Child and Family Psychiatric and Psychological Factors Associated With Child Physical Health Problems

PubMed Central

Feldman, Jonathan M.; Ortega, Alexander N.; Koinis-Mitchell, Daphne; Kuo, Alice A.; Canino, Glorisa

2010-01-01

To examine associations among Puerto Rican children's physical health problems and children's internalizing disorders, parental psychopathology and acculturative stress, and family factors. A population-based probability sample of 2491 Puerto Rican children, aged between 5 and 13 years, and caregivers from the South Bronx and the U.S. Commonwealth of Puerto Rico participated in this study. The parent version of the Diagnostic Interview Schedule for Children-IV was used to assess children's internalizing disorders. Children's anxiety disorders, parental psychopathology, and acculturative stress were associated with childhood asthma, abdominal pain, and headaches. Children's depressive disorders, maternal acceptance, and family functioning were associated with abdominal pain and headaches. Parents of children living in Puerto Rico were more likely to report physical health problems in their children than in the Bronx. Children's internalizing disorders, parental psychopathology, and acculturative stress may be important areas to target among Puerto Rican children with physical health problems. PMID:20386256

Nausea/vomiting · tachycardia · unintentional weight loss · Dx?

PubMed

Selen, Daryl J; Gilbert, Matthew P

2017-02-01

A 22-year-old woman presented to the emergency department (ED) with a 24-hour history of nausea, vomiting, diarrhea, generalized abdominal pain, and mild headache. She denied shortness of breath, chest pain, or anxiety, and didn't have a history of cardiac problems. The physical examination revealed tachycardia (heart rate, 135 beats/min) and a respiratory rate of 24 breaths per minute.

Occult Carbon Monoxide Poisoning

PubMed Central

Kirkpatrick, John N.

1987-01-01

A syndrome of headache, fatigue, dizziness, paresthesias, chest pain, palpitations and visual disturbances was associated with chronic occult carbon monoxide exposure in 26 patients in a primary care setting. A causal association was supported by finding a source of carbon monoxide in a patient's home, workplace or vehicle; results of screening tests that ruled out other illnesses; an abnormally high carboxyhemoglobin level in 11 of 14 patients tested, and abatement or resolution of symptoms when the source of carbon monoxide was removed. Exposed household pets provided an important clue to the diagnosis in some cases. Recurrent occult carbon monoxide poisoning may be a frequently overlooked cause of persistent or recurrent headache, fatigue, dizziness, paresthesias, abdominal pain, diarrhea and unusual spells. PMID:3825110

Occult carbon monoxide poisoning.

PubMed

Kirkpatrick, J N

1987-01-01

A syndrome of headache, fatigue, dizziness, paresthesias, chest pain, palpitations and visual disturbances was associated with chronic occult carbon monoxide exposure in 26 patients in a primary care setting. A causal association was supported by finding a source of carbon monoxide in a patient's home, workplace or vehicle; results of screening tests that ruled out other illnesses; an abnormally high carboxyhemoglobin level in 11 of 14 patients tested, and abatement or resolution of symptoms when the source of carbon monoxide was removed. Exposed household pets provided an important clue to the diagnosis in some cases. Recurrent occult carbon monoxide poisoning may be a frequently overlooked cause of persistent or recurrent headache, fatigue, dizziness, paresthesias, abdominal pain, diarrhea and unusual spells.

Medical Surveillance Monthly Report (MSMR). Volume 19, Number 9, September 2012

DTIC Science & Technology

2012-09-01

fever, headache, muscle aches, rash, abdominal pain, nau- sea, vomiting, and diarrhea . In severe cases, WNV infections can cause brain in# amma...Linnaeus, the northern house mosquito, are distributed across the United States and can transmit WNV, St. Louis encephalitis and dog heartworm (Figures

Association between work-related health problems and job insecurity in permanent and temporary employees

PubMed Central

2013-01-01

Objectives This research was conducted with an aim of determining the correlation between job insecurity and an employee’s work-related health problems among permanent and temporary workers. Methods Using the data from the First Korean Working Conditions Survey conducted in 2006, a total of 7,071 workers, excluding employers and the self-employed, were analyzed. Work-related health problems were categorized as backache, headache, abdominal pain, muscular pain, stress, fatigue, insomnia, anxiety or depression. Each problem was then analyzed for its relationship to job insecurity through logistic regression analysis. Results Among the 7,071 workers, 5,294 (74.9%) were permanent workers and 1,777 (25.1%) were temporary workers. For the permanent workers, presence of high or moderate job insecurity appeared more closely linked to backache, headache, abdominal pain, muscular pain, stress, fatigue, insomnia, anxiety, and depression compared to absence of job insecurity. However, for the temporary workers, only depression appeared to be associated with the presence of high job insecurity. Conclusion The study showed that the presence of job insecurity is correlated with work-related health problems. The deleterious effects of job insecurity appeared to be stronger in permanent than temporary workers. Additional research should investigate ways to effectively reduce job insecurity. PMID:24472497

Ischemic colitis related to sumatriptan overuse.

PubMed

Hodge, Joshua A; Hodge, Katherine D

2010-01-01

Serotonin-1 5-hydroxytryptamine (5-HT 1) receptor agonists are first line agents for migraine headaches. Patients with refractory headaches may use supratherapeutic doses of these medications. Described is a case of ischemic colitis related to overuse of sumatriptan. A 35-year-old woman presented with severe abdominal pain without diarrhea or hematochezia. For several days prior she had been self-treating a refractory migraine headache with frequent doses of sumatriptan. She is a nonsmoker and took no oral contraceptives or other serotonin agonists. A computed tomography scan of the abdomen revealed left-sided colitis. A colonoscopy with biopsy confirmed ischemic colitis and excluded inflammatory bowel disease (IBD). Previously published case reports have suggested an association between 5-HT 1 receptor agonists and ischemic colitis. These reports have been dismissed because the patients were taking oral contraceptives, serotonin agonists, or had other comorbidities. This healthy patient lacked risk factors for ischemia, is the youngest to be reported, and is the first without hematochezia. 5-HT 1 receptor agonists are generally considered safe. Ischemic colitis is a potentially serious complication of these agents. A retrospective review of 5-HT 1 receptor agonist users who have presented with acute onset abdominal pain or hematochezia is necessary to elucidate the incidence of this adverse event.

School-Related Stress, School Support, and Somatic Complaints: A General Population Study.

ERIC Educational Resources Information Center

Torsheim, Torbjorn; Wold, Bente

2001-01-01

Examined relationship between school-related stress, social support, and somatic complaints among Norwegian adolescents. Found that students with high levels of school-related stress had a higher odds ratio for weekly headache, abdominal pain, backache, dizziness, and coexisting somatic complaints. For social support, associations were weaker, but…

Rectal suppositories of 8-methoxsalen produce fewer gastrointestinal side effects than the oral formulation.

PubMed

Bolognia, J L; Freije, L; Amici, L; Dellostritto, J; Gasparro, F P

1996-09-01

Gastrointestinal side effects are associated with the oral ingestion of 8-methoxsalen (8-MOP), including the liquid and crystalline formulations. The objective of this study was to determine whether the gastrointestinal symptoms associated with 8-MOP could be decreased by altering the route of administration. In an open pilot study, 8-MOP rectal suppositories were given to six patients with psoriasis vulgaris who had significant nausea or abdominal pain with the oral liquid form of the drug. On a scale of 0 to 5, this group of patients reported a mean score of 4.4 for nausea, 0.3 for vomiting, 2.1 for abdominal pain, and 1.3 for headaches with oral 8-MOP. With the suppository form, the mean scores were 0 for nausea, 0 for vomiting, 0 for abdominal pain, and 0 for headaches. These latter values represent scores for the entire treatment period. Clinical severity scores of psoriasis improved from a mean of 6.5 (maximum possible score = 9) at the start of the trial to a mean of 1 at its conclusion. Plasma 8-MOP levels of more than 100 ng/ml were observed in all patients who received the suppositories; in only one patient were the 8-MOP plasma levels significantly higher with the oral form than with the rectal form. Rectal suppositories of 8-MOP were associated with significantly fewer gastrointestinal side effects than the oral form of the drug; this was accomplished without compromising clinical efficacy.

Migraine and associated comorbidities are three times more frequent in children with ADHD and their mothers.

PubMed

Kutuk, Meryem Ozlem; Tufan, Ali Evren; Guler, Gulen; Yalin, Osman Ozgur; Altintas, Ebru; Bag, Harika Gozukara; Uluduz, Derya; Toros, Fevziye; Aytan, Nurgul; Kutuk, Ozgur; Ozge, Aynur

2018-06-16

Attention deficit and hyperactivity disorder (ADHD) is a neuro-developmental disorder related to internalizing and externalizing disorders as well as somatic complaints and disorders. This study was conducted to evaluate the prevalence of headache subtypes, epilepsy, atopic disorders, motion sickness and recurrent abdominal pain among children and adolescents with ADHD and their parents. In a multi-center, cross-sectional, familial association study using case-control design, treatment naïve children and adolescents between 6 and 18 years of age diagnosed with ADHD according to the DSM-5 criteria as well as age- and gender-matched healthy controls and their parents were evaluated by a neurologist and analyzed accordingly. 117 children and adolescents with ADHD and 111 controls were included. Headache disorder diagnosis was common for both patients and healthy controls (59.0% vs. 37.8%), with a significantly elevated rate in the ADHD group (p = 0.002). Migraine was found in 26.0% of ADHD patients and 9.9% of healthy controls. Tension headache was found in 32.4% of ADHD patients and 27.9% of healthy controls. Headache diagnosis was also found to be significantly more common in mothers of children with ADHD than control group mothers (90.5% vs. 36.6%, p < 0.001). Headache diagnoses and specifically migraines were significantly more common among children with ADHD and their mothers, while recurrent abdominal pain was elevated in both parents and ADHD patients. Migraine is an important part of ADHD comorbidity, not only for children but also for mothers. Motion sickness may be reduced among families of ADHD probands. Copyright © 2018. Published by Elsevier B.V.

The use of abdominal binders to treat over-shunting headaches.

PubMed

Sklar, Frederick H; Nagy, Laszlo; Robertson, Brian D

2012-06-01

Headaches are common in children with shunts. Headaches associated with over-shunting are typically intermittent and tend to occur later in the day. Lying down frequently makes the headaches better. This paper examines the efficacy of using abdominal binders to treat over-shunting headaches. Over an 18-year period, the senior author monitored 1027 children with shunts. Office charts of 483 active patients were retrospectively reviewed to identify those children with headaches and, in particular, those children who were thought to have headaches as a result of over-shunting. Abdominal binders were frequently used to treat children with presumed over-shunting headaches, and these data were analyzed. Of the 483 patients undergoing chart review, 258 (53.4%) had headache. A clinical diagnosis of over-shunting was made in 103 patients (21.3% overall; 39.9% of patients with headache). In 14 patients, the headaches were very mild (1-2 on a 5-point scale) and infrequent (1 or 2 per month), and treatment with an abdominal binder was not thought indicated. Eighty-nine patients were treated with a binder, but 19 were excluded from this retrospective study for noncompliance, interruption of the binder trial, or lack of follow-up. The remaining 70 pediatric patients, who were diagnosed with over-shunting headaches and were treated with abdominal binders, were the subjects of a more detailed retrospective study. Significant headache improvement was observed in 85.8% of patients. On average, the patients wore the binders for approximately 1 month, and headache relief usually persisted even after the binders were discontinued. However, the headaches eventually did recur in many of the patients more than a year later. In these patients, reuse of the abdominal binder was successful in relieving headaches in 78.9%. The abdominal binder is an effective, noninvasive therapy to control over-shunting headaches in most children. This treatment should be tried before any surgery is considered. It is suggested that the abdominal binder may modulate abnormally increased intracranial pulse pressures associated with over-shunting. Interactions with the cerebrovascular bed are suspected to account for persistent headache relief after the binder is discontinued.

Children in pain: recurrent back pain, abdominal pain, and headache in children and adolescents in a four-year-period.

PubMed

van Gessel, Hester; Gassmann, Jennifer; Kröner-Herwig, Birgit

2011-06-01

To analyze the development of recurrent pain in 3 body locations in children and adolescents (baseline age, 9 to 14 years) in a 4-year period. In a large population-based longitudinal epidemiological study data was collected through annual postal questionnaires (longitudinal, n = 2025). Descriptive statistics and generalized estimating equations were used. Girls were more likely to report recurrent pain, demonstrated a steeper development during the 4-year period, and reported multiple pain more often than boys. Younger children reported less recurrent pain, but displayed a steeper trend of increasing prevalence rates as they grew older. Older children illustrated a more stable development of recurrent pain and reported multiple pain more often. Disability experienced because of recurrent pain was related strongest to pain intensity. Stable patterns of pain were related to higher intensity and disability reports. The children experienced headache as the most disabling of the 3 pains. The results show that boys and girls report recurrent pain in different patterns in the years. To identify risk factors, analysis should be performed separately for boys and girls. Furthermore, it is recommended to include children before the age of 9 years in a prevention study. Copyright © 2011 Mosby, Inc. All rights reserved.

Guaifenesin as a treatment for primary dysmenorrhea.

PubMed

Marsden, Jennifer S; Strickland, Charlene D; Clements, Tina L

2004-01-01

Dysmenorrhea is highly prevalent and causes much work loss and discomfort. A treatment with a new mechanism of action could benefit women of menstruating age. A study was undertaken to assess the efficacy of guaifenesin as a treatment for primary dysmenorrhea because of its effects of cervical dilation and cervical mucous thinning. Thirty-four subjects with primary dysmenorrhea were enrolled in a double-blind, placebo-controlled study. Three treatment surveys measured 10 symptoms (lower abdominal pain, general abdominal pain, back pain, headache, nausea, diarrhea, constipation, menstrual flow, weakness, and activities of daily living) on a 100-mm visual analog scale. Nonstudy analgesic use was also measured. Twenty-five subjects returned the first treatment survey, and 17 returned all 3 surveys. Results were nonsignificant, but guaifenesin trended toward being better than placebo for dysmenorrhea pain and associated constitutional symptoms and caused no worsening of symptoms. Lower abdominal mean pain scores from the first survey decreased 38 mm for guaifenesin versus 7 mm for placebo. By the third survey, only 2 of 8 guaifenesin participants took nonstudy analgesics compared with all 9 placebo subjects. Guaifenesin may be useful in the treatment of primary dysmenorrhea. A larger study is needed to validate these initial findings.

Development of Temporomandibular Disorders is associated with greater bodily pain experience

PubMed Central

Lim, Pei Feng; Smith, Shad; Bhalang, Kanokporn; Slade, Gary D.; Maixner, William

2009-01-01

Objectives The aim of this study is to examine the difference in the report of bodily pain experienced by subjects who develop temporomandibular disorders (TMD) and by those who do not develop TMD over a 3 year observation period. Methods This is a 3 year prospective study of 266 females aged 18–34 years initially free of TMD pain. All subjects completed the Symptom Report Questionnaire (SRQ) at baseline and yearly intervals, and at the time they developed TMD (if applicable). The SRQ is a self-report instrument evaluating the extent and location of pain experienced in the prior 6 months. Statistical analysis was carried out using repeated measures ANOVA. Results Over the 3 year period, 16 subjects developed TMD based on the Research Diagnostic Criteria for TMD. Subjects who developed TMD reported more headaches (P=0.0089), muscle soreness or pain (P=0.005), joint soreness or pain (P=0.0012), back pain (P=0.0001), chest pain (P=0.0004), abdominal pain (P=0.0021), and menstrual pain (P=0.0036) than subjects who did not develop TMD at both the baseline and final visits. Subjects who developed TMD also reported significantly more headache (P=0.0006), muscle soreness or pain (P=0.0059), and other pains (P=0.0188) when they were diagnosed with TMD compared to the baseline visit. Discussion The development of TMD was accompanied by increases in headaches, muscle soreness or pain, and other pains that were not observed in the subjects who did not develop TMD. Subjects who developed TMD also report higher experience of joint, back, chest and menstrual pain at baseline. PMID:20090437

Abdominal pain-related functional gastrointestinal disorders based on Rome III criteria in a pediatric gastroenterology clinic.

PubMed

Talachian, Elham; Bidari, Ali; Zahmatkesh, Hamed

2015-01-01

Functional gastrointestinal disorders (FGIDs) entail several distinct conditions that collectively account for a sizeable proportion of patients complaining of abdominal pain. Physicians' awareness is fundamental to avoid unnecessary evaluations and to alleviate stress-related problems. This study aimed to assess the relative frequencies of FGIDs and related categories in a selected Iranian population. We conducted this cross-sectional study in a gastroenterology clinic of a tertiary care pediatric hospital in Iran. Children and adolescents between the age of 4 and 18 years referred to the clinic from October 2011 to February 2013 were enrolled if they were diagnosed with FGID according to the Rome III criteria. A structured questionnaire was used to collect data on demographic characteristics, pain location, duration and frequency, associated symptoms, and pertinent family history. We used descriptive analyses to show mean (±SD) and relative frequencies of categories of FGIDs. We diagnosed 183 (114 female) with FGIDs out of 1307 children and adolescents who were visited in the clinic. There was history of psychiatric disorders in 42 (22.9%) participants, and migraine headaches and gastrointestinal disorders were at least in one of the parents in 21 (11.5%) and 64 (34.9%) participants, respectively. We defined 84 (46%) patients under Irritable Bowel Syndrome (IBS) category, 38 (21%) under Abdominal Migraine, 26 (14%) under Functional Abdominal Pain, 21 (11%) under Functional Dyspepsia, and 7 (4%) under Functional Abdominal Pain Syndrome. Seven children (4%) had no defining feature for FGID categories and therefore labeled as unclassified. FGID was a prevalent diagnosis among children and adolescents with abdominal pain. IBS was the largest category. Only a minority were unclassifiable under the Rome III criteria, indicating improved differentiation characteristics of Rome III criteria compared to the Rome II version.

Presentation and management of chronic pain.

PubMed

Rajapakse, Dilini; Liossi, Christina; Howard, Richard F

2014-05-01

Chronic pain is an important clinical problem affecting significant numbers of children and their families. The severity and impact of chronic pain on everyday function is shaped by the complex interaction of biological, psychological and social factors that determine the experience of pain for each individual, rather than a straightforward reflection of the severity of disease or extent of tissue damage. In this article we present the research findings that strongly support a biopsychosocial concept of chronic pain, describe the current best evidence for management strategies and suggest a common general pathway for all types of chronic pain. The principles of management of some of the most important or frequently encountered chronic pain problems in paediatric practice; neuropathic pain, complex regional pain syndrome (CRPS), musculoskeletal pain, abdominal pain and headache are also described.

Hantavirus Infection in the Republic of Georgia

DTIC Science & Technology

2009-09-01

causing hemor-rhagic fever with renal syndrome (HFRS) occur throughout most of Europe and Russia. The pathogenic hantaviruses detected in Europe and...on the strain of the infecting virus. Classic HFRS is characterized by fever , acute renal failure, hypotension, hemorrhage, and vascular leakage...Puumala virus typically induces a mild variant of HFRS (nephro- pathia epidemica) accompanied by high fever , headache, backache, and abdominal pain

Sexually Transmitted Diseases

DTIC Science & Technology

1989-12-01

fever , abdominal pain, tenderness on pelvic examination e. pharyngitis, proctitis--same as males--may lead to dissemination (11-15) Diagnosis (16) 1...weeks after chancre b. may show fever , malaise, headache, sore throat c. generalized lymphadenopathy, patchy hair loss d. rash--reddish,pink or coppery...nodes lead to sinus tract formation d. fever , chills, generalized rash--erythema nodosum or multiforme e. late complications include strictures or

Phaeochromocytoma presenting with pseudo-intestinal obstruction and lactic acidosis.

PubMed

Kek, Peng Chin; Ho, Emily Tse Lin; Loh, Lih Ming

2015-08-01

Phaeochromocytomas are rare neuroendocrine tumours with variable clinical signs and symptoms. Hypertension, tachycardia, sweating and headaches are cardinal manifestations. Although nausea and abdominal pain are the more common gastrointestinal features, rare gastrointestinal spectrums have been reported that can mimic abdominal emergencies. Metabolic effects of hypercatecholaminaemia are vast and one such rare presentation is lactic acidosis. We describe a case of phaeochromocytoma presenting with both intestinal pseudo-obstruction as well as lactic acidosis. This case report highlights the importance of having a high index of suspicion for and early recognition of the gastrointestinal and metabolic manifestations of phaeochromocytomas.

[Splenic infarction at high altitude, Huaraz-Peru (3,100 masl)].

PubMed

López de Guimaraes, Douglas; Menacho López, Julio; Villanueva Palacios, Jovita; Mosquera Vásquez, Vitaliano

2009-01-01

We report three cases of splenic infarction in healthy men for the first time that amounted to high altitudes, observed in the hospital "Victor Ramos Guardia" Huaraz (3100 m). Case 1 (1995) of 55 years, born in Cuba, from Lima, caucasian suddenly presented acute abdominal pain in epigastrium, distension, nausea and vomiting, was laparotomized for acute abdomen and surgical pathology revealed thrombosis with splenic infarction splenic artery and vein. During follow-up in Lima, hemoglobin electrophoresis showed that it was heterozygous carrier of the sickle trait (Hb A: 57% Hb S: 38.5%). Case 2 (1998) of 23 years, born in Cuba, from Lima, Black said acute abdominal pain in left hypochondrium, shortness of breath and chest pain, clinical examination and radiography of the abdomen showed the spleen volume increased. Case 3 (2006) of 17 years, natural and from Lima, mestizo, who came on tour promotion, acute abdominal pain referred onset in the epigastrium and left hypochondrium, headache, increase heat, nausea and vomiting, pharyngitis was found acute and painful, and spleen increased in size by clinical and x-ray of abdomen simple stand. None had no history of hemoglobinopathy and anemia. In general, medical management was supportive and cases 2 and 3 are recommended hemoglobin electrophoresis. We conclude that we must think of splenic infarction associated with height in any healthy person who is first at high altitude (> 3000m) and having a sudden acute abdominal pain in epigastrium and / or left hypochondrium, pain and palpable spleen and radiological study compatible with image. In this case is indicated by hemoglobin electrophoresis to determine whether there is an individual heterozygous carrier of the sickle trait. splenic infarction, high altitude, sickle trait, Huaraz.

Relief of Menstrual Symptoms and Migraine with a Single-Tablet Formulation of Sumatriptan and Naproxen Sodium

PubMed Central

Ballard, Jeanne; Diamond, Michael P.; Mannix, Lisa K.; Derosier, Frederick J.; Lener, Shelly E.; Krishen, Alok; McDonald, Susan A.

2014-01-01

Abstract Background: Dysmenorrhea and menstrual migraine may share a common pathogenic pathway. Both appear to be mediated, in part, by an excess of prostaglandin production that occurs during menstruation. Methods: Data were pooled from two replicate randomized controlled trials of 621 adult menstrual migraineurs with dysmenorrhea who treated migraine with sumatriptan-naproxen or placebo. Along with headache symptoms, nonpain menstrual symptoms (bloating, fatigue, and irritability) and menstrual pain symptoms (abdominal and back pain) were recorded at the time periods of 30 minutes and 1, 2, 4, and 4–24 hours. Relief of menstrual symptoms was compared using a Cochran-Mantel-Haenszel test. Logistic regression was used to determine the odds of a headache response with increasing numbers of moderate to severe dymenorrheic symptoms. Results: Sumatriptan-naproxen was superior to placebo for relief of tiredness, irritability, and abdominal pain at the time periods of 2, 4, and 4–24 hours (p≤0.023); back pain at the time periods of 4 and 4–24 hours (p≤0.023); and bloating at 4–24 hours endpoint (p=0.01). The odds ratios (ORs) of attaining migraine pain freedom for 2 hours and for sustained 2–24 hours decreased as moderate to severe dysmenorrhea symptoms increased with sumatriptan-naproxen versus placebo. Conclusions: Treatment with sumatriptan-naproxen may provide relief of menstrual symptoms and migraine in female migraineurs with dysmenorrhea. The presence of moderate to severe dysmenorrhea symptoms is associated with decreased response rates for menstrual migraine, suggesting that the co-occurrence of these disorders may negatively impact the results of migraine-abortive therapy. PMID:24579886

Psychological therapies for the management of chronic and recurrent pain in children and adolescents

PubMed Central

Eccleston, Christopher; Palermo, Tonya M; de C Williams, Amanda C; Holley, Amy Lewandowski; Morley, Stephen; Fisher, Emma; Law, Emily

2018-01-01

Background This is an update of the original Cochrane review first published in Issue 1, 2003, and previously updated in 2009 and 2012. Chronic pain affects many children, who report severe pain, disability, and distressed mood. Psychological therapies are emerging as effective interventions to treat children with chronic or recurrent pain. This update focuses specifically on psychological therapies delivered face-to-face, adds new randomised controlled trials (RCTs), and additional data from previously included trials. Objectives There were three objectives to this review. First, to determine the effectiveness on clinical outcomes of pain severity, disability, depression, and anxiety of psychological therapy delivered face-to-face for chronic and recurrent pain in children and adolescents compared with active treatment, waiting-list, or standard medical care. Second, to evaluate the impact of psychological therapies on depression and anxiety, which were previously combined as ‘mood’. Third, we assessed the risk of bias of the included studies and the quality of outcomes using the GRADE criteria. Search methods Searches were undertaken of CENTRAL, MEDLINE, EMBASE, and PsycINFO. We searched for further RCTs in the references of all identified studies, meta-analyses, and reviews. Trial registry databases were also searched. The date of most recent search was January 2014. Selection criteria RCTs with at least 10 participants in each arm post-treatment comparing psychological therapies with active treatment, standard medical care, or waiting-list control for children or adolescents with episodic, recurrent or persistent pain were eligible for inclusion. Only trials conducted in person (face-to-face) were considered. Studies that delivered treatment remotely were excluded from this update. Data collection and analysis All included studies were analysed and the quality of outcomes were assessed. All treatments were combined into one class, psychological treatments. Pain conditions were split into headache and non-headache. Both conditions were assessed on four outcomes: pain, disability, depression, and anxiety. Data were extracted at two time points; post-treatment (immediately or the earliest data available following end of treatment) and at follow-up (between three and 12 months post-treatment). Main results Seven papers were identified in the updated search. Of these papers, five presented new trials and two presented follow-up data for previously included trials. Five studies that were previously included in this review were excluded as therapy was delivered remotely. The review thus included a total of 37 studies. The total number of participants completing treatments was 2111. Twenty studies addressed treatments for headache (including migraine); nine for abdominal pain; two for mixed pain conditions including headache pain, two for fibromyalgia, two for recurrent abdominal pain or irritable bowel syndrome, and two for pain associated with sickle cell disease. Analyses revealed psychological therapies to be beneficial for children with chronic pain on seven outcomes. For headache pain, psychological therapies reduced pain post-treatment and at follow-up respectively (risk ratio (RR) 2.47, 95% confidence interval (CI) 1.97 to 3.09, z = 7.87, p < 0.01, number needed to treat to benefit (NNTB) = 2.94; RR 2.89, 95% CI 1.03 to 8.07, z = 2.02, p < 0.05, NNTB = 3.67). Psychological therapies also had a small beneficial effect at reducing disability in headache conditions post-treatment and at follow-up respectively (standardised mean difference (SMD) −0.49, 95% CI −0.74 to −0.24, z = 3.90, p < 0.01; SMD −0.46, 95% CI −0.78 to −0.13, z = 2.72, p < 0.01). No beneficial effect was found on depression post-treatment (SMD −0.18, 95% CI −0.49 to 0.14, z = 1.11, p > 0.05). At follow-up, only one study was eligible, therefore no analysis was possible and no conclusions can be drawn. Analyses revealed a small beneficial effect for anxiety post-treatment (SMD −0.33, 95% CI −0.61 to −0.04, z = 2.25, p < 0.05). However, this was not maintained at follow-up (SMD −0.28, 95% CI −1.00 to 0.45; z = 0.75, p > 0.05). Analyses revealed two beneficial effects of psychological treatment for children with non-headache pain. Pain was found to improve post-treatment (SMD −0.57, 95% CI −0.86 to −0.27, z = 3.74, p < 0.01), but not at follow-up (SMD −0.11, 95% CI −0.41 to 0.19, z = 0.73, p > 0.05). Psychological therapies also had a beneficial effect for disability post-treatment (SMD −0.45, 95% CI −0.71 to −0.19, z = 3.40, p < 0.01), but this was not maintained at follow-up (SMD −0.35, 95% CI −0.71 to 0.02, z = 1.87, p > 0.05). No effect was found for depression or anxiety post-treatment (SMD −0.07, 95% CI −0.30 to 0.17, z = 0.54, p > 0.05; SMD −0.15, 95% CI −0.36 to 0.07, z = 1.33, p > 0.05) or at follow-up (SMD 0.06, 95% CI −0.16 to 0.28, z = 0.53, p > 0.05; SMD 0.05, 95% CI −0.24 to 0.33, z = 0.32, p > 0.05). Authors’ conclusions Psychological treatments delivered face-to-face are effective in reducing pain intensity and disability for children and adolescents (<18 years) with headache, and therapeutic gains appear to be maintained, although this should be treated with caution for the disability outcome as only two studies could be included in the follow-up analysis. Psychological therapies are also beneficial at reducing anxiety post-treatment for headache. For non-headache conditions, psychological treatments were found to be beneficial for pain and disability post-treatment but these effects were not maintained at follow-up. There is limited evidence available to estimate the effects of psychological therapies on depression and anxiety for children and adolescents with headache and non-headache pain. The conclusions of this update replicate and add to those of the previous review which found that psychological therapies were effective in reducing pain intensity for children with headache and non-headache pain conditions, and these effects were maintained at follow-up for children with headache conditions. PMID:24796681

Sexual orientation and functional pain in U.S. young adults: the mediating role of childhood abuse.

