Alternative Ways to Treat Migraines

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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When to Refer Headache Patients

When patients have the sudden onset of a uniquely severe headache, consider intracranial (especially subarachnoid) hemorrhage these patients may be candidates for emergency evaluation including noncontrast computed tomographic (CT) scanning and lumbar puncture. Headache in the presence of fever and stiff neck may raise concern for meningitis. Other poten tial reasons for consideration of further evaluation include (1) headaches associated with persistent, unexplained neurological symptoms or signs (e.g., impaired mental status, focal sensorimotor deficits, or papilledema) (2) unprecedented, unexplained worsening of headaches (3) headaches in patients with certain underlying problems (e.g., cancer, anticoagulation, human immunodeficiency virus HIV -AIDS) and (4) headaches that are refractory to appropriate migraine-preventive treatment. As a general rule, chronic headache patients without significant red flags do not require scanning or other tests beyond routine clinical evaluation....

The Diagnosis and Treatment of Chronic Headaches

Clinicians are often frustrated by patients who continue to complain of chronic headaches despite extensive efforts at diagnosis and treatment. This frustration fosters a tendency to regard these failed headache patients as having a psychogenic problem or being complainers or drug seekers. In truth, it is clinicians, not patients, who in most cases are responsible for the failure of headache treatment because the conventional wisdom about headache diagnosis and treatment, to which most clinicians adhere, is faulty. A better way of looking at chronic headaches enables clinicians to guide patients even patients for whom treatment has failed to effective headache control. The approach is simple but not always easy, especially at the start. The first step is to understand that the mechanism of migraine is responsible for the vast majority of headaches, including headaches of all types. The next step is migraine-preventive treatment, which begins with elimination of avoidable trigger...

The Mechanism and Spectrum of Migraine

Too often the term migraine is used to denote a specific type of headache that is, a severe, unilateral, throbbing headache lasting for a few hours to a few days, accompanied by nausea and photophobia, and sometimes associated with visual disturbances. This definition of migraine is narrow and misleading. A better way to think of migraine is as a mechanism that generates a broad spectrum of headaches, at the far end of which lies the type of headaches described above that is, those that are conventionally labeled migraines. Along this spectrum lie all types of headaches, including mild to moderate, nonspecific headaches, unaccompanied by other symptoms, that are usually mislabeled as tension, stress, or sinus headaches. Of course, when headaches are mislabeled and misunderstood as to their underlying mechanism, treatment is likely to be misdirected and ineffective, and frustration will ensue. The details of the mechanism of migraine are largely lacking, but a conceptual model can be...

Mythical Causes of Headaches

Two myths, in particular, pervade headache diagnosis. The first is that of tension or stress headaches. Many clinicians were taught (and still believe) that mild to moderate, nonspecific headaches the vast majority of headaches are caused by emotional or psychological problems leading to excessive contraction of muscles around the head and neck, in turn producing pain. Electromyographic studies, however, have failed to show any consistent relationship between excessive contraction of head and neck muscles and the types of headaches that are labeled as tension or stress headaches. Although this hypothesis has come to be rejected by most headache specialists, it remains part of conventional wisdom. Consequently, misdiagnosis of the nature of headaches leads to misguided (and ultimately failed) treatment and creates frustration. The second major myth of headache diagnosis is sinus headaches. Although it is true that acute infective sinusitis can produce retrofacial pain, it is likely to...

Why Headache Treatment Fails

Table 12.4 lists 10 reasons why chronic headaches fail to respond to treatment. The first five reasons have been discussed in detail. When patients report unsatisfactory results despite proper attention to these issues, consider the presence of a hidden agenda (e.g., litigation or disability) or other emotional or psychological problems (e.g., depression or family issues) that may be impeding either patients' responses to treatment or their reporting of favorable responses. The importance of the last item on the list that is, patients not understanding their headache problem and its solution cannot be overemphasized. Although it takes time, it is essential that headache patients be educated as to the nature of their problem (i.e., the mechanism of migraine and, if appropriate, rebounding) and the importance of eliminating avoidable trigger factors. For instance, if patients don't receive an explanation as to why they have not recognized all of their dietary trigger factors on their...

A 9Year Old Boy with Skin Lesions and Headaches

A 9-year-old male presented to his physician with a 3-month history of pruritic erosive vesicular changes on the dorsum of the hands and tops of the ears in sun-exposed areas, with patchy skin thickening and hyperpigmentation. The patient also had a lifelong history of very small scarring on the face. Other symptoms included occasional headaches and stomach aches, reportedly several times a week, with no history of medications, hepatitis, excessive iron intake, increased estrogens, or exposure to chemicals. Physical examination was unremarkable except for the skin changes noted over the dorsal hands, face, and ears.

Headache Pain

In the general outpatient clinic, headaches are the main complaint evaluated by neurologists. Over 45 million people suffer from chronic headaches. This fellowship allows the clinician to gain further skill in treating chronic pain syndromes, including headaches. Some programs provide training in interventional pain techniques, similar to those learned by anesthesiologists. These procedures include epidural injections, trigger point injections, denervation procedures, and others. Many hospitals offer special headache clinics staffed by neurologists.


Headaches are among the most common complaints that patients present to their physicians. In the large majority of cases, headaches do not herald significant underlying disease and can be managed by a primary practitioner. In a small minority of cases, headaches result from serious underlying diseases, some of which may require urgent evaluation and treatment. Other headaches, while not indicative of life-threatening illness, may indicate an unusual pathophysiology requiring treatment by an experienced practitioner. The initial role of the primary care practitioner is to decide whether the history or physical examination contains danger signals indicating the need for referral for testing or to a specialist. Once such unusual cases are referred on, practitioners need a management plan for the vast majority of headache patients who will remain in their care. The initial step for these patients is the identification and avoidance of headache trigger factors. Headaches persisting after...

Cluster Headache

This primary, neurovascular headache disorder afflicts mostly men and is characterized by headache intervals (clusters) of a few months' duration separated by longer headache-free periods. A less common, chronic form of the disorder is without headache-free periods. During a headache interval, the individual has one to several episodes per day of excruciating, unilateral, periorbital pain consistently on the same side during an interval lasting one-half to one hour or so. Episodes often arise from sleep. There may be accompanying ipsilateral redness and tearing of the eye, ptosis, and nasal congestion. People with cluster headaches tend to be highly agitated during their headaches. Alcohol is an immediate trigger for most patients during headache intervals (but not in headache-free periods). Acute treatment of cluster headache involves either inhalation of 100 percent oxygen or injection of sumatriptan. Preventive treatment initiated at the onset of a headache interval and continued...


Although headache can be seen before, during, and after seizures, spells associated with headache will often be migrainous or psychogenic. In contrast to patients with seizures or TIAs, few migraine patients will have impairment of speech, memory, or consciousness, and confusion is rare. Migraine is more gradually progressive than seizures, and consciousness is almost invariably preserved. In migraine, there is usually a previous, clearly delineated history of headache with symptoms such as positive visual phenomena (including flashing lights, spots, fortification spectra), nausea, vomiting, phonophobia, and photophobia. In classic cases, abnormalities of either visual or somatic sensation will progress in a characteristic march from the initial site to the final pattern over the course of minutes. As discussed in Chapter 12, such a classic march is the exception rather than the rule. When episodes of visual distortion, malaise, and even mild headache then occur in the same patient,...


Migraines are a common cause of headaches, occurring in about 10 percent of the population. They usually cause a severe, throbbing pain, most often on one side of the head. A migraine headache can last hours or even days and can be associated with nausea and light sensitivity. Some people know when a migraine is about to start because they experience vision changes (known as an aura), commonly dark patterns or wavy lines in the corner of their eyes. Migraines used to be referred to as vascular headaches because they were thought to result from abnormal dilation of blood vessels. However, recent research has not supported this theory, and their actual cause remains unknown. A migraine can be confused with sinusitis because nasal discharge often accompanies the headache. However, unlike sinusitis, the drainage from a migraine is usually clear and one-sided. Also, the pain from migraines is more likely to be located on the side of the head, whereas sinus headaches tend to occur in the...

