How To Prevent Migraines Naturally

The Migraine And Headache Program

This product was created by a Christian Goodman and a woman who has been suffering from migraine problems for over a decade. As she followed the advice in the book along with easy to do stationary movements, she was able to help unlock the path of the oxygen to the brain and make her migraines stop forever. This was done not by treating migraines by the triggers, but by the cause of the migraines which was the lack of the body to send the oxygen and work well. Finally, the creator of the product was able to locate the problem along with easy to do tricks that are not known to the public. Along with that, you will also learn how to sit and walk correctly and loosen the muscles in the body for easier airflow into the brain. You will no longer have to face migraines and let them cripple your ability as a person. These easy tricks will even make you feel better immediately as you start doing them. You won't even need any experience on how to do these exercises because they are all super easy to do. In addition to that, you can get started today in stopping your migraines and headaches by getting the guide. Continue reading...

The Migraine And Headache Program Summary


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Cervicogenic Headache

Headaches caused by disorders of the neck has been a controversial subject some feel that it is, at best, a rare syndrome. The original diagnostic criteria were proposed by Sjaastad in 1990, and are shown in Table 1. In a comprehensive review by Antonacci et al., the sensitivity and specificity of the original criteria were measured in an Italian clinic population. Their groups (labeled A, B, and C ) correspond to individuals with varying symptoms. Group A includes those individuals with the presence of both unilateral headache without side-shift and pain starting in the neck, eventually spreading to oculofrontotemporal areas, where the maximum pain is often located. The neck pain was invariably unilateral at onset, but could eventually spread across the midline during particularly severe and protracted attacks (Table 2).

International Headache Society Diagnostic Criteria for Cluster Headache

Headache is accompanied by at least one of the following 3During part (but less than half) of the time-course of cluster headache, attacks may be less severe and or of shorter or longer duration. *During part (but less than half) of the time-course of cluster headache, attacks may be less frequent. cHistory and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12, or history and or physical and or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but attacks do not occur for the first time in close temporal relation to the disorder. (Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing.)

International Headache Society Diagnostic Criteria for Episodic and Chronic Cluster Headaches

Episodic cluster headache Description Cluster headache attacks occurring in periods lasting 7 days to 1 year separated by pain-free A. Attacks fulfilling criteria A-E for Cluster headache. 1 month. Chronic cluster headache Description Cluster headache attacks occurring for more than 1 year without remission or with remissions lasting less than 1 month.

Diagnostic Criteria According to the International Headache Society for Migraine Without Aura

AND one of the following symptoms during the headache Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing.

Diagnostic Criteria According to the International Headache Society for Migraine With Aura

At least two headache attacks by history, consistent with criteria 2-7. 2. No other disease present that might cause headache or neurological visual changes. 4. Unilateral headache location. 7. Headache also meets criteria for migraine without aura, beginning within 0-60 minutes of aura. Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing.

International Headache Society Diagnostic Criteria for Chronic Migraine Headache

Chronic migraine Headache (not attributable to another disorder) on more than 15 days month for more than 3 months fulfilling the following criteria for migraine II. Probable chronic migraine Headache meeting criteria for chronic migraine but in the presence of recent medication overuse (according to the criteria for medication overuse headache). Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing. In order to help differentiate basilar migraine from familial hemiplegic migraine, Thomsen et al. suggested adding that basilar migraine not be diagnosed when there is motor weakness. Considering the overlap with both migraine headache and the often genetically determined familial hemiplegic migraine (FHM), the etiology of basilar migraine is intriguing.

Headache Related to Intrathecal Injections

Lo SK, Montgomery JN, Blagden S, et al. Reducing incidence of headache after lumbar puncture and intrathecal cytotoxics. Lancet 1999 353 2038, 2039. Van de Velde M, Corneillie M, Vanacker B, et al. Treatment for postdural puncture headache associated with late postpartum eclampsia. Acta Anaesthesiol Belg 1999 50 99-102.

Headache see specific sections in Chapter 8 for International Headache Society criteria

Migraine without aura Idiopathic, recurrent headache manifested by attacks lasting 4-72 hours. Typical characteristics are unilateral location, pulsating quality, moderate-to-severe intensity, aggravation by routine physical activity, and associated with nausea, vomiting, photo- and phonophobia. At least five attacks fulfilling the aforementioned criteria. ii. Migraine with aura Idiopathic, recurrent disorder manifested by attacks of neurological symptoms localizable to cerebral cortex or brain stem, usually gradually developing over 5-20 minutes and lasting less than 60 minutes. Headache, nausea, and or photophobia usually follow neurologic aura symptoms directly or after an interval of less than 1 hour. Headache usually lasts 4-72 hours, but may be completely absent. b. Tension headache (episodic tension-type headache). Recurrent episodes of headaches lasting minutes to days. Pain typically pressing tightening in quality, of mild-to-moderate intensity, bilateral in...

External Compression Headache

International Headache Society Diagnostic Criteria for External Compression Headache Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing. Diagnostic Criteria for Headache Related to Intrathecal Injections A. Headache follows intrathecal injection within 4 hours. B. Headache is diffuse and present also in the recumbent position. C. Headache clears completely within 14 days. (If it persists, consider post-lumbar puncture.) Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004 24 S9-S60, and from Blackwell Publishing. 1. Headache follows intrathecal injection within 5-72 hours. 2. Headache is diffuse and present also in the recumbent position. Adapted with permission from Headache...

Tensiontype headaches

Episodic tension-type headache - Episodic tension-type headache associated - Episodic tension-type headache not associated with disorder of pericranial muscles Chronic tension-type headache - Chronic tension-type headache associated - Chronic tension-type headache not associated with disorder of pericranial muscles Headache of the tension type

Headache associated with substances or their withdrawal

Headache induced by acute substance use or exposure Headache induced by chronic substance use or exposure Headache due to substance withdrawal (acute use) Headache due to substance withdrawal (chronic use) Headache associated with substances but with uncertain mechanism Nitrate nitrite-induced headache Monosodium glutamate-induced headache Carbon monoxide-induced headache Alcohol-induced headache Other substances Ergotamine-induced headache Analgesic abuse headache Other substances Alcohol withdrawal headache (hangover) Other substances Ergotamine withdrawal headache Caffeine withdrawal headache Narcotic abstinence headache Other substances

Medicationoveruse Headache

Whereas a cause and effect has not been firmly established, overuse of symptomatic migraine drugs, opioid or butalbital compounds, or analgesics is implicated in the development of chronic daily headaches with either a migraine-like or a mixed migraine-like and tension-type-like presentation. Whereas overuse is defined in terms of treatment days (not doses) per month, the stipulation on a regular basis is significant i.e., 2 to 3 days per week on an ongoing basis. Taking symptomatic medications on several successive days with long periods without medication use does not seem to be associated with medication-overuse headache. This strategy, in fact, is often used to prevent severe menstrual migraine attacks.

Migraine Headache DRG CategT 025

Mean LOS 3.3 days Description MEDICAL Seizure and Headache Age 17 without CC M igraine headache is a primary headache syndrome that is an episodic vascular disorder with or without a common aura. Approximately 23 million people have migraine headaches in the United States. A migraine headache is a prototype of a vascular headache, which involves vasodilation and localized inflammation. Ultimately, arteries are sensitized to pain. Cerebral blood flow is diminished before the onset of the headache and is increased during the actual episode. Most migraine sufferers have a trigger, or precipitating factor, that is associated with the onset of symptoms There are two types of migraine headaches classic migraine and common migraine. Classic migraine has a prodromal (preheadache) phase that lasts approximately 15 minutes and is accompanied by disturbances of neurological functioning such as visual disturbances, speech disturbances, and paresthesias. Neurological symptoms cease with the...

