Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085631 (agitation)
 12,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We conducted a pilot study of intravenous droperidol in 35 patients (32 women and 3 men; mean age 43 years) with status migrainosus (n = 25) or refractory migraine (n = 10) in an ambulatory infusion center. Headache was graded as severe in 21 patients and moderate in 14. An intravenous line was started and kept open. Droperidol (2.5 mg) was given intravenously every 30 minutes until either three doses were given or the patient was completely or almost headache-free prior to the next dose. Seven patients received one dose, 12 received two doses, and 16, three doses (mean 5.6 mg). Our success rate (headache-free or mild headache) was 88% (22 of 25) in patients with status migrainosus and 100% (10 of 10) in patients with refractory migraine. The average time to headache improvement was 40 minutes (n = 35), to mild headache--60 minutes (n = 32), and to headache-free--105 minutes (n = 28). Nausea, vomiting, and light and sound sensitivity resolved in all but 5 patients. Four patients had an asymptomatic systolic blood pressure drop > or = 20 mm Hg. Most patients were sedated (34 of 35). Five patients developed akathisia and 1 dystonia. At follow-up 24 hours after discharge, the recurrence rate (headache intensity from none or mild to moderate or severe) was 23% in status migrainosus and 10% in refractory migraine. Twenty-one patients were sedated, while 19 had extrapyramidal symptoms, mainly restlessness. Droperidol is effective and safe in treating status migrainosus or refractory migraine. Hypotension was uncommon. Patients should be warned of sedation and akathisia.
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PMID:Droperidol treatment of status migrainosus and refractory migraine. 923 11

Strokes of the posterior circulation are uncommon in childhood. In vertebrobasilar insults, vertebral artery dissection remains a rare diagnosis. We report the case of an 8-year-old boy with a history of migraine headaches who presented with acute cerebellar signs and agitation following multiple infarctions of bilateral cerebellar hemispheres. Vertebral angiography demonstrated dissection of the left vertebral artery with occlusion of the basilar artery just distal to its origin. Risk factors for vertebral artery dissection are reviewed, with emphasis on association with migraine headaches. A review of imaging studies for the diagnosis of dissection is also presented. This case demonstrates the importance of considering arterial wall dissection in pediatric patients with a history of atypical migraines associated with new neurologic findings.
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PMID:Vertebral artery dissection and migraine headaches in children. 1106 85

Cluster headache is rare, occurring in less than 1% of the population. Studies suggest that, in addition to the pain and associated autonomic disturbances recognized to be characteristic of the syndrome, patients also may experience nausea, photophobia, behavioral agitation, or restlessness. A decreasing male:female ratio also has been noted, perhaps attributable to lifestyle trends adopted by more women that were previously associated with men, such as tobacco use, alcohol consumption, and working outside of the home. The relationship between cluster headache and hormonal events does not appear to be strong. Hormonal influences on the chronic form of cluster headache in women are a subject of investigation. The emerging understanding of the genetics of cluster headache increasingly suggests a genetic component, with familial transmission now recognized to be more common than previously appreciated. Head trauma, coronary artery disease, and migraine appear to be present in more patients with cluster headache than can be explained by chance alone. Ethnic and racial differences in prevalence are less well understood.
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PMID:Epidemiology of cluster headache. 1262 57

The purpose of the research presented in this article was to characterize restless leg syndrome (RLS) in a headache population and correlate treatment induced risks with dopamine blockers. Fifty patients with severe headache who were admitted to an outpatient infusion center were enrolled. The diagnosis of RLS was established using the International Restless Leg Syndrome Study Group criteria. Patients were screened for baseline akathisia using an akathisia scale and reexamined for akathisia after receiving intravenous infusion with one of four dopamine receptor blocking agents as treatment for their headaches. A change from baseline to post-infusion assessment of two points on a global assessment of akathisia was considered positive for drug-induced akathisia. Our results indicated that 41 (82%) of patients had episodic or chronic migraine. The rest had new daily persistent headache, cluster, or posttraumatic headache. Seventeen subjects (34%) met the criteria for RLS. Nineteen (38%) of the subjects developed drug-induced akathisia. Thirteen (76.5%) of the subjects with RLS developed akathisia compared with only 6 of the 33 (18.2%) without RLS (P<.0001). Finally, we concluded that headache patients with RLS are at a greatly increased risk of developing drug-induced akathisia when treated with intravenous dopamine receptor blocking agents.
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PMID:Restless legs syndrome and drug-induced akathisia in headache patients. 1285 35