PubMed

Roberts, Andrea L; Rosario, Margaret; Corliss, Heather L; Wypij, David; Lightdale, Jenifer R; Austin, S Bryn

2013-01-01

Pain without known pathology, termed "functional pain," causes much school absenteeism, medication usage, and medical visits. Yet which adolescents are at risk is not well understood. Functional pain has been linked to childhood abuse, and sexual orientation minority youth (gay, lesbian, bisexual, "mostly heterosexual," and heterosexual with same-sex sexual contact) are more likely to be victims of childhood abuse than heterosexuals, thus may be at greater risk of functional pain. We examined sexual orientation differences in past-year prevalence of functional headache, pelvic, and abdominal pain and multiple sites of pain in 9,864 young adults (mean age = 23 years) from a large U.S. cohort. We examined whether childhood abuse accounted for possible increased risk of functional pain in sexual minority youth. Sexual minority youth, except for gays and lesbians, were at higher risk of functional pelvic and abdominal pain and multiple sites of pain than heterosexuals. Gay and lesbian youth had elevated prevalence only of abdominal pain. Childhood abuse accounted for 14% to 33% of increased experience of multiple sites of pain in minority youth. Youth who identify as "mostly heterosexual" or bisexual or who identify as heterosexual and have had same-sex partners comprised 18% of our sample. Clinicians should be aware that patients with these orientations are at elevated risk of functional pain and may be in need of treatment for sequelae of childhood abuse. Conventional categorization of sexual orientation as heterosexual or homosexual may fail to distinguish a large number of youth who do not wholly identify with either group and may be at elevated risk of health problems.

Negotiating the maze: risk factors for suicidal behavior in chronic pain patients.

PubMed

Newton-John, Toby R O

2014-09-01

Chronic pain disorders can exert major negative effects on virtually every aspect of an individual's life. It is not surprising then that many chronic pain sufferers find themselves at a point of emotional fragility where they experience thoughts of ending their life. Suicidal behavior encompasses a spectrum of experience, from "life weariness" or passive suicidal ideation, to more active suicidal intent and suicide completion. A range of risk factors for suicidal behavior in the general population have been identified, and these apply equally to the chronic pain population: a family history of mental illness, past history of suicide attempts, and the presence of comorbid depression. With regard specifically to chronic pain patients, elevated suicide risk is also associated with severe or recurrent headache, ambiguous diagnoses (psychogenic pain, abdominal pain), and medicolegal issues related to the pain. A number of suggestions for clinicians managing chronic pain patients with regards to managing suicide risk are given.

Predictive Symptoms and Signs of Severe Dengue Disease for Patients with Dengue Fever: A Meta-Analysis

PubMed Central

Zhang, H.; Zhou, Y. P.; Peng, H. J.; Zhang, X. H.; Zhou, F. Y.; Liu, Z. H.; Chen, X. G.

2014-01-01

The aim of the meta-analysis was to provide more solid evidence for the reliability of the new classification. A systematic literature search was performed using PubMed, Armed Forces Pest Management Board Literature Retrieval System, and Google Scholar up to August 2012. A pooled odds ratio (OR) was calculated using either a random-effect or a fixed-effect model. A total of 16 papers were identified. Among the 11 factors studied, five symptoms demonstrated an increased risk for SDD, including bleeding [OR: 13.617; 95% confidence interval (CI): 3.281, 56.508], vomiting/nausea (OR: 1.692; 95% CI: 1.256, 2.280), abdominal pain (OR: 2.278; 95% CI: 1.631, 3.182), skin rashes (OR: 2.031; 95% CI: 1.269, 3.250), and hepatomegaly (OR: 4.751; 95% CI: 1.769, 12.570). Among the four bleeding-related symptoms including hematemesis, melena, gum bleeding, and epistaxis, only hematemesis (OR: 6.174; 95% CI: 2.66, 14.334; P < 0.001) and melena (OR: 10.351; 95% CI: 3.065, 34.956; P < 0.001) were significantly associated with SDD. No significant associations with SDD were found for gender, lethargy, retroorbital pain, diarrhea, or tourniquet test, whereas headache appeared protective (OR: 0.555; 95% CI: 0.455, 0.676). The meta-analysis suggests that bleeding (hematemesis/melena), vomiting/nausea, abdominal pain, skin rashes, and hepatomegaly may predict the development of SDD in patients with DF, while headache may predict otherwise. PMID:25097856

Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents

PubMed Central

Fisher, Emma; Law, Emily; Palermo, Tonya M; Eccleston, Christopher

2016-01-01

Background Chronic pain is common during childhood and adolescence and is associated with negative outcomes such as increased severity of pain, reduced function (e.g. missing school), and low mood (e.g. high levels of depression and anxiety). Psychological therapies, traditionally delivered face-to-face with a therapist, are efficacious at reducing pain intensity and disability. However, new and innovative technology is being used to deliver these psychological therapies remotely, meaning barriers to access to treatment such as distance and cost can be removed or reduced. Therapies delivered with technological devices, such as the Internet, computer-based programmes, smartphone applications, or via the telephone, can be used to deliver treatment to children and adolescents with chronic pain. Objectives To determine the efficacy of psychological therapies delivered remotely compared to waiting-list, treatment-as-usual, or active control treatments, for the management of chronic pain in children and adolescents. Search methods We searched four databases (CENTRAL, MEDLINE, EMBASE, and PsycINFO) from inception to June 2014 for randomised controlled trials of remotely delivered psychological interventions for children and adolescents (0 to 18 years of age) with chronic pain. We searched for chronic pain conditions including, but not exclusive to, headache, recurrent abdominal pain, musculoskeletal pain, and neuropathic pain. We also searched online trial registries for potential trials. A citation and reference search for all included studies was conducted. Selection criteria All included studies were randomised controlled trials that investigated the efficacy of a psychological therapy delivered remotely via the Internet, smartphone device, computer-based programme, audiotapes, or over the phone in comparison to an active, treatment-as-usual, or waiting-list control. We considered blended treatments, which used a combination of technology and face-to-face interaction. We excluded interventions solely delivered face-to-face between therapist and patient from this review. Children and adolescents (0 to 18 years of age) with a primary chronic pain condition were the target of the interventions. Each comparator arm, at each extraction point had to include 10 or more participants. Data collection and analysis For the analyses, we combined all psychological therapies. We split pain conditions into headache and mixed (non-headache) pain and analysed them separately. Pain, disability, depression, anxiety, and adverse events were extracted as primary outcomes. We also extracted satisfaction with treatment as a secondary outcome. We considered outcomes at two time points: first immediately following the end of treatment (known as ’post-treatment’), and second, any follow-up time point post-treatment between 3 and 12 months (known as ’follow-up’). We assessed all included studies for risk of bias. Main results Eight studies (N = 371) that delivered treatment remotely were identified from our search; five studies investigated children with headache conditions, one study was with children with juvenile idiopathic arthritis, and two studies included mixed samples of children with headache and mixed (i.e. recurrent abdominal pain, musculoskeletal pain) chronic pain conditions. The average age of children receiving treatment was 12.57 years. For headache pain conditions, we found one beneficial effect of remotely delivered psychological therapy. Headache severity was reduced post-treatment (risk ratio (RR) = 2.65, 95% confidence interval (CI) 1.56 to 4.50, z = 3.62,p < 0.01, number needed to treat to benefit (NNTB) = 2.88). For mixed pain conditions, we found only one beneficial effect: psychological therapies reduced pain intensity post-treatment (standardised mean difference (SMD) = −0.61, 95% CI −0.96 to −0.25, z = 3.38, p < 0.01). No effects were found for reducing pain at follow-up in either analysis. For headache and mixed conditions, there were no beneficial effects of psychological therapies delivered remotely for disability post-treatment and a lack of data at follow-up meant no analyses could be run. Only one analysis could be conducted for depression outcomes. We found no beneficial effect of psychological therapies in reducing depression post-treatment for headache conditions. Only one study presented data in children with mixed pain conditions for depressive outcomes and no data were available for either condition at follow-up. Only one study presented anxiety data post-treatment and no studies reported follow-up data, therefore no analyses could be run. Further, there were no data available for adverse events, meaning that we are unsure whether psychological therapies are harmful to children who receive them. Satisfaction with treatment is described qualitatively. ‘Risk of bias’ assessments were low or unclear. We judged selection, detection, and reporting biases to be mostly low risk for included studies. However, judgements made on performance and attrition biases were mostly unclear. Authors’ conclusions Psychological therapies delivered remotely, primarily via the Internet, confer benefit in reducing the intensity or severity of pain after treatment across conditions. There is considerable uncertainty around these estimates of effect and only eight studies with 371 children contribute to the conclusions. Future studies are likely to change the conclusions reported here. All included trials used either behavioural or cognitive behavioural therapies for children with chronic pain, therefore we cannot generalise our findings to other therapies. However, satisfaction with these treatments was generally positive. Larger trials are needed to increase our confidence in all conclusions regarding the efficacy of remotely delivered psychological therapies. Implications for practice and research are discussed. PMID:25803793

Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents.

PubMed

Fisher, Emma; Law, Emily; Palermo, Tonya M; Eccleston, Christopher

2015-03-23

Chronic pain is common during childhood and adolescence and is associated with negative outcomes such as increased severity of pain, reduced function (e.g. missing school), and low mood (e.g. high levels of depression and anxiety). Psychological therapies, traditionally delivered face-to-face with a therapist, are efficacious at reducing pain intensity and disability. However, new and innovative technology is being used to deliver these psychological therapies remotely, meaning barriers to access to treatment such as distance and cost can be removed or reduced. Therapies delivered with technological devices, such as the Internet, computer-based programmes, smartphone applications, or via the telephone, can be used to deliver treatment to children and adolescents with chronic pain. To determine the efficacy of psychological therapies delivered remotely compared to waiting-list, treatment-as-usual, or active control treatments, for the management of chronic pain in children and adolescents. We searched four databases (CENTRAL, MEDLINE, EMBASE, and PsycINFO) from inception to June 2014 for randomised controlled trials of remotely delivered psychological interventions for children and adolescents (0 to 18 years of age) with chronic pain. We searched for chronic pain conditions including, but not exclusive to, headache, recurrent abdominal pain, musculoskeletal pain, and neuropathic pain. We also searched online trial registries for potential trials. A citation and reference search for all included studies was conducted. All included studies were randomised controlled trials that investigated the efficacy of a psychological therapy delivered remotely via the Internet, smartphone device, computer-based programme, audiotapes, or over the phone in comparison to an active, treatment-as-usual, or waiting-list control. We considered blended treatments, which used a combination of technology and face-to-face interaction. We excluded interventions solely delivered face-to-face between therapist and patient from this review. Children and adolescents (0 to 18 years of age) with a primary chronic pain condition were the target of the interventions. Each comparator arm, at each extraction point had to include 10 or more participants. For the analyses, we combined all psychological therapies. We split pain conditions into headache and mixed (non-headache) pain and analysed them separately. Pain, disability, depression, anxiety, and adverse events were extracted as primary outcomes. We also extracted satisfaction with treatment as a secondary outcome. We considered outcomes at two time points: first immediately following the end of treatment (known as 'post-treatment'), and second, any follow-up time point post-treatment between 3 and 12 months (known as 'follow-up'). We assessed all included studies for risk of bias. Eight studies (N = 371) that delivered treatment remotely were identified from our search; five studies investigated children with headache conditions, one study was with children with juvenile idiopathic arthritis, and two studies included mixed samples of children with headache and mixed (i.e. recurrent abdominal pain, musculoskeletal pain) chronic pain conditions. The average age of children receiving treatment was 12.57 years.For headache pain conditions, we found one beneficial effect of remotely delivered psychological therapy. Headache severity was reduced post-treatment (risk ratio (RR) = 2.65, 95% confidence interval (CI) 1.56 to 4.50, z = 3.62,p < 0.01, number needed to treat to benefit (NNTB) = 2.88). For mixed pain conditions, we found only one beneficial effect: psychological therapies reduced pain intensity post-treatment (standardised mean difference (SMD) = -0.61, 95% CI -0.96 to -0.25, z = 3.38, p < 0.01). No effects were found for reducing pain at follow-up in either analysis. For headache and mixed conditions, there were no beneficial effects of psychological therapies delivered remotely for disability post-treatment and a lack of data at follow-up meant no analyses could be run. Only one analysis could be conducted for depression outcomes. We found no beneficial effect of psychological therapies in reducing depression post-treatment for headache conditions. Only one study presented data in children with mixed pain conditions for depressive outcomes and no data were available for either condition at follow-up. Only one study presented anxiety data post-treatment and no studies reported follow-up data, therefore no analyses could be run. Further, there were no data available for adverse events, meaning that we are unsure whether psychological therapies are harmful to children who receive them. Satisfaction with treatment is described qualitatively.'Risk of bias' assessments were low or unclear. We judged selection, detection, and reporting biases to be mostly low risk for included studies. However, judgements made on performance and attrition biases were mostly unclear. Psychological therapies delivered remotely, primarily via the Internet, confer benefit in reducing the intensity or severity of pain after treatment across conditions. There is considerable uncertainty around these estimates of effect and only eight studies with 371 children contribute to the conclusions. Future studies are likely to change the conclusions reported here. All included trials used either behavioural or cognitive behavioural therapies for children with chronic pain, therefore we cannot generalise our findings to other therapies. However, satisfaction with these treatments was generally positive. Larger trials are needed to increase our confidence in all conclusions regarding the efficacy of remotely delivered psychological therapies. Implications for practice and research are discussed.

Clinical pathways for suicidality in emergency settings: a public health priority.

PubMed

Wilhelm, Kay; Korczak, Viola; Tietze, Tad; Reddy, Prasuna

2017-05-01

Rates of self-harm in Australia are increasing and constitute a concerning public health issue. Although there are standard treatment pathways for physical complaints, such as headache, abdominal pain and chest pain, in Emergency Medicine, there is no national pathway for self-harm or other psychiatric conditions that present to the emergency department. Herein we outline the difference between clinical practice guidelines and clinical pathways, discuss pathways we have identified on self-harm in Australia and overseas and discuss their applicability to the Australian context and the next steps forward in addressing this public health issue.

An Unusual Cause of Headache in a Medical Tourist

PubMed Central

Desai, Soaham Dilip; Mehta, Manan M.

2015-01-01

With booming medical tourism, Indian doctors are seeing a lot of patients from other countries for varied medical conditions. A citizen of Nairobi presented for treatment of his complaints consisting of severe episodic headache, with abdominal pain, spermatorrhea, decreased libido, constipation, and impotence. On detailed evaluation, he was found to have developed dependence to khat chewing; a social habit in his native country and his symptoms were attributed to effects of khat withdrawal. He improved after treatment with topiramate and escitalopram and lifestyle modification. Physicians need to be aware about various cultural habits of addiction in different parts of the world and their common presentations in view of globalization of health care. PMID:25811009

Headache and co-morbid pains associated with TMD pain in adolescents.

PubMed

Nilsson, I-M; List, T; Drangsholt, M

2013-09-01

This case-control study evaluated the association of headache and other co-morbid pain with temporomandibular disorder (TMD) pain in adolescents and explored the temporal co-variance of headache and TMD pain. In a population-based sample of 12- to 19-year-olds, 350 patients with self-reported TMD pain and 350 healthy age- and sex-matched individuals were mailed questionnaires. Descriptive statistics, 95% CI, and OR analyses--logistic regression models with TMD pain as the outcome variable and adjusted for age and gender--were used for the analysis of individuals' responses. Headache, whether defined as once a week or more (OR = 6.6) or as moderate or severe (categorical), was significantly related to TMD pain. Severe headache (vs. mild) showed stronger associations with TMD (OR = 10.1) than between moderate and mild headache (OR = 5.5). Neck (OR = 4.0) and back (OR = 2.6) pain was also significantly related to TMD pain. When participants were grouped according to headache onset and TMD pain, the highest association between headache and TMD pain was found in the subgroup "Headache onset before TMD pain" (OR 9.4). In conclusion, headache appears to be independently and highly associated with TMD pain in adolescents. Neck pain and somatic complaints were also significantly associated with TMD pain. Headache seems to precede TMD pain in many adolescents with pain.

Advanced abdominal pregnancy, with live fetus and severe preeclampsia, case report.

PubMed

Hailu, Fekade Getachew; Yihunie, Getnet Tesfaye; Essa, Ahmed Amdihun; Tsega, Walelign Kindie

2017-07-26

Abdominal pregnancy may account for up to 1.4% of all ectopic pregnancies. The incidence of abdominal pregnancy differs in various literatures and ranges between 1:10,000 pregnancies to 1:30, 000 pregnancies. The clinical symptoms of an uncomplicated abdominal pregnancy are unspecific. There are reports of maternal and fetal survival from advanced abdominal pregnancies. Our case was a 26 years old gravida 4, para 3 (2 alive, one early neonatal death) woman. She presented to Felegehiwot Referal Hospital with a principal complaint of vomiting, epigastric pain, headache, and blurring of vision. Emergency cesarean delivery was decided with the impression of bicornuate uterus with intrauterine pregnancy, intrauterine growth restriction and sever preeclampsia.it was found to be advanced abdominal pregnancy. Placenta was removed and pack was used to control bleeding. Both the mother and neonate were discharged in a good condition. Abdominal pregnancy with live fetus is an extremely rare condition and requires a high index of suspicion. Endometrial cavity may not be required for development of severe preeclampsia and packing is effective in controlling bleeding in selected cases.

Importance of Pain Acceptance in Relation to Headache Disability and Pain Interference in Women with Migraine and Overweight/Obesity

PubMed Central

Lillis, Jason; Thomas, J. Graham; Seng, Elizabeth K.; Lipton, Richard B.; Pavlovic, Jelena; Rathier, Lucille; Roth, Julie; O’Leary, Kevin C.; Bond, Dale S.

2018-01-01

BACKGROUND Pain acceptance involves willingness to experience pain and engaging in valued activities while pain is present. Though pain acceptance could limit both headache-related disability and pain interference in individuals with migraine, few studies have addressed this issue. The current study evaluated whether higher levels of total pain acceptance and it’s 2 subcomponents, pain willingness and activity engagement, were associated with lower levels of headache-related impairment in women who had both migraine and overweight/obesity. METHODS In this cross-sectional study, participants seeking weight loss and headache relief in the Women’s Health and Migraine (WHAM) trial completed baseline measures of pain acceptance (Chronic Pain Acceptance Questionnaire [CPAQ]), headache-related disability (Headache Impact Test-6 [HIT-6]), and pain interference (Brief Pain Inventory [BPI]). Migraine headache frequency and pain intensity were assessed daily via smartphone diary. Using CPAQ total and subcomponent (pain willingness and activity engagement) scores, headache frequency, pain intensity, and BMI as predictors in linear regression, headache-related disability and pain interference were modeled as outcomes. RESULTS On average, participants (n=126; age=38.5±8.2 years; BMI=35.3±6.6 kg/m2) reported 8.4±4.7 migraine days/month and pain intensity of 6.0±1.5 on a 0–10 scale on headache days. After correcting for multiple comparisons (adjusted α=.008), pain willingness was independently associated with both lower headache related disability (p<.001; β=−.233) and pain interference (p<.001; β= −.261). Activity engagement was not associated with headache related disability (p=.128; β= −.138) and pain interference (p=.042; β= −.154). CPAQ Total Score was not associated with headache related disability (p=.439; β=.066) and pain interference (p=.305; β=.074). Pain intensity was significantly associated with outcomes in all analyses (p’s <.001; β’s .343−.615). CONCLUSIONS Higher pain willingness, independent of degree of both migraine severity and overweight, is associated with lower headache-related disability and general pain interference in treatment-seeking women with migraine and overweight/obesity. Future studies are needed to clarify direction of causality and test whether strategies designed to help women increase pain willingness, or relinquish ineffective efforts to control pain, can improve functional outcomes in women who have migraine and overweight/obesity. PMID:28295273

Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain

PubMed Central

Anderson, Gary C.; John, Mike T.; Ohrbach, Richard; Nixdorf, Donald R.; Schiffman, Eric L.; Truelove, Edmond S.; List, Thomas

2011-01-01

The relationship of the frequency of temple headache to signs and symptoms of temporomandibular disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included: 86 painful TMD, non-headache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria (RDC) diagnoses of myofascial pain, TMJ arthralgia and TMJ osteoarthritis. Mild to moderate intensity temple headaches were classified by frequency using criteria based on the ICHD-II classification of TTH. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), PPTs and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD-related, as well as a possible role for peripheral and central sensitization in TMD patients. PMID:21196079

Importance of Pain Acceptance in Relation to Headache Disability and Pain Interference in Women With Migraine and Overweight/Obesity.

PubMed

Lillis, Jason; Graham Thomas, J; Seng, Elizabeth K; Lipton, Richard B; Pavlović, Jelena M; Rathier, Lucille; Roth, Julie; O'Leary, Kevin C; Bond, Dale S

2017-05-01

Pain acceptance involves willingness to experience pain and engaging in valued activities while pain is present. Though pain acceptance could limit both headache-related disability and pain interference in individuals with migraine, few studies have addressed this issue. This study evaluated whether higher levels of total pain acceptance and its two subcomponents, pain willingness and activity engagement, were associated with lower levels of headache-related impairment in women who had both migraine and overweight/obesity. In this cross-sectional study, participants seeking weight loss and headache relief in the Women's Health and Migraine trial completed baseline measures of pain acceptance (Chronic Pain Acceptance Questionnaire [CPAQ]), headache-related disability (Headache Impact Test-6), and pain interference (Brief Pain Inventory). Migraine headache frequency and pain intensity were assessed daily via smartphone diary. Using CPAQ total and subcomponent (pain willingness and activity engagement) scores, headache frequency, pain intensity, and body mass index (BMI) as predictors in linear regression, headache-related disability, and pain interference were modeled as outcomes. On average, participants (n = 126; age = 38.5 ± 8.2 years; BMI = 35.3 ± 6.6 kg/m 2 ) reported 8.4 ± 4.7 migraine days/month and pain intensity of 6.0 ± 1.5 on a 0-10 scale on headache days. After correcting for multiple comparisons (adjusted α = .008), pain willingness was independently associated with both lower headache-related disability (P < .001; β = -0.233) and pain interference (P < .001; β = -0.261). Activity engagement was not associated with headache-related disability (P = .128; β = -0.138) and pain interference (P = .042; β = -0.154). CPAQ total score was not associated with headache-related disability (P = .439; β = 0.066) and pain interference (P = .305; β = 0.074). Pain intensity was significantly associated with outcomes in all analyses (Ps < .001; βs 0.343-0.615). Higher pain willingness, independent of degree of both migraine severity and overweight, is associated with lower headache-related disability and general pain interference in treatment-seeking women with migraine and overweight/obesity. Future studies are needed to clarify direction of causality and test whether strategies designed to help women increase pain willingness, or relinquish ineffective efforts to control pain, can improve functional outcomes in women who have migraine and overweight/obesity. © 2017 American Headache Society.

Children and adolescents with complex regional pain syndrome: More psychologically distressed than other children in pain?

PubMed Central

Logan, Deirdre E; Williams, Sara E; Carullo, Veronica P; Claar, Robyn Lewis; Bruehl, Stephen; Berde, Charles B

2013-01-01

BACKGROUND Historically, in both adult and pediatric populations, a lack of knowledge regarding complex regional pain syndrome (CRPS) and absence of clear diagnostic criteria have contributed to the view that this is a primarily psychiatric condition. OBJECTIVE: To test the hypothesis that children with CRPS are more functionally disabled, have more pain and are more psychologically distressed than children with other pain conditions. METHODS: A total of 101 children evaluated in a tertiary care pediatric pain clinic who met the International Association for the Study of Pain consensus diagnostic criteria for CRPS participated in the present retrospective study. Comparison groups included 103 children with abdominal pain, 291 with headache and 119 with back pain. Children and parents completed self-report questionnaires assessing disability, somatization, pain coping, depression, anxiety and school attendance. RESULTS: Children with CRPS reported higher pain intensity and more recent onset of pain at the initial tertiary pain clinic evaluation compared with children with other chronic pain conditions. They reported greater functional disability and more somatic symptoms than children with headaches or back pain. Scores on measures of depression and anxiety were within normal limits and similar to those of children in other pain diagnostic groups. CONCLUSIONS: As a group, clinic-referred children with CRPS may be more functionally impaired and experience more somatic symptoms compared with children with other pain conditions. However, overall psychological functioning as assessed by self-report appears to be similar to that of children with other chronic pain diagnoses. Comprehensive assessment using a biopsychosocial framework is essential to understanding and appropriately treating children with symptoms of CRPS. PMID:23662291

Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

PubMed Central

ICHINOSE, Daisuke; TOCHIGI, Satoru; TANAKA, Toshihide; SUZUKI, Tomoya; TAKEI, Jun; HATANO, Keisuke; KAJIWARA, Ikki; MARUYAMA, Fumiaki; SAKAMOTO, Hiroki; HASEGAWA, Yuzuru; TANI, Satoshi; MURAYAMA, Yuichi

2018-01-01

A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy. PMID:29479039

Pain sensitivity mediates the relationship between stress and headache intensity in chronic tension-type headache.

PubMed

Cathcart, Stuart; Bhullar, Navjot; Immink, Maarten; Della Vedova, Chris; Hayball, John

2012-01-01

A central model for chronic tension-type headache (CTH) posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. The prediction from this model that pain sensitivity mediates the relationship between stress and headache activity has not yet been examined. To determine whether pain sensitivity mediates the relationship between stress and prospective headache activity in CTH sufferers. Self-reported stress, pain sensitivity and prospective headache activity were measured in 53 CTH sufferers recruited from the general population. Pain sensitivity was modelled as a mediator between stress and headache activity, and tested using a nonparametric bootstrap analysis. Pain sensitivity significantly mediated the relationship between stress and headache intensity. The results of the present study support the central model for CTH, which posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. Implications for the mechanisms and treatment of CTH are discussed.

The association of headache frequency with pain interference and the burden of disease is mediated by depression and sleep quality, but not anxiety, in chronic tension type headache.

PubMed

Palacios-Ceña, María; Fernández-Muñoz, Juan J; Castaldo, Matteo; Wang, Kelun; Guerrero-Peral, Ángel; Arendt-Nielsen, Lars; Fernández-de-Las-Peñas, César

2017-12-01

A better understanding of potential relationship between mood disorders, sleep quality, pain, and headache frequency may assist clinicians in determining optimal therapeutic programs. The aim of the current study was to analyze the effects of sleep quality, anxiety, depression on potential relationships between headache intensity, burden of headache, and headache frequency in chronic tension type headache (CTTH). One hundred and ninety-three individuals with CTTH participated. Headache features were collected with a 4-weeks headache diary. The Hospital Anxiety and Depression Scale was used for assessing anxiety and depression. Headache Disability Inventory evaluated the burden of headache. Pain interference was determined with the bodily pain domain (SF-36 questionnaire). Sleep quality was assessed with Pittsburgh Sleep Quality Index. Path analyses with maximum likelihood estimations were conducted to determine the direct and indirect effects of depression, anxiety, and sleep quality on the frequency of headaches. Two paths were observed: the first with depression and the second with sleep quality as mediators. Direct effects were noted from sleep quality, emotional burden of disease and pain interference on depression, and from depression to headache frequency. The first path showed indirect effects of depression from emotional burden and from sleep quality to headache frequency (first model R 2  = 0.12). Direct effects from the second path were from depression and pain interference on sleep quality and from sleep quality on headache frequency. Sleep quality indirectly mediated the effects of depression, emotional burden and pain interference on headache frequency (second model R 2  = 0.18). Depression and sleep quality, but not anxiety, mediated the relationship between headache frequency and the emotional burden of disease and pain interference in CTTH.

Pain sensitivity mediates the relationship between stress and headache intensity in chronic tension-type headache

PubMed Central

Cathcart, Stuart; Bhullar, Navjot; Immink, Maarten; Della Vedova, Chris; Hayball, John

2012-01-01

BACKGROUND: A central model for chronic tension-type headache (CTH) posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. The prediction from this model that pain sensitivity mediates the relationship between stress and headache activity has not yet been examined. OBJECTIVE: To determine whether pain sensitivity mediates the relationship between stress and prospective headache activity in CTH sufferers. METHOD: Self-reported stress, pain sensitivity and prospective headache activity were measured in 53 CTH sufferers recruited from the general population. Pain sensitivity was modelled as a mediator between stress and headache activity, and tested using a nonparametric bootstrap analysis. RESULTS: Pain sensitivity significantly mediated the relationship between stress and headache intensity. CONCLUSIONS: The results of the present study support the central model for CTH, which posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. Implications for the mechanisms and treatment of CTH are discussed. PMID:23248808

Caffeine in the management of patients with headache.

PubMed

Lipton, Richard B; Diener, Hans-Christoph; Robbins, Matthew S; Garas, Sandy Yacoub; Patel, Ketu

2017-10-24

Caffeinated headache medications, either alone or in combination with other treatments, are widely used by patients with headache. Clinicians should be familiar with their use as well as the chemistry, pharmacology, dietary and medical sources, clinical benefits, and potential safety issues of caffeine. In this review, we consider the role of caffeine in the over-the-counter treatment of headache. The MEDLINE and Cochrane databases were searched by combining "caffeine" with the terms "headache," "migraine," and "tension-type." Studies that were not placebo-controlled or that involved medications available only with a prescription, as well as those not assessing patients with migraine and/or tension-type headache (TTH), were excluded. Compared with analgesic medication alone, combinations of caffeine with analgesic medications, including acetaminophen, acetylsalicylic acid, and ibuprofen, showed significantly improved efficacy in the treatment of patients with TTH or migraine, with favorable tolerability in the vast majority of patients. The most common adverse events were nervousness (6.5%), nausea (4.3%), abdominal pain/discomfort (4.1%), and dizziness (3.2%). This review provides evidence for the role of caffeine as an analgesic adjuvant in the acute treatment of primary headache with over-the-counter drugs, caffeine doses of 130 mg enhance the efficacy of analgesics in TTH and doses of ≥100 mg enhance benefits in migraine. Additional studies are needed to assess the relationship between caffeine dosing and clinical benefits in patients with TTH and migraine.

Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain.

PubMed

Krøll, Lotte Skytte; Hammarlund, Catharina Sjödahl; Westergaard, Maria Lurenda; Nielsen, Trine; Sloth, Louise Bönsdorff; Jensen, Rigmor Højland; Gard, Gunvor

2017-12-01

The prevalence of migraine with co-existing tension-type headache and neck pain is high in the general population. However, there is very little literature on the characteristics of these combined conditions. The aim of this study was to investigate a) the prevalence of migraine with co-existing tension-type headache and neck pain in a clinic-based sample, b) the level of physical activity, psychological well-being, perceived stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain compared to healthy controls, c) the perceived ability of persons with migraine and co-existing tension-type headache and neck pain to perform physical activity, and d) which among the three conditions (migraine, tension-type headache or neck pain) is rated as the most burdensome condition. The study was conducted at a tertiary referral specialised headache centre where questionnaires on physical activity, psychological well-being, perceived stress and self-rated health were completed by 148 persons with migraine and 100 healthy controls matched by sex and average age. Semi-structured interviews were conducted to assess characteristics of migraine, tension-type headache and neck pain. Out of 148 persons with migraine, 100 (67%) suffered from co-existing tension-type headache and neck pain. Only 11% suffered from migraine only. Persons with migraine and co-existing tension-type headache and neck pain had lower level of physical activity and psychological well-being, higher level of perceived stress and poorer self-rated health compared to healthy controls. They reported reduced ability to perform physical activity owing to migraine (high degree), tension-type headache (moderate degree) and neck pain (low degree). The most burdensome condition was migraine, followed by tension-type headache and neck pain. Migraine with co-existing tension-type headache and neck pain was highly prevalent in a clinic-based sample. Persons with migraine and co-existing tension-type headache and neck pain may require more individually tailored interventions to increase the level of physical activity, and to improve psychological well-being, perceived stress and self-rated health.

Neurophysiologic Correlates of Headache Pain in Subjects With Major Depressive Disorder.

PubMed

Scanlon, Graham C; Jain, Felipe A; Hunter, Aimee M; Cook, Ian A; Leuchter, Andrew F

2017-05-01

Headache pain is often comorbid with major depressive disorder (MDD) and is associated with greater symptom burden, disability, and suicidality. The biological correlates of headache pain in MDD, however, remain obscure. The purpose of this study was to examine the association between brain oscillatory activity and headache pain in MDD subjects. A total of 64 subjects with MDD who were free of psychoactive medications were evaluated for severity of headache pain in the past week. Brain function was assessed using resting-state quantitative electroencephalography (qEEG). We derived cordance in the theta (4-8 Hz) and alpha (8-12 Hz) frequency bands at each electrode, and examined correlations with headache pain in regions of interest while controlling for depression severity. Frontal and posterior asymmetry in alpha power was calculated in regions of interest. Headache pain severity was associated with depression severity ( r = 0.447, P < .001). In bilateral frontal and right posterior regions, alpha cordance was significantly associated with headache intensity, including when controlling for depression severity. The direction of the correlation was positive anteriorly and negative posteriorly. Frontal left dominant alpha asymmetry correlated with severity of headache but not depression symptoms. Alterations in brain oscillations identified by alpha cordance and alpha asymmetry may be associated with the pathophysiology of headache pain in depression. These findings should be prospectively confirmed.

Self-reported neck pain is associated with migraine but not with tension-type headache in adolescents.

PubMed

Blaschek, Astrid; Decke, Siona; Albers, Lucia; Schroeder, Andreas Sebastian; Lehmann, Steffi; Straube, Andreas; Landgraf, Mirjam N; Heinen, Florian; von Kries, Rüdiger

2014-10-01

The aim of the present analysis is to confirm or refute the association of neck pain to migraine or tension-type headache and to assess whether this association is independent of other risk factors for headache. Secondary school students were invited to complete a questionnaire on headache and lifestyle factors in a cross-sectional study. Neck pain was assessed via (a) a screening question concerning neck pain and (b) denoting affected areas in schematic drawings of the human body. Absolute increment in prevalence of headache with pain in the shoulder-neck region was between 7.5% and 9.6%. Gender, grade, stress and lifestyle factors were assessed as potential confounding factors. Nearly all factors were associated with shoulder-neck pain and most with headache. After adjustment for confounders, the association of neck pain with headache was almost completely confined to migraine (OR 2.39; 95% CI 1.48-3.85) and migraine + tension-type headache (OR 2.12; 95% CI 1.50-2.99), whereas the association with isolated tension-type headache was negligible (OR 1.22, 95% CI 0.87-1.69). Neck pain is associated with migraine but not with tension-type headache. A possible link between migraine and neck pain may be the cervico-trigeminal convergence of neck and meningeal sensory afferents or a disturbed descending inhibition in migraine. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Repeated measures of recent headache, neck and upper back pain in Australian adolescents.

PubMed

Grimmer, K; Nyland, L; Milanese, S

2006-07-01

The epidemiological and clinical literature identifies strong associations between adult headache, cervical and thoracic spine dysfunction and spinal posture. This paper reports on the prevalence and incidence of headache, neck and upper back pain which occurred in the previous week, in urban Australians aged 13-17 years. Commencing in 1999, we followed a cohort of South Australian students through 5 years of secondary schooling. Of our commencing cohort of students, 132 (30%) provided data on bodily pain every year. For both girls and boys, there was a significantly decreasing prevalence of headache over the study period, while neck pain and upper back pain increased. There was a significantly increasing trend over time for boys with upper back pain. Twenty percent of girls and boys consistently reported headache, neck pain or upper back pain over 5 years. The progression of early adolescent headaches to mid-adolescent neck and upper back pain potentially reflects the adolescents' biomechanical responses to intrinsic and extrinsic imposts. This requires further investigation to understand the causes of adolescent headache, neck and upper thoracic pain.

Lead intoxication and knee osteoarthritis after a gunshot: long-term follow-up case report.

PubMed

Gameiro, Vinicius Schott; de Araújo, Gabriel Costa Serrão; Bruno, Felipe Motta Moreira

2013-06-24

This case is of a man who suffered gunshots and developed saturnism. Projectiles were removed from the abdomen, but one was left in the knee for 14 years. The patient presented with weight loss, headaches, loss of sight, tiredness, cramps, painful joints and trembling. We identified ataxic movements such as intense trembling of the limbs and anaemia. The abdominal pain caused eight internments in different hospitals, and the patient always received the diagnosis of intestinal subocclusion. We removed the bullet and did a wide synovectomy. The patient did not receive a clinical treatment with chelates. The symptoms of lead poisoning ceased, but he developed knee osteoarthritis, during the 7 years of follow-up.

Treat-early and treat-mild: role of fast vs. slow escalation of headaches.

PubMed

Ng-Mak, D S; Ma, L; Hu, X H; Chen, Y-T

2009-04-01

This prospective, multi-center, observational study aimed to examine patients' early treatment decision process. Specifically, we assessed if the association between mild headache pain at treatment initiation and early treatment differed by the speed of headache escalation. Patients (n = 168) were instructed to collect information on their headache experience during the study period via an electronic diary over 30 consecutive days after enrollment. At the time of treatment, patients who treated early were 2.3 times as likely to experience mild headache pain as those who treated late. Controlling for the effect of escalation of headache, patients who treated early were three times as likely to report mild headache pain at dosing as those who treated late. The interaction between fast escalation of headache and mild pain was not statistically significant. Early treatment is associated with mild pain, regardless of the speed of headache escalation.

Migraine disability assessment (MIDAS) score: relation to headache frequency, pain intensity, and headache symptoms.

PubMed

Stewart, Walter F; Lipton, Richard B; Kolodner, Ken

2003-03-01

To determine the extent to which variation in the Migraine Disability Assessment (MIDAS) score is associated with headache frequency, pain intensity, headache symptoms, gender, and employment status. The MIDAS questionnaire is a 7-item questionnaire (with 5 scored items) designed to measure headache-related disability, to improve physician-patient communication, and to identify patients with high treatment needs. Data from 3 population-based studies (total sample, n = 397) conducted in the United States and the United Kingdom were used to evaluate the relationship between headache features (attack frequency, pain intensity, pain quality, and associated symptoms) and MIDAS score. Data on headache features were collected by telephone using a standardized interview. The MIDAS questionnaire was completed shortly after the telephone interview. General linear models were used to determine the extent to which population variation in the MIDAS score was explained by headache features. Using linear regression, variables for all headache features (ie, headache frequency, pain intensity, pain quality, and associated symptoms) and demographic characteristics explained only 22% of the variation in MIDAS scores. Almost all (19.9%) the explained variance was accounted for by average pain intensity (12.0%), number of headache days (6.1%), and exacerbation of pain with movement (1.8%). When pain intensity and headache frequency were included in the model, no statistically significant differences in MIDAS scores were observed by gender or employment status. Although explaining only 2.1% of the variance, age was significantly associated with MIDAS scores, with those under 25 years demonstrating higher MIDAS scores than other age groups. No other variables (ie, frequency of occurrence of associated symptoms and other measures of quality of pain) were associated with MIDAS scores. Challenges to the utility of the MIDAS as a measure include whether headache-related disability is largely a function of other routine headache features and whether MIDAS is inherently biased based on work status and gender. While the MIDAS score was associated with headache frequency and average pain score, these two headache features explain only a modest proportion of the variation in MIDAS scores. Additionally, gender and work status were not related to MIDAS scores. These findings suggest that the MIDAS score captures information about disability that is not inherent to other headache features and is independent of gender and work status.

Headache Disability, Suicidality and Pain Catastrophization - Are They Related

PubMed Central

Ram, Dushad; Sundarmurthy, Harsha; Rathod, Snehal; John, Deepa

2016-01-01

Introduction Studies have found that headache is associated with suicidality. Some demographic and clinical features have been reported to be associated with suicidality. Pain catastrophizing and disability may also have bearing on suicidality in patients with headache. Aim To evaluate the relationship between pain disability and catastrophizing in headache and suicidal behaviour. Materials and Methods Patients diagnosed with headache were recruited from neurology Out-Patient Department (OPD). With ethical approval and informed consent, patients were subjected to a structured interview. Headache disability and pain catastrophizing was assessed with the Henry Ford Hospital Headache Disability Inventory (HDI) and Pain Catastrophy Scale (PCS) respectively. For evaluation of suicidal ideation and behaviour, MINI International Neuropsychiatric Interview (MINI Plus) scale and The Columbia-Suicide Severity Rating Scale (C-SSRS) were applied. Data was analysed with Mann-Whitney U test and Kruskal-Wallis test using appropriate statistical programs. Results In 200 patients of headache, male: female ratio was 0.48: 1. Headache disability was significantly higher in females (p=0.060) and unemployed (p=0.019) patients whereas, pain catastrophizing was significant in patients belonging to low socioeconomic class (p=0.045). Headache disability and pain catastrophizing had significant association with suicidal ideation. Disability score was significantly associated with the score of deterrents (p=0.067) and controllability (p=0.039) subscale of intensity of suicidal ideation. There were four patients who actually attempted suicide. Pain catastrophizing was significantly associated with non-suicidal self injurious behaviour (p=0.041). Conclusion Disability due to headache and pain catastrophizing is associated with increased suicidal tendencies, behaviour and suicidal attempts. Headache in females and patients in rural habitat, unemployed individuals belonging to low socioeconomic class need special attention to reduce high risk suicidal behaviour. PMID:28050482

Headache Disability, Suicidality and Pain Catastrophization - Are They Related.

PubMed

Rathod, Harshal; Ram, Dushad; Sundarmurthy, Harsha; Rathod, Snehal; John, Deepa

2016-11-01

Studies have found that headache is associated with suicidality. Some demographic and clinical features have been reported to be associated with suicidality. Pain catastrophizing and disability may also have bearing on suicidality in patients with headache. To evaluate the relationship between pain disability and catastrophizing in headache and suicidal behaviour. Patients diagnosed with headache were recruited from neurology Out-Patient Department (OPD). With ethical approval and informed consent, patients were subjected to a structured interview. Headache disability and pain catastrophizing was assessed with the Henry Ford Hospital Headache Disability Inventory (HDI) and Pain Catastrophy Scale (PCS) respectively. For evaluation of suicidal ideation and behaviour, MINI International Neuropsychiatric Interview (MINI Plus) scale and The Columbia-Suicide Severity Rating Scale (C-SSRS) were applied. Data was analysed with Mann-Whitney U test and Kruskal-Wallis test using appropriate statistical programs. In 200 patients of headache, male: female ratio was 0.48: 1. Headache disability was significantly higher in females (p=0.060) and unemployed (p=0.019) patients whereas, pain catastrophizing was significant in patients belonging to low socioeconomic class (p=0.045). Headache disability and pain catastrophizing had significant association with suicidal ideation. Disability score was significantly associated with the score of deterrents (p=0.067) and controllability (p=0.039) subscale of intensity of suicidal ideation. There were four patients who actually attempted suicide. Pain catastrophizing was significantly associated with non-suicidal self injurious behaviour (p=0.041). Disability due to headache and pain catastrophizing is associated with increased suicidal tendencies, behaviour and suicidal attempts. Headache in females and patients in rural habitat, unemployed individuals belonging to low socioeconomic class need special attention to reduce high risk suicidal behaviour.

Risk factors for development of non-specific musculoskeletal pain in preteens and early adolescents: a prospective 1-year follow-up study

PubMed Central

El-Metwally, Ashraf; Salminen, Jouko J; Auvinen, Anssi; Macfarlane, Gary; Mikkelsson, Marja

2007-01-01

Background Musculoskeletal pain symptoms are common in children and adolescents. These symptoms have a negative impact on children's physical and emotional well-being, but their underlying aetiology and risk factors are still poorly understood. Most of the previous cohort studies were conducted among mid and/or late adolescents and were mainly focused on a specific pain location (e.g. low back pain or neck pain). The purpose of this study is to estimate occurrence of new-onset pain symptoms, in all musculoskeletal locations, in preteens and early adolescents and investigate risk factors for development of these symptoms. Methods 1756 schoolchildren (mean age 10.8) were recruited from schools in southern Finland. Information was extracted as to whether they experienced musculoskeletal pain and a total of 1192 children were identified as free of musculoskeletal pain symptoms. Information was collected on factors which could potentially predict the development of musculoskeletal pain: headache, abdominal pain, sadness/feeling down, day-time tiredness, difficulty in falling asleep, waking up during nights, level of physical activity and hypermobility. These children were followed-up 1-year later and those with new episodes of non-traumatic and traumatic musculoskeletal pain symptoms were identified. Results A total of 1113 schoolchildren (93% of baseline pain-free children) were found at one-year follow-up. New episodes of musculoskeletal pain were reported by 21.5% of these children. Of them 19.4% reported non-traumatic pain and 4.0% reported traumatic pain. The neck was the most commonly reported site with non-traumatic pain, while the lower limb was the most common site for traumatic pain. The independent risk factors for non-traumatic musculoskeletal pain were headache (OR = 1.68, [95% CI 1.16–2.44]) and day-time tiredness (OR = 1.53, [95% CI 1.03–2.26]). The risk factors for traumatic musculoskeletal pain were vigorous exercise (OR = 3.40 [95% CI 1.39–8.31]) and day-time tiredness (OR = 2.97 [95% CI 1.41–6.26]). Conclusion This study highlights that there may be two types of pain entities with both distinct and common aspects of aetiology. For primary prevention purposes, school healthcare professionals should pay attention to preteens and early adolescents practicing vigorous exercise (predictor of traumatic pain), reporting headache (predictor of non-traumatic pain) and reporting day-time tiredness (predictor of both types of pain). PMID:17521435

Case report: patient with Weil’s disease, chest pain, hepatitis b, hepatorenal syndrome, and electrolyte imbalance

NASA Astrophysics Data System (ADS)

Mustopa; Susilo, R. S. B.; Arifin; Redhono, D.; Sumandjar, T.

2018-03-01

A 48-years-old man was hospitalized due to febrile for 5 days accompanied by headache and left chest pain radiating into the back. Pain calf, abdominal pain and tea color urine has occured since 1 week before admission. Physical examination revealed temperature 38.5° C, conjungtival suffusion, jaundice sclera, irregularheart sound, hepatomegaly, gastrocnemius tenderness, Faine score 23. Laboratory tests showed leukocytosis, thrombocytopenia, elevated transaminase enzyme, ureum 181 mg/dl, creatinine 4.3 mg/dl, albumin 2.4 g/dl, sodium 110 mmol/L, potassium 2.3 mmol/L, reactive HbsAg, CKMB 68.06 ng/ml, increased HBV-DNA, negative IgM anti Leptospira. MAT demonstrated 4 positive serovar. Electrocardiography revealed AF rapid ventrikel response. Chest x-ray showed cardiomegaly. Abdominal ultrasound revealed hepatomegaly with chronic parenchimal liver disease, renal insuficiency. Fibroscan showed severe fibrosis. Patient was diagnosed with Weil’s disease and hepatorenal syndrome as complication. Patient was given clavulanate amoxicillin injections. This patient was not dialysis, only fluid balance monitoring and checked ureum-creatinine per 3 days, and there was improvement of ureum-creatinine. Hepatorenal syndrome in Weil’s disease contributed to electrolyte imbalance. In addition, chronic hepatitis B on this patient was treated with tenofovir.

A case of Crimean-Congo hemorrhagic fever complicated with acute pancreatitis.

PubMed

Bastug, Aliye; Kayaaslan, Bircan; But, Ayse; Aslaner, Halide; Sertcelik, Ahmet; Akinci, Esragul; Onguru, Pinar; Yetkin, Meltem Arzu; Bodur, Hurrem

2014-11-01

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease characterized by nonspecific symptoms like fever, myalgia, severe headache, nausea, vomiting, diarrhea, and abdominal pain. It can result in various complications during the course of the disease due to the diffuse endothelial injury involved in the pathogenesis of CCHF. Here we present a patient with CCHF complicated by acute pancreatitis, including pleural and intra-abdominal effusions. A 70-year-old patient was referred to our hospital from an endemic area with the suspicion of CCHF. The physical examination of the patient revealed high fever (38°C), somnolence, and petechial eruption. The diagnosis of case was confirmed with positive reverse transcriptase polymerase chain reaction (RT-PCR). The viral load of the patient was 4×10(9) copies/mL. On the fifth day of admission, upper abdominal pain, scleral ichter, and abdominal distention developed. The patient had abdominal tenderness with guarding. The laboratory tests revealed an amylase level of 1740 U/L (28-100), lipase level of 583 U/L (13-60), and total bilirubin level of 3.75 mg/dL (<0.3). The diagnosis of acute pancreatitis was confirmed with radiological findings. Until now, atypical presentations of CCHF have been reported in some case reports, but not acute pancreatitis. To the best of our knowledge, this is the first case of acute pancreatitis in the literature seen in the course of CCHF.

The momentary relationship between stress and headaches in adolescent girls.

PubMed

Björling, Elin A

2009-09-01

The objective of this study was to compare the relationship between repeated momentary reports of stress and headaches in female adolescents with varying degrees of headache frequency. Headaches are the most common form of pain reported by adolescents affecting more than a third of all adolescents. High levels of stress during adolescence may predispose an adolescent to experience headaches in adulthood. Randomized, momentary data collection of stress and headaches provides the most accurate data regarding the adolescent experience of these variables. The research methodology, ecological momentary assessment, is a valid approach to better understand the relationship between stress and headaches in adolescence. Data were obtained by each participant's use of an electronic diary (ED), which captured repeated momentary reports of perceived stress, head pain, and stress-related symptoms in female adolescents with varying degrees of recurrent headache. Seven times per day for the 21-day study period, teen girls responded to ED questions about their current stress levels, head pain, and stress-related symptoms. Based on participants' momentary reports of headaches, Low Headache, Moderate Headache, and Chronic Headache groups were created. General estimating equation models were used to analyze the relationship between momentary variables as well as the lag effect between stress and head pain. Thirty-one participants, aged 14-18 years, completed 2841 randomized ED reports and reported 674 occurrences of headache. The Chronic Headache and Moderate Headache groups reported significantly increased levels of stress, head pain, and headaches. The relationship between momentary stress and head pain was significantly strong both within and across participants. The strength of this relationship increased with increased headache activity. A significant lag effect was found between stress and headaches; however, the effect of depression as a moderator of the stress and headache relationship remains unclear. Perceived stress and head pain was highly correlated in these female adolescents. Given the large population of teens affected by headaches, a plausible next step would be to validate these results in other samples and to determine methods with which to identify teens who may be at risk for a pattern of increasing stress and headaches.

Use of a fixed combination of acetylsalicylic acid, acetaminophen and caffeine compared with acetaminophen alone in episodic tension-type headache: meta-analysis of four randomized, double-blind, placebo-controlled, crossover studies.

PubMed

Diener, Hans-Christoph; Gold, Morris; Hagen, Martina

2014-11-19

Most patients with episodic tension-type headache treat headache episodes with over-the-counter medication. Combination analgesics containing caffeine may be more effective and as well tolerated as monotherapy. The aim of this study was to evaluate the efficacy of the combination of acetylsalicylic acid, acetaminophen (paracetamol) and caffeine in episodic tension-type headache using recently recommended endpoints. Four randomized, controlled trials of identical design in 1,900 patients with episodic tension-type headache comparing acetylsalicylic acid, acetaminophen and caffeine vs. acetaminophen or placebo were pooled. Analysis populations were 'all headache episodes' and those with 'severe pain at baseline'. Post-hoc defined primary endpoint: headache episodes pain-free at 2 h. Secondary endpoints: headache episodes pain-free at 1 h, headache response at 2 h (mild or no pain), degree of interference with daily activities. 6,861 headache episodes were treated, including 2,215 severe headache episodes. The proportion of headache episodes pain-free at 2 h was significantly higher with the triple combination (28.5%) vs. acetaminophen (21.0%) and placebo (18.0%) (p < 0.0001), and similarly for those severe at baseline (20.2% vs. 12.1% and 10.8%; p ≤ 0.0003). A similar pattern of superiority was observed for secondary endpoints. The triple combination was generally well tolerated. The combination of acetylsalicylic acid, acetaminophen and caffeine is effective and well tolerated in episodic tension-type headache, and significantly superior to acetaminophen with regard to being pain-free at 2 h, headache response at 2 h and ability to return to daily activities, even in those with pain rated severe at baseline.

Retrospective outcome analyses for headaches in a pain rehabilitation interdisciplinary program.

PubMed

Zheng, Yuxi; Tepper, Stewart J; Covington, Edward C; Mathews, Manu; Scheman, Judith

2014-03-01

Incapacitating chronic migraine and other severe headaches can have significant impact on peoples' lives, including family and occupational functioning. Although a number of reports have investigated the prevalence and medical treatment of chronic headache, few have reported on the efficacy of treating these disorders within a comprehensive, intensive chronic pain rehabilitation program (CPRP), instead of a headache-specific program. CPRPs provide treatment of headache by focusing not only on physical pain, but also its association with impaired mood and function. We examined the efficacy of CPRP in patients with chronic headache via a retrospective analysis of 123 patients (76.4% female), ages 21 to 85, who completed the CPRP at the Cleveland Clinic between January 2007 and December 2011, and were diagnosed using International Classification of Headache Disorders, 2nd edition and International Classification of Headache Disorders, 2nd edition revision, with migraine or headache as a major complaint. Outcome measures included: pain intensity scores present at the moment of questioning where 10 is the maximal (0-10/10), Depression Anxiety Stress Scale (DASS) scores, (measuring mood), and Pain Disability Index scores (measuring function). Repeated measures t-tests were used. Average pain score on admission was 6.4, and 3.4 upon discharge. Average function on admission was moderately impaired, and normalized on discharge. The average depression score was in the moderate range, and had normalized on discharge. The average anxiety score on admission was in the severe range and was in the mild range on discharge. Results indicate that individuals had statistically and clinically meaningful improvement in pain, mood, and function. Data suggest that an interdisciplinary CPRP approach for patients diagnosed with headache can be effective in helping to decrease pain, as well as normalize mood and function. Thus, CPRPs serve as an alternative treatment to multidisciplinary headache programs, interventional pain techniques, and primary care standard headache care. © 2013 American Headache Society.

Nummular headache: diagnosis and treatment.

PubMed

Pareja, Juan A; Pareja, Julia

2003-05-01

Nummular headache (coin-shaped cephalgia) has an unusual distinct feature: it is characterized by mild-to-moderate pressure-like pain exclusively felt in a rounded or elliptical area typically 2-6 cm in diameter. Although any region of the head may be affected, the parietal area is the common localization of nummular headache. The pain remains confined to the same symptomatic area which does not change in shape or size with time. The pain is continuous but lancinating exacerbations lasting for several seconds or gradually increasing from 10 mins to 2 h may superimpose the baseline pain. The temporal pattern is either chronic or remitting. Pseudoremissions may be observed when the pain reaches a very low grade or only discomfort (not pain) in the affected area is reported. At times, discomfort may prevail. Either during symptomatic periods or interictally, the affected area may show a variable combination of hypoethesia, dysesthesia, paresthesia or tenderness. Physical and supplementary examinations are normal. Nummular headache emerges as a primary clear-cut clinical picture. The particular topography and signs of sensory dysfunction make it reasonable to vent the idea that nummular headache is an extracranial headache, probably stemming from epicranial tissues such as terminal branches of sensitive nerves. Nummular headache may seem to be the paradigm of epicranias (group of headaches and pericranial neuralgias stemming from epicranial tissues). Nummular headache must be distinguished from head pain secondary to local processes and from tender points of more extensive headaches. Although nummular headache may frequently coexist with other primary headaches, it has an independent course. Treatment is seldom necessary and in most cases simple reassurance is sufficient.

School Nurses on the Front Lines of Medicine: Connecting the Dots: SCRIPTS for Success in the Evaluation of Pediatric Rashes.

PubMed

Olympia, Robert P

2017-05-01

Although skin rashes may not necessarily prompt a visit to the school nurse's office, a rash associated with other systemic symptoms, such as fever, headache, difficulty swallowing or breathing, weakness, or abdominal pain, may cause a child to visit your office. This article describes the initial assessment and management of skin rashes in children and adolescents and delineates reasons that may prompt the school nurse to transfer a student with a rash to a local emergency department.

Multimodal Physiotherapy Based on a Biobehavioral Approach as a Treatment for Chronic Tension-Type Headache: A Case Report.

PubMed

Beltran-Alacreu, Hector; Lopez-de-Uralde-Villanueva, Ibai; La Touche, Roy

2015-12-01

Tension-type headache (TTH) is the most common primary headache affecting the general population, which is characterized by bilateral headache and mild to moderate pain. This disorder causes high levels of disability and recent scientific evidence suggests that manual therapy (MT) and therapeutic exercise are effective in reducing medication intake and decreasing the frequency and intensity of headaches in patients with TTH. A 34-year-old woman was known to have chronic TTH. Initially, the patient presented moderate headaches 5 days per week, mechanical neck pain and no positive response to analgesics. A battery of self-reports was given to the patient to assess disability (using the Spanish versions of the Headache Impact Test-6 and the neck disability index), pain (visual analogue scale) and psychosocial issues (Spanish version of the pain catastrophizing scale) involved in the headaches. All measurements were taken four times during 161 days. Eleven sessions of treatment including MT, motor control therapeutic exercise (MCTE) and therapeutic patient education (TPE) were applied. This biobehavioral-based multimodal physical rehabilitation treatment combining MT, TPE and MCTE produced a substantial reduction in pain intensity, pain catastrophizing, disability and the impact of headaches on patient's life.

Adult Sinusitis

MedlinePlus

... is a common term, but can be misleading. Facial pain/pressure or headache that occurs without nasal congestion ... sinusitis. There are many causes of headaches and facial pain. These include migraine headaches, tension headaches, temporomandibular joint ( ...

Fabry disease in children: agalsidase-beta enzyme replacement therapy.

PubMed

Borgwardt, L; Feldt-Rasmussen, U; Rasmussen, A K; Ballegaard, M; Meldgaard Lund, A

2013-05-01

Fabry disease is a rare, multiorgan disease. The most serious complications involve the kidney, brain and heart. This study aims to assess the effect of enzyme replacement therapy (ERT) using agalsidase-beta in children with Fabry disease. We carried out a nationwide, descriptive and observational retrospective cohort study of 10 children (9-16 years at baseline), who underwent regular systematic investigations for 1-8 years after initiation of ERT with agalsidase-beta (Fabryzyme®, Genzyme). Ophthalmological, echocardiographic abnormalities and hypohidrosis were found at baseline and during the follow-up period. Serious kidney, heart or brain involvement had not developed at the last follow-up examination. For the majority of the patients improvements were found concerning headache, acroparaesthesias and gastrointestinal pain during the follow-up period. The level of energy and physical activity also increased. Treatment with agalsidase-beta was associated with a reduction of neuropathic and abdominal pain and headache. Although all aspects of the Fabry pain phenotype cannot be treated with ERT, the observed effects were clinically significant in the lives of the majority of Fabry children and together with the absence of serious Fabry manifestations at last follow-up, we argue that early initiation of ERT may be considered. © 2012 John Wiley & Sons A/S.