Familial Hemiplegic Migraine

The clinical spectrum of Familial Hemiplegic Migraine associated with mutations in a neuronal calcium channel. N Engl J Med 2001 345 17-24. Ducros A, Joutel A, Vahedi K, Cecillon M, Ferreira A, Bernard E, et al. Mapping of a second locus for familial hemiplegic migraine to 1q21-q23 and evidence of further heterogeneity. Ann Neurol 1997 42 885-890. Joutel A, Bousser MG, Biousse V, Labauge P, Chabriat H, Nibbio A, et al. A gene for familial hemiplegic migraine maps to chromosome 19. Nature Genet 1993 5 40-45. Ophoff RA, Terwindt GM, Vergouwe MN, et al. Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca2+ channel gene CACNL1A4. Cell 1996 87 543-552. Terwindt GM, Ophoff RA, Haan J, Sandkuijl LA, Frants RR, Ferrari MD. Migraine, ataxia and epilepsy a challenging spectrum of genetically determined calcium channelopathies. Eur J Hum Genet 1998 6 297-307. Thomsen LL, Eriksen MK, Roemer SF, Andersen I, Oleson J,...

Cluster Headache

Cluster headache is a primary headache disorder of unclear etiology. It is more common in males, and is often precipitated by ingestion of alcohol. Not infrequently, the patient awakes from sleep with the onset of the headache. Patients are typically quite agitated during the attack, which tends to be relatively brief compared with the time-course of migraine or tension-type headaches. Cluster headaches may occur on an episodic or chronic basis. Chronic cluster headache may be primary or a stage evolving from episodic cluster headache (Tables 3 and 4).


A headache is a very common type of pain. The pain of a headache may extend over the entire head, or it may be limited to a specific area. Headache pain may range from mild to severe. Unusual or sudden changes in posture or prolonged coughing, sneezing, or exposure to sunlight can lead to a headache. In some cases, however, a headache may be a symptom of a serious underlying condition, such as a stroke or a brain tumor. Call your doctor immediately if your headache is severe or persistent, if it occurs after a blow to the head, or if it is accompanied by any of the following Tension headaches (also called muscle contraction headaches) are the most common type of headache. These headaches produce mild to moderate pain that feels as though pressure is being applied to the head or neck. The pain may be accompanied by muscle tenderness. Tension headaches can be brought on by head or neck injury, anxiety, stress, eyestrain, or poor posture. If the headaches occur almost every day, they are...

Headache Diary

TV eeping a headache diary is a good way to help X *you identify the factors that trigger your headaches so that you can take steps to prevent future headaches. Whenever you have a headache, carefully mark down the following information time headache began time headache ended medication taken for headache (type and amount) and results self-treatment for headache (such as sleep, cold compresses, or relaxation techniques) and results activity you were engaged in (such as sleeping or exercising) when headache began your location when headache began (such as indoors or outdoors) potential allergens nearby when headache began (such as pollen, tobacco smoke, dust, or pets) food or drink consumed before headache began your emotional state before headache began (such as angry, stressed, or tired) Take your headache diary with you when you visit your doctor. The information it contains will reveal any patterns related to your headaches, which is helpful for determining the triggers of your...


A total of 89 adults (87 women) living in Canada were recruited by a market research firm all were known to suffer migraine headaches. Each participant completed both the interviewer-administered QWB and the QWB-SA on non-headache as well as on headache days. Mean age was 42 (range 36 to 64). Sieber, W.J., David, K , Adams, J., Kaplan, R.M. and. Ganiats, T.G. (2000). Assessing the Impact of migraine on health-related quality of life An additional use of the Quality of Well-Being Scale -Self-Administered (QWB-SA). Headache, 40(8), 662-671 Migraine Study (lie a dache dayV) Migraine Study (lie a dache dayV)

Tension Headache

The sensitivity and specificity of the case definition criteria in diagnosis of headache a school-based epidemiological study of 5562 children in Mersin. Cephalalgia 2003 23 138-145. Rossi LN, Cortinovis I, Menegazzo L, Brunelli G, Bossi A, Macchi M. Classification criteria and distinction between migraine and tension-type headache in children. Dev Med Child Neurol 2001 43 45-51. Waldie KE, Poulton R. Physical and psychological correlates of primary headache in young adulthood a 26-year longitudinal study. J Neurol Neurosurg Psychiatry 2002 72 86-92. Zebenholzer K, Wober C, Kienbacher C, Wober-Bingol C. Migrainous disorder and headache of the tension-type not fulfilling the criteria a follow-up study in children and adolescents. Cephalalgia 2000 20 611-616.

Electrolyte Abnormalities Sodium

Hypercalcemia is found in hyperparathyroidism and malignancies with bony metastases and paraneoplastic syndromes. Signs include easy fatigue, weakness, anorexia, nausea, vomiting, weight loss, stupor, coma, body aches, headaches, thirst, polydipsia and polyuria. Treatment is with normal saline fluid resuscitation, furo-semide, sodium phosphate, corticosteroids, plicamycin, calcitonin. Surgical excision is employed for patients with hyperparathyroidism in hypercalcemic crisis.

Autoimmuneneuromuscular disorders

A number of autoimmune neuroinflammatory disorders (see 6.09 Neuromuscular Autoimmune Disorders) affect either the central or peripheral nervous system. Many of these disorders are exceptionally rare such as Moersch-Woltman syndrome (stiff-man), Lambert-Eaton myasthenic syndrome, and myasthenia gravis (MG). While uncommon, these disorders tend to be highly debilitating as they directly alter neuromuscular transmission. The most common of these disorders is MG which affects an estimated 60 000 people in the USA. The primary pathology underlying MG appears to be the production of autoantibodies directed against the alpha subunit of the neuromuscular nicotinic acetylcholine receptor. Through direct interference and complement-mediated lysis of the postsynaptic muscle membrane, the autoantibodies cause disruption in the motor endplate that leads to a weakness in skeletal muscle throughout the body. The autoimmune disorder systemic lupus erythematosus (SLE) and the neuroinflammatory...

Genetic Considerations

The course of acromegaly is slow, with very gradual changes over 7 to 10 years. Reviewing a patient's old photographs may reveal the progressive changes in facial features. Determine if the patient has had a change in hat, glove, ring, or shoe size because of an overgrowth of the hands and feet. Ask the patient if he or she has had headaches or visual disturbances, which in acromegaly are caused by the growth of the adenoma, which exerts pressure on brain tissue and cranial nerves III, IV, and VI. Establish a history of altered sexual function, which may be an indicator of decreased gonadotropin production. Ask about the presence of pain in the hands, feet, and spine, which is probably caused by bone growths also ask about problems with chewing, swallowing, or talking, which may be caused by tongue, jaw, and teeth enlargement. Note the presence of a deepening of the voice, recurrent bronchitis, excessive sweating, heat intolerance, fatigue, and muscle weakness. Check for a...

With Subcortical Infarcts And Leukoencephalopathy

CADASIL differs from other causes of diffuse subcortical ischemia, such as Binswanger's disease, by the frequent presence of migraine with or without aura, and individuals with CADASIL are not usually hypertensive. Occasionally, diagnostic confusion may occur with patients with multiple sclerosis, especially the primary progressive type, with the appearance of multiple white matter lesions. CADASIL often presents in early adulthood, and most affected individuals show symptoms by age 60. In addition to migraine with or without aura, there may be depression and mood disturbances, focal neurological deficits, pseudobulbar palsy, and dementia. Approximately 10 of patients have seizures.

Evaluation and Diagnosis

The most frequent presenting symptoms of IP are nasal obstruction (64 to 78 ), followed by headache, epistaxis, facial pain, periorbital swelling, purulent rhinorrhea, chronic sinusitis, allergy, hyposmia, visual changes, and meningitis. Some patients are even asymptomatic. These signs and symptoms make IP difficult to distinguish from inflammatory dis-

Placebos and the Placebo Effect

A well-known study of the placebo effect was reported in 1955 by Dr. Harry Beecher (1). He described the placebo effect in a variety of conditions, including the common cold, pain after surgery, headache, and seasickness. Overall, symptoms were improved in 35 percent of the people who were given the placebo. Subsequent studies of a variety of medical conditions found placebo effects that were frequently in the range of 30 to 40 percent. In some studies, placebos have been 70 percent effective.

Contamination resulting from the intake of toxic substances by animals

Shellfish poisoning symptoms include tingling and burning in face, lips, tongue, and ultimately the whole body, and parathesia followed by numbness, general motor incoordination, confusion, and headache. These symptoms develop within 30 minutes after ingestion. Death, preceded by respiratory paralysis, occurs within 12 hours. The chance of contamination and poisoning is highest during a so-called red tide. In many parts of the world, the sea sometimes suddenly becomes colored, as a result of dinoflagellate bloom. The phenomenon is referred to as red tide, although the bloom may also be yellowish, brownish, greenish, and bluish in color. The red color is probably due to the xanthophyll peridinin.