Alexander Graham Bell Association for the Deaf

Hay fever causes sneezing, profuse runny nose, and nasal obstruction or congestion. Nose and eyes may itch. Eyelids and the whites of the eyes may look red and swollen, and there may be headache or sinus pain, dark circles under the eyes, itchy throat, malaise, and fever. Perennial

How paracetamol and aspirin work

Both these drugs, used to treat minor aches and pains and to reduce fever, have a similar mode of action. They inhibit an enzyme called cyclo-oxygenase, or COX. This produces substances called prostaglandins, which are mediators produced in response to damage to cells and which tell the body that there is damage, which we feel as pain. Blocking the production of the prostaglandins therefore reduces the sensation of pain. They also cause relaxation of blood vessels in the brain which causes headache drugs such as aspirin reduce this by reducing the amount of prostaglandin present. The prostaglandins can also increase the temperature by acting on a particular area in the brain. If there are fewer of these mediators, the temperature will remain more or less normal and fever will be reduced. The prostaglandins, along with other mediators such as kinins and histamine, are also involved with the inflammation that occurs when tissue is damaged and infected by bacteria. Therefore aspirin will...

About ICON Health Publications

The Official Patient's Sourcebook on Acute Disseminated Encephalomyelitis The Official Patient's Sourcebook on Agenesis of the Corpus Callosum The Official Patient's Sourcebook on Agnosia The Official Patient's Sourcebook on Arachnoid Cysts The Official Patient's Sourcebook on Arachnoiditis The Official Patient's Sourcebook on Binswanger's Disease The Official Patient's Sourcebook on Brain and Spinal Cord Tumors The Official Patient's Sourcebook on Cerebral Atrophy The Official Patient's Sourcebook on Coma The Official Patient's Sourcebook on Corticobasal Degeneration The Official Patient's Sourcebook on Empty Sella Syndrome The Official Patient's Sourcebook on Headaches The Official Patient's Sourcebook on Locked in Syndrome The Official Patient's Sourcebook on Occipital Neuralgia The Official Patient's Sourcebook on Olivopontocerebellar Atrophy The Official Patient's Sourcebook on Progressive Multifocal Leukoencephalopathy The Official Patient's Sourcebook on Pseudotumor Cerebri The...

Selective Serotonin Reuptake Inhibitors

Potential side effects include nausea, anorexia, more frequent or loose stools, anxiety, restlessness, sleep disturbance (insomnia or hypersomnia), headache, diminished sexual drive, orgasmic dysfunction, and apathy. Sinus bradycardia is an uncommon side effect but is rarely symptomatic. Most of these adverse effects are mild or transient, and thus most patients tolerate SSRIs well in the short term. Over the long haul, however, up to 20 percent of patients will discontinue these drugs because of persistent changes in sexual drive or function, and a smaller number will discontinue use because of apathy, gastrointestinal disturbance, or sleep disturbance. Sertra-line hydrochloride is most likely to cause diarrhea, and paroxetine hy-drochloride to cause hypersomnia.

Antiretroviral Agents

The predominant adverse effect of zidovudine is myelosuppression, as evidenced by neutropenia and anemia, occurring in 16 and 24 of patients, respectively. Zidovudine has been associated with skeletal and cardiac muscle toxicity, including polymyositis. Nausea, headache, malaise, insomnia, and fatigue are common side effects.

Blood poisoning See septicemia

Most transfusions do not cause any problems, but mild side effects may include symptoms of an allergic reaction such as headache, fever, itching, increased breathing effort, or rash. This type of reaction can usually be treated with medication if the child needs more transfusions in the future. Serious reactions are rare. The most common serious side effect is serum hepatitis, an infection of the liver.

Hypermetropia Longsightedness

A constant accommodative effort to overcome excessive longsightedness may also cause eyestrain, headaches, and blurred vision. Longsightedness in children would not usually be detected by a distance letter chart test, and frequently does not even affect performance at brief near vision tests. Longsightedness in one eye will not be detected by binocular (both eye) acuity tests and, although unlikely to affect reading, can result in a permanent visual loss if not detected in the first 5 or 6 years of life. Some studies have found a weak correlation between longsightedness and reading difficulties, others have suggested that this may result from a weak negative correlation between hypermetropia and IQ (Evans, 2001).

Symptoms and Treatment

The toxins affect the central nervous system (CNS). Symptoms start within twenty minutes and may last for two to four hours, but peak hallucinogenic activity rarely lasts for more than one hour. Symptoms include anxiety and tension, visual effects such as blurring, euphoria, increased color perception with closed eyes, but also headache and fatigue. The overall sensation is usually described as pleasant.

Bottom mentality See bottom

Brain cancer Any primary cancerous tumor in the brain. Brain cancer is relatively rare. There are many different types of brain tumors, only some of which are cancerous. A malignant tumor can spread to other parts of the brain although a benign brain tumor does not spread, it can be equally devastating because the skull cannot expand to accommodate the mass growing inside. Some benign tumors become malignant. Two types of brain cancer affect HIV-infected people primary CENTRAL NERVOUS SYSTEM (CNS) LYMPHOMA and metastatic systemic lymphoma in the brain. Other brain cancers are extremely rare in HIV patients. The symptoms of a brain tumor can vary, depending on the part of the brain affected. The most frequent signs of a brain tumor are subtle changes in personality, memory, and intellectual performance that may not be noticed. A common symptom is a headache, not necessarily persistent or severe. Nausea and vomiting unrelated to food consumption occur in about a quarter of people with a...

Cigarettes and the brain

And muscles, unrefreshing sleep, tender lymph nodes, sore throat, and headache. Symptoms vary from person to person and fluctuate in severity. Specific symptoms may come and go, complicating treatment and the patient's ability to cope with the illness. Most symptoms are invisible, which makes it difficult for others to understand the vast array of debilitating symptoms.

Congenital brain defects

Injury, symptoms may include headache, vomiting, increased pulse rate, and anxiety. Symptoms usually begin to disappear within a few days. Acetaminophen or another painkiller may be prescribed for headache. Aspirin is not generally recommended because it can contribute to bleeding. Rest and relaxation with no activities requiring concentration or vigorous movement will speed recovery within a few days.

Brain Infusion of Muscimol to Treat Epilepsy

Epilepsy) with a medical history, physical and neurologic examination, chest X-ray, electrocardiogram, blood and urine tests, electroencephalographic (EEG) monitoring and magnetic resonance imaging (MRI) of the head. Patients enrolled in this study will have the following procedures 1. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the head to guide catheter electrode placement (see 2). 2. Depth catheter electrode placement into the presumed or possible location of the seizure focus (the part of the brain where the seizures originate) - Small holes are drilled through the skull. Electrodes with a hole in the center of the tubing that holds them are passed through the brain into the structures usually involved in intractable epilepsy. MRI will be done to check electrode placement. Video-EEG monitoring will continue for 5 days in patients in whom the location of the seizure focus is known but longer (up to 33 days) in patients in whom the seizure focus is difficult...

Food Allergy Symptoms

'Early allergy' (allergy Type I, II or III) may affect the mucous membrane of the oral cavity (OAS), the stomach (a surface or erosion-like mucous membrane inflammation), or the intestines (inflammatory changes of various degrees of intensity, from eosinophilic infiltration to ulceration or enteritis granuloma Caffarelli et al., 1998 ). Systemic manifestations may have a dramatic course, sometimes leading to death due to anaphylactic shock, which can develop in few minutes after food consumption. Early allergies may also affect internal organs, most frequently the upper respiratory tract (manifested as bronchial asthma). Delayed symptoms may affect the skin (nettle rash), joints (inflammations of single or numerous joints), muscles (myalgia), kidneys (nephrosis), and may also manifest as otitis media and recurrent pneumonia. They may also lead to changes in the central nervous system that cause character and mood changes, hypermotility or tiredness syndrome, headaches, 'chronic...

