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Query: UMLS:C0392326 (discomfort)
 22,423 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Headache is one of the chief complaints among patients visiting primary care physicians. Diagnosis begins with exclusion of secondary causes for headache. More than 90% of patients will have a primary-type headache, so diagnosis can often be completed without further testing. Although tension-type headaches are the most common kind of headache, patients with this type of headache rarely seek treatment unless occurrence is daily. Migraine, which affects more than 30 million people in the United States, is the most common headache diagnosis for which patients seek treatment. Migraine is a chronic, often inherited condition involving brain hypersensitivity and a lowered threshold for trigeminal-vascular activation. Intermittent debilitating attacks are characterized by autonomic, gastrointestinal, and neurologic symptoms. Migraine results in a marked decrease in a patient's quality of life, as measured by physical, mental, and social health-related instruments. Accurate assessment of a patient's disability will guide physicians in prescribing appropriate modes of therapy. However, migraine remains underdiagnosed, and patients with migraine remain undertreated. A comprehensive treatment approach to migraine may include nonpharmacologic measures, as well as abortive and prophylactic medications. Informing patients about realistic treatment expectations, possible delayed efficacy of medications, and avoidance of caffeine and overuse of medications is critical for successful outcomes. Management of migraine is a dynamic process, because headaches evolve over time and medication tachyphylaxis may occur, necessitating changes in therapy. Pathologic findings in the neck constitute an accepted etiology or precipitant for headache. Osteopathic manipulative treatment may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscular-autonomic regulatory mechanisms to reduce discomfort from headache.
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PMID:Diagnosing and managing migraine headache. 1844 26

The role of psychological factors related to headache, particularly tension-type headache (TTH), has long been a focus of investigation. The subject at issue is a complex one, with some aspects that are still being debated by experts. In episodic TTH, it is possible to hypothesise that headache is not only a "primary" headache that causes gratuitous pain to sufferers. In fact, it might represent an improper mode of communicating the sufferers' intimate discomfort, caused by an inadequate relationship between their personality profiles and events in their lives. As in migraine, in TTH, too, evidence has been found of comorbidity between headache and psychiatric disorders, including depression and anxiety disorder. Such evidence will have to be confirmed by further studies on the general population. As regards behaviour and personality traits, subjects with TTH had significantly higher scores than healthy controls on measures of automatic thoughts and alexithymia, and lower scores on assertiveness. Patients with chronic TTH had higher automatic thoughts scores than patients with episodic TTH. These findings suggest that people with TTH may have difficulty in expressing their emotions. Finally, psychological factors and emotional disturbances have been indicated as risk factors for TTH. Indeed, stress and mental tension are the most common factors that cause TTH.
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PMID:Human psyche and headache: tension-type headache. 1854 6

Migraine is known to be associated to particular psychological features. Cutaneous allodynia is a painful sensation or discomfort induced by a non-noxious stimulus, and is a frequent complaint during migraine attacks. The aim of this study was to compare the personality profile of allodynic and non-allodynic migraineurs to identify possible relationships between psychological aspects and the presence of allodynia. The Symptom Check List 90-R (SCL90R), a 90-item self-report psychological symptom inventory, was used to investigate the psychological profile of our patients. The presence of allodynia was assessed by a set of semi-structured questions that investigated if the patient experienced abnormal scalp sensitiveness and/or discomfort during headache episodes. Twenty-five nonallodynic patients and 38 allodynic migraineurs were studied. No significant difference was found between the two groups in any area of the personality profile. The psychological profile seems not to affect the presence/absence of cutaneous allodynia in migraine patients. This reinforces the hypothesis that allodynia is a "somatic" symptom, not modified by psychological aspects.
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PMID:Personality profile and allodynic migraine. 1854 20

