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Query: UMLS:C0027497 (nausea)
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The main criteria of "cervicogenic headache" are considered to be as follows: relatively rare and long-lasting unilateral attacks of severe headache, although seemingly of a non-excruciating character, signs of neck involvement, and lack of "cluster pattern". In the present communication, the clinical manifestations in 11 patients fulfilling these criteria are described. All 11 patients selected in accordance with these criteria proved to be females, the age at onset ranging from 6 to 40 years (mean, 30 years). The mean duration of symptoms was 13 years. Six patients had had previous head/neck injuries. All patients had pain periorbitally, in the temporal region, and in the low occipital region (nape of the neck); less frequent were frontal, parietal, and facial pain and pain in the upper part of the occipital region. The duration of attacks was from 3 h to 3 weeks, and the interval between attacks lasted from 2 days to 2 months. The commonest accompanying phenomena were phonophobia, dizziness, ipsilateral eyelid edema, ipsilaterally blurred vision, and irritability. Some of the patients also had nausea (n = 7) and vomiting (n = 6). On physical examination, slight to moderate reduction of movements in the neck was noted, and five patients had ipsilaterally reduced sensation for touch in the trigeminal area. All the patients except one were severely afflicted. Attacks could, in addition to occurring spontaneously, be precipitated in all patients by head movements or by pressure at specific points in the neck.
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PMID:"Cervicogenic headache": clinical manifestation. 360 68

Patients with facial pain, without overt dental disease, are often seen in both medical and dental practice. The differential diagnosis includes (a) cluster headache, in which patients have severe unilateral pains lasting 30 to 120 minutes that respond to verapamil, corticosteroids or lithium; (b) migraine, in which attacks are longer and are often accompanied by nausea and visual disturbance, and can be managed using anti-inflammatory analgesics, with or without metoclopramide, or sumatriptan, although frequent attacks are best suppressed by continuous propranolol or pizotifen; (c) trigeminal neuralgia, knifelike unilateral pains usually responsive to carbamazepine; and (d) temporal arteritis, a steadier pain very responsive to corticosteroids. There is no evidence that continuous 'idiopathic facial pain' is a result of malocclusion (i.e. the way in which the teeth fit together), and its aetiology remains obscure, although there is some biochemical evidence linking it to depression. Many patients respond to simple analgesia and firm reassurance from the physician, although antidepressant therapy (e.g. nortriptyline or dothiepin) is often of great value.
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PMID:Orofacial neuralgia. Diagnosis and treatment guidelines. 769 15

Cholesterol granulomas of the head are relatively rare. Isolated lesions of the cerebellopontine angle are even more uncommon. In this report, 17 cases of petrous apex cholesterol granulomas are presented and management is discussed. Symptoms at presentation included dizziness (14 patients), pressure (nine patients), tinnitus (eight patients), hearing loss (eight patients), otalgia (six patients), headache (six patients), nausea (three patients), drainage from ear (two patients), facial pain (two patients), seizure (two patients), lightheadedness (one patient), hemifacial spasm (one patient), and facial numbness (one patient). Six cases were managed without surgery and 11 patients underwent operative procedures. The approaches used included the infralabyrinthine (eight patients), transcanal-infracochlear (two patients), and translabyrinthine (one patient). The mean follow-up period for all cases was 29.5 months. Of those patients managed without surgery, symptoms improved in all except one, whose tinnitus was slightly worse. Of surgically treated patients, symptoms improved or remained the same except in one with worsened dizziness. There were nine patients with hearing present presurgery and seven whose hearing was preserved postsurgery. The authors present a case that was managed at another center where an attempt at surgical resection through a subtemporal middle fossa approach was unsuccessful. This lesion was successfully treated using an infralabyrinthine approach with drainage into the mastoid cavity. Cholesterol granulomas of the petrous apex can be managed without surgery when symptoms are stable or improve. Otherwise, a transmastoid extradural approach with simple drainage into the mastoid sinus or middle ear produces symptomatic improvement with low morbidity. Resection of petrous apex cholesterol granulomas is not necessary.
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PMID:Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management. 881 66

