Natural Remedies for Migraine Headaches

The Migraine And Headache Program

In this simple program you'll learn: 5 Body balancing techniques that free your diaphragm to do its actual job of pumping fresh air into your lungs. This will ensure that your body will have enough resources to do what needs to be done including healing your headaches. Simple breathing technique that boost your oxygen level. In a few minutes of practice, your blood may carry 20% more oxygen to your brain. This can immediately reduce even the worst headaches. Other breathing exercises that spread the oxygen delivered to the brain evenly. The parts of the brain that are often highly oxygen deprived will finally receive fresh oxygen on a plate. Simple head muscle exercises that remove tension from the muscles around the head such as the the jaw, the tongue, the throat, and the eyes. These exercises can quickly relieve tension from the head and eliminate headaches in just a few seconds. New revolutionary neck exercise that removes tension from the neck. Tension in the neck muscles does not only block blood flow to the brain, but will also not support the veins in pumping the blood which is their actual function. Some people experience blast of energy rushing up to their head after doing this exercise. More here...

The Migraine And Headache Program Overview

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Case of Chronic Headache

Christy, age 40, sustained head and back injury in an automobile accident, which was the beginning of her descent into chronic pain and disability. Orthopaedic, neurological, and radiological examinations were essentially negative. Yet, she developed a migraine-type headache along with chronic back pain, which in a relatively short-time rendered her a virtual invalid. The two children did not remain unaffected by their mother's predicament and their father's lack of patience and irritability he was just not the father they had known. The son was often subject to the father's inexplicable outbursts of temper over rather trivial matters. These outbursts were more common when the patient was confined to her bed for any length of time. The son became sad, and expressed a great sense of loss over the change in the family environment. He did not like being home very much, and he stopped inviting his friends home. The daughter was very close to her mother, and vigorously defended. She...

Ophthalmoplegic Migraine

A small number of migraine patients experience an ipsilat-eral oculomotor paresis in connection with an episode of migraine. Like the migraine attacks, this form of paresis appears during childhood as the initiating event in an episode that includes vomiting, photophobia, abdominal pain, irritability, and (less commonly) headache.

Headache from a Neuro Ophthalmic Point of View

Tension Headache Diagram

Headache is the most frequent cause for cooperative interaction between neurologists and ophthalmologists. Frequently, patients are seen first by their primary care physicians, and are then referred to ophthalmologists for further testing and management, chiefly to rule out ocular sources of pain. From there, they are commonly referred to neurologists, to be sure that something serious will not be missed. The diagnostic classification of headache is at first glance extraordinarily confusing or overwhelming, considering that the International Headache Society (IHS) has defined 176 different types of headache. This large number can be reduced to a more manageable level, since 90 of all primary headache syndromes are attributable to the two most common types, migraine and tension headache. The fact that there is no clearly defined system that allows for rapid classification of headache, especially cases of primary headache, underscores the importance of a carefully taken history and...

Approach To Headaches

Headache is one of the most common complaints of patients in the western world. It periodically afflicts 90 of adults, and almost 25 have recurrent severe headaches. As with many common symptoms, a broad range of conditions, from trivial to life-threatening, might be responsible. The majority of patients presenting with headache have tension-type, migraine, or cluster however, fewer than one in 20 have significant underlying pathology. Because headache symptoms usually are accompanied by a paucity of associated findings, including those on laboratory examination, the clinician must depend largely upon a thorough history with a general and focused neurologic examination as the initial workup. Careful inquiry and meticulous physical examination, keeping in mind the red Hags of headaches (Table 50-1), will serve the clinician well. Differentiating serious underlying causes of headache from more benign causes may be difficult. Table 50-2 lists some typical features of serious causes of...

Red Flags For Secondary Headache Disorders

Fundamental change or progression in headache pattern First severe and or worst headache New headache in individuals aged < 5 years or > 50 years New headache in patients with cancer, immunosuppression, pregnancy Headache associated with alteration in or loss of consciousness Headache triggered by exertion, sexual activity, or Valsalva maneuver She is very concerned about the headaches and is worried that they indicate a brain tumor. She has no meningeal signs and her neurologic examination is nonfocal. She has stiffness and achiness of the shoulder and hip girdles. Together these factors make the diagnosis of TA a strong possibility. TA usually has its onset in a woman age 50 years or older and involves inflammation of the medium- or large-size vessels. Her low-grade fever and generalized body aches may represent polymyalgia rheumatica, which is closely associated with TA. The diagnosis would be confirmed by an elevated ESR or temporal artery biopsy. Although TA is not a common...

Micronutrients Migraine

Effective in women who have migraines associated May reduce frequency and intensity of migraines5 May reduce frequency and intensity of migraines6 May reduce frequency and intensity of migraines6 Cumulative methacholine dose (total dose 64 units) Fig. 5.23 Magnesium prophylaxis against migraine headache. 43 adults with chronic migraines received either 600 mg day magnesium or placebo for 2 months. The severity and incidence of migraines was significantly reduced in the magnesium group vs. placebo. (Adapted from Taubert K. Forschrit Ther. 1994 112 328)

Approach To Migraine Headaches

Headaches are an extremely common complaint in primary care, urgent care, and emergency settings. The vast majority of adults have at least one headache each year, although most do not present for medical care. The role of the practitioner is to attempt to accurately diagnose the cause of the headache, rule out secondary causes of headaches (red flags) that may signify a serious underlying pathology, provide appropriate acute management, and assist with headache prevention when needed. The medical history in a patient with headaches should focus on several important areas. The quality and characteristics of the headache and its specific location and radiation should be identified. The presence of associated symptoms. especially neurologic symptoms that may suggest the presence of a focal neurologic lesion or increased intracranial pressure, must be documented. The age at which the patient first developed the headaches, the frequency and duration of the headaches, and the amount of...

Headache

Headache originating inside the skull may be due to traction on or distension of arteries arising from the circle of Willis, or to traction on the dura mater. Headache originating outside the skull may be due to local striated muscle spasm 14 an anatomical connection, only recently identified, between an extracranial muscle and the cervical dura mater may help to explain headache of cervical origin. Treatment by drugs is directed to relieving the muscle spasm, producing vasoconstriction or simply administering analgesics, beginning, of course, with the non-narcotics, e.g. paracetamol, ibuprofen.

Migraine

The acute migraine attack appears to begin in serotonergic (5-HT) and noradrenergic neurons in the brain. These monoamines affect the cerebral and extracerebral vasculature and also cause release of 14 As in tension headache or frontal headache from 'eyestrain'. further vasoactive substances such as histamine, prostaglandins and neuropeptides involved in pain, i.e. there is neurogenic inflammation that can be inhibited by specific antimigraine drugs (below). The migraine aura of visual or sensory disturbance probably originates in the occipital or sensory cortex the throbbing headache is due to dilatation of pain-sensitive arteries outside the brain, including scalp arteries. The acute migraine attack should be treated as early as possible with an oral dispersible (soluble) analgesic formulation so that it may be absorbed before there is vomiting and accompanying gastric stasis with slow and erratic drug absorption. Aspirin (600 mg) is effective and its antiplatelet action may add to...

Headaches

Mild headaches, which are self-resolving, can be part of the initial flulike syndrome, but 10 of patients may have severe, unrelenting headaches. The mechanism is unclear, but a migraine-like syndrome can also develop, which may require specific therapy, with agents such as mydrin or trazadone up to 150 mg po daily can help some patients with headache. Occasionally, control of headaches may require more analgesia than just Tylenol and NSAIDs, and codeine-based therapy, or even stronger analgesia, may be required.

