How To Treat 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. Read more here...

The Migraine And Headache Program Summary


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The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this book are precise.

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Prophylaxis Of Migraine Headache

The first double-blind study investigating feverfew in migraine prophylaxis was published in 1985 and involved 17 patients who had been chewing fresh feverfew leaves on a daily basis (Johnson et al 1985). Therapeutic effect was maintained when capsules containing freeze-dried feverfew powder were continued, whereas those allocated placebo capsules experienced a significant increase in the frequency and severity of headache, nausea, and vomiting during the early months of withdrawal. Since then, numerous clinical studies have been conducted to determine the role of feverfew in the prevention of migraine headache. In 2000, Ernst and Pittler published a systematic review of six randomised, placebo-controlled double-blind trials of feverfew as a prophylactic treatment and concluded that the current evidence favours feverfew as an effective preventative treatment against migraine headache, and is generally well tolerated. Clinical note Migraine Migraine is a common episodic familial...


History of the Present Illness Quality of pain (dull, band-like, sharp, throbbing), location (retro-orbital, temporal, suboccipital, bilateral or unilateral), time course of typical headache episode onset (gradual or sudden) exacerbating or relieving factors time of day, effect of supine position. Age at onset of headaches change in severity, frequency awakening from sleep analgesic or codeine use family history of migraine. The worst headache ever (subarachnoid hemorrhage). Associated Symptoms Weakness, diplopia, photophobia, fever, nasal discharge (sinusitis) neck stiffness (meningitis) eye pain or redness (glaucoma) ataxia, dysarthria, transient blindness. Lacrimation, flushing, intermittent headaches (cluster headaches), depression.

Migraine Prevention

A case reported the use of ginger for the prevention of migraines (30). A 42-year-old woman suffered migraine with aura once or twice every 2 or 3 months for 10 years. Because the frequency and duration of migraine increased, the patient was prescribed 500-600 mg of powdered ginger to be taken at the onset of aura, then every 4 hours for the next 3-4 days. The patient reported some relief within 30 minutes of the first dose. Then she added uncooked fresh ginger to her diet. In a 13-month period, she reported only six migraines. These results should be confirmed in a double-blind, controlled trial.


An open-labelled trial investigated the effects of oral CoQ10 supplementation (1 50 mg day) over 3 months in 32 volunteers with a history of episodic migraine with or without aura. CoQ10 significantly reduced both the frequency of attacks and the number of days with migraine after 3 months' treatment (Rozen et al 2002). In 2005, Sandor et al investigated the effects of CoQ10 (300 mg day) taken over 3 months in 42 migraine subjects in a double-blind, randomised, placebo controlled study. 47.6 of CoQ10 treated patients responded to treatment compared with 14.4 for placebo, experiencing a (50 or less) reduction in migraine frequency (number Coenzyme Q10 307 frequency, headache days and days with nausea in the third treatment month and was well tolerated.

Nucleoside Analogs nukes NRTIs Mechanism of action

Nucleoside analogs are easy to take, and once-daily dosing is sufficient for most of these drugs. Overall tolerability is fairly good. Frequent complaints during the first weeks are fatigue, headache and gastrointestinal problems, which range from mild abdominal discomfort to nausea, vomiting and diarrhea. The gastrointestinal complaints are easily treated symptomatically.

Adverse Reactions

A systematic review of the herb's safety, published in 2005, analysed data from six electronic databases, postmarketing surveillance studies, spontaneous reporting schemes (including WHO), herbalist organisations and manufacturers (Daniele et al 2005). The review concluded that vitex is a safe herbal medicine and any adverse effects associated with its use tend to be mild and reversible. The most common adverse effects are nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritis and erythematous rash. Additionally, no drug interactions have been reported.

Safety Of Alphavirus Vectors

The pathogenicity of the alphavirus family varies significantly, but the three most commonly used vectors, SFV, SIN, and VEE, are considered only mild pathogens (1). There are descriptions of some SFV-related epidemics of febrile illnesses in the Central Republic of Africa (48). The typical symptoms of the infected individuals were fever and persistent headache. Some SIN and SFV strains have additionally showed strong neurovirulence and pathogenicity in young mice.

Overview of alphavirus structure and biology

There are over 25 identified members of the alphavirus genus, reviewed in references 4 and 5, many of which are geographically restricted despite the wide range of competent mosquito vectors and susceptible hosts. Alphaviruses are generally maintained in nature in cycles with different species of mosquitos, birds, or nonhuman mammals. However, viral zoonoses via mosquito vectors occur in humans with most of these viruses. These zoonotic infections can cause mild to significant morbidity and rare mortality in selected circumstances particularly in the very young and immunocompromised (5,7-13). Alphaviruses are capable of infection and proliferation in a wide range of tissues, including neuronal, glial, skeletal and smooth muscle, synovial, epidermal, brown adipose, lymphoid, and other mesenchymal tissues (5,14,15). This diverse tropism may explain a number of human clinical symptoms including the nearly ubiquitous myalgia and arthralgia associated with these viral zoonoses along with...

Invasive Fungal Sinusitis

These patients typically suffer from a longstanding history of upper respiratory allergies, asthma, and nasal polyposis. The disease can take months or years to progress and symptoms include the erosion of barriers separating the paranasal cavities, as well as adjacent structures such as the orbits, brain, and pituitary gland (Stringer, 2000). Additionally patients suffer from mycotic aneurysms, carotid artery ruptures, erosion of the maxillary floor which results in palatal degradation, and erosion of the cribriform plate which results in chronic headaches, seizures, and decreased mental status. Etiological agents found in clinical cases are the same as those in the noninvasive and the acute invasive forms (Schell, 2000).

Corrosion And Aerosol Mousses

Water quality is an important issue to address in minimizing the potential for aerosol-can corrosion. Unless you have a foolproof method for controlling corrosion in water containing mousse products, always use deionized or purified water Trace amounts of chloride ions can wreak havoc on an aqueous aerosol product, ensuring corrosion and leakage of the pressurized containers within months after production. There are many electronegative ions that can have a similar effect, the most common being anionic surfactants. Salt is sometimes added, or formed as a by-product during the preparation and isolation of surfactants and other formulation excipients. If there is an element of doubt as to the existence of chloride ions in a raw material for your mousse formulation, check with the manufacturer it could save you a lot of time and headaches

Epinephrine Adrenalin

Ped 0.01 mg kg SC q15 minutes for 2 doses then q4 hrs as needed. Clearance MAO COMT metabolism. Adverse effects may cause hypertension, dysrhythmias, headache, nervousness, nausea vomiting, myocardial ischemia dysrhythmias potentiated by halothane metabolic effects increases adipose tissue lipolysis, liver glycogenolysis, inhibits release of insulin.

Clinical Manifestations

Fever, headache, and cough may be the only symptoms. The presence of epistaxis, sinonasal ulceration or eschar, palatal eschar, proptosis, decreased vision, or facial swelling is alarming and suggestive of invasive disease (21). Rapid disease progression follows. Patients may initially report facial pain that progresses to facial anesthesia as trigeminal nerve invasion occurs. Once infection reaches the frontal lobes, mental status changes and obtundation ensues. Spread from the sphenoid sinus to the adjacent cavernous sinus is heralded by cranial nerve palsy or visual loss.

Signs and symptoms

Although there is a broad spectrum of PML symptoms due to the variety of localized areas of demyelination, the clinical signs and course of disease have several common characteristics. In addition to cognitive disorders, which may range from mild impairment of concentration to dementia, focal neurological deficits are very typical of PML. Mono- and hemiparesis are observed most frequently, as well as speech and even visual deficits. We have seen several blind patients with PML. These deficits may be isolated and initially present as discrete changes in coordination, rapidly leading to considerable disabilities. Epileptic seizures may occur. Loss of sensibility, fever or headache are rare and are usually more typical of cerebral toxoplasmosis.

Clinical Presentation

The most common manifestations of cerebral hemisphere dysfunction are headache and mental status changes. Other signs include confusion, dementia, seizures, and hemiparesis. Diplopia is the most common symptom of cranial nerve dysfunction with the cranial nerve VI being the most frequently affected, followed by cranial nerve III and IV. Trigeminal sensory or motor loss, cochlear dysfunction, and optic neuropathy are also common findings. Spinal signs and symptoms include weakness (lower extremities more often than upper), derma-tomal or segmental sensory loss and pain in the neck, back, or following radicular patterns. Nuchal rigidity is only present in 15 per cent of the cases 1-6 .

