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Search Results for : Cephalgia
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Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Switching stable patients with schizophrenia from depot and oral antipsychotics to long-acting injectable risperidone: reasons for switching and safety.
Author(s): Hawley, C; Turner, M; Latif, MA; Curtis, V; Saleem, PT; Wilton, K
Journal: Hum Psychopharmacol 2010 Mar 2; Vol. 25, Issue 1; Page(s) 37-46
[Medline ID - 20041474]

OBJECTIVE: An international, non-randomised study evaluated efficacy and safety of risperidone long-acting injectable (RLAI) compared to previous treatment. To investigate generizability of the European data set to the UK subset safety and switching data are reported here. METHODS: Patients with schizophrenia or other psychotic disorder, symptomatically stable on antipsychotic medication, received intramuscular injections of RLAI 25 mg (to a maximum of 50 mg) every 2 weeks for 6 months. RESULTS: Of 182 UK patients enrolled, 79% had schizophrenia, 21% other psychotic disorders. Insufficient efficacy (43%), side effects (45%), and non-compliance (25%) were the most common reasons for switching. Sixty-nine per cent of patients completed the trial; 8% discontinued due to adverse events (AEs). Most frequent treatment-emergent AEs were headache (8.2%), relapse (7.7%) and insomnia (7.1%); 8 (4.4%) patients reported injection-related AEs. There were significant improvements in extrapyramidal symptom rating scale total and subscale (particularly Parkinsonism) scores, regardless of previous medication (total cohort, p < or = 0.0001). There was a small but significant increase in body weight at endpoint (1.2 kg, p = 0.0023). One patient suffered a myocardial infarction and died (not treatment-related). There were no substantial differences between the full data set and the UK sub-population CONCLUSION: Switch to RLAI was well-tolerated in stable patients over 6 months. The European data set is generalizable to the UK patient population.

Improving the clinical diagnosis of influenza--a comparative analysis of new influenza A (H1N1) cases.
Author(s): Ong, AK; Chen, MI; Lin, L; Tan, AS; Nwe, NW; Barkham, T; Tay, SY; Leo, YS
Journal: PLoS One 2010 Mar 18; Vol. 4, Issue 12; Page(s) e8453
[Medline ID - 20041115]

BACKGROUND: The presentation of new influenza A(H1N1) is broad and evolving as it continues to affect different geographic locations and populations. To improve the accuracy of predicting influenza infection in an outpatient setting, we undertook a comparative analysis of H1N1(2009), seasonal influenza, and persons with acute respiratory illness (ARI) in an outpatient setting. METHODOLOGY/PRINCIPAL FINDINGS: Comparative analyses of one hundred non-matched cases each of PCR confirmed H1N1(2009), seasonal influenza, and ARI cases. Multivariate analysis was performed to look for predictors of influenza infection. Receiver operating characteristic curves were constructed for various combinations of clinical and laboratory case definitions. The initial clinical and laboratory features of H1N1(2009) and seasonal influenza were similar. Among ARI cases, fever, cough, headache, rhinorrhea, the absence of leukocytosis, and a normal chest radiograph positively predict for both PCR-confir med H1N1-2009 and seasonal influenza infection. The sensitivity and specificity of current WHO and CDC influenza-like illness (ILI) criteria were modest in predicting influenza infection. However, the combination of WHO ILI criteria with the absence of leukocytosis greatly improved the accuracy of diagnosing H1N1(2009) and seasonal influenza (positive LR of 7.8 (95%CI 3.5-17.5) and 9.2 (95%CI 4.1-20.3) respectively). CONCLUSIONS/SIGNIFICANCE: The clinical presentation of H1N1(2009) infection is largely indistinguishable from that of seasonal influenza. Among patients with acute respiratory illness, features such as a temperature greater than 38 degrees C, rhinorrhea, a normal chest radiograph, and the absence of leukocytosis or significant gastrointestinal symptoms were all positively associated with H1N1(2009) and seasonal influenza infection. An enhanced ILI criteria that combines both a symptom complex with the absence of leukocytosis on testing can improve the accuracy of predicting both seasonal and H1N1-2009 influenza infection.

A more detailed classification of mild head injury in adults and treatment guidelines.
Author(s): Lee, YB; Kwon, SJ
Journal: J Korean Neurosurg Soc 2009 Dec 31; Vol. 46, Issue 5; Page(s) 451-8
[Medline ID - 20041055]

OBJECTIVE: The purpose of this study was to analyze risk factors that are associated with intracranial lesion, and to propose criteria for classification of mild head injury (MHI), and appropriate treatment guidelines. METHODS: The study was based on 898 patients who were admitted to our hospital with Glasgow Coma Scale (GCS) score of 13 to 15 between 2003 and 2007. The patients' initial computerized tomography (CT) findings were reviewed and clinical findings that were associated with intracranial lesions were analyzed. RESULTS: GCS score, loss of consciousness (LOC), age and skull fracture were identified as independent risk factors for intracranial lesions. Based on the data analysed in this study, MHI patients were divided into four subgroups : very low risk MHI patients are those with a GCS score of 15 and without a history of LOC or headache; low risk MHI patients have a GCS score of 15 and with LOC and/or headache; medium risk MHI patients are those with a GCS score of 15 and with a skull fracture, neurological deficits or with one or more of the risk factors; high risk MHI patients are those with a GCS score of 15 with abnormal CT findings and GCS score of 14 and 13. CONCLUSION: A more detailed classification of MHI based on brain CT scan findings and clinical risk factors can potentially improve patient diagnosis. In light of our findings, high risk MHI patients should be admitted and treated in same manner as those with moderate head injury.