Symptoms of Restless Legs Syndrome (RLS) can begin in childhood and persist into adulthood. To our knowledge, no one has done a systematic review of the literature to determine if the descriptions of 'growing pains' are consistent with the diagnosis of childhood RLS. Our group and that of Ekbom have noted that childhood onset RLS can be misdiagnosed as 'growing pains'. We therefore reviewed the work of seven groups of authors that addressed 'growing pains' as an isolated phenomenon in order to determine whether the descriptions of 'growing pains' were consistent with the clinical features of RLS. We found no consistent pattern in the descriptions even when articular pain was excluded. Thus, it is unlikely that all patients with 'growing pains' have RLS and it is likely that 'growing pains' is a heterogeneous disorder. The aforementioned authors were not looking for features unique to RLS and descriptions of the complete symptom complex of RLS are usually lacking. Further complicating the data are problems with methodology, e.g. in some studies small children and their parents were asked to retrospectively recall remote and infrequent events, and in other studies, articular pain was not adequately ruled out. Inconsistent with the hypothesis that RLS and 'growing pains' are the same are the high association of 'growing pains' with migraine headaches and abdominal pain. However, from this background emerge subsets of patients with 'growing pains' that are described as having one, some, or all of the following features consistent with the diagnosis of RLS: symptoms that are primarily in the legs, the patients rub their legs to get relief of the discomfort, the symptoms are worse at night, sleep disturbance is present and the discomfort is sometimes accompanied by motor restlessness A non-painful form of 'growing pains' has even been described. Ekbom and Brenning, a contemporary of Ekom, directly addressed the relationship between 'growing pains' and RLS. Ekbom felt that 'growing pains' and RLS were probably different since 'growing pains' disappear after childhood and one of his patients described her childhood 'growing pains' as being different from the sensory discomfort of her adult onset RLS. However, Brenning showed that RLS-like features in adulthood and a previous history of 'growing pains' in childhood occurred far more frequently in the parents of children with 'growing pains' than in control parents. More work needs to be done on the potential relationship between 'growing pains' and RLS.
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PMID:Is there a subpopulation of children with growing pains who really have Restless Legs Syndrome? A review of the literature. 1459 26

Cluster headaches are characterized by strictly unilateral paroxysmal attacks of severe pain with associated autonomic sign and symptom. Prevalence is 5 times higher in men than in women in our cases. About 10-15% of patients have chronic symptoms without remissions, but we estimated less frequent in Japanese (6.6% in our series). Pain almost invariably recurs on the same side, but in some patients (16.4%) the affected site switches. Cluster headache may be inherited in about 5% of our cases. Attacks frequently occur at night (60.7%). The patients (64.8%) are restless or agitated during an attack. Recent PET studies elucidated that acute attacks causes activation of the posterior hypothalamic grey matter. The excitement of the area might be responsible for peculiar clinical characteristics of agitation. Some patients (66.0%) have also have symptoms (especially a visual aura) usually attributed to migraine. Treatment of cluster headache includes both acute therapy aimed at aborting individual attacks and prophylactic therapy aimed at preventing recurrent attacks during the cluster period. There are many choices using for both therapies. Based on our clinical experience, we recommended the combination of nasal sumatriptan for acute attacks and verapamil 240 mg/day for prophylaxis.
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PMID:[Cluster headache and other trigeminal autonomic cephalalgias: diagnosis and treatment]. 1565 Dec 99

To investigate the prevalence of sleep disorders and their symptoms in children with headaches, 64 patients in the outpatient clinics of the University of Chicago Department of Pediatric Neurology were interviewed. Investigated disorders included excessive daytime sleepiness, narcolepsy, insomnia, sleep apnea, restlessness, and parasomnias. Unlike previous studies, subjects were compared with matched control patients by age and sex. Both headache and nonheadache groups completed a 111-item questionnaire detailing sleep symptoms and behaviors. It was found that children with headaches have a significantly higher prevalence of excessive daytime sleepiness, narcolepsy, and insomnia than children without headaches (P < 0.005), which is consistent with prior literature. A similar result was obtained in examining only migraines. However, we did not find a significantly higher prevalence of symptoms of sleep apnea, restlessness, and parasomnias, which contradicts previous literature. Also, the effect of medications taken by headache patients as a confounding factor was insignificant. Overall, pediatricians may find it beneficial to ask about daytime sleepiness, narcolepsy, and insomnia when treating a headache patient.
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PMID:Characterization of symptoms of sleep disorders in children with headache. 1637 71