The Relaxation Response Resiliency Program (3RP) in Patients with Headache and Musculoskeletal Pain: A Retrospective Analysis of Clinical Data.

PubMed

Gonzalez, Adam; Shim, Minjung; Mahaffey, Brittain; Vranceanu, Ana-Maria; Reffi, Anthony; Park, Elyse R

2018-05-14

Headache and musculoskeletal pain are associated with both physical and mental health symptoms, which together are mutually reinforcing. Addressing mental and physical health symptoms (including pain) concomitantly may provide an effective and efficient way to improve outcomes in this population. We tested an evidence-based, eight-session multimodal group program, the Relaxation Response Resiliency Program (3RP), in patients with headache and musculoskeletal pain. A total of 109 adults (30 with headaches, 79 with musculoskeletal pain). Participant were 109 adults (30 with headaches, 79 with musculoskeletal pain) referred by their medical doctor, who completed a battery of questionnaires before and after completion of the 3RP. On average, patients with headache and musculoskeletal pain had higher pretreatment scores for anxiety, depression, and somatization symptoms than the nonpatient normative sample for the Symptom Checklist 90-Revised. Significant improvements were identified from pre- to post-treatment in all mental health symptoms (moderate to large effects) and frequency of pain and co-occurring physical health symptoms (small to moderate effects). Patients also reported significant decreases in degree of discomfort and life interference, which were relatively more modest in the musculoskeletal pain group compared with the headache group. Overall, results of this study suggest that the 3RP may be an effective treatment for reducing pain and psychological symptoms in patients with headaches and musculoskeletal pain. Future work is needed to evaluate the 3RP via a randomized clinical trial in these patient populations. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Rift Valley fever: the Nigerian story.

PubMed

Adeyeye, Adewale A; Ekong, Pius S; Pilau, Nicholas N

2011-01-01

Rift Valley fever (RVF) is an arthropod-borne zoonotic disease of livestock. It is characterised by fever, salivation, abdominal pain, diarrhoea, mucopurulent to bloody nasal discharge, abortion, rapid decrease in milk production and death in animals. Infected humans experience an influenza-like illness that is characterised by fever, malaise, headaches, nausea and epigastric pain followed by recovery, although mortality can occur. RVF was thought to be a disease of sub-Saharan Africa but with the outbreaks in Egypt and the Arabian Peninsula, it may be extending its range further afield. Virological and serological evidence indicates that the virus exists in Nigeria and, with the warning signal sent by international organisations to countries in Africa about an impending outbreak, co-ordinated research between veterinarians and physicians in Nigeria is advocated.

Probable chronic renal failure caused by Lonomia caterpillar envenomation

PubMed Central

2013-01-01

Erucism is a skin reaction to envenomation from certain poisonous caterpillar bristles. In Brazil, most reports of erucism provoked by Lonomia caterpillars are from the southern region. Most manifestations of erucism are local and include burning pain, itching, local hyperthermia and, rarely, blisters (benign symptoms with spontaneous regression in a few hours). General symptoms such as nausea and vomiting, headache, fever, myalgia, abdominal pain and conjunctivitis may also occur. Uncommon symptoms include arthritis, coagulation disorders (manifested as bruising and bleeding), intracerebral hemorrhage and acute renal failure, which comprise serious complications. The present study reports the case of 60-year-old patient from Rio de Janeiro state, Brazil, who came into contact with a caterpillar and developed, a few days later, chronic renal disease. PMID:23849585

Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache.

PubMed

Silva, Ariovaldo Alberto da; Brandão, Karina Viana; Faleiros, Bruno Engler; Tavares, Rafael Mattos; Lara, Rodrigo Pinto; Januzzi, Eduardo; Carvalho, Anísio Bueno de; Carvalho, Eliane Maria Duarte de; Gomes, João Bosco Lima; Leite, Frederico Mota Gonçalves; Alves, Betania Mara Franco; Gómez, Rodrigo Santiago; Teixeira, Antônio Lúcio

2014-02-01

Clinical differentiation between the primary headaches and temporomandibular disorders (TMD) can be challenging. To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001). Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001). TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.

Temporomandibular Disorders and Headache: A Retrospective Analysis of 1198 Patients

PubMed Central

Di Paolo, Carlo; D'Urso, Anna; Di Sabato, Francesco; Pompa, Giorgio

2017-01-01

Aim. Headache is one of the most common diseases associated with Temporomandibular Disorders (TMDs). The aim of this study was to evaluate, retrospectively, if headache influences TMD's symptoms. Material and Methods. A total sample of 1198 consecutive TMD patients was selected. After a neurological examination, a diagnosis of headache, according to the latest edition of the International Classification of Headache Disorders, was performed in 625 subjects. Patients were divided into two groups based on presence/absence of headache: Group with Headache (GwH) and Group without Headache (GwoH). Descriptive statistics and Chi-square index were performed. Results. Sociodemographic (gender, marital status, and occupation) and functional factors, occlusion (occlusal and skeletal classes, dental formula, and occlusal abnormalities), and familiar pain did not show a statistically significant correlation in either group. Intensity and frequency of neck pain, arthralgia of TMJ, and myalgia showed higher correlation values in GwH. Conclusion. This study is consistent with previous literature in showing a close relationship between headache and TMD. All data underlines that headache makes pain parameters more intense and frequent. Therefore, an early and multidisciplinary treatment of TMDs should be performed in order to avoid the overlay of painful events that could result in pain chronicity. PMID:28420942

Changes Over Time of Prescription and Nonprescription Analgesics for Headache With or Without Other Somatic Pain: Effects of Prescription Regulatory Changes.

PubMed

Halvorsen, Marianne Moe; Clench-Aas, Jocelyne; Patil, Grete; Lundqvist, Christofer

2016-07-01

The aim of this study was to examine the association and changes over time between headaches with or without somatic pain and the self-reported use of pain medication. The study further examined whether the law amendment in 2003 in Norway releasing the sale of nonprescription drugs to shops has changed these relationships. The study is on the basis of repeated self-report cross-sectional studies from 1998 to 2012 in Norway. A total of 27,247 adults were included. As expected, there was a strong association between headache, especially headache with comorbid somatic pain and consumption of prescription versus nonprescription analgesics, although the overall consumption decreased slightly after 2003. We conclude that the strong association between especially headache, whether complicated by somatic pain or not, and the consumption of prescription-free analgesics did not seem to be negatively affected by the prescription regulatory changes. The very high use of nonprescription medication among headache patients suggests the need for continued observation and information regarding the risk of medication-overuse headache. In Norway, headache was strongly associated with use of over-the-counter analgesics, for other somatic pain prescription analgesics were equally common. Between 1998 and 2012 headache and related analgesic consumption was reduced and other somatic pain increased. Making over-the-counter analgesics available outside pharmacies in 2003 did not increase the self-reported intake. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Sleep disorders and chronic craniofacial pain: Characteristics and management possibilities.

PubMed

Almoznino, Galit; Benoliel, Rafael; Sharav, Yair; Haviv, Yaron

2017-06-01

Chronic craniofacial pain involves the head, face and oral cavity and is associated with significant morbidity and high levels of health care utilization. A bidirectional relationship is suggested in the literature for poor sleep and pain, and craniofacial pain and sleep are reciprocally related. We review this relationship and discuss management options. Part I reviews the relationship between pain and sleep disorders in the context of four diagnostic categories of chronic craniofacial pain: 1) primary headaches: migraines, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs) and hypnic headache, 2) secondary headaches: sleep apnea headache, 3) temporomandibular joint disorders (TMD) and 4) painful cranial neuropathies: trigeminal neuralgia, post-herpetic trigeminal neuropathy, painful post-traumatic trigeminal neuropathy (PTTN) and burning mouth syndrome (BMS). Part II discusses the management of patients with chronic craniofacial pain and sleep disorders addressing the factors that modulate the pain experience as well as sleep disorders and including both non-pharmacological and pharmacological modalities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Recurrent neck pain and headaches in preadolescents associated with mechanical dysfunction of the cervical spine: a cross-sectional observational study with 131 students.

PubMed

Weber Hellstenius, Sue A

2009-10-01

To identify if there were differences in the cervical biomechanics in preadolescents who had recurrent neck pain and/or headaches and those who did not. A controlled comparison study with a convenience sample of 131 students (10-13 years old) was performed. A questionnaire placed students in the no pain group or in the neck pain/headache group. A physical examination was performed by a doctor of chiropractic to establish head posture, active cervical rotation, passive cervical joint functioning, and muscle impairment. The unpaired t test and the chi(2) test were used to test for differences between the 2 groups, and data were analyzed using SPSS 15 (SPSS Inc, Chicago, Ill). Forty percent of the children (n = 52) reported neck pain and/or recurrent headache. Neck pain and/or headache were not associated with forward head posture, impaired functioning in cervical paraspinal muscles, and joint dysfunction in the upper and middle cervical spine in these subjects. However, joint dysfunction in the lower cervical spine was significantly associated with neck pain and/or headache in these preadolescents. Most of the students had nonsymptomatic biomechanical dysfunction of the upper cervical spine. There was a wide variation between parental report and the child's self-report of trauma history and neck pain and/or headache prevalence. In this study, the physical examination findings between preadolescents with neck pain and/or headaches and those who were symptom free differed significantly in one of the parameters measured. Cervical joint dysfunction was a significant finding among those preadolescents complaining of neck pain and/or headache as compared to those who did not.

Armored brain: A case report and review of the literature.

PubMed

Petraglia, Anthony L; Moravan, Michael J; Jahromi, Babak S

2011-01-01

Calcified chronic subdural hematomas occur infrequently. When the calcifications are extensive and bilateral, the condition is termed "armored brain". We describe a case of "armored brain" incidentally discovered in an adult presenting with abdominal pain and mild headaches, long after initial placement of a ventriculo-peritoneal (VP) shunt. A 38-year-old woman, treated at infancy with a VP shunt, presented with a 2-month history of abdominal pain associated with nausea and chills. She was neurologically intact on exam. An abdominal computed tomography (CT) scan demonstrated a rim-enhancing loculated fluid collection surrounding the patient's distal VP shunt catheter tip. As a part of her initial work-up, she received a head CT to evaluate the proximal VP shunt, which demonstrated large bilateral chronic subdural hematomas with heavily calcified walls. She was eventually taken to the operating room (OR) for replacement of the distal catheter. It was felt that her acute clinical presentation was unrelated to the bilateral, calcified subdural hematomas and thus the decision was made to manage them conservatively. This rare complication of chronic shunting for hydrocephalus is sometimes referred to as armored brain. Surgery for armored brain is infrequently indicated and beneficial in only small subgroup of patients, with management guided by clinical presentation. Our patient fully recovered after shunt revision alone.

Headaches after traumatic spinal cord injury in Estonia.

PubMed

Sabre, Liis; Rugo, Mariann; Asser, Toomas; Kõrv, Janika; Braschinsky, Mark

2016-04-01

Patients with traumatic spinal cord injury (TSCI) often suffer from different types of pain. However, headaches after TSCI have not been studied. The aim of this article is to examine the occurrence of headache among patients with TSCI. This cross-sectional study included individuals with TSCI from 1997 to 2012 in Estonia. Patients with TSCI were interviewed via telephone. The interview was based on a questionnaire specifically designed to identify headache type using the International Classification of Headache Disorders, third edition (beta version). There were 73 patients with a mean age 37.1 ± 10.6 years. The mean time since TSCI was 7.5 ± 4.0 years. The most frequently mentioned pain was headache (71%), followed by back pain (60%) and pain in neck (44%).Headaches were more frequent after the trauma compared with the headaches before TSCI (71% vs 51%, ITALIC! p = 0.02). Headaches that arose after TSCI were not related to the concomitant brain injury ( ITALIC! p = 0.15). The occurrence of headache did not depend on the severity or the level of the TSCI.Eighty-five percent of patients had not contacted any physician and headache was not diagnosed. This is the first study that evidentially shows that headache is the most prevalent pain condition after TSCI. Despite this, the majority of patients never consult a physician, nor is their headache diagnosed or appropriately managed. This indicates that further studies are needed to provide evidence regarding the prevalence and causes of headache and its impact on quality of life. © International Headache Society 2015.

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints.

PubMed

Friedrichsdorf, Stefan J; Giordano, James; Desai Dakoji, Kavita; Warmuth, Andrew; Daughtry, Cyndee; Schulz, Craig A

2016-12-10

Primary pain disorders (formerly "functional pain syndromes") are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition "chronic-on-acute pain." We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

Prevalence of neck pain and headaches: impact of computer use and other associative factors.

PubMed

Smith, L; Louw, Q; Crous, L; Grimmer-Somers, K

2009-02-01

Headaches and neck pain are reported to be among the most prevalent musculoskeletal complaints in the general population. A significant body of research has reported a high prevalence of headaches and neck pain among adolescents. Sitting for lengthy periods in fixed postures such as at computer terminals may result in adolescent neck pain and headaches. The aim of this paper was to report the association between computer use (exposure) and headaches and neck pain (outcome) among adolescent school students in a developing country. A cross-sectional study was conducted and comprehensive description of the data collection instrument was used to collect the data from 1073 high-school students. Headaches were associated with high psychosocial scores and were more common among girls. We found a concerning association between neck pain and high hours of computing for school students, and have confirmed the need to educate new computer users (school students) about appropriate ergonomics and postural health.

The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache.

PubMed

Day, Melissa A; Thorn, Beverly E

2016-04-01

This study aimed to determine if mindfulness-based cognitive therapy (MBCT) engenders improvement in headache outcomes via the mechanisms specified by theory: (1) change in psychological process, (i.e., pain acceptance); and concurrently (2) change in cognitive content, (i.e., pain catastrophizing; headache management self-efficacy). A secondary analysis of a randomized controlled trial comparing MBCT to a medical treatment as usual, delayed treatment (DT) control was conducted. Participants were individuals with headache pain who completed MBCT or DT (N=24) at the Kilgo Headache Clinic or psychology clinic. Standardized measures of the primary outcome (pain interference) and proposed mediators were administered at pre- and post-treatment; change scores were calculated. Bootstrap mediation models were conducted. Pain acceptance emerged as a significant mediator of the group-interference relation (p<.05). Mediation models examining acceptance subscales showed nuances in this effect, with activity engagement emerging as a significant mediator (p<.05), but pain willingness not meeting criteria for mediation due to a non-significant pathway from the mediator to outcome. Criteria for mediation was also not met for the catastrophizing or self-efficacy models as neither of these variables significantly predicted pain interference. Pain acceptance, and specifically engagement in valued activities despite pain, may be a key mechanism underlying improvement in pain outcome during a MBCT for headache pain intervention. The theorized mediating role of cognitive content factors was not supported in this preliminary study. A large, definitive trial is warranted to replicate and extend the findings in order to streamline and optimize MBCT for headache. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Association Between Headaches and Temporomandibular Disorders is Confounded by Bruxism and Somatic Symptoms.

PubMed

van der Meer, Hedwig A; Speksnijder, Caroline M; Engelbert, Raoul H H; Lobbezoo, Frank; Nijhuis-van der Sanden, Maria W G; Visscher, Corine M

2017-09-01

The objective of this observational study was to establish the possible presence of confounders on the association between temporomandibular disorders (TMD) and headaches in a patient population from a TMD and Orofacial Pain Clinic. Several subtypes of headaches have been diagnosed: self-reported headache, (probable) migraine, (probable) tension-type headache, and secondary headache attributed to TMD. The presence of TMD was subdivided into 2 subtypes: painful TMD and function-related TMD. The associations between the subtypes of TMD and headaches were evaluated by single regression models. To study the influence of possible confounding factors on this association, the regression models were extended with age, sex, bruxism, stress, depression, and somatic symptoms. Of the included patients (n=203), 67.5% experienced headaches. In the subsample of patients with a painful TMD (n=58), the prevalence of self-reported headaches increased to 82.8%. The associations found between self-reported headache and (1) painful TMD and (2) function-related TMD were confounded by the presence of somatic symptoms. For probable migraine, both somatic symptoms and bruxism confounded the initial association found with painful TMD. The findings of this study imply that there is a central working mechanism overlapping TMD and headache. Health care providers should not regard these disorders separately, but rather look at the bigger picture to appreciate the complex nature of the diagnostic and therapeutic process.

Occlusal stabilization splint therapy in orofacial pain and tension-type headache.

PubMed

Kostrzewa-Janicka, J; Mierzwinska-Nastalska, E; Rolski, D; Szczyrek, P

2013-01-01

Studies suggest an association between orofacial pain, accompanying temporomandibular disorders of myogenous origin, and headache, especially its tension-type. The occlusal appliance therapy is one of the options for the treatment of orofacial pain due to masticatory muscles tenderness. The aim of the present study was to assess the effectiveness of occlusal stabilization splint therapy in myofascial pain and tension-type headache in patients with sleep-disordered breathing. Forty three such patients were enrolled into the study group. The patients were treated with stabilization occlusal splint of vertical thickness at vertical jaw separation, established individually for each patient using a cephalometric analysis. The intensity of orofacial pain (numeric rating scale) and headache (analog rating scale), frequency of headache (%), and jaw qualitative function were assessed at baseline and after 2 and 6 months. Medians of headache and orofacial pain intensity were reduced after 6 months of treatment compared with baseline: 6.0 vs. 2.0 (p < 0.0001) and 6.0 vs. 1.0 (p < 0.0001), respectively. Pain decreased below 3 score points in 61.8 % of the patients with headache (p = 0.23) and in 85.3 % of patients with orofacial pain (p < 0.0001). Overall, the improvement in both signs and symptoms of orofacial pain was observed 81.4 % of patients after using occlusal stabilization splint for 6 months. We conclude that occlusal stabilization splint was effective in reducing painful symptoms of temporomandibular disorders of myogenous origin, a frequent feature of sleep disordered breathing.

Pheochromocytoma with inferior vena cava thrombosis: An unusual association.

PubMed

Kota, Sunil K; Kota, Siva K; Jammula, Sruti; Meher, Lalit K; Modi, Kirtikumar D

2012-04-01

Pheochromocytomas have been described in association with vascular abnormalities like renal artery stenosis. A 48-year-old man was admitted to our hospital with the complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and hypertension. For last several days, he was having a dull aching abdominal pain. Abdominal computed tomography (CT) revealed the presence of a left adrenal pheochromocytoma. An inferior vena cava (IVC) venogram via the right jugular vein demonstrated occlusion of the IVC inferior to the right atrium. Surgical removal of pheochromocytoma was done, followed by anticoagulant treatment for IVC thrombosis, initially with subcutaneous low molecular weight heparin, and then with oral warfarin, resulting in restoration of patency. To the best of our knowledge, the occurrence of pheochromocytoma in IVC thrombosis has not been reported so far from India. Possible mechanisms of such an involvement are discussed.

Evaluation of Women with Myofascial Abdominal Syndrome Based on Traditional Chinese Medicine

PubMed Central

Mitidieri, Andréia; Gurian, Maria Beatriz; Silva, Ana Paula; Tawasha, Kalil; Poli-Neto, Omero; Nogueira, Antônio; Reis, Francisco; Rosa-e-Silva, Júlio

2015-01-01

Objectives: This study used semiology based on traditional Chinese medicine (TCM) to investigate vital energy (Qi) behavior in women with abdominal myofascial pain syndrome (AMPS). Methods: Fifty women diagnosed with chronic pelvic pain (CPP) secondary to AMPS were evaluated by using a questionnaire based on the theories of “yin-yang,” “zang-fu”, and “five elements”. We assessed the following aspects of the illness: symptomatology; specific location of myofascial trigger points (MTrPs); onset, cause, duration and frequency of symptoms; and patient and family history. The patients tongues, lips, skin colors, and tones of speech were examined. Patients were questioned on various aspects related to breathing, sweating, sleep quality, emotions, and preferences related to color, food, flavors, and weather or seasons. Thirst, gastrointestinal dysfunction, excreta (feces and urine), menstrual cycle, the five senses, and characteristic pain symptoms related to headache, musculoskeletal pain, abdomen, and chest were also investigated. Results: Patients were between 22 and 56 years old, and most were married (78%), possessed a elementary school (66%), and had one or two children (76%). The mean body mass index and body fat were 26.86 kg/ cm2 (range: 17.7 — 39.0) and 32.4% (range: 10.7 — 45.7), respectively. A large majority of women (96%) exhibited alterations in the kidney meridian, and 98% had an altered gallbladder meridian. We observed major changes in the kidney and the gallbladder Qi meridians in 76% and 62% of patients, respectively. Five of the twelve meridians analyzed exhibited Qi patterns similar to pelvic innervation Qi and meridians, indicating that the paths of some of these meridians were directly related to innervation of the pelvic floor and abdominal region. Conclusion: The women in this study showed changes in the behavior of the energy meridians, and the paths of some of the meridians were directly related to innervation of the pelvic floor and abdominal region. PMID:26998387

Evaluation of Women with Myofascial Abdominal Syndrome Based on Traditional Chinese Medicine.

PubMed

Mitidieri, Andréia; Gurian, Maria Beatriz; Silva, Ana Paula; Tawasha, Kalil; Poli-Neto, Omero; Nogueira, Antônio; Reis, Francisco; Rosa-E-Silva, Júlio

2015-12-01

This study used semiology based on traditional Chinese medicine (TCM) to investigate vital energy (Qi) behavior in women with abdominal myofascial pain syndrome (AMPS). Fifty women diagnosed with chronic pelvic pain (CPP) secondary to AMPS were evaluated by using a questionnaire based on the theories of "yin-yang," "zang-fu", and "five elements". We assessed the following aspects of the illness: symptomatology; specific location of myofascial trigger points (MTrPs); onset, cause, duration and frequency of symptoms; and patient and family history. The patients tongues, lips, skin colors, and tones of speech were examined. Patients were questioned on various aspects related to breathing, sweating, sleep quality, emotions, and preferences related to color, food, flavors, and weather or seasons. Thirst, gastrointestinal dysfunction, excreta (feces and urine), menstrual cycle, the five senses, and characteristic pain symptoms related to headache, musculoskeletal pain, abdomen, and chest were also investigated. Patients were between 22 and 56 years old, and most were married (78%), possessed a elementary school (66%), and had one or two children (76%). The mean body mass index and body fat were 26.86 kg/ cm2 (range: 17.7 - 39.0) and 32.4% (range: 10.7 - 45.7), respectively. A large majority of women (96%) exhibited alterations in the kidney meridian, and 98% had an altered gallbladder meridian. We observed major changes in the kidney and the gallbladder Qi meridians in 76% and 62% of patients, respectively. Five of the twelve meridians analyzed exhibited Qi patterns similar to pelvic innervation Qi and meridians, indicating that the paths of some of these meridians were directly related to innervation of the pelvic floor and abdominal region. The women in this study showed changes in the behavior of the energy meridians, and the paths of some of the meridians were directly related to innervation of the pelvic floor and abdominal region.

"Headache Tools to Stay in School": Assessment, Development, and Implementation of an Educational Guide for School Nurses

ERIC Educational Resources Information Center

Lazdowsky, Lori; Rabner, Jonathan; Caruso, Alessandra; Kaczynski, Karen; Gottlieb, Sarah; Mahoney, Elyse; LeBel, Alyssa

2016-01-01

Background: Headache is the most common type of pain reported in the pediatric population, and chronic headache is an increasingly prevalent and debilitating pain condition in children and adolescents. With large numbers of students experiencing acute headaches and more students with chronic headache reentering typical school settings, greater…

Sleep apnoea and chronic headache.

PubMed

Sand, T; Hagen, K; Schrader, H

2003-03-01

The objective of this study was to estimate prevalence of headache and body pain among patients referred for suspected sleep apnoea syndrome compared with the occurrence in a large population-based study (the Nord-Trøndelag Health Study). Between 1995 and 1998, ambulatory polysomnography was successfully performed in 421 consecutive patients, 324 of whom completed a questionnaire about sleep-related habits, headache and body pain. Headache and neck pain were more likely among patients admitted for polysomnography compared with the general population (n = 41 340). In the multivariate analyses, this association was mainly restricted to those with frequent complaints (> or =7 days per month). Chronic headache (headache > or = 15 days per month) was seven times more common among individuals with and without confirmed obstructive sleep apnoea syndrome than in the general population. There was no linear dose-response relationship between headache and neck pain and severity of apnoea or oxygen desaturation. Thus, hypoxia per se is less likely to explain the high headache prevalence among patients admitted for polysomnography.

Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: A randomized, placebo-controlled clinical trial

PubMed Central

Moraska, Albert F.; Stenerson, Lea; Butryn, Nathan; Krutsch, Jason P.; Schmiege, Sarah J.; Mann, J. Douglas

2014-01-01

Objective Myofascial trigger points (MTrPs) are focal disruptions in skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type headache (TTH). The present study applied massage focused on MTrPs of subjects with TTH in a placebo-controlled, clinical trial to assess efficacy on reducing headache pain. Methods Fifty-six subjects with TTH were randomized to receive 12 massage or placebo (detuned ultrasound) sessions over six weeks, or to wait-list. Trigger point release (TPR) massage focused on MTrPs in cervical musculature. Headache pain (frequency, intensity and duration) was recorded in a daily headache diary. Additional outcome measures included self-report of perceived clinical change in headache pain and pressure-pain threshold (PPT) at MTrPs in the upper trapezius and sub-occipital muscles. Results From diary recordings, group differences across time were detected in headache frequency (p=0.026), but not for intensity or duration. Post hoc analysis indicated headache frequency decreased from baseline for both massage (p<0.0003) and placebo (p=0.013), but no difference was detected between massage and placebo. Subject report of perceived clinical change was a greater reduction in headache pain for massage than placebo or wait-list groups (p=0.002). PPT improved in all muscles tested for massage only (all p's<0.002). Discussion Two findings from this study are apparent: 1) MTrPs are important components in the treatment of TTH, and 2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on headache that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention. PMID:25329141

Clinical characteristics of pain in patients with pituitary adenomas.

PubMed

Dimopoulou, C; Athanasoulia, A P; Hanisch, E; Held, S; Sprenger, T; Toelle, T R; Roemmler-Zehrer, J; Schopohl, J; Stalla, G K; Sievers, C

2014-11-01

Clinical presentation of pituitary adenomas frequently involves pain, particularly headache, due to structural and functional properties of the tumour. Our aim was to investigate the clinical characteristics of pain in a large cohort of patients with pituitary disease. In a cross-sectional study, we assessed 278 patients with pituitary disease (n=81 acromegaly; n=45 Cushing's disease; n=92 prolactinoma; n=60 non-functioning pituitary adenoma). Pain was studied using validated questionnaires to screen for nociceptive vs neuropathic pain components (painDETECT), determine pain severity, quality, duration and location (German pain questionnaire) and to assess the impact of pain on disability (migraine disability assessment, MIDAS) and quality of life (QoL). We recorded a high prevalence of bodily pain (n=180, 65%) and headache (n=178, 64%); adrenocorticotropic adenomas were most frequently associated with pain (n=34, 76%). Headache was equally frequent in patients with macro- and microadenomas (68 vs 60%; P=0.266). According to painDETECT, the majority of the patients had a nociceptive pain component (n=193, 80%). Despite high prevalence of headache, 72% reported little or no headache-related disability (MIDAS). Modifiable factors including tumour size, genetic predisposition, previous surgery, irradiation or medical therapy did not have significant impact neither on neuropathic pain components (painDETECT) nor on headache-related disability (MIDAS). Neuropathic pain and pain-related disability correlated significantly with depression and impaired QoL. Pain appears to be a frequent problem in pituitary disease. The data suggest that pain should be integrated in the diagnostic and therapeutic work-up of patients with pituitary disease in order to treat them appropriately and improve their QoL. © 2014 European Society of Endocrinology.

Unspecific clinical manifestation of cauda equina myxopapillary ependymoma

PubMed Central

Kariev, Gayrat Maratovich; Halikulov, Elbek Shodievich; Rasulov, Shavkat Orzikuloviich

2015-01-01

A 9-year-old boy admitted to the neurosurgical hospital complaining of headache, vomiting, abdominal pain, and weakness in the arms and legs, urinary retention. Previously, the patient had a treatment of pediatricians. He was examined, magnetic resonance imaging revealed the tumor of the conus medullaris and cauda equina. The surgery was performed with removal myxopapillary ependymoma (ME). Postoperative neurological symptoms regressed; he has received radiotherapy postoperatively. This case illustrates a rare clinical presentation of ME, which simulated intracranial, thoracic, and caudal pathology. We presented features of the clinical presentation, diagnostics, and treatment options of this ependymoma. PMID:26396623

Pharmacokinetics of Understudied Drugs Administered to Children Per Standard of Care

ClinicalTrials.gov

2018-04-02

Adenovirus; Anesthesia; Anxiety; Anxiolysis; Autism; Autistic Disorder; Bacterial Meningitis; Bacterial Septicemia; Benzodiazepine; Bipolar Disorder; Bone and Joint Infections; Central Nervous System Infections; Convulsions; Cytomegalovirus Retinitis; Early-onset Schizophrenia Spectrum Disorders; Epilepsy; General Anesthesia; Gynecologic Infections; Herpes Simplex Virus; Infantile Hemangioma; Infection; Inflammation; Inflammatory Conditions; Intra-abdominal Infections; Lower Respiratory Tract Infections; Migraines; Pain; Pneumonia; Schizophrenia; Sedation; Seizures; Skeletal Muscle Spasms; Skin and Skin-structure Infections; Thromboprophylaxis; Thrombosis; Treatment-resistant Schizophrenia; Urinary Tract Infections; Withdrawal; Sepsis; Gram-negative Infection; Bradycardia; Cardiac Arrest; Cardiac Arrhythmia; Staphylococcal Infections; Nosocomial Pneumonia; Neuromuscular Blockade; Methicillin Resistant Staphylococcus Aureus; Endocarditis; Neutropenia; Headache

Use of orthopedic manual physical therapy to manage chronic orofacial pain and tension-type headache in an adolescent

PubMed Central

Stuhr, Sarah H; Earnshaw, Darren H; Duncombe, Alison M

2014-01-01

Temporomandibular dysfunction (TMD) is frequently associated with multiple headache types. While the efficacy of orthopedic manual physical therapy (OMPT) intervention for TMD with/without headache symptoms has been investigated, it has received less attention than other musculoskeletal conditions. This case describes the OMPT treatment and outcome of a 14 year-old female with a 2-year history of facial pain surrounding the right temporomandibular joint (TMJ), and bilateral occipital and temporal tension-type headaches (TTHs). Intervention included manual mobilization of the TMJ and surrounding cervical/facial soft tissue structures, postural re-education, and patient/family education on prevention, self-treatment, and postural adaptations. Outcomes included pain free and maximal mouth opening (MMO), pressure pain threshold (PPT) over the masseter muscle belly, fear avoidance beliefs questionnaire-physical activity subscale (FABQ-PA), jaw pain and function questionnaire (JPFQ), visual analog pain scale (VAS) for facial pain, and headache frequency, duration, and intensity on a VAS. Results included increased pain free and MMO by 22 mm, improved PPT bilaterally by 403.05 kPa on the affected, and 360.88 kPa on the unaffected side, and decreased reported headache frequency, duration, and intensity. Score decreases of 5 points on VAS with MMO, 8 points on FABQ-PA, and 5 points on JPFQ were also noted. Further research is warranted to investigate the effects of OMPT on pain processing and functional outcomes in patients with TMD and headache. PMID:24976748

Reduction of Current Migraine Headache Pain Following Neck Massage and Spinal Manipulation

PubMed Central

Noudeh, Younes Jahangiri; Vatankhah, Nasibeh; Baradaran, Hamid R.