Total Pesticide Exposure Calculation among Vegetable Farmers in Benguet, Philippines.
Author(s): Lu, JL
Journal: J Environ Public Health 2009 Dec 31; Vol. 2009; Page(s) 412054
[Medline ID - 20041012]

This was a cross-sectional study that investigated pesticide exposure and its risk factors targeting vegetable farmers selected through cluster sampling. The sampling size calculated with P = .05 was 211 vegetable farmers and 37 farms. The mean usage of pesticide was 21.35 liters. Risk factors included damaged backpack sprayer (34.7%), spi lls on hands (31.8%), and spraying against the wind (58%). The top 3 pesticides used were pyrethroid (46.4%), organophosphates (24.2%), and carbamates (21.3%). Those who were exposed to fungicides and insecticides also had higher total pesticide exposure. Furthermore, a farmer who was a pesticide applicator, mixer, loader, and who had not been given instructions through training was at risk of having higher pesticide exposure. The most prevalent symptoms were headache (64.1%), muscle pain (61.1%), cough (45.5%), weakness (42.4%), eye pain (39.9%), chest pain (37.4%), and eye redness (33.8%). The data can be used for the formulation of an integrated program on safety and health in the vegetable industry.

Management of medication overuse headache.
Journal: Drug Ther Bull 2010 Apr 7; Vol. 48, Issue 1; Page(s) 2-6
[Medline ID - 20427444]

Headache is one of the most frequent reasons for medical consultation in both general practice and specialist neurology clinics.1 Prescribed and over-the-counter medications are taken to alleviate headaches, but may be used incorrectly.2 In particular, use of some drugs both frequently and regularly can have a paradoxical effect, causing headaches rather than relieving them, and leading to medication overuse headache (MOH).3 Such overuse is a common cause of frequent headache. Here we review MOH and its management.

Primary angioleiomyoma in the sellar region: a case report and literature review.
Author(s): Xu, Y; Jing, Y; Ma, S; Ma, F; Wang, Y; Ma, W; Li, Q
Journal: Clin Neuropathol 2010 Mar 20; Vol. 29, Issue 1; Page(s) 21-5
[Medline ID - 20040329]

OBJECTIVE: Angioleiomyoma (vascular leiomyomas, angiomyoma) is a rare, benign soft tissue tumor which consists of a mixture of well-differentiated smooth muscle cells and thick-walled vessels. Here we report a case of angioleiomyoma in the sellar region, which is the first case report of angioleiomyoma at this anatomical location. CLINICAL PRESENTATION: A 53-year-old man was admitted with a medical history of three months episodic headache and one month visual deteri oration, both of which progressed gradually. The neurological examination showed nothing remarkable except a slightly decreased adrenocorticotrophic hormone (ACTH) level. Preoperative magnetic resonance imaging revealed a pituitary apoplexy. Gross total resection of the tumor was then performed. PATHOLOGICAL FINDINGS: Histological and immunohistochemical studies showed a typical microscopic appearance of an angioleiomyoma present in a rather uncommon place. The pertinent literature regarding the features of this tumor was reviewed and discussed. CONCLUSIONS: Intracranial angioleiomyoma is a benign soft tissue tumor with excellent prognosis. Early diagnosis of this tumor is difficult.

What do we know about chronic tension-type headache?
Author(s): Fern; ández-de-Las-Peñas, C
Journal: Discov Med 2010 May 21; Vol. 8, Issue 43; Page(s) 232-6
[Medline ID - 20040276]

In the past few years there has been an increasing body of knowledge about etiological mechanisms of chronic tension type headache (CTTH), permitting a better understanding of this syndrome. It seems that CTTH diagnostic criteria should be modified to improve its differential diagnosis against migraine, since CTTH is a syndrome of "featureless" headaches characterized by nothing but pain in the head. It has been demonstrated that pressure pain hypersensitivity and pericranial muscle tenderness are both consequence and not causative factors of CTTH. An updated pain model has suggested that CTTH can be explained by referred pain from trigger points (TrPs) in the cranio-cervical muscles, mediated through the spinal cord and the trigeminal nerve nucleus caudalis. Different therapeutic strategies (pharmacological and non-pharmacological) are generally used for the management of these patients. CTTH is generally treated with non-steroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, and physical therapy, although the therapeutic efficacy of these approaches is controversial.

