were significantly superior both to placebo and to 1000 mg acetaminophen, and acetaminophen was significantly superior to placebo. The significant analgesic adjuvant effect of caffeine was independent of patients' usual caffeine use or their caffeine consumption in the 4 hours before medication. For each treatment, the pooled analgesic responses for the four studies of APAP/ASA/CAF were virtually superimposable on the responses in the two APAP/CAF studies. The combinations produced more stomach discomfort, nervousness, and dizziness than acetaminophen or placebo.
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PMID:Caffeine as an analgesic adjuvant in tension headache. 795 22

The effects of continuous and intermittent caffeine abstinence and their time course were investigated under field conditions. After 3 days with habitual coffee, subjects were switched for 9 days to regular instant coffee (n = 40), decaffeinated coffee (n = 40), or an intermittent regime (2 days decaff, 1 day caff, repeated, n = 40). Subjects were blind to the caffeine treatment. Motor activity was assessed continuously; subjective variables, blood pressure (BP), and heart rate (HR) were assessed by the subjects six times per day (electronic diary). Compliance was confirmed by the different caffeine concentrations in daily saliva samples. Continued caffeine consumption showed no effects. Caffeine abstinence resulted in increased HR, decreased motor activity, subjective wakefulness, and well-being, and in increased headaches and use of analgetics. The subjective effects and headaches were transient, i.e., they disappeared after a few days of abstinence and weakened over successive, separated abstinence periods. BP was not affected by the caffeine treatment. The intermittent onset of caffeine consumption resulted in increased wakefulness, whereas the other variables normalized to baseline level.
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PMID:Cardiovascular, behavioral, and subjective effects of caffeine under field conditions. 797 94

The risk of renal papillary necrosis and renal dysfunction due to the chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) is unknown. In a prospective study of 259 heavy analgesic users seen in a general medical hospital over an 11-year-period beginning in January 1982, 69 new cases of analgesic nephropathy with renal papillary necrosis were confirmed by intravenous urogram (26.6%), ultrasonography (30.4%), and/or computed tomography (43%). Twenty-nine of these patients (42%) had consumed excessive quantities of NSAIDs alone; an additional nine patients (13%) had consumed NSAIDs predominantly in combinations with paracetamol, aspirin, phenacetin, caffeine, and/or traditional herbal medications. Of those patients who consumed NSAIDs alone, 17 had consumed only a single type of NSAID and the remaining 12 had consumed multiple types of NSAIDs. The amount of NSAIDs administered ranged from 1,000 to 26,600 capsules or tablets over a 2- to 25-year period. Renal impairment (serum creatinine, 126 to 778 mumol/L) was noted in 26 of these 38 patients (64.8%). The reasons given for consuming NSAIDs include gouty arthritis (18 patients), osteoarthritis (seven patients), rheumatoid arthritis (six patients), chronic headache (three patients), gouty arthritis plus chronic headache (three patients), and chronic backache (one patient). All patients were prescribed these drugs and were followed medically. The occurrence of analgesic nephropathy was predominantly in males (male to female ratio, 1.9:1). Most of the patients did not have the characteristic psychological profile attributed previously to analgesic abuse nephropathy. Associated addictive habits, such as the use of psychotropic drugs and sleeping tablets, purgative abuse, and alcoholism, were absent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic renal disease and papillary necrosis associated with the long-term use of nonsteroidal anti-inflammatory drugs as the sole or predominant analgesic. 802 20

This paper describes the prevalence and correlates of symptoms and health problems in pregnancy using data from a prospective population study in London. Data on the prevalence of 11 symptoms and 12 health problems were obtained at three points in pregnancy from a consecutive sample of 1513 white women. Relationships were examined between these symptoms and a range of psychosocial factors including social class, education, marital status, income, smoking, alcohol, caffeine, attitude to pregnancy and whether the pregnancy was planned. Most women reported nausea and breast tenderness in early pregnancy. Heartburn, backache, constipation and headaches were also common. The prevalence of symptoms tended to increase with gestation except for nausea and vomiting. Women with manual occupations, minimum education, low income, single marital status and unplanned pregnancy reported more of most symptoms except nausea which was associated with higher social status. A negative attitude to pregnancy was associated with more headaches but was unrelated to nausea. Women who smoked reported more 'nerves and depression' but less nausea. In general, nausea and vomiting showed a different pattern of associations from all other symptoms.
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PMID:Symptoms and health problems in pregnancy: their association with social factors, smoking, alcohol, caffeine and attitude to pregnancy. 804 82

