Natural Treatment to Help With Migraine
Lo SK, Montgomery JN, Blagden S, et al. Reducing incidence of headache after lumbar puncture and intrathecal cytotoxics. Lancet 1999 353 2038, 2039. Van de Velde M, Corneillie M, Vanacker B, et al. Treatment for postdural puncture headache associated with late postpartum eclampsia. Acta Anaesthesiol Belg 1999 50 99-102.
Episodic cluster headache Description Cluster headache attacks occurring in periods lasting 7 days to 1 year separated by pain-free A. Attacks fulfilling criteria A-E for Cluster headache. 1 month. Chronic cluster headache Description Cluster headache attacks occurring for more than 1 year without remission or with remissions lasting less than 1 month.
Headache induced by acute substance use or exposure Headache induced by chronic substance use or exposure Headache due to substance withdrawal (acute use) Headache due to substance withdrawal (chronic use) Headache associated with substances but with uncertain mechanism Nitrate nitrite-induced headache Monosodium glutamate-induced headache Carbon monoxide-induced headache Alcohol-induced headache Other substances Ergotamine-induced headache Analgesic abuse headache Other substances Alcohol withdrawal headache (hangover) Other substances Ergotamine withdrawal headache Caffeine withdrawal headache Narcotic abstinence headache Other substances
Occasionally foods with a high content of tyramine, such as cheese, coffee, red wine and yeast extract, are responsible for migrainous headaches.19 In some patients the association is obvious and these patients usually avoid these foods. In other cases of chronic headache, once other treatable causes have been excluded, a diet excluding foods with high tyramine content may be tried. However, double-blind challenges are often unsuccessful in confirming a relationship of foods with headaches.
Migraine without aura Idiopathic, recurrent headache manifested by attacks lasting 4-72 hours. Typical characteristics are unilateral location, pulsating quality, moderate-to-severe intensity, aggravation by routine physical activity, and associated with nausea, vomiting, photo- and phonophobia. At least five attacks fulfilling the aforementioned criteria. ii. Migraine with aura Idiopathic, recurrent disorder manifested by attacks of neurological symptoms localizable to cerebral cortex or brain stem, usually gradually developing over 5-20 minutes and lasting less than 60 minutes. Headache, nausea, and or photophobia usually follow neurologic aura symptoms directly or after an interval of less than 1 hour. Headache usually lasts 4-72 hours, but may be completely absent. b. Tension headache (episodic tension-type headache). Recurrent episodes of headaches lasting minutes to days. Pain typically pressing tightening in quality, of mild-to-moderate intensity, bilateral in...
The clinical spectrum of Familial Hemiplegic Migraine associated with mutations in a neuronal calcium channel. N Engl J Med 2001 345 17-24. Ducros A, Joutel A, Vahedi K, Cecillon M, Ferreira A, Bernard E, et al. Mapping of a second locus for familial hemiplegic migraine to 1q21-q23 and evidence of further heterogeneity. Ann Neurol 1997 42 885-890. Joutel A, Bousser MG, Biousse V, Labauge P, Chabriat H, Nibbio A, et al. A gene for familial hemiplegic migraine maps to chromosome 19. Nature Genet 1993 5 40-45. Ophoff RA, Terwindt GM, Vergouwe MN, et al. Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca2+ channel gene CACNL1A4. Cell 1996 87 543-552. Terwindt GM, Ophoff RA, Haan J, Sandkuijl LA, Frants RR, Ferrari MD. Migraine, ataxia and epilepsy a challenging spectrum of genetically determined calcium channelopathies. Eur J Hum Genet 1998 6 297-307. Thomsen LL, Eriksen MK, Roemer SF, Andersen I, Oleson J,...
AND one of the following symptoms during the headache Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing.
Mean LOS 3.3 days Description MEDICAL Seizure and Headache Age 17 without CC M igraine headache is a primary headache syndrome that is an episodic vascular disorder with or without a common aura. Approximately 23 million people have migraine headaches in the United States. A migraine headache is a prototype of a vascular headache, which involves vasodilation and localized inflammation. Ultimately, arteries are sensitized to pain. Cerebral blood flow is diminished before the onset of the headache and is increased during the actual episode. Most migraine sufferers have a trigger, or precipitating factor, that is associated with the onset of symptoms There are two types of migraine headaches classic migraine and common migraine. Classic migraine has a prodromal (preheadache) phase that lasts approximately 15 minutes and is accompanied by disturbances of neurological functioning such as visual disturbances, speech disturbances, and paresthesias. Neurological symptoms cease with the...
Headache is accompanied by at least one of the following 3During part (but less than half) of the time-course of cluster headache, attacks may be less severe and or of shorter or longer duration. *During part (but less than half) of the time-course of cluster headache, attacks may be less frequent. cHistory and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12, or history and or physical and or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but attacks do not occur for the first time in close temporal relation to the disorder. (Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing.)
Headaches caused by disorders of the neck has been a controversial subject some feel that it is, at best, a rare syndrome. The original diagnostic criteria were proposed by Sjaastad in 1990, and are shown in Table 1. In a comprehensive review by Antonacci et al., the sensitivity and specificity of the original criteria were measured in an Italian clinic population. Their groups (labeled A, B, and C ) correspond to individuals with varying symptoms. Group A includes those individuals with the presence of both unilateral headache without side-shift and pain starting in the neck, eventually spreading to oculofrontotemporal areas, where the maximum pain is often located. The neck pain was invariably unilateral at onset, but could eventually spread across the midline during particularly severe and protracted attacks (Table 2).
At least two headache attacks by history, consistent with criteria 2-7. 2. No other disease present that might cause headache or neurological visual changes. 4. Unilateral headache location. 7. Headache also meets criteria for migraine without aura, beginning within 0-60 minutes of aura. Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing.
International Headache Society Diagnostic Criteria for External Compression Headache Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing. Diagnostic Criteria for Headache Related to Intrathecal Injections A. Headache follows intrathecal injection within 4 hours. B. Headache is diffuse and present also in the recumbent position. C. Headache clears completely within 14 days. (If it persists, consider post-lumbar puncture.) Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing. 1. Headache follows intrathecal injection within 5-72 hours. 2. Headache is diffuse and present also in the recumbent position. Adapted with permission from Headache...
Chronic migraine Headache (not attributable to another disorder) on more than 15 days month for more than 3 months fulfilling the following criteria for migraine II. Probable chronic migraine Headache meeting criteria for chronic migraine but in the presence of recent medication overuse (according to the criteria for medication overuse headache). Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing. In order to help differentiate basilar migraine from familial hemiplegic migraine, Thomsen et al. suggested adding that basilar migraine not be diagnosed when there is motor weakness. Considering the overlap with both migraine headache and the often genetically determined familial hemiplegic migraine (FHM), the etiology of basilar migraine is intriguing.
Whereas a cause and effect has not been firmly established, overuse of symptomatic migraine drugs, opioid or butalbital compounds, or analgesics is implicated in the development of chronic daily headaches with either a migraine-like or a mixed migraine-like and tension-type-like presentation. Whereas overuse is defined in terms of treatment days (not doses) per month, the stipulation on a regular basis is significant i.e., 2 to 3 days per week on an ongoing basis. Taking symptomatic medications on several successive days with long periods without medication use does not seem to be associated with medication-overuse headache. This strategy, in fact, is often used to prevent severe menstrual migraine attacks.