Diet Migraine

Foods are often triggers for migraine. Potential food sensitivities should try to be identified elimination diets can pinpoint the offending foods (see pp.205).1 Reactive hypo-glycemia may also trigger migraines (see pp. 185).2 Substances that may trigger migraine blood vessels and stimulate migraine)

Chronic Health Effects Of Repeated Lowlevel Exposure

For chronic or repeated subclinical exposures to OP compounds, be they CW nerve agents or OP pesticides, the data in regards to long-term health effects are less consistent. In regards to the nerve agents, the report of Burchfiel et al.30 about the effects of repeated low doses of sarin to rhesus monkeys producing a long-term increase in relative power in the EEG beta frequency bands is the most-cited study in support for a long-term health effect. There are no human studies known to the authors of this review other than the National Academy of Sciences report on the volunteer program mentioned earlier, that directly address the possible adverse, long-term health effects of repeated subclinical exposures to nerve agents.10 Workers exposed to small amounts of nerve agents that produced mild, non-threatening medical signs of exposure, reported CNS effects such as headache, insomnia, excessive dreaming, restlessness, drowsiness,

Approach To Reading

The method of establishing the diagnosis was discussed in the previous section. One way of determining the most likely diagnosis is to develop standard approaches to common clinical problems. It is helpful to understand the most common causes of various presentations, such as the worst headache of the patient's life is worrisome for a subarachnoid hemorrhage (see the Clinical Pearls at end of each case). A 38-year-old woman is noted to have a 2-day history of a unilateral, throbbing headache with photophobia. What is the most likely diagnosis With no other information to go on, the student would note that this woman has a unilateral headache with photophobia. Using the most common cause information, the student would make an educated guess that the patient has a migraine headache. If instead the patient is noted to have the worst headache of her life, the student would use the Clinical Pearl The worst headache of the patient 's life is worrisome for a subarachnoid hemorrhage. The more...

Some Common Design Configurations

This is the most common clinical trial design for confirmatory therapeutic (Phase 3) trials. Subjects are randomised, to one of two or more treatment 'arms'. These treatments will include the investigational drug at one or more doses, and one or more control treatments such as placebo and or an active comparator. Parallel group designs are particularly useful in conditions that fluctuate over a short-term basis, e.g. migraine or irritable bowel syndrome, but are also used in chronic stable diseases such as Parkinson's disease and forms of cancer. The particular advantages of the parallel group design are simplicity, the ability to approximate more closely the likely conditions of use, and the avoidance of 'carry-over effects' (see below).

Epidemic outbreaks of fatiguelike illnesses

Not everyone agreed with McEvedy and Beard's conceptualisations and a more recent review of the outbreaks suggested that the aetiology of these outbreaks was more heterogeneous than previously reported. In this review Briggs and Levine (1994) suggested that although excessive fatigue, myalgia, headache and low grade fever were common to all epidemics, there were marked differences in the reporting of neuropsychological symptoms, lending support to the notion that multiple aetiological agents were responsible for the outbreaks. symptoms were tiredness, mood and sleep disturbances, headache, and joint or muscle pain. Men and women were affected equally and this fact, coupled with the absence of 'hysterical' type symptoms such as pseudo-paraesthesias or unexplained losses of sensation, argued against the mass hysteria hypothesis (Murdoch 1988). Using a case-control approach Poore and colleagues (1984) ruled out pollution and chemical contaminants as possible causes. They were also unable...

Pain from disease acute

Although most people have experienced some form of injury pain, probably fewer have experienced pain from disease, excepting perhaps headaches and toothaches. However, even the common cold or flu can be associated with some degree of pain, such as headaches or more generalised body aches involving muscles and joints. Sometimes the headache can be quite localised and intense. Headaches can occur with symptoms other than those of a cold however, as in migraine, where it is more associated with stress. Here the pain can be much more debilitating as it disturbs the ability to concentrate and think. It can seem to the sufferer to have a particular 'shape' or configuration inside the head which may reflect the route of blood vessels or other structures (see Schoenen et al. 1994 for a discussion).

Contraindications and Side Effects It

Is contraindicated in cases of hypersensitivity or idiosyncratic responses to the drug or where there are preexisting blood dyscrasias. The drug can cause a serious cumulative bone marrow suppression, notably thrombocytopenia and leukopenia (121,122), that can contribute to the development of overwhelming infectious disease. This requires reducing dosages. Irreversible renal failure as a consequence of hemolytic uremic syndrome is also possible (121). Occasionally adult respiratory distress syndrome has also been seen. When extravasation is seen during administration, cellulitis, ulceration, and sloughing of tissue may be the consequence (123,124). The drug is known to be tumorigenic in rodents. Its safety in pregnancy is unclear and teratogenicity is seen in rodent studies. Other side effects include fever, anorexia, nausea, vomiting, headache, blurred vision, confusion, drowsiness, syncope, fatigue, edema, thrombophlebitis, hematemesis, diarrhea, and pain. It is not clear that all...

Caveats and Qualifications

A second factor that appears to influence the response to injury and pain, if not sensitization, is genetic background. Mutations in specific genes have recently been linked to two pain disorders erythmalgia (162) and hemiplegic migraine (163). More subtle changes in specific genes have also been shown to influence the response to noxious stimulation and analgesics and the likelihood of developing a pain condition. These include single-nucleotide polymorphisms in genes encoding the m-opioid receptor (164), an isoform of cytochrome P450 (165), melanocortin receptor-1 (166), and a catalytic enzyme catechol-O-methyl transferase (COMT) (167). Specific haplotype blocks of COMT correlate with both pain tolerance and threshold ratings and increased likelihood of developing a pain syndrome (168).

Pain from disease chronic

Sometimes pain from an acute disease situation can fail to be cured and enter into a long-term or chronic state. This is usually defined as pain that continues for more than three months. Pain from bones, joints and the lower back in particular are common types under this heading. It can be associated with an injury as perhaps in some low back pain, or in some cases of low back pain there may be no obvious damage (CSAG 1994). There may be general wear and tear linked with disease as in arthritic or rheumatic conditions. There may be disease of the nervous system itself causing chronic pain, and some headaches can be chronic (Schoenen et al. 1994). Neurogenic pain is associated with damage or disease of the nervous system and this can lead to a very severe burning kind of pain which is very difficult to treat. Types include causalgia, various neuralgias, and even phantom pain, although this latter is still a great mystery (Melzack and Wall 1996).

Nonarteriosclerotic Diseases of Cerebral Arteries

The diagnosis of these diseases often presents difficulties early diagnosis, however, is important because appropriate therapy may halt or even reverse the disease process. The clinical presentation varies across a broad spectrum. The disease may begin acutely as a TIA or a full blown stroke, or it may progress gradually with headaches, multifocal neurologic signs, seizures, behavioral changes, psychosis, and cognitive decline often progressing to dementia. Several diseases also affect the systemic blood vessels and produce visceral and cutaneous changes. Segmental constriction (beading) of the arterial wall, as seen on angiogram, is characteristic for some for others, the definite diagnosis may require tissue biopsy. The cerebral pathology also ranges widely Some angiopathies have a predilection for the large, and some for the small vessels infarctions and hemorrhages may be solitary or multiple, small or large.

Inflammatory Vascular Diseases

Giant cells infiltrate the vessel walls, thickening the intima and the media thus, the lumen becomes significantly reduced, and the temporal arterial wall becomes tender and pulseless. The disease commonly affects individuals over 50 years of age. Headache in the temporal region and elevated sedimentation rate are diagnostic.

Saccular Berry Aneurysm

An unruptured aneurysm may remain clinically silent or may cause pulsating headaches, TIAs, and focal symptoms and signs through local pressure (see Fig. 4.32). In carotid territories, aneurysms produce visual deficit, visual field defect, and an isolated third nerve palsy. An aneurysm within the cavernous sinus presents with frontal and orbital headache, oculomotor and abducens palsies, Horner syndrome, and sensory deficit over the forehead and maxilla (V 1 and V 2 divisions). When it ruptures, it produces a carotid-cavernous (arte-riovenous) fistula with pulsating exophthalmos, bruit over the eye, hemorrhagic edema of the eyelid, and visual failure from retinal hemorrhage and occlusion of central retinal vein. In vertebrobasilar territories, aneu-rysms produce trigeminal, acoustic, or lower cranial nerve deficits and brainstem symptoms and signs.

Clinical Trials with RSR13 A total

Nearly one-third of patients with systemic cancer develop brain metastases, a complication that profoundly affects the patients' quality of life and survival. In early studies, untreated patients with brain metastases had a median survival time of about 1 month. Without more aggressive treatment, nearly all patients died as a direct result of the brain metastases (526). Even with contemporary treatment, specifically earlier diagnosis, radiation therapy, and systemic chemotherapy, approximately 30-50 of brain metastases patients die as a direct result of the brain metastases (527). Expanding intracranial tumor masses lead to intractable headaches, nausea and vomiting, serious cognitive dysfunction, and one or more focal neurological deficits, including hemiparesis, seizures, visual, speech, and gait disturbances (528). Acute, catastrophic neurological com

Starting and stopping use

If the patient is heavily tobacco-dependent and severe anxiety, irritability, headache, insomnia and weight gain (about 3 kg) and tension are concomitants of attempts to stop smoking, an anxiolytic sedative (or (3-adrenoceptor blocker) may be useful for a short time, but it is important to avoid substituting one drug-dependence for another.