The characteristics of disturbing primary headache and the occurrence of headache types were studied by sending a questionnaire to 1132 Finnish families of 6-year-old children. Children with headache in the preceding 6 months and their controls were clinically examined at the ages of 6 and 13. During the follow-up, half of the headaches, classified as migraine at age 6 years, were unchanged and 32% turned into tension-type headache. In children with tension-type headache, the situation was unchanged in 35%, and in 38% of children the headache type had changed to migraine. At preschool age the most common location of headache was bilateral and supraorbital, and at puberty bilateral and temporal. During the follow-up, symptoms concurrent with headache, such as odour phobia, dizziness and balance disturbances became more typical, whereas restlessness, flushing and abdominal symptoms became less marked. The early manifestation of both migraine and tension-type headache predict equally often migraine in puberty with marked changes in concurrent symptoms and pain localization.
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PMID:Changing headache from preschool age to puberty. A controlled study. 1737 6

Recent studies have suggested that abnormalities of dopamine and trace amines (tyramine, octopamine, and synephrine), products of tyrosine metabolism, may constitute the metabolic events that predispose to the occurrence of cluster headache (CH) and migraine attacks. This hypothesis is supported by the following evidences: the discovery of trace amine associated receptors (TAARs), expressed on the olfactory epithelium, amigdala, hypothalamus, periacqueductal gray, and the biochemical anomalies of dopamine and trace amines. The possible effects of these biochemical abnormalities on TAARs and dopamine receptors, located in different areas of CNS, may explain the behaviour (restlessness, anxiety and, at times, hypersexuality) and the autonomic signs during the painful attacks of CH, and the premonitory symptoms of migraine crisis (thirst, craving, yawning, alteration of smell, depression etc.).
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PMID:Biochemistry of neuromodulation in primary headaches: focus on anomalies of tyrosine metabolism. 1750 88

The objective of this study was to determine the clinical effects of party pills containing benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP) when taken alone and in combination with alcohol. The study was a randomised, double-blind, placebo-controlled trial conducted in a hospital-based clinic in Wellington, New Zealand. Thirty-five volunteers who had previously used party pills containing BZP were included in this trial. Participants received one of the following four treatments: 300 mg/74 mg BZP/TFMPP and placebo, 300 mg/74 mg BZP/TFMPP and 57.6 g (6 units) alcohol, placebo and 57.6 g (6 units) alcohol and double placebo. The primary outcome variable was a measure of driving performance, the standard deviation of lateral position (SDLP) measured at 6.5 h. Secondary measures included adverse events, cardiovascular effects, psychological function and delayed effects on sleep. The study was stopped early, after 35 of the planned 64 subjects had undertaken testing, because of severe adverse events that occurred in four of 10 BZP/TFMPP-only subjects, three of seven combined BZP/TFMPP and alcohol subjects, none of the 6 placebo subjects, and none of the 12 alcohol-only subjects. The overall rate of severe adverse events (defined as causing considerable interference with usual activity and/or rated by subject as severe) in those receiving BZP/TFMPP was seven of 17 (41.2%, 95% CI 18.4-67.1). The severe events included agitation, anxiety, hallucinations, vomiting, insomnia and migraine. BZP/TFMPP significantly improved the driving performance, decreasing SDLP at -4.2 cm (95% CI -6.8 to -1.6, P = 0.002). The effect of alcohol was to increase SDLP: 2.3 cm (95% CI -0.3 to 4.9, P = 0.08). BZP/TFMPP also resulted in increased heart rate and blood pressure and in difficulty in getting to sleep. BZP/TFMPP alone or with alcohol carries a significant risk of severe adverse events when taken in similar doses to those recommended by manufacturers.
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PMID:Randomised double-blind, placebo-controlled trial of the effects of the 'party pills' BZP/TFMPP alone and in combination with alcohol. 1932 46


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