Episodic tension-type headache - Episodic tension-type headache associated - Episodic tension-type headache not associated with disorder of pericranial muscles Chronic tension-type headache - Chronic tension-type headache associated - Chronic tension-type headache not associated with disorder of pericranial muscles Headache of the tension type
Misdiagnosis of cluster headache. Curr Pain Headache Rep 2002 6 76-82. Lampl C. Childhood-onset cluster headache. Pediatr Neurol 2002 27 138-140. Smetana GW. The diagnostic value of historical features in primary headache syndromes a comprehensive review. Arch Intern Med 2000 160 2729-2737. Torelli P, Cologno D, Cademartiri C, Manzoni GC. Application of the International Headache Society classification criteria in 652 cluster headache patients. Cephalalgia 2001 21 145-150. van Vliet JA, Eekers PJ, Haan J, Ferrari MD Dutch RUSSH Study Group. Features involved in the diagnostic delay of cluster headache. J Neurol Neurosurg Psychiatry 2003 74 1123-1125. Wheeler SD, Carrazana EJ. Delayed diagnosis of cluster headache in African-American women. J Natl Med Assoc 2001 93 31-66.
Migraines, also called vascular headaches, are thought to involve blood vessels in the brain, although the exact cause is unknown. Some cheeses contain a naturally occurring compound called tyramine, which, in susceptible people, can cause an increase in blood pressure, an increase in the size of blood vessels in the brain, and headache pain. For people who take drugs called monoamine oxidase inhibitors (MAOIs), avoidance of all foods containing tyramine including aged cheeses is essential. foods, aged cheeses have the highest tyramine content. The amount of tyramine in cheeses differs greatly because of the variations in processing, fermenting, aging, degradation, or even bacterial contamination. The following types of cheeses are aged or have been reported to be high in tyramine and should be avoided if you are susceptible to migraines or if you take MAOIs
It is claimed that the condition can be allayed by holding a freshly cut slice of raw POTATO to the temples (R B Browne). BAY berries, too, at least according to Gerard, stamped with a little Scammonie and saffron, and labored in a mortar with vinegar and oile of Roses to the form of a liniment, and applied to the temples and fore part of the head, do greatly ease the pain of the megrim , and he also advised the juice of the leaves and roots of DAISY to help the megrim . CAMOMILE tea will help, both for migraine and any sort of headache (Schauenberg & Paris), and PELLITORY-OF-SPAIN was also used once. A leechdom from a 15th century collection advises sufferers to take pellitory of Spain, and stone-scar lichen and hold long between thy teeth on the sore side and chew it and it will run to water (Dawson. 1934). The root of STINKING IRIS has the reputation of being a painkiller, and a migraine remedy (Conway).
Taking a drink made from the infused flowers of HONEYSUCKLE seems a pleasant way of getting rid of a headache (V G Hatfield), as is ROSEMARY tea, in a simple infusion of the leaves and flowers (Hill), or you could just rub the forehead with a handful of the herb (Newman & Wilson), and one can do the same with PEPPERMINT leaves, or drink the tea (Vesey-Fitzgerald). BISTORT tea is used in Cumbria (Newman & Wilson). Probably the best of all the headache remedies is LIME-BLOSSOM tea. It is used a lot in France, where tilleul is taken, a slightly sedative drink (F G Savage). It is a very pleasant drink, and is taken a lot for insomnia, too (Tongue. 1965). MARIGOLD water was for a long time a favourite for a headache (see Rollinson for an example from Cumbria). PEACH leaves bound round the head will bring relief (Puckett). A freshly cut slice of raw POTATO held to the temples is a headache cure (R B Browne), just as a HORSERADISH leaf, bruised and wetted, could be tied to the head (Thomas &...
The sensitivity and specificity of the case definition criteria in diagnosis of headache a school-based epidemiological study of 5562 children in Mersin. Cephalalgia 2003 23 138-145. Rossi LN, Cortinovis I, Menegazzo L, Brunelli G, Bossi A, Macchi M. Classification criteria and distinction between migraine and tension-type headache in children. Dev Med Child Neurol 2001 43 45-51. Waldie KE, Poulton R. Physical and psychological correlates of primary headache in young adulthood a 26-year longitudinal study. J Neurol Neurosurg Psychiatry 2002 72 86-92. Zebenholzer K, Wober C, Kienbacher C, Wober-Bingol C. Migrainous disorder and headache of the tension-type not fulfilling the criteria a follow-up study in children and adolescents. Cephalalgia 2000 20 611-616.
Acetaminophen 325-650 mg PO q 4-6 hr Nonnarcotic analgesic that is thought Manages headache Generally, patients are not admitted to the hospital for a cerebral concussion. Make sure that before the patient goes home from the emergency department, the significant others are aware of all medications and possible complications that can occur after a minor head injury. Teach the patient and significant other(s) to recognize signs and symptoms of complications, including increased drowsiness, headache, irritability, or visual disturbances that indicate the need for reevaluation at the hospital. Teach the patient that occasional vomiting after sustaining a cerebral concussion is normal. The patient should not go home alone, because ensuing complications are apt to include decreased awareness and confusion.
EEE virus is the most virulent of the encephalitic alphaviruses, causing a high mortality due to encephalitis. Prodromal symptoms of fever, headache and myalgias are common. The onset of encephalitis tends to be fulminant and is associated with continued fever, increased headache, meningismus, obtundation and seizures. Mortality overall is 30 in recent studies, with higher rates in children and the elderly. Recovery is more likely in those individuals with a long (5 7 day) prodrome and without coma. Sequelae are common, with more that 80 of survivors having significant neurological residua including paralysis, seizures and mental retardation. WEE virus causes encephalitis with signs and symptoms similar to those of EEE. There is a 3-5 day prodrome of fever and headache that may progress to irritability, nuchal rigidity, photophobia and altered mental status. Severe disease, seizures, fatal encephalitis and significant sequelae are more likely to occur in infants and in young children....
Acute pulmonary infection usually asymptomatic with symptomatic disease, fever, headache, malaise, myalgia, abdominal pain, and chills with exposure to large inoculum, severe dyspnea may occur nonspecific signs of infection erythema nodo-sum and erythema multiforme occsional joint pain and infiltrated papules in the skin
Migraine headaches generally begin in childhood or near puberty, affect females more than males, and continue episodically and with decreasing severity until middle age. It is uncommon for migraine headaches to occur throughout old age. Migraine headaches often increase in frequency during pregnancy in the first trimester for those who have experienced them before pregnancy. Oral contraceptives and hormone replacement therapy also increase the frequency of headaches. Migraine headaches have a higher prevalence among whites than among African Americans and Asian Americans.
Be sure the patient understands all the medications, including the dosage, route, action, and adverse effects. Instruct the patient to keep the nitroglycerin bottle sealed and away from heat. The medication may lose its potency after the bottle has been opened for 6 months. If the patient does not feel a sensation when the tablet is put under the tongue or does not get a headache, the pills may have lost their potency.
Most patients show a fall in prolactin levels within a few days of commencing bromocriptine therapy and a reduction of tumour volume within 6 weeks. Side effects can be troublesome (nausea, vomiting, headache, postural hypotension) and are minimized by commencing the therapy at night for the first 3 days of treatment and taking the tablets in the middle of a mouthful of food. Longer term side effects include Raynauds, constipation, and psychiatric changes - especially aggression, which can occur at the start of treatment.
It can be said that the present state of knowledge on the pharmacological potential of this large family is virtually vestigial. A classic example of Sapindaceae of neuro-pharmacological interest is Paullinia cupana, used by the Tapajoz Indians of the Amazon region to make a tonic beverage since very early times. The dried paste prepared from the roasted seeds containing not less that 45 of caffeine has been used for the treatment of headache and astringent in diarrhea (British Pharmaceutical Codex, 1934, Brazilian Pharmacopoeia, 1959). Today a large number of phytopharmaceutical products containing guarana are on the market. Another example is Paullinia yopo, used for the same purpose by Colombian Indians. Caffeine is the most widely consumed psychostimulant substance, being self-administered throughout a wide range of conditions and present in numerous dietary products including coffee, tea, cola drinks, chocolate, candy, and cocoa.