Parental Chronic Pain and Its Impact on the Children

Three studies examined the effects on the children of the specific parental pain disorders of severe headaches (Mikail and von Bayer, 1990), temporomandibu-lar joint(TMJ) pain (Raphael et al., 1990), and chronic low back pain (Rickard, 1988). In their comparison of children of parents suffering from headaches with a control group, Mikail and von Bayer, concluded that the children of headache sufferers were more somatically focused, had more headaches, and showed greater maladjustment and lower social skills than the control group. A major problem It is probable that major mood disorders have a genetic basis, thus making the offspring susceptible. Beyond that, parental depression may create problems in child rearing. Parental bonding with young children may be loosened the well parent's attention may also be focused on the patient, further contributing to the child's feeling of isolation and rejection. These two factors have considerable power to create emotional disturbances in...

Xanthinecontaining Drinks

Occur in habitual coffee drinkers (5 or more cups day) 12-16 h after the last cup they include headache (lasting up to 6 days), irritability, jitteriness they may occur with transient changes in intake, e.g. high at work, lower at the weekend. Habitual tea and coffee drinkers are seldom willing to recognise that they have a mild drug dependence. Chronic overdose. Excessive prolonged consumption of caffeine causes anxiety, restlessness, tremors, insomnia headache, cardiac extrasystoles and confusion diarrhoea may occur with coffee and constipation with tea. The cause can easily be overlooked if specific enquiry into habits is not made including children regarding cola drinks. Of coffee drinkers, up to 25 who complain of anxiety may benefit from reduction of caffeine intake. An adult heavy user may be defined as one who takes more than 300 mg caffeine day, i.e. 4 cups of 150 ml of brewed coffee, each containing 80 20 mg caffeine per cup or 5 cups (60 20) of instant coffee. The...

Case Illustration Mrs Gardner

Gardner, in her forties, was a patient for years at a pain clinic with complaints of unremitting tension-type headache. Married, she had a son (John) and a daughter (Ann). Despite her pain, Mrs. Gardner worked full time and managed her family affairs with great efficiency. Her husband, a mild-mannered man, depended on his wife for the smooth running of the household, and was nominally involved in domestic affairs. The family was a well-functioning unit. Ann, who was 12 years old, was beginning to show some mild rebelliousness, which led to an occasional rift between mother and daughter. Otherwise they enjoyed a close relationship. family had significantly regained its equilibrium. As Mrs. Gardner's depression improved, so did her headaches. Shortly, thereafter, she was discharged from the pain clinic. Several points are worth noting. First, Mrs. Gardner's headaches by themselves had virtually no negative impact on the well-being of the family. Clinical depression, on the other...

Use in Prevention and Therapy

Moderate to severe iron deficiency produces clear signs of anemia. However, subclinical chronic iron deficiency (reduced iron stores), without signs of anemia, is much more subtle and common. It produces nonspecific symptoms of fatigue, lack of energy, headache, and difficulty concentrating. Supplemental iron together with vitamin C replenishes depleted iron stores and can eliminate these symptoms.

Pain as a Solution for Sexual Problems

In one case, the husband avoided sexual relations on the grounds that they might indeed worsen his wife's headache. This man had a rather cold, clinical attitude toward his wife's condition, and the marriage was clearly devoid of intimacy, at least on his part. His wife clearly sought a closer relationship. He remained adamant in his belief that sexual activity and headaches were mutually exclusive, and found Finally, the intriguing case of a young man who developed serious headaches soon after his marriage, which actively interfered with his sexual activities. He had a lifelong problem with intimacy and was somewhat overwhelmed by his newfound marital responsibilities. Pain for him served the purpose of buying time. Pain or, for that matter, any other symptom is used in complex and multiple ways in interpersonal relations. The meanings and functions of pain are not always evident, but in the cases presented here, the use of pain to avoid sexual relations, whether by the patient or...

Nucleoside Reverse Transcriptase Inhibitors

Adverse reactions early in treatment may include anorexia, nausea, vomiting, headache, dizziness, malaise and myalgia, but tolerance develops to these and usually the dose need not be altered. More serious Eire anaemia and neutropenia which develop more commonly when the dose is high, and with advanced disease. A toxic myopathy (not easily distinguishable from HIV-associated myopathy) may develop with long-term use. Rarely, a syndrome of hepatic necrosis with lactic acidosis may occur with zidovudine (and with other reverse transcriptase inhibitors).

Acute Aseptic Meningitis Encephalitis and Myelitis Clinical Features

Meningitis presents with fever, general malaise, headaches, photophobia, nuchal rigidity, nausea, vomiting, and muscle aches. Altered states of consciousness, focal neurologic deficits, and seizures are common in encephalitis. Flaccid mono- or paraparesis suggests myelitis. The CSF yields a mild to moderate pleocytosis, typically with lymphocytes however, during the initial stage, PNLs may also be present. Protein is moderately elevated and glucose is normal. Viral-specific DNA and RNA are identified in the CSF and blood using PCR assay and in-situ hybridization.

Disease Specific Data on Pain and Other Symptoms at End of Life

A retrospective chart review at a tertiary care hospital was conducted summarizing the end-of-life care of US patients more than 5 years old dying from cystic fibrosis (9). Of these patients, 25 had been receiving opioids for the treatment of chronic headache or chest pain for more than their last 3 months of life. When opioids were used for the treatment of breathlessness or chest pain, the proportion increased to 86 . When pain was present, it was described as serious pain, with chest, head, extremity, abdomen, and back the more common locations (10). Increasing pain for this patient population may signal advanced progressive disease (10).

The Meaning and Function of Pain in Marriage The Interactional Perspective

When a patient announces to his partner that he has a headache, what could he possibly mean Watzlawick and his colleagues (1967) made the following profound observation All behavior in an interactional situation has message value, that is, is communication. It follows that how one may try, one cannot not communicate. Activity or inactivity, words or silence all have message value. I have a headache, even at its simplest intention, has multiple meanings tiredness, menstrual period, unwillingness to undertake certain tasks, revenge, attention seeking, helplessness, and anger are some of the feelings and emotions that are conveyed. Madanes and Haley (1977) noted that when a woman is talking about her headaches to a therapist, she is talking about more than one kind of pain. That is, behavior is always a communication, on many levels. The message 'I have a headache' is a report on an internal state but it may also be a way of declining sexual relations or of getting the husband to help...

Helminthic infections

Diethylcarbamazine kills both microfilariae and adult worms. Fever, headache, anorexia, malaise, urticaria, vomiting and asthmatic attacks following the first dose are due to products of destruction of the parasite, and reactions are minimised by slow increase in dosage over the first 3 days. Levamisole paralyses the musculature of sensitive nematodes which, unable to maintain their anchorage, are expelled by normal peristalsis. It is well tolerated, but may cause abdominal pain, nausea, vomiting, headache and dizziness. Metriphonate is an organophosphorus anticholinesterase compound that was originally used as an insecticide. Adverse effects include abdominal pain, nausea, vomiting, diarrhoea, headache and vertigo. Praziquantel paralyses both adult worms and larvae. It is extensively metabolised. Praziquantel may cause nausea, headache, dizziness and drowsiness it cures with a single dose (or divided doses in one day). Pyrantel depolarises neuromuscular junctions of susceptible...

Oculomotor Pareses in Children

Acquired oculomotor pareses in childhood are mostly traumatic, the consequence of frequent migraine episodes, associated with tumors, or in the context of acute meningitis. Aneurysms as a cause of oculomotor paresis are a rarity in children. An acquired, nontraumatic paresis in a child requires an MRI study with contrast enhancement. If meningitis is suspected, a lumbar puncture is indicated. Depending on the child's age, evaluation to rule out or treat amblyopia in the affected eye is necessary

Incidence And Clinical Presentation

The presenting symptoms of patients with ET are variable. Many patients (12-67 ) reach medical attention fortuitously, as a result of an extreme degree of thrombocytosis detected when obtaining a routine blood cell count. Most patients present with symptoms related to small- or large-vessel thrombosis or minor bleeding. Neurologic complications are common, with headaches being the most common and paresthesias of the extremities second.1617 Transient neurologic symptoms seen in ET include unsteadiness, dysarthria, dysphoria, motor hemiparesis, scintillating scotomas, amaurosis fugaz, vertigo, dizziness, migrainelike symptoms, syncope, and seizures.