Poison through the US Mail

Thinking he had got away with murder, Molineux struck again, this time sending a sample of Emerson's Bromo-seltzer to Harry Cornish, athletic director of the prestigious Knickerbocker Athletic Club at the corner of Madison Avenue and 45th Street. It arrived on Christmas Eve, 1898, together with a pretty silver stand to hold it in, and it was this which caused Cornish to give it to his widowed aunt Catherine Adams, because it was similar in style to other silver ornaments she had in her home, located near Central Park. Cornish lived at his aunt's house and he was there when she took some of the Bromo-seltzer for a headache on the morning of 28 December. Immediately she screamed and started writhing in agony 30 minutes later she was dead. The contents of the bottle were later analysed and found to contain 42 mercury cyanide.

Coalition politics See activism

The illness is seen in three different forms acute, chronic, and disseminated. The acute infection is often not noticed by most people. Symptoms can be fever, headache, dry cough, malaise, weight loss, and muscle aches. Acute pulmonary coccidioidomycosis is almost always mild, producing few or no symptoms, and resolves without treatment. The incubation period is seven to 21 days. Chronic disease can occur up to 20 years after an initial infection that has not been recognized or treated. Disseminated infection can affect the spleen, lymph system, bones, and heart area. Meningitis is common in disseminated cases. Diagnostic tests and biopsies can be done to check for disease. HIV-positive people often test negative for the disease serologically.

Locum Tenens The Fillin Physician

Many new doctors fresh out of residency training are taking a closer look at locum tenens practice. They are joining the traditional locum tenens workforce older doctors who have recently retired or who are just sick of the hassles of their full-time practice. It is quite easy to acquire a locum tenens position right away. You can go to web sites like or sign on with national agencies that will find you that ideal short-term job. For a fee, these agencies take care of all the headache-inducing paperwork, like arranging for malpractice insurance, state licensure, and accommodations. Many hospital employers even pay your travel and living expenses.

Egas Moniz Antonio Caetano de Abreu Freire

Users say Ecstasy lowers their inhibitions and relaxes them, increases awareness and feelings of pleasure, and gives people energy. However, after taking MDMA some people report side effects such as headaches, chills, eye twitching, jaw clenching, blurred vision, and nausea. unlike the drug LsD, low doses of MDMA do not cause people to hallucinate.

Why do the different forms of mercury cause different effects

The answer lies mainly in their distribution and properties. Elemental (liquid) mercury is volatile and can be inhaled. If sufficient of it enters the body, it is able to enter tissues such as the brain and cause damage, giving rise to headaches and also damaging the gums and teeth, for example. Liquid mercury, if taken into the stomach (which could occur if a child chewed and broke a thermometer, for example), would not be especially hazardous as the metal would be eliminated from the intestines in due course in the faeces. Little would be absorbed into the bloodstream. Inorganic mercury, such as occurs in salts (for example, mercuric chloride, also known as corrosive sublimate), can be absorbed from the gut and sufficient enters the bloodstream to bind to sulphur-containing

Dont Take Two Aspirin and Call Me in the Morning

A 13-year-old girl presented to the emergency department of a tertiary medical center complaining of a severe headache and her heart beating too fast. Her mother reported a 3-month history of headaches occurring 2-3 times per week, bilateral in nature, occurring with sudden onset at any time of day, and lasting less than one hour. The headaches had been increasing in severity. The patient denied nausea, vomiting, photophobia, paresthesias, and aura. She was sleeping 8-10 hours each night and was not allowed any caffeinated beverages. She had not begun menses. Over-the-counter analgesics were ineffective and used only a few times. The patient had no history of upper respiratory infection, seasonal allergies, or sinusitis during the previous 3 months. She had no significant past medical history she had received all her immunizations. Family history included hypertension, coronary artery disease, and thyroid cancer in her deceased paternal grandfather, migraine headaches in her mother,...

Differential Diagnosis

In a healthy pediatric patient, the most common causes of headache are caffeine withdrawal, stress tension, sleep deprivation, sinusitis, cluster headache, and migraine. Several of these etiologies were ruled out by taking a careful history. Physical exam and CT of the head demonstrated no hemorrhage, tumor, or other structural malformation. Of great concern are the symptoms that accompany the headaches in this patient anxiety, palpitations, and sweating. While these symptoms could be explained by a psychiatric illness, such as an anxiety disorder, the extremely elevated blood pressure observed in the emergency department would not be consistent with a psychiatric cause. In children, hypertension is unusual, and almost always secondary to underlying disease or congenital malformation. The signs and symptoms coincident with headache in this patient are classically associated with pheochromocytoma.

Encephalitis lethargica

Symptoms often begin with headache, fever, and prostration that leads to hallucinations, confusion, paralysis, disturbed behavior, and problems in speech, memory, and eye movement. The amnesia in patients with this disorder is probably caused by the destruction of the hippocampus and amygdala. Some patients may also suffer damage to the front lobes and in extreme cases show symptoms of the Kluver-Bucy syndrome, a condition causing a range of symptoms including amnesia, visual problems, and altered sexual behavior. There may be a gradual loss of consciousness and sometimes coma seizures may also occur.

Cytomegalovirus CMV disease

Cytomegalovirus encephalitis encephalitis caused by cytomegalovirus. Studies have shown that CMV encephalopathy is underdiagnosed. It frequently occurs unnoticed in persons with CMV retinitis. Symptoms include dementia, headache, confusion, and fever. The infection progresses rapidly, leading to death within weeks or months.

William Heberden 17101801

The hemicrania, or pain of one half of the head, was very early distinguished by medical writers from the other species of headaches but we have not yet advanced much in knowing how this differs from other pains of the head. Commentaries on the History and Cure of Diseases Ch. 17 (i802)

Encephalitis California

Usually, symptoms begin with headache, fever, and prostration, leading to hallucinations, confusion, paralysis of one side of the body, and disturbed behavior, speech memory, and eye movement. There is a gradual loss of consciousness and sometimes a coma epileptic seizures may develop. If the meninges are affected, the neck is usually stiff and the eyes are unusually sensitive to light.

The Emergence Of Sars Coronavirus

Severe acute respiratory syndrome (SARS) was first described in November 2002, when inhabitants of Guangdong Province, China, presented with an influenza-like illness that began with headache, myalgia, and fever, often followed by acute atypical pneumonia, respiratory failure, and death. The outbreak spread over Asia, and to Europe and North America. A total of 8,096 cases were recorded, of which 774 (9.6 ) died.1-5 The etiological agent of SARS was identified as a novel coronavirus, SARS-CoV.6-10 This 2002-2003 SARS-CoV epidemic strain was successfully contained by conventional public health measures by July 2003.11, 12

Biogenic Amines In Wine And Beer

Wine and beer contain low concentrations of biogenic amines (Stratton et al., 1991), a summary is given in Table 6.10. White wines generally contain very low levels of biogenic amines (Littlewood et al., 1988), while red wines have higher levels (Ough, 1971). Wines are reported to generally contain less than 10 mg per liter (Ough, 1971 Pechanek et al., 1983 Baucom et al., 1986), however there have been some reports of much higher biogenic amine content (Baucom et al., 1986 Ough, 1971). Biogenic amine concentrations of 8 mg per liter may cause headaches if large quantities are consumed (Ough, 1971). Soufleros et al. (1998) state that biogenic amine production is dependent on the microflora and the amino-acid composition of the wine after fermentation. The amino-acid composition after fermentation is dependent on the grape variety, vine nutrition, and yeast metabolism. The pH is also an important factor the higher the pH, the higher the levels of biogenic amines produced (Lonvaud-Funel...