2012-01-01

Background Migraine headache significantly impacts the health of individuals and of society. The application of simple physical nonpharmacological techniques could greatly reduce the therapeutic costs and side effects in acute onset of such headaches. Methods Ten male patients (mean age was 32.0 ± 10.59 years) with acute onset of a migraine headache according to IHS-2004 diagnostic criteria were enrolled in the study. Neck and upper thoracic spine massage and manipulation technique was performed. Headache pain intensity was assessed before and after the intervention by means of a verbal analog scale. Results Following treatment, headache pain intensity was significantly reduced compared to the pretreatment values (1.85 ± 1.11 vs. 5.80 ± 2.25, p = .005). As a percentage, this represents a mean pain reduction of 68.77% ± 18.56. No side effects were observed, and all of the patients reported satisfaction with the intervention. Conclusion Our results show that the applied cervical and upper thoracic massage and manipulation technique could reduce the headache attack pain intensity in patients with migraine headaches, though further testing, including study designs that make use of control groups, is needed. PMID:22553478

Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management

PubMed Central

White, Paul F.; Elvir Lazo, Ofelia Loani; Galeas, Lidia; Cao, Xuezhao

2017-01-01

The use of opioid analgesics for postoperative pain management has contributed to the global opioid epidemic. It was recently reported that prescription opioid analgesic use often continued after major joint replacement surgery even though patients were no longer experiencing joint pain. The use of epidural local analgesia for perioperative pain management was not found to be protective against persistent opioid use in a large cohort of opioid-naïve patients undergoing abdominal surgery. In a retrospective study involving over 390,000 outpatients more than 66 years of age who underwent minor ambulatory surgery procedures, patients receiving a prescription opioid analgesic within 7 days of discharge were 44% more likely to continue using opioids 1 year after surgery. In a review of 11 million patients undergoing elective surgery from 2002 to 2011, both opioid overdoses and opioid dependence were found to be increasing over time. Opioid-dependent surgical patients were more likely to experience postoperative pulmonary complications, require longer hospital stays, and increase costs to the health-care system. The Centers for Disease Control and Prevention emphasized the importance of finding alternatives to opioid medication for treating pain. In the new clinical practice guidelines for back pain, the authors endorsed the use of non-pharmacologic therapies. However, one of the more widely used non-pharmacologic treatments for chronic pain (namely radiofrequency ablation therapy) was recently reported to have no clinical benefit. Therefore, this clinical commentary will review evidence in the peer-reviewed literature supporting the use of electroanalgesia and laser therapies for treating acute pain, cervical (neck) pain, low back pain, persistent post-surgical pain after spine surgery (“failed back syndrome”), major joint replacements, and abdominal surgery as well as other common chronic pain syndromes (for example, myofascial pain, peripheral neuropathic pain, fibromyalgia, degenerative joint disease/osteoarthritis, and migraine headaches). PMID:29333260

Abdominal Pain

MedlinePlus

... and Recurrent or Functional Abdominal Pain (RAP or FAP) What is abdominal pain? Abdominal pain , or stomachache, ... recurrent abdominal pain (RAP) or functional abdominal pain (FAP)? If your health care provider has ruled out ...

Pain perception studies in tension-type headache.

PubMed

Bezov, David; Ashina, Sait; Jensen, Rigmor; Bendtsen, Lars

2011-02-01

Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. Understanding of pathophysiology of TTH is paramount for development of effective treatments and prevention of chronification of TTH. Our aim was to review the findings from pain perception studies of pathophysiology of TTH as well as to review the research of pathophysiology of TTH. Pain perception studies such as measurement of muscle tenderness, pain detection thresholds, pain tolerance thresholds, pain response to suprathreshold stimulation, temporal summation and diffuse noxious inhibitory control (DNIC) have played a central role in elucidating the pathophysiology of TTH. It has been demonstrated that continuous nociceptive input from peripheral myofascial structures may induce central sensitization and thereby chronification of the headache. Measurements of pain tolerance thresholds and suprathreshold stimulation have shown presence of generalized hyperalgesia in chronic tension-type headache (CTTH) patients, while DNIC function has been shown to be reduced in CTTH. One imaging study showed loss of gray matter structures involved in pain processing in CTTH patients. Future studies should aim to integrate pain perception and imaging to confirm this finding. Pharmacological studies have shown that drugs like tricyclic anti-depressant amitriptyline and nitric oxide synthase inhibitors can reverse central sensitization and the chronicity of headache. Finally, low frequency electrical stimulation has been shown to rapidly reverse central sensitization and may be a new modality in treatment of CTTH and other chronic pain disorders. © 2010 American Headache Society.

Whiplash headache is transitory worsening of a pre-existing primary headache.

PubMed

Stovner, L J; Obelieniene, D

2008-07-01

Acute and chronic whiplash headache are new diagnostic entities in the ICHD-2 (5.3, 5.4). In a prospective cohort study, 210 rear-end collision victims were identified consecutively from police records and asked about head and neck pain in questionnaires after 2 weeks, 3 months and 1 year. The results were compared with those of matched controls who were also followed for 1 year. Of 210 accident victims, 75 developed headache within 7 days. Of these, 37 had also neck pain and complied with the criteria for acute whiplash headache. These 37 had the same headache diagnoses, headache features, accompanying symptoms and long-term prognosis as the 38 without initial neck pain who therefore did not comply with the acute whiplash headache diagnosis. Previous headache was a major risk factor for headache both in the acute and chronic stage. Compared with the non-traumatized controls, headache in the whiplash group had the same prevalence, the same diagnoses and characteristic features, and the same prognosis. Both acute and chronic whiplash headache lack specificity compared with the headache in a control group, and have the same long-term prognosis, indicating that such headaches are primary headaches, probably elicited by the stress of the situation.

Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort.

PubMed

Baron, Eric P; Lucas, Philippe; Eades, Joshua; Hogue, Olivia

2018-05-24

Medicinal cannabis registries typically report pain as the most common reason for use. It would be clinically useful to identify patterns of cannabis treatment in migraine and headache, as compared to arthritis and chronic pain, and to analyze preferred cannabis strains, biochemical profiles, and prescription medication substitutions with cannabis. Via electronic survey in medicinal cannabis patients with headache, arthritis, and chronic pain, demographics and patterns of cannabis use including methods, frequency, quantity, preferred strains, cannabinoid and terpene profiles, and prescription substitutions were recorded. Cannabis use for migraine among headache patients was assessed via the ID Migraine™ questionnaire, a validated screen used to predict the probability of migraine. Of 2032 patients, 21 illnesses were treated with cannabis. Pain syndromes accounted for 42.4% (n = 861) overall; chronic pain 29.4% (n = 598;), arthritis 9.3% (n = 188), and headache 3.7% (n = 75;). Across all 21 illnesses, headache was a symptom treated with cannabis in 24.9% (n = 505). These patients were given the ID Migraine™ questionnaire, with 68% (n = 343) giving 3 "Yes" responses, 20% (n = 102) giving 2 "Yes" responses (97% and 93% probability of migraine, respectively). Therefore, 88% (n = 445) of headache patients were treating probable migraine with cannabis. Hybrid strains were most preferred across all pain subtypes, with "OG Shark" the most preferred strain in the ID Migraine™ and headache groups. Many pain patients substituted prescription medications with cannabis (41.2-59.5%), most commonly opiates/opioids (40.5-72.8%). Prescription substitution in headache patients included opiates/opioids (43.4%), anti-depressant/anti-anxiety (39%), NSAIDs (21%), triptans (8.1%), anti-convulsants (7.7%), muscle relaxers (7%), ergots (0.4%). Chronic pain was the most common reason for cannabis use, consistent with most registries. The majority of headache patients treating with cannabis were positive for migraine. Hybrid strains were preferred in ID Migraine™, headache, and most pain groups, with "OG Shark", a high THC (Δ9-tetrahydrocannabinol)/THCA (tetrahydrocannabinolic acid), low CBD (cannabidiol)/CBDA (cannabidiolic acid), strain with predominant terpenes β-caryophyllene and β-myrcene, most preferred in the headache and ID Migraine™ groups. This could reflect the potent analgesic, anti-inflammatory, and anti-emetic properties of THC, with anti-inflammatory and analgesic properties of β-caryophyllene and β-myrcene. Opiates/opioids were most commonly substituted with cannabis. Prospective studies are needed, but results may provide early insight into optimizing crossbred cannabis strains, synergistic biochemical profiles, dosing, and patterns of use in the treatment of headache, migraine, and chronic pain syndromes.

Self-reported comorbid pains in severe headaches or migraines in a US national sample.

PubMed

Plesh, Octavia; Adams, Sally H; Gansky, Stuart A

2012-06-01

To compare prevalence of self-reported comorbid temporomandibular joint muscle disorder-type, neck, back, and joint pains in people with severe headache or migraine; and analyze these self-reported pains in the 2000-2005 US National Health Interview Survey by gender and age for non-Hispanic whites, Hispanics, and non-Hispanic blacks (African Americans). National Health Interview Survey data included information on gender, age, race, ethnicity, health status, and common pain types: severe headache or migraine, temporomandibular joint muscle disorder-type, neck, and low back in the last 3 months, as well as prior-month joint pains. Analyses included survey prevalence estimation and survey logistic regression to obtain odds ratios and 95% confidence intervals. The study included 189,967 adults: 48% males, 52% females; 73% white, 12% Hispanic, and 11% black. Of the entire sample, 29,712 (15%) reported severe headache or migraine, and 19,228 (64%) had severe headache or migraine with at least 1 comorbid pain. Two or more comorbid pains were reported in 10,200 (33%), with no gender difference, and with Hispanics (n = 1847 or 32%) and blacks (n = 1301 or 30%) less likely to report 2 or more comorbid pains than whites (n = 6747 or 34%) (odds ratio = 0.91, P = .032; OR = 0.82, P < .001, respectively). This group also reported significantly lower ratings of self-rated health (P < .001). Differences in type of comorbid pain by age patterns were found. Severe headache or migraine is often associated with other common pains, seldom existing alone. Two or more comorbid pains are common, similarly affecting gender and racial/ethnic groups. © 2012 American Headache Society.

Central mechanisms of stress-induced headache.

PubMed

Cathcart, S; Petkov, J; Winefield, A H; Lushington, K; Rolan, P

2010-03-01

Stress is the most commonly reported trigger of an episode of chronic tension-type headache (CTTH); however, the causal significance has not been experimentally demonstrated to date. Stress may trigger CTTH through hyperalgesic effects on already sensitized pain pathways in CTTH sufferers. This hypothesis could be partially tested by examining pain sensitivity in an experimental model of stress-induced headache in CTTH sufferers. Such examinations have not been reported to date. We measured pericranial muscle tenderness and pain thresholds at the finger, head and shoulder in 23 CTTH sufferers (CTH-S) and 25 healthy control subjects (CNT) exposed to an hour-long stressful mental task, and in 23 CTTH sufferers exposed to an hour-long neutral condition (CTH-N). Headache developed in 91% of CTH-S, 4% of CNT, and 17% of CTH-N subjects. Headache sufferers had increased muscle tenderness and reduced pain thresholds compared with healthy controls. During the task, muscle tenderness increased and pain thresholds decreased in the CTH-S group compared with CTH-N and CNT groups. Pre-task muscle tenderness and reduction in pain threshold during task were predictive of the development and intensity of headache following task. The main findings are that stress induced a headache in CTTH sufferers, and this was associated with pre-task muscle tenderness and stress-induced reduction in pain thresholds. The results support the hypothesis that stress triggers CTTH through hyperalgesic effects on already increased pain sensitivity in CTTH sufferers, reducing the threshold to noxious input from pericranial structures.

A Case Report of Cystic Pheochromocytoma.

PubMed

Junejo, Shoaib Z; Tuli, Sandeep; Heimann, David M; Sachmechi, Issac; Reich, David

2017-07-25

BACKGROUND Pheochromocytoma is a rare catecholamine-producing tumor with an estimated incidence of less than 0.1% in the global population. We present a case of cystic pheochromocytoma that was diagnosed as an incidental finding. The patient presented with abdominal pain and had a history of hypertension. CASE REPORT A 64-year-old man with hypertension presented with a clinical history of intermittent abdominal pain for one year. He denied sweating, palpitations, headache or back pain. He was found to have an elevated blood pressure of 170/90 and no palpable abdominal mass. Contrast-enhanced computed tomography (CT) imaging of the abdomen and pelvis were performed that showed cystic mass measuring 9 cm in diameter arising from the left adrenal gland with contrast-enhancing mural nodules. Magnetic resonance imaging (MRI) confirmed the cystic nature of the mass. Laboratory analysis showed an elevated plasma normetanephrine (NMN) of 1,087 pg/ml and metanephrine (MN) of 372 pg/ml; 24-hour urine showed elevated levels of NMN and MN, 3,002 mg/24 h and 1,596 mg/24 h, respectively. Given the laboratory and radiologic findings, a diagnosis of cystic pheochromocytoma was made. After controlling blood pressure with the alpha-blocker, doxazosin, the patient was hydrated and scheduled for an elective adrenalectomy. The histopathology of the excised adrenal gland was consistent with a cystic pheochromocytoma. CONCLUSIONS Cystic pheochromocytoma is a very rare tumor that may present without symptoms. The clinical course of cystic pheochromocytoma is similar to that of solid pheochromocytoma. Early surgical intervention is recommended, following blood pressure control with an alpha-blocker, and adequate hydration.

Headache and Facial Pain in Sickle Cell Disease.

PubMed

Vgontzas, Angeliki; Charleston, Larry; Robbins, Matthew S

2016-03-01

Children and adolescents with sickle cell disease (SCD) have a high prevalence of recurrent headaches (24.0-43.9 %). Acute presentation with headache can be diagnostically challenging, as the clinician must consider evaluation of several potentially devastating conditions including vascular diseases (stroke, hemorrhage, venous sinus thrombosis, moyamoya, posterior reversible encephalopathy syndrome), facial and orbital bone infarcts, dental pain, and osteomyelitis. Patients with SCD and primary headache disorders may benefit from comprehensive headache treatment plans that include abortive therapy, prophylactic therapy, and non-pharmacological modalities. Although there is limited data in adults, those with SCD are at risk for medication overuse headache secondary to frequent opioid use. Addressing headache in patients with SCD may help to reduce their use of opioids and disability and improve pain and quality of life.

Fibromyalgia and headache: an epidemiological study supporting migraine as part of the fibromyalgia syndrome.

PubMed

Marcus, Dawn A; Bernstein, Cheryl; Rudy, Thomas E

2005-11-01

Fibromyalgia is defined by widespread body pain, tenderness to palpation of tender point areas, and constitutional symptoms. The literature reports headache in about half of fibromyalgia patients. The current epidemiological study was designed to determine the prevalence and characteristics of headache in fibromyalgia patients. Treatment-seeking fibromyalgia patients were evaluated with measures for fibromyalgia, chronic headache, quality of life, and psychological distress. Multivariate analysis of variance (MANOVA) and t-tests were used to identify significant differences, as appropriate. A total of 100 fibromyalgia patients were screened (24 fibromyalgia without headache and 76 fibromyalgia with headache). International Headache Society diagnoses included: migraine alone (n = 15 with aura, n = 17 without aura), tension-type alone (n = 18), combined migraine and tension-type (n = 16), post-traumatic (n = 4), and probable analgesic overuse headache (n = 6). Fibromyalgia tender point scores and counts and most measures of pain severity, sleep disruption, or psychological distress were not significantly different between fibromyalgia patients with and without headache. As expected, the fibromyalgia patients with headache scored higher on the Headache Impact Test (HIT-6) (62.1 +/- 0.9 vs 48.3 +/- 1.6, p < 0.001). HIT-6 scores were >60 in 80% of fibromyalgia plus headache patients, representing severe impact from headache, and 56-58 in 4%, representing substantial impact. In summary, chronic headache was endorsed by 76% of treatment-seeking fibromyalgia patients, with 84% reporting substantial or severe impact from their headaches. Migraine was diagnosed in 63% of fibromyalgia plus headache patients, with probable analgesic overuse headache in only 8%. General measures of pain, pain-related disability, sleep quality, and psychological distress were similar in fibromyalgia patients with and without headache. Therefore, fibromyalgia patients with headache do not appear to represent a significantly different subgroup compared to fibromyalgia patients without headache. The high prevalence and significant impact associated with chronic headache in fibromyalgia patients, however, warrants inclusion of a headache assessment as part of the routine evaluation of fibromyalgia patients.

Exploring Temporal Patterns of Stress in Adolescent Girls with Headache.

PubMed

Björling, Elin A; Singh, Narayan

2017-02-01

As part of a larger study on perceived stress and headaches in 2009, momentary perceived stress, head pain levels and stress-related symptom data were collected. This paper explores a temporal analysis of the patterns of stress, as well as an analysis of momentary and retrospective stress-related symptoms compared by level of headache activity. Adolescent girls (N = 31) ages 14-18 were randomly cued by electronic diaries 7 times per day over a 21-day period responding to momentary questions about level of head pain, perceived stress and stress-related symptoms. Multivariate general linear modelling was used to determine significant differences among headache groups in relation to temporal patterns of stress. Significant headache group differences were found on retrospective and momentary stress-related symptom measures. A total of 2841 diary responses captured stress levels, head pain and related symptoms. The chronic headache (CH) group reported the highest levels of hourly and daily stress, followed by the moderate headache (MH) and low headache (LH) groups. Patterns of stress for the three headache groups were statistically distinct, illustrating increased stress in girls with more frequent head pain. This evidence suggests that because of increased stress, girls with recurrent head pain are likely a vulnerable population who may benefit from stress-reducing interventions. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

PubMed Central

Friedrichsdorf, Stefan J.; Giordano, James; Desai Dakoji, Kavita; Warmuth, Andrew; Daughtry, Cyndee; Schulz, Craig A.

2016-01-01

Primary pain disorders (formerly “functional pain syndromes”) are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.” We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy. PMID:27973405

Local infiltration of gonyautoxin is safe and effective in treatment of chronic tension-type headache.

PubMed

Lattes, K; Venegas, P; Lagos, N; Lagos, M; Pedraza, L; Rodriguez-Navarro, A J; García, C

2009-04-01

Gonyautoxin are phycotoxins, whose molecular mechanism of action is a reversible block of the voltage-gated sodium channels at axonal level, impeding nerve impulse propagation. To evaluate clinical efficacy of gonyautoxin in the treatment of patients with chronic tensional-type headache. Open trial from September 2004 to 2005 in Hospital Clínico Universidad de Chile. Twenty-seven patients with chronic tension-type headache were locally infiltrated with gonyautoxins (50 micrograms) in ten sites considered as pain trigger points in a fixed infiltration protocol. In each site, a volume of 200 microlitres was injected. EMG recording was performed before and immediately after infiltrations. Main outcome measures are where a significantly drop-off in acute headache pain score occurs and number of days without headache pain. No side effects were detected in the follow-up period. From base line of 2 weeks, 19 patients of 27 (70%) are the successfully responders to the treatment. They showed the remarkable immediate effect after infiltration demonstrated by trapezium EMG recording. Patients reported a fall in pain score 5 minutes post-injection from 5.0 +/- 2.8 to 1.6 +/- 1.6 (mean +/- SD). The responder showed an average of 8.1 +/- 9.9 weeks of headache pain-free, all of them without a second infiltration or use of any additional analgesic medication. The therapeutic properties of gonyautoxin local infiltration in chronic tension-type headache patients are shown to be safe and effective. This report describes a new therapy for chronic tension-type headache involving local infiltrations of gonyautoxins. The immediate headache pain relief effect shown only minutes after toxin infiltrations were the most remarkable feature of this protocol. This is the first gonyautoxins testing report in the treatment of chronic tension-type headache.

Armored brain: A case report and review of the literature

PubMed Central

Petraglia, Anthony L.; Moravan, Michael J.; Jahromi, Babak S.

2011-01-01

Background: Calcified chronic subdural hematomas occur infrequently. When the calcifications are extensive and bilateral, the condition is termed “armored brain”. We describe a case of “armored brain” incidentally discovered in an adult presenting with abdominal pain and mild headaches, long after initial placement of a ventriculo-peritoneal (VP) shunt. Case Description: A 38-year-old woman, treated at infancy with a VP shunt, presented with a 2-month history of abdominal pain associated with nausea and chills. She was neurologically intact on exam. An abdominal computed tomography (CT) scan demonstrated a rim-enhancing loculated fluid collection surrounding the patient's distal VP shunt catheter tip. As a part of her initial work-up, she received a head CT to evaluate the proximal VP shunt, which demonstrated large bilateral chronic subdural hematomas with heavily calcified walls. She was eventually taken to the operating room (OR) for replacement of the distal catheter. It was felt that her acute clinical presentation was unrelated to the bilateral, calcified subdural hematomas and thus the decision was made to manage them conservatively. Conclusions: This rare complication of chronic shunting for hydrocephalus is sometimes referred to as armored brain. Surgery for armored brain is infrequently indicated and beneficial in only small subgroup of patients, with management guided by clinical presentation. Our patient fully recovered after shunt revision alone. PMID:21918735

Quadriplegia due to lead-contaminated opium--case report.

PubMed

Beigmohammadi, Mohammad Taghi; Aghdashi, Moosa; Najafi, Atabak; Mojtahedzadeh, Mojtaba; Karvandian, Kassra

2008-10-01

Utilization of lead-contaminated opium may lead to severe motor neuron impairment and quadriplegia. Forty years oriented old male, opium addict, was admitted to the ICU, with headache, nausea and abdominal pain, and weakness in his lower and upper extremities without definitive diagnosis. The past medical and occupational history was negative. Laboratory investigation showed; anemia (Hb 7.7 g/dl), slightly elevated liver function tests, elevated total bilirubin, and ESR. Abdominal sonography and brain CT scan were normal. EMG and NCV results and neurologic examination were suggestive for Guillain-Barre. He underwent five sessions of plasmapheresis. Blood lead level was > 200 microg/dl. He received dimercaprol (BAL) and calcium disodium edetate (CaEDTA) for two five days session. Upon discharge from ICU all laboratory tests were normal and blood lead level was reduced, but he was quadriplegic. The delayed treatment of lead poisoning may lead to irreversible motor neuron defect.

Blood pool scintigraphy of the skull in relation to head-down tilt provocation in patients with chronic tension-type headache and controls.

PubMed

Hannerz, Jan; Schnell, P-O; Larsson, Stig; Jacobsson, Hans

2004-03-01

To investigate the mechanisms behind the increase of chronic tension-type headache during head-down tilt. The pathophysiology of chronic tension-type headache is unknown. Ten patients suffering from chronic tension-type headache and 10 age- and sex-matched controls were studied with respect to pain intensity and alterations in cranial blood volume using planar scintigraphy and radiolabeled autologous erythrocytes before, during, and after head-down tilt, a procedure known to increase chronic tension-type headache. Four of 8 patients with chronic tension-type headache studied had increased cerebrospinal fluid pressure. During head-down tilt, the pain increased significantly in the group with chronic tension-type headache (P <.001) while the procedure did not cause headache in the controls. Blood volume significantly increased extracranially and decreased intracranially in both groups during head-down tilt. The extracranial nasal blood volume was significantly related to the pain experienced by the patients with chronic tension-type headache before and during head-down tilt. Although the changes in blood volume and, presumably, the increase of intracranial pressure were similar in the patients with chronic tension-type headache and the controls, only the patients experienced pain and pain increase during head-down tilt. This indicates that the pre-head-down tilt conditions must be different in the 2 groups and should be related to increased cerebrospinal fluid pressure/intracranial venous pressure in patients with chronic tension-type headache compared with controls. A difference in central mechanisms may, however, also be of importance for the difference in headache provocation in the 2 groups during head-down tilt.

Identification of subgroups of patients with tension type headache with higher widespread pressure pain hyperalgesia.

PubMed

Fernández-de-Las-Peñas, César; Benito-González, Elena; Palacios-Ceña, María; Wang, Kelun; Castaldo, Matteo; Arendt-Nielsen, Lars

2017-12-01

Identification of subgroups of patients with different levels of sensitization and clinical features can help to identify groups at risk and the development of better therapeutic strategies. The aim of this study was to identify subgroups of patients with tension type headache (TTH) with different levels of sensitization, clinical pain features, and psychological outcomes. A total of 197 individuals with TTH participated. Headache intensity, frequency, and duration and medication intake were collected with a 4-weeks diary. Pressure pain thresholds were assessed bilaterally over the temporalis muscle, C5-C6 joint, second metacarpal and tibialis anterior muscle to determine widespread pressure pain hyperalgesia. The Hospital Anxiety and Depression Scale assessed anxiety and depression. The State-Trait Anxiety Inventory evaluated the state and trait levels of anxiety. The Headache Disability Inventory evaluated the burden of headache. Health-related quality of life was determined with the SF-36 questionnaire. Groups were considered as positive (three or more criteria) or negative (less than three criteria) on a clinical prediction rule: headache duration <8.5 h/day; headache frequency <5.5 days/week; bodily pain <47 and vitality <47.5. The ANCOVA revealed that subjects in group 1 (positive rule, n = 89) exhibited longer headache history, shorter headache duration, lower headache frequency, higher widespread pressure hyperalgesia, higher anxiety trait levels, and lower quality of life (all, P < 0.01) than those subjects within group 2 (negative rule, n = 108). Differences were similar between men and women. This study identified a subgroup of patients with TTH with higher sensitization, higher chronicity of headaches and worse quality of life but lower frequency and duration of headache episodes. This subgroup of individuals with TTH may need particular attention and specific therapeutic programs for avoiding potential chronification.

PubMed Central

FARRI, A.; ENRICO, A.; FARRI, F.

2012-01-01

SUMMARY In 1988, diagnostic criteria for headaches were drawn up by the International Headache Society (IHS) and is divided into headaches, cranial neuralgias and facial pain. The 2nd edition of the International Classification of Headache Disorders (ICHD) was produced in 2004, and still provides a dynamic and useful instrument for clinical practice. We have examined the current IHC, which comprises 14 groups. The first four cover primary headaches, with "benign paroxysmal vertigo of childhood" being the forms of migraine of interest to otolaryngologists; groups 5 to 12 classify "secondary headaches"; group 11 is formed of "headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures"; group 13, consisting of "cranial neuralgias and central causes of facial pain" is also of relevance to otolaryngology. Neither the current classification system nor the original one has a satisfactory collocation for migraineassociated vertigo. Another critical point of the classification concerns cranio-facial pain syndromes such as Sluder's neuralgia, previously included in the 1988 classification among cluster headaches, and now included in the section on "cranial neuralgias and central causes of facial pain", even though Sluder's neuralgia has not been adequately validated. As we have highlighted in our studies, there are considerable similarities between Sluder's syndrome and cluster headaches. The main features distinguishing the two are the trend to cluster over time, found only in cluster headaches, and the distribution of pain, with greater nasal manifestations in the case of Sluder's syndrome. We believe that it is better and clearer, particularly on the basis of our clinical experience and published studies, to include this nosological entity, which is clearly distinct from an otolaryngological point of view, as a variant of cluster headache. We agree with experts in the field of headaches, such as Olesen and Nappi who contributed to previous classifications, on the need for a revised classification, particularly with regards to secondary headaches. According to the current Committee on headaches, the updated version of the classification, presently under study, is due to be published soon; it is our hope that this revised version will take into account some of the above considerations. PMID:22767967

Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study

PubMed Central

Hesse, Toni; Holmes, Laura G.; Kennedy-Overfelt, Vicki; Kerr, Lynne M.; Giles, Lisa L.

2015-01-01

Recurrent headaches cause significant burden for adolescents and their families. Mindfulness-based interventions (MBIs) have been shown to reduce stress and alter the experience of pain, reduce pain burden, and improve quality of life. Research indicates that MBIs can benefit adults with chronic pain conditions including headaches. A pilot nonrandomized clinical trial was conducted with 20 adolescent females with recurrent headaches. Median class attendance was 7 of 8 total sessions; average class attendance was 6.10 ± 2.6. Adherence to home practice was good, with participants reporting an average of 4.69 (SD = 1.84) of 6 practices per week. Five participants dropped out for reasons not inherent to the group (e.g., extracurricular scheduling); no adverse events were reported. Parents reported improved quality of life and physical functioning for their child. Adolescent participants reported improved depression symptoms and improved ability to accept their pain rather than trying to control it. MBIs appear safe and feasible for adolescents with recurrent headaches. Although participants did not report decreased frequency or severity of headache following treatment, the treatment had a beneficial effect for depression, quality of life, and acceptance of pain and represents a promising adjunct treatment for adolescents with recurrent headaches. PMID:26798398

A Systematic Review and Meta-Analysis of the Global Burden of Chronic Pain Without Clear Etiology in Low- and Middle-Income Countries: Trends in Heterogeneous Data and a Proposal for New Assessment Methods.

PubMed

Jackson, Tracy; Thomas, Sarah; Stabile, Victoria; Shotwell, Matthew; Han, Xue; McQueen, Kelly

2016-09-01

The global burden of chronic pain is projected to be large and growing, in concert with the burden of noncommunicable diseases. This is the first systematic review and meta-analysis of the prevalence of chronic pain without clear etiology in general, elderly, and working populations of low- and middle-income countries (LMICs). We collected and reported data using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, excluding acute pain or pain associated with a concurrent medical condition. One hundred nineteen publications in 28 LMICs were identified for systematic review; the 68 reports that focused on general adult populations (GP), elderly general populations (EGP), or workers (W) were evaluated using mixed-effects regression meta-analysis. Average chronic pain prevalence is reported as a percentage of the population, with 95% confidence interval for each pain type and population (GP, EGP, and W; NA is equal to not available): unspecified chronic pain (34[26-42], 62[41-81], and NA); low back pain (21[15-27], 28[16-42], and 52[26-77]); headache (42[27-58], 30[19-43], and 51[13-88]); chronic daily headache (5[3-7], 5[1-12], and 10[0-33]); chronic migraine (GP 12[6-19]); chronic tension type headache (GP 8[3-15]); musculoskeletal pain (25[19-33], 44[28-62], and 79[60-94]); joint pain (14[11-18], 34[16-54], and NA); chronic pelvic/prostatitis pain (GP 4[0-14]); temporomandibular disorder (35[4-78], 8[0-24], and NA); abdominal pain (EGP 17[6-32]); fibromyalgia (Combined GP, EGP, W 6[5-7]); and widespread pain (7[1-18], 19[8-32], and NA). Chronic low back pain and musculoskeletal pain were 2.50 (1.21-4.10) and 3.11 (2.13-4.37) times more prevalent among W, relative to a GP. Musculoskeletal, joint, and unspecified pain were 1.74 (1.03-2.69), 2.36 (1.09-4.02), and 1.83 (1.13-2.65) times more prevalent among the EGP, relative to a GP. There was significant heterogeneity among studies for all pain types (I > 90%). Chronic pain is prevalent in LMICs, and where there was sufficient evidence, generally more prevalent in EGP and W. This meta-analysis reveals the spectrum of chronic pain without clear etiology in LMICs. Steps should be taken to reduce heterogeneity in the assessment of global chronic pain. Possible actions may include standardization of chronic pain definition, widespread adoption of validated questionnaires across cultures, attention to inequitably burdened populations, and inclusion of queries regarding known associations of chronic pain with social and psychological factors that, in combination, increase the global burden of noncommunicable disease and disability.

[Headache in children and adolescents. Epidemiology, biopsychosocial correlates, and psychological treatment approaches].

PubMed

Kröner-Herwig, B

2014-08-01

An abundance of studies have consistently shown that headache is the most prevalent pain in children and adolescents. Weekly headache is experienced by more than 10 % and is distinctly more frequent in girls. The number of headache-affected youths with high disability is lower than expected (~ 4 %). Headache is associated with pain in other body sites, thus multiple pain is experienced more often than isolated headache. Various somatic symptoms and even chronic diseases are also correlated with headache. Headache in parents carries a high risk of also occurring in their children. Various other psychosocial factors such as dysfunctional psychological traits are closely linked with headache, the most prominent being internalizing symptoms. However, externalizing symptoms also correlate with headache. Pain catastrophizing, as well as somatosensory amplification and anxiety sensitivity, have been shown to characterize individuals with headache. Features of the social environment, such as life events, school, as well as family stressors and socioeconomic parameters, are among the risk factors. Psychological interventions such as biofeedback, relaxation, and cognitive-behavioral training have proved their efficacy in headache treatment according to several meta-analyses. The latter has also been conducted in group settings and more recently in self-management focused trainings using electronic media. They mainly aim at the prevention of further headache episodes. The goal of this training is the strengthening of self-efficacy beliefs and active coping strategies. It is proposed that these competencies could contribute to the successful long-term prevention of an adverse course of headache into adulthood.

Chiropractic Adjustment

MedlinePlus

... physical function. Why it's done Low back pain, neck pain and headache are the most common problems for ... headaches and other spine-related conditions, such as neck pain. Not everyone responds to chiropractic adjustments. A lot ...

Occipital neuralgia.

PubMed

Dougherty, Carrie

2014-05-01

Occipital pain is a common complaint amongst patients with headache, and the differential can include many primary headache disorders such as cervicogenic headache or migraine. Occipital neuralgia is an uncommon cause of occipital pain characterized by paroxysmal lancinating pain in the distribution of the greater, lesser or third occipital nerves. Greater occipital nerve blockade with anesthetics and/or corticosteroids can aid in confirming the diagnosis and providing pain relief. However, nerve blocks are also effective in migraine headache and misdiagnosis can result in a false positive. Physical therapy and preventive medication with antiepileptics and tricyclic antidepressants are often effective treatments for occipital neuralgia. Refractory cases may require intervention with pulsed radiofrequency or occipital nerve stimulation.

Has aerobic exercise effect on pain perception in persons with migraine and coexisting tension-type headache and neck pain? A randomized, controlled, clinical trial.

PubMed

Krøll, L S; Sjödahl Hammarlund, C; Gard, G; Jensen, R H; Bendtsen, L

2018-04-10

A large subset of persons with migraine suffers from coexisting tension-type headache and neck pain which may adversely affect the prognosis of migraine. Aerobic exercise has been shown to decrease migraine burden in these persons. Therefore, the aim of this study was to investigate whether the effect of aerobic exercise in persons with migraine and coexisting tension-type headache and neck pain can be explained by changes in pain perception. Seventy consecutively recruited persons with migraine and coexisting tension-type headache and neck pain were randomized into exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 min, three times/week for 3 months. Controls continued their usual daily activities. Pericranial tenderness, pain thresholds, supra-thresholds and temporal summation were assessed at baseline, after treatment and at follow-up (6 months from baseline). Fifty-two persons with migraine and coexisting tension-type headache and neck pain completed the study. Aerobic exercise did not induce consistent changes in nociceptive pathways measured by pericranial tenderness, pressure pain thresholds and sensitivity to electrical stimulation. The effect of aerobic exercise cannot be explained by measurable effects on the pain modulation system. Thus, the positive effect on migraine burden may rather be explained by positive alteration of avoidance behaviour. Aerobic exercise can be recommended as a safe and inexpensive migraine treatment strategy. This study adds further knowledge about the positive effect of aerobic exercise for persons with migraine and coexisting tension-type headache and neck pain. This effect cannot be measured by changes in pain modulation, but may rather be explained by positive alteration of avoidance behaviour. © 2018 European Pain Federation - EFIC®.

Modeled Forecasts of Dengue Fever in San Juan, PR Using NASA Satellite Enhanced Weather Forecasts

NASA Technical Reports Server (NTRS)

Morin, Cory; Quattrochi, Dale; Zavodsky, Bradley; Case, Jonathan

2015-01-01

Dengue virus is transmitted between humans and mosquitoes of the genus Aedes and causes approximately 96 million cases of disease (dengue fever) each year (Bhatet al. 2013). Symptoms of dengue fever include fever, headache, nausea, vomiting, and eye, muscle and joint pain (CDC). More sever manifestations such as abdominal pain, bleeding from nose and gums, vomiting of blood, and clammy skin occur in rare cases of dengue hemorrhagic fever (CDC). Dengue fever occurs throughout tropical and sub-tropical regions worldwide, however, the geographical range and size of epidemics is increasing. Weather and climate are drivers of dengue virus transmission dynamics (Morin et al. 2013) by affecting mosquito proliferation and the virus extrinsic incubation period (i.e. required time for the virus to replicate and disseminate within the mosquito before it can retransmit the virus).

Breaking the language barrier: machine assisted diagnosis using the medical speech translator.

PubMed

Starlander, Marianne; Bouillon, Pierrette; Rayner, Manny; Chatzichrisafis, Nikos; Hockey, Beth Ann; Isahara, Hitoshi; Kanzaki, Kyoko; Nakao, Yukie; Santaholma, Marianne

2005-01-01

In this paper, we describe and evaluate an Open Source medical speech translation system (MedSLT) intended for safety-critical applications. The aim of this system is to eliminate the language barriers in emergency situation. It translates spoken questions from English into French, Japanese and Finnish in three medical subdomains (headache, chest pain and abdominal pain), using a vocabulary of about 250-400 words per sub-domain. The architecture is a compromise between fixed-phrase translation on one hand and complex linguistically-based systems on the other. Recognition is guided by a Context Free Grammar Language Model compiled from a general unification grammar, automatically specialised for the domain. We present an evaluation of this initial prototype that shows the advantages of this grammar-based approach for this particular translation task in term of both reliability and use.

Increase in body temperature during migraine attacks.

PubMed

Ordás, Carlos M; Cuadrado, María L; Rodríguez-Cambrón, Ana B; Casas-Limón, Javier; del Prado, Náyade; Porta-Etessam, Jesús

2013-08-01

Intermittent fever has been occasionally related to migraine, either as a migraine equivalent or as a migraine accompaniment. We present a case of recurrent increase in body temperature consistently associated with migraine headaches. A 15-year-old girl reported a 3-year lasting history of migraine without aura, with a feeling of warmth occurring in each episode. Ancillary tests did not show any evidence of secondary headaches or any systemic disease. A 2-month headache diary was obtained, with daily records of headache intensity (0, no headache; 1, mild pain; 2, moderate pain; 3, severe pain) and simultaneous measurements of axillary temperature. Both parameters were registered in the evening, at 6:00 pm every day. The distribution of headache intensity and body temperature as well as the relationship between both variables over time were analyzed with nonparametric tests. The number of days without pain was 28 (45.2%); a mild headache was present on 13 days (21%), a moderate headache on 15 days (24.2%), and a severe headache on 6 days (9.7%). Headache days were associated with higher body temperature than headache-free days (median values: 37.3°C vs 36.6°C; Mann-Whitney U-test, P < 0.001). Moreover, a positive correlation was found between headache intensity and body temperature (Spearman's rho coefficient: 0.83, P < 0.001). Recurrent increase in body temperature may be another manifestation of the complex clinical spectrum of migraine. This symptom is probably related to hypothalamic involvement. Wiley Periodicals, Inc.

The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache.

PubMed

Pihut, Malgorzata; Ferendiuk, Ewa; Szewczyk, Michal; Kasprzyk, Katarzyna; Wieckiewicz, Mieszko

2016-01-01

Temporomandibular joint dysfunction are often accompanied by symptoms of headache such as tension-type headache which is the most frequent spontaneous primary headache. Masseter muscle pain is commonly reported in this group. The purpose of the study was to assess the efficiency of intramuscular botulinum toxin type A injections for treating masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. This prospective outcome study consisted of 42 subjects of both genders aged 19-48 years diagnosed with masseter muscle pain related to temporomandibular joint dysfunction and tension-type headache. The subjects were treated by the intramuscular injection of 21 U (mice units) of botulinum toxin type A (Botox, Allergan) in the area of the greatest cross-section surface of both masseter bellies. Pain intensity was evaluated using visual analogue scale (VAS) and verbal numerical rating scale (VNRS) 1 week before the treatment and 24 weeks after the treatment. The obtained data were analyzed using the Wilcoxon matched pairs test (p ≤ 0,005). The results of this study showed a decrease in the number of referred pain episodes including a decrease in pain in the temporal region bilaterally, a reduction of analgesic drugs intake as well as a decrease in reported values of VAS and VNRS after injections (p = 0,000). The intramuscular botulinum toxin type A injections have been an efficient method of treatment for masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache.

A rare presentation of pheochromocytoma in pregnancy: a case report.

PubMed

Ghalandarpoor-Attar, Seyedeh Noushin; Ghalandarpoor-Attar, Seyedeh Mojgan; Borna, Sedigheh; Ghotbizadeh, Fahimeh

2018-02-09

Early diagnosis of pheochromocytoma and its proper management can lessen its mortality and morbidity. This case report describes a 24-year-old pregnant woman with an unusual presentation of pheochromocytoma. An Iranian 24-year-old primigravid woman from Kordistan province was referred to our center with left flank pain at 37 weeks of gestation. She had a history of gestational diabetes mellitus since the 12th week of gestation which was managed by insulin administration. She also had a history of pulsatile bi-temporal headache for 2 years prior to her referral to us. She underwent complete abdominal and pelvic ultrasound imaging for her flank pain. This examination revealed a heterogeneous mass of 119 × 87 × 79 mm above her left kidney, highly suspicious of being an adrenal-originating tumor. Subsequently, we consulted an endocrinologist. She underwent abdominopelvic magnetic resonance imaging and her 24-hour urine metanephrine, normetanephrine, and vanillylmandelic acid were assessed. Finally, the diagnosis of pheochromocytoma was confirmed. She underwent a cesarean section and adrenal mass excision at the 40th week of gestation. This timely diagnosis resulted in her proper management and good maternal and neonatal treatment outcomes. Our patient had pheochromocytoma during pregnancy. She had no complaints about hypertension before or during pregnancy until giving birth to her child; her only symptoms were a vague left flank pain, gestational diabetes, and headaches for the past 2 years. The unusual symptom of flank pain led to timely diagnosis and a good treatment outcome.

Diagnosis of pheochromocytoma in the setting of Parkinson disease.

PubMed

Mehta, Shyamal H; Prakash, Rajan; Prisant, L Michael; Isales, Carlos M; Morgan, John C; Williams, Hadyn; Sethi, Kapil D

2009-06-01

A 59-year-old man with a 7-year history of Parkinson disease (PD) presented with episodes of sudden, severe headaches with neck pain, tachycardia, sweating and pallor. During these episodes, the patient showed marked elevations in blood pressure, regardless of posture. This was unusual, given that he had no prior history of hypertension. The array of symptoms raised suspicions of pheochromocytoma, but diagnosis was challenging, as the standard diagnostic biochemical tests were confounded by dopaminergic medications. Further work-up revealed left adrenal medullary hyperplasia. Several reports exist of pseudopheochromocytoma in patients on dopaminergic therapy, but this is the first documented case of pheochromocytoma syndrome due to adrenal medullary hyperplasia in a patient with PD. This case highlights the challenges of performing a diagnostic work-up in a PD patient with symptoms suggestive of pheochromocytoma, and illustrates the utility of (123)I-metaiodobenzylguanidine ((123)I-MIBG) single-photon emission CT in making a diagnosis.Investigations. Physical examination, laboratory tests, abdominal MRI scan, abdominal (123)I-MIBG scan, abdominal (18)F-fluorodeoxyglucose PET scan. Pheochromocytoma syndrome due to adrenal medullary hyperplasia.Management. Surgical excision of the left adrenal gland.

Association between functional gastrointestinal disorders and migraine in children and adolescents: a case-control study.

PubMed

Le Gal, Julie; Michel, Jean-Francois; Rinaldi, Victoria Elisa; Spiri, Daniele; Moretti, Raffaella; Bettati, Donatella; Romanello, Silvia; Berlese, Paola; Lualdi, Rosa; Boizeau, Priscilla; Viala, Jerome; Bellaiche, Marc; Zuccotti, Gian Vincenzo; Crichiutti, Giovanni; Alberti, Corinne; Titomanlio, Luigi

2016-10-01

Functional gastrointestinal disorders and migraine are both common causes of medical attention. We have previously shown an association between migraine and infant colic. In this case-control study, we aimed to establish whether there is an association between migraine and other functional gastrointestinal disorders in children and adolescents. We included children and adolescents aged 6-17 years presenting to the emergency department of four tertiary hospitals in France and Italy. Patients diagnosed with either migraine or tension-type headache by the hospital's paediatric neurologist were enrolled as cases. Patients presenting to the emergency department with minor trauma and no history of recurrent headache were enrolled as controls. Investigators masked to a patient's group allocation diagnosed functional gastrointestinal disorders using the Rome III diagnostic criteria. Univariable and multivariable analyses were done to identify specific disorders and baseline factors associated with migraines and tension-type headache. Between Nov 1, 2014, and Jan 31, 2015, we enrolled 648 controls and 424 cases (257 patients with migraine and 167 with tension-type headache). 83 (32%) children and adolescents in the migraine group were diagnosed with functional gastrointestinal disorders compared with 118 (18%) in the control group (p<0·0001). Multivariable logistic regression showed a significant association between migraine and three gastrointestinal disorders: functional dyspepsia (odds ratio 10·76, 95% CI 3·52-32·85; p<0·0001), irritable bowel syndrome (3·47, 1·81-6·62; p=0·0002), and abdominal migraine (5·87, 1·95-17·69; p=0·002). By contrast, there was an inverse association between migraine and functional constipation (0·34, 0·14-0·84, p=0·02). 41 (25%) participants with tension-type headache had functional gastrointestinal disorders, which did not significantly differ from the prevalence of these disorders in the control group (p=0·07); no significant association was noted between any functional gastrointestinal disease and tension-type headaches. Three abdominal-pain-related functional gastrointestinal disorders were associated with migraine in children and adolescents. These findings are of value to the diagnosis and management of these common diseases. Future studies should investigate whether antimigraine drugs are of benefit in functional gastrointestinal disorders. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of mindfulness-based stress reduction on pain severity and mindful awareness in patients with tension headache: a randomized controlled clinical trial.

PubMed

Omidi, Abdollah; Zargar, Fatemeh

2014-09-01

Programs to improve the pain and health status in illnesses with pain such as headache are still in their infancy. Mindfulness-based stress reduction (MBSR) is a new psychotherapy that appears to be effective in treating chronic pain. This study evaluated efficacy of MBSR in improving pain severity and mindful awareness in patients with tension headache. This study was a randomized controlled clinical trial that was conducted in 2012 in Shahid Beheshti Hospital of Kashan City. Sixty patients who were diagnosed with tension-type headache according to the International Headache Classification Subcommittee were randomly assigned to treatment as usual (TAU) or MBSR groups. The MBSR group received eight weekly treatments. Any session lasted 120 minutes. The sessions were based on MBSR protocol. Diary scale for measuring headache and Mindful Attention Awareness Scale (MAAS) were administered at pretreatment, and posttreatment, and three-month follow-up in both groups. The data was analyzed using repeated measures analysis of variance. The mean of pain severity was 7.36 ± 1.25 before intervention that was significantly reduced to 5.62 ± 1.74 and 6.07 ± 1.08 after the intervention and follow-up (P < 0.001). In addition, the MBSR group showed higher scores in mindful awareness in comparison with the control group at posttest session. The mean of mindful awareness before intervention was 34.9 ± 10.5 and changed to 53.8 ± 15.5 and 40.7 ± 10.9 after the intervention and follow-up sessions (P < 0.001). MBSR could reduce pain and improve mindfulness skills in patients with tension headache. It appears that MBSR is an effective psychotherapy for treatment of patients with tension headache.

Widespread Pressure Pain Hypersensitivity Is Similar in Women With Frequent Episodic and Chronic Tension-Type Headache: A Blinded Case-Control Study.

PubMed

Palacios Ceña, María; Castaldo, Matteo; Kelun Wang; Torelli, Paola; Pillastrini, Paolo; Fernández-de-Las-Peñas, César; Arendt-Nielsen, Lars

2017-02-01

To investigate differences in widespread pressure pain hyperalgesia in the trigemino-cervical and extra-trigeminal (distant pain-free) regions in women with frequent episodic (FETTH) and chronic (CTTH) tension-type headache. It seems that people with tension-type headache exhibit central sensitization. No study has investigated differences between FETTH and CTTH in terms of widespread pressure pain hypersensitivity. Forty-three women with FETTH, 42 with CTTH, and 45 women without headache diagnosis were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over trigeminal area (ie, temporalis muscle), extra-trigeminal (ie, C5/C6 zygapophyseal joint), and two distant points (ie, second metacarpal and tibialis anterior muscle) by a blinded assessor. Clinical features of the headache were collected with a 4-week headache diary. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). The ANCOVA revealed that PPTs were significantly decreased bilaterally over trigeminal (mean differences ranging from 97.5 to 101.5 kPa), extra-trigeminal (from 94.3 to 114.5 kPa), and distant points (from 99.4 to 208.6 kPa) in both FETTH and CTTH groups compared with controls (all, P < .001). No differences between FETTH and CTTH were observed (all points, P > .217). Anxiety (all, P > .803) or depression (P > .206) did not influence pressure pain hyperalgesia. No associations between widespread pressure hypersensitivity and headache features were observed (all, P > .110). Current results suggest the presence of similar local and widespread pressure hyperalgesia, not associated with anxiety or depression, in women with FETTH and CTTH supporting that localized and central manifestations are involved in both the episodic and chronic forms of tension-type headache. © 2016 American Headache Society.

Lead toxicity in battery workers.

PubMed

Qasim, Saeeda Fouzia; Baloch, Malka

2014-11-01

Lead poisoning is a medical condition caused by increased levels of lead in the body. Routes of exposure include contaminated air, water, soil, food and consumer products. Occupational exposure is the main cause of lead poisoning in the adults. Two cases of occupational lead poisoning in adult battery workers are hereby presented. Both male patients had initial non-specific symptoms of intermittent abdominal pain, fatigue and headache for 6 - 8 years. Later on, they developed psychosis, slurred speech, tremors of hands and initially underwent treatment for Parkinsonism and Wilson's disease because of clinical misdiagnosis. They were diagnosed with lead poisoning later and were treated successfully with lead chelator (CaNa2 EDTA).

A Prospective Cohort Study of Outpatient Interdisciplinary Rehabilitation of Chronic Headache Patients.

PubMed

Krause, Steven J; Stillman, Mark J; Tepper, Deborah E; Zajac, Deborah

2017-03-01

To evaluate the efficacy of an intensive outpatient program designed to improve functioning and reduce psychological impairment in chronic headache patients. Chronic headaches, occurring 15 or more days per month, for three or more months, may arise from multiple International Classification of Headache Disorders diagnoses: Chronic Migraine, Chronic Tension Type Headache, New Daily Persistent Headache, Chronic Post Traumatic Headaches, and Medication Overuse Headache. Several interdisciplinary programs that treat patients with chronic headaches have reported decreases in headache frequency. This study sought to evaluate the effect of a 3 week interdisciplinary treatment program for patients with chronic headache disorders on headache severity, functional status, and psychological impairment. Subjects were 379 patients admitted to an outpatient chronic headache treatment program. Assessments of headache severity, psychological status, and functional impairment were completed by 371 (97.8%) of these at the time of admission. At discharge, 340 subjects (89.7%) provided assessment data, and 152 (40.1%) provided data at 1-year follow-up. Subjects' mean ratings on a 0-10 scale for their headache pain in the prior week declined, and these improvements were maintained at follow-up. (Estimated marginal means on a 0-10 scale for Average pain: admission 6.1, discharge 3.5, follow-up 3.3; for Least pain: admission 3.2; discharge 1.5; follow-up 1.3; for Worst pain: admission 8.2; discharge 6.4; follow-up 5.7), and similar results were found for current pain (admission 4.7; discharge 2.8; follow-up 2.4): Measures of functional impairment also improved following treatment, and these gains were maintained at 12 month follow up (Estimated marginal mean Headache Impact Test-6 score: admission 66.1, discharge 55.4, follow-up 51.9; Estimated marginal mean Pain Disability Index score: admission 36.2, discharge 14.1, follow-up 11.6). As measured by the Depression, Anxiety and Stress Scale, anxiety and reactivity to stress decreased following treatment, and remained improved at follow-up (Estimated marginal mean score for Anxiety: admission 8.7, discharge 5.2, follow-up 4.4; Estimated marginal mean score for stress: admission 14.9, discharge 7.2, follow-up 7.6). Depression decreased with treatment, but while 1-year follow-up depression scores remained significantly lower than at admission, they were also significantly higher than at discharge (Estimated marginal means: admission 13.3, discharge 4.1, follow-up 6.6). The study supports the efficacy of the treatment model. Limitations of the study and suggestions for future research are also discussed. © 2017 American Headache Society.

Head pain referral during examination of the neck in migraine and tension-type headache.

PubMed

Watson, Dean H; Drummond, Peter D

2012-09-01

To investigate if and to what extent typical head pain can be reproduced in tension-type headache (TTH), migraine without aura sufferers, and controls when sustained pressure was applied to the lateral posterior arch of C1 and the articular pillar of C2, stressing the atlantooccipital and C2-3 segments respectively. Occipital and neck symptoms often accompany primary headache, suggesting involvement of cervical afferents in central pain processing mechanisms in these disorders. Referral of head pain from upper cervical structures is made possible by convergence of cervical and trigeminal nociceptive afferent information in the trigemino-cervical nucleus. Upper cervical segmental and C2-3 zygapophysial joint dysfunction is recognized as a potential source of noxious afferent information and is present in primary headache sufferers. Furthermore, referral of head pain has been demonstrated from symptomatic upper cervical segments and the C2-3 zygapophysial joints, suggesting that head pain referral may be a characteristic of cervical afferent involvement in headache. Thirty-four headache sufferers and 14 controls were examined interictally. Headache patients were diagnosed according the criteria of the International Headache Society and comprised 20 migraine without aura (females n = 18; males n = 2; average age 35.3 years) and 14 TTH sufferers (females n = 11; males n = 3; average age 30.7 years). Two techniques were used specifically to stress the atlantooccipital segments (Technique 1 - C1) and C2-3 zygapophysial joints (Technique 2 - C2). Two techniques were also applied to the arm--the common extensor origin and the mid belly of the biceps brachii. Participants reported reproduction of head pain with "yes" or "no" and rated the intensity of head pain and local pressure of application on a scale of 0 -10, where 0 = no pain and 10 = intolerable pain. None of the subjects reported head pain during application of techniques on the arm. Head pain referral during the cervical examination was reported by 8 of 14 (57%) control participants, all TTH patients and all but 1 migraineur (P < .002). In each case, participants reported that the referred head pain was similar to the pain they usually experienced during TTH or migraine. The frequency of head pain referral was identical for Techniques 1 and 2. The intensity of referral did not differ between Technique 1 and Technique 2 or between groups. Tenderness ratings to thumb pressure were comparable between the Techniques 1 and 2 when pressure was applied to C1 and C2 respectively and across groups. Similarly, there were no significant differences for tenderness ratings to thumb pressure between Technique 1 and Technique 2 on the arm or between groups. While tenderness ratings to thumb pressure for Technique 2 were similar for both referral (n = 41) and non-referral (n = 7) groups, tenderness ratings for Technique 1 in the referral group were significantly greater when compared with the non-referral group (P = .01). Our data support the continuum concept of headache, one in which noxious cervical afferent information may well be significantly underestimated. The high incidence of reproduction of headache supports the evaluation of musculoskeletal features in patients presenting with migrainous and TTH symptoms. This, in turn, may have important implications for understanding the pathophysiology of headache and developing alternative treatment options. © 2012 American Headache Society.

Successful Treatment of Abdominal Cutaneous Entrapment Syndrome Using Ultrasound Guided Injection

PubMed Central

Hong, Myong Joo; Seo, Dong Hyuk

2013-01-01

There are various origins for chronic abdominal pain. About 10-30% of patients with chronic abdominal pain have abdominal wall pain. Unfortunately, abdominal wall pain is not thought to be the first origin of chronic abdominal pain; therefore, patients usually undergo extensive examinations, including diagnostic laparoscopic surgery. Entrapment of abdominal cutaneous nerves at the muscular foramen of the rectus abdominis is a rare cause of abdominal wall pain. If abdominal wall pain is considered in earlier stage of chronic abdominal pain, unnecessary invasive procedures are not required and patients will reach symptom free condition as soon as the diagnosis is made. Here, we report a case of successful treatment of a patient with abdominal cutaneous nerve entrapment syndrome by ultrasound guided injection therapy. PMID:23862004

Frontal headache induced by osteoma of frontal recess.

PubMed

Kim, Kyung Soo

2013-01-01

We reported a case of osteoma involving the frontal recess, which presented as frontal headache and reviewed literatures. Also, this case highlights that sinunasal osteomas can cause pain by local mass effects, referred pain, or prostaglandin E2-mediated mechanisms. © 2012 American Headache Society.

Muscle pain in the head: overlap between temporomandibular disorders and tension-type headaches.