Acute Systemic Reactions Following Intravenous Bolus Heparin

ASR refers to a variety of symptoms and signs that characteristically begin 5-30 min after an intravenous heparin bolus is given to a patient with circulating HIT antibodies (Nelson et al., 1978 Warkentin et al., 1992, 1994 Popov et al., 1997 Ling and Warkentin, 1998 Warkentin, 2002b Mims et al., 2004) (Table 5 Fig. 3). Only about one quarter of at-risk patients who receive a heparin bolus develop such a reaction. The most common signs and symptoms are fever and chills, hypertension, and tachycardia. Less common are flushing, headache, chest pain, dyspnea, tachypnea, and large-volume diarrhea. In some patients, severe dyspnea is the predominant sign, termed pseudo-pulmonary embolism (Popov et al., 1997 Hartman et al., 2006) multiple small perfusion defects on radionuclide lung scans can be shown (Nelson et al., 1978 Ling and Warkentin, 1998). Fatal cardiac and respiratory arrest has been reported (Ansell et al., 1986 Platell and Tan, 1986 Hewitt et al., 1998). cardiopulmonary arrest...

Surveys of Sick Individuals about their Use of OTC Healthcare Products

In a random-digit-dialing survey of 1505 adults, 77 of those who reported an illness in the past six months had self-treated with an OTC medication, in contrast to 43 who said they visited a physician for their illness (Labrie, 2001). Of those reporting headache symptoms, 81 self-treated of those reporting cold, cough, flu, or sore throat symptoms, 72 self-treated. This survey did not determine the time between OTC use and first contact with the healthcare system. However, it did ascertain whether OTC use was an individual's first action after the onset of symptoms. Of the individuals reporting headache symptoms, 54 said their first course of action was to take an OTC medication (34 said their first course of action was to wait and see if the symptoms would go away, and only 4 said their first course of action was to consult a physician). For individuals with cold, cough, flu, and sore throat symptoms, the first course of action was self-treatment with an OTC product in 42 , watchful...

Cerebrospinal Fluid Marker Concentrations

Endodermal Sinus Tumor Cns

Metastatic mixed nonseminomatous germ cell tumor. The patient was a 24-year-old man who presented with testicular pain and abdominal bloating. Examination revealed right testicular induration and an upper abdominal mass on the right side. His abdominal computed tomography (CT) scan (A) demonstrated a large retroperitoneal mass. There were no lung metastases seen on chest CT. The preoperative serum a-fetoprotein (AFP) level was 18,345 ng mL, the serum beta-human chorionic gonadotropin (p-hCG) level was 302 ng mL, and the lactate dehydrogenase (LDH) level was 704 U L. Inguinal orchiectomy was undertaken, and histopathologic study showed a mixed pattern including major elements of embryonal malignant teratoma and seminoma as well as a small element of choriocarcinoma. Postoperative serum AFP was 7,435 ng mL, serum p-hCG was 76 ng mL, and the LDH was 673 U L. The patient then commenced his first cycle of POMB ACE chemotherapy. Midway through the first cycle of chemotherapy,...

Prehospital Management

Once infected by P. falciparum, without prompt diagnosis and appropriate treatment, progression to severe malaria is likely in a non-immune child. This should always be assumed even for children raised in malaria-endemic areas but now residing in non-malarious areas. Immunity requires years of repeated infection and rapidly wanes when the person is no longer exposed to infective mosquito bites. When a child presents with a possible travel-associated or tropical illness it is important to take a detailed travel and exposure history. Important points to focus upon include a full vaccination history whether malaria chemoprophylaxis was taken correctly, if indicated whether specific measures were employed to prevent insect bites. Nevertheless, as malaria prophylaxis and preventative measure are never 100 effective malaria should be considered in any patient presenting with a fever who has travelled to or come from an endemic area (for details visit or http topics malaria en )....

Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is often referred to by other names or used interchangeably with similar disorders, such as chronic fatigue and immune dysfunction syndrome (CFIDS), fibromyalgia (FM), myalgic encephalomyelitis (ME), Gulf War Syndrome, and chronic Epstein-Barr disease. Recently, the Centers for Disease Control (CDC) has published epidemiologic figures estimating that approximately 800,000 Americans are affected by CFS. The associated economic loss is estimated in the billions of dollars, due to disability, medical expenses, and loss of wages. CFS is an incompletely understood, yet severely disabling disease of unknown etiology. It is characterized by profound, debilitating fatigue, of greater than 6 months duration that cannot be resolved with rest. Associated symptoms include fever, sore throat, myalgias, lymphadenopathy, sleep disturbance, headaches, neurocognitive difficulties (such as memory and concentration impairment and mental fog''), and symptoms associated with...

Introduction And Background

Since its introduction almost a quarter of a century ago, the indications for DREZ lesioning have expanded to include the treatment of many types of intractable pain including traumatic plexus avulsions, conus medullaris and cauda equina lesions, postherpetic pain, postamputation pain, brachial plexus radiation injuries, brachial plexus stretch injuries, cancer pain, postoperative (postrhizotomy and postthoracotomy) pain, and peripheral nerve injury pain. In addition, a specialized variation of the spinal cord DREZ lesion, the nucleus caudalis DREZ operation, was developed to treat intractable facial pain and is often indicated for other refractory cranial pain Nashold, 1992 , including trigeminal neuralgia that has failed other procedures, anesthesia dolorosa complicating prior procedures, peripheral nerve pain after infection or trauma (including dental procedures), cluster headaches, and others.

Idiomatic and Conventional Expressions

A first study presented American and Brazilian college students with three types of symptoms that may possibly result from a person being hungry (these were translated into Brazilian Portuguese for the Brazilian participants). Local symptoms referred to specific parts of the body, general symptoms referred to whole body experiences, and behavioral symptoms referred to various behaviors that may result as a consequence of a person being hungry. Each of these three symptoms included items that we presumed may be closely related to the experience of being hungry, items possibly being related, and items not at all related to hunger. An analysis of these ratings showed that both English and Portuguese speakers gave similar ratings to the different items. For example, the two groups of participants agreed that strong effects of hunger on the human body include the stomach grumbles, thought of food makes one's mouth water, one has a stomachache, and one has a headache (local symptoms) one...

Toxicity Of Stereotactic Radiosurgery

Acute complications from SRS are generally minimal and usually transient. These side effects may include infection or numbness at a pin site, headache, seizure, nausea, vomiting, fatigue, and exacerbation of existing neurologic symptoms. To prevent some of these side effects, many centers premedicate and discharge patients on corticosteroids. For those patients with a history of seizures, some centers also give antiseizure medications. The most common late toxicities include radiation necrosis, steroid dependency, and exacerbation of neurologic symptoms such as motor weakness, numbness, or gait difficulties. Given the difficulty in distinguishing between radiation necrosis and recurrent persistent tumor, the reoperation rates have varied widely. In the RTOG 9305 study, the incidence of Grade III or higher toxicity was not significantly different in either arm (34).

Ultrasonography and Magnetic Resonance Imaging A Tale of Two Patients

Cavities Cranial With Homeostasis

The two patients enter the hospital medical scanning unit hoping for opposite outcomes. Vanessa Q., who has suffered several early pregnancy losses, hopes that an ultrasound exam will reveal a viable embryo in her still-flat abdomen. Michael P., a sixteen-year-old who has excruciating headaches, is to undergo a magnetic resonance imaging (MRI) scan to assure his physician (and himself ) that the cause of the headache is not a brain tumor. Michael and his parents nervously wait two days for the expert eyes of a radiologist to interpret the MRI scan. Happily, the scan shows normal brain structure. Whatever is causing Michael's headaches, it is not a possibly life-threatening brain tumor.

Significance to humans

Chironex Flexeri Anatomy

Overall impact of cubozoans is much greater as stings are not always reported. Carukia barnesi is now recognized as the cause of Irukandji syndrome, which results in severe backache, muscle pains, chest and abdominal pains, headache, localized sweating, and piloerection, as well as nausea and reduced urine output. There is a box jelly antivenom that binds to both C. fleckeri and C. barnesi, and vinegar can inhibit unfired nematocysts from firing (although it stimulates nematocyst firing with other cnidarians).