Prefers knowing a little about everything in medicine

To be a good family physician, you must be content knowing something about everything, but not everything about anything. It comes as no surprise that family physicians must be adept at approaching the widest variety of clinical complaints. According to the US Department of Health and Human Services, the most common problems prompting a visit to the physician are related to coughing and the throat. Family physicians encounter these problems on a daily basis. But the scope of disease and their symptoms is much wider. They commonly treat medical conditions (hypertension, diabetes, headaches, rashes), surgical problems (diverticulosis, suspi-

Symptoms Treatment and Outcome

Some patients have symptoms of acute HiV infection within days or weeks after infection. These symptoms are similar to those of many viral illnesses and include a nonspecific rash, fever, sore throat, headache, cough, flulike symptoms, mouth ulcers, diarrhea, enlarged lymph nodes, and arthralgia. The acute illness settles spontaneously over a few weeks and is followed by a period, which may last years, during which patients do not have symptoms. As the immune system becomes more severely affected, patients develop symptoms of AIDS such as loss of weight, diarrhea, enlarged lymph nodes, and opportunistic infections (infections that are not common in healthy people).

Clinical Features Of

Anterograde amnesia is not the only behavioural abnormality in TGA. Further impressive symptoms are repetitive questioning and repetitive comments. Not only do patients ask the same questions over and over, they frequently use exactly the same wording in each round of questions and give exactly the same comments to the answer. The simple explanation that patients repeat the question because they forget the answer does not hold, as patients repeat the same questions regardless of changing circumstances, and they may repeat questions which are only loosely related to the worry brought forward by the experience of not knowing what is happening to them. Indeed, there are patients who repeat questions over and over in spite of being apparently little concerned or even anosognosic about their disorder (Hodges & Ward, 1989 Stillhard et al., 1990). Repetitive behaviour is not necessarily confined to questions or comments but may also concern senseless motor actions like washing hands (Caplan,...

Ectoparasitic Infections

Lindane 1 should be applied one time and washed off six to eight hours later some clinicians recommend a second application one week later. Generally, lindane is an appropriate alternative treatment for scabies however, there have been reports of possible resistance (47) and there are multiple possible adverse side effects. Convulsions may occur if applied after a bath or in patients with extensive dermatitis (121). Lindane has also been associated with the development of aplastic anemia (122,123) and brain tumors in children (120), though data are few. Accidental ingestion can lead to lindane-induced central nervous system toxicity, manifested by headache, nausea, vomiting, tremors, convulsions, respiratory failure, coma, and death (124). It is possible that toxic side effects are due to overexposure or improper use. Lindane should not be used by patients with seizures or neurologic disease (119), pregnant or lactating women, or by children Epidemics occurring in nursing homes or...

Dependence on Alcohol or Drugs

Although substance use disorders are mostly self-inflicted, they can be initiated or sustained through the well-intentioned treatment of a variety of common complaints (e.g., anxiety, headaches, insomnia, chronic pain). For most front-line practitioners, few days go by without repeated requests for more or stronger psychoactive medications. Once a substance use disorder has become established, it brings its own cargo of medical and psychiatric problems.

Hand foot and mouth disease

Symptoms usually appear within four to six days after infection. The mild illness usually lasts only a few days and includes ulcers inside the cheeks, on gums, or tongue, together with a fever, achiness, sore throat, headache, and poor appetite. Two days later, a rash on palms, fingers, soles, and diaper area appear this is the signal that the virus is abating.

Channel gating See gating current

Channelopathy Any disease that arises because of a defect in an ion channel. Channelopathies are known that involve the ion channels for potassium, sodium, chloride and calcium. There are also channelopathies involving the acetylcholine receptor, the glycine receptor and other receptors. Each channelopathy can play a role in a number of different diseases. For example, the calcium channelopathies include familial hemiplegic migraine, malignant hyperther-mia, episodic ataxia type 2, spinocerebellar ataxia type 6, hypokalemic periodic paralysis type I, central core disease, congenital night blindness and stationary night blindness. Other examples are Long QT syndrome, Andersen's syndrome.

Memory trace See engram

Symptoms vary depending on the size and location of the tumor. headache is the most common symptom of this type of tumor, although not all tumors will trigger one. A tumor in the frontal lobe may produce progressive weakness of one area of the body, seizures, or mental changes (such as drowsiness, listlessness, dullness, or personality change). A tumor in the dominant side of the brain (the left side in most righthanded people) can produce speech difficulties such as aphasia, the loss of the ability to smell, visual problems, loss of bladder control, or anomia (problems in recognizing and naming objects).

Rash on the Soles of the Feet

A 43-year-old male presented to the infectious disease clinic with a 2-month history of worsening skin rash and lesions. The lesions were not painful and were predominantly on his face and forearms, but also covered the palms of his hands and soles of his feet. He was treated one month prior to this presentation with azithromycin, and the rash had improved slightly. In addition to the worsening rash and skin lesions, he noted the development of painless lesions on his penis that were resolving at the time of presentation. He also reported a history of night sweats, which coincided with the appearance of the rash, a sore throat, mild weight loss, headaches without visual alterations, and mild neck stiffness. The day prior to presentation he noted a single episode of anal discharge that was yellow and nonbloody. He had no history of fever, chills, nausea, vomiting, diarrhea, or penile discharge.

Definition of Disease

Secondary syphilis is characterized by systemic manifestations of the disease. The presenting feature is usually a rash and lesions on the mucous membranes. The rash is typically rough, red, or brownish red, and found mainly on the palms of the hands and soles of the feet.1 Rash may be accompanied by fever, swollen lymph nodes, sore throat, patchy hair loss, headache, weight loss, muscle ache, and fatigue.1 The rash can appear concurrent with a healing chancre or can appear several weeks to years later. The rash will resolve without treatment, but without treatment the risk of developing late or tertiary disease is greater.

Jerome S Schwartz Phillip Song and Andrew Blitzer Introduction

Headaches are one of the most common patient complaints to primary care physicians in the United States. The debilitating nature of many headache disorders often results in significant loss of productivity, social engagement, and quality of life. Although the overwhelming majority of headache disorders are benign in nature, patients often fear the worst case scenario, such as an aneurysm or brain tumor. To compound the situation, physicians, particularly those who are unfamiliar with headache management, often needlessly resort to extensive diagnostic examinations in search of organic pathology, thereby creating additional anxiety and financial burden. This chapter describes the most common headache disorders with particular attention to migraine and tension-type headaches (TTHs). Because many of the routinely prescribed medications have inadequate efficacy and significant adverse effects, alternative treatment regimens are under investigation. Botulinum neurotoxin (BoNT) injection is...

Hypogammaglobulinemia agammaglobulinemia

Hypoglycemia Deficiency of sugar in the blood. This condition may result in shakiness, cold sweat, fatigue, hypothermia, headache, and malaise, accompanied by confusion, irritability, and weakness. Hypoglycemia may ultimately result in seizures, coma, and possibly death.


Migraine Headache Nearly 27.9 million, or 10 to 15 of Americans suffer from moderate to severe migraine headaches, accounting for nearly 10 million physician visits yearly (5,6). Headaches account for nearly 1 to 2 of all emergency room visits, with migraines making up nearly 40 of headache-related visits (7). Migraines affect nearly 18 of women and 6 of men however, these estimates may underreport the true incidence of the disease, because many patients go undiagnosed. The disorder most commonly affects individuals between the ages of 25 and 55 (8). Diagnostic Criteria for Migraine and Tension-Type Headache c. Headache has at least two of the following characteristics d. During headache, at least one of the following 2. Tension-type headache (code 2.1) c. Headache has at least two of the following characteristics d. During headache, both of the following Migraine is considered a leading cause for missed days at work in the United States. Lost productivity at work or school, impaired...

