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

In this report, we present the symptoms, biochemical investigations, 24 hour ambulatory blood pressure and heart rate recordings in a patient before and following removal of a predominantly adrenaline-secreting phaeochromocytoma. The symptoms were of episodic shaking, faintness, nausea, palpitations, sweating and panic, chest and neck pain with headache, and are consistent with previous reports. Ambulatory blood pressure recording demonstrated that mean daily blood pressure was normal, with normal diurnal variation, and two episodes of severe hypertension and bradycardia coincident with symptoms (MAP 150 mmHg and HR 49 beats/minute, MAP 178 mmHg and HR 29 beats/minute, respectively), not reported in predominantly adrenaline-secreting phaeochromocytoma.
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PMID:Twenty-four hour ambulatory blood pressure and heart rate in a patient with a predominantly adrenaline secreting phaeochromocytoma. 793 55

38 women aged between 23 and 42 years had secondary amenorrhea and clinical hypoesterogenism as assessed by the failure to have a withdrawal bleed in response to a progestin. All women were initially treated with up to 7.5 mg bromocriptine but it was discontinued because of failure to lower serum prolactin (PRL) or intolerance. Each woman had a basal computerized tomography (CT) scan before estrogen (E) replacement therapy, which was repeated after 6 months, and then yearly. The clinical course was monitored at 3-month intervals for the first year and the yearly. The patients were classified by CT scan as having either idiopathic hyperprolactinemia (19 patients), microadenoma (18 patients), or macroadenoma (1 patient). All patients have been followed with continuous exogenous E therapy for 2 to 6 years. The serum PRL was measured as a single random value by a double antibody homologous radioimmunoassay. 29 received physiological replacement with conjugated E (.625 mg, Premarin) from days 1 to 25 of each month, and added medroxyprogesterone acetate (10 mg, Provera) from days 16 to 25 of each month for 4.0 +or- 1.2 years. There was a significant decrease of serum PRL, and monthly withdrawal bleeding occurred in all women with alleviation of E-deficiency symptoms. 9 patients were treated with OCs for 2.0 +or- .8 years. There was a downward trend in the serum PRL without statistical significance. With abnormal CT scans, 6 patients with microadenomas had a decrease in size, whereas the remainder were unchanged. The patient with the macroadenoma (patient 29) had an onset of headaches after 4 months of therapy, but there was no change in the size of the tumor. The patients with normal CT scans did not show any change. The microadenomas in 2 of 3 women decreased in size. In summary, E-replacement therapy may be given to women with E deficiency, despite the presence of pathological hyperprolactinemia, as the induction of rapid growth of an underlying pituitary adenoma was not confirmed.
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PMID:The safety of physiological estrogen plus progestin replacement therapy and with oral contraceptive therapy in women with pathological hyperprolactinemia. 845 75

The US Food and Drug Administration finally approved the injectable contraceptive Depo-Provera (DMPA) in October 1992, 25 years after its introduction. Women return to a health facility every 90 days for an intramuscular injection of 150 mg DMPA, which provides them 99% effective contraception. Menstrual changes and spotting are the leading reasons for DMPA discontinuation. Eventually, more than 50% of DMPA users develop amenorrhea. During the first year, women gain about 2 kg and weight increases as time passes. Weight gain is the second leading reason for DMPA discontinuation. DMPA may adversely affect glucose tolerance in women at risk for diabetes, but it does not affect cardiovascular or metabolic functions. It may increase the risk of osteoporosis. A rare side effect is convulsions. 1-10% of DMPA users have other central nervous system effects, such as headaches, dizziness, and depression. Itching and rashes may develop. Fertility returns within 1 year after discontinuation. DMPA is linked to low birth weight. It apparently does not harm breast-fed infants or hinder lactation. A World Health Organization study shows that DMPA users less than 35 years old experience a slight increase in breast cancer but a reduced incidence of endometrial cancer. Nurses are instrumental in guiding women as they choose DMPA and in informing them about its potential side effects, including breast cancer risk. They must screen women for pregnancy and evaluate their risk of breast cancer. They must determine whether women are able to return every 3 months for DMPA injections. Women who select DMPA must use other contraception, e.g., barrier protection, within the first 24 hours after initial injection. Nurses should counsel them about the likely menstrual changes to reduce the likelihood of dissatisfaction. They should recommend a daily dose of 1200 mg of elemental calcium and daily exercise of long bones to minimize the risk of developing osteoporosis.
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PMID:Depo-Provera. 849 47