Disorders of Supranuclear Eye Movements

Refixation Saccades

Spasm of the Near Reflex Spasm of the near reflex, also referred to as convergence spasm, is characterized by intermittent spasm of convergence, of miosis, and of accommodation.95 Symptoms include headache, photophobia, eyestrain, blurred vision, and diplopia. Patients may appear to have bilateral sixth nerve palsies, but careful observation will reveal miosis and high myopia (8-10 D) on dry retinoscopy, accompanying the failure of abduction.172 This key clinical clue prevents misdiagnosis and misdirected testing.172,182,252,430

Reactive Lymphocytosis In Common Disease States

Reactive Lymphocytes Pics

It is normal for young children between the ages of 1 and 4 to have a relative lymphocytosis. The white cell differential in this age group will show a reversal in the number of lymphocytes to segmented neutrophils from the adult reference range. The lymphocytes, however, will have normal morphology (Fig. 10.11). By far the most common disease entity displaying variation in lymphocytes is infectious mononucleosis. This is viral illness caused by the Epstein-Barr virus (EBV), a member of the human herpes virus family, type 4. Although young children may become infected with EBV, the virus has a peak incidence at around 20 years of age. Most adults have been exposed to EBV by midlife, and this is recognized by demonstratable antibody production whether or not they have had an active case of infectious mononucleosis. The virus is found in body fluids, especially saliva, and is frequently passed through exchanges such as kissing, sharing food utensils, or drinking cups. The virus, which...

Combined Ocular Motor Nerve Palsies

Tested by observing for intorsion of the affected eye in downgaze. If multiple ocular motor nerve palsies are indeed present, a thorough history and examination, neuroimaging of the rostral brainstem, cavernous sinuses, and orbits, and examination of the cerebrospinal fluid (CSF) are typically necessary to distinguish between the myriad possible localizations and etiologies. Prompt diagnosis is particularly important for children with infections or pituitary apoplexy the latter is often accompanied by severe headache, ophthalmoplegia caused by rapid expansion into the cavernous sinus, and rapid mental status deterioration.

Spinal Nerve Injuries

Birth injuries, dislocations, vertebral fractures, stabs, gunshot wounds, and pressure from tumors can all injure spinal nerves. Suddenly bending the neck, called whiplash, can compress the nerves of the cervical plexuses, causing persistent headache and pain in the neck and skin, which the cervical nerves supply. If a broken or dislocated vertebra severs or damages the phrenic nerves associated with the cervical plexuses, partial or complete paralysis of the diaphragm may result.

Perfusion Disturbances of the Brain

Left Lateral Ventricle Hemmorhage

Sudden Headache Does the patient suffer from chronic headache attacks or is this a new type of headache Is there a history of medication with headache as potential side effect or could the patient be intoxicated Did the headache occur under physical stress or exertion Does the patient suffer from arterial hypertension Is the headache accompanied by other neurological symptoms or loss of consciousness Will Klington (37) is brought to the emergency unit unconscious. It is late at night. His escorts report that Will started to complain about a sudden, severe headache completely out of the blue, then vomited and lost consciousness a few minutes later. The colleague on duty has immediately transferred the patient to CT, where Giufeng and Greg are working together this evening. The CT shows an impressive finding (Fig. 11.2). Gregory leaves Giufeng exactly one minute for her diagnosis and runs out of the room. Migraine, cluster-headache Migraine and cluster headache are clinical diagnoses...

Causes and symptoms

A rare but important cause of HSDD is a functioning prolactin-secreting tumor of the pituitary gland, a prolactinoma. Men with this condition typically state that they can achieve an erection, but that they have no interest in sexual relations. In the female, prolactinomas are associated with galactorrhea (lactation in the absence of pregnancy), amenorrhea, symptoms of estrogen deficiency, and dyspareunia. Although pro-lactinomas are benign tumors, they can cause visual disturbances by enlarging and causing pressure on the optic nerves within the confines of the sella turcica, the location of the pituitary gland at the base of the brain. Headaches and enlargement of the male breasts are fairly common in this condition. The diagnosis is confirmed by the finding of high levels of circulating prolactin in the blood. Enlargement of the pituitary gland area may be detected by the use of magnetic resonance imaging (MRI) or computerized axial tomography (CAT) scanning, also...

Herpes Simplex Virus Type

HEADACHE (AS PART OF A COMBINATION) Tiger balm is a popular OTC preparation that contains clove oil, menthol, cassia oil, camphor, cajuput oil and sometimes peppermint oil. It is generally used to relieve the symptoms of sore muscles, but a randomised double-blind study found that it is also as effective as paracetamol in reducing headache severity (Schattner & Randerson 1996). Although encouraging, the role of cloves in this combination is difficult to assess from the study.

Clinical Presentation And Imaging Findings

Common presenting symptoms of LGA include seizures, headache, altered mental status, and focal neurological deficit. Seizures are the presenting symptom in more than 50 per cent of all cases 12,13 . Headache and focal neurological deficit occur less frequently, and signs of raised intracranial pressure are uncommon 12 . Magnetic resonance imaging (MRI) is the most sensitive test available to

Proton pump inhibitors

Adverse events with PPI's are rare, have similar rates as H2B's, and include headache, diarrhea, nausea, abdominal pain, and flatulence 2 , 78 . There is no difference in the frequency or type of adverse events in elderly patients compared to younger patients in clinical trials 36 . However, there are other metabolic and physiologic concerns with long-term PPI therapy. A main concern with long-term PPI therapy is an increase in gastrin production, which was thought to possibly have dangerous trophic effects on the gastric mucosa 50 . There was an increase in the incidence of micronodular hyperplasia, atrophic gastritis (1 to 25 ), and there was a strong association between ar-gyrophil cell hyperplasia and degree of corpus gastritis

Other White Matter Diseases

During the past few years, the application of advanced MR techniques for the assessment of patients with migraine has shown that, similarly to what has been described in other chronic vascular affections, including leukoaraiosis, cerebral autosomal dominant ar-teriopathy with subcortical infarcts and leukoencepha-lopathy (CADASIL), brain damage extends beyond the resolution of conventional imaging and diffusely involves the normal-appearing brain tissue (NABT). In a preliminary study using *H-MRS at 3.0 T, we found that NAA is reduced in white matter lesions as well as in the NAWM of patients with migraine (Fig. 15.3). Concentrations of choline follow an opposite trend, with increased concentrations in the NAWM and lesions. Preliminary findings obtained with DT MRI at 3.0 T also suggest the presence of occult damage in the NABT of patients suffering from migraine.

Somatosensory Symptoms

Although headache has not been particularly associated with MS, one report cited a patient with severe acute headache, associated with a solitary new lesion in the periaqueductal gray region (55). This unusual case supports observations in patients with implanted electrodes, in which perturbation in this area can produce headache. In another unusual case, headache, mimicking subarachnoid hemorrhage occurred. A patient with a history of facial myokymia developed apoplectic headache and a third nerve palsy. Investigations revealed no evidence of subarachnoid hemorrhage or aneurysm, but MRI showed more than 30 white matter lesions, and CSF examination revealed oligoclonal bands (56).

Antidepressants MAOI group

In addition to their anticholinergic side-effects (similar to those described above for the tricyclics), MAOIs may cause potentially dangerous interactions with sympathomimetic drugs (including common-cold remedies) and tyramine-containing foods (Box 23.5), which must therefore be avoided. Such interactions produce headache and palpitations rarely, they can produce a hypertensive crisis that may lead to stroke or sudden death. In order to do so, however, the

Pharmacological Toxicological Effects

There are numerous accounts of anecdotal evidence supporting the use of St. John's wort for premenstrual syndrome (PMS) (36). One open, uncontrolled study was conducted to determine the efficacy of St. John's wort in treating PMS. The primary outcome was measured by a daily symptom checklist of 17 symptoms rated on a scale of 0 to 4 based on the Hospital Anxiety and Depression (HAD) scale and modified Social Adjustment Scale (SAS-M) broken down into four subscales mood, behavior, pain, and physical. A total of 25 women were selected to participate in the study in which they received 300 mg hypericum standardized to 900 g hypericin daily. The results from the daily symptoms survey after the first cycle show a statistically significant reduction from the baseline value of 128.42 to 70.11. After the second cycle, there was a further reduction to 42.74. Of the four subscales, St. John's wort had the greatest improvement on the mood subscale (57 ) and the least improvement on the physical...

Drugs In Development And Novel Drug Targets

Olcegepant Migraine and cluster headaches Receptors for calcitonin gene-related peptide (CGRP) are abundant in vascular smooth muscle and endothelium, and activation of these receptors is known to cause relaxation of blood vessels. Olcegepant is an antagonist of at least some types of CGRP receptors and is in clinical development for migraine and cluster headaches. Bosentan is currently in limited clinical use as a vasodilator in pulmonary hypertension, but other small-molecule endothelin receptor antagonists are now under clinical development for broader therapeutic indications, including hypertension and congestive heart failure. Vasopressin V2 receptor antagonists are also in clinical development for congestive heart failure, based on their capacity to oppose vaso-pressin-induced vasoconstriction and renal fluid retention.