Special Procedures In Neurology

If sticking long needles into the backs of your patients is not enough, neurology also offers other types of procedures for medical students with great manual dexterity. In addition to EMG testing, neurologists perform injections of Bot-ulinum toxin, a neuromuscular relaxant, to treat patients with severe dystonia, headaches, and even wrinkles. Within the emerging specialty of neurologic intensive care, these clinicians make use of even fancier procedures placement of intracranial probes and shunts, evaluation of transcranial Doppler studies, and even performing cerebral angiograms.

Definition of the Disease

Once transferred to humans, the typical incubation period for the virus ranges from 3 to 14 days. While the most severe cases of West Nile can result in a life-threatening meningoencephalitis, the majority of cases of West Nile are mild and clinically unappar-ent. In about 20 of cases, infected individuals will develop a 3 -6-day febrile illness characterized by headache and general malaise.4-6 Approximately 1 in 150 west Nile patients will develop meningoencephalitis manifesting as a febrile illness with severe headaches, neck stiffness, stupor, altered mental status, coma, tremors, convulsions, muscle weakness, and abnormal movements. Replication of the virus in various peripheral sites precedes invasion of the central nervous system (CNS). It is believed that the virus migrates from the peripheral sites through the olfactory system into the CNS. Once inside the CNS, patients can develop encephalitis, meningitis, or a combination of both meningoencephalitis. This condition typically...

Fellowships And Subspecialty Training

Since the founding of the National Institute of Neurologic Disease and Stroke in 1950, subspecialization within neurology has developed at an accelerating rate. According to the American Academy of Neurology (AAN), the most common areas of clinical focus among neurologists were headache, epilepsy, stroke, and neurophys-iology. Most fellowships in neurology last 1 to 2 years following completion of residency training. For medical students interested in a career in academic neurology, a research-oriented fellowship in a subspe-cialty is almost imperative. Only two of the following fellowships (clinical neurophysi-ology and headache pain) are ACGME-approved and lead to board certification.

Carbon monoxide a common but lethal poison

As the above cases demonstrate, carbon monoxide poisoning can arise from quite unexpected sources and can be serious. Indirect poisoning from this source of the gas is probably relatively uncommon, but direct poisoning with carbon monoxide is probably the most common type of accidental poisoning that affects the general population. There are probably several hundred poisonings from carbon monoxide every year in the UK alone, some of which are fatal. Some mild cases may well go undetected as the main symptom is a headache.

Postinjection Management

The headache relief from BoNT-A may take several weeks to reach maximal effect. Patients should maintain an accurate headache diary during the course of botulinum injections, documenting the time, severity, duration, location, and frequency of all headache events (42). Any medications taken to relieve acute breakthrough headaches should be noted. The patient should return for reevaluation at 4 to 6 weeks following the previous injection to document any

Lambda Legal Defense and Education Fund

Lamivudine A nucleoside reverse transcriptase inhibitor (NRTI) from GlaxoSmithKline. It is used in the treatment of HIV and hepatitis B. It was the first drug to be approved for the treatment of hepatitis B. It has been one of the longest used drugs against HIV and has proved durable for many people. It is used in the combination pills combivir and trizivir. 3TC works well in combination with AZT and has shown to decrease mutations causing resistance that can arise in taking AzT. It is available in both a liquid and a pill formulation. It is taken twice daily. The most common side effects are nausea, vomiting, fatigue, and headaches. 3TC does not work well with zalcitabine. (Also known as 3TC and Epivir.)

Vocabulary Builder

Methysergide An ergot derivative that is a congener of lysergic acid diethylamide. It antagonizes the effects of serotonin in blood vessels and gastrointestinal smooth muscle, but has few of the properties of other ergot alkaloids. Methysergide is used prophylactically in migraine and other vascular headaches and to antagonize serotonin in the carcinoid syndrome. Sumatriptan A serotonin agonist that acts selectively at 5HT1 receptors. It is used in the treatment of migraines. nih

Frequency Of Injections

Repeated injections are necessary as the botulinum effect subsides. There is tremendous variation among patients with respect to optimal dosing frequency. Some patients experience relief well beyond the predicted pharmacokinetic duration of the drug. This suggests a possible neuromodulating effect of the toxin at the CNS level. In addition, the response to toxin injection may change over time, with some patients reporting greater therapeutic effect with repeat injections (46). Although the majority of patients require repeat injections at 3- to 4-month intervals, the headache diaries serve as a useful guide for the physician to direct future treatment.

Transient Global Amnesia TGA

TGA typically occurs in people ages fifty and older. Although migraine, temporal lobe seizures, and transient ischemic attacks have been cited as possible causes, compelling evidence is lacking. Certain medicines have also been implicated, including sleeping medications and sedative hypnotics. One provocative causal hypothesis concerns transient reduction of blood flow to the medial temporal lobes or thalamus, structures critical for memory function. This type of reduced perfusion can occur with physical and emotional stress, when normal blood flow is partially diverted to other areas of the body. Reported trigger events include pain, physical exertion, cold water exposure, severe emotional stress, and sexual intercourse.

How Is Pain Diagnosed

There is no way to tell how much pain a person has. No test can measure the intensity of pain, no imaging device can show pain, and no instrument can locate pain precisely. Sometimes, as in the case of headaches, physicians find that the best aid to diagnosis is the patient's own description of the type, duration, and location of pain. Defining pain as sharp or dull, constant or intermittent, burning or aching may give the best clues to the cause of pain. These descriptions are part of what is called the pain history, taken by the physician during the preliminary examination of a patient with pain.

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Munculus representing the body extends widely over the brain surface. Transient numbness beginning in the hand or face and spreading over adjacent parts of the body in a matter of minutes is a classic prodrome of migraine. Similar spread occurring in a matter of seconds is typical of a seizure. Instantaneous numbness of face and arm lasting for minutes to hours is typical of transient ischemic attack (TIA) involving a large vessel, from either a cardiac embolus or carotid disease.

Young Woman with Postpartum Cerebral Venous Thrombosis and Abnormal Coagulation Tests

An 18-year-old young woman was transferred from an outside hospital to the neurology service for evaluation of headaches, seizures, and a parietooccipital infarct on a computed tomography scan. She had undergone an emergency caesarean section in the 34th week of her second pregnancy 4 weeks earlier. The baby did not survive. After the delivery, she started having severe, continuous, throbbing temporooccipital headaches. One week prior to admission, she had four episodes of generalized, tonic-clonic seizures. Apart from the headaches, she had no other symptoms, and the physical examination was normal. However, a magnetic resonance venogram and arteriogram showed a left transverse venous sinus thrombosis and a left temporal lobe infarct. Review of her past medical history revealed that she had one prior miscarriage at gestational age month 2. The family history was noticeable for a cousin with possible cerebrovascular accident in her 20s.

Neurofibromatosis 365

Other symptoms of NF2 may include facial weakness, headache, vision changes, and a lump or swelling under the skin caused by the development of a neurofibroma. In a family member at risk for NF2, a positive diagnosis can be made if mild signs of NF are found elsewhere, such as one or two cafe-au-lait spots or a small lump under the scalp or skin.

TTPClinical Presentation

Hemolytic anemia (MAHA), neurological symptoms, renal function abnormalities, and fever. Neurological symptoms are present in most patients diagnosed with TTP. The most common symptoms include confusion and severe headaches, but focal neurological symptoms, seizures, and coma can also occur. In patients with TTP, renal impairment is variable, and the urine analysis may be abnormal due to mild proteinuria and microhematuria with or without red cell casts. Fever is noted in about 60 of patients. Abdominal pain, possibly due to gastrointestinal ischemia, and neutrophilia are also sometimes observed.