Progressive Rubella Panencephalitis

Mycotic infections may present acutely or may progress insidiously and slowly over weeks or months. Headaches, visual symptoms, nuchal rigidity, cranial nerve deficits, and low-grade fever are common presenting symptoms. Depending on the location of the pathologic lesions, focal symptoms and signs develop. Confusion, disorientation, psychiatric symptoms, and cognitive impairment evolve in chronic cases and may present diagnostic difficulties. A high suspicion for fungal infection and the use of appropriate tests secures the correct diagnosis.

Purulent Leptomeningitis

Purulent leptomeningitis occurs at all ages from birth through old age. The age-related preferences of common bacteria are listed in Table 6.2. The onset is sudden, with fever, headaches, photophobia, and nuchal rigidity. Severe cases are complicated by an altered state of consciousness, seizures, cranial nerve deficits, and focal neurologic symptoms and signs. The cerebrospinal fluid (CSF) shows elevated cell count, chiefly with polymorphonuclear leukocytes (PNLs), increased protein levels, and decreased glucose levels. The causative microorganisms are identified in the sediment of the CSF using Gram stain and by culturing the CSF and blood. Polymerase chain reaction (PCR) and immunologic techniques identify the bacteria within hours of onset.

It Is Just Not Good for

Wills, in his mid-fifties, had a very long history of migraine-type headaches. He was referred to a pain clinic when his pain worsened and the frequency increased. His marital history showed chronic discord over sexual relations. He acknowledged his great need and drive for sex, which was exactly the opposite of his wife's. Their sexual relations came to a sudden halt when on a couple of occasions, immediately following sexual intercourse, he had a major migraine attack. Mrs. Wills concluded that sex were injurious to his health and categorically refused to engage in any sexual relations. Her rationale was simple. Sex caused him more pain and it was in his interest to desist. She had no intention of contributing to his pain.

Other monoclonal antibodies

Tolerated except for mild fatigue, nausea, and headaches. Moreover, single-agent activity was approximately 15 .75 Based on preclinical data suggesting synergy, a phase I II study of the combination of galiximab and rituximab was conducted, and a response rate of 58.3 was reported.76 This combination has been evaluated as the initial therapy for patients with follicular lymphoma in a Cancer and Leukemia Group B phase II trial and results are pending.

What Happens to Communication

This little vignette captures a very common pattern of communication, or lack thereof, between a husband and wife who care deeply about each other. Both partners compromise their willingness to discuss their respective feelings lest they should hurt the other. The price for such collusion of silence can be high. Over time, the quality and quantity of communication deteriorate, with far-reaching consequences. Chronic pain impacts negatively on family communication for another complex reason. It is often the elusive and incomprehensible nature of chronic pain itself that militates against healthy family communication. Family members are often confused by the level of disability in the absence of any definite medical cause. They are confused and angered, but their emotions, by and large, remain unexpressed. Faulty communication under these circumstances is not hard to comprehend. A brief review of the research literature follows to highlight the extent of communication problems among...

Clinical Features

The multiplicity of MS plaques and their locations at various anatomic sites account for the great variability of clinical symptoms and signs (Table 8.2). Visual impairment, varying from diminished visual acuity to total blindness in one or both eyes, orbital pain, and frontal headaches are often the presenting symptoms. However, any cerebral or spinal cord dysfunction may introduce the disease.

Variants of Multiple Sclerosis

Neuromyelitis optica or Devic's disease. A 30-year-old woman presented with a history of headaches and rapidly progressing loss of vision in the left eye that began about 5 weeks following a difficult labor and a short febrile episode. Shortly after the onset of visual impairment, she developed paresthesias and weakness in all four extremities and urinary retention. After a short period of improvement, her condition deteriorated she became quadriplegic and experienced respiratory difficulties. Six months after the onset of symptoms, she died. A. Extensive demyelination in left optic nerve. B. Extensive demyelination in the swollen cervical and thoracic cord (Weil stain). C. Massive perivascular lymphocytic infiltration (HE). Neuromyelitis optica or Devic's disease. A 30-year-old woman presented with a history of headaches and rapidly progressing loss of vision in the left eye that began about 5 weeks following a difficult labor and a short febrile episode. Shortly after the onset of...

The Case of Mrs Allan How Can I Bother My Husband

This woman, in her late twenties, was referred to a pain clinic for persistent headaches, which had begun to interfere with her activities of daily living. Her pain was unresponsive to medical ministrations, and she was investigating alternative ways of controlling her pain. Her husband was a graduate student working on his doctoral dissertation. They had two preschool children. Investigation of her family and social situation revealed some startling facts. Three persons she had been close to had died within the past few months. She denied any feelings of grief and generally minimized these losses. She and her husband had not talked about these deaths. She did not wish to waste his time with her problems. He was in a critical stage with his research, and she felt he should be left alone. This led the therapist to a conversation about her pain and how she was coping. She said she was trying to carry on as normally as possible, but at times it was very hard to do so. She did not get...

The Case of Mrs Beals

Beals, in her early sixties, with a history of headache, furnishes a clear example of direct and clear communication on the wife's part and indirect and masked communication on the husband's part. Her husband had spent all his working career traveling the world, which left Mrs. Beals to take charge of all family affairs. She raised three children with very little help from her husband. The relationship was amicable until Mr. Beals retired. Then Mrs. Beals's headaches all of a sudden took a turn for the worse.

The Effects on Children

A 14-year-old boy, whose mother had persistent headache following an automobile accident, reported that his father was yelling at him for no reason. His mother could hear from her bed the angry outbursts of her husband, which she found to be very distressing. In therapy, the father acknowledged that he was taking his anger out on his son (a fine illustration of indirect and masked message) for his frustration with what had happened to his wife. He and his wife had a wonderful partnership, and now everything was put at risk because of an accident. His frustration and anger did not have any legitimate outlet and found inappropriate expression. He could not tell his wife about his disappointment and anger because he knew that she was just as upset or perhaps even more so. The boy complained that he had no one to talk to. His father was angry and he did not wish to upset his mother with his problems. His only recourse was to withdraw. His 10-year-old sister was spared his father's anger...

Adverse Effects of Proton Pump Inhibitors

Headache is one of the most frequently reported adverse events in clinical trials where PPIs have been examined (frequency 1.3-8.8 ). Patients with headache also had a significant incidence of diarrhea, nausea, and dizziness. A discontinuation of PPI therapy resulted in a cessation or reduction of the headache in 80.0 (20 of 25) (156).

Pretreatment Evaluation And Education

Fatigue and headache, depression and irritability, alopecia, nausea and vomiting, loss of appetite, insomnia, and the potential for disturbances in bone marrow and thyroid function. Ribavirin side effects, such as hemo-lysis and risk of teratogenicity, are discussed in detail. The patient is advised on the need for adequate contraception, and, if the patient is a female of childbearing potential, she is informed that monthly pregnancy tests will be performed while she is on therapy, and for 6 mo after stopping therapy. A detailed discussion of the authors' approach to these other side effects is found later in this chapter. therapy. In addition, use of other medication is discussed, particularly the use of Tylenol and nonsteroidal anti-inflammatory drugs (NSAIDs). Tylenol is preferred as the drug of choice for the flu-like symptoms associated with IFN, and for the headaches, but many patients are worried about the use of Tylenol and need to be informed that up to 3 g d has little...

Who Does What An Exploration of Family Roles

Another study investigated the association between physical symptoms including headaches (79 ), stomach discomfort (62 ), and back pain (61 ) and work and family roles in a group of 403 women, 25 to 55 years of age (Barnett et al., 1991). Work in itself was not a negative factor, but combined with a positive marriage or partnership, women were more likely to reap physical health benefits from the rewards of their altruism toward their fellow workers and from positive support from supervisors. However, worries at work contributed to complaints of high levels of physical symptoms. The authors stated, The significant interactions between women's family roles and particular work factors underscore the need to incorporate into our research paradigm the non-workplace lives of female as well as male workers (p. 99). They also reported absence of studies of male workers examining the effects of either partnership or parental status on the relationship between workplace factors and physical...