A leading patient complaint is headaches which tend to occur more often in women than men. Nonvascular headache is the most common and is caused by tension or muscle contraction. Oral contraceptives (OCs) do not affect nonvascular headaches. They can also be safely used in women who experience common migraines whose symptoms do not become more severe or frequent during OC use. On the other hand, women who have classic migraine (headache accompanied by focal neurologic symptoms) or common migraine with symptoms becoming more severe or frequent during OC use should discontinue OC use. Instead, they should use a barrier method or the IUD. Estradiol treatment appears to be effective in treating menstrual migraine. Since the data are inconclusive about the effect of OCs on young women who have experienced a stroke or transient ischemic attacks, it would be best for them to use a barrier method. Most antiepileptic drugs (phenobarbital, phenytoin, paramethadione, and carbamazepine) cause enzyme induction which may be linked to decreased levels of estrogen and increases in irregular bleeding, thereby increasing the likelihood of an epileptic OC user becoming pregnant. Possible contraceptive failure exposes a developing fetus to the teratogenic properties of the antiepileptic drugs. Thus, physicians should prescribe OCs with 50 mcg of ethinyl estradiol rather than 35 mcg ethinyl estradiol. Epileptic women can also use Depo-Provera, because it is not only effective in preventing pregnancy but reduces seizure frequency. It is important for any contraceptive method chosen for epileptic women to be effective because pregnancy intensifies seizures which in turn can damage the mother and/or fetus and cause neonatal distress.
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PMID:Contraceptive methods for women with neurologic disorders. 851 48

The authors present their findings from the study of adolescents' reasons for discontinuing the use of Norplant and Depo-Provera. Their experiences after method discontinuation were also assessed. 35 adolescents of mean gynecologic age 4.7 years and body mass index (BMI) 24.2 who discontinued Depo-Provera, and 31 adolescents of mean gynecologic age 3.4 years and BMI 24.1 who discontinued Norplant were periodically assessed during use of the methods and up to 12 months after discontinuation. The most common reasons for discontinuation of both Norplant and Depo-Provera after mean periods of 21.8 and 9.2 months use, respectively, were irregular menstrual bleeding (64%), weight gain (41%), and increased headaches (30%). The resumption of menstrual regularity and dysmenorrhea was noted sooner after discontinuation of Norplant, compared to Depo-Provera. The increase in BMI noted at the discontinuation of Depo-Provera persisted up to 6 months after discontinuation of either method. 62% of adolescents reported no break in contraceptive practice. The condom was the most popular method (37%) after discontinuation of Depo-Provera, and oral contraceptives (39%) after discontinuation of Norplant. The authors conclude that health care providers should aggressively manage physical problems associated with Depo-Provera and Norplant use, and expedite the transition to new contraceptive methods in an effort to minimize the high pregnancy rates observed after discontinuation of these methods in adolescents.
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PMID:Adolescents' reasons for and experience after discontinuation of the long-acting contraceptives Depo-Provera and Norplant. 886 83

