Headache
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Chronic headache fluctuates in response to changes in hormonal levels. Headache generally improves with rising estrogen levels, and worsens with falling levels. Headache should, therefore, predictably improve with pregnancy and worsen postpartum. ⋯ Headache improved significantly for 41% of the women, with a slightly greater tendency for headache to improve in women with migraine compared to those with tension-type or combined migraine and tension-type headaches. Headache activity was not influenced by history of menstrual migraine, history of headache change with prior pregnancies, parity, or breast-feeding. In general, women reporting headache at the end of their first trimester continued to report headache throughout pregnancy and postpartum.
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Randomized Controlled Trial Clinical Trial
Intranasal lidocaine for migraine: a randomized trial and open-label follow-up.
To study the efficacy of intranasal lidocaine for the treatment of migraine when administered by subjects in a nonclinic setting. ⋯ Intranasal lidocaine 4% provides rapid relief of migraine symptoms. For those subjects who do respond, the effect does not diminish over 6-month follow-up.
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The purpose of the present study was to determine the prevalence of migraine among 2351 secondary school students aged 15 to 19 years. Six hundred fifty-nine students (120 males and 539 females) complained of migraine, including 148 with additional tension-type headache (mixed headache). Migraine with aura was diagnosed in 213 students (49 with mixed headache). ⋯ Nine percent of them have migraine with aura and 19%, migraine without aura. The prevalence of migraine among secondary school students is about three times higher in females than in males. Migraine with tension-type headache differs from pure migraine in respect of more numerous attacks within 1 year among females, and of more frequent occurrence of migraine with sensory aura among males.
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To report the consistent effect of intranasal lidocaine 4% on preventing headache following aura in one individual. ⋯ Intranasal lidocaine consistently prevented the development of headache symptoms following aura in this individual. Such an effect suggests a role for the sphenopalatine ganglion in the development of migraine pain.
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Case Reports
Chronic inflammatory demyelinating polyneuropathy presenting with headache and papilledema.
Chronic inflammatory demyelinating polyneuropathy is a disorder typified clinically by motor and sensory neuropathy of at least 2 months' duration and pathologically by multifocal inflammatory demyelination. Its usual presentation is with features reflecting the polyneuropathy, namely limb weakness with hyporeflexia or areflexia and sensory symptoms of glove and stocking distribution. In this report, we detail the course of a 53-year-old man who presented to our neurological service with a severe headache in association with papilledema. ⋯ His headache, papilledema, and limb symptoms responded to oral corticosteroid therapy, the standard treatment for this type of neuropathy. We hypothesize that his headache and papilledema were due to the elevated cerebrospinal fluid protein level as a result of the polyneuropathy. To our knowledge, this is the first report of headache being a prominent and early symptom of this disorder.