PubMed

Svensson, Peter

2007-06-01

A variety of painful problems can affect the muscles in the head and face. Both temporomandibular disorders and tension-type headaches are believed to have a significant contribution from the skeletal muscles and have several clinical features in common. It still unclear, however, to what extent these two prevalent disorders are separate entities or have similar pathophysiological background. There is now reasonably good evidence that myofascial temporomandibular disorder patients are more likely to have a tension-type headache problem and vice versa, but the overlap is not complete. Studies have documented similarities regarding sensitization of the nociceptive pathways, dysfunction of the endogenous pain modulatory systems as well as contributing genetic factors, but there are also a number of distinct differences between temporomandibular disorders and tension-type headaches that need to be considered. Using the current classification systems, myofascial temporomandibular disorder pain and tension-type headache disorders do overlap and appear to share many of the same pathophysiological mechanisms, but it would be premature to consider them as identical entities since the importance of, for example, the affected muscles and associated function and genetic background needs to be established. Orofacial pain and headache specialists should collaborate to further develop diagnostic procedures and management strategies of temporomandibular disorders and tension-type headaches.

Effects of Anger Awareness and Expression Training versus Relaxation Training on Headaches: A Randomized Trial

PubMed Central

Slavin-Spenny, Olga; Lumley, Mark A.; Thakur, Elyse R.; Nevedal, Dana C.; Hijazi, Alaa M.

2013-01-01

Background and purpose Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches. Methods Young adults with headaches (N = 147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment. Results On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls. Conclusions Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from emotional expression versus emotional reduction approaches to chronic pain. PMID:23620190

Self- Reported Comorbid Pains in Severe Headaches or Migraines in a US National Sample

PubMed Central

Plesh, Octavia; Adams, Sally H; Gansky, Stuart A

2012-01-01

Aims To compare prevalence of self-reported comorbid temporomandibular joint muscle disorder (TMJMD)-type, neck, back and joint pains in people with severe headache or migraine; analyze these self-reported pains in the 2000–2005 US National Health Interview Survey (NHIS) by gender and age for Non-Hispanic Whites, Hispanics and Non-Hispanic Blacks (African Americans). Methods NHIS data included information on gender, age, race, ethnicity, health status, and common pain types: severe headache or migraine, TMJMD-type, neck, and low back in the last 3 months, as well as prior month joint pains. Analyses included survey prevalence estimation and survey logistic regression to obtain odds ratios and 95% confidence intervals. Results 189,967 adults, 48% males, 52% females; 73% White, 12% Hispanic, and 11% Black were included. 29,712 (15%) of the entire sample reported severe headache or migraine, 19,228 (64%) had severe headache or migraine with at least one comorbid pain. 10,200 (33%) reported 2 or more comorbid pains, with no gender difference, and with Hispanics (n=1,847 or 32%) and Blacks (n=1,301 or 30%) less likely to report 2 or more comorbid pains than Whites (n=6,747 or 34%) (OR=0.91, p=0.032; OR=0.82, p<0.001, respectively). This group also reported significantly lower ratings of self-rated health (p<0.001). Differences in type of comorbid pain by age patterns were found. Conclusions Severe headache or migraine is often associated with other common pains, seldom existing alone. Two or more comorbid pains are common, similarly affecting gender and racial/ethnic groups. PMID:22553936

The Relationship of Parental Pain Catastrophizing with Parents Reports of Children's Anxiety, Depression, and Headache Severity.

PubMed

Akbarzadeh, Ghazale; Daniali, Hojjat; Javdzadh, Mohsen; Caes, Line; Ranjbar, Seyran; Habibi, Mojtaba

2018-01-01

Parental pain catastrophizing is a construct recognized to have a significant impact on experience of pain in both children and parents. This research aimed to investigate the probable relationship of parental pain catastrophizing with the parent's reports of children's anxiety, depression and headache severity amongst Iranian parents of children with chronic or recurrent headache. This study was conducted in 2015-16, in two pediatric neurological centers located in Tehran, Iran; with a convenience sampling method and 212 parents (120 mothers and 92 fathers) of 132 children with a chronic or recurrent headache (migraine and tension-type). They completed the Pain Catastrophizing Scale; Numeric Pain Rating Scale, asking for the average of pain severity in last three months before the research, and the Anxiety and Depression subscales of the Children Behavioral Check List. The mean age of parents was 35.41 yr (SD=5.58) and the mean age of children was 9.83 yr (SD=2.77). A total of 72 girls and 60 boys participated in this study with a mean pain severity for headache in last three months before the research of 4.99 (SD=2.63). Probable sex differences according to parental pain catastrophizing, pain severity, anxiety, and depression were assessed amongst parents. In the next step, the predictability of pain severity from parental pain catastrophizing was evaluated. Results indicated a significant relationship in maternal pain catastrophizing and estimates of pain intensity by mothers. These findings represent the importance of parent's especially mother's cognitive factors affecting their reports of their children's pain and related emotional disturbances.

Efficacy of manual and manipulative therapy in the perception of pain and cervical motion in patients with tension-type headache: a randomized, controlled clinical trial.

PubMed

Espí-López, Gemma V; Gómez-Conesa, Antonia

2014-03-01

The purpose of this study was to evaluate the efficacy of manipulative and manual therapy treatments with regard to pain perception and neck mobility in patients with tension-type headache. A randomized clinical trial was conducted on 84 adults diagnosed with tension-type headache. Eighty-four subjects were enrolled in this study: 68 women and 16 men. Mean age was 39.76 years, ranging from 18 to 65 years. A total of 57.1% were diagnosed with chronic tension-type headache and 42.9% with tension-type headache. Participants were divided into 3 treatment groups (manual therapy, manipulative therapy, a combination of manual and manipulative therapy) and a control group. Four treatment sessions were administered during 4 weeks, with posttreatment assessment and follow-up at 1 month. Cervical ranges of motion pain perception, and frequency and intensity of headaches were assessed. All 3 treatment groups showed significant improvements in the different dimensions of pain perception. Manual therapy and manipulative treatment improved some cervical ranges of motion. Headache frequency was reduced with manipulative treatment (P < .008). Combined treatment reported improvement after the treatment (P < .000) and at follow-up (P < .002). Pain intensity improved after the treatment and at follow-up with manipulative therapy (P < .01) and combined treatment (P < .01). Both treatments, administered both separately and combined together, showed efficacy for patients with tension-type headache with regard to pain perception. As for cervical ranges of motion, treatments produced greater effect when separately administered.

Cough Headaches

MedlinePlus

... secondary cough headaches may require surgery. Symptoms Primary cough headaches Begin suddenly with and just after coughing ... by a dull, aching pain for hours Secondary cough headaches Secondary cough headaches often have symptoms similar ...

Prevalence of recurrent complaints of pain among Greek schoolchildren and associated factors: a population-based study.

PubMed

Bakoula, Chryssa; Kapi, Aikaterini; Veltsista, Alexandra; Kavadias, George; Kolaitis, Gerasimos

2006-08-01

To determine the prevalence of recurrent complaints of pain (RCP) in Greek children, and to examine associations with socio-demographic characteristics and psychosocial factors. Cross-sectional study comprising a nationally representative population of 8130 7-y-old Greek schoolchildren. Data were collected by mailed questionnaires (response rate 89%). RCP was defined as present if at least one of the complaints of headache, abdominal pain or limb pain occurred at least once a week. The RCP prevalence rate was 7.2%, with significant gender differences (8.8% of girls, 5.7% of boys; p<0.001). RCP was significantly positively associated with a chronic health problem among the children, frequent change of residence, poor school performance, often watching TV and rarely playing with other children. There were no statistically significant associations of RCP with family structure and socio-economic status. The results are indicative of the prevalence of RCP in Greek schoolchildren. This study enlightens the psychosocial component of RCP and emphasizes the importance of gathering information on children's social background in medical settings.

Influence of Temple Headache Frequency on Physical Functioning and Emotional Functioning in Subjects with Temporomandibular Disorder Pain

PubMed Central

List, Thomas; John, Mike T.; Ohrbach, Richard; Schiffman, Eric L.; Truelove, Edmond L.; Anderson, Gary C.

2015-01-01

Aims To investigate the relationship of headache frequency with patient-reported physical functioning and emotional functioning in temporomandibular disorder (TMD) subjects with concurrent temple headache. Methods The Research Diagnostic Criteria for TMD (RDC/TMD) Validation Project identified, as a subset of 614 TMD cases and 91 controls (n = 705), 309 subjects with concurrent TMD pain diagnoses (RDC/TMD) and temple headache. The temple headaches were subdivided into infrequent, frequent, and chronic headache according to the International Classification of Headache Disorders, second edition (ICHD–II). Study variables included self-report measures of physical functioning (Jaw Function Limitation Scale [JFLS], Graded Chronic Pain Scale [GCPS], Short Form–12 [SF–12]) and emotional functioning (depression and anxiety as measured by the Symptom Checklist–90R/SCL–90R). Differences among the three headache subgroups were characterized by increasing headache frequency. The relationship between ordered headache frequency and physical as well as emotional functioning was analyzed using linear regression and trend tests for proportions. Results Physical functioning, as assessed with the JFLS (P < .001), SF-12 (P < .001), and GCPS (P < .001), was significantly associated with increased headache frequency. Emotional functioning, reflected in depression and anxiety, was also associated with increased frequency of headache (both P < .001). Conclusion Headache frequency was substantially correlated with reduced physical functioning and emotional functioning in subjects with TMD and concurrent temple headaches. A secondary finding was that headache was precipitated by jaw activities more often in subjects with more frequent temple headaches. PMID:22558607

Headache and Pain in Guillain-Barré Syndrome.

PubMed

Farmakidis, Constantine; Inan, Seniha; Milstein, Mark; Herskovitz, Steven

2015-08-01

While moderate and severe back or extremity pain is frequent in Guillain-Barré syndrome (GBS), headache appears to be uncommon. Most of the reports of headache in GBS place it in the context of the posterior reversible encephalopathy syndrome (PRES) which is increasingly recognized as a likely dysautonomia-related GBS complication. There are also a few reports of headache in the setting of increased CSF pressure and papilledema and in association with the Miller Fisher GBS variant. In comparison, back and extremity pain is highly prevalent. Aching muscle pain and neuropathic pain are the two most common of several pain types. Pain may be a heralding feature and has been described in patients as long as 2 years after disease onset. Pain management is a major axis of treatment in GBS. Gabapentin is a reasonable first-line choice, and opioid medications can be added for more severe pain but there are few clinical trials to inform specific recommendations. While the understanding of pain pathophysiology in GBS is incomplete, its prevalence and clinical impact are increasingly recognized and studied. Pain should be considered a cardinal manifestation of GBS along with acute, mostly symmetric weakness and diminished reflexes.

A Rare Case of Adrenal Pheochromocytoma with Unusual Clinical and Biochemical Presentation: 
A Case Report and Literature Review

PubMed Central

Mula-Abed, Waad-Allah S.; Ahmed, Riyaz; Ramadhan, Fatima A.; Al-Kindi, Manal K.; Al-Busaidi, Noor B.; Al-Muslahi, Hilal N.; Al-Lamki, Mohammad A.

2015-01-01

A 50-year-old Omani woman presented to the Outpatient Clinic, Royal Hospital, Oman with right upper abdominal pain and backache that had lasted 10 days. She had no palpitation, sweating, or hypertension (blood pressure 122/78mmHg). The patient’s history revealed that she had a similar incidence of abdominal pain two months prior, which was a "dull ache" in nature and somewhat associated with headache. The pain was relieved using a mild analgesic drug. Abdominal ultrasonography showed a right adrenal mass, and both computed tomography and magnetic resonance imaging of the adrenal glands confirmed a right adrenal mass consistent with adrenal pheochromocytoma. However, clinical biochemistry tests revealed normal levels of plasma catecholamines (dopamine, norepinephrine, and epinephrine) and metanephrine, which are unusual findings in adrenal pheochromocytoma. Meanwhile, the patient had markedly raised plasma normetanephrine (10-fold) which, together with the normal metanephrine, constitutes a metabolic profile that is compatible with extra-adrenal pheochromocytoma. The patient also had markedly raised chromogranin A (16-fold), consistent with the presence of a neuroendocrine tumor. Laparoscopic right adrenalectomy was done and the adrenal tumor was excised and retrieved in total. Histopathology and immunohistochemistry confirmed the diagnosis of adrenal pheochromocytoma; the tumor cells being positive for chromogranin, synaptophysin, and S-100 protein. Following surgery, the patient did well and showed full recovery at follow-up after three months. Molecular genetic testing showed no pathogenic mutation in pheochromocytoma genes: MAX, SDHA, SDHAF2, SDHB, SDHC, SDHD, VHL, and PRKAR1A. A review of the literature was conducted to identify the pathophysiology and any previous reports of such case. To our knowledge, this is the first report in Oman of the extremely rare entity of pheochromocytoma with an unusual clinical and biochemical scenario. PMID:26421121

A Rare Case of Adrenal Pheochromocytoma with Unusual Clinical and Biochemical Presentation: 
A Case Report and Literature Review.

PubMed

Mula-Abed, Waad-Allah S; Ahmed, Riyaz; Ramadhan, Fatima A; Al-Kindi, Manal K; Al-Busaidi, Noor B; Al-Muslahi, Hilal N; Al-Lamki, Mohammad A

2015-09-01

A 50-year-old Omani woman presented to the Outpatient Clinic, Royal Hospital, Oman with right upper abdominal pain and backache that had lasted 10 days. She had no palpitation, sweating, or hypertension (blood pressure 122/78mmHg). The patient's history revealed that she had a similar incidence of abdominal pain two months prior, which was a "dull ache" in nature and somewhat associated with headache. The pain was relieved using a mild analgesic drug. Abdominal ultrasonography showed a right adrenal mass, and both computed tomography and magnetic resonance imaging of the adrenal glands confirmed a right adrenal mass consistent with adrenal pheochromocytoma. However, clinical biochemistry tests revealed normal levels of plasma catecholamines (dopamine, norepinephrine, and epinephrine) and metanephrine, which are unusual findings in adrenal pheochromocytoma. Meanwhile, the patient had markedly raised plasma normetanephrine (10-fold) which, together with the normal metanephrine, constitutes a metabolic profile that is compatible with extra-adrenal pheochromocytoma. The patient also had markedly raised chromogranin A (16-fold), consistent with the presence of a neuroendocrine tumor. Laparoscopic right adrenalectomy was done and the adrenal tumor was excised and retrieved in total. Histopathology and immunohistochemistry confirmed the diagnosis of adrenal pheochromocytoma; the tumor cells being positive for chromogranin, synaptophysin, and S-100 protein. Following surgery, the patient did well and showed full recovery at follow-up after three months. Molecular genetic testing showed no pathogenic mutation in pheochromocytoma genes: MAX, SDHA, SDHAF2, SDHB, SDHC, SDHD, VHL, and PRKAR1A. A review of the literature was conducted to identify the pathophysiology and any previous reports of such case. To our knowledge, this is the first report in Oman of the extremely rare entity of pheochromocytoma with an unusual clinical and biochemical scenario.

Intracutaneous sterile water injections do not relieve pain in cervicogenic headache.

PubMed

Sand, T; Bovim, G; Helde, G

1992-11-01

Intracutaneous sterile water injections have been reported to relieve acute labor pain and cervical pain in whip-lash patients. A double blind cross-over trial has presently been conducted in 10 women with cervicogenic headache in order to investigate whether sterile water injections were effective in this disorder. No benefit was observed for either treatment (isotonic saline or sterile water), neither on pain during the first 14 days nor on neck mobility. We conclude that intracutaneous sterile water injections is not effective in cervicogenic headache.

Referred pain elicited by manual exploration of the lateral rectus muscle in chronic tension-type headache.

PubMed

Fernández-de-Las-Peñas, César; Cuadrado, Maria Luz; Gerwin, Robert D; Pareja, Juan A

2009-01-01

To analyze the presence of referred pain elicited by manual examination of the lateral rectus muscle in patients with chronic tension-type headache (CTTH). A case-control blinded study. It has been found previously that the manual examination of the superior oblique muscle can elicit referred pain to the head in some patients with migraine or tension-type headache. However, a referred pain from other extraocular muscles has not been investigated. Fifteen patients with CTTH and 15 healthy subjects without headache history were included. A blinded assessor performed a manual examination focused on the search for myofascial trigger points (TrPs) in the right and left lateral rectus muscles. TrP diagnosis was made when there was referred pain evoked by maintained pressure on the lateral corner of the orbit (anatomical projection of the lateral rectus muscle) for 20 seconds, and increased referred pain while the subject maintained a medial gaze on the corresponding side (active stretching of the muscle) for 15 seconds. On each side, a 10-point numerical pain rate scale was used to assess the intensity of referred pain at both stages of the examination. Ten patients with CTTH (66.6%) had referred pain that satisfied TrPs diagnostic criteria, while only one healthy control (0.07%) reported referred pain upon the examination of the lateral rectus muscles (P < 0.001). The elicited referred pain was perceived as a deep ache located at the supraorbital region or the homolateral forehead. Pain was evoked on both sides in all subjects with TrPs, with no difference in pain intensity between the right and the left. The average pain intensity was significantly greater in the patient group (P < 0.001). All CTTH patients with referred pain recognized it as the frontal pain that they usually experienced during their headache attacks, which was consistent with active TrPs. In some patients with CTTH, the manual examination of lateral rectus muscle TrPs elicits a referred pain that extends to the supraorbital region or the homolateral forehead. Nociceptive inputs from the extraocular muscles may sustain the activation of trigeminal neuron, thus sensitizing central pain pathways and exacerbating headache.

The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial.

PubMed

Krøll, Lotte Skytte; Hammarlund, Catharina Sjödahl; Linde, Mattias; Gard, Gunvor; Jensen, Rigmor Højland

2018-01-01

Aim To evaluate aerobic exercise in migraine and co-existing tension-type headache and neck pain. Methods Consecutively recruited persons with migraine and co-existing tension-type headache and neck pain were randomized into an exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 minutes, three times/week. Controls continued usual daily activities. Pain frequency, intensity, and duration; physical fitness, level of physical activity, well-being and ability to engage in daily activities were assessed at baseline, after treatment and at follow-up. Results Fifty-two persons completed the study. Significant between-group improvements for the exercise group were found for physical fitness, level of physical activity, migraine burden and the ability to engage in physical activity because of reduced impact of tension-type headache and neck pain. Within the exercise group, significant reduction was found for migraine frequency, pain intensity and duration, neck pain intensity, and burden of migraine; an increase in physical fitness and well-being. Conclusions Exercise significantly reduced the burden of migraine and the ability to engage in physical activity because of reduced impact of tension-type headache and neck pain. Exercise also reduced migraine frequency, pain intensity and duration, although this was not significant compared to controls. These results emphasize the importance of regular aerobic exercise for reduction of migraine burden.

Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache.

PubMed

Fernández-de-las-Peñas, César; Fernández-Mayoralas, Daniel M; Ortega-Santiago, Ricardo; Ambite-Quesada, Silvia; Palacios-Ceña, Domingo; Pareja, Juan A

2011-02-01

Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.

The Relationship of Parental Pain Catastrophizing with Parents Reports of Children’s Anxiety, Depression, and Headache Severity

PubMed Central

AKBARZADEH, Ghazale; DANIALI, Hojjat; JAVDZADH, Mohsen; CAES, Line; RANJBAR, Seyran; HABIBI, Mojtaba

2018-01-01

Objective Parental pain catastrophizing is a construct recognized to have a significant impact on experience of pain in both children and parents. This research aimed to investigate the probable relationship of parental pain catastrophizing with the parent’s reports of children’s anxiety, depression and headache severity amongst Iranian parents of children with chronic or recurrent headache. Materials & Methods This study was conducted in 2015-16, in two pediatric neurological centers located in Tehran, Iran; with a convenience sampling method and 212 parents (120 mothers and 92 fathers) of 132 children with a chronic or recurrent headache (migraine and tension-type). They completed the Pain Catastrophizing Scale; Numeric Pain Rating Scale, asking for the average of pain severity in last three months before the research, and the Anxiety and Depression subscales of the Children Behavioral Check List. Results The mean age of parents was 35.41 yr (SD=5.58) and the mean age of children was 9.83 yr (SD=2.77). A total of 72 girls and 60 boys participated in this study with a mean pain severity for headache in last three months before the research of 4.99 (SD=2.63). Probable sex differences according to parental pain catastrophizing, pain severity, anxiety, and depression were assessed amongst parents. In the next step, the predictability of pain severity from parental pain catastrophizing was evaluated. Results indicated a significant relationship in maternal pain catastrophizing and estimates of pain intensity by mothers. Conclusion These findings represent the importance of parent’s especially mother’s cognitive factors affecting their reports of their children’s pain and related emotional disturbances. PMID:29379563

Peripheral neuromodulation: a review.

PubMed

Goroszeniuk, Teodor; Pang, David

2014-05-01

Peripheral nerve stimulation (PNS) is likely the most diverse and rapidly expanding area of neuromodulation. Its expansion has become possible due to both technological and clinical advances in pain medicine. The first implantable systems were surgically placed. However, it is currently commonplace to use percutaneous leads, as this approach has become instrumental in its expansion. The first percutaneous peripheral nerve stimulators were reported in 1999. Cylindrical leads were implanted to stimulate the greater occipital nerve to manage intractable headache. It has been expanded into other individual nerves or nerve plexuses to treat neuropathic, visceral, cardiac, abdominal, low back and facial pain. The use of PNS in modulating organ function in treatment of syndromes such as epilepsy, incontinence and obesity with vagal, tibial and gastric stimulation is under extensive investigation. New technologies that allow easier and safer electrode placement are expected to further expand the uses of PNS. A noninvasive stimulation will open this treatment modality to more clinicians of varying backgrounds.

[Analgesic-antispasmodic effect and safety of lysine clonixinate and L-hyoscinbutylbromide in the treatment of dysmenorrhea].

PubMed

Hernández Bueno, J A; de la Jara Díaz, J; Sedeño Cruz, F; Llorens Torres, F

1998-01-01

The purpose of this longitudinal open but not comparative study was to confirm the safety and efficacy of Lysine clonixinate (125 mg) and hyoscinbutylbromide (10 mg) capsules, during a period of observation of there menstrual cycles on 30 women with uterine dysfunction due to primary or secondary dysmenorrhea. The time of evolution for primary dysmenorrhea was of 4.46 years, and for secondary was of 1.77 years. Some associated manifestations of dysmenorrhea were: nausea (92%), vomit (92%), general pain (82.1%), abdominal pain (85.7%) and headache (46.4%). Regarding to the menstrual pain intensity, at first was highly severe in 10.7% severe in 42.9%, and moderate in 46.4%. At the end of the study, only 1 of 28 patients showed menstrual pain of moderate intensity. Only three adverse effects of light intensity were found without needing treatment, related to the manifestations of gastralgia and sleepiness. The association of a spasmolytic analgesic (Lysine clonixinate and hyoscinbutylbromide bromide) on the treatment for primary or secondary dysmenorrhea, reduces and prevents the menstrual pain (colic) as well as the associated manifestations with few spasmolytic association is efficacy and safety.

Assessment of deep dynamic mechanical sensitivity in individuals with tension-type headache: The dynamic pressure algometry.

PubMed

Palacios-Ceña, M; Wang, K; Castaldo, M; Guerrero-Peral, Á; Caminero, A B; Fernández-de-Las-Peñas, C; Arendt-Nielsen, L

2017-09-01

To explore the validity of dynamic pressure algometry for evaluating deep dynamic mechanical sensitivity by assessing its association with headache features and widespread pressure sensitivity in tension-type headache (TTH). One hundred and eighty-eight subjects with TTH (70% women) participated. Deep dynamic sensitivity was assessed with a dynamic pressure algometry set (Aalborg University, Denmark © ) consisting of 11 different rollers including fixed levels from 500 g to 5300 g. Each roller was moved at a speed of 0.5 cm/s over a 60-mm horizontal line covering the temporalis muscle. Dynamic pain threshold (DPT-level of the first painful roller) was determined and pain intensity during DPT was rated on a numerical pain rate scale (NPRS, 0-10). Headache clinical features were collected on a headache diary. As gold standard, static pressure pain thresholds (PPT) were assessed over temporalis, C5/C6 joint, second metacarpal, and tibialis anterior muscle. Side-to-side consistency between DPT (r = 0.843, p < 0.001) and pain evoked (r = 0.712; p < 0.001) by dynamic algometer was observed. DPT was moderately associated with widespread PPTs (0.526 > r > 0.656, all p < 0.001). Furthermore, pain during DPT was negatively associated with widespread PPTs (-0.370 < r < -0.162, all p < 0.05). Dynamic pressure algometry was a valid tool for assessing deep dynamic mechanical sensitivity in TTH. DPT was associated with widespread pressure sensitivity independently of the frequency of headaches supporting that deep dynamic pressure sensitivity within the trigeminal area is consistent with widespread pressure sensitivity. Assessing deep static and dynamic somatic tissue pain sensitivity may provide new opportunities for differentiated diagnostics and possibly a new tool for assessing treatment effects. The current study found that dynamic pressure algometry in the temporalis muscle was associated with widespread pressure pain sensitivity in individuals with tension-type headache. The association was independent of the frequency of headaches. Assessing deep static and dynamic somatic tissue pain sensitivity may provide new opportunities for differentiated diagnostics and possibly a tool for assessing treatment effects. © 2017 European Pain Federation - EFIC®.

Characterization of abdominal pain during methylnaltrexone treatment of opioid-induced constipation in advanced illness: a post hoc analysis of two clinical trials.

PubMed

Slatkin, Neal E; Lynn, Richard; Su, Chinyu; Wang, Wenjin; Israel, Robert J

2011-11-01

Methylnaltrexone is a selective peripherally acting mu-opioid receptor antagonist that decreases the constipating effects of opioids without affecting centrally mediated analgesia. In two double-blind, placebo-controlled, Phase III studies of methylnaltrexone for opioid-induced constipation in patients with advanced illness, abdominal pain was the most common adverse event (AE) reported. This analysis sought to further characterize the Medical Dictionary for Regulatory Activities-defined abdominal pain AEs experienced in these studies. A post hoc analysis of verbatim descriptions was used to further assess AEs characterized as abdominal pain in both trials. Descriptive summary statistics were used to assess severity of abdominal pain, effect of abdominal pain on global pain scores, and other characteristics. Logistic regression analysis was used to determine the association of baseline characteristics with abdominal pain. Most verbatim descriptions of abdominal pain referred to "abdominal cramps" or "cramping." Abdominal pain AEs were mostly mild to moderate in severity and did not affect patients' global evaluation of pain. The incidence of abdominal pain AEs in methylnaltrexone-treated patients was greatest after the first dose and decreased with subsequent doses. No association between abdominal pain AEs and most baseline patient characteristics was noted. Abdominal pain AEs in methylnaltrexone-treated patients in clinical trials are usually described as "cramps" or "cramping," are mostly mild to moderate in severity, and decrease in incidence with subsequent dosing. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

The longitudinal effectiveness of lateral atlantoaxial intra-articular steroid injection in the treatment of cervicogenic headache.

PubMed

Narouze, Samer N; Casanova, Jose; Mekhail, Nagy

2007-03-01

The most accepted mechanism of cervicogenic headache is referred pain from cervical structures innervated by the upper three cervical spinal nerves. The lateral atlantoaxial joint is not an uncommon cause of cervicogenic headache. In this retrospective study, we examined the effect of lateral atlantoaxial intra-articular steroid injection in managing 32 patients with cervicogenic headache who have a clinical picture suggestive of atlantoaxial joint pain. The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires. A total of 115 patients with cervicogenic headache who were referred to our institute were identified. Of those patients, 32 had a clinical picture suggestive of atlantoaxial joint pain and subsequently underwent a diagnostic/therapeutic intra-articular block. Fifteen of the 32 patients (46.8%) had a postprocedure pain score of 0 (95% CI = 17.5-72.1%). Twenty-six of the 32 patients (81.2%) had a decrease in their postprocedure pain score of 50% or more (95% CI = 62.4-97.6%). The mean preprocedure pain score was 6.8 and postprocedure was 2.2 (Bonferroni-adjusted P < 0.001). At 1 and 3 months, the mean pain scores were 1.9 (P < 0.001) and 3.6 (P < 0.008), respectively. However, at 6 months, the mean pain score was 3.7, and this was not statistically significant (P = 0.208). Lateral atlantoaxial intra-articular corticosteroid injections may provide short-term analgesia for patients with pain originating from the lateral atlantoaxial joint.

[Lay and medical conceptions of headache and migraine : Investigation of members of blue collar and service professions].

PubMed

Dreßke, S

2016-08-01

Every professional segment has its own typical forms of stress, which for members result in patterns of bodily conception and interpretation of pain. The way individuals cope with these typical forms of pain reflects their social identity, social status and group membership. In this study pain was investigated from a sociological perspective as a medium contributing to socialization processes in stress collectives. Cultural conceptions of headache and migraine were investigated in members of blue collar occupations, in service professions and patients in specialized medical pain care. In this study 49 qualitative biographical interviews were conducted with patients suffering from headache and migraine. The study population included persons from the general outpatient population and patients recruited from specialized inpatient pain clinics. Members of blue collar occupations with specific body-oriented, mechanical stress patterns and dominant masculine attitudes, perceived headache and migraine as atypical deviations, which are contextualized as body pain. Professionals in the service sector with specific communicative-emotional work patterns perceived headache and migraine as typical and accepted deviations. Both pain conceptions represent dominant body norms and social commitments in each group; however, in specialized pain care these everyday concepts are transformed by increasing expert knowledge resulting in medicalized life styles and in identity conceptions conforming to the medical imperative. The success of specialized treatment of headache depends to a certain extent on the ability of patients to impose a medically regulated life style on their significant others; however, this can conflict with the demands of everyday life.

Examination of the diagnostic validity of 'headache attributed to whiplash injury': a controlled, prospective study.