The Dendritic Release Of Neuroactive Peptides From Dendritic Branches Of Primary Sensory Neurons

Agent was capable of depleting to near totality the immunoreactivity to substance P in presumptive sensory fibers at their point of entry in the spinal cord (Jessell et al., 1978). The neonatal application of capsaicin was shown to elicit a marked impairment of the vasodilatory responses following antidromic stimulation (Lembeck and Holzer, 1979 Gamse et al., 1979b). Nowadays there is abundant evidence for a peripheral effector role of dendritically released substance P and a number of neuroactive peptides from peripheral branches of sensory neurons. The current view is that sensory peptides are locally released to facilitate the passage of blood borne substances (plasma extravasation) to respond to peripheral noxia. This mechanism is central to what is known as neurogenic inflammation and might be involved in a number of pathological conditions as varied as migraine and disturbances of the upper airways.

Food Allergies and Intolerances

Some people are sensitive to certain foods but are not actually allergic to them because the food does not trigger an allergic reaction. Food preservatives called sulfites and flavor enhancers such as monosodium glutamate (MSG) can produce headaches and other symptoms. Some people get migraine headaches after consuming red wine, cheese, or chocolate. Talk to your doctor about any symptoms you may be experiencing that you think may be food-related.

Transdermal contraceptive patch

Amenorrhea, irregular bleeding, and weight gain (typically 1 to 3 kg) are the most common adverse effects of DMPA. Adverse effects also include acne, headache, and depression. Fifty percent of women report amenorrhea by one year. Persistent 2. Weight gain, hypertension, headache, mastalgia, or other nonmenstrual complaints are common.

Complications of Blood Transfusion

Transfusion reaction is the result of hemolysis from improperly typed and crossed blood or clerical error (80 ). It occurs in 1 of 6000 transfusions. Manifestations of hemolysis occur after 50 mL or less of blood has been transfused. The patient develops fever and chills. The symptoms may progress to headache, back pain, substernal chest pain, dypsnea and hypotension.

Studies in MS and Other Conditions

No well-conducted studies have shown that aspartame causes MS or worsens symptoms in most people with the disease. Through, the CAM website of the Rocky Mountain Multiple Sclerosis Center, we conducted a survey of aspartame use among a large group of people with MS. We had 3,075 people with MS respond to this survey. A minority (15 percent) of those who responded experienced problems that they attributed to aspartame use. Headache was the most common complaint, which was noted by about one third (36 percent) of those who noticed symptoms related to aspartame. Among MS symptoms, those that were reported to be worsened most commonly by aspartame were fatigue, thinking problems, weakness, and numbness. Nearly two-thirds of people reported that their aspartame-related symptoms began within minutes or hours of using the sweetener. Overall, these findings indicate that the majority of people with MS do not have problems with aspartame and that the most common symptom provoked...

Additional Resources Books

Lipton RB, Newman LC, Cohen JS, et al. Aspartame as a dietary trigger of headache. Headache 1989 29 90-92. Newman LC, Lipton RB. Maxalt MLT-down an unusual presentation of migraine in patients with aspartame-triggered headaches. Headache 2001 41 899-901. Van dewn Eeden SK, Koepsell TD, Longstreth WT Jr., et al. Aspartame ingestion and headaches a randomized crossover trial. Neurology 1994 44 1787-1793.

Multiplicity and ligand specificity

Two forms of the enzyme exist, MAO-A and MAO-B, that are encoded by separate genes.53 These enzymes are 80 similar, and possess overlapping, albeit sometimes distinctive, substrate specificities. Serotonin, norepinephrine, and epinephrine are the major endogenous substrates for MAO-A. The indoleamine nucleus of serotonin appears in a few drug classes, notably the triptan class of antimigraine drugs. These drugs are metabolized by MAO-A via pathways that ultimately generate carboxylic acid metabolites.40 The acetylenic compound, clorgyline, is a selective mechanism-based inhibitor of MAO-A, and reversible inhibitors of the enzyme are under development as antidepressant drugs. Amongst the neurotransmitters, dopamine is selectively metabolized by MAO-B. Another acetylenic compound, deprenyl, is a selective mechanism-based inhibitor of MAO-B and the levo enantiomer, selegiline, is marketed as Eldepryl and used as an adjunct to l-DOPA in Parkinsonism. The rationale here is to minimize...

Local Infiltration and Nerve Blocks

Spinal headache is a second complication produced by intracranial hypotension. Treatment of spinal headache includes fluid boluses, treatment with caffeine, or an injection of blood into the epidural space at the level of lumbar puncture known as an autologous blood patch.

Microbial toxins 2331 Introduction

After an incubation period of 12 to 72 hours, symptoms may start with nausea and vomiting, followed by tiredness, headache, muscular paralysis, double vision, and respiratory problems, often with fatal results. The duration of botulism is 1 to 10 days, mortality is relatively high (30 to 65 ). In most foods, botulinum spores are of no consequence unless they are able to germinate and produce the toxin. The exception is infant foods in which botulinum spores are potentially infective and may give rise to toxicogenesis in the infant intestine. A good example of this is infant botulism caused by contaminated honey. Toxicity and symptoms. Biogenic amines have a stimulatory or toxic effect on the consumer. The symptoms of intoxication, persisting for several hours, include burning throat, flushing, headache, nausea, hypertension, numbness and tingling of the lips, rapid pulse, and vomiting. Especially, histamine has been indicated as the causative agent in several outbreaks of food...

Brown recluse spider bite

Bite minimally symptomatic fewer than 10 of bites result in severe skin necrosis signs of progression within 48-72 hours of the bite mild-to-severe pain beginning 2-8 hours after bite central papule and associated erythema occur 6-12 hours after bite purple vesicle sometimes ulcerates stellate necrotic area sometimes ensues. Constitutional signs and symptoms hemol-ysis hemoglobinuria thrombocytopenia disseminated intravascular coagulation fever headache malaise arthralgia nausea vomiting

Primary Nursing Diagnosis

Surgery is indicated to prevent rupture or rebleeding of the cerebral artery. The decision to operate depends on the clinical status of the patient, including the level of consciousness and severity of neurological dysfunction, the accessibility of the aneurysm to surgical intervention, and the presence of vasospasm. Surgical procedures used to treat cerebral aneurysms include direct clipping or ligation of the neck of the aneurysm to enable circulation to bypass the pathology. An inoperable cerebral aneurysm may be reinforced by applying to the aneurysmal sac such materials as acrylic resins or other plastics. Postoperatively, monitor the patient closely for signs and symptoms of increasing ICP or bleeding, such as headache, unequal pupils or pupil enlargement, onset or worsening of sensory or motor deficits, or speech alterations.

Isopropanol Pharmacology and Toxicity

CNS Three times more CNS depression than EtOH, lethargy, weakness, headache, ataxia, dysarthria, confusion, apnea, respiratory depression, hypotension. Pulmonary and gastrointestinal Acetone breath, hemorrhagic gastritis and hemor-rhagic tracheobronchitis. Metabolic Exception only toxic alcohol not causing metabolic acidosis or hypoglycemia euglycemia is maintained ketonemia and ketonuria occur from acetone poisoning.

Enalaprilat IV Vasotec

Nicardipine (Cardene IV) is a calcium channel blocker. It is contrain-dicated in presence of CHF. Tachycardia and headache are common. The onset of action is 10 min, and the duration is 2-4 hours. The dose is 5 mg hr continuous infusion, up to 15 mg hr. H. Fenoldopam (Corlopam) is a vasodilator. It may cause reflex tachycardia and headaches. The onset of action is 2-3 min, and the duration is 30 min. The dose is 0.01 mcg kg min IV infustion titrated, up to 0.3 mcg kg min.