Pharmacological Treatment of the Paraphilias

Methoxyprogesterone acetate (MPA) is the most commonly used hormonal agent for the reduction of sex drive in the United States (140,146,154,155). It does not compete with androgens at the receptor level but blocks levels of testosterone by inducing hepatic testosterone reductase. The goal of this strategy is to reduce baseline testosterone to 50 of initial values. Common dosages are 50-300 mg orally or 300-400 weekly via intramuscular injections with reduction to 100 mg weekly for a maintenance program. Depot preparations of methoxyprogesterone are also available. Side-effects include weight gain, hyper-glycemia due to an exaggerated insulin response to a glucose load, headaches and increased risk of deep vain thromboses.

Ebola and Marburg Fever

The incubation period for Ebola virus is between 3 and 21 days and for Marburg virus between 3 and 9 days. In contrast to Lassa fever, the onset of VHF caused by these viruses is abrupt, with onset of a prodrome lasting less than 7 days. This comprises non-specific symptoms including fever, chills, severe headache, malaise, myalgia and a maculopapular rash (onset day 2 to 7 typically on the face, neck, trunk and arms). This is followed by a rapid and progressive deterioration with severe, watery diarrhoea, abdominal pain and cramps, nausea and vomiting. Patients typically have ghost-like, drawn features with deep-set eyes and an expressionless facies. This phase is characterised by extreme lethargy. Other clinical features include chest pain, sore throat, hiccups, conjunctivitis, haematemesis, cough, photophobia and back pain.

Typical vs Atypical Ischemia

Could there be an association with her eleven year history of migraine headaches This issue is somewhat more promising as an area of investigation. There have been cases of acute ischemic heart disease associated with several classes of agents used to treat migraine or vascular headaches. These include ergotamine derivatives, methysergide, and the newest class of serotonin receptor agonists. However, with all of these drugs that can potentially stimulate smooth muscle contraction and lead to coronary artery spasm, it is generally accepted that the rare coronary events are secondary to superimposed drug use in the presence of pre-existing coronary atherosclerosis. There are also anecdotal reports of patients with migraine headaches who have spontaneous coronary artery spasm, presumably due to hyper-reactivity of their coronary circulation. In the current case, there was no history of pre-existing migraine headache for which she had taken medication. Since patients with migraines are so...

Some Diseases Of The Visual System Retina and Optic Nerve Lesions

Giant Cell Arteritis of the Central Retinal Artery This disease occurs in those age 60 or older, with a sudden onset of central blindness. Superficial temporal arteries are typically tender, pulseless, and tortuous. There is almost always an elevated erythrocyte sedimentation rate and a low-grade fever. The history will often contain complaints of headache and stiff, aching, weak shoulder and hip muscles. Funduscopy shows total retinal ischemia (see the following section). Diagnosis, including temporal artery biopsy, is an emergency.

Health Precautions For Researchers Handling Bats

Symptoms of rabies usually develop 10-14 days after exposure and include pain, burning and numbness at the site of infection, headaches, insomnia, fever, and difficulty swallowing. However, usually by the time the symptoms are apparent, the progression of the disease can no longer be prevented, ultimately resulting in fatal inflammation of the brain and spinal cord. Therefore, it is imperative that a person seek immediate medical attention after any potential exposure. People handling bats should obtain pre-exposure immunization, which is conferred by 3 doses of vaccine, and check their titers regularly. Additionally, they should simply avoid exposure. Bats captured to establish a captive colony should be quarantined for at least 6 months to assess possible sickness. Always wear gloves when handling bats and avoid rapid and unpredictable movements which increase the chance of bites.

Acute seroconversion illness

At least 50 of patients have an acute illness associated with seroconversion. The illness usually occurs within 6 weeks of infection and is characterised by fever, night sweats, malaise, severe lethargy, anorexia, nausea, myalgia, arthralgia, headache, photophobia, sore throat, diarrhoea, lymphadenopathy, generalised maculoerythematous rash and thrombocytopenia. Neurological manifestations including meningoencephalitis and peripheral neuritis are commonly observed. Acute HIV infection should be considered in the differential diagnosis of illnesses resembling glandular fever. This illness is self-limiting and usually revolves within 1 to 3 weeks. However, chronic lethargy, depression and irritability may persist after the acute illness. Non-specific viraemic sequelae such as mucosal ulceration, desquamation, exacerbation of seborrhoea and recurrences of herpes simplex may occur (see Fig. 24.1).

Antiviral Therapy of Shingles in Dermatology

5 times daily for 7 days speeds skin healing and reduces the severity of acute neuritis. The benefit of acyclovir therapy was most evident when therapy started within 72 h of disease onset 3-9 . A meta-analysis of the acyclovir data showed that acyclovir has a significant benefit in the reduction of ZAP since it shortened the time to complete cessation of pain in all patients by nearly 80 compared with placebo 10 . Other studies have shown no benefit of acyclovir in reducing the duration of PHN 11, 12 . Typical side effects are transient rises in serum creati-nine or urea, nausea, vomiting, diarrhoea, stomach pain, rash and headache. Compared with acyclovir in the standard dose of 800 mg five times daily, brivudin 125 mg once daily for 7 days showed a significantly better antiviral activity (faster stop of viral replication), and it was as effective as acyclovir with respect to the resolution of acute zoster pain. With its once daily dosing schedule, brivudin offers a considerable...

Countertransference issues

The exchange of information and the professional conversation around genetic counselling is a human encounter in the service of the patient but, the counsellor is also there as a real person. The experienced and secure counsellor will have little difficulty acknowledging personal reactions but, sometimes, the less experienced or insecure can regard their personal emotional reactions as a lack of professionalism which needs to be hidden or denied. All counsellors are at risk of being disturbed at some point or another and they may experience physical sensations or feelings. Headaches, tiredness, or being depleted or stressed are common physical complaints depression, anxiety or feeling unexpectedly angry, common emotional reactions. These feelings and sensations are unpleasant but can be understood, alleviated or even prevented by a deeper understanding of the delicate, interactional processes by which individuals affect one another. This involves addressing counter-transference...

Health Outcomes Of Stressful Life Events

Life Events Theory Health Psychology

Efforts in contemporary life event research aim at a better understanding of the linkage between stress and the manifestation of illness. Research striving to identify single events as the cause of illness often fail. Ideally, nding a truly causal relationship between a speci c stressor (e.g., loss of a loved person) and a speci c disease (e.g., breast cancer) would be a breakthrough in this eld. The onset of speci c diseases has been related frequently to prior stress experience. Tension headache, for example, seems to be closely connected to daily hassles, whereas a link to major life events has not been found. Infectious diseases such as the common cold can be triggered by stress. Prospective studies have shown that people develop a cold several days after the onset of negative life events. Experimental studies with the intentional administration of cold viruses have found that persons under stress are more likely to develop a cold than if they are relaxed. In a British common cold...

Enhanced Cognitive Function And Alertness

One double-blind, placebo-controlled study assessed the effects of four different doses of guarana (37.5, 75, 1 50 and 300 mg) in 22 subjects (Haskell et al 2005). Cognitive performance and mood were assessed at baseline and again 1, 3 and 6 hours after each dose using the Cognitive Drug Research computerised assessment battery, serial subtraction tasks, a sentence verification task and visual analogue mood scales. All doses improved picture and word recognition, results on the Bond-Lader visual analogue scales and caffeine research visual analogue scales showing improvements in alertness and reduced ratings of headache. The two lower doses produced better results than the two higher doses, which were associated with impaired accuracy of choice reaction and on one of the subtraction tests. Several observations suggest that these effects were not due to caffeine alone. Firstly, effects were still apparent 6 hours after administration and secondly, better results were obtained with a...

Generalized anxiety disorder

DSM-TV-TR specifies interference with work, family life, social activities, or other areas of functioning as a criterion for generalized anxiety disorder TCD-10 does not mention interference with tasks or other activities as a criterion for the disorder. Both diagnostic manuals mention such physical symptoms as insomnia, sore muscles, headaches, digestive upsets, etc. as common accompaniments of GAD, but only DSM-TV-TR specifies that an adult patient must experience three symptoms out of a list of six (restlessness, being easily fatigued, having difficulty concentrating, being irritable, high levels of muscle tension, and sleep disturbances) in order to be diagnosed with the disorder. sion disorder, other anxiety disorders, or a substance abuse disorder. They also frequently have or develop such stress-related physical illnesses and conditions as tension headaches, irritable bowel syndrome (IBS), temporomandibular joint dysfunction (TMJ), bruxism (grinding of the teeth during sleep),...