Idiopathic Carotid and Coronary Vasospasm: A New Syndrome?
Author(s): Yoshimoto, H; Matsuo, S; Umemoto, T; Kawakami, N; Moriyama, T
Journal: J Neuroimaging 2009 Dec 31
[Medline ID - 20040009]

ABSTRACT We present the first case of cerebral infarction due to idiopathic reversible vasospasm of the extracranial internal carotid artery without headache or identifiable cause in a patient who subsequently suffered acute myocardial infarction due to vasospasm of the coronary artery. J Neuroimaging 2009;XX:1-4.

Headache: what do children and mothers expect from pediatricians?
Author(s): Raieli, V; Compagno, A; Pandolfi, E; La Vecchia, M; Puma, D; La Franca, G; Ragusa, D
Journal: Headache 2010 Aug 19; Vol. 50, Issue 2; Page(s) 290-300
[Medline ID - 20039963]

BACKGROUND: Headache is a frequent occurrence among children and adolescents, and one of the most common causes of medical consultation. While serious conditions presenting headache as the chief complaint are not common in the pediatric population, enormous sums are invested to perform very expensive and often unnecessary diagnostic investigations. Pediatricians should adopt a flexible and diversified diagnostic/therapeutic approach and, at the same time, should not forget to take into consideration the demands, expectations, and worries of children and their parents. OBJECTIVE: The aim of this study was to assess simultaneously children's and mothers' expectations from the pediatric consultation concerning headache, and pediatricians' opinions about said expectations. In addition, we attempted to investigate mothers', children's, and pediatricians' opinions about symptomatic and prophylactic treatment of headache. METHOD: A total of 100 young headache sufferers, 50 were male and 50 were female, from 10 to 16 years of age, were enrolled in this study. Two diversified, self-administered, ad hoc questionnaires about their expectations from the pediatric treatment of headache and about symptomatic and prophylactic treatment were delivered to each patient and their mother, to which they responded separately. A third self-administered questionnaire was delivered to a sample of 50 pediatricians. RESULTS: Our study showed that children and their mothers sometimes have different expectations about the consultation of the pediatrician and of the headache specialist. Frequency of pain was the main reason for pediatric consultation for 70% of mothers, whereas only 2% of them (as opposed to what pediatricians believed) consulted the pediatrician because they were worried about a tumor. Moreover, a high percentage of children and mothers expected from the pediatric consultation to be reassured that it is not a serious illness and to find out the causes of headache (60% and 47%, and 45% and 62%, respectively). A total of 26% of children wanted to know the progression of headache in the future, but only 3% of mothers shared the same demand. With regard to their expectations, pediatricians agree only in part with children and their mothers. On the contrary, the majority of children (68%), mothers (49%), and pediatricians (90%) agree that a symptomatic treatment was necessary in the presence of a severe pain. In addition, 61% of children, 37% of mothers, and 74% of pediatricians believed that a prophylactic treatment was necessary when the pain is severe and long-lasting. CONCLUSION: Pediatricians sometimes do not consider sufficiently children's and mothers' wishes and expectations and, consequently, could limit the outcome of their diagnostic-therapeutic approach. This is particularly important because, in the developmental age, an accurate r ecognition of patients' and parents' expectations represents an essential requirement for a favorable outcome of the consultation.

The primary headaches as a reflection of genetic darwinian adaptive behavioral responses.
Author(s): Montagna, P; Pierangeli, G; Cortelli, P
Journal: Headache 2010 Aug 19; Vol. 50, Issue 2; Page(s) 273-89
[Medline ID - 20039962]

OBJECTIVE: The objective of this study is to present a view of the primary headaches as genetically determined behavioral responses consistent with sickness behavior and defense reaction, respectively. BACKGROUND AND DESIGN: A review of the literature bearing on the behavioral, humoral, and functional imaging aspects of the primary headaches shows that migraine and cluster headache (CH) are pain conditions characterized by different behaviors during the attacks. Here it is postulated that the behavioral responses to migraine and CH are evolutionary conserved reactions consistent with sickness behavior and defense reaction. RESULTS: The sickness behavior observed during migraine attacks is a pan-mammalian adaptive response to internal and external stressors, characterized by withdrawal and motor quiescence, sympatho-inhibition and lethargy, in which visceral pain signals a homeostatic imbalance of the body and/or brain. In contrast, the defense reaction in CH consists of a fight-or-flight reaction, with motor restlessness and agitation, in which pain is exteroceptive in kind. CONCLUSION: These different behavioral responses are thus specific to different kinds of pain, distinguished by the behavioral significance of the pain (visceral pain in migraine vs exteroceptive pain in CH), and imply brain matrices involving different networks in the brainstem, hypothalamus, and forebrain regions that engender evolutionarily conserved adaptive genetic responses. Cytokines play an important role in their development. Predictions and limitations of the hypothesis are discussed together with implications for genetic studies on headaches.
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