Clinical Presentation And Differential Diagnosis

The commonest causes of cerebral mass lesions in HIV-seropositive patients are toxoplasmosis and primary cerebral lymphoma and the differential diagnosis often proves difficult. Both diagnoses occur in patients with advanced immunodeficiency (CD4 cell counts < 50 X 106 L) and present with headaches and focal neurologic deficits. Clinical features that favor PCL include a more gradual onset over 2-8 weeks and the absence of a fever. CT and MRI scanning usually reveal solitary or multiple ring enhancing lesions with prominent mass effect and edema. Again, these features occur in both diagnoses, although PCL lesions are usually periventricular while toxoplasmosis more often affects the basal ganglia. Thus, the combination of clinical findings and standard radiologic investigations rarely provide a definitive diagnosis. Moreover, toxoplasma serology (IgG) is falsely negative in 10-15 of patients with cerebral toxoplasmosis. More than 85 patients with cerebral toxoplasmosis will respond...

Autonomic dysreflexia

Two to four months post-injury the person with cervical spinal cord injury may suddenly experience a flushing in the face and complain of severe headache. The blood pressure increases from 100 60 to 240 120 mmHg. When looking for triggering factors, the staff might find an obstruction of the urinary outlet. When urine passes again the blood pressure returns to normal. This reaction, the so-called autonomic dysreflexia reaction, is seen in cord-injured people with a lesion level above T6. The clinical reaction is not an all-or-none reaction but graded in mild cases the person just feels a small chill. Investigations have shown that the reaction is caused by a severe vasoconstriction below lesion level in skin, muscular (Karlsson et al., 1998) and renal vascular beds (Gao et al., 2002). Presumably also the splanchnic gastrointestinal vascular bed is involved. The reaction is mediated by the sympathetic nervous system as shown by a profound increase in noradrenalin spillover below lesion...

Pharmacokinetic Properties Some

Adverse reactions, which are mostly mild and reversible, include headache, dizziness, joint swelling, and leukopenia. Lomefloxacin, sparfloxacin, ofloxacin, and trovafloxacin alatrofloxacin cause photosensitization. Quinolones can affect the central nervous system by two mechanisms (1) accumulation of ingested xanthines, including caffeine and theophylline

Causes Of Hyponatremia

5.3 An 83-year-old woman comes to your office complaining of a headache and mild confusion. Her only medical history is remarkable only for hypertension, which is well controlled with hydrochlorothiazide. Her examination and laboratory tests show no signs of infection, but her serum sodium level is 119 mEq L, and plasma osmolarity is 245 mOsm kg. She appears to be clinically hypovolemic. What is the best initial therapy

Typical Signs and Symptoms of Brain Tumors

Typical signs and symptoms of a brain tumor include headache, neurological deficits, psychic changes (the patient and his her relatives are usually unaware of these changes or misjudge them as trivial, especially when they have developed gradually) epileptic attacks, and visual symptoms ( Table 12.3).

Maintenance and Management of the System

The next two cases differ significantly from the previous two in terms of family life-stage issues. The previous two cases represented the problems of families in their early forties with very young children in one family and a teenage daughter in the other. The next two cases represent a recently married young couple in which the wife suffered from severe migraine, and an older couple in their late sixties in which the husband had many chronic health problems including herpes zoster, which is a very painful condition.

Trials and Tribulations of Newlyweds

Erikson, in her late twenties, had suffered from migraine headaches since her teens. They had worsened over time, and at the time of her referral to a pain clinic she was not coping well. The headaches did not prevent her from obtaining an advanced degree in business management and rapidly achieving a senior position in a major financial institution. Her husband, like his wife, was an only child and grew up as the center of his parents' attention. He had led a charmed life. He had degree in engineering and also had a very responsible position. This highly educated couple had been married for seven months. They experienced problems with role performance that had much to do with their life stage, the newness of the marriage, the absence of rules, and the wife's migraine. Other factors contributed to making matters worse. First, Mrs. Erikson's headaches and their unpredictable nature contributed to many uncertainties in their lives, including her depending on Mr. Erikson for...

Clinical Presentation

Pituitary Gland Carotid Artery

The signs and symptoms depend on the speed at which the pathological process progresses. Abrupt expansion of the intrasellar contents, after infarction or hemorrhage into a pituitary adenoma, causes a rapid onset of combined, often bilateral cranial neuropathies, associated with severe headache and uni- or bilateral, often profound, loss of vision. With a subarachnoid hemorrhage, the patient's condition can rapidly deteriorate to the level of a coma. Neuroradio-logical imaging will show an enlarged sella with intrasellar bleeding and or necrosis.

Answers To Case 29 Bacterial Meningitis

Summary A 20-year-old college student presents with a 3-day history of fever, headache, myalgias, and nausea. He has no respiratory or gastrointestinal symptoms, hut now has developed photophobia. He is febrile to I02.3 F. tachycardic. and normotensive. His physical examination is generally unremarkable with a nonlocal neurologic examination but some neck stiffness, suggesting meningeal irritation. He has no skin lesions as might be seen in meningococcemia.

Central nervous system

Adverse effects include sedation and dry mouth. Tricyclic antidepressants antagonise the antihypertensive action and increase the rebound hypertension of abrupt withdrawal. Low dose clonidine (Dixarit, 50-100 microgram d) also has a minor role in migraine prophylaxis, menopausal flushing and choreas.

The prevalence of fatigue and somatic symptoms in the community

Other CFS symptoms are also common in the community, with 36 per cent of primary care patients reporting headache, 34 per cent insomnia, and 59 per centjoint or limb pain (Kroenke 1998). General population surveys also show that during any two-week period up to 30 per cent of people complain of muscle aches and pains, 38 per cent of headache, and 16 per cent of sleep disturbance (Dunnell and Cartwright 1972 Hannay 1978). While it may be logical to assume that these symptom reports are a result of biological processes, there is now substantial evidence to show that how individuals interpret bodily sensations and symptoms is strongly affected by psychological processes.

Interpreting symptoms

On a community-wide level, this process can be seen in a dramatic form in mass psychogenic illness. This is the shared occurrence of a group of similar symptoms in a cohesive social setting for which there is no plausible pathological explanation. In most cases individuals present with ambiguous symptoms, typically headache, cough, pain, rash, dizziness and nausea that develop in response to a threatening experience such as a strong odour or perceived toxin. There are some dramatic examples of mass psychogenic illness such as an epidemic that occurred in a group of over 1,000 naval recruits housed in common barracks (Struewing and Gray 1990). All developed at least one new symptom over a ten-hour period, and 375 were evacuated to hospital. There was a perception of an airborne toxin among recruits and medical personnel. Air sample testing and laboratory findings were unremarkable. Most recruits transported from the scene improved quickly without specific therapy. Similar dramatic...

N M OBrien and T P OConnor

Histamine toxicity can result in a wide variety of symptoms such as rash, urticaria, inflammation, nausea, vomiting, diarrhoea, abdominal cramping, hypotension, tingling sensations, flushing, palpitations and headache. In general, toxic symptoms are relatively mild and many patients may not attend a doctor. Thus, the exact prevalence worldwide of histamine toxicity is unclear. The prevalence of cheese-related toxicity is also unclear although several incidences have been reported in the literature. For most individuals, ingestion of even large concentrations of biogenic amines, such as histamine, does not elicit toxicity symptoms since they are rapidly converted to aldehydes by monoamine oxidase (MAO) and diamine oxidase (DAO) and then to carboxylic acids by oxidative deamination. These enzymes, present in the gastrointestinal tract, may prevent reduce the absorption of unmetabolised histamine into the bloodstream. However, if MAO and DAO are impaired due to a genetic defect or the...

Parental Chronic Pain and Illness and Its Effect on Children

A few studies that investigated specific pain disorders and their impact on children did report elevated health problems in children (Mikail and von Bayer, 1990 Rickard, 1988). Aaromaa (1998) reported that headache in family members, especially the mother, predicted headaches in the children. This investigation was designed to predict early life factors for headaches in young children rather than focusing on the impact of parental headache. Smith (1998) found that child care was compromised when a parent was in the throes of a migraine attack. These two studies show the impact of parental headache on young children. This vulnerability received further support in an investigation of 40 children with headache and a matched control group (Gulhati and Minty, 1998). The findings were complex, but showed that both parents in the headache group experienced more illnesses than those in the control group. Furthermore, greater loneliness was expressed by the mothers of the headache group. They...