Drug therapy is only one possibility to treat headache or migraine. In a migraine attack aspirin, acetaminophen, non-steroidal antiinflammatory drugs like ibuprofen, naproxen and mefenamic acid are used. Further more weak opiates, caffeine, metoclopramide and the new 5-HT1-receptor agonist sumatriptan are effective in the attack. Ergotamine and dihydroergotamine are probably the most effective though their side effects are troublesome. For prophylactic treatment, the beta-adrenergic receptor blockers propranolol, metoprolol and atenolol are the drugs of first choice. Also calcium channel antagonists like flunaricine and antidepressant drugs like amitryptiline and doxepine are used.
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PMID:[Pharmacotherapy of headache with special reference to migraine]. 805 12

The effect of caffeine on neuroendocrine stress responses in the workplace was studied in 14 habitual coffee drinkers. Urinary catecholamine and cortisol levels were measured on 2 study days, in a 4-hour interval from morning until noon, while participants performed their normal work-related activities. Caffeine (300 mg) or placebo was administered blind at the beginning of study intervals, after overnight caffeine abstinence. Retrospective mood and symptom ratings were collected at the end of each morning. Caffeine elevated urinary epinephrine levels during work by 37% but did not affect norepinephrine or cortisol levels. Subjective reports suggest that caffeine abstinence was associated with symptoms of caffeine withdrawal by the end of the morning. Effects included higher ratings of sleepiness, lethargy, and headache and a reduced desire to socialize. Results suggest caffeine may increase the activity of the sympathetic adrenal-medullary system during everyday activities in the work environment. This action may potentiate psychophysiological responses elicited by occupational stressors.
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PMID:Neuroendocrine responses to caffeine in the work environment. 808 74

Chronic daily headache appears in migraine patients due to chronic consumption of analgesics-ergotamine. This entity was considered intractable without hospital admission. Our aim was to study the response of this headache to an outpatient treatment protocol. The therapeutic protocol included: 1. Oral information to the patient about the role of analgesics in the chronification of the headache; 2. Abrupt withdrawal of analgesics-ergotamine; 3. Administration of naproxen as symptomatic medication, and 4. Prophylactic treatment. After 2.5 months of treatment we evaluated both the frequency and the intensity of pain episodes as well as analgesic consumption. Thirty patients (8.6% of the outpatient consultations) suffered from chronic daily headache secondary to chronic analgesic abuse. Twenty five were females and 5 were males, their mean age +/- SD being 43 +/- 11 years. The mean +/- SD number of units of analgesics-ergotamine taken per week was 28 +/- 12. Three patients exclusively abused analgesics, the remainder either ergotamine, caffeine and various analgesics (18) or caffeine or several analgesics not containing ergotamine (9). In 29 patients the response was positive. Twenty (67%) showed an excellent improvement (> 75%) in frequency and intensity and completely gave up analgesics. The remaining nine (30%) improved moderately (50-75%). Only 3 patients in this group carried on taking analgesics. One patient showed no improvement. Our work confirms the epidemiological magnitude of chronic daily headache and shows that this is a treatable entity on an outpatient basis combining the abrupt withdrawal of analgesics-ergotamine, and their replacement by naproxen, with prophylactic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Daily chronic headache in patients with migraine induced by abuse of ergotamine-analgesics: response due to a protocol of outpatient treatment]. 810 38

We have examined the relationship between perioperative headache and various factors in 219 patients who fasted from midnight and underwent minor surgery under general anaesthesia. Four to six hours after operation all patients completed a questionnaire on previous frequency of headache, daily consumption of caffeine and occurrence of perioperative headache. The duration of fasting, type of surgery, premedication and anaesthetic agents used were obtained from the anaesthetic record. After multivariate logistic regression analysis a significant risk of preoperative headache was found in patients who normally experienced headache more than twice a month (odds ratio (OR): 7.7; confidence interval (CI): 2.9-20.1), had a daily caffeine consumption > 400 mg/24 h (OR: 5.0; CI: 1.6-14.8) and who were anaesthetized after 12:00 (OR: 3.7; CI: 1.4-9.8). The risk of postoperative headache was significantly greater in patients with preoperative headache (OR: 16.9; CI: 6.5-43.8), daily caffeine consumption > 400 mg/24 h (OR: 3.9; CI: 1.5-9.6) and in those patients who received atracurium, which was similar to the risk of tracheal intubation.
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PMID:Effect of previous frequency of headache, duration of fasting and caffeine abstinence on perioperative headache. 813 47


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