Types of Pain See Table 9 p363

Nociceptive pain, the normal type of pain, is that which arises from actual or potential tissue damage and results from the activation of noci-ceptors and subsequent processing in an intact nervous system. Somatic pain is the variety of nociceptive pain mediated by somatosensory afferent fibers it is usually easily localizable and of sharp, aching, or throbbing quality. Postoperative, traumatic, and local inflammatory pain are often of this variety. Visceral pain is harder to localize (e.g., headache in meningitis, biliary colic, gastritis, mesenteric infarction) and may be dull, cramplike, piercing, or waxing and waning. It is mediated peripherally by C fibers and centrally by spinal cord pathways terminating mainly in the limbic system. This may explain the unpleasant and emotionally distressing nature of visceral pain. Visceral pain may be felt in its site of origin or may be referred to another site (e. g., from the diaphragm to the shoulder). Neuropathic pain is that which is...

Normal or low serum gonadotropin concentrations and all other tests normal

This result is one of the most common outcomes of laboratory testing in women with amenorrhea. Women with hypothalamic amenorrhea (caused by marked exercise or weight loss to more than 10 percent below the expected weight) have normal to low serum FSH values. Cranial MRI is indicated in all women without an a clear explanation for hypogonadotropic hypogonadism and in most women who have visual field defects or headaches. No further testing is required if the onset of amenorrhea is recent or is easily explained (eg, weight loss, excessive exercise) and there are no symptoms suggestive of other disease.

Primary Sleep Disorders Dyssomnias

Obstructive sleep apnea is characterized by daytime somnolence with frequent dozing, nocturnal respiratory pauses, and loud snoring. Impaired concentration, decreased performance, and headaches are also common. Extrinsic sleep disorders. Sleep may be disturbed by external factors such as noise, light, mental stress, and medication use. Disturbance of the circadian rhythm. Sleep may be disturbed by shift work at night or by intercontinental travel (jet lag). Parasomnias. These disorders include confusion on awakening (sleep drunkenness), sleepwalking (somnambulism), nightmares, sleep myo-clonus, bedwetting (enuresis), and nocturnal grinding of the teeth (bruxism).

Classification Antibiotic penicillin

Special Concerns Safety and efficacy in children less than 12 years of age have not been established. Side Effects At site of injection Pain and thrombophlebitis. GI Diarrhea, N&V, flatulence, abdominal distention, glossitis. CNS Fatigue, malaise, headache. GU Dysuria, urinary retention. Miscellaneous Itching, chest pain, edema, facial swelling, erythema, chills, tightness in throat, epistaxis, substernal pain, mucosal bleeding, candidiasis. Drug Interactions See also Anti-Infectives and Penicillins. How Supplied See Content

Pharmacologic Therapy

Fluoxetine (Sarafem) and sertraline (Zoloft) have been approved for the treatment of PMDD. SSRIs are recommended as initial drug therapy in women with PMS and PMDD. Common side effects of SSRIs include insomnia, drowsiness, fatigue, nausea, nervousness, headache, mild tremor, and sexual dysfunction. Insomnia, drowsiness, fatigue, nausea, nervousness, headache, mild

Hemicrania Continua And Paroxysmal Hemicranias

Originally described by Sjaastad and Spierings in 1984, hemicrania continua is a primary headache syndrome classified among the indomethacin-responsive headaches because of its selective and consistent response to this agent. It shares some features with cluster headache and migraines as well. Other hemicranial headaches share clinical and probably a pathophysiological basis, and are grouped here. The autonomic manifestations of these disorders are a common feature, and should be routinely

Diagnostic Criteria for Hemicrania Continua

Headache for a total of more than 2 months. 2. Relative lack of migraine symptoms and signs.6 4. Lack of effect of migraine and cluster headache drugs (triptans and ergotamine). 3The pain is mostly in the anterior area, but not infrequently also in the auricular occipital area. Provided the dosage is adequate 150 mg per day for 3 days. In the doubtful case, the indotest should be carried out (see Headache 1998 38 122-128). This is particularly important in the remitting cases, because a betterment of pain in reality being because of a remission may falsely be ascribed to indomethacin. investigated in the history. SUNCT syndrome (short-lasting unilateral neuralgiform headache with conjunctival injection and earing) is a rare but distinct syndrome.

Public health importance

The most common bacterial pathogen causing epidemic meningitis in most countries is the meningococcus, Neisseria meningitidis. Meningococcal meningitis is characterized by sudden onset with fever, intense headache, stiff neck, occasional vomiting and irritability. A purpuric rash is a feature of meningococcaemia. Epidemic meningitis has been recognized as serious public health problem for almost 200 years. The main source of the infection is nasopharyngeal carriers. The infection is usually transmitted from person to person in aerosols in crowded places. Rural-to-urban migration and overcrowding in poorly designed and constructed buildings in camps and slums can contribute to transmission. The disease can be treated effectively with appropriate antimicrobial and, with rapid treatment, the case-fatality in an epidemic is usually between 5 and 15 .

Chronic paroxysmal hemicrania

There is no suggestion of one of the disorders such as trigeminal neuralgia, idiopathic stabbing headache, cough headache, benign exertional headache, headache associated with sexual activity, or hypnic headache. 3. Such a disorder is present, but the first headache attacks do not occur in close temporal relation to the disorder. 1. There is no suggestion of one of the disorders such as trigeminal neuralgia, idiopathic stabbing headache, cough headache, benign exertional headache, headache associated with sexual activity, or hypnic headache. 3. Such a disorder is present, but the first headache attacks do not occur in close temporal relation to the disorder. Adapted with permission from Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias SUNCT syndrome and other short-lasting headache with autonomic features, including new cases. Brain 1997 120 193-209.

Diagnostic Criteria for Sunct Syndrome

SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and (earing) syndrome is characterized by short-lasting attacks of unilateral pain that are much briefer than those seen in any other trigeminal-autonomic cephalagia and very often accompanied by prominent lacrimation and redness of the ipsilateral eye. 3History and physical and neurological examinations do not suggest any of the disorders, such as trigeminal neuralgia, idiopathic stabbing headache, cough headache, benign exertional headache, headache associated with sexual activity, or hypnic headache, or history and or physical and or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but attacks do not occur for the first time in close temporal relation to the disorder. (Adapted with permission from Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache...

Intraventricular Hemorrhage

Intraventricular hemorrhage (intracellular met-hemoglobin). A 78-year-old woman with headache after thrombolytic therapy for femoral artery occlusion had a CT scans 6 hours after surgery (a). This shows intraventricular hemorrhage in the bilateral lateral ventricles (arrows). Three days after surgery (b-f), the T2-weighted image (b) shows hypointense lesions in the bilateral lateral ventricles with fluid-fluid levels (arrows) and the Tl-weighted image (c) shows hyperintense lesions in the same distributions (arrows).The DW image (d) shows hypointense lesions (arrows) with surrounding hy-perintensities.These are ascribed to magnetic susceptibility artifacts.The b0 image (e) also shows hypointense lesions (arrows). These hypointensities are more prominent than on the T2-weighted images (b). The ADC map (f) shows hypointense lesions (arrows)

Leukotriene modifiers

Zafirlukast (Accolate) is modestly effective for maintenance treatment of mild-to-moderate asthma It is less effective than inhaled corticosteroids. Taking zafirlukast with food markedly decreases its bioavailability. Theophylline can decrease its effect. Zafirlukast increases serum concentrations of oral anticoagulants and may cause bleeding. Infrequent adverse effects include mild headache, gastroin

Differential Diagnosis Drug Induced Bradycardia

Angina Reduce anginal attacks and decrease post-myocardial infarction mortality. Tachydysrhythmias Used in theophylline overdose, butadenosine preferred over P-blockers. Tremor Propanolol over prescribed agitation, stage fright, and panic attacks ( shakes ). Migraine headaches.

Syndromes Table 18 p 370

Pathological breathing patterns may be due to metabolic, toxic, or mechanical factors (obstructive sleep apnea) or to a lesion of the nervous system (p. 118). Morning headaches, fatigue, daytime somnolence, and impaired concentration may reflect a (nocturnal) breathing disorder. Neurogenic or myogenic breathing disorders often come to medical attention because of coughing attacks or food going down the wrong pipe. Neurological diseases are often complicated by respiratory dysfunction. The respiratory parameters (respiratory drive, coughing force, blood gases, vital capacity) should be carefully monitored over time so that intubation and or tracheostomy for artificial ventilation can be performed as necessary.