It is still believed to be an unlucky flower to bring indoors (Widdowson), as, for instance, in the Isle of Man (Gill. 1932), or in Sussex, where they say it sweeps someone out of the house (Vickery. 1985). RED POPPIES are equally unlucky to bring indoors, or even touch. Irish women had a dread of touching them (Grigson. 1955), but it is likely that proscriptions were designed to stop children picking them, i.e., getting into the growing corn and causing possible damage. They were told that if they picked poppies they would wet the bed, or it would provoke a thunderstorm, or give themselves a headache, etc., Even GOLDEN ROD has been seen as unlucky, certainly not to be taken indoors (Vickery. 1995). The same applies to WOOD ANEMONES picking them would provoke a thunderstorm (it was actually called Thunderbolt in Staffordshire (Vickery. 1995)). BLUEBELLS are equally unlucky to bring indoors (Devonshire Association. Transactions. vol 65 1933). Devonshire superstition has it that it is...
Minor problems tiredness, backache, constipation, piles, headache. Intermediate perineal pain, breast problems, tearfulness depression. Major hypertension, vaginal discharge, abnormal bleeding, stitch breakdown, voiding difficulties incontinence, urinary infection, side effects of epidural. Minor problems tiredness, backache, constipation, piles, headache. Intermediate perineal pain, breast problems, tearfulness depression. Major hypertension, vaginal discharge, abnormal bleeding, stitch breakdown, voiding difficulties incontinence, urinary infection, side effects of epidural.
Agitated saline contrast echocardiography in this 28-yr-old female who complained of migraine headaches shows good opacification of right heart chambers. Clear evidence of right-to-left shunting (appearance of saline bubbles into left heart chambers) occurred early during rest. She was diagnosed with a secundum atrial septal defect. (Please see companion DVD for corresponding video.)
Most of the clinical features of pheochromocytoma result from metabolic and hemodynamic actions of norepinephrine and epinephrine secreted by the tumor (1,5,13). Hypertension is the most common clinical sign. Headache, excessive truncal sweating, and palpitations are the most common symptoms. Although pallor is found only in a small number of patients, the presence of this sign is highly suspicious for pheochromocytoma and, together with hypertension and excessive sweating, provides a high probability of the diagnosis. Some patients may also suffer from anxiety, unusual nervousness, constipation, low energy level, and exhaustion after attacks (Table 1). Differential diagnoses include panic and anxiety syndromes, hypernoradrenergic hypertension, supraventricular tachycardia, baroreflex failure, postural tachycardia syndrome, cluster or migraine headache, hypertensive encephalopathy, hypoglycemia, carcinoid tumor, adrenomedullary hyperplasia, and hyperthyroidism. Pheochromocytomas must...
Moving from the general population to those seen in general practice, a picture of consulting patterns was obtained using a national database study of UK general practices 3 . Data relating to 284,162 women aged 12-70 who had a general practice contact in 1991 were analysed to identify subsequent contacts over the following 5 years. The monthly prevalence rate was 21.5 per 1000 and the monthly incidence rate was 1.58 per 1000. These prevalence rates are comparable to those for migraine, back pain and asthma in primary care. Older women had higher monthly prevalence rates for example, the rate was 18.2 per 1000 in the 15-20 year age group and 27.6 per 1000 in women over 60 years of age. This association was thought to be due to persistence of symptoms in older women, the median duration of symptoms being 13.7 months in 1320 year olds and 20.2 months in women over the age of 60 4 . It is clear that future population-based studies need to include older women.
There have been reports that humans are susceptible to EMCV. However, most of the evidence has been indirect, based on the presence of antibodies. In the 1950s, only a few documented cases of EMCV infection in humans were associated with fever, neck stiffness, lethargy, delirium, and headache. Human cases have been reported in Australia, in an area with a high incidence ofEMCV in pigs. An EMCV outbreak in a zoo in the US, involving multiple animal species, did not result in illness in humans, although a zoo attendant who cared for EMCV-infected primates demonstrated a high antibody titer. Recent serological surveys indicate that human EMCV infections are relatively common in certain areas of the world (i.e., Austria, Greece), but generally are asymptomatic or unrecognized. Recent advances toward using pig tissues as a means of overcoming the acute shortage of transplantation tissues and organs for humans have made it necessary to determine the risk of transmitting this zoonotic virus...
Streptococcal pharyngitis, commonly known as strep throat, is one of the commonest bacterial diseases of humans, being particularly common in children of school age. The primary means of transmission is by the inhalation from coughs and sneezes of respiratory droplets containing Streptococcus pyogenes (p-haemolytic type A streptococci), although other routes (kissing, infected handkerchiefs) are possible. The primary symptoms are a red and raw throat (and or tonsils), accompanied by headaches and fever. S. pyogenes attaches to the throat mucosa, stimulating an inflammatory response and secreting virulence factors that destroy host blood cells. Although self-limiting within a week or so, strep throat should be treated with penicillin or erythromycin as more serious streptococcal diseases such as scarlet fever and rheumatic fever may follow if it is left untreated.
TaqMan reverse transcription-polymerase chain reaction (TaqMan RT-PCR) is a recently developed technique (1) that has been used to study gene expression in tissues of the central nervous system (CNS) including the striatum. For example, TaqMan has been used to profile mRNA distribution patterns across the brain for y-aminobutyric acid-B (GABAb) receptor subunits (2), 5-hydroxytryptamine4 (5-HT4) receptor splice variants (3), novel G-protein-coupled receptors (4), and ion channels including vanilloid receptors (5) and two pore potassium channels (6). More specifically, TaqMan RT-PCR studies have demonstrated a huge enrichment of dopamine D2 (7) and D3 (8) receptors in human striatal tissues compared to other brain regions. In addition, the technique has been utilized for the analysis of gene expression changes in animal models of CNS diseases including Parkinsons's disease (9), stroke (10), and migraine (7).
Cranial mass, such as headache or visual field defects, or defects in other pituitary hormones such as gonadotropins, which usually are lost first (female irregular or absent menses male erectile dysfunction), followed by hypothyroid symptoms, followed finally by loss of ACTH.
Many people eat a variety of foods and show no ill effects however, a few people exhibit adverse reactions to certain foods. Food sensitivities refer to the broad concept of individual adverse reactions to foods. Food sensitivities are reproducible, unpleasant reactions to specific food or food ingredients. There are many types of adverse reactions to foods, e.g., hives, headaches, asthma, and gastrointestinal complaints. Food sensitivities can be divided into primary and secondary sensitivities (Table 10.1).
Asymptomatic or mild headache I Moderate to severe headache, nuchal rigidity, may have oculomotor - no headache or focal signs I Glasgow Coma Scale score 15 - headache, nuchal rigidity, no focal signs II Glasgow Coma Scale score 13-14 - may have headache, nuchal rigidity, no focal signs III Glasgow Coma Scale score 13-14 - may have headache, nuchal rigidity, or focal signs IVa Glasgow Coma Scale score 9-12 - may have headache, nuchal rigidity, or focal signs IVb Glasgow Coma Scale score 8 or less - may have headaches, nuchal rigidity, or focal signs V Mildly ill, alert and responsive, headache present II - Lethargic, headache, no focal signs
Headache, nausea, anxiety, irritability Headache, anxiety, irritability, hypertension, palpitations, appetite suppression, tremor, insomnia Most patients with idiopathic hypersomnia have neither a family history nor an obvious associated viral illness. Autonomic nervous system dysfunction has been associated with some of these cases, including orthostatic hypotension, syncope, vascular headaches, and peripheral vascular complaints. Little is known
Chronic hypertension pre-dates pregnancy or appears in the first 20 weeks whereas pregnancy-induced hypertension develops in the pregnancy, resolves after delivery and is not associated with proteinuria. Pre-eclampsia defines hypertension that is associated with proteinuria occurring after 20 weeks and resolving after birth. Pre-eclampsia occurs in 2-10 of pregnancies and is associated with both maternal and neonatal morbidity and mortality 5 . Risk factors include nulliparity, age of 40 years and above, family history of pre-eclampsia, history of pre-eclampsia in a prior pregnancy, a body mass index greater than 35, multiple pregnancy and pre-existing diabetes or hypertension. Hypertension is often an early sign that pre-dates the development of serious maternal and fetal disease and should be assessed regularly in pregnancy. There is little evidence as to how frequently blood pressure should be checked and so it is important to identify risk factors for pre-eclampsia early in...
Lassa fever begins after 7-18 days of incubation, with fever, headache and malaise. Aching in the large joints, pain in the lower back, a nonproductive cough, severe headache and sore throat are common. Many patients also develop severe retrosternal or epigastric pain. Vomiting and diarrhea occurs in between a half and two-thirds of patients. In more severely ill patients complete prostration may occur by the 6th to 8th day of illness. Patients with Lassa fever appear toxic and anxious, and in the absence of shock, the skin is usually moist from diapheresis. There is an elevated respiratory rate and pulse. The systolic blood pressure may be low. There is no characteristic skin rash petechiae and ecchymoses are rare, nor is jaundice a feature of Lassa fever. Conjunctivitis is common, but rare conjunctival hemorrhages portend a poor prognosis. Seventy percent of patients have pharyngitis, often exudative, but few if any petechiae, and ulcers are rare. Mucosal bleeding occurs in 15-20 of...
Two forms of meningitis have been described with HIV-1 infection. At the time of seroconversion to HIV-1, most patients develop cerebrospinal fluid (CSF) abnormalities, and a few develop symptoms of headache, meningitis, encephalitis, myelopathy, and plexitis. This acute meningitis is clinically indistinguishable from other forms of aseptic meningitis. Chronic recurring meningitis can also occur, characterized by headaches and CSF abnormalities without signs of meningeal irritation. Late in the course of the H1V-1 infection, particularly when there is marked immunosuppression, patients may develop H1V-1 -associated encephalopathy (AIDS dementia complex), H1V-1 -associated myelopathy (spinal vacuolar myelopathy), and neurological problems secondary to opportunistic processes.
The most common cranial mononeuropathy is the third cranial nerve palsy. The patient presents with pain in the orbit, or sometimes with a frontal headache (53,71). There is typically ptosis and ophthalmoplegia, although the pupil is usually spared (72,73). Recovery occurs usually over three months. The clinical onset and time-scale for recovery, and the focal nature of the lesions on the third cranial nerve, on postmortem studies suggested an ischaemic etiology (53,74). It is important to exclude any other cause of third cranial nerve palsy (aneurysm or tumour) by computed tomography or MRI scanning, where the diagnosis is in doubt. Fourth, sixth, and seventh cranial nerve palsies have also been described in diabetic subjects, but the association with diabetes is not as strong as that with third cranial nerve palsy.
Asymptomatic or result in only mild upper respiratory tract symptoms (common cold). Other mild enteroviral illness, such as fever, headache, malaise, and mild gastrointestinal symptoms, may also occur. Serious illness that brings the patient to the attention of a physician is much less frequent. Inapparent infections and prolonged excretion of virus, especially in stools, are common. These properties of enterovirus infection, and the fact that enterovirus infection is extremely common, make it difficult to establish a definitive link between infection and specific disease unless the virus can be isolated from a nonsterile site that is linked to the observed pathology (e.g., isolation from cerebrospinal fluid in the case of aseptic meningitis). Often, the association between infection and disease is based on studies of outbreaks in which a large number of persons with the same clinical signs and symptoms have evidence of infection with the same serotype. Such studies have clearly...
Legionella causes two different manifestations of pulmonary disease a mild, flulike illness, called Pontiac fever, and pneumonia. Pontiac fever has an incubation period of 1-2 days and is characterized by malaise, myalgias, fever, headache, and, sometimes, nonproductive cough. Only symptomatic therapy is required, and complete recovery within 1 week can be expected. Pneumonia, on the other hand, is the predominant manifestation of the more severe form of legionellosis, Legionnaires' disease. This pneumonia can be associated with multiorgan failure. The incubation period of legionnaires' disease ranges from 2 to 10 days, and antimicrobial chemotherapy is necessary for complete recovery of the patients. Nevertheless, in elderly or pulmonary-compromised patients, Legionnaires' disease has a mortality rate of up to 50 . 5,8
The buboes continue to enlarge, sometimes reaching the size of a hen's egg, and when these buboes burst there is agonizing pain. Death can come 2 to 4 days after the onset of symptoms. Sometimes, however, the bacteria enter the bloodstream. This second form of the disease, which may occur without the development of buboes, is called septicemic plague. Septicemic plague is characterized by fever, chills, headache, malaise, massive hemorrhaging, and death. Septicemic plague has a higher mortality than bubonic plague.
Migraine is a very difficult symptom to describe and has many causes. It is familial and many people describe migraine that is related to foods. Whether it is due to direct effects of molecules that are in the food or an immunological reaction to the food is difficult to establish. The same is true for arthralgia. I am not aware of any double-blind studies that have shown an association between arthralgia and food. The association of foods with symptoms such as ME (myalgic encephalomyelitis) is very difficult to prove or disprove.
The main primary mediator, histamine, activates Hj and H2 receptors. Pruritus, rhinorrhea, tachycardia, and bronchospasm are caused by the Hj receptors, whereas both Hj and H2 receptors mediate headache, flushing, and hypotension. Gastrointestinal signs and symptoms are associated with histamine more so than with tryptase levels.
While listeriosis during pregnancy usually presents with flu-like symptoms which can lead to infection of the fetus causing abortion, premature birth or stillbirth, in non-pregnancy associated cases it mainly manifests as meningoencephalitis and or septicemia. The onset of meningoencephalitis (which is rare in pregnant women) can be sudden, with fever, intense headache, nausea, vomiting, and signs of meningeal irritation, or may be subacute, particularly in an immunocompromised or an elderly host (13). Rhomben-cephalitis is an unusual form of listeriosis, which involves the brain stem and is similar to circling disease in sheep. L. monocytogenes can produce a wide variety of focal infections conjunctivitis, skin infection, lymphadenitis, hepatic abscess, cholecystitis,
If the symptoms are largely subjective, such as headaches or behaviour changes, and an improvement is observed with the exclusion diet, DBPCFC is essential. If the diagnosis is confirmed, food should be excluded for a longer period. Again, reintroduction or challenge should be done at regular intervals, especially in children who often grow to tolerate the food. When more than one food is suspected the dietitian should carefully monitor the exclusion diet and suggest appropriate replacement foods.
At least two clinical presentations of ATIN due to diuretics occur. An insidious form in which renal failure appears to develop over a several-month period of time and an acute form which develops over days to a few weeks. In the first form the onset of renal failure from the time of initiation of diuretic therapy varies from 3 to 12 months. Gradual onset of renal failure often is associated with skin rash and peripheral eosinophilia occur in this form of ATIN. In addition, many of these patients have underlying glomerulonephropathy with nephrotic syndrome. A clue to the diagnosis of ATIN in such cases is an accelerated rate of deterioration in renal function. The second form occurs shortly after initiation of therapy ranging from a few days up to 1 month. In many of these cases thiazides and triamterene were administered concomitantly. Both forms may present with systemic manifestations including fever, myalgia skin rash, and eosinophilia. Importantly, discontinuation of the diuretic...