Role Of The Virus In Aids Pathogenesis

In the primary infection, entry of the virus through mucosa involves its association with dendritic cells which then transport the virus to lymphatic tissues. The virus can rapidly multiply there in activated CD4+ lymphocytes and macrophages. Since the number of activated CD4 lymphocytes is small, it becomes a limiting factor which depends on intercur-ring microbial infections. Biologically, this phase is characterized by a peak of viral antigens (not always present) and a large number of viral RNA copies in blood, and a peak of interferons. Specific cytotoxic lymphocytes (CTL) then appear followed by the appearance of antibodies against viral glycoproteins and internal proteins. Clinically, when the level of viral replication is high, symptoms can be detected (fever, adenopathy, headaches). However, the infection can be sometimes completely inapparent.

Giant Cell Temporal Arteritis

Immune-mediated inflammation of the temporal and other extracranial arteries produces headache and temporal artery tenderness, often accompanied by palpable abnormalities in the temporal arteries. Suspect this disorder in elderly persons, especially those with associated systemic symptoms of polymyalgia rheumatica (myalgias, fatigue, malaise, and anorexia). The erythrocyte sedimentation rate usually (but not always) is markedly elevated, but prompt temporal artery biopsy should be obtained for diagnosis. Urgent corticosteroid therapy is indicated, lest delayed treatment result in ocular ischemia and permanent visual loss.

Idiopathic Intracranial Hypertension Pseudotumor Cerebri

This condition, which results in increased intracranial pressure and consequent headaches and visual disturbances, should be considered especially in young, obese women and is almost always associated with papilledema. After a brain CT or magnetic resonance imaging (MRI) scan (to rule out a mass lesion or hydrocephalus), the diagnosis is confirmed by lumbar puncture and careful cerebrospinal fluid pressure measurement with the patient as relaxed as possible and with legs extended, to avoid artifactually elevated pressure due to the Valsalva effect. Treatment is indicated not only to relieve headaches but also to prevent permanent optic nerve damage, and options include multiple lumbar punctures, acetazolamide, corticosteroids, lumboperitoneal shunting, and fenestration of the optic nerve sheath.

Stereotactic radiosurgery 295

Stars most often appear following a blow to the back of the head because that is the location of the visual cortex. In fact, stimulating the cells in this part of the brain with a probe can also set off a twinkling-star show. Scientists also believe that the pulsing star-like visual hallucinations often seen by migraine sufferers is caused by spontaneous electrical signaling in the visual cortex.

Phase i clinical trials in solid tumors

Recently, results of a phase I trial by Aghajanian et al. have been published. In this study, 43 patients in a variety of neoplasms were treated with single-agent bortezomib in doses ranging from 0.13 to 1.56 mg m2 dose. The tumor types included were non-small-cell lung cancer (NSCLC), colon, head and neck, melanoma, ovary, renal, prostate, bladder, cervix, endometrial, esophagus, gastric, and unknown primary. A total of 89 doses were administered, with an average of 2 cycles per patient. The median number of previous chemotherapeutic regimens was four. Reported DLTs were diarrhea and sensory neurotoxicity. Other side effects seen were fatigue, fever, anorexia, nausea, vomiting, rash, pruritus, and headache. There was no dose-limiting hematological toxicity. One partial response was seen in a patient with NSCLC. The maximum tolerated dose (MTD) was established at 1.56 mg m2. Pharmacodynamics studies showed a dose-related inhibition of 20S proteasome activity with increasing dose of...

The Elimination of Trigger Factors

The first step in preventive treatment of migraine is to try to keep the total level of trigger factors below the threshold of activation. This is accomplished by eliminating trigger factors that are avoidable recognizing that, for practical purposes, many important trigger factors cannot be avoided, including stress, hormones, and barometric pressure changes. This fact makes it all the more important to focus on the avoidable trigger factors. For the most part avoidable trigger factors are things that patients put in their mouths and swallow certain dietary items (Table 12.1) and medications (Table 12.2). Patients tend to recognize few if any of their dietary trigger factors, and, to comply with a migraine-preventive diet that eliminates these potential factors, they must understand why they have not figured this out for themselves. The first reason is that dietary trigger factors can act on a delayed basis, 24 hours or more after consumption. Second, no individual dietary item...

Subarachnoid hemorrhage 299

Oral contraceptives also increase the risk of stroke in women under 50 however, the older high-dose pills were far more dangerous than today's low-dose versions. Several studies have suggested an increased risk for low-dose pills, but others have found a significant risk only in women who smoke as well as take the pill. Women who smoke, use birth control pills, and have migraines appear to have an even greater chance of having a stroke.

The Proper Use of Preventive Medication

For a migraine-preventive medication to work, it must be used in the proper setting. The proper setting includes elimination of rebounding and of avoidable trigger factors. If these steps have been taken and a patient continues to have unsatisfactory headache severity and frequency, then preventive medication is an appropriate next step. Preventive medication options are listed in Table 12.3. The initial dosage should be low to avoid side effects, and dosage should be steadily increased over one to two months until the patient achieves satisfactory headache control, has intolerable side effects that cannot be circumvented, or is taking the maximal allowable dosage. If one preventive medication is ineffective despite maximal tolerable allowable dosage, the next option should be substituted in its place. If a preventive medication is partially effective, but the dosage cannot be raised further, it is reasonable to leave that medication in place and add a second preventive medication to...

The Appropriate Use of Analgesics

Mild to moderate headaches are appropriately treated with plain aspirin, acetaminophen, or an antiinflammatory agent. These medications probably do not cause rebounding and therefore could be used as often as several times per week without fear of that complication, but usage of any analgesic so frequently indicates that preventive treatment should be undertaken or upgraded. Antiinflammatory agents are most likely to be effective if they are taken early and at relatively high dosage (e.g., 600-800 mg of ibuprofen or 440-660 mg of naproxen sodium). Simple analgesics and antiinflammatories are unlikely to work for severe headaches. It is reasonable to treat infrequent severe headaches with a prescription analgesic, and triptans, from which there are a number to choose, are generally the best option as long as there is no contraindication, such as probable coronary artery disease. The problems with using triptans or other prescription analgesics too often namely, decreased compliance...

Obstructive Sleep Apnea

Sleep apnea (see Chapter 11) can occur at any age from infancy to adolescence, but it's most commonly detected in older children and adolescents. Older children with sleep apnea usually snore loudly, and their parents often describe their breathing as heavy with pauses and snorts. Fragmentation of sleep can lead to sleepwalking, sleep terrors, and bed-wetting, and children may complain of morning headaches.

Ergocalciferol Synonym for calciferol

Ergotamine tartrate Ergotamine is a natural alkaloid of the ergot of rye (Secale cornutum). An a-adrenergic blocking agent with a direct stimulating effect on the smooth muscle of peripheral and cranial blood vessels also causes depression of vasomotor centres. Ergotamine has serotonin antagonist properties. Used to relieve migraine by constricting cranial arteries.

Butazolidin See phenylbutazone

Side effects common calcitonin injections can cause flushing, headache, nausea, diarrhea, redness at the injection site, and less often, an allergic rash or hypocalcemia (low blood calcium level). The flushing, nausea, and diarrhea can sometimes be overcome by reducing the dose. Nasal calcitonin seldom causes side effects other than mild nasal irritation.

The Family Reunion Party

A 59-year-old woman presented to the emergency department with a 10-hour history of chest pain, nausea, and headache. The pain initiated after a family reunion party and persisted into the evening even after rest. Initially, the patient thought the symptoms were due to the large meal and late hours of the party. The medical history revealed hypertension, type II diabetes, and 30 years of smoking. The patient was not taking any medications at the time except for aspirin and a medicinal herbal tea.

