摘要:

SYNOPSISThe relationship between the incidence of post‐traumatic headache and the severity of head injury has been a controversial issue. The milder the head injury, the more frequently severe headache is noted as a symptom. To investigate this relationship, 121 civilians were investigated using simplified classifications of the grade of headache, type of injury (mild or severe), cervical X‐ray and head CT findings, and clinical history. All the subjects were claiming compensation for work‐related injuries.In the mildly injured group, 46/64 patients complained of severe headache, while only 19/57 had severe headache in the severely injured group (p<0.001). Abnormal findings on the cervical X‐ray films including degenerative changes were more frequent in the severe headache group (p<0.02). CT abnormalities correlated positively with the severity of head injury (p<0.001), but showed an inverse relationship with the incidence of headache (p<0.01). Mentally impaired patients also complained of headache less frequently (p<0.01). On the basis of these results, possible organic mechanisms related to the pathogenesis of post‐traumatic headache are

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209427.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISWe investigated the utility of the newly revised version of the Minnesota Multiphasic Personality Inventory, the MMPI‐2, for assessing psychopathology in three diagnostic headache groups, Post Traumatic, Status Migrainosus, and Status Migrainosus with Analgesic Rebound. We also investigated whether distinct clusters of headache sufferers could be identified using the MMPI‐2 clinical scales, and whether these clusters coincide with headache diagnosis. Eighty‐one patients in treatment at the Houston Headache Clinic were diagnosed and administered the MMPI‐2. Significant levels of psychopathology were found in all three diagnostic groups. Furthermore, Cluster Analysis identified three clusters of patients with equal proportions of patients from the three diagnostic groups. Cluster I patients were abnormally high on many MMPI‐2 clinical scales; Cluster 2 patients showed more moderate elevations, and Cluster 3 patients had essentially normal profiles. We concluded that the MMPI‐2 offers additional information not available through medical diagnosis alone. Thus, it is crucial to include psychological assessment in any comprehensive evaluation of chronic headache patients. Further implications for treatment planning and effectiveness ar

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209432.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISSix patients with episodic cluster headache were investigated as to blood pressure, heart rate, cerebrospinal fluid pressure (Pcsf) and frontal vein pressure (Pvf) during five nitroglycerin (NG) provoked attacks and one spontaneous attack. In a seventh studied patient the NG failed to provoke an attack. The earlier reported decrease of systolic blood pressure and increase of diastolic blood pressure and heart rate after NG administration were also found in these patients. The “dynamite headache” was related to the start and duration of an increase of the cerebrospinal fluid pressure. There was no relationship between the start or the maximum pain of the cluster headache attack and changes in Pcsf or Pvf. On breathing oxygen during a cluster headache attack, there was a decrease of Pcsf but in some patients a temporary increase of Pvf was observed, which possibly indicates that oxygen simultaneously attains constriction of arteries and ve

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209436_a.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISWe retrospectively studied the long‐term (2‐year) outcome of 50 consecutive patients admitted to our inpatient headache program because of chronic daily headache (CDH) associated with the overuse of analgesics, ergotamine, or both. They had been detoxified, given repetitive intravenous dihydroergotamine (IVDHE) and prophylactic medications as part of the program, and had become headache‐free on this regimen. At the time of admission, 37 of the 50 patients had transformed migraine (TM), 12 had new daily persistent headache (NDPH), and 1 had chronic tension‐type headache; 29 of the patients with TM, 7 of those with NDPH, and the single patient with chronic tension‐type headache had coexistent migraine. Substances abused, alone or in combination, included: caffeine in 39 patients (av. 441 mg/d), acetaminophen in 32 (av. 2187 mg/d), aspirin in 24 (av. 1807 mg/d), ibuprofen in 9 (av. 1156 mg/d), narcotics in 7 (av. 10.1 mg morphine equivalents/d) and ergotamine in 11 (av. 2.3 mg/d). Twenty patients were using preventive medication at the time of admission. Follow‐up evaluations were performed at 3, 6, 12, and 24 months after discharge. Forty‐three patients were analyzed at 3 months. Of these, 44% had an excellent or good result and 28% a fair result; 3 were overusing analgesics. At 24 months, 39 patients were analyzed: 59% had a good or excellent result and 28% a fair result; 5 were overusing analgesics, 4 of whom were doing poorly.We conclude that most patients (87%) detoxified from analgesic/ergotamine overuse as part of an inpatient treatment program using repetitive IV DHE continue to do well over the long term, as demonstrated by the findings obtained during 2 years