In this key study Parker et al. showed that the group of adults with allergic-type symptoms were significantly more likely to suffer swelling and respiratory symptoms than the group with non-allergic complaints and negative skin prick tests. The group with non-allergy-mediated complaints reported significantly more non-specific problems such as neurological symptoms (headache, fainting, numbness), gastrointestinal symptoms (bloating and distension but not pain, vomiting or diarrhoea) and musculoskeletal symptoms (cramps and stiff joints).
Action Against Allergy is an independent charity founded in 1978 by Amelia Nathan Hill. She was chronically ill with migraine, stomach upsets, painful limbs and joints and other severe symptoms and her doctor, who could find no cause, thought she was being poisoned. After many years of searching, she undertook an elimination diet devised by British allergy pioneer Dr Richard Mackarness and found subsequently that her health improved dramatically.
Immune intervention with human intravenous immunoglobulin (IVIg) has become appropriate in some patients with forms of peripheral diabetic neuropathy that are associated with signs of antineuronal autoimmunity (94,95). Chronic inflammatory demyelinating polyneuropathy associated with diabetes is particularly responsive to IVIg infusion. Treatment with immunoglobulin is well tolerated and is considered safe, especially with respect to viral transmission (96). The major toxicity of IVIg has been an anaphylactic reaction, but the frequency of these reactions is now low and confined mainly to patients with immunoglobulin (usually IgA) deficiency. Patients may experience severe headache because of aseptic meningitis, which resolves spontaneously. In some instances, it may be necessary to combine treatment with prednisone and or azathioprine. Relapses may occur requiring repeated courses of therapy.
School personnel are usually the first to notice excessive absences. Diagnosis and treatment requires collaboration between the school, family, primary medical care provider, and mental health providers. Because of frequent complaints of physical symptoms (headache, sore throat, stomachache), it is important for the physician to determine if underlying medical causes are present. It is also important that medical excuses for the child's absences not be written unless there is a documented medical condition present.
This virus was first isolated from Argas pusillus ticks collected from bats in Malaysia and from the bloods of those bats (Scotophilus temmencki), and has been isolated from ticks and mosquitoes that had fed on infected bats. It was subsequently isolated from pooled brain, liver, spleen, and kidney tissues of other bats in Kyrgyzstan and Tadzhikistan. The virus also was isolated from a staff member of a virology institute in Tadzhikistan who had contracted the infection during field work with bats. Sporadic human cases of this disease have been recognized for more than 20 years in central Asia, particularly in Tadzhikistan, and in Malaysia, and the virus may occur in parts ofIran, Afghanistan, India, and Pakistan. The nonfatal illness caused by this virus is characterized by fever, headache, and myalgias, which are sufficiently nonspecific to be generally undiagnosed or mistaken for diseases caused by other pathogens.
Life does not return to normal. Children's behavior may regress and be more like that of younger children. Children may develop fears related to the trauma or other fears such as fear of the dark or fear of being alone. Schoolwork suffers and grades may fall. Adolescents may drop out of school. Children and adolescents may behave badly, get in fights, or complain of physical symptoms such as headaches or stomachaches. Adults may be unable to return to work or to perform their jobs as before. Personal relationships may also suffer when people argue, blame one another, or find it difficult to trust others. The quality of life for the person who has suffered the trauma is worse than before.
Headache, nausea, vomiting, diplopia, blurred vision, seizures, irritability, restlessness, decrease in school performance, decreased motor performance, sleep loss, weight loss, memory loss progressing to lethargy and drowsiness. Late signs decreased level of consciousness, decreased motor response to commands, decreased response to pain, change in pupils, posturing, papilledema.
Azithromycin was given per os for 5 days 500 mg twice daily on the first day and 500 mg once daily for the following 4 days. Clinical examinations were performed 14 days, 6 months, and 1 year after the termination of the treatment. Besides the appearance of EM, local (itching, burning, pain) and general (fatigue, malaise, headache, myalgia, arthralgia) clinical symptoms (CS) were monitored. Follow-up serological tests were performed 2 months, 6 months, and 1 year after the termination of treatment. Side effects of treatment were recorded at the first follow-up visit. At each examination, clinical response was evaluated as successful (complete resolution of EM and CS), improved (complete resolution of EM but not of CS), and unsuccessful (incomplete resolution of EM and CS or the appearance of signs of late Lyme disease).
Serological evidence of natural infection with these viruses has been demonstrated in a wide variety of wild and domestic mammals. The available data suggest that mammals may represent a dead-end host rather than a vector because horizontal transmission is rare and viremia is transient. CHP and Piry viruses have been reported to produce disease in humans. The disease is usually characterized by an influenza-like illness with fever, myalgia, headache, and malaise of 3-6 days duration. Human laboratory infection with Piry virus has been reported due to aerosol inhalation, splashing virus in the eye and contamination of a cut or scratch with infected material. Antibodies to ISF virus have also been reported in humans, but it is unknown whether this infection resulted in clinical illness. No epizootic or epidemic is known for these viruses. Pathogenicity and immunogenicity of CHP and ISF viruses for laboratory animals have been studied. Both viruses were highly pathogenic for mice by the...
Rickettsia rickettsii This is transmitted via contact with the wood tick, the dog tick, or the Lone Star tick, with an overall incidence of 0.2-0.5 cases per 100000 population. The usual neurological features consist of headache, neck stiffness, altered sensorium, and convulsions. Other neurological abnormalities include ataxia, aphasia, neural hearing loss, and papilledema. The neuro-pathological findings consist of cerebral edema, perivascular and meningeal lymphocytic infiltration, and extensive necrotizing vasculitis
About 10 days after exposure the patient enters the prodromal phase which lasts from 2 to 4 days. The initial symptoms consist of fever, malaise, sneezing, rhinitis, congestion, conjunctivitis and cough. At the beginning of the prodromal stage, a transitory rash can sometimes develop which has an urticarial or macular appearance, but disappears prior to the onset of the typical exanthem. Once the exanthem has reached its height, the fever usually falls and the conjunctivitis as well as the respiratory symptomatology begin to subside. Antibody titers rise, virus shedding then decreases and the patient rapidly improves. Continuation of clinical symptoms of the respiratory tract or fever suggests complications (Table 2). Modified measles occur in partially immunized hosts such as infants with residual maternal antibodies or in the course of live vaccine failure. The illness is mild and follows the regular sequence of events seen in acute measles but is less symptomatic. Atypical measles...
The cardinal symptom of OSA is excessive daytime sleepiness, which appears to be related to recurrent arousals from sleep associated with obstructive events 14 . Other associated signs and symptoms include snoring, unrefreshing sleep, nocturnal choking (or dreams about choking or drowning), witnessed apneas, nocturia, morning headaches, mild cognitive impairment, and reduced libido 2 . Diagnosis is confirmed by assessment of sleep, typically via polysom-nography. While exact cut points are arbitrary, a mean of 5-15 obstructive events per hour of sleep represents mild dysfunction, 15-30 events per hour represents moderate dysfunction, and 30 events per hour represents severe dysfunction 15 . Treatment options for OSA include weight loss, including discontinuation of weight-increasing medications, positional therapy, continuous positive airway pressure (CPAP), and mandibular advancement devices or surgery for clearly identifiable causes of upper airway obstruction 14 . The first line of...
Everybody must surely be familiar with the symptoms of gastroenteritis - sickness, diarrhoea, headaches and fever. The cause of this gastroenteritis may be bacterial (e.g. Salmonella) or viral. The major cause of the viral form is the human rotavirus , which, together with the Norwalk virus, is responsible for the majority of reported cases. The rotavirus has a segmented, dsRNA genome, and is a non-enveloped virus.