Myeloproliferative Disorders

PRV is frequently discovered incidentally when a complete blood count is performed for another reason. When symptoms are present, they are usually nonspecific. Fatigue, headache, and diaphoresis are common. Pruritis, often following a hot shower, is a frequent complaint. Up to 15 of patients may present with a thrombotic episode. Thrombotic cerebrovascular accidents, coronary artery thrombosis, Budd-Chiari syndrome, and pulmonary embolus all occur. Cavernous sinus thrombosis may also occur in untreated or poorly controlled disease. Erythromelalgia is specific to PRV and ET, and it is associated with an elevated platelet count and paradoxical vasodilation. It is characterized by redness, warmth, and a burning pain affecting the digits and responds promptly to aspirin. Gout may be a presenting manifestation of an MPD. There is an increased incidence of peptic ulcer disease in patients with PRV. Iron deficiency may occur and may initially mask the diagnosis. An elevated hematocrit with...

Argentina Biosurveillance

Incubation period may be affected by amount of virus introduced. Reported as long as years. Anxious feeling, sensory alteration, headache, slight fever followed by extreme sensitivity to light, increased salivation, and pupil dilation. Liquids are violently rejected by muscular contractions as disease progresses. May prevail until death or develop generalized paralysis until death. No clinical disease in wild animals. Anorexia, nausea, vomiting, diarrhea. Followed by fever, muscle pain, swollen eyelids, headache and chills. Muscle pain may last several months.

Surgical Complications

Infection risks are probably the most feared complication with the use of intraspinal opioids. Infection can occur at the pump insertion site, along the catheter track, and within the intrathecal space. The hardware must be placed under sterile technique according to manufacturer recommendations with the use of perioperative antibiotics and intraoperative antibiotic irrigation. After the initial pump filling before implantation, the first puncture to refill the pump should not be earlier than 10 days after implantation. While bacteri-ostatic filters are present in the pump and the catheter tubing, great care should be taken by trained practitioners to not introduce bacteria during subsequent refills. Meningitis, although rare, should be suspected in the presence of fever, headache, stiff neck, rigors, and photophobia. If an infection develops, normal skin flora, such as Staphylococcus aureus and S. epider-midis, are the most common offenders.

Rhinocerebral Mucormycosis

And soft-tissue swelling are initially seen, followed in a few days by double vision, increasing fever, and obtundation. Examination reveals a unilateral generalized reduction of ocular motion, chemosis, and proptosis. Facial skin adjacent to paranasal sinuses may be invaded by direct extension, turning progressively red, purple, and black. Fever, decreased vision, and facial swelling are the most common complaints in the first 72 hours of the disease (6). Other common complaints include facial pain and nasal congestion or discharge. Headache was found early in the disease in only 25 of patients in one large study but may be a common late finding.

Chemotherapy Of Meningiomas

Several investigators have reported the results of cytotoxic and immune modulating chemotherapy approaches in meningioma patients 1,2,43,44,55 . Initial reviews of treatment responses in older sets of patients did not suggest any benefit from chemotherapy 56 . In a review of 25 patients with malignant meningioma treated at MD Anderson from 1944 through 1992, Younis and associates noted 10 that had received cytotoxic chemotherapy. The regimens consisted of intra-arterial or intravenous cisplatin, intravenous dacarbazine, and intravenous doxorubicin. None of the patients had an objective response or clinical improvement that could be attributed to chemotherapy. These results were in contrast to earlier descriptions of malignant meningioma patients that had had modest responses to adriamycin 57 . Bernstein and colleagues reported a patient with invasive rectal cancer who was receiving chemotherapy with 5-fluorouracil (425 mg m2 day x 5 days), folinic acid (20 mg m2 day x 5 days), and...

Jugular foramen syndrome

Primary lesions of the jugular foramen include glomus jugulare tumors, schwannomas, and meningiomas. Metastatic lesions to the jugular foramen are more common than primary neoplasms (36,38-42). Glomus jugulare tumors are the most common primary neoplasms of the jugular foramen. These are vascular tumors arising from neuroectodermally derived paraganglia present at the jugular fossa, the inferior tympanic canaliculus, the promontory, and within the vagus nerve. Paraganglia are very similar histologically and embryologically to the adrenal medulla. They, along with their derivative glomus tumors (jugulare and tympanicum), are typically supplied by the inferior tympanic branch of the ascending pharyngeal artery (43) however, the blood supply to glomus tumors may be very extensive, originating from the external carotid, the internal carotid, and the vertebral arteries (44). These tumors are more common in females (6 1 female-to-male ratio) and usually present in middle age. Functional...

Schemata And Cognitive Processes

Guarnaccia, 1989 Kleinman et al., 1986 Krause & Carr 1978). Symptoms of nervios include, headaches, trembling, heart palpitations, stomach and appetite disturbances, trouble with concentration, sleep problems, and worrying (Guarnaccia & Farias, 1988). Sufferers are more frequently women than men, and they are disportionately from rural and lower class backgrounds.

Supportive Therapeutics

The use of corticosteroids is often necessary in PBT and MBT patients to control the symptoms caused by increased intracranial pressure (e.g., headache, nausea and emesis, confusion, and weakness) 1,2,21 . Peritumoral edema is the principal cause of elevated intracranial pressure and is mediated through numerous mechanisms, including the leaky neovasculature associated with tumor angiogenesis, as well as increased permeability induced by factors secreted by the tumor and surrounding tissues, such as oxygen-free radicals, arachidonic acid, glutumate, histamine, bradykinin, atrial natriuretic peptide, and vascular endothelial growth factor (VEGF) 22-24 . Dexamethasone is the high-potency steroid used most often to treat the edema associated with brain tumors 1,21 . It has several advantages over other synthetic glucocorti-coids, including a longer half-life, reduced miner-alocorticoid effect, lower incidence of cognitive and behavioral complications, and diminished...

Common presenting symptoms

For females the five other symptoms that are included are menstrual disorders, depression, vaginal discharge, anxiety and headache. In the British study the most common symptoms are virtually identical between males and females and include cough, rash, sore throat, abdominal pain, bowel symptoms, chest pain, back pain, spots, sores and ulcers, and headache.

Premenstrual syndrome

Many women report depressed mood, irritability, or anxiety, often combined with physical symptoms such as breast tenderness, headaches, bloated feelings, and weight gain, for up to 2 weeks before the onset of menstruation. Premenstrual tension has been used successfully as a defence in criminal trials, although

Allergic rhinosinusitis

The sinuses and in uncomplicated allergic rhinosinusitis, sinus radiographs may demonstrate mucosal thickening. Some patients may appreciate nasal congestion as headache rather than as facial pressure pain. Abnormal mobility of the tympanic membrane and the presence of otitis media commonly are noted. Fatigue, perhaps due to sleep disturbances caused by nasal airflow obstruction, commonly accompanies allergic rhinosinusitis (6).

Drug Dependency Assessment

Similar withdrawal symptoms can also occur with sedatives, anticonvulsants such as clonazepam and carbamazepine, and muscle relaxants such as carisoprodol (11-13,127). Frequent nicotine and caffeine use is also an important consideration in pain management. Nicotine abstinence symptoms can cause restlessness, palpitation, and irritability, and caffeine abstinence can precipitate headaches.

School attendance problems

School refusal is reluctance to attend school, due either to fear of teachers or other children (school phobia), or fear of leaving the mother (separation anxiety). The mother often covertly encourages it because she herself is depressed or immature, and reluctant to be separated from the child. The child may complain of headache or abdominal pain on school mornings. Treatment includes psychotherapy for the child and mother, dealing with any contributory factors at school, and encouragement to attend.

Hallucinogens and related disorders

LSD is the best known and most potent of the hallucinogens. LSD was first synthesized by Alfred Hoffman for a pharmaceutical company in Germany in 1938 while searching for a headache remedy. Hoffman discovered the hallucinogenic properties of LSD accidentally in 1943. The drug became popular with hippies in the mid-1960s when its sense-altering properties were reputed to offer a window into enhanced creativity and self-awareness. LSD also occurs naturally in morning glory seeds.

Agents Of Atypical Pneumonia

Infection by Legionella is frequently heralded by an abrupt onset of malaise, weakness, headaches, and myalgia (Bentley 1984). Most patients cough hemoptysis occurs in one-third of patients. Mental status changes are reported in 25 to 75 of older patients. Other associated features are bradycardia, liver dysfunction, diarrhea, and hyponatriemia, but none of these features are specific and all may occur with severe pneumonia of other etiologies.

