Headache
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Migraine is an episodic headache disorder associated with various combinations of neurologic, gastrointestinal, and autonomic symptoms. Gastrointestinal disturbances including nausea, vomiting, abdominal cramps, or diarrhea are almost universal. Sensory hyperexcitability manifested by photophobia, phonophobia, and osmophobia are frequently experienced. ⋯ The most important features of a migraine medication were rapid and effective relief of headache pain, decreasing the likelihood of headache recurrence, and not causing nausea. Many migraine patients suffer needlessly because their nausea and vomiting are both unreported to, and unrecognized by physicians. The presence of these symptoms is crucial to diagnose migraine not accompanied by aura.
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Comparative Study
Exteroceptive suppression of temporalis muscle activity: a blind study of tension-type headache, migraine, and cervicogenic headache.
Exteroceptive suppression of temporalis muscle activity (ES2 duration) has been reported to be reduced in chronic tension-type headache in previous open studies (with varying stimulus and analysis methods). We studied ES2 duration and latency in 11 patients with chronic tension-type headache, 10 patients with cervicogenic headache, 11 migraine patients, and 9 headache-free control subjects. The investigator was blinded as to the diagnostic category. ⋯ ES2 duration tended to decrease with increasing duration of headache history. Consistent asymmetries of ES2 latency and duration were not found among patients with (unilateral) cervicogenic headache. Thus, the role of ES2 in headache diagnosis still seems to be unsettled.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of dihydroergotamine with metoclopramide versus meperidine with promethazine in the treatment of acute migraine.
Migraineurs often seek office-based treatment for acute headache. To compare the efficacy and side effect profile, we entered 27 migraineurs into a prospective, randomized, double-blind study where each patient received either 75 mg meperidine with 25 mg promethazine IM or .5 mg dihydroergotamine with 10 mg metoclopramide IV. After 1 hour, pain relief was similar in the two groups, but side effects were significantly greater in the meperidine with promethazine regimen group. The dihydroergotamine with metoclopramide regimen is effective, and has minimal side effects, making it an attractive method for office-based treatment of acute migraine.
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This review focuses on the prevalence, causes, evaluation, and treatment of headache in individuals infected with human immunodeficiency virus type 1 (HIV-1). Headaches, one of the commonest medical complaints in the general population, occur frequently in patients infected with the HIV-1. HIV-related headaches can occur at any time during the infection: at seroconversion, during the incubation period, in patients with symptomatic HIV-1 infection, or after an AIDS-defining illness. ⋯ The headaches seen in this population reflect a complex web of interactions imposed by immune competency, multiple etiologies, treatments, and premorbid conditions. Prompt recognition and early treatment of headache is essential since it may improve quality of life and, depending on the diagnosis, prolong survival. Physicians need to be alert and adaptable when assessing HIV-infected individuals with headache since multiple causes can exist in the same patient and new syndromes, complications, and investigational drugs are continually being identified.
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Recurrent abdominal pain in children, frequently diagnosed as "abdominal migraine," is thought to evolve into more typical migraine headache during the teens and twenties. If this transformation occurred, we would expect some adult migraineurs to retain abdominal pain; but we could not recall this symptom being mentioned by patients. ⋯ We, therefore, asked 100 migraineurs about abdominal symptoms during migraine attacks: only one experienced unexplained abdominal pain. We conclude that abdominal pain is not a feature in adult migraineurs, leading us to support the notions that: (1) recurrent abdominal pain of childhood has a number of causes; (2) abdominal migraine may be an incorrect attribution and is liable to be over diagnosed; (3) abdominal migraine requires more precise definition; (4) the transition from childhood abdominal migraine to adult migraine needs precise prospective study.