Acute Disseminated Postinfectious and Postvaccination Encephalomyelitis

Bal Concentric Sclerosis Pathology

The onset is acute with headaches, fever, meningeal signs, focal neurologic deficits, and often seizures. The disease resolves within several weeks, and the course is monophasic. The outcome varies from full recovery through variable residual neurologic impairment to death, which occurs in about 20 to 30 of cases. Acute hemorrhagic leukoencephalitis. A 42-year-old man, with a 3-week history of muscle and stomach aches and cough, suddenly developed headaches, neck pain, fever, and left hemiparesis. Four days later, he became hemiplegic and comatose. Six days after the headaches began, he died. Grossly, the hemispheric white matter displayed multiple petechial hemorrhages. Histologic section shows fibrinoid necrosis of a small vessel, dense perivascular and diffuse parenchymal infiltrations with neutrophils and lymphocytes, and small hemorrhages (HE). Acute hemorrhagic leukoencephalitis. A 42-year-old man, with a 3-week history of muscle and stomach aches and cough, suddenly developed...

Licorice Glycyrrhizin

One trial (20), which evaluated a glycyrrhizin-based compound against other herbs, included 193 hepatitis C patients, followed prospectively for 2-16 yr for evidence of progression to cirrhosis or the development of hepatocellular carcinoma. Although glycyrrhizin appeared to slow the histological progression of the disease, both groups appeared to progress to carcinoma more frequently than in similar patients treated with IFN. Side effects attributed to glycyrrhizin included hypokalemia in 11 and hypertension (HT) in 3.6 . In a single randomized control study of iv glycyrrhizin vs placebo, among 58 IFN nonresponders or patients unlikely to respond (cirrhotic patients with genotype 1), the herb resulted in lower ALT, with no effect on HCV RNA levels (21). The adverse effects of glycyrrhizin in humans are well-characterized. Glycyrrhizin inhibits 11- -hydroxysteroid hydrogenase in the kidney, inhibiting the conversion of cortisol to cortisone. This results in a...

Affected Children The Gardner Family

Gardner's case was discussed in Chapter 3. To recap the essentials, this woman in her forties with a very long history of headaches also developed clinical depression. She was very slow to react to antidepressants. In the meantime, her entire family, consisting of husband and two children, John, aged 17, and Ann, aged 12, came apart at the seams. Ann became a great source of concern to both parents. John was old enough to fend for himself and there was no evidence that he had any particular difficulties. He maintained his closeness with his mother and tried to be as helpful as he could around the house. Even in the depth of her depression, Mrs. Gardner continued to show appreciation for John's fortitude and loyalty.

Approach To Suspected Meningitis

Acute bacterial meningitis can progress over hours to days. Typical symptoms include fever, neck stiffness, and headache. Patients may also complain of photophobia, nausea and vomiting, and more nonspecific constitutional symptoms. Approximately 75 of patients will experience some confusion or altered level of consciousness. Forty percent may experience seizures during the course of their illness. These include enteroviruses, which tend to be more common in the summer and fall, when patients may present with severe headache, accompanied by symptoms of gastroenteritis. The CSF w hite blood cell (WBC) count will be elevated, with a predominance of lymphocytes, and usually glucose and protein levels are normal (Table 29-1). Either herpes simplex virus (HSV)-l or HSV-2 can cause herpes simplex meningitis. The CSF of these patients will also have a normal glucose level, whereas protein and WBC counts will be elevated with a predominance of lymphocytes. Typically, these patients have a high...

Signs and Symptoms of Nonarteritic Anterior Ischemic Optic Neuropathy

The average age of patients with acute nonarteritic anterior ischemic optic neuropathy (NAION) is about 61 years. The visual loss occurs abruptly and without a prodromal warning, usually while the patient is asleep or within a 12-h period, and there is no associated pain or headache. The initial swelling of the optic disc subsides within 2 months, leaving a pale, atrophic appearance, which is often sectoral (most commonly located in the superior half of the disc). There is for the most part no or very little recovery of function. In about 10 to 20 of cases, there is one or more additional episodes of abrupt loss, in a descending staircase pattern, within the ensuing 2- to 3-week period after the acute onset. Later recurrences of loss in the same eye are very uncommon, but involvement of the contralateral eye can generally be expected within the subsequent 5-year period. As in other ischemic disorders, several risk factors play a role in the process. Aside from the association with...

Approach To Hypertensive Emergencies

Cerebral blood flow is a good example of vascular compensation by vasodilation or vasoconstriction in response to changes in arterial pressure (Figure 10-1). In normotensive adults, cerebral blood flow remains relatively constant over a range of mean arterial pressures between 60 and 120 mmHg because cerebral vasoconstriction limits excessive cerebral perfusion. As the mean arterial pressure increases beyond the normal range of cerebral autoregulation, there is cerebrovascular endothelial dysfunction and increased permeability of the blood-brain barrier, leading to vasogenic edema and the formation of microhemorrhages. Patients then manifest symptoms of hypertensive encephalopathy, such as lethargy, confusion, headaches, or vision changes. Typical imaging findings on MRI include posterior leukoencephalopathy, usually in the parietooccipital regions, which may or may not be seen on CT scanning. Without therapy, the condition can lead to seizures, coma, and death.

Carbonic anhydrase inhibitors

This condition may affect unacclimatised people at altitudes over 3000 metres especially after rapid ascent symptoms range from nausea, lassitude and headache to pulmonary and cerebral oedema. The initiating cause is hypoxia at high altitude, the normal hyperventi-latory response to falling oxygen tension is inhibited because alkalosis is also induced. Acetazolamide induces metabolic acidosis, increases respiratory drive, notably at night when apnoetic attacks may occur, and thus helps to maintain arterial oxygen tension 125-250 mg b.d. may be given orally on the day before the ascent and continued for 2 days after reaching the intended altitude, and 250 mg b.d. is used to treat established high-altitude sickness. (Note that this is an unlicenced indication in the UK). Dexamethasone may be used as an alternative or in addition, 2mg 6-hourly for prevention, and 4 mg 6-hourly for treatment.

Approach To Suspected Hepatitis Viral Hepatitis

Most cases of acute hepatitis are caused by infection with one of five viruses hepatitis A. B. C, D, or E. They can produce virtually indistinguishable clinical syndromes, although it is unusual to observe acute hepatitis C. Affected individuals often complain of a prodrome of nonspecific constitutional symptoms, including fever, nausea, fatigue, arthralgias, myalgias, headache, and sometimes pharyngitis and coryza. This is followed by the onset of visible jaundice caused by hyperbilirubinemia, with tenderness and enlargement of the liver, and dark urine caused by bilirubinuria. The clinical course, and prognosis then vary based on the type of virus causing the hepatitis.

Discriminative Stimuli

Operant behavior is said to be emitted in the sense that it often occurs without an observable stimulus preceding it. This is in contrast to reflexive responses, which are elicited by a preceding stimulus. Reflexes are tied to the physiology of an organism and, under appropriate conditions, always occur when the eliciting stimulus is presented. For example, Pavlov showed that dogs automatically salivated when food was placed in their mouths. Dogs do not learn the relationship between food and salivation this reflex is a characteristic of the species. Stimuli may also precede operant behavior. However, these events do not force the occurrence of the response that follows them. An event that precedes an operant and sets the occasion for behavior is called a discriminative stimulus, or SD (pronounced esse-dee). Discriminative stimuli change the probability that an operant will be emitted based on a history of differential reinforcement. Differential reinforcement involves reinforcing an...

Approach To Suspected Pneumonia

The atypical pneumonia is characterized as having a more insidious onset, with a dry cough, prominent extrapulmonary symptoms such as headache, myalgias, sore throat, and a chest radiograph that appears much worse than the auscultatory findings. This type of presentation usually is attributed to Mycoplasma pneumoniae. Although these characterizations are of some diagnostic value, it is very difficult to reliably distinguish between typical and atypical organisms based on clinical history and physical examination as the cause of a specific patient's pneumonia. Therefore, pneumonias typically classified according to the immune status of the host, the radiographic findings, and the setting in which the infection was acquired, in an attempt to identify the likely causative organism and to guide initial empiric therapy. Typical community-acquired pneumonia, as opposed to nosocomial or hospital-acquired pneumonia, is most commonly caused by S. pneumoniae, MoraxeUa catarrhalis, or...

