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 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

Aspirin 650 mg and metoclopramide 10 mg in an effervescent preparation (Migravess) were compared with effervescent aspirin 650 mg (Alka-Seltzer) and placebo for common migraine attacks with a double-blind cross-over design. One hundred and eighteen patients with common migraine were entered. Eighty-five patients completed all three forms of treatment, eleven completed two, and six completed one. Medicine was taken when patients were sure they had a migraine attack and not just interval headache. After each form of treatment, they mailed a report form to the investigators. Additional medication was allowed after 2 h and was taken for 79/95 placebo treated attacks, 63/92 Migravess treated attacks, and 51/86 aspirin treated attacks (p less than 0.01). Aspirin was significantly better than placebo for pain but not quite significant for nausea. Migravess was significantly better than placebo for pain and for nausea. There was no significant difference between aspirin and Migravess with regard to analgesic effectiveness (p = 0.33) or to antinausea effect (p = 0.18).
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PMID:Effervescent metoclopramide and aspirin (Migravess) versus effervescent aspirin or placebo for migraine attacks: a double-blind study. 637 73

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.
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PMID:Treatment of the acute migraine attack--current status. 640 72

Low dose estrogen tablets, containing less than 50 mcg of ethinyl estradiol, were formulated because of the recognized dose response relationship with the steroid content of the tablet and side effects. These new oral contraceptives (OCs) are as effective as the older high-dose OCs, and available evidence reports fewer side effects. This discussion reviews pharmacology of these new OCs, the mechanism of action, contraindications, side effects, and problems with the low-dose estrogen OC. Ethinyl estradiol is the only estrogen used in the low-dose combination OC. There are several synthetic progestins: norethindrone, norethindrone acetate, norgestrel, levonorgestrel, and ethynodiol diacetate. These progestins have different potencies so the pharmacologic activity cannot be accurately predicted based on the amount present in the tablet. The synthetic steroids in OCs are absorbed in the small intestine, metabolized in the liver, excreted in the bile and feces with a half-life of 24 hours. The low-dose estrogen combination preparation is taken 3 out of every 4 weeks. Its contraceptive effect is primarily a result of hypothalamic mediated gonadotropin suppression with subsequent inhibition of ovulation. Contraindications to taking the low-dose OC are the same as for the higher dose OC: thromboembolic or cardiovascular disease, estrogen dependent neoplasia, markedly impaired liver function, undiagnosed genital bleeding, congenital hyperlipidemia, pregnancy, and women over age 30 who smoke. Relative contraindications include hypertension, diabetes mellitus, migraine headaches, uterine myomas, and epilepsy. The often quoted 2-5-fold increased incidence of thromboembolic disease, myocardial infarction, and stroke is based on large epidemiologic studies involving patients taking the older higher dose OCs. Current data from patients taking the newer low-dose medication demonstrate minimal if any increased incidence of these problems in young women who do not smoke. The low-dose estrogen OCs have minimal effect on lipid levels. Early reports of patients using the low-dose OC have shown little if any increased incidence of hypertension. The low-dose contraceptives have little effect on glucose tolerance, and there is no evidence to show an increased incidence of overt diabetes in OC users. There is no evidence that use of the combination OC causes an increase in cancer of the cervix, uterus, or ovaries. Clinical complaints of nausea, breast discomfort, chloasma, weight changes, and depression are reduced with the low-dose estrogen preparation. Hypomenorrhea while taking the OC occasionally occurs because the lower dose of estrogen is insufficient to stimulate the endometrial growth in face of the predominant progestin-atrophy effect.
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PMID:Oral contraceptives in 1984. 649 Mar 38

The absorption of effervescent paracetamol (1000 mg) was investigated in nine female patients during a migraine attack and in the same patients when headache free. Migraine attack decreased (P less than 0.05) the areas under the serum paracetamol concentration-time curves (AUC) of 0-2 h, 0-4 h and 0-6 h and the peak serum concentration. The severity of nausea correlated significantly with the decrease in the AUC values. Our results support findings of delayed gastric emptying in migraine attacks. Both a delay and an impairment of drug absorption may follow.
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PMID:Effect of migraine attacks on paracetamol absorption. 652 26

The speculative efforts of the scientists who research the atavistic enigma of the "spontaneous" aches which affect the head, nuc and neck of a great number of people, seem to be driven by the conviction that they are faced with a systemic autonomic illness rather than a local one. Pain is an obligatory phenomenon which dominates this ailment, and is more or less patently paralleled by a constellation of autonomic functions such as nausea, vomiting, vaso-constrictor dilation and arterial hypotension. An analogous vegetative constellation emerges at "cascades", that is, a stereotypical succession, following upon intense physiological (induced) pain. In a migraine attack, the autonomic hyperfunctions are the same in quality but their chronology is completely disrupted: the usual vegetative "cascade" being deeply perverted. In spite of concentric assaults by clinicians, biologists, rhythmologists and psychologists this species of medical sphynx has remained throughout the centuries. The core of the dilemma is in essence the following: are we dealing with a physiological or a pathological pain? The former (physiological pain) should be symptomatic of vascular (migraine) or psychic (muscle contraction headache) disorder; the latter (pathological) should be symptomatic of a malfunctioning of the nociceptor system.
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PMID:Concluding remarks on the Capri symposium: myths, facts and new trends in migraine. 661 7