Before breast symptoms occur, chills, fever, and tachycardia are present. Usually the infection is unilateral localized symptoms include intense pain, tenderness, redness, and heat at the infection site. In addition, the woman often feels as if she has the flu, with symptoms of muscular aching, fatigue, headache, and continued fever.
Neisseria meningitidis is part of the normal biota of the nasal cavity and throat in a fourth or more of the population, but these carriers show no symptoms of disease. For reasons not yet fully understood, these bacteria may invade the bloodstream and subsequently invade and colonize the meninges (the membranes that surround the spinal cord and brain). Early symptoms may include headache, fever, and vomiting, and death can quickly follow, due to the endotoxin produced (a toxin associated with the surface of the producing cells, usually gram-negative bacteria). Without proper care, the fatality rate can exceed 80 , but with treatment this can be reduced to below 10 .
No correlations are found between a mutation and a clinical phenotype because a family unique presentation such as migraine or stroke is also found with several other mutations. 2,3 Additionally, we did not notice neither different clinical presentations nor different skin vessel wall lesions in CADASIL patients with mutations located either in the first or very last exons. Interestingly, a homozygous patient followed in Finland was indistinguishable when compared with an age-matched heterozygous patient with the same R133C Notch3 mutation. The double dose of gene defect does not appear to aggravate the symptoms, which indicates that either mutated Notch3 receptors retain some of their function, or other molecules can compensate for the loss. 16
Begins with the penetration of the infecting organism, the spirochete Treponema pallidum, into the skin or mucosa of the body. Within 10 to 90 days after the initial infection, the primary stage begins with the appearance of a firm, painless lesion called a chancre at the site of entry. In women, the chancre often forms in the vagina or on the cervix and therefore goes unnoticed. If it is left untreated, the chancre heals spontaneously in 1 to 5 weeks. As this primary stage resolves, systemic symptoms appear, thus signaling the start of the secondary stage. Secondary stage symptoms include malaise, headache, nausea, fever, loss of appetite, sore throat, stomatitis, alopecia, condylomata lata (reddish-brown lesions that ulcerate and have a foul discharge), local or generalized rash, and silver-gray eroded patches on the mucous membranes. These symptoms subside in 1 week to 6 months, and the infected person enters a latent stage, which may last from 1 to 40 years. During latency,...
Possible symptoms of brain tumors include epileptic seizures and pressure within the skull, which may result in headaches, nausea, vomiting, or blurred vision. Some children experience crossed eyes and double vision as a result of the pressure, and some children lose their vision totally. Symptoms of skull pressure in school-age children include decreased school performance, fatigue, personality changes, and headaches. In younger children, symptoms include irritability, decreased appetite, developmental delays, and losing previously acquired intellectual and motor skills infant symptoms include increased head size, vomiting, and failure to thrive. Possible symptoms of spinal cord tumors include numbness or weakness of the legs and abnormal movements and positioning of the body (American Cancer Society, 2004).
Vice versa the rate of spread of hypoexcitability (spreading depression) induced by the focal application of K+ or glutamate is similar to the diffusion rate of Ca2+ through glial cell populations (2050 mm s). Spreading depression (SD) is characterised by changes in electrical impedance, lengthening of refractory periods, increases in concentration of extracellular K+ ( K+ o) and variation in tissue volume. It has been detected in hippocampus, olfactory bulb, spinal cord, superior colliculus and cerebellum. SD may underlie several nervous diseases seizure discharges, migraine, cerebral ischaemia.
Related to the endocrine cycle and which (i.e. those which persist) are not. This is also a valuable way of demonstrating whether symptoms or medical problems such as premenstrual migraine, asthma and epilepsy are truly related to the hormone cycle. If a woman was undergoing a hysterectomy for a gynaecological indication, such information may help the patient make the decision to conserve or retain her ovaries. If any PMS or other premenstrual symptom is eradicated by GnRH, it is likely (though not guaranteed) that she would also benefit from removal of ovaries if the hysterectomy is being undertaken. This information would be valuable in the final pre-operative counselling.
The course of acromegaly is slow, with very gradual changes over 7 to 10 years. Reviewing a patient's old photographs may reveal the progressive changes in facial features. Determine if the patient has had a change in hat, glove, ring, or shoe size because of an overgrowth of the hands and feet. Ask the patient if he or she has had headaches or visual disturbances, which in acromegaly are caused by the growth of the adenoma, which exerts pressure on brain tissue and cranial nerves III, IV, and VI. Establish a history of altered sexual function, which may be an indicator of decreased gonadotropin production. Ask about the presence of pain in the hands, feet, and spine, which is probably caused by bone growths also ask about problems with chewing, swallowing, or talking, which may be caused by tongue, jaw, and teeth enlargement. Note the presence of a deepening of the voice, recurrent bronchitis, excessive sweating, heat intolerance, fatigue, and muscle weakness. Check for a...
Orungo (ORU) virus caused mild epidemic disease (fever, nausea, headache and rash) in Nigeria. The virus occurs in a band across Africa from Uganda to Sierra Leone. It is an orbivirus in the Reoviridae. ORU is probably mosquito transmitted, but the species that transmit it in nature are not known. Although the vertebrate reservoir hosts are unknown, wild primates have antibody and are suspected to be involved in virus maintenance.
Many units have now developed a severe pre-eclampsia protocol. Cases which require protocol determined management are often defined as those with severe hypertension (greater than 170 110 mmHg) or hypertension with an additional complication such as headache, visual disturbance, epigastric pain, clonus (more than three beats) or a platelet count less than 100 or AST more than 50 IU units per litre.
Fatal familial insomnia (FFI) 509, 511 Familial hemiplegic migraine (FHM) 137, 271 Manic depression see depression Major depressive disorder (MDD) see depression Maple syrup disease (MSD) 137, 512 MASA syndrome 458 Migraine 165 Migraine (familial hemiplegic (FHM)) 271 Motoneuron disease (MND) 514-16 Multiple sclerosis (MS) 152, 154, 332 Myasthenia gravis 221 Myotonia congenita (see Thomsen's disease) Myotonic dystrophy 514
It is possible to have severe disease and normal blood pressure or proteinuria. In a survey in women with eclampsia, only just over half had a recent measurement indicating both significant proteinuria and hypertension 2 . The syndrome of pre-eclampsia is multisystemic, and other organ involvement must be carefully considered, including the placenta. Other signs of the disease have not been included in the definition for pragmatic reasons, but they are often equally important. A careful history should also include whether women have symptoms such as visual disturbance, headaches and epigastric pain. Sometimes nausea or even vomiting can be a presenting feature. However, at least 50 of women even with severe disease will be asymptomatic 2 . When managing women,
The clinical symptoms in the early phase of a VHF are very similar irrespective of the causative virus and resemble a flu-like illness or a common enteritis. Headache, myalgia, gastrointestinal symptoms, and symptoms of the upper respiratory tract dominate the clinical picture. Hepatitis is also common. Therefore, especially in the early phase, virological testing is of utmost importance in diagnosis. The late phase of a VHF is more specific and characterized by organ manifestations and organ failure. Hemorrhage, the hallmark of a VHF, is present only in a fraction of patients depending on the virus species or even virus strain. Mild and subclinical courses seem to occur in all hemorrhagic fevers. However, if the disease is symptomatic, the case fatality ranges between 5 and 30 , but may be as high as 80 in Ebola fever.
CADASIL differs from other causes of diffuse subcortical ischemia, such as Binswanger's disease, by the frequent presence of migraine with or without aura, and individuals with CADASIL are not usually hypertensive. Occasionally, diagnostic confusion may occur with patients with multiple sclerosis, especially the primary progressive type, with the appearance of multiple white matter lesions. CADASIL often presents in early adulthood, and most affected individuals show symptoms by age 60. In addition to migraine with or without aura, there may be depression and mood disturbances, focal neurological deficits, pseudobulbar palsy, and dementia. Approximately 10 of patients have seizures.