Gene Therapies in the Works

In a sense, gene therapy is nothing fundamentally new, but merely another way to deliver therapeutic substances into people's bodies. Few of us think twice before swallowing aspirin for a headache or taking antibiotics to cure a bacterial infection. These treatments dispense helpful chemicals that our bodies cannot manufacture. Many standard medical practices go a bit further by prescribing enzymes or other functional protein products for individuals with specific genetic deficiencies. For example, blood-clotting factors are routinely administered to hemophiliacs, as is insulin to diabetic patients who are unable to produce adequate levels of this substance on their own. Gene therapy delivers DNA rather than proteins or other substances and thereby shifts the production site for health-enhancing chemicals from outside the body to inside. In gene therapy, if all goes well, a transgene, shuttled to a person via recombinant DNA methods, activates within the patient's cells to produce...

How do people view risks

We can, of course, reduce the risks in our lives by not doing anything with a risk attached, but even staying in bed all day carries a risk, for example, of thromboembolism as a result of inactivity. Life itself is a risky business and most of us learn to accept this. Using chemicals is one of the risks most of us take. If we have a headache or some other minor ailment we take an aspirin and in so doing take a very small but known risk that it may harm us, for it sometimes causes bleeding in the stomach. We can minimize the risk by taking only the necessary dose and by taking it with food, but if we don't accept the risk we should not take the drug. Life and its activities cannot be risk-free there is no such thing as an absolutely safe drug just as there is no absolutely safe way to travel. We have to decide if the risk is worth taking.

Simian Tcell lymphotrophic virus STLV

Sinusitis Infection of the sinuses, the air sacs next to the nasal passages, usually as a result of a cold or allergy. Sinusitis is common, especially in people with HIV infection, although the reason for this is obscure. Symptoms are pus drainage from the nose, headache, face pain, and fever. The usual treatment is with antibiotics taken by mouth, such as TRIMETHOPRIM-SULFAMETHOXZOLE, AMOXICILLIN, erythromycin, cephalexin (Keflex), ciprofloxacin (Cipro), or tetracycline. Some people do not respond to these drugs, and their sinuses need to be drained.

Overthe Counter Statins

Over-the-counter drugs are great for medical problems like a cold or headache. These are problems that a person can immediately identify and he or she can tell when they're going away. If, for example, you take a cold medicine for a runny nose and sore throat, you know that when the symptoms abate, your cold is getting better. Your results and side effects don't need to be monitored by a doctor. The same cannot be said for treating high cholesterol. First, you need a lab test to diagnose it. And, more important, you need continued lab tests to determine if your treatment is working. So if your doctor told you that you had high cholesterol and you treated yourself with an over-the-counter statin, an important part of the process would be missing You wouldn't know whether or not the treatment was working. Were your LDL levels dropping low enough Were your triglyceride levels safe What about HDL Doctors have better control over monitoring patients' results on prescription medications...

Severe acute respiratory syndrome 449

Septicemia is characterized by sudden onset of fever, chills, rapid breathing, headache, nausea or diarrhea, and clouding of consciousness. skin rashes and jaundice may occur, and the hands may be particularly warm. If large amounts of toxins are produced by the bacteria the patient may fall into a state of septic shock.

Spermicidal jelly See spermicide

Spinal tap A procedure, also called a lumbar puncture, for obtaining cerebrospinal fluid, the fluid that surrounds the brain and the spinal cord. The procedure involves inserting a needle into the middle of the back and into the meninges, the membrane that contains the cerebrospinal fluid. The needle is inserted between the L3 and L4 vertebrae. The fluid is then analyzed for evidence of infection of the brain or spinal cord. This is the only manner of detecting some infections. Repeat spinal taps then measure the effectiveness of treatment in these illnesses. In cryptococcal meningitis, spinal taps are performed in order to drain some fluid to prevent the pressure on the brain from building up too much. Despite sounding unpleasant and risky, a spinal tap is a well-established medical procedure and is rarely associated with any important complications. The most common complaint is of headache after the procedure, which is less likely to occur if the person lies flat once the spinal tap...

Calcineurin inhibitors

Agent in many kinds of organ transplantations (Starzl et al., 1989 Wong et al., 2005). However, the experience with the systemic use of tacrolimus in autoimmune diseases is limited to some severe cases in which 'all other medications' have been tried unsuccessfully. In the 1990s, tacrolimus was also introduced as a topical agent producing favourable results in various skin disorders (Ruzicka et al., 1999). Meanwhile, safety and efficacy data of the topical formulation are available for more than 10 years from at least 20,000 cases worldwide (Assmann et al., 2001 Gupta et al., 2002). Tacro-limus ointment is generally well tolerated and all studies have shown a very good safety profile. The most common side effects are the sensation of skin burning and pruritus at the site of application, which are mostly of short duration and of mild or moderate severity. Sometimes, its application also leads to local erythema, skin infections, and, in rare cases, to flu-like symptoms and headache. In...

Extraintestinal Manifestations

CD has been shown to be closely associated with a number of other disorders. Dermatitis herpetiformis, a skin disease characterized by symmetric pruritic papulovesicular lesions and the presence of granular deposits of IgA in the skin, affects 10-20 of patients with CD and responds to withdrawal of gluten from the diet. CD is also strongly associated with type I diabetes and autoimmune thyroid disease, especially hypothyroidism. The prevalence of CD in type I diabetes patients is 3-8 .2 Patients with untreated CD have an increased risk of certain types of cancer, specifically non-Hodgkin lymphoma, enteropathy-associated T-cell lymphoma, small intestinal adenocarcinoma, and esophageal or oropharyngeal squamous carcinoma. Neurological disorders, including peripheral neuropathy, cerebellar ataxia, epilepsy, and migraine, have also been shown to be associated with CD. Women with untreated CD may present with infertility, and infertility secondary to impotence or abnormally low sperm count...

St Louis encephalitis

Less common side effects include stomach problems, headaches, lethargy, irritability, nausea, euphoria, depression, nightmares, dry mouth, constipation, anxiety, hallucinations, nervous tics, and tremors. In children at risk for tic disorders such as tourette's syndrome the medication may trigger the condition. Because individual reactions and needs change, it is very important that the use and result of the medication be monitored.

Changes to legal aid legislation

The costs of legal aid are rising annually and are a headache for the government. Recent changes to the rules so as to reduce access to legal aid excluded medical negligence cases. Even though seven years had elapsed the Lord Chancellor's Legal Services Commission in 2002 was still having to press legal firms to screen cases more critically before applying for legal aid using the same standards as they would use for no win, no fee cases. When seen from clinical managers' viewpoint there have really been very few perceptible changes since the Woolf Report and they should therefore live in the continued expectation of protracted, frustrating, and often futile combat with the legal advisers of the legally aided.

Tumor necrosis factor TNF inhibitor Drugs that work to inhibit tumor necrosis factor

It is characterized by sustained bacteremia and infestation of the pathogen within the mononuclear phagocytic cells of the liver, lymph nodes, spleen, and peyer's patches of the ileum, accompanied by fever, rash, headache, malaise, and abdominal pain. Diagnosis is made by isolation of the bacteria from the blood. typhus Any of a group of infectious diseases caused by Rickettsia. Typhus is characterized by great prostration, severe headache, generalized maculopapular rash, sustained high fever, and usually progressive neurologic involvement, ending in a crisis in 10 to 14 days. Three diseases are included in this group epidemic (louse-borne) typhus, caused by Rickettsia prowazekii Brill-zinsser disease (recrudescent typhus), caused by Rickettsia prowazekii and murine (flea-borne) typhus, caused by Rickettsia typhi. Although clinically and pathologically similar, they differ in intensity of symptoms severity and mortality rate. Broad spectrum antibiotics, such as...