Psychological effects

A woman who is sexually assaulted loses control over her life during the period of the assault. Her integrity and her life are threatened. She may experience intense anxiety, anger, or fear. After the assault, a rape-trauma syndrome often occurs. The immediate response may last for hours or days and is characterized by generalized pain, headache, chronic pelvic pain, eating and sleep disturbances, vaginal symptoms, depression, anxiety, and mood swings.

The Second US Trial SAAB

The next trial measured incontinence episode frequency, IQOL, stress-pad test weights, and 24-h pad weights with about 35 patients in each dose group and restricted itself to stress and mixed UI patients.35 Unexpectedly, only the 20 mg group showed statistically significant improvement in all measures, while those at dose 40 mg showed significance in only stress-pad test and IQOL, and the 30 mg dose group only showed significance in IQOL (Figures 6 and 8). In hindsight, this absence of a dose response is not surprising since the dose increments of 20, 30, and 40 mg duloxetine are proportional to increments of, for example, 1, 1.5, and 2 aspirins. One might not expect to see a dose-dependent reduction in headaches in groups of 35 patients across those doses of aspirin. When all duloxetine arms were pooled, significance was retained for all measures except 24-h pad weights, which still showed twice as much reduction as placebo. As in the first trial, the overall incidence of adverse...

Water Excess without Salt Excess

At the other extreme, when the concentration of dissolved solids gets below a certain limiting value, we lose all interest in drinking fluids. Our brains stop producing antidiuretic hormone. In the normal subject, this causes the urine to become very dilute and to increase enormously in volume. As a result, the concentration of dissolved solids returns to a normal value. In the subject with kidney disease, by contrast, there is little increase in urine flow and the urine doesn't become as dilute. Low concentration of dissolved solids is seen more commonly in patients with kidney disease than is high concentration of dissolved solids. This condition, when severe, is called water intoxication its symptoms are variable, but often there is a severe headache.

Introduction to the toxicological aspects of nutrient intake

First, attention should be paid to the margin between physiological need and toxic intake, i.e., dose. On the one hand, nutrients are necessary for life and good health, on the other, they may pose life threatening risks. When the intake of nutrients is very low, this may lead to lethal deficiencies, whereas a very high intake may cause toxic effects. The requirements for optimal nutrient intake are based on both deficiency and toxicity data. The optimal intake of a nutrient may be defined as the intake that meets the minimal physiological needs of an organism for that nutrient, and does not cause adverse effects. An example of the implications of overintake is the acute vitamin A toxicity in Arctic and Antarctic explorers on the consumption of polar bear liver containing about 600 mg retinol per 100 g liver. The explorers were informed by the Eskimos that eating polar bear liver may cause drowsiness, headache, vomiting, and extensive peeling of the skin.

Clinical Grading Scales in Subarachnoid Hemorrhage

Asymptomatic or mild headache I Moderate to severe headache, nuchal rigidity, may have oculomotor - no headache or focal signs I Glasgow Coma Scale score 15 - headache, nuchal rigidity, no focal signs II Glasgow Coma Scale score 13-14 - may have headache, nuchal rigidity, no focal signs III Glasgow Coma Scale score 13-14 - may have headache, nuchal rigidity, or focal signs IVa Glasgow Coma Scale score 9-12 - may have headache, nuchal rigidity, or focal signs IVb Glasgow Coma Scale score 8 or less - may have headaches, nuchal rigidity, or focal signs V Mildly ill, alert and responsive, headache present II - Lethargic, headache, no focal signs

Antipyretic Analgesics

Antipyretic Mechanism Action

Acetaminophen (paracetamol) has good analgesic efficacy in toothaches and headaches, but is of little use in inflammatory and visceral pain. Its mechanism of action remains unclear. It can be administered orally or in the form of rectal suppositories (single dose, 0.5-1.0 g). The effect develops after about 30 min and lasts for approx. 3 h. Acetaminophen undergoes conjugation to glucuronic acid or sulfate at the phenolic hydroxyl group, with subsequent renal elimination of the conjugate. At therapeutic dosage, a small fraction is oxidized to the highly reactive N-acetyl-p-benzoquinonimine, which is detoxified by coupling to glutathione. After ingestion of high doses (approx. 10 g), the glutathione reserves of the liver are depleted and the quinonimine reacts with constituents of liver cells. As a result, the cells are destroyed liver necrosis. Liver damage can be avoided if the thiol group donor, N-acetylcysteine, is given intravenously within 6-8 h after ingestion of an excessive...

Clinical presentation

Eighty-five percent of patients with bacterial meningitis present with fever, headache, meningismus or nuchal rigidity, and altered mental status. Other common signs and symptoms include photophobia, vomiting, back pain, myalgias, diaphoresis, and malaise. Generalized seizures can occur in up to 40 of patients with ABM.

Temporal Arteritis See Polymyalgia Rheumatica

The primary manifestation of temporal arteritis is headache, although the major complication is acute, often irreversible visual loss. Polymyalgia rheumatica is the systemic form of temporal arteritis and has evolved separate diagnostic criteria, which are presented separately. Pathologically, biopsy of extracranial arteries (e.g., temporal artery) shows three major findings granulomas with giant cells, often near remnants of the internal elastic membrane nonspecific neutrophilic, eosinophilic, and lymphocytic infiltration of blood vessel wall intimal fibrosis.

Tetrodotoxic Fish Poisoning

Vectors All pufferfish (balloonfish, blowfish, fugu fish, globefish, swellfish, toadfish), porcupine fish, marine sunfish xanthid crabs, marine worms blue-ringed octopus bites skin secretions of some newts, frogs, and toads. Incubation 10-20 minutes. Symptoms Initial paresthesias, perioral burning, then salivation, headache, nausea and vomiting (diarrhea rare), sweating, glove and stocking paresthesias then numbness, tremor, ataxia, dysarthria, dysphagia, respiratory depression then paralysis, cardiovascular instability, stupor, and coma. Diagnosis Mouse bioassay, TLC, HPLC, gas chromatography mass spectrometry. Treatment Supportive protect airway, gastric lavage then AC-MDAC, IV fluids, vasopressors, and mechanical ventilation. Prognosis CFR 62 survivors will recover within 1 week of ICU care (not universally available, especially in developing world).

Miscellaneous Saltwater Fish Poisoning

Shark poisoning Consumption of cooked shark meat from large bull and tiger sharks has caused an initial ciguatera-like illness with perioral paresthesias, ataxia, and pruritus, then coma and death (increased CFR 30 ). Structure of two toxins (carchatoxins A and B) is unknown. Mackerel poisoning Mild, self-limited diarrhea after consumption of cooked mackerel species due to a castor oil-like toxin. Mackerel liver consumption has also caused a hypervitamin-osis-A-like syndrome with headache, nausea, vomiting, diarrhea, and a macular rash that later desquamates. A similar hypervitamin-osis-A-like syndrome occurs after polar bear liver consumption and may cause pseudotumor cerebri.

Experimental Disease Models

However, there are model of parts of the pathophysiology in animals and in humans.40 The essential issue is what is one trying to do If the question is to screen or evaluate new chemical entities (NCEs) for migraine, then basic animal studies are used. For exploration of identified questions in humans, there are now models of trigeminal function in humans that can allow, for example, dose selection for further clinical trials. A list of models is shown in Table 2. A case history example would be the development to proof-of-principle of the potential for adenosine A1 receptor agonists in the acute treatment of migraine (see Section

Clinical Trial Issues

The methods for doing clinical trials in migraine have been largely set out. The International Headache Society (IHS) has provided guidelines41 that evolved with the sumatriptan development program.42 In general terms, for acute attack treatments, since patients seek rapid, quick, and prolonged relief of pain, the primary endpoint of the 2 h painfree Table 2 Models of aspects of migraine pathophysiology experimental animal or human headache Measurement of nociceptive-specific blink reflex Allows classic pharmacology and receptor characterization but will not address unmet needs in primary headache such needs include nonvascular treatments Screen for pharmacology of peripheral trigeminal transmission with a high false-positive rate48 Useful for identifying neuronal targets for inhibiting trigeminal nociceptive

Current Treatment

The management of migraine may be divided into three parts. First, the diagnosis, which rests on a careful clinical history and neurological examination.4 Second, after an explanation of what can and cannot be done, and particularly advice about lifestyle in the context of migraine as an episodic, probably ionopathic disorder. Third, physicians can offer preventive treatment to reduce the attack frequency and severity, or acute attack treatment for individual attacks. Preventive Treatments for Migraine A simple rule for frequency might be that for 1-2 headaches a month there is usually no need to start a preventive, for 3-4 it may be needed but not necessarily, and for 5 or more a month, prevention should definitely be on the agenda for discussion. Options available for treatment4 vary somewhat by country in the European Union and again compared to North America. The largest problem with preventives is not that there are none, but that they have fallen into migraine from...

Unmet Medical Needs

The greatest unmet need in migraine is a broader recognition of the biological basis of the problem. It remains true after the decade of the triptans, 1995-2005, that the majority of migraine sufferers in the western world, and certainly the developing world, still do not access best-practice care. If diagnostic rates in most of the world reflect those of the US, where nearly 50 of migraine sufferers do not have the diagnosis made,65 and only a minority are treated with migraine-specific treatments, the opportunity to do good is huge. Any medicine development needs to bear this in mind. Having said that, the obvious need in acute treatment is a purely neuronally acting treatment that has no vascular side effects this would be a major opportunity given the perceived cardiac safety issues with triptans.66 A drug with less recurrence, i.e., a greater 24-h sustained painfree response, would also be most welcome by the fully one-third of migraineurs who suffer headache recurrence the...

African devils claw Grapple plant Harpagophytum procumbens Pedaliaceae

Devil's claw or grapple plant derives its name from the formidable claw, the dried hooked thorns of the fruit used in seed dispersal, which are a hazard to any passing cloven-hoofed animal or careless human. The plant is native to southern and eastern Africa and it is collected in regions bordering the Kalahari Desert. It thrives in clay or sandy soils and is often found in parts of the South African veldt. The tubers are traditionally used as a tonic, for illnesses of the blood, fever, problems during pregnancy, and kidney and bladder ailments. Since the mid-1980s and with considerable research effort, African devil's claw has been developed into a very successful and relatively well-characterized phy-tomedicine for the treatment of pain relief in joint diseases, back pain, and headache. Most pharmacological and clinical research has been conducted on standardized extracts. The secondary storage tubers are collected and, while they are still fresh, they are cut into small pieces and...

Subarachnoid Hemorrhage

Subarachnoid Hemorrhage

Subarachnoid and intraventricular hemorrhage due to arteriovenous malformation (intracellular met-hemoglobin). A 48-year-old female presented with acute onset of severe headache had a CT scan 24 hours after the onset of symptoms (a), which shows diffuse subarachnoid (arrowhead) and intraventricular hemorrhage (arrows). Forty-eight hours after the onset of symptoms (b-g) she had an MRI.On this examination the T2-weighted image (b) showed intraventricular hemorrhage (arrows), which is hypointense when compared with the cerebrospinal fluid.The diffuse subarachnoid hemorrhage cannot be visualized on the T2-weighted image.The T1-weighted image (c) shows the intraventricular hemorrhage (arrows) as hyperintense when compared with cerebrospinal fluid,but neither sequence can visualize the subarachnoid hemorrhage. The FLAIR image (d), however, shows both the subarachnoid (arrowheads) and intraventricular hemorrhage (arrows). The subarachnoid hemorrhage cannot be visualized on the DW image (e),...

Feverfew Tanacetum parthenium Asteraceae

Feverfew has been used as a bitter tonic and an antipyretic (i.e., to reduce fever) for many centuries there was renewed interest in the plant in the 1990s as a potential treatment for migraines. Tanacetum parthenium is known in South America as Santa Maria and is an important species in

Pharmacologic Highlights

Teach the patient and significant others about the nature of this disorder and necessary self-assessments and self-care activities. Teach the patient to report any signs of petechiae and ecchymoses formation, bruising, bleeding gums, and other signs of frank bleeding. Encourage the patient to stand unclothed in front of a mirror once a day to check for areas of bruising. Headaches and any change in level of consciousness may indicate cerebral bleeding and, therefore, need to be reported to the healthcare workers immediately. Teach the signs and symptoms of blood loss, such as pallor or fatigue. Demonstrate correct mouth care for the patient and significant others by using a soft toothbrush to avoid mouth injury. Recommend electric shavers for both men and women. Teach the patient to use care when taking a rectal temperature to prevent rectal perforation. Recommend care when clipping fingernails or toenails. If any bleeding does occur, instruct the patient to apply pressure to the area...

Background Information

Protein kinases can be assayed using two types of substrate, intact proteins or synthetic peptides, and there are advantages and disadvantages to the use of each. A number of intact proteins may be used as general protein kinase substrates, and those in common use are available in relatively pure form from a number of manufacturers at reasonable prices. The main disadvantage to the use of proteins as substrates is the lack of specificity, sometimes making interpretation of experimental data difficult. Intact proteins such as myelin basic protein (MBP) contain many different phosphorylation sites. MBP can be phosphorylated by MAP kinase, some protein kinase C isoforms, and Ca2+ calmodulin kinase II, each at one or more sites. Hence, it is often impossible to differentiate which kinase is responsible for phospho-rylating MBP in a complex mixture like a whole cell lysate. Some proteins cause headaches because they cannot be used with simple experimental protocols, e.g., casein.

Trigeminal Nucleus Caudalis


Migraine Migraine is a periodic headache often accompanied by nausea and sensitivity to light and noise (photophobia and phonophobia). A typical attack consists of a prodromal phase of warning (premonitory) symptoms, followed by an aura, the actual headache phase, and a resolution phase. Attack characteristics often change over time. Attacks often tend to occur in the morning or evening but may occur at any time. They typically last 4-72 hours. Prodromal phase. The migraine attack may be preceded by a period of variable prodromal phenomena lasting a few hours to two days. Most patients complain of sensitivity to smells and noise, irritability, restlessness, drowsiness, fatigue, lack of concentration, depression, and polyuria. In children, the chief complaints are abdominal pain and dizziness. Aura. This is the period preceding the focal cerebral symptoms of the actual migraine headache. Some patients experience attacks without an aura (common migraine), while others have attacks with...

Clinical manifestation

Acute pulmonary infection usually asymptomatic with symptomatic disease, fever, headache, malaise, myalgia, abdominal pain, and chills with exposure to large inoculum, severe dyspnea may occur nonspecific signs of infection erythema nodo-sum and erythema multiforme occsional joint pain and infiltrated papules in the skin

Ginger Zingiber officinale Zingiberaceae

Ginger is one of the world's most commonly used culinary spices. The medicinal use of ginger has an ancient history and can be traced back to Greek and Roman times. In Indian medicinal practice the plant has been mentioned in religious scriptures dating back to 2000 bc. The rhizome of the plant is used and is best recognized in Ayurvedic medicine as an aid to digestion and to treat rheumatism inflammation. Trikatu ( three spice ) is an example of an Ayurvedic remedy containing ginger, used to improve digestive and respiratory function, which also contains black pepper (Piper nigrum) and Indian long pepper (Piper longum). Across the world ginger is a popular food additive to aid digestion. Some of its more unusual uses are to promote hair growth (Japan), treat nerve disorders (India), and as an aphrodisiac (Cuba, Yemen). Ginger is acknowledged in Ayurveda to be effective against nausea and neurological dysfunction. Ginger consumption has also been reported to have a beneficial effect...

Secondary Sleep Disorders

Secondary Sleep Disorders

Sleep can be impaired by dementia, Parkinson disease, dys-tonia, respiratory disturbances secondary to neuromuscular disease (muscular dystrophy, amyotrophic lateral sclerosis), epilepsy (nocturnal attacks), and headache syndromes (cluster headaches, migraine). Fatal familial insomnia is a genetic disorder of autosomal dominant inheritance (p. 252). Sleep disorders due to systemic disease. Sleep can be impaired by pulmonary diseases (asthma, COPD), angina pectoris, nocturia, fibromyalgia, and chronic fatigue syndrome.

Miscellaneous Venomous Hydroids and Jellyfish

Mauve stinger Pelagia noctiluca yellow-to-luminescent pink jellyfish contact causes initial blisters that heal slowly with hyperpigmenta-tion. Systemic toxicity with weakness, headache, nausea, vomiting possible. Topical-like anesthetics more effective for pain than topical antihistamines and corticosteroids.

Selective serotonin reuptake inhibitors SSRIs

Of the very limited comparative clinical data available, a meta-analysis of 20 short-term comparative studies of five SSRIs (citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline) showed no difference in efficacy between individual compounds but a slower onset of action of fluoxetine. The most common adverse reactions to the SSRIs, according to FDA and MHRA websites, were gastrointestinal (especially nausea) and neuropsychiatric (particularly headache, tremor, discontinuation reactions, and sexual dysfunction Table 7).

Early Subacute Hematoma

Hematoma Edema

Acute to early subacute hemorrhage (deoxy-hemoglobin and intracellular met-hemoglobin). A 49-year-old man with headache and aphasia was referred for MR imaging 24 hours after the onset of symptoms (a-e).This study shows a left temporal lobe lesion that is hypointense on the T2-weighted image (a) (arrow deoxy-hemoglobin and intracellular met-hemoglobin) with surrounding edema. On the Tl-weighted image (b) the lesion is heterogeneous with areas of hypointensity (arrow deoxyhemoglobin) and hyperintensity (arrowhead intracellular met-hemoglobin).The DW image (c) demonstrates hypointensity (arrow deoxy-hemoglobin and intracellular met-hemoglobin). The surrounding hyperintense rim (arrowhead) is a magnetic susceptibility artifact.This peripheral artifact is also seen around the hypointensity (arrow) created by deoxy-hemoglobin and intracellular met-hemoglobin on the b0 image (d). ADC cannot be calculated accurately, which is easy to understand when looking at the extremely heterogeneous...

Clinical Manifestations Of Dengue Infection

Dengue fever is characterized by sudden onset of fever, frontal headache, retro-orbital pain, general malaise, generalized myalgias and arthralgias, nausea, vomiting, and rash. One characteristic feature of dengue fever is the severity of body pain, which can be incapacitating and explains why the disease is sometimes called breakbone fever. Other nonspecific symptoms may be present, such as anorexia, mild conjunctival injection, diarrhea, pruritus, and changes in taste sensation. Leukopenia and thrombocytopenia are frequent, and liver enzymes may be mildly elevated. The febrile period lasts 5-7 days, but the patient may remain symptomatic for several more days. The disappearance of fever correlates with the disappearance of viremia. Convalescence may be marked by a period of lassitude. There have been reports of severe depression after the acute period of illness (4,5).

Dehydrogenases and reductases

Alcohol dehydrogenase (E.C. 1.1.1) (ADH)32 toxifies ethanol to acetaldehyde, which is then (predominantly) detoxified by an aldehyde dehydrogenase (E.C. 1.2.1) to acetic acid. The second step, the aldehyde dehydrogenase-mediated oxidation to acetic acid, is inhibited by disulfiram (Antabus), which is used in the treatment of alcohol addiction. After alcohol consumption disulfiram leads to the accumulation of the toxic acetaldehyde. The resulting toxicity provokes headache and nausea, which is intended to keep the alcoholic from further alcohol consumption. Many other aldehydes, such as the a,b-unsaturated aldehydes (lipid peroxidation products), are also markedly toxic. Thus, aldehyde dehydrogenase predominantly leads to detoxification. However, as is the case with all adequately investigated drug-metabolizing enzymes, aldehyde dehydrogenase plays a dual role with respect to toxification detoxification, the nature of which depends on the substrate in question. Methanol is metabolized...

White willow Salix alba and Salix spp Salicaceae

The genus Salix includes numerous trees and shrubs common in alpine ecosystems and along the margins of streams. The white willow, Salix alba, is a tree that commonly grows in areas periodically flooded along streams and lakes. Willow bark (known to pharmacists as Salicis cortex) is a European phytomedicine with a long tradition of use for treatment of chronic pain, rheumatoid diseases, fever, and headache, and one of its main compounds, salicine, served as a lead substance for aspirin (acetylsalicylic acid). Leonard Fuchs devotes a chapter in his New Kreutterbuch (1543), illustrated with three drawings of different species, to the various classes of willow. The leaves are reported to be good for treating some gastrointestinal complaints, and the bark to be useful for treating warts and corns. Acetylsalicylic acid is today used in a similar way. Fuchs's use of willow as a treatment for podagra (i.e., gout, especially of the big toe) mirrors modern uses in the treatment of a variety of...

Mescal bean Sophora secundiflora Fabaceae

Despite the use of mescal beans in Native American vision quests, none of these alkaloids are known to have hallucinogenic properties. Depending on the amount consumed and the method of preparation, mescal beans can cause a range of effects, from vomiting, headaches, and nausea to intoxication, stupor, and even death. Mescal beans are usually consumed in a decoction. Some 30 Native American peoples have made use of mescal beans, almost all of them using the beans for their decorative value less than half of them have used mescal for its psychoactive effects. Mescal beans have been found at archaeological sites dating back to 7,000 14C years ago, in Texas, New Mexico, and Mexico, where they may have been used for ornamental purposes.

Description Medical Nonmalignant Breast

Before breast symptoms occur, chills, fever, and tachycardia are present. Usually the infection is unilateral localized symptoms include intense pain, tenderness, redness, and heat at the infection site. In addition, the woman often feels as if she has the flu, with symptoms of muscular aching, fatigue, headache, and continued fever.

Clinical features

In the early stages, a painful chancre (rare in T b. gambiense infection), which originates as a papule and evolves into a nodule, may be found at the primary site of a tsetse fly bite. There may be fever, intense headache, insomnia, painless lymphadenopathy, anaemia, local oedema and rash. In the later stage there is cachexia, sleep disturbance and signs of central nervous system impairment. The disease may run a protracted course of several years in the case of T. b. gambiense. In the case of T. b. rhodesiense, the disease has a rapid and acute evolution. Both diseases are always fatal in the absence of treatment.

New Research Areas

Serotonin 5HT1B 1D receptor agonists, the triptans 7, and related 5HT receptor agonists, 9, 10, provided the most important advance in migraine therapeutics in the four millennia that the condition has been recognized. Simultaneously the development of triptans, with their vasoconstrictor action, produced a small clinical penalty in terms of coronary vasoconstriction and an enormous intellectual question the extent to which migraine is a vascular problem. Functional neuroimaging and neurophysiological studies have consistently developed the theme of migraine as a brain disorder and thus demand that the search for neurally acting antimigraine drugs should be undertaken. CGRP receptor blockade is an effective acute antimigraine strategy and is nonvasconstrictor terms of the mechanism of action. It is likely that direct blockade of CGRP release by inhibition of trigeminal nerves would be similarly effective. Options for such an action based on preclinical work include serotonin 5HT1F and...

Discharge And Home Healthcare Guidelines

In the bacterial form, bacteria enter the meningeal space and elicit an inflammatory response. This process includes the release of a purulent exudate that is spread to other areas of the brain by the cerebrospinal fluid (CSF). If it is left untreated, the CFS becomes thick and blocks the normal circulation of the CFS, which may lead to increased intracranial pressure (ICP) and hydrocephalus. Long-term effects of the illness are predominantly caused by a decreased cerebral blood flow because of increased ICP or toxins related to the infectious exudate. If the infection invades the brain tissue itself, the disease is then classified as encephalitis. Other complications include visual impairment, cranial nerve palsies, deafness, chronic headaches, paralysis, and even coma.

Gender Ethnicracial And Life Span Considerations

Migraine headaches generally begin in childhood or near puberty, affect females more than males, and continue episodically and with decreasing severity until middle age. It is uncommon for migraine headaches to occur throughout old age. Migraine headaches often increase in frequency during pregnancy in the first trimester for those who have experienced them before pregnancy. Oral contraceptives and hormone replacement therapy also increase the frequency of headaches. Migraine headaches have a higher prevalence among whites than among African Americans and Asian Americans.

Ketorolac tromethamine

Additional Side Effects CV Vasodilation, pallor. Oral Dry mouth, stomatitis. GI GI pain, peptic ulcers, nausea, dyspepsia, flatulence, GI fullness, excessive thirst, GI bleeding (higher risk in geriatric clients), perforation. CNS Headache, nervousness, abnormal thinking, depression, euphoria. Hypersensitivity Bronchospasm, anaphylaxis. Miscellaneous Purpura, asthma, abnormal vision, abnormal liver function.