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209439.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISTranscranial Doppler sonography examination was performed on 44 patients with migraine with aura and 88 controls. All patients were investigated in headache‐free periods and 10 of them also during a migraine attack. During the headache‐free period a not significant increase of mean flow velocity in patients compared to controls was obtained. The pulsatility index (PI) mean values were also higher in patients than in controls and the differences were significant in the MCA (p<0.05). No difference between right and left side was observed. During the attack the mean flow velocity (MFV) decreased in all arteries but the decrease was significant only in MCA and ACA (p<0.05). The mean PI increased in all arteries but not significantly. These variations were observed both on the headache and contralateral side. Nevertheless, the MFV decrease in all arteries was observed in four patients only. In four patients the MFV decrease was found in the anterior arteries and the MFV increase in the posterior arteries, while in two patients the MFV increase was observed both in the anterior and posterior arteries. The correlation between the variations of MFV values during the attacks and the time interval from the onset of attacks showed that the PCA and BA flow velocities were increased in patients examined between 0.5 and 3 hours, while an increase in MCA and ACA flow velocities were observed only in patients examined after 1.5 ho

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209446.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISSixty‐one separate self‐injections of ketorolac tromethamine (ToradolÒ) by 16 patients diagnosed with episodic migraine with or without aura were evaluated over a 90‐day period for safety, efficacy of painreduction, and the ability of this therapy program to prevent the necessitation of emergency room acute care. Prior to initiation of treatment, patients were formally instructed on intramuscular injection techniques by a member of our nursing staff. Patients were instructed to call upon the onset of a severeheadache interfering with daily functioning and, then, were permitted to proceed with the injection. Headache intensity ratings were collected prior to injection and intermittently for the following twenty‐four hours. The results demonstrate safety and efficacy of this form of therapy. A significant percent of ketorolac usages (64%) resulted in a good response and significant reduction in head pain. Twenty‐three percent of ketorolac usages resulted in a mild response and only 13% of usages provided no relief. Furthermore, 13% of all usages failed to prevent the necessitation for emergency room treatment. The results are discussed in terms of the impact of self‐injection on pain relief and substantial cost‐reduction by decreasing emergency ro

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209452.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISThe efficacy of the repetitive intravenous dihydroergotamine (DHE) inpatient protocol for refractory headache is wellestablished. We conducted a retrospective and prospective study of long‐term headache patients at our clinic toevaluate this regimen in an outpatient setting.Treatment consisted of oral metoclopramide and four doses of DHE, with the total dose equaling 4 mg.,administered over two days. Patients were followed for up to 10 weeks while they continued to receive prophylacticmedication. Responsiveness was rated in terms of decreased frequency or severity of headache: excellent (75% to100%), moderate (50–75%), mild (25–50%), and none (0–25%).In the retrospective study, 69% (43/62) of patients with chronic daily muscle‐contraction‐type headache and severemigraine had an excellent response at two days. An excellent or moderate response was sustained over three weeks in65% (32/49) of the study group (13 patients were dropped from the study for failing to comply with record keepingrequirements). At the 6‐ and 10‐week follow‐up evaluations, the majority of patients (76% and 70%, respectively)reported mild or no relief.Among patients with refractory daily headache or frequent severe migraine studied prospectively, 80% (28/35)reported an excellent response at two days. After six weeks, 66% (23/35) showed excellent or moderate relief. For bothgroups combined, 73% (71/97) of patients showed an excellent response to DHE at two days, with 43% (33/77)sustaining excellent or moderate relief at six weeks. Side effects, including nausea, leg cramps, facial flushing,increased blood pressure, diarrhea, burning at the injection site, and tightness in the throat and/ or chest, were generallymild and transient. Side effects were milder with outpatient DHE versus our experience with inpatient DHE.Outpatient repetitive IV DHE treatment offers flexibility in the management of severe headache. Our studiesdemonstrate the safety and efficac

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209455.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISA case is presented which has features of Cervicogenic Headache and of Hemicrania Continua. A sudden maneuver of the neck and later a greater occipital nerve block, both resulted in relief of the pain. A cervical cause is suggested.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209459.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISWe evaluated the effect of flunarizine (Fz) (10 mg/d) on migraine in e double‐blind placebo‐controlled design. The attacks' frequency, duration, severity and associated symptoms were compared before and after treatment. Forty‐two patients completed a three‐month trial period; 21 patients received Fz and 21 placebo, Statistical analysis showed no significant difference between Fz and placebo (p>0.051. In this study Fz was not more efficient than placebo in m

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209461.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISTwo cases are reported of patients who were diagnosed as having both migraine and Raynaud's disease. Because they were able to achieve effective control of both headaches and extremity temperature after undergoing a comprehensive approach‐utilizing medication, biofeedback, and psychotherapy‐it is suggested that both conditions are manifestations of the same disorder. It is recommended that a first step in approaching concurrent diagnoses of this type involve combined treatment as is often used in response to the singular diagnosis of migra

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3209463_b.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY