Natural Treatments to Help With Migraine

The Migraine And Headache Program

In this simple program you'll learn: 5 Body balancing techniques that free your diaphragm to do its actual job of pumping fresh air into your lungs. This will ensure that your body will have enough resources to do what needs to be done including healing your headaches. Simple breathing technique that boost your oxygen level. In a few minutes of practice, your blood may carry 20% more oxygen to your brain. This can immediately reduce even the worst headaches. Other breathing exercises that spread the oxygen delivered to the brain evenly. The parts of the brain that are often highly oxygen deprived will finally receive fresh oxygen on a plate. Simple head muscle exercises that remove tension from the muscles around the head such as the the jaw, the tongue, the throat, and the eyes. These exercises can quickly relieve tension from the head and eliminate headaches in just a few seconds. New revolutionary neck exercise that removes tension from the neck. Tension in the neck muscles does not only block blood flow to the brain, but will also not support the veins in pumping the blood which is their actual function. Some people experience blast of energy rushing up to their head after doing this exercise. More here...

The Migraine And Headache Program Summary

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M Tension and Migraine Headaches

There is a wealth of outcome research demonstrating that these two disorders can be effectively treated with biofeedback techniques. For tension headaches, BFRT, with placements of the EMG sensors in the frontal location, combined with general relaxation techniques, such as PMR has been shown to be effective. Utilization of specific muscle feedback of the muscles of the face, neck, and cervical area has also proven effective. This author recommends the combination of frontal EMG feedback, PMR, and specific muscle feedback of the face, neck, and cervical area. The muscles selected for the feedback are determined by a dynamic EMG assessment. For biofeedback treatment of migraines the treatment of choice is finger temperature feedback combined with a relaxation technique, such as autogenic training. For those clients unresponsive to the finger temperature feedback, usually frontal EMG feedback will be effective. Based on the outcome research, biofeedback should be the treatment of choice...

Complications of Migraine

Status Migrainosus Previously, this condition was called intractable migraine or persistent (pernicious) migraine. It is distinguished as a migraine attack with the headache phase lasting more than 72 hr despite treatment. A headache-free interval of less than 4 hr may occur. Any episode of migraine, in any form of migraine, may evolve into an intractable, daily, continuous headache attack, unresponsive to standard treatments. The headache may be unilateral or global, pulsatile or pressure-like, or may have characteristics of both migraine and tension-type headaches. The headache progressively intensifies to a debilitating pain, accompanied by the usual characteristics of migraine. Typically, the associated nausea and vomiting are severe, leading to osmophobia, dehydration, refusal to eat, and prostration. The photophobia, phonophobia, and headache exacerbated by any movement forces the patient to remain in a dark and quiet room, unable to function at even a basic level. Some...

Cluster Headache Variant

These headache attacks are believed to be a form of cluster headache or CPH but do not meet their criteria. Cluster headache variant, originally described by Diamond and Medina, is a syndrome consisting of a triad of symptoms atypical cluster headaches, multiple jabs, and background continuous headache. The atypical cluster headache is irregular in location, duration, and frequency, occurring several times a day. Multiple jabs are sharp, variable, painful episodes, lasting only a few seconds and occurring several times a day. Background headaches are chronic, continuous, often unilateral, sharply localized and of variable severity, and have vascular features throbbing and exacerbated by physical exertion. The pathophysiology is unknown. The therapy consists of indomethacin or lithium.

Familial Hemiplegic Migraine

Familial hemiplegic migraine is an autosomal-dominant subtype of migraine with aura with strong penetrance. Approximately 55 of affected families can be linked to chromosome 19,15 on chromosome 1, and 30 are still to be determined. Joutel et al. found that familial hemiplegic migraine was linked to chromosome 19 in two large French pedigrees. The critical area was mapped to a 30-cm region of the short arm of chromosome 19p13.1. Familial hemiplegic migraine is due to missense mutation in a pore-forming human a1A subunit of neuronal P Q-type Ca2 + channels (CACNA1A). More than 15 missense mutations in the CACNA1A have been reported. P Q calcium channels are coupled to neurotransmitter release and expressed on soma and dendrites throughout the mammalian brain. How these mutations affect the functioning of the calcium channel is not well understood. Recent reports show calcium currents attributed to a1A channel mutations partially diminished, and, in some studies, increased in other...

Secondary Causes of Headache

SUBARACHNOID HEMORRHAGE Epidemiology SAH has an annual incidence of approximately 1 per 10,000 in the United States10 and represents 1 percent of all nontraumatic headaches seen in the ED.1 However, SAH accounts for up to a quarter of all sudden severe headaches.6 SAH occurs in young people, with a median age of 50 years. Mortality rates from SAH are high 50 percent of patients die within 6 months, and only 58 percent of survivors regain their premorbid neurologic state.22 Clinical Features At the time of presentation, almost half of patients with SAH have normal findings on neurologic examination, including normal vital signs, normal level of consciousness, and no neck stiffness.22 The headache of SAH is most commonly severe and of sudden onset, but it may also be more subtle. The most common location for the headache is occipitonuchal.8 Many presentations are atypical and may mislead the clinician. For example, sudden-onset intense neck pain may be mistakenly attributed to...

Headaches of Ocular Origin

Headache is rarely due to the eye, with the exception of obvious ocular pathology. Photophobia, associated with migraine, is rarely caused by diseases of the eye, eye muscles, or the optic nerves. Reading, eye strain, eye muscle imbalance, or refractive errors are rare causes of headache.

Vascular Headaches A Migraine

By definition, migraine is an idiopathic, recurring headache disorder manifesting in attacks lasting 4-72 hr (untreated or unsuccessfully treated), usually unilateral location, of pulsating quality, and of moderate to severe intensity that may inhibit or prohibit daily activities. Pain is aggravated by routine physical activity and is associated with nausea and or vomiting, photophobia, and phonophobia. History, physical, and neurological examinations do not suggest a secondary headache due to other disorders. Migraine is an inherited neurological condition. A parental history can be obtained in 50-60 of patients with migraine. The form of inheritance has not been identified, although some genetic studies suggest an autosomal-dominant type in familial hemiplegic migraine. For the more frequent types of migraine, genetic influence is less clear. Migraine has a marked impact on the economy and society. Surveys show that 8 of men and 14 of women miss all or part of a day of work or...

Other Forms of Migraine

Migraine with prolonged aura, perviously termed complicated or hemiplegic migraine, is characterized by one or more aura symptoms lasting more than 60 min and less than 1 week. Any of the various forms of aura may occur. This type of migraine is relatively rare. The headache usually starts within 1 hr of aura onset, becomes progressively more intense, and may linger for a prolonged period. Different forms of aura can be experienced at the same time. The intensity of the pain is usually less than that in the more common types of migraines. The aura persists into the headache stage and may continue after the pain subsides. The typical clinical features of the headache are the same with this complicated form of migraine. The etiology or mechanism of migraine with prolonged aura and related symptoms is unclear. It has been assumed that a neurological deficit of longer duration is caused by prolonged vasoconstriction or limited spasm of a cerebral artery occurring as a part of the migraine...

Tensiontype Headache

Tension-type headache was previously known by several terms muscle contraction headache, stress headache, ordinary headache, essential headache, psychogenic headache, or psychomyogenic headache. It is defined as recurrent episodes of headache lasting minutes to days. There are two primary forms episodic and chronic. The pain is bilateral, with pressing or tightening (nonpulsating) quality of mild-to-moderate severity. The headache is not aggravated by routine physical activity. Photophobia or phonopho-bia may be present, and nausea may occur in the chronic form. The episodic type has been experienced by almost everyone, is usually relieved by over-the-counter analgesics, and does not require a physician's intervention. The chronic type is daily or almost daily, and the victim is prone to dependency problems with analgesics, tranquilizers, or sedatives. The prevalence in the general population ranges from 30 to 80 . The 1-year prevalence of episodic tensiontype headaches is about 55 in...

Investigation of the ED Headache Patient

COMPUTED TOMOGRAPHY SCANNING The ED patient whose headache requires emergent investigation usually begins with a noncontrast computed tomography (CT) scan.4 The use of contrast material increases the time, expense, and risk of adverse effects (minor 10 percent, severe 0.1 percent), 5 and the noncontrast CT scan usually adequately excludes critical lesions or mass effects requiring emergent interventions. In particular, the noncontrast CT scan is the best neuro imaging test for diagnosing an acute SAH, but CT scan cannot rule it out. When there is strong suspicion of small lesions likely to be missed without contrast (e.g., in an AIDS patient suspected of cerebral toxoplasmosis or suspected small brain mass), then a CT with contrast material may be needed. 5 MAGNETIC RESONANCE IMAGING The cost and restricted availability of magnetic resonance imaging (MRI) limit its utility in the emergency investigation of headache. MRI is more sensitive than CT in evaluating brain injuries, such as...

Post Lumbar Puncture Headache

If a patient complains of headache following a lumbar puncture, it is probably related to a loss of CSF secondary to leakage through a dural defect. The headache is often exacerbated in the upright position and relieved with recumbency. The pain has been described as a dull ache that may become throbbing. The headache onset starts within hours to days after the procedure and may persist for 2 to 3 weeks. The symptoms usually subside spontaneously. Prevention is the key and the use of smaller needles has been recommended to decrease the incidence of these headaches. Treatment of the post-lumbar puncture headache consists of bed rest in the horizontal position. A blood patch to stop the leak may be beneficial.

Primary Headache Syndromes

The term primary headache includes all forms of migraine, tension-type, and cluster headaches. There is considerable clinical overlap in primary headache syndromes, and it has been suggested that they share a pathophysiology and represent different ends of a clinical spectrum. 7 MIGRAINE Epidemiology Migraine headaches are common, with onset usually in the early teens or even younger. Prevalence is estimated at approximately 5 percent for males and 15 to 17 percent for females.2 Prevalence peaks in both sexes at around 40 years of age and then gradually declines. Pathophysiology Early theories postulated abnormal vasculature as the root cause of migraine headaches, with vasoconstriction being responsible for the aura and rebound vasodilatation the cause of the pounding headache. It now seems clear that migraines are a primary response of brain tissue to some trigger, while the disordered activity of blood vessels is secondary. Pain-sensitive intracranial structures, such as blood...

TABLE 2291 Considerations for Nonenhanced Head CT for Headache

Headache associated with unexplained fever is also an indication for neuroimaging, particularly when there is associated meningismus and photophobia. Although diagnosis is made by lumbar puncture, imaging is typically recommended to exclude hydrocephalus. Despite the absence of scientific validation, it has become the standard of care to precede lumbar puncture with nonenhanced head CT (NECT). Secondary hydrocephalus tends not to obviate performing lumbar puncture, but it will lead the physician to performing a low-volume lumbar puncture. Further, it can alert the physician to the possible need for shunt placement. Acute or recurrent hydrocephalus can present with headache as well as nausea, incontinence, and ataxia. There is generally an increase in the intraventricular volume. Hydrocephalus can be caused by a number of processes including prior subarachnoid hemorrhage, prior trauma, meningitis, masses obstructing the ventricular system, or masses external to the ventricles but...

Migraine and headaches

Occasionally foods with a high content of tyramine, such as cheese, coffee, red wine and yeast extract, are responsible for migrainous headaches.19 In some patients the association is obvious and these patients usually avoid these foods. In other cases of chronic headache, once other treatable causes have been excluded, a diet excluding foods with high tyramine content may be tried. However, double-blind challenges are often unsuccessful in confirming a relationship of foods with headaches.

Epidemiology And Comorbidity A Migraine Prevalence

Migraine is a highly prevalent condition affecting approximately 10 of the population. Migraine prevalence is age, gender, and race dependent. Women are more affected (lifetime prevalence, 12-17 ) than men (4-6 ). In the American Migraine Study, the 1-year prevalence of migraine increased with age among women and men, reaching the maximum at ages 35-45 and declining thereafter. Migraine prevalence decreases in older women but never decreases to prepubertal or even male prevalence. Migraine prevalence is influenced by race and geographical region. It is highest in North America and Western Europe and more prevalent among Caucasians than African or Asian Americans. The influence of environmental and genetic factors varies. Migraine without aura is influenced by a combination of genetic and environmental factors, whereas migraine with aura has a stronger genetic influence. Behavioral, emotional, and climatologic changes may trigger migraine, modify the vulnerability to migraine, or...

Comorbidity of Migraine

The term comorbidity refers to the greater than coincidental association of two conditions in the same individual. Migraine is comorbid with many disorders (Table I). This can alert clinicians to identify them. Comorbid illness impacts pharmacologic treatment of migraine headache. One drug may be useful for more than one disease (i.e., valproate and topiramate may be therapeutic for both migraine and epilepsy). On the other hand, some treatments may be contraindicated in certain comorbid illnesses. Beta-blockers should be avoided in patients with migraine and depression. Careful attention to a drug's effect on comorbid conditions optimizes health care use and may improve patient's quality of life.

Migraine without Aura

The headache is characterized by episodes of head pain lasting 4-72 hr and having at least two of the following characteristics pulsatile quality, moderate to severe intensity, unilateral location, and worsening with physical activity. To fulfill the IHS criteria for migraine, headache must also have occurred on at least five occasions and have been accompanied Migraine with Aura Diagnostic Criteria 4. Headache follows aura with a free interval of less than 60 min

Migraine with and without Aura

Migraine has a strong genetic component. In a Danish population-based survey of migraine using IHS criteria, the sex- and age-standardized risk of suffering from migraine with aura and migraine without aura among first-degree relatives was 1.9 (95 CI, 1.6-2.2) and 1.4 (95 CI, 1.0-1.8), respectively. This suggests that migraine without aura is caused by a combination of genetic and environmental factors, whereas migraine with aura is more heavily influenced by genetic factors. Proposed modes of inheritance for migraine include autosomal-recessive inheritance for migraine with aura and sex-linked transmission, multifactorial, or autosomal-recessive inheritance for migraine without aura. Russell's epidemiology study, which included a segregation analysis of migraine with and without aura, found that both entities have multi-factorial inheritance. This analysis cannot detect genetic heterogeneity and therefore cannot exclude a mitochondrial or Mendelian pattern of inheritance. Migraine is...

TABLE 2194 Emergency Department Treatment Options for Migraine Headache

Dexamethasone has been touted as effective in reducing the rate of recurrent migraine following standard treatment. 2 In one ED-based RCT, patients received either 20 mg intravenous dexamethasone or placebo after standard migraine therapy. A significant reduction in the rate of 48- to 72-h recurrent migraine was found in the dexamethasone group as compared to the placebo group.19 Special mention is reserved for the use of opioid analgesics in migraine. Meperidine is still used as an acute migraine treatment despite several studies that have shown it to be less effective than other agents.20 The frequent use of opioids in chronic and recurrent headache conditions may lead to adverse effects, and may even exacerbate headaches.20 While some patients may require opioid analgesics, the preferred treatment is one of the numerous, more effective alternatives to opioids. 2 Pregnant Women Migraines generally improve during pregnancy, especially after the first trimester. Nonpharmacologic...

Migraine

Pregnancy usually improves classic migraines. However, when migraines do occur, they are difficult to treat, because ergot alkaloid should not be used and there has been little experience with the use of sumatriptan in pregnancy. Treatment therefore rests upon the use of analgesics and antiemetic agents. Acetominophen, codeine, and meperidine have all been shown to be safe for use in pregnancy.

Headache

Headsche Zone

Headache tops the list of common scourges of mankind. It is so common that everybody suffers from it at some time or another. When the problem becomes chronic and recurrent, life becomes miserable. Medicines and 'over-the-counter' pills worth millions of rupees are purchased every year by the victims of headache. However, none of them is absolutely safe, especially when consumed over a prolonged period. Common causes and features of headache have been tabulated below. Victim admits to be facing unfavourable circumstances and of possessing a worrying nature. Headache is usually mild and may be located anywhere front, top or back of the head. Mild pain in the forehead, occuringonly after the eyes have been used, for hours together, in tasks requiring a lot of concentration. Headache is relieved if eyes are rested for a while. 4 Migraine Vascular headache, usually affecting one half of the head cause is unknown but some consider it psychological. Pain is very severe and many a time...

Migraines and Cheese

Migraines, also called vascular headaches, are thought to involve blood vessels in the brain, although the exact cause is unknown. Some cheeses contain a naturally occurring compound called tyramine, which, in susceptible people, can cause an increase in blood pressure, an increase in the size of blood vessels in the brain, and headache pain. For people who take drugs called monoamine oxidase inhibitors (MAOIs), avoidance of all foods containing tyramine including aged cheeses is essential. foods, aged cheeses have the highest tyramine content. The amount of tyramine in cheeses differs greatly because of the variations in processing, fermenting, aging, degradation, or even bacterial contamination. The following types of cheeses are aged or have been reported to be high in tyramine and should be avoided if you are susceptible to migraines or if you take MAOIs

Headaches

The next disorder we will focus upon involves headaches. Headache is ubiquitous and is always one of the top five reasons why people visit doctors. Headaches are classified by various schemes, but, most simply, they can be viewed as involving migraine headache, tension headache, cluster headache, and trigeminal neuralgia. Migraine headache in its various manifestations can involve unilateral or bilateral headache that is usually associated with a prodrome (preceding the headache) or codrome (occurring with the headache) of nausea, vomiting, photosensitivity-photophobia, and alterations in mood. Its etiology is not fully known, but it is now thought to involve excessive serotonergic activity due to histamine-induced release of 5HT from mast cells in the vertebrobasilar arterial system. In this model, the excessive serotonergic activity results in alternating constrictions and relaxation of vascular structures, which, with repetition, result in vasospasm. The vasospasm is thought to be...

Migraine with Aura

The migraine aura is a recurrent neurologic symptom that develops gradually (in more than 4 min) and persists for less than 1 hr. Headache, nausea, and or photophobia usually follow within 60 min after resolution of the aura but may not necessarily develop (acephalgic migraine). Visual aura is most frequently reported (99 ), followed by sensory (31 ), aphasic (18 ), and motor aura (6 ). The stereotypical visual aura is a serrated arc of scintillating, shining, crenelated shapes that begins near the point of fixation and Diagnostic Criteria for Chronic Migraine A. Daily or almost daily (> 15 days month) headache for > 1 month B. Average headache duration of > 4hr day if untreated History of episodic migraine meeting any IHS criteria History of increasing headache frequency with decreasing severity of migrainous features over at least 3 months Headache at some time meets IHS criteria for migraine 1.1-1.6 other than duration D. Does not meet criteria for new daily persistent...

Sinus Headache

Sinus headache is an often cited complaint of many patients, although the acute headache due to actual sinusitis occurs less frequently than the rate quoted by the advertising media. Acute sinusitis presents with fever, pain triggered by pressure or direct percussion, and headache. Fever is the cardinal sign of this infective process. The pain associated with sinus diseases is a constant, dull ache. If the patient is suffering from acute sinusitis, the headache will typically increase in intensity as the day progresses. To confirm the diagnosis, sinus X-rays or sinus CT should be performed. Treatment consists of antimicrobial therapy and decongestants.

Chronic Migraine

Under the term chronic migraine, or transformed migraine, we propose to include all cases of chronic daily headache with features of a both migraine and tension-type headache that do not meet criteria for new daily persistent headache or hemicrania continua. Table V proposes criteria for chronic migraine. The typical patient is a woman with a past history of episodic migraine who develops a daily or almost daily headache that is mild to moderate in severity, with superimposed typical migraine attacks. The associated symptoms, such as phonophobia, photophobia, nausea, and vomiting, often become less severe and frequent. Many patients with chronic migraine overuse analgesics, triptans, and ergots, leading to increased frequency of headaches, some of them in the context of withdrawal from acute medication the so-called rebound headache. Rebound headache leads to the consumption of more analgesics, creating a vicious cycle. Patients benefit from a detoxification treatment, thereby...

Cluster Headache

This form of vascular headache has been known as histaminic cephalalgia, Horton's headache, migrai-nous neuralgia, sphenopalatine neuralgia, petrosal neuralgia, red migraine, Raeder's syndrome, Sluder's syndrome, erythromelalgia, and Bing's erythroproso-palgia. The defining characteristic of cluster headaches is their occurrence in cycles (clusters) that occur and disappear spontaneously. There are two forms of cluster headache episodic and chronic. The majority of patients with cluster headaches experience the episodic form, in which the headache cycles or series last for several weeks or months and then may disappear for years. For those unfortunate few with the chronic form, headache remission is briefer than 14 days, or the cycle of headaches is continuous, without any headache-free intervals.

Clinical Features

The signs and symptoms of hypercapnia depend on the absolute value of Pa co2 and its rate of change. Acute elevations result in increased intracranial pressure, and patients may complain of headache, confusion, or lethargy. With severe hypercapnia, seizures and coma can result. Extreme hypercapnia can result in cardiovascular collapse, but this is usually seen only with acute elevations of Pa co2 to over 100 mmHg. As opposed to acute hypercapnia, chronic hypercapnia, even over 80 mmHg, may be well tolerated.

Clinical Presentation

The majority of SICH patients present with a decreased level of consciousness or coma. Other common symptoms include headache, nausea, and vomiting. More focal signs vary depending on location. a. Cerebellar Cerebellar hemorrhages present with varying degrees of altered consciousness, headache, ipsilateral gaze palsy, and ipsilateral ataxia. Hemiparesis and hemisensory disturbances are uncommon. If the hematoma extends into the fourth ventricle, patients often present with hydrocephalus. Large hematomas are particularly dangerous because of their propensity to cause herniation and compression of the nearby brain stem. Mortality rates are high for patients who are comatose at presentation.

TABLE 791 Vomiting and Diarrhea The Gastroenteritis Mnemonic

Second, determine what symptoms accompany the vomiting. Is the patient febrile Fever could point toward an infectious or inflammatory source, or it could represent a toxicologic cause, such as salicylate intoxication. Is there associated abdominal pain, back pain, headache, or chest pain that may point to a specific cause Pancreatitis, cholecystitis, peptic ulcer disease, appendicitis, and pelvic inflammatory disease typically cause abdominal pain. Back pain usually accompanies aortic dissections, rupturing aortic aneurysms, pyelonephritis, and renal colic. Vomiting is one of the signs of increased intracranial or intraocular pressure and may be a foreboding sign in patients complaining of headache. Finally, the complaint of vomiting associated with chest or epigastric pain might suggest a diagnosis of myocardial ischemia. In female patients, obstetric and gynecologic causes of vomiting should always be considered. In a pregnant woman, epigastric pain and vomiting accompanying...

Clinical Significance

Migraine Cycle

Frequently, Balantidium infections can be asymptomatic however, severe dysentery similar to those with amoebiasis may be present. Symptoms include diarrhea or dysentery, tenesmus, nausea, vomiting, anorexia, and headache. Insomnia, muscular weakness, and weight loss have also been reported. Diarrhea may persist for weeks or months prior to development of dysentery. Fluid loss is similar to that observed in cholera or cryptosporidiosis. Symptomatic infections can occur, resulting in bouts of dysentery similar to amebiasis. Colitis caused by Balantidium is often indistinguishable from E. histolytica (Castro et al, 1983). Diarrhea, nausea, vomiting, headache, and anorexia are characteristic of balantidiasis.

NonST Segment Elevation Myocardial Infarction Nstemi and Unstable Angina

-Morphine sulfate 2-4 mg IV push prn chest pain. -Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn headache. -Lorazepam (Ativan) 1-2 mg PO tid-qid prn anxiety. -Zolpidem (Ambien) 5-10 mg qhs prn insomnia. -Docusate (Colace) 100 mg PO bid. -Ondansetron (Zofran) 2-4 mg IV q4h prn N V. -Famotidine (Pepcid) 20 mg IV PO bid OR -Lansoprazole (Prevacid) 30 mg qd.

Neurologic Complications

Central nervous system (CNS) disease occurs in 90 percent of patients with AIDS, and 10 to 20 percent of HIV-infected patients initially present with CNS symptoms.17 Neurologic disease is caused by a variety of opportunistic infections and neoplasms as well as the direct and indirect effects of HIV infection on the CNS. Common presenting symptoms indicative of CNS pathology include seizures, altered mental status, headache, meningismus, and focal neurologic deficits. 17 Emergency department evaluation should include a complete neurologic examination and, when appropriate, computed tomography and lumbar puncture. Specific CSF studies that may be of value include opening and closing pressures, cell count, glucose, protein, Gram stain, India ink stain, bacterial culture, viral culture, fungal culture, toxoplasmosis and cryptococcus antigen, and coccidioidomycosis titer. Even if the emergency department evaluation is unrevealing, all patients with new or changed neurologic signs or...

Zoonotic Encephalitis And Meningitis

Zoonotic encephalitis is most often transmitted hematologically as an arboviral infection with an arthropod vector and animal host. Often the vector is a mosquito or tick and the animal host is a small animal or bird. The one exception is rabies, which follows peripheral nerve tracts after inoculation from an infected animal's bite. Additionally, encephalitis may be seen in the nonviral zoonotic infections of Bartonella henselae, Brucella canis, borreliosis, Coxiella burnetii, Ehrlichia sp., listeriosis, leptospirosis, Lyme disease, RMSF, psittacosis, and toxoplasmosis.1 ,29,30 The presentation is one of a prodromal illness with malaise, myalgia, fever and, occasionally, parotiditis. This prodromal phase advances to a sudden decline in mental status associated with headache and fever. Prompt recognition and therapy of encephalitis is important, given the high morbidity and mortality rates. However, it is significant to recognize that there are no pathognomonic signs and symptoms that...

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.

Transmission by water or food viral gastroenteritis

Everybody must surely be familiar with the symptoms of gastroenteritis - sickness, diarrhoea, headaches and fever. The cause of this gastroenteritis may be bacterial (e.g. Salmonella) or viral. The major cause of the viral form is the human rotavirus , which, together with the Norwalk virus, is responsible for the majority of reported cases. The rotavirus has a segmented, dsRNA genome, and is a non-enveloped virus.

Other Tropical Diseases

Malaria is endemic in tropical America, Africa, and some Asian countries. Cerebral malaria is an acute encephalopathy, which occurs only with infection by Plasmodium falciparum.41 Clinically, cerebral malaria presents itself with fever, headache, delirium and confusion progressing to coma. Despite appropriate treatment, cerebral malaria carries a mortality of 22 .42 Generalized seizures occur in 40 of adult patients and in most children. Epilepsy has long been recognized as a late sequel of cerebral malaria.41 Pathological examination of the brain in fatal cases has shown severe vasculopathy with hemorrhages, and granuloma of Durck formed by astroglial reaction.42 These lesions may act as epileptogenic foci in those who survive, giving rise to chronic epileptic seizures. A special relationship has been described between cerebral malaria and febrile convulsions. Together they may lead to 5 of pediatric emergency consultations in endemic areas such as central Africa and the Amazon...

Autonomic Dysreflexia

Autonomic dysreflexia is dramatic paroxysmal hyperactivity of uninhibited sympathetic and parasympathetic nerves in children with spinal cord lesions proximal to thoracic level 6. It is caused by stimulation below the level of the lesion by bladder overdistention, fecal impaction, skin breakdown, or fractures. Presentation is sweating, flushing, pounding headache, hypertension, bradycardia, and piloerection above the level of the lesion. Death or cerebral vascular accident may result. 17

Water Soluble Vitamins

Side effects are associated with large therapeutic doses of niacin. Nicotinic acid in large doses (100 to 300 mg oral or 20 mg intravenous) can result in vasodilative effects. Symptoms include flushing reaction, cramps, headache, and nausea. Therapeutic levels of niacin have been used successfully to reduce serum cholesterol, but with other reversible side effects such as pruritis, desquamation, and pigmented dermatosis. On the other hand, high doses of nicotinamide (used to therapeutically treat niacin deficiency) have no side effects. Nicotinamide does not lower serum cholesterol.

Clinical Conditions in Adolescents

DYSMENORRHEA AND MITTELSCHMERZ Primary dysmenorrhea is defined as painful menstruation during ovulatory periods, in the absence of pelvic disease. This significant problem, which may cause 5 to 10 percent of women to miss school or work, occurs shortly after menarche and is most severe in young, nulliparous women. The crampy lower abdominal midline pain of primary dysmenorrhea is secondary to progesterone-mediated myometrial contractions and arteriolar vasospasm. The pain precedes menstrual flow by 12 to 24 h and subsides after menses begins. In severe cases, cramps may be associated with nausea, vomiting, back pain, headache, and irritability. Dysmenorrhea can be relieved with antiprostaglandin therapy (NSAIDs). The OCP should be used as a second-line therapy. Pelvic ultrasound or laparoscopy may be helpful in the assessment of patients with uncertain diagnoses or with pain that does not respond to therapy. Secondary or acquired dysmenorrhea occurs later in life and is associated...

Standard Industrial Classification Manual

When one is in a grocery store, one is faced with an incredible selection of processed foods. For food manufacturers, this illustrates only one point the amount of research and development that precedes their marketing. For regulatory agencies such as the Food and Drug Administration and the Department of Agriculture, this confirms the amount of work needed to assure the safety and whole-someness of these products. However, for some other federal agencies, this poses an entirely different headache. For example, the Department of Labor (DOL) and the Environmental Protection Agency (EPA) must classify and give a name to each establishment that manufactures each product in order to enforce their legal mandates. To them it is a huge logistic nightmare. For example, the DOL must have access to a record of the number of employees suffering injuries in each type or category of food processing plants. To fill this need, the executive branch of the government has developed the Standard...

Neurologic Syndromes of High Altitude

Until recently, most neurologic events at high altitude were attributed to HACE or AMS. Clearly, this has been a diagnostic oversimplification. Other syndromes now recognized as related to high altitude include altitude syncope, cerebrovascular spasm (migraine equivalent), cerebral arterial or venous thrombosis (infarct), transient ischemic attack, and cerebral hemorrhage. These syndromes are characterized by more focal neurologic findings than in cerebral edema, though differentiation in the field may be impossible.

The Anger Episode Model

Models Anger

Private experiences may consist of thoughts about the importance of retaliation, images of harming others, or physiological arousal unseen by others. Adults high on the trait of anger seem to experience anger episodes of greater intensity and longer duration than do low-trait-anger adults. The most common physical sensations associated with anger are muscle tension, rapid heart rate, headache, and upset stomach.

Bleeding Complications

The emergency physician needs to be aware of major bleeding emergencies that can develop in patients with hemophilia. These patients require emergent factor replacement therapy and management by hemophilia specialists. Air transport to specialized centers should be considered for intracranial, intrathoracic, or intraabdominal bleeding, even if the patient appears stable. Bleeding into the central nervous system (CNS) can occur spontaneously as well as with trauma. Any patient with hemophilia who complains of a new headache or any neurologic symptoms requires immediate factor replacement therapy followed by immediate computed tomographic (CT) scanning of the head. Spontaneous or traumatic bleeding into the neck, retropharynx, or pharynx has a high potential for airway compromise. Such bleeding can be spontaneous or precipitated by successful or unsuccessful placement of external jugular lines or other trauma. These patients require immediate factor replacement and immediate CT scanning...

TABLE 2156 Estimated Risk of Infection Transmission via Blood Products 1998

HYPERVOLEMIA The transfusion of PRBCs or plasma results in the rapid expansion of intravascular volume. Such expansion may not be well tolerated by patients with limited cardiovascular reserve, particularly infants and elderly patients. Patients may complain of headaches and shortness of breath on examination, they will have signs of congestive heart failure. Treatment consists of slowing the rate of infusion and diuresis of the patient. As a general guide, infusions in adults are at a rate of 2 to 4 mL kg h. This can be slowed to 1 mL kg h in patients at risk of fluid overload.

Using Clinical Data to Guide Decision Making

With the clinical data compiled in the history and physical examination, patients may be classified according to the ACEP groupings ( Ta.bIe,.219.-.2.). Patients suspected of having critical secondary causes of headache should undergo emergent investigations, as outlined below, and have appropriate treatment initiated. Those suspected of benign and reversible secondary causes should undergo diagnostic tests if required and have treatment initiated, generally as outpatients. The largest group of ED headache patients have assessments that suggest a benign primary headache syndrome, and the objective for these patients is to provide effective therapy. Appropriate follow-up should be ensured for all discharged patients. Outpatient investigation and referral may be required, especially in cases such as poorly controlled primary headache syndromes or occasionally a patient with a suspected critical secondary cause not needing emergent investigation (e.g., suspected brain tumor without...

Central nervous system

Clinically postinfectious encephalomyelitis begins abruptly with symptoms and signs that point to damage chiefly of the white matter of the brain and spinal cord. Headache and delerium at onset may give way to lethargy and coma. Seizures at onset are frequent. There may be neck stiffness and fever. Focal signs may be superimposed, spinal cord involvement with limb paralysis being the most frequent. The spinal fluid shows an increased protein content and sometimes a lymphocytic pleocytosis. Mortality is 20 , and half the survivors have residual deficits. The illness does not recur. Administration of high doses of glucocorticoids every 4-6 h is the treatment of choice. Anti-phospholipid antibodies, strokes, epilepsy and migraine Antibodies to phospholipid are seen in 25 of systemic lupus erythematosus cases. They also occur sporadically. Phospholipid-specific antibodies bind to and activate platelets. This leads to vascular thromboses which, when they occur in the CNS, cause strokes....

Sickle Cell Disease

Stroke occurs by age 20 in over 10 percent of patients with sickle cell anemia and is the most common cause of ischemic stroke in children. The risk is inversely proportional to age, with the highest incidence noted between ages 2 and 5. Symptoms are similar to those in patients without sickle cell disease and range from brief TIAs to hemiparesis, depending on the vascular territory involved and duration of ischemia. Cerebral aneurysms also occur with increased frequency in patients with sickle cell anemia, and careful evaluation for SAH is mandated for patients presenting with headache and neurologic findings.

Alcohol Abuse and Alcohol Related Problems

There is ample justification for ambivalence about alcohol. Even while appreciating the many benefits derived from some of kinds of drinking, one may realistically fear the harms or risks that are associated with others. Recent studies suggest that intoxication is often highly correlated with a wide range of alcohol-related problems, ranging from headaches and hangovers to absenteeism at school or work from generalized aggression to spouse or child abuse, including homicide, suicide, illnesses, accidents, and fetal alcohol effects. Drinking and driving is of speical concern because its consequences affect not only the driver but also others on the road. Specifically, a blood-alcohol concentration of over 0.10 can realistically be viewed as risky at any given time, and chronic drinking at that level tends to be injurious to the body.

Seizures in Pregnancy

When a woman beyond 20 weeks of gestation develops seizures in the setting of hypertension, edema, and proteinuria, her condition is referred to as eclampsia. Attention should be paid to signs and symptoms associated with eclampsia such as headache, blurry vision, confusion, hyperreflexia, and epigastric pain. Rarely, eclampsia may occur up to eight weeks postpartum.

Posterior Communicating Artery PCA Aneurysm

Acute cranial nerve III palsy with ipsilateral pupillary dilation is a PCA aneurysm until proven otherwise. Concomitant headache is a frequent but not absolute finding. Expansion of an aneurysm of the posterior communicating artery frequently causes compression of the outer fibers of CN III. The pupillomotor fibers are located in the outer portion of CN III therefore the pupil becomes dilated on the affected side (see Fig.230-19). These patients require emergent blood pressure reduction, neuroimaging, and neurosurgical consultation.

Mitochondrial Encephalomyopathy Lactic Acidosis and Strokelike Syndrome

Migraine-like headaches are part of the clinical spectrum of MELAS, a well-characterized genetic disorder. MELAS is an inherited mitochondrial disease, resulting from different point mutations in the mitochondrial DNA. Most common is an A-to-G point mutation in the mitochondrial gene encoding for tRNA Leu(UUR) at nucleotide position 3243. Other point mutations occur at codons 3271 and 3252. Several studies analyzing the mitochondrial DNA in peripheral blood from migraine with and without aura patients have consistently failed to show an association between the commonly studied point mutations or deletions in mitochondrial DNA and migraine. In a Japanese study, 26 of migraine patients showed an A-to-G mutation in the coding region for the ND4 subunit of the respiratory complex I. Thus, migraine as a monosymptomatic expression of a defined mito-chondrial cytopathy seems rare.

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy

Approximately one-third of CADASIL patients have migraine early in life with prolonged visual, sensory, motor, or aphasic aura. Recurrent strokes occur between 30 and 50 years of age secondary to a generalized arteriopathy. The arteriopathy develops slowly, resulting in destruction of smooth muscle cells and thickening and fibrosis of the walls of small and medium-sized penetrating arteries with consequent narrowing of the lumen. Multiple lacunar infarcts, Whether the appearance of aura symptoms early in the course of CADASIL is related to changes in the Notch 3 gene or merely reflects the proximity of the Notch 3 gene to the familial hemiplegic migraine gene defect remains to be clarified.

Differential Diagnosis

The primary headache disorders, such as migraine, tension-type headache, and cluster headache, are those in which headache represents the primary symptom of a physiological disorder. These disorders do not have identifiable gross microscopy pathology. The secondary headache conditions are those in which the headache represents a symptom of a pathological organic process. Some conditions, such as severe hypertension, withdrawal syndromes, or cerebral venous thrombosis, may mimic benign disorders such as migraine. The importance of accurate and timely diagnosis cannot be overestimated because a delay in appropriate treatment may in certain settings result in death or permanent neurological injury. Depending on the temporal profile of presentation of headaches they can be divided into sudden, abrupt, onset headaches, which should be assumed to be the result of an acute neurological event subacute onset headaches, in which the symptoms appear over minutes, hours, or days and insidious...

Suggested Reading

G., Di Gennaro, G., D'Onofrio, M., Ciccarelli, O., Santorelli, F. M., Fortini, D., Nappi, G., Nicoletti, F., and Casali, C. (2000). mtDNA A3243G MELAS mutation is not associated with multigenerational female migraine. Neurology 54, 1005-1007. Diener, H. C. (1999). Efficacy and safety of intravenous acetylsa-licylic acid lysinate compared to subcutaneous sumatriptan and parenteral placebo in the acute treatment of migraine. A doubleblind, double-dummy, randomized, multicenter, parallel group study. The ASASUMAMIG Study Group. Cephalalgia 19, 581588. Dooley, M., and Faulds, D. (1999). Rizatriptan A review of its efficacy in the management of migraine. Drugs 58, 699-723. Haan, J., Terwindt, G. M., Maassen, J. A., 'tHart, L. M., Frants, R. R., and Ferrari, M. D. (1999). Search for mitochondrial DNA mutations in migraine subgroups. Cephalalgia 19, 20-22. Landy, S. H., and McGinnis, J. (1999). Divalproex sodium Review of prophylactic migraine efficacy, safety and dosage, with...

Recovery Curves And Treatment

The first and most obvious risk factor for poor recovery is greater severity of injury and related neurological physiological dysfunction. A complicated mild head injury defined by positive neuroima-ging findings or a high probability of axonal shear strain injury (based on documented loss of consciousness, posttraumatic amnesia, and or retrograde amnesia) places a patient in a high-risk category for slow and poor recovery. Other factors, such as pain (e.g., headache and back and neck trauma), depression, stress, sleep disturbance, poor premorbid health, and cognitive abilities, previous head injuries, psychiatric disorders, substance abuse, advanced age, poor social support systems, inadequate information about mild head injury recovery, and pending litigation, can all contribute to a patient's individual vulnerability to and risk for poor outcome. Given the complexity of these factors, and the previously mentioned neurocognitive deficits that may accompany these injuries, a...

Case presentation 2 continued

Your patient is treated with daily INH and vitamin B6. She increasingly complains of tiredness and headaches, and difficulty concentrating on her university studies. After 5 months, she has decided that she will not continue with treatment. You convince her to complete 6 months of therapy, which you know to be an acceptable alternative to the full 9 months recommended by the CDC, and she agrees to this. You emphasize to her that treatment for latent TB infection is imperfect and that a small chance of future TB remains. You recommend that, should she ever develop symptoms compatible with TB, she will need to be investigated for this. You estimate that her baseline lifetime risk of TB reactivation was up to 5 , and following treatment, you have reduced this risk to 2 or less.

Inappropriate Antidiuretic Hormone Secretion

Inappropriate antidiuretic hormone secretion (IADHS) may occur in a variety of diseases, including malignancies, acute and chronic pulmonary diseases, central nervous system and endocrine disorders, acute psychosis, and surgical stress. It can be induced by drugs such as phenothiazines, cyclophosphamide, vincristine, thiazides, morphine, carbamazepine, and cisplatin. IADHS may accompany certain malignancies, particularly small-cell lung carcinoma, head neck carcinomas, brain tumors, and lymphomas. The symptoms of IADHS syndrome include anorexia, nausea, headache, confusion, with the possible end result being coma. Laboratory findings include serum hyponatremia, elevated urinary sodium concentrations with normal renal and adrenal homeostasis. Few cases of prostate cancer associated with IADHS syndrome have been reported, and tumors were either poorly differentiated or small cell carcinoma and were almost uniformly metastatic at the time of diagnosis. Most of the patients died a few...

Intracranial vascular disease

The patient complains of a sudden very severe headache the like of which they have never experienced before. They may then lose consciousness (coma-producing haemorrhage) or remain unwell without going into coma (non-coma producing) approximately 20 die immediately or very soon after the haemorrhage. The survivors develop meningism due to the blood passing into the spinal subarachnoid space meningism causes painful stiffness of the neck and lumbar region, which worsens with movement, and must not be confused with spinal pathology (see Chapter 20). Patients may develop neurological deficit either from the site of the aneurysm (e.g. a 3rd nerve palsy from an aneurysm of the internal carotid artery) or from ischaemia resulting from spasm of the major vessels and or narrowing or occlusion of more distal vessels within the cerebral substance.

Airborne transmission strep throat

Streptococcal pharyngitis, commonly known as strep throat, is one of the commonest bacterial diseases of humans, being particularly common in children of school age. The primary means of transmission is by the inhalation from coughs and sneezes of respiratory droplets containing Streptococcus pyogenes (p-haemolytic type A streptococci), although other routes (kissing, infected handkerchiefs) are possible. The primary symptoms are a red and raw throat (and or tonsils), accompanied by headaches and fever. S. pyogenes attaches to the throat mucosa, stimulating an inflammatory response and secreting virulence factors that destroy host blood cells. Although self-limiting within a week or so, strep throat should be treated with penicillin or erythromycin as more serious streptococcal diseases such as scarlet fever and rheumatic fever may follow if it is left untreated.

Clinical Features Acute Overdose

The signs and symptoms of MAOI toxicity are often nonspecific. Even in its most severe form, it can resemble numerous other conditions (see below). Most clinical overdose information has come from single case reports or case series, with tremendous variation in presentation. Hence, there is no typical presentation to MAOI toxicity nor is there an orderly progression of symptoms. The clinician should anticipate the rapid development of life-threatening symptoms in all MAOI overdose patients. The initial symptoms of MAOI overdose are reported to include headache, agitation, irritability, nausea, palpitations, and tremor. The earliest signs of MAOI toxicity include sinus tachycardia, hyperreflexia, hyperactivity, fasciculations, mydriasis, hyperventilation, nystagmus, and generalized flushing. In cases of moderate toxicity, opisthotonus, muscle rigidity, diaphoresis, chest pain, hypertension, diarrhea, hallucinations, combativeness, confusion, marked hyperthermia, and trismus may become...

Meningococcal Meningitis

Neisseria meningitidis is part of the normal biota of the nasal cavity and throat in a fourth or more of the population, but these carriers show no symptoms of disease. For reasons not yet fully understood, these bacteria may invade the bloodstream and subsequently invade and colonize the meninges (the membranes that surround the spinal cord and brain). Early symptoms may include headache, fever, and vomiting, and death can quickly follow, due to the endotoxin produced (a toxin associated with the surface of the producing cells, usually gram-negative bacteria). Without proper care, the fatality rate can exceed 80 , but with treatment this can be reduced to below 10 .

Cyclic Vomiting Syndrome

Gastrointestinal disorders and intense abdominal pain, diarrhea, and fever also occur. The dehydration and electrolyte imbalance cause intense thirst and may be life-threatening. The child generally is well between attacks. Frequently, there is a familial history of migraine.

Acute Mountain Sickness AMS

CLINICAL PRESENTATION The diagnosis of AMS is based on the setting, symptoms, and physical findings. The setting is rapid ascent of an unacclimatized person to 2000 m (6600 ft) or higher. Typically, the person on arrival feels lightheaded and slightly breathless, especially with exercise. One to six hours later, but sometimes delayed for one day or more (and especially after a night's sleep), the typical symptoms of mild AMS develop they are similar to an alcohol hangover. The headache usually is described as bifrontal and worsened with bending over and the Valsalva maneuver. Gastrointestinal symptoms include anorexia, nausea, and sometimes vomiting, and the chief constitutional symptoms are lassitude and weakness. The person with AMS is often irritable and wants to be left alone. Sleepiness and a deep inner chill, also are common. If the illness progresses, the headache becomes more severe, and vomiting, oliguria, and increased dyspnea develop. Lassitude may progress to the victim...

African American Traditional Medicine

African Americans, the second largest minority in the United States, have a diabetes rate 33 greater than Whites (Tull & Roseman, 1995). The heterogeneous traditional medical system combines African healing, Civil War era medicine, West Indian Voodoo, fundamentalist Christianity, and European medical and anatomical systems (Snow, 1974). A fundamental belief is the direct connection between the forces of nature and health. Seasonal (e.g., phases of the moon) and natural climatic events as well as lucky numbers play a role in illness prevention, etiology, treatment, and prognosis. Health is considered to be good fortune and is part of God's plan but must include appropriate self-care of the mind, body, and spirit (Lieberman et al., 1996, 1999). Traditionally, the major causes of illness were (1) exposure to cold causing mucus and the clotting of blood that can lead to headache, hypertension, and stroke (2) dirt or germs leading to heat, fever, rashes, and inflammation (3) improper...

Break the data down into large numbers of subgroups and publish the one that produces a significant result

This trick works best where there are plenty of apparently logical reasons for subdividing the data and human data is ideal for this. Subdivide by gender, age, ethnicity, social class and disease status (or any combination of these) and when you find that your new treatment reduces blood pressure to a statistically significant extent among Caucasian, Protestant, males aged 35-55 who also suffer from migraine, then this is obviously the group upon whom we should especially focus.

Subarachnoid haemorrhage

Subarachnoid haemorrhage (SAH) is included here as an example of brain injury because misdiagnosis is common. It occurs in 6-12 per 100 000 per year and has a peak incidence around the age of 50 years. Headache is common, but studies have found that, if patients with the worst headache of their lives and a normal neurological examination only were considered, 12 had SAH. Neurological examination is often normal and in these cases, a third of patients are misdiagnosed in studies. These studies also show that misdiagnosis leads to worse outcome - 65 misdiagnosed patients rebled and rebleeding carries a 40-50 mortality. SAH commonly presents with a thunderclap headache - a distinct, sudden, severe headache. It need not be in any location neck pain or vomiting may predominate. The first episode of severe headache cannot be classified as migraine or tension headache (International Headache Society). The

Case presentation 2

A 64-year-old woman is brought to the emergency department by her daughter after a new onset seizure. The patient had been well until 48 hours prior when she had the abrupt onset of fever and headache. Over the next 2 days, she developed confusion and exhibited bizarre behaviour, and subsequently had a seizure. She has no significant past medical history. She takes no medications and does not use alcohol, tobacco, or drugs. The season is spring. The patient is retired and spends most of her time indoors and has not travelled recently. Her daughter recalls no animal exposures. On physical examination, she has a temperature of 38-9 C, a pulse of 100 beats per minute, and a blood pressure of 140 64 mmHg. She is minimally responsive, without nuchal rigidity or focal neurologic findings. Her Glasgow Coma Scale score is 8. A serum white blood cell count is normal. A CT scan of the head reveals no intracranial mass lesions. Evaluation of CSF demonstrates a leukocyte count of 500 cells mm3...

Herpes Zoster Shingles

Immunocompromised patients have an increased risk of disseminated disease. This can be recognized clinically by evidence of the rash involving more than a single dermatome or crossing the midline. Disseminated disease may occur in patients with skin lesions limited to a single dermatome. Patients with disseminated disease may develop pneumonitis, hepatitis, meningoencephalitis, or other organ system involvement and should be admitted for IV acyclovir. Immunocompromised patients with shingles without evidence of dissemination can be treated as outpatients with oral acyclovir at the standard dosing, with instructions to return if the rash spreads or if they develop respiratory symptoms, headaches, or other signs of organ system disease. Close follow-up with their primary care provider is recommended.

Oral contraceptive pills OCPs suppress LH and FSH

Danazol (Danocrine) has been highly effective in relieving the symptoms of endometriosis, but adverse effects may preclude its use. Adverse effects include headache, flushing, sweating and atrophic vaginitis. Androgenic side effects include acne, edema, hirsutism, deepening of the voice and weight gain. The initial dosage should be 800 mg per day, given in two divided oral doses. The overall response rate is 84 to 92 percent. Headache, nausea, hypertension

Traumatic Brain Injury

Since the 1980s, Margaret Ayers has reported several studies successfully using NF to bring patients out of long-standing coma states and, in some instances, to help those with stroke and traumatic brain injury (TBI) return to premorbid levels of function. Several NF clinicians such as Daniel Hoffman and Steven Stockdale have published evidence that the majority of TBI clients undergoing NF treatment report improvement in cognitive functioning, headaches, and or ability to relax along with significant normalization of EEG. Whereas these reports often have been considered incredible by mainline medicine, they seem less surprising in view of scientific evidence for nerve regeneration or neural reorganization and recovery of neurological function even in older adults. Given the fact that strokes, TBI, and other neurological disorders (depending on age, location of injury, etc.) can

Severe preeclampsia

Delivery should be initiated, after a course of antenatal corticosteroid therapy if possible, when there is poorly controlled, severe hypertension, eclampsia, thrombocytopenia (less than 100,000 platelets microL), elevated liver function tests with epigastric or right upper quadrant pain, pulmonary edema, rise in serum creatinine concentration by 1 mg dL over baseline, placental abruption, or persistent severe headache or visual changes. Fetal indications for delivery include nonreassuring fetal testing, severe oligohydramnios, or severe fetal growth restriction (less than the 5th percentile).

Tranquilizer Rescinnamine

Catharanthus and Vinca alkaloids, usually discussed together, are quite distinct. The most important alkaloids of the Catharanthus genus are vincaleukoblastine, leurocris-tine, and leurosine, all antileukemic agents. Vincaleukoblastine and leurocristine are used clinically. The most important alkaloid of Vinca is vincamine, used to treat hypertension, angina, and migraine headaches. Alkaloids of this type produce marked hypotensive effects and curare-like action. The ethers of vincaminol are potent muscle relaxants. Ergot alkaloids (Eorgonovine, ergotamine, ergosine, ergocristine, ergocyptine, ergocornine, ergosinine, ergocristinine, etc) Barley, rye (contaminated from ergot produced by the fungi Claviceps paspali and C. pupurea) Uterine stimulation, analgesic for migraine headache Headache (man), hypotension (man, mammals) LD506 (mouse, intraperitoneal) 12.7 g kg, LDa (monkey, intravenous) 52 mg kg Vasoactivity, musculotropic (rabbit) intestinal and uterine contraction (rabbit,...

Viral Hemorrhagic Fevers

The clinical symptoms in the early phase of a VHF are very similar irrespective of the causative virus and resemble a flu-like illness or a common enteritis. Headache, myalgia, gastrointestinal symptoms, and symptoms of the upper respiratory tract dominate the clinical picture. Hepatitis is also common. Therefore, especially in the early phase, virological testing is of utmost importance in diagnosis. The late phase of a VHF is more specific and characterized by organ manifestations and organ failure. Hemorrhage, the hallmark of a VHF, is present only in a fraction of patients depending on the virus species or even virus strain. Mild and subclinical courses seem to occur in all hemorrhagic fevers. However, if the disease is symptomatic, the case fatality ranges between 5 and 30 , but may be as high as 80 in Ebola fever.

Immobilization Hypercalcemia

Most cases of immobilization hypercalcemia are seen in adolescent boys following recent spinal cord injuries. 16 Risk factors include age less than 21 years, complete neurologic injuries, cervical injuries, prolonged immobilization, and dehydration. 16 Presenting symptoms include anorexia, nausea, headache, malaise, and depression in mild cases. In more severe cases, patients may have persistent nausea and vomiting, gastric dilatation, fecal impaction, and abdominal pain. Microscopic calcium deposition in the kidney may impair its ability to concentrate urine, leading to polyuria and polydipsia. Patients may also develop cardiac dysrhythmias and seizures.16

Effects of Radiation Exposure on Humans

The Chronic Radiation Syndrome (CRS) was defined as a complex clinical syndrome occurring as a result of the long-term exposure to total radiation doses that regularly exceed the permissible occupational dose by far (2-4 Sv year). Clinical symptoms are diffuse and may include sleep and or appetite disturbances, generalized weakness and easy fatigability, increased excitability, loss of concentration, impaired memory, mood changes, headaches, bone pain, and hot flashes. The severity of delayed effects depends on dose. These delayed effects may include cancer, cataracts, non-malignant skin damage, death of non-regenerative cells tissue, genetic damage, impact on fertility, and suppression of immune functions.

The Course of Infectious Diseases

The incubation period is superseded by the prodromal period, which lasts from several hours to several days. The first symptoms of the disease develop during this period. These symptoms are, e.g. headache, malaise, slightly elevated body temperature, myalgia, loss of appetite, catarrh, gastrointestinal dysfunction, and the like. A correct final diagnosis cannot be established at this stage.

Adaptive Dose Designs

An example of a group-sequential, adaptive, placebo-controlled up and down designs was published by Hall et al. in 2005 (37), wherein the objective was to test mechanism of action for a drug for migraine headache and to select a dose range for later clinical trials. This design (Fig. 2A) was used, given a lack of information across a desired target dose range, small sample size, and to reduce exposure of patients to ineffective treatment. Adaptive dose selection was based on response rate of 60 that is observed with other drugs. If more than 60 of the treated patients in each sequential group responded favorably to the drug, a next lower dose was evaluated in the next sequential group and a next higher dose was tested if unfavorable. An adaptive stopping rule was

Pseudotumor Cerebri Idiopathic Intracranial Hypertension

Increased ICP, papilledema, normal cerebrospinal fluid, and normal CT MRI characterize pseudotumor cerebri. Most patients are 20- to 30-year-old obese women, although this condition can occur at any age. Patients complain of nausea, vomiting, headaches, and transient visual obscurations. They can develop CN VI paresis, causing horizontal diplopia (double vision on lateral gaze). A variety of conditions (pregnancy) and exogenous agents (oral contraceptives, vitamin A, tetracycline, nalidixic acid, and corticosteroid withdrawal or prolonged use) have been associated with this poorly understood disease. It can be self-limited, but the recurrence rate can be as high as 40 percent and permanent loss of visual field can occur. Treatment is aimed at weight reduction and use of diuretics. Serial lumbar punctures are

TABLE 342 Signs and Symptoms of Chronic Pain Syndromes

MYOFASCIAL HEADACHES AND TRANSFORMED MIGRAINE Myofascial headache is a variant of tension headache and is characterized by the presence of trigger points on the scalp constant, squeezing pain and occasionally shooting pain. Nausea, vomiting, neck pain, and neck tenderness may be present. It is important to differentiate this disorder from common tension headache because myofascial headache may benefit from referral for injection of trigger points. Transformed migraine is a syndrome in which classic migraine headaches change over time and develop into a chronic pain syndrome. One cause of this change is frequent treatment with narcotics.8 In this regard, patients who initially have vascular symptoms eventually have predominantly muscular symptoms nonthrobbing, squeezing, bandlike pain associated with muscle tenderness and tension. Nausea and vomiting or failure of oral antimigraine medications often prompts an ED visit.

False food allergy or pseudoallergy

These types of reaction outnumber the true immunologically mediated ones. Various clinical syndromes are also known to be induced by such reactions, for example chronic urticaria, anaphylactic shock, intermittent diarrhea and irritable bowel syndrome, migraines, rhinitis and asthma. Table 3 lists some of the substances and mechanisms implicated in false food reactions. Present in large amounts in some foods causes pulsatile headache and

Empirical Support For Biofeedback

Research during the late 1970s and 1980s focused on the use of biofeedback with adult populations for a variety of disorders. This literature base has been criticized for lack of scientific rigor. From the empirical studies that have been conducted with adults, biofeedback appears to be most useful in combination with other forms of biobehavioral interventions, most notably relaxation training. Specifically, support exists for the use of EMG biofeedback for tension headaches in combination with relaxation training. And, thermal biofeedback in combination with relaxation training appears to be effective in treating migraine headaches (Holroyd & Penzien, 1994). Empirical studies of biofeedback with pediatric populations became more prevalent during the past decade. Similar to adults, empirical research with children and adolescents supports the use of biofeedback as part of a package of cognitive-behavioral treatment. Biofeedback-assisted relaxation training has been found to be...

Therapeutic use of IFNa

Effects, including fever, headache, chills, fatigue, anorexia, leukopenia and thrombocytopenia. Despite their current limitations, IFNs are now well established as useful drugs. IFNa is the most widely used and has received approval in many countries, including Food and Drug Administration (FDA) approval in the US, for several clinical indications. Since 1986 it has been used as a therapy against haii v-cell leukemia. Significant regression of the cancer is observed in more than 90 of patients. Since 1988, IFNa has been successfully used as a therapy against diseases associated with human papillomavirus infection such as juvenile laryngeal papillomatosis and condyloma acuminatum. Since that same year it has also been used in the treatment of Kaposi's sarcoma in patients infected with HIV. Around 30 of the patients who reccive IFNa, however, withdraw from treatment because of side-effects associated with the high IFNa doses. In 1991, IFNa was licensed for the treatment of chronic...

Clinical Manifestations

Aneurysmal rupture normally gives rise to blood in and around the basal cisterns in the subarachnoid space (subarachnoid hemorrhage) but may hemorrhage into the ventricular system (intraventricular hemorrhage), brain parenchyma (intracerebral hemorrhage), or, rarely, the subdural space leading to subdural hemorrhage. This rupture presents clinically as the sudden onset of severe headache (often described as the ''worst headache of my life'') and is often associated with signs of meningeal irritation (such as nausea vomiting, meningismus, photophobia, and phonophobia). Aneurysmal SAH often occurs during straining or exertion, such as with exercise, intercourse, or a bowel movement. SAH may also lead Symptoms preceding the major SAH, such as atypical headaches or neck stiffness, have been ascribed to small hemorrhages and are termed ''sentinel leaks'' or ''warning headaches.'' These symptoms occur in as many as 70 of patients, leading about half of these patients to seek medical...

Epidemiology And Transmission

In developing countries, human Cryptosporidium infection occurs mostly in children younger than five-years old, with peak occurrence of infections and diarrhea in children less than 2 years of age (Bern et al., 2000, 2002 Bhattacharya et al., 1997 Mata, 1986 Newman et al., 1999). Frequent symptoms include diarrhea, abdominal cramps, vomiting, headache, fatigue, and low-grade fever (Nimri and Hijazi, 1994). The diarrhea can be voluminous and watery, but usually resolves within one to two weeks without treatment. Not all infected children have diarrhea or other gastrointestinal symptoms, and the occurrence of diarrhea in children with cryptosporidiosis can be as low as 30 in community-based studies (Bern et al., 2002 Xiao et al., 2001a). Even subclinical cryptosporidiosis exerts a significant adverse effect on child growth, as infected children with no clinical symptoms experience growth faltering, both in weight and in height (Checkley et al., 1997, 1998). Cryptosporidium-infected...

Richard M Suinn and Jerry L Deffenbacher

Anxiety management training (AMT) typically takes six to eight sessions after an assessment suggests that a self-managed relaxation approach is appropriate. It may take a few sessions longer if other emotions (e.g., anger) or psychophysiological disorders (e.g., tension or migraine headaches) are added to anxiety treatment goals. AMT can be conducted with individuals or in small groups. AMT is easily adapted to other distressing emotions and to physiological conditions associated with stress. For example, in applying AMT to anger, the training procedures remain the same, but the content of the scenes and homework focus on these emotions rather than on anxiety. In adapting AMT to tension headaches, stress-inducing scenes may be broader than anxiety, for other emotions may trigger tension headaches. Clients can also identify the early warning signs of headaches and apply relaxation skills when these cues are perceived.

Rocky Mountain Spotted Fever

Rocky Mountain spotted fever, a potentially fatal multisystem illness caused by Rickettsia rickettsii, is introduced to humans via the tick vector. Without adequate, timely management, the mortality rate increases to 50 percent. After introduction of the organism to body tissues, it disseminates via the blood stream and invades vascular endothelium causing a necrotizing vasculitis. Constitutional symptoms of fever, headache, and myalgias develop about one week after exposure. The rash in classic RMSF is evident 4 days (range 1 to 15 days) after the onset of fever and other symptoms. In a minority of patients, usually the adult, the rash is not noted during the entire disease course. This entity, Rocky Mountain spotless fever, occurs in approximately 15 percent of cases. After exposure to the organism, clinical infection develops usually within 3 to 4 days (range 2 to 10 days) and progresses rapidly to severe illness. The patient may complain of severe headache, sudden fever, altered...

Nature Of The Catecholaminergic Systems

In this condition urinary excretion of free catecholamines is also increased. The major clinical manifestations of this illness are high blood pressure, increased heart rate, sweating, rapid breathing, headaches, and the sensation of impending doom.

Other Vasculopathies

FMD affects the cervical arteries and occurs mainly in women. Fifty percent of patients present with multiple, recurrent symptoms due to cerebral ischemia or infarction. FMD has been reported to cause spontaneous dissection in young adults and subarachnoid hemorrhage. Twenty to 50 of patients with FMD are found to have intracranial aneurysms and patients may be at higher risk for carotid dissection, arterial rupture, and carotid cavernous fistula. The most common complaint from patients suffering from FMD is headaches, which are commonly unilateral and may be mistaken for migraines.

New Contraceptive Technologies

Norplant suppresses ovulation, and changes the female physiology to discourage pregnancy. For women who choose this contraceptive technique, it offers 100 percent compliance and effectiveness without the need to attend to individual acts of intercourse or to daily medications. There are some side effects and contraindications for use, including the possibilities of weight gain, headaches, and a general feeling of malaise. Implantation and removal remain expensive in the United States, costing between 500 and 750 (Planned Parenthood).

TABLE 1014 Laboratory Evaluation for Suspected Preeclampsia or Hellp Syndrome

All patients with a sustained blood pressure of 140 90 or greater and any symptoms that may be secondary to hypertension should be hospitalized. Patients with severe hypertension whose blood pressure is greater than 140 90, and who have epigastric or liver tenderness, visual disturbance, or severe headache are managed in the same way as patients with eclampsia, with administration of magnesium sulfate,12 antihypertensives as needed, and delivery of the fetus. The dose of intravenous magnesium sulfate is 4 to 6 g over 15 min followed by intravenous infusion of 1 to 2 g h. Reflexes and serum magnesium levels should be followed to

Complications Of Epidural Analgesia

Dural tap occurs in about 0.5 of obstetric epidurals. Once recognised, the management is straightforward. There should be no bearing down in the second stage of labour and there should be an elective forceps delivery. After delivery an epidural infusion should be set up with 0.9 saline or Hartmann's solution, and 1 litre infused over 24 hours. The patient should be reviewed daily by a senior member of staff. If the patient develops a postural occipito-frontal headache then this should initially be treated by encouraging oral fluids and by simple analgesia. Ibuprofen in regular doses is often effective. If the headache becomes incapacitating, an epidural blood patch should be offered. If accepted, this should be carried out with the minimum of delay. Infection or pyrexia will contra-indicate the technique. Under aseptic conditions a new epidural puncture is carried out and up to 20 ml of the patient's blood is injected into the epidural space. Further blood is sent for culture. To...

TABLE 1192 Standards for Tachypnea in Infants and Children

The clinical presentation may be suggestive of the etiologic agent. Two classic presentations have been described for pneumonia typical pneumonia and atypical pneumonia. Typical pneumonia is characterized by abrupt onset of fever, chills, pleuritic chest pain, and productive cough. Associated physical examination findings include high-grade fever, localized findings on chest examination, and a toxic appearance. Atypical pneumonia is characterized by gradual onset (over days) of headache, malaise, nonproductive cough, and low-grade fever. Associated physical examination findings may include wheezing, prolonged expiration, rhinitis, conjunctivitis, pharyngitis, and rash. The typical pattern is generally thought to be associated with a bacterial pathogen, and the atypical pattern is thought to be more characteristic of a viral infection however, significant overlap exists, and identification of a causal agent based on clinical presentation is not always reliable. 31 Typical clinical...

Food Intolerance and Allergy

Many people eat a variety of foods and show no ill effects however, a few people exhibit adverse reactions to certain foods. Food sensitivities refer to the broad concept of individual adverse reactions to foods. Food sensitivities are reproducible, unpleasant reactions to specific food or food ingredients. There are many types of adverse reactions to foods, e.g., hives, headaches, asthma, and gastrointestinal complaints. Food sensitivities can be divided into primary and secondary sensitivities (Table 10.1).

Cerebrovascular Disease

The Human Brain Harry Sieplinga

Hemorrhagic infarction is frequently the cause of elevations in ICP, but the contribution of cerebral edema has been controversial. Intracerebral hemorrhage presents with focal neurologic deficits, headache, nausea, vomiting, and or evidence of mass effect. The edema associated with intracerebral hemorrhage is predominantly vasogenic (Fig. 3), climaxing 48-72 hr following the initial event. Secondary ischemia with a component of cytotoxic edema may result from impaired diffusion in the extracellular space of the perihemorrhage region. Expansion of the hematoma volume or extension of edema may precipitate cerebral herniation. Figure 4 demonstrates uncal herniation that resulted from expansion of a hematoma. Other forms of hemorrhage, including hemorrhagic transformation of ischemic territories and subarachnoid hemorrhage, may be associated with edema that results from the noxious effects of blood degradation products. Cerebral venous thrombosis may lead to venous stasis and elevations...

Painless Visual Reduction Loss

GIANT-CELL ARTERITIS (TEMPORAL ARTERITIS) Giant-cell arteritis (GCA) is a systemic vasculitis involving medium-sized arteries in the carotid circulation and can include the aorta and its primary branches. GCA can cause a painless ischemic optic neuropathy with devastating visual consequences and rapid contralateral involvement if not diagnosed and treated promptly. Patients are generally over 50 years of age and frequently have a history of polymyalgia rheumatica. Women are more commonly affected than men. Symptoms may include headache, jaw claudication, myalgias, fatigue, fever, anorexia, and temporal artery tenderness. Up to 33 percent may have associated neurologic symptoms such as transient ischemic attacks or stroke. The patient can develop rapid and profound visual loss, with the contralateral eye becoming involved within days to weeks. The physical examination will frequently reveal an APD if the optic nerve circulation is involved. An elevated Westergren sedimentation rate is...

Alcohol and Facial Flushing

Genetic variations in ADH and ALDH may explain why particular individuals develop some of the pathologies of alcoholism and others do not. For example, up to 50 of Orientals have a genetically determined reduction in ALDH2 activity ('flushing' phenotype). As a result, acetaldehyde accumulates after ethanol administration, with plasma levels up to 20 times higher in people with ALDH2 deficiency. Even small amounts of alcohol produce a rapid facial flush, tachycardia, headache, and nausea. Acetaldehyde partly acts through cate-cholamines, although other mediators have been implicated, including histamine, bradykinin, prostaglandin, and endogenous opioids.

Dietary Sources High Intakes and Antimetabolites

The greatest interest, in pharmacological terms, has been centered around nicotinic acid, which has been shown to have marked antihyperlipidemic properties at daily doses of 2-6 g. Nicotinamide does not share this particular pharmacological activity. Large doses of nicotinic acid reduce the mobilization of fatty acids from adipose tissue by inhibiting the breakdown of triacylglycerols through lipolysis. They also inhibit hepatic triacylglycerol synthesis, thus limiting the assembly and secretion of very low-density lipoproteins from the liver and reducing serum cholesterol levels. Large doses of nicotinic acid ameliorate certain risk factors for cardiovascular disease for instance they increase circulating high-density lipoprotein levels. The ratio of HDL2 to HDL3 is increased by nicotinic acid there is a reduced rate of synthesis of apolipoprotein A-II and a transfer of some apolipoprotein A-I from HDL3 to HDL2. These changes are all considered potentially beneficial in reducing the...

Relief Is in the Active Site Cyclooxygenase Isozymes and the Search for a Better Aspirin

Each year, several thousand tons of aspirin (acetyl-salicylate) are consumed around the world for the relief of headaches, sore muscles, inflamed joints, and fever. Because aspirin inhibits platelet aggregation and blood clotting, it is also used in low doses to treat patients at risk of heart attacks. The medicinal properties of the compounds known as salicylates, including aspirin, were first described by western science in 1763, when Edmund Stone of England noted that bark of the willow tree Salix alba was effective against fevers, aches, and pains. By the 1830s, German chemists had purified the active components from willow and from another plant rich in salicylates, the meadowsweet, Spiraea ulmaria. However, salicylate itself was bitter-tasting and its use had some unpleasant side effects, including severe stomach irritation in some cases. To address these problems, Felix Hoffmann and Arthur Eichengrun synthesized acetyl-salicylate at the Bayer company in Germany in 1897. The new...

Characteristics of patients with food intolerance

In this key study Parker et al. showed that the group of adults with allergic-type symptoms were significantly more likely to suffer swelling and respiratory symptoms than the group with non-allergic complaints and negative skin prick tests. The group with non-allergy-mediated complaints reported significantly more non-specific problems such as neurological symptoms (headache, fainting, numbness), gastrointestinal symptoms (bloating and distension but not pain, vomiting or diarrhoea) and musculoskeletal symptoms (cramps and stiff joints).

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