The varied clinical features of viral infections of the nervous system can be explained in large part by the factors discussed above. Thus, a virus may infect only meningeal or ependymal cells, and cause a clinical syndrome known as viral meningitis or acute aseptic meningitis. This clinical syndrome is characterized by fever, headache and nuchal rigidity secondary to meningeal irritation but without clinical signs suggesting parenchymal disease. The commonest causes of acute viral meningitis are enteroviruses and mumps virus. Encephalitis is a clinical syndrome in which, in addition to fever, headache and stiff neck, there is paralysis, seizures or other evidence of parenchymal disease of the brain. The commonest causes of severe encephalitis in man are herpes simplex virus and the arthropod-borne viruses. The former infects neurons and glia and causes diffuse necrotizing encephalitis in the newborn, but focal encephalitis in the immune child or adult presumably because diffuse virus...
Although discussed in detail in Chapter 22, a brief description of those associated with painful symptomatology is provided here (7,8). Those cranial mononeuropathies affecting the nerves supplying the external ocular muscles typically present with sudden onset of diplopia and an ipsilateral headache often described as a dull pain coming from behind the eye. Similarly, many of the focal limb neuropathies including entrapment neuropathies (7) might present with painful symptoms in the area supplied by the individual nerve. The tarsal tunnel syndrome, which is analogous to the carpal tunnel syndrome in the upper limbs, may present with localized foot pain, which should be distinguished from the pain of the diffuse sensorimotor neuropathy.
A seventeen-year-old boy comes to your office and asks for a comprehensive psychological evaluation. He has been experiencing some headaches, anxiety and depression. A high school dropout, he has been married for a year and has a one-year-old baby but has left his wife and child and returned to live with his parents. He works full time as an auto mechanic and has insurance that covers the testing procedures. You complete the testing. During the following year, you receive requests for information about the testing from a number of people
Originally described by Sjaastad and Spierings in 1984, hemicrania continua is a primary headache syndrome classified among the indomethacin-responsive headaches because of its selective and consistent response to this agent. It shares some features with cluster headache and migraines as well. Other hemicranial headaches share clinical and probably a pathophysiological basis, and are grouped here. The autonomic manifestations of these disorders are a common feature, and should be routinely
SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and (earing) syndrome is characterized by short-lasting attacks of unilateral pain that are much briefer than those seen in any other trigeminal-autonomic cephalagia and very often accompanied by prominent lacrimation and redness of the ipsilateral eye. 3History and physical and neurological examinations do not suggest any of the disorders, such as trigeminal neuralgia, idiopathic stabbing headache, cough headache, benign exertional headache, headache associated with sexual activity, or hypnic headache, or history and or physical and or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but attacks do not occur for the first time in close temporal relation to the disorder. (Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache...
Headache for a total of more than 2 months. 2. Relative lack of migraine symptoms and signs.6 4. Lack of effect of migraine and cluster headache drugs (triptans and ergotamine). 3The pain is mostly in the anterior area, but not infrequently also in the auricular occipital area. Provided the dosage is adequate 150 mg per day for 3 days. In the doubtful case, the indotest should be carried out (see Headache 1998 38 122-128). This is particularly important in the remitting cases, because a betterment of pain in reality being because of a remission may falsely be ascribed to indomethacin. investigated in the history. SUNCT syndrome (short-lasting unilateral neuralgiform headache with conjunctival injection and earing) is a rare but distinct syndrome.
An example of a group-sequential, adaptive, placebo-controlled up and down designs was published by Hall et al. in 2005 (37), wherein the objective was to test mechanism of action for a drug for migraine headache and to select a dose range for later clinical trials. This design (Fig. 2A) was used, given a lack of information across a desired target dose range, small sample size, and to reduce exposure of patients to ineffective treatment. Adaptive dose selection was based on response rate of 60 that is observed with other drugs. If more than 60 of the treated patients in each sequential group responded favorably to the drug, a next lower dose was evaluated in the next sequential group and a next higher dose was tested if unfavorable. An adaptive stopping rule was
There is no suggestion of one of the disorders such as trigeminal neuralgia, idiopathic stabbing headache, cough headache, benign exertional headache, headache associated with sexual activity, or hypnic headache. 3. Such a disorder is present, but the first headache attacks do not occur in close temporal relation to the disorder. 1. There is no suggestion of one of the disorders such as trigeminal neuralgia, idiopathic stabbing headache, cough headache, benign exertional headache, headache associated with sexual activity, or hypnic headache. 3. Such a disorder is present, but the first headache attacks do not occur in close temporal relation to the disorder. Adapted with permission from Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias SUNCT syndrome and other short-lasting headache with autonomic features, including new cases. Brain 1997 120 193-209.
Hyperimmunoglobulinemia D with periodic fever syndrome (HIDS), also called Dutch type periodic fever, is an autosomal recessive disorder caused by mutations in MVK, which encodes mevalonate kinase (MK) (Drenth et al. 1999 Houten et al. 1999a Valle 1999). HIDS patients have episodes of fever, lymphadenopathy, abdominal pain, arthralgia, and or rash that last about 4-8 days, approximately every 4-8 weeks, though these time periods vary (Drenth et al. 1994). The rash has no predilection for the lower legs, unlike that of FMF, nor is it usually migratory, like that seen in TRAPS. Patients may also suffer from diarrhea, nausea, headache, and malaise during attacks. Generally the disease presents in infancy. Biochemical markers found in some but not all HIDS patients include elevated serum IgD levels (Drenth et al. 1994) and increased mevalonate concentration in the urine during febrile attacks (Drenth et al. 1999 Houten et al. 1999a Frenkel et al. 2001 Kelley and Takada 2002). Attacks can...
An interesting development from dopaminergic agents is the search for drugs for the treatment of premenstrual syndrome because pituitary prolactine release is under tonic hypothalamic inhibition by dopamine. Besides, the dopaminergic system plays an important role in physiopathology of migraine, and a dopamine antagonist such as prochlorperazine has exhibited antimigraine properties in animals by possible central amplification of cholinergic transmission. There is therefore a need for original dopaminergic agents, and one of the possible more exciting sources for such agents is the medicinal flora of Asia and the Pacific. The evidence available so far suggests that such agents would be present in the following medicinal plants.
The incubation period ranges from 2 to 6 weeks with a mean duration of 4 weeks. The prodromal (preicteric) period of normally 4-6 days (which may vary from 1 day to more than 2 weeks) is characterized by nonspecific symptoms, like anorexia, nausea with vomiting, malaise, abdominal pain, loss of appetite, accelerated pulse, rash, headache, and fever (38-39 C) as well as by gastrointestinal symptoms, normally in form of obstipation, but diarrhea is also observed.
Sleepwalking (SW) represents motor activation during an abnormal arousal, usually from deep NREM sleep. Common during childhood (1-17 ), SW tends to diminish in frequency following adolescence but can persist into or even begin during adult life (2.5 ) 15,16 . Behaviors can vary from sitting up in the bed to full ambulation. Behaviors can be very complex and include walking, running, driving, eating, and violence. Mental activity is usually poorly recalled but may include dream-like visual imagery, which tends to be both less detailed and less bizarre than traditional REM dream reports. Individuals are variably amnestic for the episodes. Typically occurring during the early part of the sleep cycle and emerging from the deeper stage N3 of NREM sleep, they may technically derive from any NREM stage. Many individuals report that frequency and severity of sleepwalking increase with stressful life experiences. Cases have been associated with migraine and thyrotoxicosis 17,18 . There is...