Strategy, Management and Health Policy Enabling Technology, Genomics, ProteomicsPreclinical ResearchPreclinical Development Toxicology, Formulation Drug Delivery, PharmacokineticsClinical Development Phases I-III Regulatory, Quality, ManufacturingPostmarketing Phase IVIndividuals who suffer migraine, particularly migraine with visual aura (MwA), are susceptible to physiologically strong visual stimuli and find them aversive. Strong stimuli including bright light and certain visual patterns produce discomfort and perceptual illusions and can trigger migraine attacks. Perceptual illusions and visual discomfort are reported by most migraine sufferers and those with frequent headaches. These phenomena suggest that visual stimulation and consequent visual cortical activity contribute to the triggering of some migraine attacks. Perceptual illusions in MwA patients were found to be associated with hyper-activation in visual cortex. This excessive cortical activity is called visual stress. The cortex is generally hypothesized to be hyperexcitable in migraine, and this hyperexcitability could be the underlying mechanism of visual stress. It is hypothesized that visual stress results from too great a neural (hyperneural) activity in response to strong physiological sensory stimulation, particularly, but not exclusively, visual. A strong physiological visual input may cause a spread of excitation through hyperexcitable cortex, leading to neurons firing inappropriately and thereby resulting in perceptual illusions and distortions, and possibly promoting a migraine attack. Over the last 10 years, the use of colored filters to treat perceptual distortion of text has become common in many schools in Britain. The efficacy of precision spectral filters (PSF) in preventing migraine headache has been reported in several studies. One preliminary study revealed the suppressing effect of the PSF on visual cortical activity in a MwA patient, suggesting that it might be this reduction in cortical activation that is responsible for the reduction of the frequency of migraine attacks in those who benefited from the PSF. PSF offer a possible new prophylactic therapy for migraine. They are safe, free of side effects, and inexpensive.
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PMID:Prevention of Visual Stress and Migraine With Precision Spectral Filters. 1864 81

Cortical hyperexcitability in migraine could arise from abnormally weak inhibition or from strengthened intracortical excitatory mechanisms. The present study employed binocular rivalry to differentiate between these possibilities. Rivalry between static oriented grating patterns was examined in migraine with aura (MA), migraine without aura (MoA) and headache-free control participants. A non-significant trend toward elevated mean dominance intervals (monocular percepts, in seconds) was seen in both migraine groups at all contrasts. Second, significant interocular differences in rivalry dominance durations were seen in the MoA group compared with controls; this difference also approached significance in the MA group. Finally, both MA and MoA exhibited significantly greater visual discomfort than the control group in the presence of both static stripes and flickering visual stimuli. The rivalry results provide no support for weakened intracortical inhibition in migraine. Optical or neural precortical differences in the eyes' input strengths paired with enhanced recurrent cortical excitation can explain these findings.
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PMID:Binocular rivalry in migraine. 1879 42

The objective of this study was to evaluate, in patients with migraine and healthy volunteers, with and without a history of motion sickness, the degree of discomfort elicited by drifting striped patterns. Eighteen healthy volunteers (HV) and 30 migraine patients participated in the study. Discomfort was greater in migraine patients than in HV, and in individuals with a history of motion sickness than in those without, but the effect of history of migraine was independent of history of motion sickness. Generalized Estimating Equations models for binary correlated data revealed that these differences did not depend on levels of duty cycle, spatial and temporal frequencies. Visual discomfort in migraine patients was associated with worse performance. There was a significant correlation between median degree of discomfort across conditions and number of migraine attacks in the past month. Discomfort to drifting striped patterns may be related to central sensitization in migraine patients.
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PMID:Migraine and motion sickness independently contribute to visual discomfort. 2097 88

We describe a case of ear candling presenting as hearing loss, and review the literature. Ear candling is considered as an alternate medical therapy for dewaxing the ears, discomfort in ears and sinuses, rhinitis, sinusitis, glue ear, colds, flu, migraines, poor or "muffled" hearing, high stress, and ringing in the ear. There is no evidence of its effectiveness, and it can actually cause damage to the ears.
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PMID:Ear candling: a case report. 1995 63