US teenagers have had access to the injectable contraceptive depot medroxyprogesterone acetate (DMPA; Depo-Provera) since the US Food and Drug Administration approved it in 1992. DMPA suppresses follicle stimulating hormone and luteinizing hormone (LH) levels, which in turn prevents the LH surge and thus inhibits ovulation. It also causes a thick cervical mucus (reducing sperm penetration). Since DMPA also changes tubal mobility and creates shallow and atrophic endometrium, implantation is prevented. DMPA must be administered every 3 months to be effective. Its first-year failure rate is 0.3%, which is lower than that of oral contraceptives (3%). Advantages of DMPA are that it: allows for privacy; improves compliance (since action is required every 3 months rather than every day); has no estrogen-related complications (e.g., thrombophlebitis); is effective; is safe for breast feeding teenagers; reduces seizure frequency in teenagers with epilepsy; has a favorable effect on sickle cell disease or coagulopathy; reduces menstrual flow, thus preventing iron-deficiency anemia; reduces menstrual pain and pre-menstrual symptoms; and decreases risk of pelvic inflammatory disease. The leading disadvantages are menstrual irregularities and spotting. Some other possible disadvantages include weight gain (most common reason for discontinuation), delayed return of fertility, headaches, acne, and nervousness. Health providers must perform a complete history of teenagers requesting DMPA. They should determine the presence or absence of absolute and relative contraindications to DMPA. Absolute contraindications are known or suspected pregnancy, undiagnosed or abnormal vaginal bleeding, known or suspected history of breast cancer, acute liver disease or jaundice, thromboembolism, and sensitivity to DMPA. DMPA is administered intramuscularly at a concentration of 150 mg/ml. Health providers need to use a frank, nonjudgmental, empathic, and unhurried approach to facilitate a trusting relationship and rapport with teenagers. Advanced counseling on the pros and cons of DMPA, how DMPA works, and DMPA's inability to protect against sexually transmitted diseases is essential.
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PMID:Use of depo-provera in teens. 892 Mar 51

Depo-Provera was approved for general contraceptive use in the US in October 1992. This retrospective study examined the records of the first 510 women who initiated Depo-Provera use at a North Carolina county health department in 1993. The mean age of Depo-Provera users in this series was 23.5 years; 80% were unmarried. The mean number of living children was 1.3. At the time of injection, an appointment was set for a second injection 12 weeks later. Women were considered as continuers as long as they received an injection within 16 weeks of the last injection--the maximum duration of effectiveness. A total of 181 acceptors (36%) continued Depo-Provera use for 12 months, with an average interval between injections of 13 weeks. The 4-month and 8-month continuation rates were 67% and 46%, respectively. Of the 227 discontinuations, 64 were due to non-bleeding-related side effects such as weight gain, headache, and hair loss and 56 were because of bleeding problems. An additional 39 discontinuations were by default, i.e., acceptors waited more than 16 weeks for repeat injection and were refused. Another 102 women (20%) were lost to follow-up. If it is assumed that women lost to follow-up continued at the same rate as other women, the 12-month continuation rate rises. Discontinuation rates were significantly lower among only two sociodemographic groups: women covered by Medicaid for either all or none of the injections and women who reported bleeding side effects at their last injection. The provision of estrogen therapy to Depo-Provera users who experience irregular bleeding could increase compliance with this new method.
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PMID:Depot medroxyprogesterone acetate pioneers. A retrospective study at a North Carolina Health Department. 943 59

Objective: This paper focuses on the user profile, side effects, and discontinuation rates of Depo-Provera users at Grady Memorial Hospital, a large inner-city hospital in Atlanta, Georgia.Methods: Between July 1993 and April 1996 baseline and follow-up interviews were conducted with African-American and Caucasian women who were using a contraceptive method. Women had to choose a method that they had not used in the previous 3 months.Results: Depo-Provera was one of the top two contraceptive methods chosen at Grady Memorial Hospital. Convenience and effectiveness were the main reasons for its selection. Of the total Grady Hospital sample (n = 1,346), 404 women (30%) selected Depo-Provera as their method of contraception. Approximately 70% of the Depo-Provera users were aged 16-25 years, African American (98.3%), had never been married (88%), were on Medicaid (73.5%), and had had at least one pregnancy (94.3%). Depo-Provera users experienced menstrual (92.6%) and non-menstrual (67.6%) side effects. Menstrual side effects included amenorrhea, irregular cycles, spotting, and long menses. The most prevalent non-menstrual side effects were weight gain and headaches.The 12-month discontinuation rate of Depo-Provera was 49.2%, compared to oral contraceptives (66%) and Norplant (15%). The main reason cited for discontinuation of Depo-Provera was non-menstrual side effects (35.6%), menstrual side effects (23.1%), and inconvenience (12.0%). Of all women who initiated Depo-Provera use, 11.0% were pregnant at 12 months and 16.5% became pregnant by the first follow-up survey (average of 17 months).Conclusions: At Grady Memorial Hospital, Depo-Provera was a popular birth control method with high discontinuation rates. Menstrual, non-menstrual side effects, and inconvenience were the chief discontinuation factors. The impact of Depo-Provera discontinuation upon the pregnancy rate is substantial.
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PMID:Depo-provera: an excellent contraceptive for those who continue to use it. 1083 19