Considerable uncertainty exists regarding the appropriate use and dose limitations for ergotamine tartrate (ET) and dihydroergotamine (DHE) for the treatment of migraine despite more than 50 years of clinical experience. The Quality Standards Subcommittee (QSS) of the American Academy of Neurology (AAN) appointed an advisory committee from experts in the Headache and Facial Pain Section. As their initial project, the committee elected to review the clinical literature on the appropriate use of these compounds in the treatment of migraine. Subsequently, clinical practice guidelines were formulated and recently published in Neurology. The Headache and Facial Plan Section and the QSS of the AAN were able to reach consensus on the basis of a thorough literature review and formulated practice parameters that describe and define the limits of ergot use, provide information on the oral and parenteral dosing of ET and DHE, and provide physicians with guidance to avoid ET overuse by patients. Because this project was completed prior to the availability of the intranasal (IN) formulation of DHE, intranasal DHE is not included in the practice parameter. Ergotamine tartrate and DHE were found to be safe and effective for the treatment of migraine as long as recommended dosages are not exceeded and high-risk patients such as those with uncontrolled hypertension, coronary or peripheral artery disease, thyrotoxicosis, or sepsis do not receive these compounds. In addition, the committee recommended restricting the use of ET in some instances because the overuse of ET has been associated with physical and psychological dependence resulting in predictable recurrent and/or rebound headaches, and subsequent severe withdrawal symptoms, including nausea, upon discontinuance of ET. None of these symptoms have been reported for DHE. These guidelines should help physicians provide optimal antimigraine therapy with these drugs.
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PMID:Appropriate use of ergotamine tartrate and dihydroergotamine in the treatment of migraine: current perspectives. 900 73

A detailed study of the clinical characteristics of migraine without aura (MOA) reveals some interesting data. A questionnaire was returned by 200 patients who met the International Headache Society criteria for MOA. The peak of onset of migraine was between 10 and 19 years of age. The headache was side-locked in 19%. It was exclusively bilateral in 9%. The majority (86.2%) of the patients who described headaches in only one site located them in the fronto-temporal area. Neck pain was associated with migraine attacks in 70.5% and face pain in 73.5%. A pounding quality was noted by 81%. Every patient described the headache as moderate to severe. Only 55% stated that it was aggravated by routine physical activity. Nausea occurred in 91%, photo and phonophobia in 77%, and vomiting in 50%. This close look at MOA uncovers a great complexity of symptoms.
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PMID:[Clinical characteristics of migraine without aura]. 968 24

Although controversial, opioid analgesics have been prescribed for patients with chronic facial pain. Based primarily on survey data and a few well-controlled clinical trials, long-term opioid treatment provides adequate pain reduction in 41% to 100% of patients with chronic nonmalignant pain. However, only 25% of chronic facial pain patients reported adequate pain relief with chronic opioid treatment. Work, home, and school function are generally reestablished or maintained during chronic opioid treatment, but 25% to 38% of patients remain dysfunctional, and one study indicated that 20% of patients became dysfunctional during treatment. Chronic opioid treatment is associated with many transient side effects; constipation, dizziness, nausea, vomiting, itching, and fatigue have been reported in 5% to 42% of patients taking opioids over 1 year. Although survey studies suggest that the risks of addiction are low in typical patients, drug abuse rates up to 17.3% and prescription abuse rates up to 27.6% were reported within groups of chronic opioid users. Chronic opioid use induces analgesic tolerance and physical dependence, which may result in a serious abstinence syndrome in users and children born to users. Chronic opioid use also may induce harmful immune system changes, diminish cognitive and motor function, and produce nociceptive hyperexcitability. This article shows that the use of long-term opioids for chronic facial pain is not justified based on the available data. Despite these perceived problems, there is anecdotal evidence that chronic facial pain patients will respond positively to opioid analgesics. In our experience, the pain assessment scale and a modification of the World Health Organization's three-step analgesic ladder, which prescribes nonopioid analgesics, can be the starting point for the successful management of chronic facial pain.
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PMID:The use of nonopioid drugs in management of chronic orofacial pain. 973 70

In a primary care setting, the efficacy and safety of ciprofloxacin (CIP) 500 mg b.i.d. were compared with those of cefuroxime axetil (CA) 250 mg b.i.d., each given for 10 days, in a nationwide, open, prospective, randomized trial of 1414 adults with acute sinusitis. Patients were enrolled if they had clinically documented acute sinusitis (ie, rhinosinusitis) (<4 weeks' duration), based on the 1997 American Academy of Otorhinolaryngology--Head and Neck Surgery criteria of either two major or one major and two minor symptoms. The primary efficacy variable was clinical response (resolution or failure) at the posttherapy assessment on study days 14 through 26. The most common presenting major signs and symptoms of acute rhinosinusitis were facial congestion, nasal drainage/purulence, facial pain/pressure, and nasal obstruction/blockage. The minor symptom, headache, was more common and severe than was nasal obstruction/blockage. A total of 1219 patients were clinically evaluable. Clinical resolution was observed in 559 of 613 (91.2%) CIP-treated patients and 546 of 606 (90. 1%) CA-treated patients. The two regimens were statistically equivalent (95% confidence interval, -2.16% to 4.71%). There were 80 drug-related adverse events reported in the CIP-treated patients and 81 drug-related adverse events reported in the CA-treated patients. The main adverse events were nausea (n = 18) and diarrhea (n = 7) in patients treated with CIP and diarrhea (n = 14), nausea (n = 12), headache (n = 7), and vaginitis (n = 7) in those treated with CA. CIP 500 mg b.i.d. was found to be statistically equivalent to CA 250 mg b.i.d. in the treatment of acute rhinosinusitis.
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PMID:Multicenter comparative trial of ciprofloxacin versus cefuroxime axetil in the treatment of acute rhinosinusitis in a primary care setting. Rhinosinusitis Investigation Group. 982 44

The aim of this study was to determine whether trigeminal nerve discharge associated with painful stimulation of the temple would intensify symptoms of motion sickness in migraine sufferers. If so, this would support the notion that symptoms such as nausea and headache interact with each other during attacks of migraine. Symptoms of motion sickness were rated at 2 min intervals during 15 min of optokinetic stimulation in 27 migraine sufferers and 23 age- and sex-matched controls. To document changes in frontotemporal blood flow, pulse amplitude was monitored with photoelectric pulse transducers. To induce facial pain, ice was applied to the temple for 30 s, three times at 4 min intervals during optokinetic stimulation. On another occasion, pain was induced during optokinetic stimulation by immersing the non-dominant hand in 2 degrees C ice water for 30 s, three times at 4 min intervals. On a third occasion, measures were obtained during optokinetic stimulation alone. Migraine sufferers rated themselves as being generally more susceptible to motion sickness than controls. In addition, symptoms of motion sickness provoked by optokinetic stimulation were greater in migraine sufferers than in controls. Painful stimulation of the temple intensified nausea and headache during optokinetic stimulation, whereas painful stimulation of the hand did not. Since nausea also intensifies facial pain during motion sickness, nausea and headache may reinforce each other in a vicious circle. In the absence of painful stimulation, increases in pulse amplitude during optokinetic stimulation were greater in migraine sufferers than controls, possibly because the discomfort associated with motion sickness triggered extracranial vasodilatation in migraine sufferers as part of a fight-or-flight (defense) response. Extracranial vasodilatation did not differ between migraine sufferers and controls when ice was applied to the temple or hand during optokinetic stimulation, implying that the additional discomfort associated with painful stimulation of the head and hand evoked a defense response in controls. These findings suggest that a mechanism which boosts extracranial neurovascular reflexes to stress and which heightens symptoms of motion sickness, increases susceptibility to migraine.
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PMID:Facial pain increases nausea and headache during motion sickness in migraine sufferers. 1549 9

This article presents a case study of a patient diagnosed with dysfunction of the sternocleidomastoid (SCM) muscle, a condition which can result in head and face pain, nausea, dizziness, coryza, and lacrimation. In this particular case, the SCM muscle had developed tightness and weakness with presence of multiple trigger points within both heads. A combination of passive and active treatments were utilized to successfully treat this condition.
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PMID:Sternocleidomastoid syndrome: a case study. 1754 18

We evaluated approaches taken by Northeastern Turkish adolescents to cope with menstrual pain. The questionnaire was prepared according to the facial pain rating scale and applied to 1,408 female high school students (16.05 +/- 1.05 years of age). We investigated the characteristics of dysmenorrhea in adolescents, dysmenorrhea management strategies used by adolescents, and use of medication. We evaluated the relationships among pain duration, severity, and duration of dysmenorrhea experience using the chi-squared test. Dysmenorrhea was considered to be painful menstruation during the past three cycles and was experienced by 81.7% of subjects. It mostly occurred during the past 1-3 years (65.6%). Pain was mostly initiated a day before (38.8%) or at the beginning of (45.8%) menstrual flow and lasted for 1-3 days. It was felt in multiple locations but most commonly in the lower abdomen and lumbar region. Major symptoms associated with dysmenorrhea were sweating, low appetite, headache, distraction, nausea, vomiting, and dizziness, as well as varying degrees of pain severity. Approaches taken to deal with dysmenorrhea were: consulting a health professional (8.9%), medication (46.1%), nonmedicinal activities, and other empirical strategies (24.4%). Medication was recommended mostly by mothers (39.0%) and was taken when pain became unbearable (65.5%). More than one-third of the subjects did not know which drug they took. Major nonpharmacologic measures were: heating pad use (36.5%), sleeping (31.0%), walking (11.3%), and massaging (11.0%). Seeing a physician (p < .001), taking medication (p < .001), and applying empirical strategies to prevent dysmenorrhea (p < .01) were associated with prolonged dysmenorrhea. Medication was associated with shortening pain duration during one menstrual cycle. Except for empirical strategies to prevent dysmenorrhea, all other methods used to prevent dysmenorrhea were related to pain duration and severity. Adolescents should be encouraged to consult a physician and should be prescribed medication in addition to other measures to alleviate menstrual pain and shorten its duration. Moreover, school curriculum should be redesigned to address proper management strategies for adolescent problems. School nurses can also provide consultation services and arrange informative seminars to increase public awareness of this issue.
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PMID:Evaluation of menstrual pain management approaches by Northeastern Anatolian adolescents. 1926 82


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