Respiratory Protective Equipment

Although these air-supplied devices can reduce personal exposure to aeroallergen to negligible levels, they do have major drawbacks they do not easily facilitate detailed work up close to the animal when the risk of exposure is high they may be uncomfortable if used for long periods, leading to headaches and neck discomfort and they may not be suitable for some tasks, such as socialization.

Stress urinary incontinence

SUI due to sphincter insufficiency is treated with alpha-adrenergic agonists. Phenylpropanolamine or pseudoephedrine is the first line of pharmacologic therapy for women with SUI. Side effects include anxiety, insomnia, agitation, respiratory difficulty, headache, sweating, hypertension, and cardiac arrhythmia. Use caution with arrhythmias, angina, hypertension, or hyperthyroidism.

Insulinlike Growth Factor1 Igf1

In a metabolic ward study in patients with HIV associated wasting fed a weight-maintaining diet, daily infusions of rhIGF-1 (4 g kg h for 12 h) produced significant short-term retention of nitrogen, averaging approx 1.7 g d (39). However, a waning effect was noted after 9 d of therapy. Notably, infusion of a higher dose of rhIGF-1 (12 g kg h for 12 h) produced no significant nitrogen retention. This reverse dose-response relationship may have resulted from the suppression of IGF binding protein-3 (IGFBP-3) in patients given the higher dose, reducing thereby the bioavailability of the exogenous rhIGF-1. Leucine and glycine flux, measured by stable isotope techniques, were unaffected by treatment at either dosing level. The predominant side effect of this treatment was headache, which occurred in 10 of 13 subjects treated.

Changing Ones State Of Consciousness A Motivated

This chapter argues that people generally use drugs (legal and illegal) on purpose, because they wish to, because it makes them feel good or better, rather than because they are forced to do so by the pharmacology of the drugs they choose to take. People, it is argued, use drugs to make the world an easier place to live in, to assist coping with a painful mental state, for pure fun, to help with a physical infirmity, and so forth. Taking drugs is a motivated act people do it to achieve certain ends, both desirable and undesirable. Some people use drugs to alleviate withdrawal symptoms. This too is a motivated act, comparable to taking paracetamol for a headache, except that the symptoms are caused in part by the drug itself in the first place. We say in part since there is clear evidence that severity of withdrawal symptoms is context dependent (e.g. Hinson et al., 1986 McRae and Seigal, 1990). In the McRae and Seigal study, for instance, rats that lever-pressed to receive opiates...

What conditions are often missed

This question refers to the common 'pitfalls' so often encountered in general practice. This area is definitely related to the experience factor and includes rather simple non-life-threatening problems that can be so easily overlooked unless doctors are prepared to include them in their diagnostic framework. Classic examples include smoking or dental caries as a cause of abdominal pain allergies to a whole variety of unsuspected everyday contacts foreign bodies occupational or environmental hazards as a cause of headache, respiratory discomfort or malaise and faecal impaction as a cause of diarrhoea. We have all experienced the 'red face syndrome' from a urinary tract infection whether it is the cause of fever in a child, lumbar pain in a pregnant woman or malaise in an older person. The dermatomal pain pattern caused by herpes zoster prior to the eruption of the rash (or if only a few sparse vesicles erupt) is a real trap. Lead poisoning Malnutrition (unsuspected) Menopause syndrome...

Octreotide Sandostatin

Dose (ped) 1-10 mcg kg every 12 hrs beginning at low end of range and increasing by 0.3 mcg kg dose at every 3 days max dose 1500 mcg 24 hr. Clearance hepatic and renal. Adverse effects may cause nausea, decreased GI motility, transient hyperglycemia, cholelithiasis, abdominal discomfort, headache, pain at injection site growth hormone suppression with long term use. Comments cyclosporine levels may be reduced.

Desmopressin Acetate DDAVP

Adverse effects may cause headache, nasal congestion, abdominal cramps, hypertension. Comments use with caution in hypertension, coronary artery disease, patients with predisposition to thrombus chlorpropamide, carbamazepine, and clofibrate potentiate the antidiuretic effect.

Aminocaproic Acid Amicar

Dose loading dose of 100-150 mg kg IV over the first 30-60 minutes followed by constant infusion of 33.3 mg kg hour for about 8 hours or until bleeding controlled. Most common regimen for adult 5 gram loading (started prior to skin incision) followed by constant infusion of 1 gm hour. Clearance primarily renal elimination. Contraindications DIC, hematuria. Adverse effects hypotension, bradycardia, dysrhythmias, elevated LFT's, thrombosis, nausea, diarrhea, weakness, headache, decreased platelet function, false increase in urine amino acids. Comments reduce dose by 75 in patients with oliguria or ESRD use caution in cardiac, renal or hepatic disease.

Physical Examination

HEENT Cranial or temporal tenderness (temporal arteritis), asymmetric pupil reactivity papilledema, extraocular movements, visual field deficits. Conjunctival injection, lacrimation, rhinorrhea (cluster headache). Indications for MRI scan Focal neurologic signs, papilledema, decreased visual acuity, increased frequency or severity of headache, excruciating or paroxysmal headache, awakening from sleep, persistent vomiting, head trauma with focal neurologic signs or lethargy. Differential Diagnosis Migraine, tension headache systemic infection, subarachnoid hemorrhage, sinusitis, arteriovenous malformation, hypertensive encephalopathy, temporal arteritis, meningitis, encephalitis, post concussion syndrome, intracranial tumor, venous sinus thrombosis, benign intracranial hypertension (pseudotumor cerebri), subdural hematoma, trigeminal neuralgia, glaucoma, analgesic overuse. Characteristics of Migraine Childhood to early adult onset family history of headache aura of scotomas or...

Statistical Prediction

The shortcomings of clinical judgment for functional analyses were illustrated in a study by O'Brien (1995). In this study, the self-monitoring data for a client who complained of headaches were given to eight clinical psychology graduate students. Over a period of 14 days, the client monitored a number of variables including stress level, arguments, hours of sleep, number of headaches, headache severity, duration of headaches, and number of painkillers taken. The task for the graduate students was to estimate the magnitude of functional relationships that existed between pairs of target behaviors and controlling factors by generating a subjective correlation (p. 352). Results were both surprising and disappointing The graduate students identified the controlling variables that were most strongly correlated with each headache symptom only 51 of the time.

Officebased Obesity Care

A significant portion of the time spent in the evaluation and treatment of the obese patient can be expedited by use of protocols and procedures. A self-administered medical history questionnaire can be either mailed to the patient prior to the initial visit or completed in the waiting room. In addition to standard questions, sections of the form should inquire about past obesity treatment programs, a body weight history, current diet and physical activity levels, social support, and goals and expectations. The review-of-systems section can include medical prompts that are more commonly seen among the obese, such as snoring, morning headaches and daytime sleepiness (for obstructive sleep apnea), urinary incontinence, intertrigo, and sexual dysfunction, among others.

Mood Disorders A Major Depressive Disorder

In some cultures, symptoms of depression are not generally recognized as a case for mental disorders. In addition, symptoms of depression might be presented in somatic terms rather than sadness or guilt (Castillo, 1997). For example, among Latin American and Mediterranean cultures depressive experiences might be manifested in terms of complaints of nerves and headaches Asians may show similar experiences in terms of weakness, tiredness, or imbalance, whereas among people from the Middle East and American Indian tribes these experiences might be shown in terms of difficulties with the heart or being Heartbroken, respectively (see DSM-IV, 1994, pp. 324-325). The severity of the depression might also be evaluated differently across cultures (e.g., sadness may lead to less concern than irritability in some cultures). Hallucinations and delusions, which are sometimes part of Major Depressive Disorder, should be differentiated from cultural hallucinations and delusions (e.g., fear of being...

Specific Multicultural Issues

Psychological problems in somatic terms (Chun, Enomoto, & Sue, 1996 Sue & Sue, 1990). The reason for this is that reports about physical conditions (e.g., chest pain, headaches, fatigue) are often more acceptable (i.e., result in less shame and guilt) than reports about psychiatric disorders. This situation may be problematic in those cases when a clinician suspects that an Asian client is experiencing a severe depression (including suicidal ideation and or attempts) because of his or her knowledge of having HIV (not AIDS), but the client elects to talk about physical conditions (unrelated to this disease) rather than the depression resulting from having that knowledge.