Therapeutic Use of the Environment

The sixth and final reason is perhaps the hardest to define. Aspects of a specific environment afford opportunities for health care workers to use them for therapeutic ends. In this definition, a specific environment is not a therapeutic necessity but can be a therapeutic aid or tool. A good example could be the use of woodland or rivers for group tasks in team building during a recreational summer camp or the phrasing of a therapy task as homework in a school-based headache treatment. Realizing the therapeutic benefits of an environment is often dependent on the treatment philosophy, model of treatment, and the skills and experience of the therapists.

Electrolyte Composition

In clinical practice the use of hyponatraemic dialysis fluid (sodium concentration 130-135 mmol l) has declined and should be avoided as secondary to the loss of sodium by diffusion, there is a decrease in plasma osmolar-ity resulting in cellular over-hydration which contributes to disequilibrium syndrome (fatigue, 'washed-out' feeling, muscle cramps, headache, neurological symptoms), and intradialytic hypotension. For the majority of patients a hypernatraemic dialysis fluid (sodium concentration 140145 mmol l) is used to avoid excessive sodium losses arising from ultrafiltration and to prevent cardiovascular in Normal plasma concentrations of magnesium are between 0.8 and 1.2 mmol l. In dialysis patients levels may be normal increased or even decreased. Low plasma levels have recently been identified as a possible risk factor for haemodialysis headache 17 . Commercially manufactured concentrates contain magnesium concentrations ranging from 0.25 to 0.75 mmol l. Magnesium-free...

Early Experiences in the 19 th Century

J.Russell Reynolds (physician to Queen Victoria) noted, In almost all painful maladies I have found Indian Hemp by far the most useful of drugs. Dr. Reynolds cites neuralgia, facial pain and neuritis as being particularly responsive to cannabis. He also wrote Migraine Very many victims of this malady have for years kept their suffering in abeyance by taking hemp at the moment of threatening, or onset of the attack.

Signs and Symptoms of the Arteritic Form of AION j Note

Giant Cell Arteritis

The average age at the onset of anterior ischemic optic neuropathy in patients with temporal arteritis (AAION) is about 75 years. Arteritis can also present with branch retinal vessel occlusions, choroidal infarctions, or retinal ischemia, as indicated by the presence of numerous cottonwool spots. Ischemic pareses of the extraocular muscles may be present, and ischemia of the scalp, sufficient to cause patchy areas of hair loss, have been known to appear. Even myocardial infarctions, hemispheric strokes, and cranial nerve palsies can be caused by severe forms of arteritic disease. Temporal arteritis (also called giant cell arteritis, cranial arteritis, or Horton's cephalgia a now-obsolete term ) has the following typical signs and symptoms headache, jaw claudication, scalp pain when combing or brushing the hair, malaise, fatigue, low-grade fever, anorexia, migratory myalgias, weight loss, and thickened, cord-like enlargements of the superficial, subcutaneous arteries of the scalp (...

Chemistry for Chemical Genomics

Organic chemistry is the science of the synthesis and properties of molecules that are constructed from only a few atom types, such as carbon, hydrogen, nitrogen, oxygen, and sulfur, with carbon atoms constituting the majority of the core of these chemicals. As these atoms are also the building blocks of naturally occurring peptides or oligonucleotides, this chemistry was termed organic, as opposed to other disciplines of chemistry. Such chemicals, commonly referred to as small molecules, are valuable as medicines to treat diseases ranging from headache to cancer.

Disorders Of Adrenal Medullary Hormones

Pheochromocytomas are tumors that produce excess catecholamines. The majority of pheochromocytomas arise from the adrenal medulla. The classic symptoms of pheochomocytomas are those attributable to excess hormone production, which include recurring episodes of sweating, headache, and a feeling of heightened anxiety. Although the disease is rare, any patient with hypertension that is difficult to control should be assessed for pheochromocytoma. The peak incidence for the disorder is in the third to fifth decades of life.

Meningeal Involvement

Meningeal myelomatosis occurs rarely. Limited reports have recently been reviewed.60 Patients may experience headache, mentation changes, multiple cranial nerve palsies, and speech and gait disturbances.61 IgD and IgA myelomas appear to be overrepresented in these cases. Advanced stage with high tumor-labeling index, and, in particular, plasma cell leukemia (19 ) are common causes of central nervous system (CNS) disease. Specific laboratory findings include the presence of myeloma cells62 and paraprotein in the cerebrospinal fluid (CSF).63

Hyperviscosity Syndrome

The circulatory disturbances resulting from hyper-viscosity lead to various clinical manifestations. Headache, blurred vision, reduced visual acuity, and drowsiness are common. Occasionally, patients may present with dementia or psychosis.104 Progressive, severe CNS dysfunction results in obtundation, vertigo, seizure, gait ataxia, and coma. Dyspnea may precede overt congestive heart failure. Bleeding occurs most commonly as epistaxis, ecchymosis, and sometimes GI

Subarachnoid Hemorrhage

Basal Subarachnoid Hemorrhage

Prodromal symptoms with localized, often pulsating headaches and third nerve palsy may precede the aneurysmal rupture. The highly characteristic presentation of SAH is abrupt, with severe, often excruciating headaches and meningeal signs. Altered mentation, extraocular muscle palsy, subhyaloid hemorrhage, and

Medulloblastoma Grade

Medulloblastoma manifests with truncal ataxia and broad-based gait. Being fast-growing in the posterior fossa, it produces increased ICP, with headache, vomiting, and papilledema early in its clinical course. The tumor is inhomogeneously hyperintense on T2-weighted images and enhances with gadolinium on Tl-weighted images. Postoperative survival averages 5 years.

Optic Atrophy after Papilledema Definition

The pathogenic mechanism is not well understood, but ischemia is thought to play an important role. The time needed to develop this complication is variable and is not predictable in individual cases. The transient obscurations of vision often associated with papilledema seem to be unrelated to the risk of atrophy. The visual impairment can begin acutely or subacutely, often with arcuate visual field defects that are very similar to those in patients with chronic open-angle glaucoma, and as is the case with glaucoma, the central-most portions of the visual field are initially spared. The process, once begun, can seem impossible to stop, resulting in total optic atrophy and blindness. Patients with chronic papilledema need to be monitored by an experienced ophthalmologist. Papillede-ma that threatens in this manner (i.e., moderate to marked levels of papilledema that last longer than a few weeks) must be brought under control, either by shunting procedures or...

Physical Health Consequences

Gastrointestinal problems in battered women are not uncommon. In fact, studies suggest that battered women have significantly more self-reported gastrointestinal symptoms than the average woman. Drossman (1994) tested the relationship of physical or sexual abuse history with the health status of female gastroenterology outpatients at a university medical center. Such a history was reported in 44 of the sample. After controlling for medical diagnosis and demographic variables, Drossman found that patients with an abuse history reported significantly more severe abdominal pain, a higher frequency of pelvic pain, more symptoms of headache and fatigue, and more lifetime surgeries than those not abused. J. Campbell (2002), in her review of the health consequences of partner violence, noted that the victims suffer from a host of health problems ranging from headaches and back pain to dizziness and fainting. Neurological problems can result from blows to the head. Cardiac symptoms such as...

Hydroxyurea hydroxycarbamide in sickle cell anaemia

Anagrelide is an oral agent which inhibits platelet aggregation but at lower doses it lowers platelet counts in man due to a marked effect on megakaryocyte maturation. It is nonmutagenic and effectively controls thrombocytosis in PRV and essential thrombocythaemia (ET). Adverse effects are cardiovascular headache, forceful heartbeats, fluid retention and arrhythmias.

Mitochondrial Encephalomyopathy with Lactic Acidosis and Strokelike Episodes

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) of children and young adults is defined by retinitis pigmentosa, recurrent attacks of focal neurologic deficits, seizures, migrainous headaches, progressive external ophthalmoplegia, intellectual deterioration, and myopathy. The disease is maternally inherited and is associated with point mutations in transfer RNA (tRNA) genes.

Tumors of the Adenohypophysis

Adenomas arising in the anterior lobe of the pituitary gland constitute 10 to 15 of all intracranial tumors. Approximately two-thirds of pituitary adenomas secrete hormones, and the remaining one-third are hormonally inactive (null-cell adenomas). The tumors grow slowly, occur chiefly in adults between 30 and 60 years of age, and are more common in women than men. Endocrine symptoms due to hormonal overproduction stand in the foreground of the clinical picture and provide the basis for classification. The endocrine activities of the various adenomas and their corresponding clinical manifestations are listed in Table 11.7. Additional characteristic symptoms and signs result from compression or invasion of the adjacent structures and include headaches, bitemporal hemianopsia, hypothalamic dysfunction, cavernous sinus syndrome, hydrocephalus, and pituitary hypofunction. Enzyme assays and MRI make possible the early diagnosis of these tumors before they reach a size large enough to erode...