Biogenic amines are formed in foods as a result of amino acid decarboxylation catalyzed by bacterial enzymes. When consumed in sufficient quantities, these compounds will cause headache, hypertension, fever, and heart failure. Technologies such as vacuum packaging and carbon dioxide-modified atmosphere packaging (CO2-MAP), when combined with low-temperature storage (-1.5 degrees C), allow fresh pork to have a storage life long enough for export to overseas markets. During low-temperature storage of pork in these packaging systems, the lactic acid bacteria (LAB), which possess the enzymes for biogenic amine formation, dominate the microflora. The objectives of this study were to determine the quantities of biogenic amines in packaged fresh pork, to monitor LAB growth, and to determine the storage life by sensory evaluation. Vacuum-packaged and CO2-MAP pork were stored at -1.5+/-0.5 degrees C for 9 and 13 weeks, respectively. Phenylethylamine, putrescine, cadaverine, histamine, tyramine, spermidine, and spermine concentrations were determined weekly by high-performance liquid chromatography and capillary gel electrophoresis. LAB and carnobacteria were enumerated weekly. Samples were evaluated for odor and appearance. The CO2-MAP was successful in delaying bacterial growth and the development of unacceptable off-odors compared with the vacuum packaging. The storage lives of the vacuum-packaged and CO2-MAP pork were 5 and 13 weeks, respectively. High-performance liquid chromatography was the superior method for biogenic amine quantification. Tyramine and phenylethylamine in pork of both packaging treatments approached levels considered to be potentially toxic. Given Canada's increasing role in the export of fresh meat to foreign markets, it is recommended that the formation of biogenic amines in vacuum-packaged and CO2-MAP pork be further investigated.
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PMID:Biogenic amines in vacuum-packaged and carbon dioxide-controlled atmosphere-packaged fresh pork stored at -1.50 degrees C. 1127 71

The use of depo-medroxyprogesterone acetate (DMPA), or Depo Provera, has been debated for the 20 years since it became available in 1967. The US Food and Drug Administration (FDA) refused to approve Depo Provera on the basis that it caused breast tumors in a controlled study of Beagle dogs and Rhesus monkeys conducted by Upjohn, the manufacturer. Depo Provera has been approved in over 60 other countries and is in use in 30 or 40 others with an estimated total of almost 5 million users. A natural hormone, progesterone, DMPA is injected intramuscularly and absorbed slowly. Common dosage is 150 mg every 3 months and usually is administered during the 1st week of the menstrual cycle. The pregnancy rate with Depo Provera is .44 pregnancies/100 women years for women receiving 100 mg every 3 months. No pregnancies were recorded in recent studies for women receiving 150 mg. Possible side effects include amenorrhea, weight gain, dizziness and headaches. The median time for contraception after the presumed duration of one's last injection is 5-1/2 months. Some countries only permit women who already have 1 child to use Depo Provera. The FDA in the US approves the use of Depo Provera for treatment of endometrial and renal cancer but accuses it of causing cancer in Beagles and Rhesus monkeys. The studies were conducted over 7 and 10-year periods, respectively, with extremely negative results including the death of 3 dogs due to "drug-induced diabetes," atrophication of adrenal glands, and malignant tumors. There were similar results for the monkey study. In the UK, the Committee for Safety in Medicine supports Upjohn's view that Beagles are unsuitable for comparison testing because "all dogs are acutely sensitive to progesterone." Groups such as the National Women's Health Network, the institute for Food and Development Policy, and "Mother Jones" have used the media to generate opposition to Depo Provera, citing a double standard for rich and poor women, developed and less developed countries. The proponents of Depo Provera criticize health activists for imposing their own standards on women in developing countries. Regarding concerns about greater risk of Acquired Immune Deficiency Syndrome (AIDS), Depo Provera can be injected with disposable needles. In response to the controversy, Upjohn withdrew its application to the FDA in September 1986 but intends to resubmit with new information from a World Health Organization report, which showed no evidence of an increased risk of cancers of the endometrium, liver, or breast.
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PMID:Depo Provera: still controversial. 1217 73


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