Pagets disease of bone

Paget's disease of bone (PDB) is one of the most common chronic skeletal diseases affecting up to 3 of many White populations over the age of 60 years. Its ethnic and geographic distribution is variable, with a high prevalence in Whites from the United Kingdom, Australia, North America and Western Europe. PDB is characterized by focal areas of increased bone resorption and formation, leading to deformity and or enlargement. The axial skeleton (pelvis, lumbar and thoracic spine, and sacrum) is most frequently involved, followed by the femur, skull, and tibia. The newly formed bone in pagetic lesions is disorganized, frequently resulting in bowing and increased fracture. Bony overgrowth in the skull may lead to nerve entrapment, headache, and deafness.


The adverse events reported in subjects receiving either filgrastim or sargramostim are similar. The most frequently reported adverse events attributed to filgrastim are bone pain, injection site reaction, rash, acute neutrophilic dermatoses, allergic reactions, worsening of inflammatory conditions, and splenic enlargement. For sar-gramostim, they are bone pain, fever, headache, chills or muscle ache, rash or injection site reactions, shortness of breath, and edema or capillary leak (93). To date, little published information exists about the adverse event profile associated with pegfilgrastim treatment, which is understandable given the recent approval of peg-filgrastim. Adverse events with this growth factor appear to be similar to those observed with its parent compound (filgrastim) (129,130). Mild-to-moderate bone pain that is easily managed with non-narcotic analgesics is the most frequently observed adverse event, being reported by approx 25 of patients receiving pegfilgrastim...

Toxicity Of Ia Chemotherapy

Neurological toxicity related to IA chemotherapy administration can be acute or chronic 4-7 . The most common acute neurological effects arise within 24-48 h of drug infusion and include seizure activity, confusional episodes, headaches, and focal deficits. For most studies, the risk of occurrence of an acute neurological event is 8-12 per cent. Supraophthalmic IA delivery of drug appears to be associated with a greater risk for acute neurological toxicity than infraophthalmic delivery 32,56 . In general, acute neurological toxicity is most likely to occur with IA carmustine (and other nitrosoureas) and cisplatin, and occurs less frequently with IA carboplatin and methotrexate.

Brainstem Malignant Glioma Subtypes

This tumor may occur at any age but is most common between 5 to 10 yr of age, and is distinctly uncommon before 2 yr of age (38). The typical presentation of this tumor is a triad of cranial nerve palsies, ataxia, and cerebrospinal tract dysfunction. Most often the VIth and VIIth cranial nerves are involved (sometimes unilaterally), and the motor and cerebellar signs often involve contralateral limbs. Symptoms may be present for several weeks but some patients come to medical attention within hours of their first complaint. On occasion, signs and symptoms of hydrocephalus (headache, irritability, and limited upgaze) may be the factor that brings the patient to medical attention. The MRI (Fig. 1) appearance and clinical course for these tumors is quite typical and there is seldom a question of diagnosis. These tumors are hypointense on T1 weighted images and hyperintense on T2 weighted images. They may involve the entire pons and appear to expand the entire body of the affected portion...

Cerebral Vein Thrombosis

Patients with cerebral vein thrombosis can present with one of two major patterns. The first is with focal neurologic defects due to venous thrombosis resulting in localized infarction. Infarctions are often hemorrhagic due to continued arterial blood flow, which pumps blood into the infarcted area. Patients with deep cerebral vein thrombosis may present with severe deficits and coma due to infarction of deep brain structures. Secondly and more commonly, patients with cerebral vein thrombosis will present first with signs of increased intracranial pressure due to obstruction of venous flow and cerebral spinal fluid reabsorption. Patients will have severe headaches, nausea and vomiting and then may progress to coma. Patients may also have reduced vision and blindness due to pressure on the optic nerve. Frequently patients have a prolonged course lasting for days with gradual worsening of symptoms.

Occupational exposure

Several studies found an increased risk ofrespiratory symptoms or disease in people with occupational exposure to vehicle exhausts. A study ofhighway tollbooth workers reported an increased number of acute irritative symptoms in exposed people, such as headache, nasal congestion, eye irritation and dry throat (Yang et al., 2002). Bus drivers, conductors and taxi drivers in Shanghai showed higher prevalence ofrespiratory symptoms and chronic respiratory diseases than controls not exposed to vehicle emissions (Zhou et al., 2001). The adjusted ORs were 1.95 for throat pain (95 CI 1.55-2.46), 3.90 for phlegm (95 CI 2.61-5.81), 1.96 for chronic rhinitis (95 CI 1.11-3.46) and 4.19 for chronic pharyngitis (95 CI 2.49-7.06).

Adverse Effects and Toxicity

Clinical studies have reported very few adverse effects that are of a mild nature (usually gastric distress or headache) following saw palmetto administration at normal doses. One randomized, double-blind study of finasteride, tamsulosin, and saw palmetto for 3 months observed no differences among the three treatments in terms of the effectiveness measures and no change in sexual function in those individuals receiving saw palmetto, though ejaculation disorders were noted as the most common side effect in those individuals receiving either tamsulosin or finasteride (26).

What Should Be Clarified Beforehand

Coumarin-derivative anticoagulants such as warfarin can also be a problem - ritonavir can significantly lower plasma levels (Llibre 2002). Further typical problem drugs include migraine remedies, prokinetic drugs and sedatives. One fatal case has been described with ergotamine and ritonavir (Pardo 2003). Drugs or alcohol can also interact with HAART. For those in substitution programs, the methadone requirement may be significantly increased by certain antiretroviral drugs such as nevirapine and efavirenz (Clarke S 2001). To a lesser extent, this is also true for ritonavir and nelfinavir. There is inconsistent data on lopinavir, but it may also require dose adjustments (McCance-Katz 2003, Stevens 2003). Tenofovir does not seem to have significant interactions with methadone (Smith 2004). Other combinations may lead to even more dangerous effects. Several deaths have been reported after simultaneous dosing with ritonavir and amphetamines or ecstasy, or the popular narcotic gamma...

Rocky Mountain Spotted Fever Rmsf

RMSF is an acute febrile systemic tick illness with significant mortality caused by the organism Rickettsia rickettsii. The infection is most commonly seen in the southeast United States. The incubation period is between 2 and 14 days. The symptoms are nonspecific, with fever, severe headache, myalgias, prostration, and nausea vomiting. The characteristic maculopapular rash usually appears on the fourth febrile day on the wrists, ankles, palms, soles, and forearms. A vasculitis may develop that can cause hypotension, edema, and petechiae. Specific organ involvement includes cardiac (car-diomegaly, myocarditis, EKG changes), pulmonary involvement (interstitial pneumonitis), and neurologic (mild headache to lethargy, seizures, coma, transient deafness, tremor, rigidity, paralysis, ataxia, aphasia, blindness). The initial diagnosis is often made clinically. Confirmation is obtained by serology, skin biopsy, or direct isolation and identification of the organism. Treatment is with...

Presentation And Clinical Course

After an incubation period of 2-20 days (10 days on average), patients typically experience the sudden onset of fever, chills, nausea, vomiting, headache, and myalgia. This corresponds to the septicemic phase, which lasts 3-7 days. Physical exam findings at this time are relatively nonspecific, and include maculopapular skin rash, pharyngeal injection, lymphadenopathy, organomegaly, and muscle tenderness. The presence of conjunctival suffusion or muscle tenderness involving the calves and lumbar region should raise the suspicion of leptospirosis. The illness may progress to a second stage, after a 1- to 4-day asymptomatic period, resulting in a biphasic illness. This immune phase, characterized by the appearance of IgM antibodies, is again difficult to distinguish from other febrile illnesses, and is thought to result from the host immune response rather than the pathogen itself. Fever is generally lower than in the septicemic phase. Signs and symptoms of meningitis are often present,...

Patient Selection And Test Dosing

Baclofen, which is gamma-amino-butyric acid (GABA), acts as an agonist at the intraspinal inhibitory sites along the stretch reflex pathway, thereby effecting a decrease in the patients spasticity. Baclofen may be administered orally however, it is water soluble and, therefore, only small amounts cross the blood-brain barrier effectively 6 . Too often maximum oral doses may not sufficiently control the patients spasticity, and patients may even experience unpleasant side effects, such as nausea, drowsiness, mental confusion, ataxia, and headache. The rationale, therefore, for administering baclofen intrathecally is that it concentrates the drug at the dorsal gray matter of the spinal cord where it is required for therapeutic effect. Furthermore, when introduced directly into the intrathecal space, effective cerebrospinal fluid (CSF) concentrations of baclofen are achieved with plasma concentrations 100 times less than those occurring with oral administration, thereby avoiding any...