Spontaneous Intracerebral Hematoma

Hematoma Intracerebral

Hypertensive intracerebral hemorrhage accounts for about 10 to 12 of all strokes. The onset is abrupt. Generalized symptoms include headaches, vomiting, confusion, depressed consciousness ranging from stupor to coma and, in some patients, seizures. Focal symptoms indicate the site of the hemorrhage. Expansion of the hemorrhage and edema may continue, causing deterioration for about 24 hours. Early mortality remains high, at 30 to 40 .

Clinical Approach

Transient ischemic attacks, often called mini-strokes, refer to the sudden onset of a focal neurologic deficit, with spontaneous resolution within 24 hours (usually within the first hour). Not all transient focal neurologic events actually represent ischemia, however. The differential diagnosis includes classic migraine, postictal paralysis, seizures, cerebral hemorrhage, or even slow-evolving intracranial processes such as subdural hematoma, abscess, or tumors, which can suddenly produce symptoms because of edema or hemorrhage or result in seizure activity. However, clinical evaluation and imaging studies of the brain should be sufficient to exclude most or all of these diagnoses.

H2 receptor antagonists

Adverse effects and interactions are few in short-term use. Minor complaints include headache, dizziness, constipation, diarrhoea, tiredness and muscular pain. Bradycardia and cardiac conduction defects may also occur. Cimetidine is a weak antiandrogen, and may cause gynaecomastia and sexual dysfunction in males. In the elderly particularly, it may cause CNS disturbances including lethargy, confusion and hallucinations. Cimetidine inhibits cytochromes P450, in particular CYP 1A2 and CYP 3A4 and there is potential for The drugs are well tolerated but headache, dizziness, reversible confusion, constipation and diarrhoea may occur. In addition, urticaria, sweating and somnolence are reported with nizatidine. The drugs do not inhibit hepatic microsomal enzymes and do not block androgen receptors.

Proton pump inhibitors PPIs

Adverse effects include nausea, headache, diarrhoea, constipation and rash but are uncommon. Omeprazole inhibits the 2C family of the cytochrome P450 system, decreasing the metabolism of warfarin, diazepam, carbamazepine and phenytoin, and enhancing the action of these drugs (but inhibition is less than with cimetidine).

Endocrine Abnormalities and Cytokines

Weight Loss Cytokine

The clinical symptoms of anorexia, nausea, fever, asthenia, fatigue, lethargy, myalgia, sickness, diarrhoea, anaemia, leucocytopaenia, tachycardia, headache, neurovegetative disturbances, etc., can be attributed to the release of cytokines by macrophages and activated inflammatory cells.

Macroscopic And Microscopic Features Of Neoplasms

The anatomic site of a tumor will also determine its effect on vital functions. A lymphoma growing in the mediastinum may press on major blood vessels to produce the superior vena caval syndrome, manifested by edema of the neck and face, distention of veins of the neck, chest, and upper extremities, headache, dizziness, and fainting spells. Even a small tumor growing in the brain can produce such dramatic central nervous system effects as localized weakness, sensory loss, aphasia, or epileptic-like seizures. A lung tumor growing close to a major bronchus will produce airway obstruction earlier than one growing in the periphery of the lung. A colon carcinoma may invade surrounding muscle layers of the colon and constrict the lumen, causing intestinal obstruction. One of the frequent symptoms of prostatic cancer is inability to urinate normally.

Some Day I Am Going to Leave This

Rose, age 35, had a long-standing history of mixed headaches. She was referred to our pain clinic by her neurologist, who, in his letter of referral, stated that Rose had failed to respond to all his efforts and suggested that perhaps the clinic would consider a more psychological approach to treating her headache problems. Rose, a slender, plainly dressed woman, who seemed very nervous about the visit, knew the reason for her referral to the pain clinic, and was dismayed by the fact that her headaches, if anything, were worse. She was a health-care professional herself and acknowledged that the neurologist could do no more. She spoke very slowly and softly, at times becoming inaudible. She was asked how she felt about her visit to the clinic. After a prolonged pause, which, as the therapist was to realize later, would be a permanent feature of these sessions, she replied that she did not know, an answer she was to give with disconcerting frequency. She had been married for several...

Colloid Cyst of the Third Ventricle

A 35-year-old woman who suffered from severe headaches died suddenly. Transverse section at the thalamus level shows a cherry-sized colloid cyst blocking the foramen Monro. The lateral ventricles are moderately dilated. Separation of corpus callosum is artifactual. Colloid cyst of the third ventricle. A 35-year-old woman who suffered from severe headaches died suddenly. Transverse section at the thalamus level shows a cherry-sized colloid cyst blocking the foramen Monro. The lateral ventricles are moderately dilated. Separation of corpus callosum is artifactual. gradually leads to hydrocephalus. Clinically, the colloid cyst presents with headaches, often precipitated and aggravated by head movements. Due to obstruction of the foramen Mono and a sudden rise of ICP, death may occur suddenly. Histologically, the cyst wall contains cuboidal and columnar epithelial cells and mucin-producing cells.

Primary Central Nervous System Lymphomas

PCNSLs can occur at any age from childhood on. The peak incidence is in the fifth and sixth decades in immunocompetent patients, and in the third and fourth decades in immunosuppressed patients. The clinical history is short, only a few weeks or months. General manifestations are headaches, neuropsychiatric symptoms, cognitive decline, altered mentation, and seizures. Focal neurologic signs indicate the location of the tumor. A cytologic study of the CSF using immunohistochemi-cal markers and neuroimaging are the appropriate diagnostic tests.

Comprehension Questions

34.1 A 28-year-old male presents for evaluation of headaches. He has had several episodes of unilateral throbbing headaches that last 8-12 hours. When they occur, he gets nauseated and just wants to go to bed. Usually they are relieved after he lies down in a dark, quiet room for the remainder of the day. He is missing significant amounts of work because of the headaches. He has a normal examination today. Which of the following statements is true regarding this situation A. He needs a CT scan of his head to evaluate for the cause of his headache. B. When he gets his next headache, he should breathe in 100 oxygen and use a triptan medication. 3-4.2J A 52-year-old woman presents to the office for an acute visit complaining of 2 hours of headache. She says that it came on suddenly and is the worst headache she has ever had. Her blood pressure is elevated at 145 95 mm Hg. but otherwise she has no focal neurologic abnormalities on examination. Which of the following is the most...

Outcomes In Subpopulations In Registries

Participants in both the DVA Persian Gulf Health Registry and the CCEP registry represent a broad cross-section of service members who deployed to the Gulf, although the demographics of participants as a group differ from the deployed population in some respects as discussed above. At the time the comprehensive reports were published, 18,075 individuals had participated in CCEP, and 52,216 individuals had been evaluated through the PGHR.56-60 The Presidential Advisory Committee (PAC) combined the data from both sources in their evaluation of the findings of the registries.59 As stated, not all registry participants are ill 10 of CCEP participants are asymptomatic, while 12 of PGHR participants report no symptoms. Symptomatic participants in both registries reported a broad range of symptoms spanning a variety of organ systems. The most common symptoms reported in CCEP participants were joint pain, fatigue, headache, and skin rash. Most commonly reported symptoms for the PGHR were...

Side Effects Of Cannabis And Nabilone

Clinical trials with nabilone showed that nearly all patients experienced at least one side effect. The most common being drowsiness followed by dizziness, euphoria, dry mouth, ataxia, visual disturbances, concentration difficulties, sleep disturbance, dysphoria, hypotension, headache and nausea (in decreasing order of incidence). Other reported side effects include confusion, disorientation, hallucinations, psychosis, depression, decreased co-ordination, tremors, tachycardia, decreased appetite and abdominal pain. Tolerance to drowsiness and euphoria develops rapidly without any noticeable drop in analgesic capability.

Stop Headache Drug Free

Stop Headache Drug Free

If you are suffering from headaches, you can make the pain stop just by following some basic but little known principles. Take 15 minutes browsing through this guide and you'll find dozens of tips to gain control in the battle against headache pain.

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