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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The efficacy of diclofenac sodium, a potent prostaglandin inhibitor, in patients with acute migraine attacks in a double-blind placebo-controlled study involving 86 migraine patients. Forty-six patients with acute migraine attacks were treated with intramuscular injection of 75 mg diclofenac sodium, and another group of forty patients with intramuscular injection of paracetamol. Partial or complete relief of pain and other symptoms of acute migraine attack was achieved within 10 minutes after treatment in the diclofenac sodium group and within 32 minutes in the paracetamol group. Complete relief of attack was achieved within 30 minutes after diclofenac sodium in 40 patients (88%) compared to 7 patients (17.5%) of the paracetamol group (P less than 0.001). Five of the patients treated with diclofenac sodium needed a second injection for complete relief of pain during the 2-to-4 hour follow-up period. Side effects were rare and minimal. In conclusion, diclofenac sodium administered intramuscularly is a very effective drug in treating acute migraine attacks.
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PMID:Treatment of acute migraine attack with diclofenac sodium: a double-blind study. 155 95

A registration system for symptoms of occupational musculoskeletal injuries has been developed and evaluated. The system is based on the recording of two aspects of the pain sensation: the intensity (five point scale) and the frequency (three point scale) of pain. The two primary indicators are summed to give a combined symptom score. The scoring system was evaluated in terms of its ability to predict the probability of a medical consultation due to a musculoskeletal pain problem. The intensity and frequency parameters were shown to contribute significantly and to carry equal weight when optimising the symptom score by a logistic regression analysis. In the scoring of pain symptoms a distinction was made between pain experienced during and outside working hours and only the first category was included. The separation eliminated some symptoms that the workers did not consider work related (mostly due to migraine, arthritis). Repeated interviews of 14 subjects showed, however, that this procedure could cause classification problems.
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PMID:Individual and work related factors associated with symptoms of musculoskeletal complaints. I. A quantitative registration system. 155 11

A six-week cardiovascular exercise program was provided to 11 subjects classified as experiencing classical migraines, while 9 similarly-classified subjects served as waiting-list controls. Measures included the Canadian Aerobic Fitness test, a headache diary to record the Frequency, Intensity, and Duration of migraine episodes and the Pain-Severity, Affective-Distress, and Support scales of the West Haven-Yale Multidimensional Pain Inventory (MPI). Measures were taken on both treatment and control subjects before, mid-way through, and upon termination of the first aerobic program, as well as after a two week follow-up. The aerobic classes were effective in significantly improving cardiovascular fitness. Pain Severity decreased significantly for those receiving aerobic training, who also showed (nonsignificant) trends, over the measurement periods, toward reductions in Affective Distress as well as the Frequency, Intensity and Duration of migraines, but these trends failed to reach statistical significance. Control subjects demonstrated no systematic changes in any of the dependent measures. These results suggest possible long-term benefits of aerobic fitness in the management of classical migraines.
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PMID:The effects of aerobic exercise on migraine. 155 33

Earlier definitions of migraine and tension-type headache assumed knowledge of pathophysiology. These definitions were system specific and simplistically defined migraine as vascular in origin and tension-type headache as muscular. These definitions were vague and have led to lack of precision in diagnosis. Newer understandings of the pathophysiology of headache suggest that there may be a relationship between the two disorders based on central mechanisms. Overuse of analgesics and ergotamines has also been found to contribute to chronic daily headache through the phenomenon of rebound pain. These mechanisms have important implications in the treatment of primary headache disorders.
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PMID:Chronic daily headache. 155 89

Women tend to suffer more often from migraine than men (19% vs. 9%). Further menstruation is associated with attacks in 60% of women who have migraine. Moreover 14% of women with migraine suffer from attacks only with menses. Migraine may be linked to late luteal phase dysphoric disorder and dysmenorrhea. these conditions occur when the greatest fluctuation of estrogen levels occur. These fluctuations indeed cause prostaglandin levels to rise, prolactin release to intensify, and central nervous system opioid dysregulation to occur. In fact, several studies show that decreasing levels of estrogen activate menstrual migraine. Further estrogens and progesterone trigger synthesis of endometrial prostaglandins. In fact, prostaglandins regulate descending norepinephrine pain control systems in the brain, thus increased levels of prostaglandins decreases the pain threshold. In addition, falling levels of estrogens produce dopamine receptor hypersensitivity. Dopamine antagonists cause increased prolactin release throughout the luteal phase in all women and during the entire menstrual cycle in women with menstrual migraine. Physicians can treat menstrual migraine with various nonsteroidal antiinflammatory drugs, simple or combination analgesics, ergotamine, or hormonal therapy when other treatments fail. They should be aware that diuretics and pyridoxine are ineffective in treating menstrual migraine. Several replacement therapies to treat menopausal women with migraine exist. these include adding androgens, reducing estrogen dosage, converting to continuous dosing, and converting to parenteral dosing. Some data show an increase in or severity of migraine among oral contraceptive (OC) users, but other studies find no difference in headache among OC and placebo users. In fact, OCs may exacerbate, improve, or not change the frequency or severity of headaches.
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PMID:The role of sex hormones in headache. 155 90