Astroviruses Viral gastroenteritis is usually a mild illness characterized by nausea, vomiting, diarrhea, malaise, abdominal pain, headache, and fever (fecal-oral routes via person-to-person contact or ingestion of contaminated foods and water) The incubation period is 18 to 36 h, with the illness being mild and self-limiting. It is hard to establish a diagnosis because the virus only replicates in the host. The Norwalk-like virus appears to be responsible for several large outbreaks throughout the U.S., usually at large gatherings (banquets, picnics, etc.). The attack rate is high and those who consume the virus get sick. The disease is self-limiting, mild, and characterized by nausea, vomiting, diarrhea, and abdominal pain. Headache and low-grade fever may occur. The infectious dose is unknown but presumed to be low. The virus can be identified on early stool specimens by immune electron microscopy and various immunoassays. Norwalk gastroenteritis is transmitted by the fecal-oral...
Mycotoxicoses have been known for a long time. Ergotism occurred in the Middle Ages, around the 14th century in Europe. Ergot is a fungus, Claviceps purpurea, that grows on rye, and the consumption leads to intoxications and episodes of hallucinations, delirium, and convulsion and causes arteriolar spasms and gangrene. The gangrenous effects are associated with alkaloids that are partial a-adrenergic agonists and promote vasoconstriction, and the hallucinogenic effects are because the ergot mold contains derivatives of the hallucinogen lysergic acid, with ergonovine (ergometrine) and ergotamine (Figure 13.1), being the most important. All are pharmacologically active compounds. Ergotamine causes constriction of vessels and has been used for migraines. Extensive use of ergotamine can result in gangrene. Ergonavine is a potent inducer of uterine constriction. In 1850, ergot alkaloids were associated with ergotism, then known as the holy fire or St. Anthony's fire. In 1951, an outbreak...
Side effects are associated with large therapeutic doses of niacin. Nicotinic acid in large doses (100 to 300 mg oral or 20 mg intravenous) can result in vasodilative effects. Symptoms include flushing reaction, cramps, headache, and nausea. Therapeutic levels of niacin have been used successfully to reduce serum cholesterol, but with other reversible side effects such as pruritis, desquamation, and pigmented dermatosis. On the other hand, high doses of nicotinamide (used to therapeutically treat niacin deficiency) have no side effects. Nicotinamide does not lower serum cholesterol.
Leukemia is a cancer involving the blood-forming cells. It typically affects the white blood cells, but it can also affect other types of blood cells (i.e., red blood cells or platelets). Leukemia initially develops in the bone marrow (i.e., the inner part of the bones where blood cells are produced) and then spreads to the blood. Once in the blood, the leukemia can spread to the lymph nodes, the central nervous system (i.e., the brain and spinal cord), or other organs. Symptoms of leukemia include fatigue, pale skin, infection, easy bleeding or bruising, bone pain, swelling of the abdomen, swollen lymph nodes, swollen thymus gland, headaches, seizures, vomiting, rashes, gum disease, and extreme weakness (American Cancer Society, 2004).
Many varieties of animal- or plant-based foods are sources of biogenic amines. Dopamine and tyramine are natural components of banana, cheese, and avocado, and bacterial action on the amino acids (see previously) found in meats and fish can produce putrescine and cadaverine. Also, histamine and b-phenylethylamine have been implicated as etiological agents in several outbreaks of food poisoning. These amines can affect the vascular system, resulting in vessel constriction and subsequently increased blood pressure (pressor amine effects). Norepinephrine and dopamine or catecholamines are pressor amines important as neutrotransmitters in adrenergic nerve cells. They cause diet-induced migraine headaches, and, in some cases, hypertensive crisis.
Teach the patient and significant others about the nature of this disorder and necessary self-assessments and self-care activities. Teach the patient to report any signs of petechiae and ecchymoses formation, bruising, bleeding gums, and other signs of frank bleeding. Encourage the patient to stand unclothed in front of a mirror once a day to check for areas of bruising. Headaches and any change in level of consciousness may indicate cerebral bleeding and, therefore, need to be reported to the healthcare workers immediately. Teach the signs and symptoms of blood loss, such as pallor or fatigue. Demonstrate correct mouth care for the patient and significant others by using a soft toothbrush to avoid mouth injury. Recommend electric shavers for both men and women. Teach the patient to use care when taking a rectal temperature to prevent rectal perforation. Recommend care when clipping fingernails or toenails. If any bleeding does occur, instruct the patient to apply pressure to the area...
Inappropriate antidiuretic hormone secretion (IADHS) may occur in a variety of diseases, including malignancies, acute and chronic pulmonary diseases, central nervous system and endocrine disorders, acute psychosis, and surgical stress. It can be induced by drugs such as phenothiazines, cyclophosphamide, vincristine, thiazides, morphine, carbamazepine, and cisplatin. IADHS may accompany certain malignancies, particularly small-cell lung carcinoma, head neck carcinomas, brain tumors, and lymphomas. The symptoms of IADHS syndrome include anorexia, nausea, headache, confusion, with the possible end result being coma. Laboratory findings include serum hyponatremia, elevated urinary sodium concentrations with normal renal and adrenal homeostasis. Few cases of prostate cancer associated with IADHS syndrome have been reported, and tumors were either poorly differentiated or small cell carcinoma and were almost uniformly metastatic at the time of diagnosis. Most of the patients died a few...
Serious manifestations of neurological disease are fortunately rare in pregnancy, though cerebral haemorrhage remains a significant cause of maternal death. Epilepsy and migraine are common causes of morbidity. Migraine Headaches are a common problem in pregnancy and migraine sufferers may find their symptoms worsen during the first trimester. Many patients may be using ergot alkaloids to treat migraine prior to the onset of pregnancy and they must be advised not to use these during pregnancy. Migraines may improve considerably in the second and third trimesters 6 but in patients in whom continuing problems exist, the strategies that are employed for prophylaxis are low-dose aspirin, paracetamol and codeine as pain relief and propranolol if attacks continue to be troublesome despite these measures. If focal migraine occurs as a new symptom in pregnancy an experienced opinion to exclude serious underlying causes must be sought. Cerebral vein thrombosis is rare in pregnancy 7 , and it...
Hydrocephalus is the enlargement of the intracranial cavity caused by the accumulation of cerebrospinal fluid in the ventricular system. This results from an imbalance in the production and absorption of the fluid which causes an increase in intracranial pressure as the fluid builds up. Fluid may accumulate as a result of blockage of the flow (noncommunicating hydrocephalus) or impaired absorption (communicating hydrocephalus). As the head enlarges to an abnormal size, the infant experiences lethargy, changes in level of consciousness, lower extremity spasticity and opisthotonos and, if the hydrocephalus is allowed to progress, the infant experiences difficulty in sucking and feeding, emesis, seizures, sunset eyes, and cardiopulmonary complications as lower brain stem and cortical function are disrupted or destroyed. In the child, increased intracranial pressure (ICP) focal manifestations are experienced related to space-occupying focal lesions and include headache, emesis, ataxia,...
The primary manifestation of temporal arteritis is headache, although the major complication is acute, often irreversible visual loss. Polymyalgia rheumatica is the systemic form of temporal arteritis and has evolved separate diagnostic criteria, which are presented separately. Pathologically, biopsy of extracranial arteries (e.g., temporal artery) shows three major findings granulomas with giant cells, often near remnants of the internal elastic membrane nonspecific neutrophilic, eosinophilic, and lymphocytic infiltration of blood vessel wall intimal fibrosis.
Headache Happiness! Stop Your Headache BEFORE IT STARTS. How To Get Rid Of Your Headache BEFORE It Starts! The pain can be AGONIZING Headaches can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows. And just think of how unwelcome headaches are while you're trying to work.