Trigeminal Function and Pathology

Trigeminal neuralgia is the term given to the occurrence of intense pain, often in patients over 60 years, within one or more of the peripheral territorial divisions of the trigeminal system. The diagnosis involves the localization of the pain using a trigeminal sensory map this is useful in differentiating the pain from that involving, for example, the facial nerve. Infection of sensory nerve roots by herpes zoster causes painful shingles-like symptoms. In winter, inflammatory conditions cause nociceptive activity in afferents from the mucosa of the middle ear, larynx, pharynx, and pharyngotympanic tube. Dental pain is ascribed to nociceptive activity in trigeminal afferents, and frontal headache may be due to activation of trigeminal afferents activated by lesions distorting cerebral arteries.

Characteristics of the genus Shigella 14101 Introduction

Infections with Sh. dysenteriae almost always develop full and severe symptoms of dysentery. Similar symptoms, although often less severe, can also be associated with Sh. boydii and Sh. flexneri. Most adult infections by these species, however, and virtually all by Sh. sonnei do not progress beyond relatively mild, non-bloody diarrhoea. Symptoms may differ in young children and be of greater severity, possibly involving extraintestinal symptoms, including convulsions, headaches and delirium.

Finding Your Glomerular Filtration Rate

Too much water loading can lead to a severe headache, nausea, vomiting, and even convulsions. This problem tends to be self-perpetuating, because nausea and pain are powerful stimuli for the secretion of antidiuretic hormone. Thus the patient's discomfort, brought on by too much water loading and or by painful attempts to draw blood, may in itself make it difficult to urinate. Eventually, though, the water load is excreted and all symptoms disappear.

Amitriptyline hydrochloride

Action Kinetics Amitriptyline is metabolized to an active metabolite, nortriptyline. Has significant anti-cholinergic and sedative effects with moderate orthostatic hypotension. Very high ability to block serotonin uptake and moderate activity with respect to norepinephrine uptake. Effective plasma levels of ami-triptyline and nortriptyline Approximately 110-250 ng mL. Time to reach steady state 4-10 days. tV2 31-46 hr. Up to 1 month may be required for beneficial effects to be manifested. Amitriptyline is also found in Limbritrol and Triavil. Uses Relief of symptoms of depression, including depression accompanied by anxiety and insomnia. Chronic pain due to cancer or other pain syndromes. Prophylaxis of cluster and migraine headaches. Non-FDA Approved Uses Pathologic laughing and crying secondary to forebrain disease, bulimia nervosa, antiulcer agent, enuresis. Contraindications Use in children less than 12 years of age. How Supplied Injection 10 mg mL Tablet 10 mg, 25 mg, 50 mg, 75...

Characteristics of the genus Vibrio 14141 Introduction

V. parahaemolyticus causes a predominantly diarrhoeal syndrome. Typical symptoms are diarrhoea, abdominal cramps and nausea. Vomiting occurs in ca 50 of cases and there may be a headache. Mild fever and chills occur in ca 25 of cases. Onset is usually after 4-24 hours, although longer and shorter periods have been reported. Symptoms usually abate within 2-3 days and death is very rare. A second, more severe, dysenteric form has been described (Twedt, 1989), which is characterised by bloody, or mucoid, stools. Human pathogenicity of V. para-haemolyticus usually correlates with presence of direct, thermostable haemolysin activity (Kanagawa reaction). Kanagawa-negative strains can be a cause of diarrhoea, however, and are important outside tropical countries.

Obstetric And Developmental Effects

Indirect effects of maternal cocaine use include negative health consequences for mothers, which then impact their pregnancies. Women using cocaine are more likely to suffer arrhythmias, cardiac ischemias, and hemorrhagic strokes. In addition, they may develop pregnancy complications similar to preeclampsia, including hypertension, headaches, blurred vision, and placen-tal abruption, as well as vascular damage and uterine vasoconstriction, leading to problems such as spontaneous abortion and premature delivery (Church & Subramanian, 1997). Poor maternal weight gain and increased energy demands are another common effect of cocaine use in pregnant women, often leading to decreased birthweights and poorer prenatal nutrition (Church et al., 1991).

Characteristics of the genera Aeromonas and Plesiomonas

Symptoms of Pl. shigelloides infection appear within 24 to 48 hours and are predominantly diarrhoeal (94 ). Diarrhoea is accompanied by abdominal pain (74 ), nausea (72 ), chills (49 ), fever (37 ), headache (34 ) and vomiting (33 ). Recovery is usually within 1 to 9 days, but may be prolonged. Three types of diarrhoeal symptoms have been described, secretory, shigella-like and choleralike. Secretory diarrhoea is most common and can vary greatly in severity. The shigella-like type is also potentially severe, with symptoms of prolonged duration, while the cholera-type illness is very rare.

Yohimbe and Yohimbine

Limited studies have evaluated the effectiveness and safety of yohimbe for sexual disorders. Some studies indicate that yohimbe may be beneficial for erectile dysfunction in men and decreased libido in women. However, it has many serious side effects, including severely decreased blood pressure, abnormalities of heart rhythm (arrhythmias), heart failure, and death. Other side effects include insomnia, anxiety, tremor, high blood pressure, rapid heart rate, headache, nausea, and vomiting. The FDA has determined that yohimbe is not safe or effective and that it should not be available for over-the-counter use. Yohimbine, the active ingredient in yohimbe, is available by prescription in the United States.

Posterior Reversible Encephalopathy Syndrome

Toxic Encephalopathy Brain

Posterior reversible encephalopathy syndrome is a remarkably heterogeneous group of disorders, related to hypertensive encephalopathy, severe preeclampsia eclampsia, immunosuppressive drug or interferon neurotoxicity, uremia and thrombotic thrombocytopenic purpura 33 . The clinical symptoms are headache, altered mental status, seizures and visual loss. Posterior reversible encephalopathy syndrome is due to dysfunction of a cerebrovascular autoregulatory system, and a vasculopathy of small vessels, the arterioles. Brain perfusion is maintained by the autoregulatory system of the small arteries and arterioles that have myogenic and neurogenic components. Since the vertebrobasilar system and posterior cerebral arteries are sparsely innervated by sympathetic nerves, the occipital lobes and other posterior brain regions are susceptible to a breakthrough of the autoregulation in case of a sudden elevation of the systemic blood pressure. Endothelial damage, which can attenuate the myogenic...

Hydrocephalus Introduction

Hydrocephalus is the enlargement of the intracranial cavity caused by the accumulation of cerebrospinal fluid in the ventricular system. This results from an imbalance in the production and absorption of the fluid which causes an increase in intracranial pressure as the fluid builds up. Fluid may accumulate as a result of blockage of the flow (noncommunicating hydrocephalus) or impaired absorption (communicating hydrocephalus). As the head enlarges to an abnormal size, the infant experiences lethargy, changes in level of consciousness, lower extremity spasticity and opisthotonos and, if the hydrocephalus is allowed to progress, the infant experiences difficulty in sucking and feeding, emesis, seizures, sunset eyes, and cardiopulmonary complications as lower brain stem and cortical function are disrupted or destroyed. In the child, increased intracranial pressure (ICP) focal manifestations are experienced related to space-occupying focal lesions and include headache, emesis, ataxia,...

Medical Complications Direct Results of Cocaine

CNS manifestations of cocaine exposure include seizures, status epilep-ticus, cerebral hemorrhage, and transient ischemic attacks. Cocaine may produce hyperpyrexia through direct effects on thermoregulatory centers. Depression of the medullary centers may result in respiratory paralysis, and sudden death may be caused by respiratory arrest, myocardial infarction or arrhythmia, or status epilepticus (Cregler & Mark, 1986). Migraine-like headaches have been associated with cocaine withdrawal and may be linked to serotonin dys-regulation (Satel & Gawin, 1989). Rhabdomyolysis is a complication of cocaine use. When it is accompanied by acute renal failure, severe liver dysfunction, and disseminated intravascular coagulation, the fatality rate is high (Roth, Alarcon, Fernandez, Preston, & Bourgoignie, 1988).

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