Colloid cyst of the third ventricle, although a benign lesion, carries with it high mortality and morbidity if not diagnosed in time. The most common presenting symptom is headache. A 31-year-old man with a history of intermittent, throbbing, unilateral headache and nausea was admitted because of exacerbation of his headache, which responded poorly to medication. A few hours after admission he became comatose. A colloid cyst of the third ventricle causing acute hydrocephaly was diagnosed by computed tomographic scan and removed in toto. Despite an uneventful postoperative course the patient was left with permanent bilateral cerebral damage. In patients with headache not responding to conventional medication, colloid cyst of the third ventricle perhaps should be ruled out, even if the symptoms are suggestive of vascular headache, such as migraine headache.
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PMID:Colloid cyst of the third ventricle--a neurological emergency. 665 Sep 50

102 patients using Trinordiol, a triphasic oral contraceptive (OC) containing ethinyl estradiol and d-norgestrel, were followed for 932 cycles in a study of secondary effects. Follow-up visits were scheduled after 1,3, and 6 months and every 6 months thereafter. 26 patients discontinued use of the pills during the study after using them for a total of 159 cycles. 5 discontinued because of abdominal pain, 1 for breast tenderness, and 1 because of headaches or migraines. 7 discontinued because of metrorrhagia, 4 for weight gain, 3 for amenorrhea, 2 for nausea and vomiting, and 1 each for nervousness, water retention, acne, desire for pregnancy, leaving the country, hypertension, and unknown motivation. the average age of patients was 23.6 years, with a range from 14-48. 76% were aged 15-29 years. 52.9% were nulliparas. 58.8% were Belgian, 21.6% were from Mediterranean Europe, 10.8% were Moroccan, and 7.9% were from black Africa. Only 1 patient, a 37 year old, developed hypertension. 15 patients gained more than 2 kg and 17 lost more than 2 kg. 15.8% complained of spotting during the 1st cycle compared to 3.1% during the 6th cycle, 5.2% during cycle 7-12, and 9.1% during cycle 13-30. Among 35 patients who did not discontinue treatment, 7 complained of amenorrhea and 1 of scanty menstrual bleeding, 14 of pain including 7 cases of pelvic pain, 2 of dysmenorrhea, 3 of breast tenderness, and 2 of headaches, 15 of leukorrhea, 3 of nausea, 2 of dizziness, and 1 each of fatigue, acne, galactorrhea, and cutaneous pruritus. 1 case of myoma at the level of the uterine cornu was identified after 24 cycles of treatment. In all, 61 patients had some complaint, while 41 were totally satisfied. No patient became pregnant during the study.
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PMID:[Clinical study of the secondary effects associated with taking a triphasic anti-ovulatory contraceptive]. 670 4

This article, arguing that consumers have a right to be informed about the dangers of health care measures, discusses the health risks of oral contraceptives (OCs) and IUDs. In a brief review of the history of contraceptive development and use, it is stated that the 1st OC was tested on only 132 women in Puerto Rico before being approved for commercial use. OCs, which inhibit ovulation, sperm penetration, and implantation of the egg, represent the surest and most convenient contraceptive yet developed. Despite their advantages, pills may cause various secondary effects such as spotting, water retention, irritability, nervousness, nausea, vaginitis, migraine headaches, hypertension, and others, whose alleviation is responsible for large additional profits to the pharmaceutical industry. Although results are difficult to interpret and the passage of time may not have been sufficient, disquieting indications of a possible carcinogenic effect of OCs have been noted. The pill has been implicated in an elevated incidence of thromboembolism and is known to influence the metabolism of some substances, and the list of contraindications for pill use is long. Women wishing to use pills should consult a conscientious physician who will take a complete medical history, perform a thorough physical, and furnish complete information on the risks of pill use. IUD mode of action is incompletely understood. Fewer than 2/3 of women accepting IUDS are able to tolerate them for more than 1 year, from 7 to 20% of IUDs are spontaneously expelled, and from 3-35% are removed at the request of the client for pelvic pain and bleeding. Another 4-15% are removed each year for other medical reasons. IUD related mortality is less than that related to OCs, but a series of secondary effects and contraindications are associated with their use. If a woman chooses to use an IUD despite everything, she should choose a physician experienced in IUD insertion who is not experimenting with a new type of device. The preference for powerful contraceptives has caused women to excuse men from sharing in the responsibility for birth control, among other deleterious effects.
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PMID:[Contraception: yes, but at what cost?]. 675 25

We have observed 27 migraineurs whose headaches occurred in groups separated by headache-free periods. Twenty-one of the patients were women. The headaches occurred on either side in most patients. The headaches were severe lasting for an average of 25.5 hours, often preceded by scintillating scotomas, and often associated with nausea, vomiting, and photophobia. The attacks occurred in cycles that lasted an average of six weeks. The cycles recurred an average of five times per year; during the cycles, severe migraine occurred several times per week. In many patients, the cycles were often accompanied by a constant, low-grade headaches and depression. Twenty-two patients were treated with lithium carbonate. Complete or partial control of the headaches was achieved in 19 patients.
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PMID:Cyclical migraine. 678 69


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