Science and Technology

Adult stem cells-derived cardiomyocyte have been successfully obtained. These cells present characteristics of differentiated ventricular cardiomyocyte, including a typical action potential. The ability to expand human adult stem cells in vitro provides unlimited potential for producing quantities of cardiomyocyte -progenitors, which could be employed to assess the effects of NCEs on cardiac ion channels, electrical activity, and contractility.206 The challenge posed by the introduction of new techniques and technologies in formulating a risk assessment is to improve and enhance the safe progression of an NCE to the marketplace, while preventing unnecessary delays (or discontinuances), based on non-clinical findings that are not relevant or interpretable in terms of clinical response or human risk. Ultimately, increase in scientific knowledge and development of new technologies should lead to the development of new, robust, and predictive assays models for ADRs that are currently...


Another hormonal intervention that is already discussed for several years could be the blockade of prolactin, which is increased in 20 of the patients with SLE. The treatment with bromocriptine was recently reviewed by Walker (2001) Smaller studies indicate some benefit comparable to hydro-xychloroquine in one trial, but the efficacy has to be evaluated in controlled trials with larger number of patients. The use in daily practice is mostly prohibited by side effects, such as nausea and headaches.

Hydroxytryptamine7 Receptors

The recent development of selective 5-HT7 receptor antagonists such as SB269970-A and SB656104-A has facilitated the linkage of 5-HT7 receptors to specific effects in various brain regions (389,390). The 5-HT7 receptors are highly expressed in the brain, particularly in the neocortex, hippocampus, and hypothalamus, as well as in the suprachiasmatic nucleus, where they have been proposed to participate in the regulation of circadian rhythm (377,391). There is increasing evidence that 5-HT7 receptors play a role in the control of circadian rhythms and sleep, anxiety, cognitive disturbances, and possibly vasoactive headaches (390). 5-HT7 receptors have been demonstrated to inhibit serotonin release in slices of rat raphe nuclei (392). 5-HT7 receptors are expressed endoge-nously in astrocytes and three splice variants (5-HT7 a b d) are expressed in various human glioblastoma cell lines (393,394), where they mediate increases in cAMP levels. 5-HT7 receptors also increase progesterone...

Selected Nonbacterial Poisonings 1531 Marine Toxins Poisoning

Consumption of improperly stored scombroid fish may cause symptoms of histamine poisoning due to the outgrowth on their surfaces of microflora excreting histidine. The main symptoms include skin redness, headache, vomiting, diarrhea, lip and throat burning, and tachycardia. Scombrotoxic poisoning begins from two minutes to two hours after ingestion of marine toxins. (Phycotoxins of marine food are exhaustively treated in Chapter 7 of this volume.)

The Developing Role Of

When cosmetic BTX injections were first used to diminish forehead wrinkles, practitioners observed that their patients also had fewer episodes of migraine headaches (10). This serendipitous observation instigated clinical trials examining the efficacy of neurotoxin use for the treatment of migraine headaches. Initially, the efficacy of Botox injections for migraine prophylaxis was thought to be related to muscle relaxation. However, the level of efficacy of pain relief from injections did not significantly correlate with the level of weakness or muscle relaxation. Traditionally, migraines were thought to be caused by vasoconstriction followed by vasodilatation. Although the exact pathophysiology of migraines remains elusive, many clinicians now believe that migraines arise from increased sensitivity of cerebral structures in the dorsal raphe area of the brainstem. These sensitized cerebral structures, when reacting to stimuli, can trigger a cascade of responses that activate the...

There are No Safe Drugs Only Safe Ways of Using Them

The drug phenacetin became very popular in certain countries because of particular circumstances. For example, the Spanish flu epidemic of 1918 led to widespread use of the drug for the treatment of the high temperature and aches and pains. It also became a favourite with Swiss watchmakers who suffered badly from headaches as a result of the close work required in watchmaking.

Mesencephalon See midbrain

Migraine A severe headache with accompanying symptoms of nausea, diarrhea, visual disturbances, and depression that attacks about 8 million Americans 75 percent of them women. The symptoms of migraine can occur at any age, although it is common to see the first headache during the teenage years. Most patients have had the first attack by the time they are 40 years old attacks often recur, but tend to get less severe as a patient ages. Most people with migraine have family members who also have the disorder. What characterizes a migraine and differentiates it from other types of headache is its specific symptoms. of course, not all migraine sufferers experience the same symptoms, and different symptoms can occur at different times. These include Throbbing or pounding pain Unlike other types of head pain, migraine pain is a relentless throbbing or pounding as though the pulse is beating severely in the head. The pain usually begins on one side of the head, at the temple, and can spread...

Medulla oblongata Full name of the medulla

Symptoms are vomiting and headache just after awakening (caused by increased pressure within the skull). other symptoms include irritability, sluggishness, personality change, and impaired attention and memory. Because the cerebellum controls and coordinates activities such as walking and speech, these activities may be affected as the tumor grows an ataxic gait (stumbling, uncoordinated movements) is a common initial symptom. Depending on the exact location of the tumor, there may be muscle weakness, spasticity, reflex change, limp muscles, stiff neck, imperfect eye coordination, or rapid eye movements.

Moniliasis See thrush

Monkeypox in humans produces a vesicular and pustular rash similar to that of smallpox. The incubation period from exposure to fever onset is about 12 days, and the typical illness with fever, headache, muscle ache, and rash lasts from two to four weeks. The rash, which appears as raised, acne-like bumps, appears within a few days and goes through several stages before crusting and falling off.

The case of Susan Barber

Some time after this, on Thursday 4 June 1981, Michael complained of feeling unwell. First it was a headache, and then stomach pains and nausea. By the Saturday the doctor was called and antibiotics prescribed. The following Monday he was having difficulty breathing and had to be taken to the local hospital. His condition worsened and he was transferred to Hammersmith Hospital with severe kidney dysfunction. The medical staff were at a loss to explain his condition. Paraquat poisoning was considered a possibility, and junior staff were asked to collect urine and blood samples for analysis by the National Poisons Unit. Michael eventually died twenty-three days after the first symptoms had been detected. It had been anything but a quick death. A post-mortem was carried out by the pathologist, Professor Evans. He suspected paraquat poisoning and samples of the body tissues were sent for preparation for histology . Samples of the organs were also preserved. Professor Evans was told that...

Tricothecenes and other mycotoxins

Fusarium species produce a number of toxic tricothecene alkaloids T2 toxin, nivalenol, and deoxynivalenol can all be readily detected and measured. Contamination with deoxynivalenol, particularly of wheat and wheat products, seems to be the most common. The symptoms vary, depending on the extent of contamination and therefore the level of exposure to the toxin. In relatively mild cases the victim suffers from headaches, nausea and vomiting, painfully inflamed tonsils, sore throat, and skin eruptions. In severe cases diarrhoea, sweating, swelling and necrosis of the mouth, swelling of glands such as those in the armpits, blood in the urine, fever, delirium, convulsions, and brain haemorrhage can all occur. The toxins can also reduce the production of white blood cells in the bone marrow, which results in increased susceptibility to infections as white blood cells are involved in our defence against bacteria.

Sinusitis and Quality of Life

What's important about this response is it reflects that sinusitis leads to more than just headaches or nasal drainage or blocked breathing passages. It affects your overall quality of life. Regardless of your worst symptom whether it's pain, congestion, a perpetually runny nose, fatigue, or something else you share a common bond with others who have sinusitis reduced quality of life. Basic elements of daily living from getting a good night's sleep to doing your job to enjoying your free time may become difficult or impossible. You have plenty of company in experiencing sinus problems. Chronic sinusitis (see the sidebar Defining Sinusitis ) is one of the most commonly diagnosed chronic illnesses in the United States, more prevalent than heart disease and migraine headaches. More than thirty-five million adult Americans suffered from sinusitis in 2001, according to a 2004 report by the U.S. Centers for Disease Control and Prevention. That's a whopping 17.4 percent of American adults....

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