Headache
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In order to study the frequency and characteristics of post-angiography headache, we interviewed 45 consecutive patients (mean age +/- SD = 57 +/- 15 years; M/F = 15/30) who underwent transfemoral cerebral angiography for: ischemic cerebrovascular disease (n = 33); suspected arteriovenous malformations (n = 4; one confirmed); suspected cerebral aneurysm (n = 5; two confirmed); and arterial dissection (n = 3; one confirmed and one was a follow-up study of a previously demonstrated dissection). Postangiography headache developed in 15 (33%) patients, 125 +/- 99 min after the completion of the study. It was unilateral in nine (60%) patients, homolateral to the usual side of migraine headache in two or three migraineurs, and pulsating in six (40%). ⋯ Patients with and those without postangiography headache were comparable in mean age, sex, and indication for angiography. Fifty-three percent (8/15) of patients with postangiography headache and 23% (7/30) of the non postangiography headache group reported prior recurrent headaches (P = 0.047, likelihood ratio chi-square). Postangiography headache has the characteristics of delayed arterial pain which may be related to a catheter-induced or contrast dye-induced release of vasoactive substances, notably nitric oxide and serotonin.
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Case Reports
Denial of hospitalization by insurers for inpatient treatment of medication rebound headaches.
Inpatient treatment with intravenous dihydroergotamine has been remarkably successful in managing chronic daily headaches due to excessive use of analgesics or ergotamine tartrate. Recently we have been denied authorization in appropriate patients for this procedure by third party payers on the grounds that it was "not medically necessary," "based on anecdotal information," or is "an outpatient procedure." Three cases are described in which the insurer's decision was either contested as an issue of substandard care, or the patient elected to pay for the procedure. ⋯ Time and energy spent on combating the position of the third party payer on issues of standards of specialist care should be unnecessary. Publication of standards of care by specialists, and a requirement that these care standards must be provided by third party payers are needed in order that quality medical care can continue in this society.
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Comparative Study
Postconcussion symptoms and cognitive functioning in posttraumatic headache patients.
Forty-two patients with posttraumatic headache of at least three months duration following motor vehicle accident completed the Postconcussion Syndrome Checklist which assessed their experience of 10 commonly reported cognitive, emotional, and physical symptoms. The patients also completed the Beck Depression Inventory and a brief battery of neuropsychological tests. Results indicated that postconcussion symptoms remained quite prevalent among these subjects. ⋯ However, depressed subjects reported more severe cognitive and emotional symptoms than did nondepressed subjects. Additional information about postconcussion symptom prevalence and a description of the relationship between self-reported symptoms, cognitive functioning on neuropsychological tests, and depression is provided. The implications of these findings are discussed.
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Tension-type headache is the term designated by the International Headache Society to describe what was previously called tension headache, muscle contraction headache, psychomyogenic headache, stress headache, ordinary headache, and psychogenic headache. The International Headache Society defines tension-type headache more precisely, distinguishes between the episodic and the chronic varieties, and divides them into two groups, those associated with a disorder of the pericranial muscles and those not associated with this type of disorder. Most clinic-based studies of tension-type headache suffer from selection bias, as they include patients with more severe headaches, patients with concomitant migraine, and patients with chronic daily headache. ⋯ Secondary causes of chronic daily headache include post-traumatic headache, cervical spine disorders, and headache associated with vascular disorders and nonvascular intracranial disorders. Patients with frequent headaches are prone to overuse analgesics, ergotamine, or both. Most patients with chronic daily headache overuse symptomatic medication.(ABSTRACT TRUNCATED AT 250 WORDS)
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The aim of this study was to clarify the changes of inhibitory interneuronal activity in patients with chronic tension-type headache with disorder of pericranial muscle after treatment, and the pharmacological mechanisms of tizanidine--an alpha 2 adrenergic agonist. The effects of tizanidine on exteroceptive suppression (ES) of the temporalis muscle were examined in eighteen patients with chronic tension-type headache with disorder of pericranial muscles, before and two weeks after the administration of tizanidine. The left mental nerve was stimulated, under the maximal voluntary contraction of the temporalis muscles. ⋯ However, ES produced by 10 times the sensory threshold did not change. This suggests that the effect of tizanidine may be relatively mild. The interneurones mediating ES2 may be modified by the alpha 2 agonist.