An estimated 17 to 18 percent of all women, and six percent of men, experience migraines. Hormonal shifts may cause migraines to recur, worsen, or even begin during the perimenopause and are a significant cause of discomfort and disability. However, very little research has explored the experience of migraines in this population. The purpose of this study was to describe the experiences of perimenopausal women with migraines, via online questionnaires and discussion boards, and to evaluate the feasibility of collecting women's health data via the Internet. In an earlier study, we found that midlife women had difficulty attending focus groups due to other time commitments. This study was designed to increase accessibility to the research via the Internet. Of the 43 women recruited into the study, 21 were also interviewed in "real-time" qualitative interviews; all received passwords to complete online questionnaires and participate in three- to four-week discussion boards on the study Web site. Quantitative data were imported into SPSS; narrative qualitative data from discussion boards were transferred to a software package for analysis. Online questionnaires and discussion boards were found to be feasible methods for data collection for this population. Qualitative data analysis revealed themes related to women's efforts to predict and control their headaches, the relationship of headaches to women's menses and menopausal symptoms, and the effects of migraines on their lives. In this paper we describe the process of using the Internet, feminist issues related to this innovative methodology, and also discuss the results of a major study theme, the experience of headaches in relationship to the menstrual cycle.
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PMID:Online Data Collection in Women's Health Research: A Study of Perimenopausal Women with Migraines. 2020 41

Dry eye is a multifactorial disease of tears and ocular surface that causes discomfort, visual disturbance and tear film instability. It is a common disorder that affects specially adults and women and can cause quality of life impairment comparable to migraine, shortness of breath and chronic renal insufficiency, depending on its symptoms or complications. New concepts regarding physiopathology, classification and treatment have been presented and should be known by ophthalmologists because of their relevance on day-by-day application. There are about 100 different medications currently in use for dry eye besides other methods of treatment, so it is necessary to establish what is really safe and effective for dry eye. This paper presents a review about Dry Eye Syndrome etiopathogenesis and treatment.
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PMID:[Dry eye: etiopathogenesis and treatment]. 2054 55

Migraine is a disabling, painful primary headache disorder that is associated with various combinations of neurological, gastrointestinal, autonomic and pain symptoms. Gastrointestinal disturbances associated with migraine, including nausea and vomiting, affect a majority of migraineurs and often result in a delay in taking or avoidance of pharmacological intervention. Gastric stasis and vomiting may lead to delayed or inconsistent absorption of orally administered medications. Many migraineurs awake early in the morning with their attack progressing and already associated with nausea and vomiting. As a result, there is a need for a novel, non-invasive, non-oral delivery system for fast and effective acute treatment of migraine. There are two non-oral delivery systems currently available in the US for the acute treatment of migraine: three nasal sprays and two injectable formulations. Although nasal sprays depend partially on nasal mucosal absorption, a significant amount of drug is swallowed, transits the stomach and is absorbed in the small intestine, which is not as rapid or effective a route of delivery for those migraineurs with gastric stasis. Sumatriptan is rapidly absorbed by subcutaneous injection with or without a needle, but the invasiveness and discomfort of the delivery, the high incidence of adverse events and the high recurrence rate all limit its use for many patients. Iontophoretic delivery of medication is a non-invasive transdermal approach that uses small amounts of electrical current to promote rapid movement of the ionized drug through the skin and into the systemic circulation. This delivery bypasses hepatic first-pass metabolism and also avoids gastric transit delay and slowing of small intestinal absorption associated with gastrointestinal stasis in migraineurs. Two pharmacokinetic studies have demonstrated that iontophoretic transdermal delivery of sumatriptan results in rapid and consistent achievement of therapeutic plasma concentrations. These studies also suggest that, by avoiding patient exposure to a rapid rise in and high plasma concentrations of sumatriptan as seen with injectable sumatriptan, transdermal delivery using iontophoresis may significantly reduce typical triptan-related adverse events. A large, randomized, double-blind, placebo-controlled, multicentre clinical trial showed statistically significant efficacy, good tolerability and virtually no triptan-related adverse events. Iontophoretic delivery of sumatriptan, with a novel transdermal patch device, offers patients a migraine-specific medication that is non-invasive and non-oral. Clinically, transdermal delivery provides rapid and effective relief of migraine while bypassing the gastrointestinal tract, with minimal classic triptan-related adverse effects. This unique approach facilitates the rapid absorption of this migraine-specific triptan, which should improve the chances of consistently achieving a therapeutic plasma concentration of sumatriptan, resulting in effective migraine relief.
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PMID:Innovative delivery systems for migraine: the clinical utility of a transdermal patch for the acute treatment of migraine. 2125 93


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