Recent evidence suggests that migraine may not be due to vasoconstriction followed by reactive vasodilation, and tension-type headache may not be due to excess muscle contraction. The prodromes of migraine may have a hypothalamic origin, and the aura and changes in cognition may have a cortical neuronal origin. The pain of migraine and tension-type headache may be generated centrally or enhanced or generated by neurogenic inflammation. Drugs used to treat headache frequently interact with serotonin receptor subtypes: abortive drugs at the 5-HT1 receptor and preventive drugs at the 5-HT2 receptor.
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PMID:Advances in understanding the pathophysiology of headache. 155 93

A patient is described with a 17-year history of intractable left-sided facial pain. The pain occurred daily in 5 sec spasms to a maximum of one every 2-3 min and was restricted to the left upper face. It was associated with rhinorrhoea on the left and often with ipsilateral facial flushing. Conventional therapy, including carbamazepine, baclofen and three posterior fossa explorations, had not provided lasting relief. Local facial stimulation by tapping a painful trigger point led to both pain and flushing of the face ipsilaterally. During this flushing, blood was collected and assayed using sensitive radioimmunoassays for several neuropeptides (neuropeptide Y, substance P, vasoactive intestinal polypeptide and calcitonin gene-related peptide). A marked (119%) increase in calcitonin gene-related peptide was noted in the external jugular vein blood ipsilaterally during the flushing with no change in the other peptides measured. To quantitate the effect of calcitonin gene-related peptide on human extracranial vessels, standard pharmacological procedures were used to examine the potency of the peptide as a vasodilator of human facial artery. The IC50 of calcitonin gene-related peptide for the prostaglandin F2 alpha-precontracted human facial artery was 10(-9) mol/l. The relevance of these observations to the clinical problem of migraine is considered.
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PMID:Cutaneous sensory stimulation leading to facial flushing and release of calcitonin gene-related peptide. 155 59

Psychophysiological investigations of tension headaches and migraines have produced inconsistent and inconclusive findings. The study reported here aimed to further explore headache mechanisms by repeating earlier research with two main variations. The first pertained to recording and analytic procedures: a different approach was taken to measuring and interpreting cephalic vascular activity. The second was in the experimental conditions used: pain levels were manipulated so that the psychophysiology of headaches could be studied under conditions of pain increasing and decreasing. The findings provided no support for the role of muscle tension as a headache mechanism. Tentative support was obtained for vascular models of headaches. Headaches were associated with distension of the superficial temporal artery between pressure pulses. The data suggested that local vasomotor activity might play a role in dilating the temporal artery but that the effect seemed driven by elevated blood pressure and heart rate.
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PMID:Psychophysiological mechanisms of chronic headaches: investigation using pain induction and pain reduction procedures. 156 Apr 26

Eighty-five patients with non-organic abdominal pain, were interviewed with the help of a questionnaire. Those who responded to a high fibre diet were excluded from the study. Twenty-seven patients had multiple pains and 58 described a single pain, which was intermittent in 39. A detailed analysis of the symptoms and family history of the latter group suggested that in 19 patients the symptoms might have been caused by abdominal migraine. Six of these 19 had typical migraine-associated symptoms during the attack, characteristic abdominal pain and a family or personal history of classical migraine. Abdominal migraine should be considered in patients with non-organic abdominal pain where symptoms are not typical of irritable bowel syndrome and when organic disease has been excluded.
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PMID:Abdominal migraine: a cause of abdominal pain in adults? 157 6

In a double-blind, parallel randomized study, the prophylactic efficacy and tolerance of cyclandelate was evaluated versus pizotifen over a period of 16 weeks in 84 patients with migraine. The trial was initiated with a single-blind four week placebo run-in phase (baseline) in order to eliminate placebo-responders and non-compliant patients (n = 23). Sixty-one patients qualified for the subsequent active treatment period of 12 weeks. Cyclandelate or pizotifen were administered at a dosage of 1600mg/day (800mg/placebo/800mg) or 0.5mg t.i.d., respectively. Cyclandelate was clinically effective in the prophylactic treatment of migraine as shown by an average reduction of greater than 60% in three migraine parameters; frequency of attacks (FA 77.6%), total pain index (TPI 64.0%) and number of awakenings with headache (AwH 72.7%). This clinical efficacy was significantly superior (p less than 0.01) to that seen with pizotifen in all migraine parameters throughout the study. An average reduction of about 50% in FA, TPI and AwH was already observed in the cyclandelate group after 4-6 weeks suggesting an early onset of action. Side-effects in the cyclandelate group were fewer and less pronounced than in the pizotifen group. All patients included in the active treatment period completed the study. Thus, we conclude that cyclandelate is an effective and well tolerated drug for the prophylactic treatment of migraine.
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PMID:Efficacy and tolerance of cyclandelate versus pizotifen in the prophylaxis of migraine. 157 38


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