Urban Poor Settlements And Health

Urban poor communities have rapidly grown in the towns and cities in Nepal. At present, there are about 63 squatter settlements in Kathmandu Valley which accommodate 2,600 families or nearly 15,000 people and are growing at the rate of 25 per year (Pradhan, 2003). Most squatters are located along the flood prone polluted river banks (Shakya, 2003). The squatter sheds are susceptible to roof leakage, wall wetting and room flooding in the rainy season. Three to nine people live in two rooms which have no ventilation. None of the households have sanitary toilets and the toilet effluents are directly discharged into the river. Availability of drinking water is about 24 liters per family per day. Even these water samples are found unfit for drinking in most of the cases. The water samples show fecal contamination of 56 to 260 Coliform 100ml water. Firewood is the dominant form of cooking energy in most of the squatter sheds which are mostly unventilated. Cold, cough, fever, diarrhea and...

Using Multiple Self Report Measures for Construct Validation

A third example is a study by Martin and colleagues (Martin et al., 2000), who assessed construct validity using an adaptation of Campbell and Fiske's (1959) MTMM approach, this time for assessing the convergent and discriminant validity of a migraine-specific quality-of-life questionnaire (MSQ Jhingran, Osterhaus, Miller, Lee, & Kirch-doerfer, 1998). Specifically, the authors used three analyses to establish construct validity. First, they estimated the MTMM based on a multi-trait-monomethod correlation matrix containing interscale correlations and Cronbach's alpha (internal consistency coefficients) on the diagonal of the correlation matrix. Convergent and discriminant validity were estimated by correlating the MSQ scores with scores from two other self-report measures. The results revealed low to moderate correlations with the other self-report measures, leading the authors to the conclusion that their instrument measures a related, but distinct construct.

Pharmacological Toxicological Effects 51 Neurological Effects

Feverfew's mechanism of action in the prevention of migraine headaches is not known. It is speculated that feverfew affects platelet activity or inhibits vascular smooth-muscle contraction, perhaps by inhibiting prostag-landin synthesis (4). Results of in vitro studies suggest that rather than acting as a cyclooxygenase inhibitor, feverfew inhibits phospholipase A2, thus inhibiting release of arachidonic acid from the cell membrane phospholipid bilayer (11,12). Drugs that are serotonin antagonists are used in migraine prevention (e.g., methysergide) (9). During a migraine, serotonin is released from platelets (9), and in vitro studies using a bovine platelet bioassay have shown that parthenolide, as well as other sesquiterpene lactones, inhibits platelet serotonin release (13). Both parthenolide and a chloroform extract of dried, powdered leaves were also able to inhibit serotonin release and platelet aggregation in an in vitro study using human platelets and a variety of...

Mutagenicity CarcinogenicityTeratogenicity

In 30 patients with migraine who had been taking feverfew leaves, tablets, or capsules for at least 11 months, there was no increase in chromosomal aberrations or sister chromatid exchange in circulating lymphocytes compared to patients with migraine not taking feverfew matched for age and sex. The Ames salmonella mutagenicity test was also performed on urine samples from 10 patients using feverfew and 10 matched nonusers, with no indication of mutagenicity (26).

Melkersson Rosenthal Syndrome

Melkersson-Rosenthal syndrome is characterized by a triad of recurrent episodes of facial paralysis and facial edema along with a fissured tongue. Other neurologic sequelae have been documented, including headache, trigeminal neuralgia, cranial nerve dysfunction, and autonomic dysfunction. Although the etiology is unknown, recent investigation points toward a granulomatous disease leading to recurrent attacks of edema and inflammation of the face and oral cavity with a predilection for facial nerve involvement. Facial nerve involvement may be unilateral or bilateral, with varying frequencies of attacks and progression. No confirmatory blood test, histopathology, or radiographic evaluation is available, as the diagnosis is entirely clinical.

Computed tomography

Computed tomography scanning, also called CT scan, CAT scan, or computerized axial tomography, is a diagnostic tool that provides views of internal body structures using x rays. In the field of mental health, a CT scan may be used when a patient seeks medical help for symptoms that could possibly be caused by a brain tumor. These symptoms may include headaches, emotional abnormalities, or intellectual or memory problems. In these cases, a CT scan may be performed to rule out a tumor, so that other tests can be performed in order to establish an accurate diagnosis.

Clinical Manifestationssystemic

An extensive discussion of the systemic manifestations of HIV AIDS would be quite lengthy and beyond the scope of this chapter. Note will be made of the PHI, which presents with fever, myalgias, pharyngitis, arthralgias, headache, and malaise. Nonpruritic maculo-papular rash of the face and trunk is reported in 30 to 70 of cases (10) Generalized lymphadenopathy, nausea, vomiting, neurological complications, oral ulceration, and candidiasis might be observed. Since PHI can present before antibody test seroconversion, diagnostic testing should utilize measurement of specific viral antigens or viral load for detection of HIV infection.

Cerebral Venous Dural Sinus Thrombosis

Thrombosis of the dural venous sinuses is an unusual cause of stroke in HIT patients that was first reported by Stevenson (1976). Often, there is a second hypercoagulable state, such as pregnancy (Van der Weyden et al., 1983 Calhoun and Hesser, 1987) or myeloproliferative disease (Kyritsis et al., 1990), that may have interacted with HIT to cause this complication. Platelet-rich white clots were identified in the superior sagittal venous sinus in one necropsy study (Meyer-Lindenberg et al., 1997). Clinicians should have a high index of suspicion for dural sinus thrombosis when a patient develops progressive focal neurological signs, decreased level of consciousness, seizures, or headache during or soon after stopping heparin treatment (Beland et al., 1997 Pohl et al., 1999, 2000 Warkentin and Bernstein, 2003). Treatment includes immediate discontinuation of heparin, use of an alternative anticoagulant, and possibly, intravenous gammaglobulin (see Chapter 12).

Clinical Presentation And Diagnostic Evaluation

Patients may present with a variety of manifestations of their CNS metastases, including headache, focal neurologic deficit, focal or nonspecific visual changes, confusion, vomiting, and or seizures. Alternatively, they may be asymptomatic and may be diagnosed only when CNS imaging is undertaken.9 The intensity of diagnostic evaluation of the CNS in patients with testicular germ cell cancer is based on individual risk stratification. Patients with higher-risk

Extragonadal Germ Cell Tumors

Extragonadal Germ Cell Tumors

Primary intracranial GCTs occur in the pineal and suprasellar regions15 (see also Chapter 28). They represent approximately 1 of all primary intracra-nial cancers, and may be slightly more common in Japan and Taiwan. These tumors also may be either seminomas or nonseminomas. The presentation of pineal tumors is usually with headache, nausea and vomiting, and evidence of raised intracranial pressure. There may be signs of Parinaud's syndrome (paralysis of conjugate upward gaze). The usual

Firerelated Injuries And Fatalities

Asphyxia is always a risk when an individual is exposed to smoke. While many wildland firefighters use particulate masks, private citizens may be unprepared and have no form of airway protection. Wildland firefighters are not as likely to experience the extreme, acute exposures that structural firefighters encounter. However, they are more likely to have prolonged exposure to smoke. Common compounds found in the air of wildland fires include carbon monoxide, sulfur dioxide, particulate carbon and silica, polyaromatic hydrocarbons, aldehydes, and benzene. Of greatest concern are aldehydes and carbon monoxide. Aldehyde exposure results in local irritation, while carbon monoxide exposure is associated with nonspecific warning signs such as headache, and high levels can be potential fatal. While the long-term effects of respiratory contaminants are not fully known, studies have shown decreased short-term pulmonary function in wildland firefighters. Also of concern are exacerbations of...

Tickborne Relapsing Fever

Tick-borne relapsing fever is a spirochete disease caused by at least 13 different Borrelia species and is present worldwide. The vector is the soft tick Ornithodoros, and rodents are commonly infected. The soft tick bite is usually painless. The incubation period is 4-18 days. Relapsing fever presents as a viral-like illness with high fever, myalgias, chills, and headache, and many patients have an eschar at the bite site. The clinical course will usually involve the initial syndrome for 3 days followed by an asymptomatic period of 7 days then another relapse. Neurologic symptoms are common. Diagnosis is made by demonstration of borreliae in peripheral blood during a febrile episode (thick and thin smear preparation, Wright or Giemsa stain can be used). Treatment is with Doxycycline, Penicillin, Erythromycin, or Ceftriaxone.

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