PubMed

Schrader, H; Stovner, L J; Obelieniene, D; Surkiene, D; Mickeviciene, D; Bovim, G; Sand, T

2006-11-01

Acute and chronic headache attributed to whiplash injury are new diagnostic entities in the International Classification of Headache Disorders, second edition. A main objective of the present study was to assess the validity of these nosologic entities by studying the headache pattern in an inception cohort of 210 rear-end car collision victims and in 210 matched controls. Consecutive drivers involved in rear-end collisions were identified from the daily records of the Traffic Police Department of Kaunas, Lithuania. A standard self-report questionnaire was sent to the drivers between 2 and 7 days after the collision, and their passengers were recruited as well. Headache and neck pain were evaluated within 7 days of the collision, at 2 months and 1 year after the collision. A control group of non-traumatized subjects received questionnaires at the time of the selection and 1 year later. Of the 75 collision victims who developed headache within the first 7 days of the collision, 37 had a clinical picture in accordance with the criteria for acute whiplash headache (i.e., concomitant neck pain) and 38 did not. For acute headache after collision, concomitant neck pain was of no relevance to the headache type or its course. In both these subgroups, migraine and tension-type headache could be diagnosed in similar proportions and the prognosis after 2 months and 1 year was also similar. Preexisting headache was a strong prognostic factor in both groups for both acute and chronic pain. Compared with the non-traumatized control group, the 1-year incidence of new or worsened headache, or of headache improvement, was the same. A likely interpretation of the data is that acute headaches after rear-end car collisions mainly represent episodes of a primary headache precipitated by the stress of the situation. We conclude that the nosologic validity of both acute and chronic whiplash headache is poor as the headaches, in accordance with the criteria lack distinguishing clinical features and have the same prognosis compared with headaches in a control group.

Painful languages of the body: experiences of headache among women in two Peruvian communities.

PubMed

Darghouth, Sarah; Pedersen, Duncan; Bibeau, Gilles; Rousseau, Cecile

2006-09-01

This exploratory study focuses on the understandings of and experiences with headache in two settings in Peru: the Quechua-speaking district of Ayacucho, in southern Peru, and a poor urban district of Lima Metropolitana. More specifically, it explores the personal and collective meanings constructed around women's headache experiences. Structured and open-ended interviews were administered to patients suffering headache to elicit interpretations of headache episodes. An analysis of the collected narratives suggests that headache is often comprehended in a polysemic framework, where meanings ascribed in bodily, emotional, family, and social terms articulate individual and shared notions of suffering within larger contexts of social dislocation. Often woven into experiences of solitude, headache accounts are lived and told in dynamic temporal spaces, and narrate dissolution of family ties and tensions associated with women's roles. The results underscore the significance of patients' subjective interpretations of painful experiences and underscore the connections between bodily and emotional pain and distress experienced at family, community, and larger social levels.

Aspirin is first-line treatment for migraine and episodic tension-type headache regardless of headache intensity.

PubMed

Lampl, Christian; Voelker, Michael; Steiner, Timothy J

2012-01-01

(1) To establish whether pre-treatment headache intensity in migraine or episodic tension-type headache (ETTH) predicts success or failure of treatment with aspirin; and (2) to reflect, accordingly, on the place of aspirin in the management of these disorders. Stepped care in migraine management uses symptomatic treatments as first-line, reserving triptans for those in whom this proves ineffective. Stratified care chooses between symptomatic therapy and triptans as first-line on an individual basis according to perceived illness severity. We questioned the 2 assumptions underpinning stratified care in migraine that greater illness severity: (1) reflects greater need; and (2) is a risk factor for failure of symptomatic treatment but not of triptans. With regard to the first assumption, we developed a rhetorical argument that need for treatment is underpinned by expectation of benefit, not by illness severity. To address the second, we reviewed individual patient data from 6 clinical trials of aspirin 1000 mg in migraine (N = 2079; 1165 moderate headache, 914 severe) and one of aspirin 500 and 1000 mg in ETTH (N = 325; 180 moderate, 145 severe), relating outcome to pre-treatment headache intensity. In migraine, for headache relief at 2 hours, a small (4.7%) and non-significant risk difference (RD) in therapeutic gain favored moderate pain; for pain freedom at 2 hours, therapeutic gains were almost identical (RD: -0.2%). In ETTH, for headache relief at 2 hours, RDs for both aspirin 500 mg (-4.2%) and aspirin 1000 mg (-9.7%) favored severe pain, although neither significantly; for pain freedom at 2 hours, RDs (-14.2 and -3.6) again favored severe pain. In neither migraine nor ETTH does pre-treatment headache intensity predict success or failure of aspirin. This is not an arguable basis for stratified care in migraine. In both disorders, aspirin is first-line treatment regardless of headache intensity. © 2011 American Headache Society.

Pain in Sleepwalking: A Clinical Enigma

PubMed Central

Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves

2015-01-01

Study Objectives: Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes. Design: Cross-sectional case-control study. Setting: Data were collected at the Sleep Disorders Center, Montpellier, France. Participants: One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes. Measurements and Results: Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury. Conclusion: Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia episodes, suggesting a relationship between dissociated brain activity and nociceptive dysregulation. Citation: Lopez R, Jaussent I, Dauvilliers Y. Pain in sleepwalking: a clinical enigma. SLEEP 2015;38(11):1693–1698. PMID:25902807

Effect of systemic monosodium glutamate (MSG) on headache and pericranial muscle sensitivity.

PubMed

Baad-Hansen, L; Cairns, Be; Ernberg, M; Svensson, P

2010-01-01

We conducted a double-blinded, placebo-controlled, crossover study to investigate the occurrence of adverse effects such as headache as well as pain and mechanical sensitivity in pericranial muscles after oral administration of monosodium glutamate (MSG). In three sessions, 14 healthy men drank sugar-free soda that contained either MSG (75 or 150 mg/kg) or NaCl (24 mg/kg, placebo). Plasma glutamate level, pain, pressure pain thresholds and tolerance levels, blood pressure (BP), heart rate and reported adverse effects were assessed for 2 h. No muscle pain or robust changes in mechanical sensitivity were detected, but there was a significant increase in reports of headache and subjectively reported pericranial muscle tenderness after MSG. Systolic BP was elevated in the high MSG session compared with low MSG and placebo. These findings add new information to the concept of MSG headache and craniofacial pain sensitivity.

The Effectiveness of Mindfulness-Based Stress Reduction on Perceived Pain Intensity and Quality of Life in Patients With Chronic Headache.

PubMed

Bakhshani, Nour Mohammad; Amirani, Ahmadreza; Amirifard, Hamed; Shahrakipoor, Mahnaz

2015-08-06

The aim of this study was to determine the effectiveness of Mindfulness-Based Stress reduction (MBSR) on perceived pain intensity and quality of life in patients with chronic headache. Thus, forty patients based on the diagnosis of a neurologist and diagnostic criteria of the International Headache Society (IHS) for migraine and chronic tension-type headache were selected and randomly assigned to the intervention group and control group, respectively. The participants completed the Pain and quality of life (SF-36) questionnaire. The intervention group enrolled in an eight-week MBSR program that incorporated meditation and daily home practice, per week, session of 90-minutes. Results of covariance analysis with the elimination of the pre-test showed significantly improvement of pain and quality of life in the intervention group compared with the control group. The findings from this study revealed that MBSR can be used non-pharmacological intervention for improvement the quality of life and development of strategies to cope with pain in patients with chronic headache. And can be used in combination with other therapies such as pharmacotherapy.

Chronic abdominal wall pain--a diagnostic challenge for the surgeon.

PubMed

Lindsetmo, Rolv-Ole; Stulberg, Jonah

2009-07-01

Chronic abdominal wall pain (CAWP) occurs in about 30% of all patients presenting with chronic abdominal pain. The authors review the literature identified in a PubMed search regarding the abdominal wall as the origin of chronic abdominal pain. CAWP is frequently misinterpreted as visceral or functional abdominal pain. Misdiagnosis often leads to a variety of investigational procedures and even abdominal operations with negative results. With a simple clinical test (Carnett's test), >90% of patients with CAWP can be recognized, without risk for missing intra-abdominal pathology. The condition can be confirmed when the injection of local anesthetics in the trigger point(s) relieves the pain. A fasciotomy in the anterior abdominal rectus muscle sheath through the nerve foramina of the affected branch of one of the anterior intercostal nerves heals the pain.

Can palpation-induced muscle pain pattern contribute to the differential diagnosis among temporomandibular disorders, primary headaches phenotypes and possible bruxism?

PubMed Central

Porporatti, André-Luís; Calderon, Patrícia-dos-Santos; Conti, Paulo-César-Rodrigues; Bonjardim, Leonardo-Rigoldi

2016-01-01

Background The evaluation of possible differences in the distribution or characteristics of palpation-induced pain in the masticatory muscles could be valuable in terms of diagnostic assessment. The aim of this study was to evaluate the impact of different combinations of anterior temporalis (AT) and masseter palpation-induced pain in the diagnostic of temporomandibular disorder (TMD), primary headaches and bruxism. Material and Methods A total of 1200 dental records of orofacial pain adult patients were analyzed. The outcomes were dichotomously classified (presence/absence) as following: a) AT and/or masseter palpation-induced pain; b) myogenous TMD; c) temporomandibular joint (TMJ) arthralgia (arthrogenous TMD); d) migraine; e) tension-type headache (TTH); f) self-reported bruxism. Binomial logistic regression model (α = 5%) was applied to the data considering the palpation-induced muscle pain as the dependent variable. Results Mean age (SD) were 35.7 years (13.4) for 635 included dental records (83% females). Myogenous and arthrogenous TMD, migraine, TTH and bruxism were mainly associated with, respectively, masseter palpation-induced pain (p<0.001 - OR=5.77, 95%CI 3.86-8.62), AT or masseter palpation-induced pain (p<0.001 - OR=2.39, 95%CI 1.57-3.63), bilateral AT palpation-induced pain (p<0.001 - OR=2.67, 95%CI 1.64-4.32), masseter and AT palpation-induced pain (p=0.009 - OR=1.62, 95%CI 1.12-2.33) and bilateral masseter palpation-induced pain (p=0.01 - OR=1.74, 95%CI 1.13-2.69). Conclusions Palpation-induced pain in the masticatory muscles may play a role in the differential diagnosis among painful TMD, primary headaches and bruxism. Key words:Diagnosis, temporomandibular joint disorders, migraine, tension-type headache, bruxism. PMID:26615507

Prevalence of headache and orofacial pain in adults and elders in a Brazilian community: an epidemiological study.

PubMed

de Siqueira, Silvia Regina D T; Vilela, Talissa Tavares; Florindo, Alex Antonio

2015-06-01

Headache and orofacial pain are often persistent and not easy to be evaluated. The objective of this study was to investigate the epidemiology of headache and orofacial pain in Brazilian adults and elders in a district of São Paulo (Brazil). population-based cross-sectional; Adults (18-59 years old) and elderly people (above 60 years old) were evaluated according to their socio-demographic characteristics, prevalence and location of pain and associated factors. The subjects were interviewed about their orofacial complaints, which were investigated with a validated questionnaire. Five hundred and five adults and 385 elders agreed in participating of this study. More than half of the population had pain (45.3% of adults and 56.6% of elderly); 10.6% of subjects had bruxism and 10.2% had toothache; 48.6% of the adults with pain and 58.7% of the elders with pain had impairment in daily activities due to the pain. The prevalence of head and facial pain was 55.5%. Headache was more prevalent in the adult group compared with the elderly group. Bruxism was associated with headache (p = 0.029), toothache (p < 0.001), facial pain (p < 0.001) and fatigue at the face (p = 0.004). This study showed a high prevalence of head and orofacial pain, and their potential aetiologies need further investigation. The pain complaints were associated with comorbidities and the use of medication. Facial painful diseases impact the quality of life of adults and should be diagnosed and treated. © 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

Pain in Sleepwalking: A Clinical Enigma.

PubMed

Lopez, Régis; Jaussent, Isabelle; Dauvilliers, Yves

2015-11-01

Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes. Cross-sectional case-control study. Data were collected at the Sleep Disorders Center, Montpellier, France. One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes. Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury. Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia episodes, suggesting a relationship between dissociated brain activity and nociceptive dysregulation. © 2015 Associated Professional Sleep Societies, LLC.

Medical evacuation for unrecognized abdominal wall pain: a case series.

PubMed

Msonda, Hapu T; Laczek, Jeffrey T

2015-05-01

Chronic abdominal pain is a frequently encountered complaint in the primary care setting. The abdominal wall is the etiology of this pain in 10 to 30% of all cases of chronic abdominal pain. Abdominal cutaneous nerve entrapment at the lateral border of the rectus abdominis muscle has been attributed as a cause of this pain. In the military health care system, patients with unexplained abdominal pain are often transferred to military treatment facilities via the Military Medical Evacuation (MEDEVAC) system. We present two cases of patients who transferred via MEDEVAC to our facility for evaluation and treatment of chronic abdominal pain. Both patients had previously undergone extensive laboratory evaluation, imaging, and invasive procedures, such as esophagogastroduodenoscopy before transfer. Upon arrival, history and physical examinations suggested an abdominal wall source to their pain, and both patients experienced alleviation of their abdominal wall pain with lidocaine and corticosteroid injection. This case series highlights the need for military physicians to be aware of abdominal wall pain. Early diagnosis of abdominal cutaneous nerve entrapment syndrome by eliciting Carnett's sign will limit symptom chronicity, avoid unnecessary testing, and even prevent medical evacuation. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Depression, mood state, and back pain during microgravity simulated by bed rest

NASA Technical Reports Server (NTRS)

Styf, J. R.; Hutchinson, K.; Carlsson, S. G.; Hargens, A. R.

2001-01-01

OBJECTIVE: The objective of this study was to develop a ground-based model for spinal adaptation to microgravity and to study the effects of spinal adaptation on depression, mood state, and pain intensity. METHODS: We investigated back pain, mood state, and depression in six subjects, all of whom were exposed to microgravity, simulated by two forms of bed rest, for 3 days. One form consisted of bed rest with 6 degrees of head-down tilt and balanced traction, and the other consisted of horizontal bed rest. Subjects had a 2-week period of recovery between the studies. The effects of bed rest on pain intensity in the lower back, depression, and mood state were investigated. RESULTS: Subjects experienced significantly more intense lower back pain, lower hemisphere abdominal pain, headache, and leg pain during head-down tilt bed rest. They had higher scores on the Beck Depression Inventory (ie, were more depressed) and significantly lower scores on the activity scale of the Bond-Lader questionnaire. CONCLUSIONS: Bed rest with 6 degrees of head-down tilt may be a better experimental model than horizontal bed rest for inducing the pain and psychosomatic reactions experienced in microgravity. Head-down tilt with balanced traction may be a useful method to induce low back pain, mood changes, and altered self-rated activity level in bed rest studies.

Rebound Headaches

MedlinePlus

... relievers. Common pain relievers such as aspirin and acetaminophen (Tylenol, others) may contribute to rebound headaches — especially ... OTC) pain relievers that combine caffeine, aspirin and acetaminophen (Excedrin, others) are common culprits. This group also ...

The association between adolescent and parental use of non-prescription analgesics for headache and other somatic pain - A cross-sectional study.

PubMed

Hasseleid, Synva Nesheim; Clench-Aas, Jocelyne; Raanaas, Ruth Kjærsti; Lundqvist, Christofer

2017-07-01

Over the last years, concern has been expressed about adolescents' possible liberal attitude towards - and use of - non-prescription analgesics. A high consumption of analgesics is unfortunate as it may lead to various harmful effects and worsening of headache. In order to address this challenge, it is necessary to achieve a more extensive knowledge about adolescent consumption. The main aim of this study was to examine the association between adolescent and parental use of non-prescription analgesics, taking into account headache as well as other somatic pain. The effects of parental prescription analgesics use was a secondary aim. The study is based on data from two cross-sectional health studies conducted in 2005 and 2012 in Norway, including 646 adolescents and an accompanying parent. By using sample weights, the final weighted sample used in the analysis was 1326. Data was collected through postal questionnaires to parents and adolescents as well as parental telephone interviews. Questionnaires included questions on different pain locations and the pain for each location was graded according to how troubling the pain was. Medication data on prescription and non-prescription analgesics was from telephone interviews and was quantified based on the pattern over the past 4 weeks. Multivariate logistic regression models and complex samples analyses were used. 20% of adolescents were reported as using non-prescription analgesics during the previous 4 weeks. Girls were more often reported to use non-prescription analgesics than boys. Headache and all other somatic pain locations except back pain were reported more frequently among girls while boys more frequently reported back pain. There was a clear association between the use of non-prescription analgesics and headache with 34% of adolescents with headache using non-prescription analgesics versus 19% of adolescents with other somatic pain and 14% of adolescents not reporting pain. Among adolescents reporting headache, 9% were reported to use non-prescription analgesics daily or almost daily versus 3% and 2% among those reporting other somatic pain and reporting no pain respectively. In addition, parental use of non-prescription analgesics was a strong independent predictor of adolescent use (adjusted OR 1.69 for boys, 1.54 for girls). This relationship increased when the adolescents were less bothered by headache themselves. Headache is the dominant medication-driving pain for non-prescription analgesics among adolescents but parental medication use of non-prescription analgesics also strongly influences adolescent use. There is a need for health services to improve information to parents and adolescents about risks associated with use of analgesics and also to work on prophylactic strategies focusing on adolescents. Parents should be made aware that their medicine use strongly influences that of their children. Copyright © 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Sinus Headaches

MedlinePlus

... Achy feeling in your upper teeth Sinusitis or migraine? Migraines and headaches from sinusitis are easy to confuse ... types of headaches may overlap. Both sinusitis and migraine headache pain often gets worse when you bend ...

Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement.

PubMed

Gil-Martínez, Alfonso; Grande-Alonso, Mónica; López-de-Uralde-Villanueva, Ibai; López-López, Almudena; Fernández-Carnero, Josué; La Touche, Roy

2016-12-01

The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD). A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11). A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p < 0.001, d = 1.99; and p < 0.001, d = 1.17), craniomandibular pain and disability (p < 0.001, d = 1.34; and p < 0.001, d = 0.9, respectively), and impact of headache (p < 0.001, d = 1.91; and p < 0.001, d = 0.91, respectively). In addition, significant differences were observed between JP group and MP group for impact of headache (p < 0.001, d = 1.08). Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (β = 0.62; p < 0.001). In the mixed chronic pain group, neck disability (β = 0.40; p < 0.001) and kinesiophobia (β = 0.30; p = 0.03) were significant covariate (33 % of variance) of craniomandibular pain and disability. Mixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain.

Managing Rocky Mountain spotted fever.

PubMed

Minniear, Timothy D; Buckingham, Steven C

2009-11-01

Rocky Mountain spotted fever is caused by the tick-borne bacterium Rickettsia rickettsii. Symptoms range from moderate illness to severe illness, including cardiovascular compromise, coma and death. The disease is prevalent in most of the USA, especially during warmer months. The trademark presentation is fever and rash with a history of tick bite, although tick exposure is unappreciated in over a third of cases. Other signature symptoms include headache and abdominal pain. The antibiotic therapy of choice for R. rickettsii infection is doxycycline. Preventive measures for Rocky Mountain spotted fever and other tick-borne diseases include: wearing long-sleeved, light colored clothing; checking for tick attachment and removing attached ticks promptly; applying topical insect repellent; and treating clothing with permethrin.

Fatal yellow fever in a traveler returning from Venezuela, 1999.

PubMed

2000-04-14

On September 28, 1999, a previously healthy 48-year-old man from California sought care at a local emergency department (ED) and was hospitalized with a 2-day history of fever (102 F [38.9 C]), chills, headache, photophobia, diffuse myalgias, joint pains, nausea, vomiting, constipation, upper abdominal discomfort, and general weakness. On September 26, he had returned from a 10-day trip to Venezuela. On September 29, an infectious disease physician from the ED contacted the Marin County Health Department (MCHD) about the patient's symptoms; MCHD reported his illness to the California Department of Health Services (CDHS) as a suspected case of viral hemorrhagic fever. This report describes the investigation of the case.

Brazilian Spotted Fever: the importance of dermatological signs for early diagnosis*

PubMed Central

Couto, Daíne Vargas; Medeiros, Marcelo Zanolli; Hans, Gunter; de Lima, Alexandre Moretti; Barbosa, Aline Blanco; Vicari, Carolina Faria Santos

2015-01-01

Brazilian spotted fever is an acute febrile infectious disease caused by Rickettsia rickettsii, transmitted by tick bite. As this disease is rare and has high mortality rates in Brazil, the clinical aspects and epidemiological data may help the diagnosis. We report a case of Brazilian spotted fever in a 19-year-old patient who presented maculopapular exanthema in the palmar region and upper limbs, lymphadenopathy, fever, chills, headache, conjunctival hyperemia, nausea, vomiting, dyspnea, myalgia, developing neurological signs and abdominal pain. He was treated with doxycycline with clinical improvement. We emphasize the importance of the recognition of this disease by dermatologists as cutaneous manifestations are the key findings to establish early diagnosis and prevent complications. PMID:25830998

Maintenance of Pain in Children With Functional Abdominal Pain.

PubMed

Czyzewski, Danita I; Self, Mariella M; Williams, Amy E; Weidler, Erica M; Blatz, Allison M; Shulman, Robert J

2016-03-01

A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of 3 methods for assessing pain-stooling relations (ie, diary, parent report, child report). Seventy-six children (7-10 years old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18 to 24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent questionnaires were examined in relationship to the persistence of abdominal pain frequency. Children's baseline anxiety was not related to persistence of pain frequency. Children who, however, displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not.

Psychological Risk Factors in Headache

PubMed Central

Nicholson, Robert A.; Houle, Timothy T.; Rhudy, Jamie L.; Norton, Peter J.

2008-01-01

Headache is a chronic disease that occurs with varying frequency and results in varying levels of disability. To date, the majority of research and clinical focus has been on the role of biological factors in headache and headache-related disability. However, reliance on a purely biomedical model of headache does not account for all aspects of headache and associated disability. Using a biopsychosocial framework, the current manuscript expands the view of what factors influence headache by considering the role psychological (i.e., cognitive and affective) factors have in the development, course, and consequences of headache. The manuscript initially reviews evidence showing that neural circuits responsible for cognitive–affective phenomena are highly interconnected with the circuitry responsible for headache pain. The manuscript then reviews the influence cognitions (locus of control and self-efficacy) and negative affect (depression, anxiety, and anger) have on the development of headache attacks, perception of headache pain, adherence to prescribed treatment, headache treatment outcome, and headache-related disability. The manuscript concludes with a discussion of the clinical implications of considering psychological factors when treating headache. PMID:17371358

Associations between pain drawing and psychological characteristics of different body region pains.

PubMed

Hayashi, Kazuhiro; Arai, Young-Chang P; Morimoto, Atsuko; Aono, Shuichi; Yoshimoto, Takahiko; Nishihara, Makoto; Osuga, Tomoaki; Inoue, Shinsuke; Ushida, Takahiro

2015-04-01

Pain drawings have frequently been used for documentation of pain and a convenient diagnosis tool. Pain drawings were found to be associated with psychological states in chronic patients with low back pain. Few researchers have investigated pain drawings except in low back pain. The aim of this study was to investigate the pain, pain drawings, psychological characteristics, and pain interference in the head, neck-shoulder (NS), and low-back/lower-limb (LB-LL) regions among patients with chronic pain. We included a total of 291 patients with new chronic pain (headache, 62; NS pain, 87; LB-LL pain, 142). The pain drawings and scores of 10-cm Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Short-Form McGill Pain Questionnaire (SF-MPQ), and Pain Disability Assessment Scale (PDAS) were extracted from medical records. A subset of 60 pain drawings was scored by senior and junior evaluators to assess inter-rater agreement. We investigated the correlation between pain drawings and VAS, HADS, PCS, SF-MPQ, and PDAS in each body region group at the initial visit. Moreover, almost all patients received nonsurgical treatment as a follow-up and were investigated using VAS after treatment. The reliability of pain drawings was substantial with an interevaluator reliability in headache, NS, and LB-LL pain. Nonorganic pain drawings were associated with psychological disturbances in NS and LB-LL pain, but not headache. Poor outcomes were associated with nonorganic drawings in LB-LL pain, but not in the case of headache or NS pain. Our results suggest that the characteristics of patients with nonorganic drawings differ according to body regions. © 2014 World Institute of Pain.

Menopause: Medicines to Help You

MedlinePlus

... Side Effects Headaches Painful or tender breasts Vaginal spotting Stomach cramps/ Bloating Nausea and vomiting Hair loss ... Side Effects Headaches Painful or tender breasts Vaginal spotting Stomach cramps/ Bloating Nausea and vomitting Hair loss ...

Exertional headache and coronary ischemia despite normal electrocardiographic stress testing.

PubMed

Cutrer, F Michael; Huerter, Karina

2006-01-01

Exertional headaches may under certain conditions reflect coronary ischemia. We report the case of a patient seen in a neurology referral practice whose exertional headaches, even in the face of two normal electrocardiographic stress tests and in the absence of underlying chest pain were the sole symptoms of coronary ischemia as detected by Tc-99m Sestamibi testing SPECT stress testing. Stent placement resulted in complete resolution of headaches. Exertional headache in the absence of chest pain may reflect underlying symptomatic coronary artery disease (CAD) even when conventional electrocardiographic stress testing does not indicate ischemia.

[The Investigation of Prevalence of Enterobius vermicularis (L.1758) in Primary School Age Children and Its Relation to Various Symptoms].

PubMed

Yazgan, Serkan; Çetinkaya, Ülfet; Şahin, İzzet

2015-06-01

In this study, we aimed to determine the prevalence of Enterobius vermicularis (E. vermicularis) using anal tape technique in four different primary schools in the town of Kayseri. For this purpose, cellophane-tape samples were collected from a total of 438 students. Of all the students, 229 (52.2%) are female and 209 (47.7%) are male. In this study, the relationship between E. vermicularis and the parameters such as school, gender, residential structure, bathroom, water source, parents' monthly income, the number of rooms and members in the house and some symptoms such as anal itching, nasal itching, allergies, irritability, headaches and dizziness, night fears, dental grinding at night, abdominal pain, diarrhea, loss of appetite and weight loss were investigated. E. vermicularis was determined in 44 of the 438 students (which is 10.4%). There were statistically significant relation between
E. vermicularis and parameters such as residential structure, the number of rooms in the house, dental grinding at night, abdominal pain, parents' level of education. There was also statistically significant relation between E. vermicularis and socio-echonomical situation of primary schools. We believe that carrying out periodic screening in schools in which especially low-income and parasite-infected children should be treated, informed about prevention and control methods.

Adolescent disc degeneration--no headache association.

PubMed

Laimi, K; Erkintalo, M; Metsähonkala, L; Vahlberg, T; Mikkelsson, M; Sonninen, P; Parkkola, R; Aromaa, M; Sillanpäa, M; Rautava, P; Anttila, P; Salminen, J

2007-01-01

The objective of the study was to determine whether adolescents with headache have more disc degeneration in the cervical spine than headache-free controls. This study is part of a population-based follow-up study of adolescents with and without headache. At the age of 17 years, adolescents with headache at least three times a month (N = 47) and adolescents with no headache (N = 22) participated in a magnetic resonance imaging (MRI) study of the cervical spine. Of the 47 headache sufferers, 17 also had weekly neck pain and 30 had neck pain less than once a month. MRI scans were interpreted independently by three neuroradiologists. Disc degeneration was found in 67% of participants, with no difference between adolescents with and without headache. Most of the degenerative changes were located in the lower cervical spine. In adolescence, mild degenerative changes of the cervical spine are surprisingly common but do not contribute to headache.

[Rome III classification of functional gastrointestinal disorders in children with chronic abdominal pain].

PubMed

Plocek, Anna; Wasowska-Królikowska, Krystyna; Toporowska-Kowalska, Ewa

2010-01-01

The updated Rome III Classification of paediatric functional gastrointestinal disorders (FGIDs) associated with abdominal pain comprises: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, functional abdominal pain (FAP), functional abdominal pain syndrome (FAPS). To assess the value of the Rome criteria in identifying FGIDs in children with chronic abdominal pain. The study group consisted of 439 consecutive paediatric patients (192 boys and 247 girls) aged 4-18 years (mean age was 11.95 +/- 3.89 years) referred to the Paediatric Gastroenterology Department at Medical University of Lodz from January 2008 to June 2009 for evaluation of abdominal pain of at least 2 months' duration. After exclusion of organic disease children suspected of functional chronic abdominal pain were categorized with the use of Rome III criteria of FGIDs associated with abdominal pain (H2a-H2d1) and the Questionnaire on Paediatric Gastrointestinal Symptoms (with the permission of doctor L. S. Walker). The patients with known nonabdominal organic disease, chronic illness or handicap were excluded. In 161 patients (36.58%) organic etiology was confirmed. Of the 278 children (63.42%) with functional chronic abdominal pain, 228 (82.02%) met the Rome III criteria for FGIDs associated with abdominal pain (FD, 15.5%; IBS, 21.6%; abdominal migraine, 5%; FAP 24.5%; FAPS, 15.9%). Fifty cases (17.98%) did not fulfill the criteria for subtypes of abdominal pain-related FGIDs--mainly due to different as defined by Rome III criteria (at least once per week) frequency of symptom presentation. (1) In the authors'investigations FGIDs was the most frequent cause of chronic abdominal pain in children. (2) The significant number of children with nonclassified FGIDs implies the need to modify the diagnostic criteria of Rome III classification concerning the prevalence of symptoms.

Chronic abdominal wall pain misdiagnosed as functional abdominal pain.

PubMed

van Assen, Tijmen; de Jager-Kievit, Jenneke W A J; Scheltinga, Marc R; Roumen, Rudi M H

2013-01-01

The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. In this cross-sectional analysis, 4 Dutch primary care practices employing physicians who were unaware of the existence of ACNES were selected. A total of 535 patients ≥18 years old who were registered with a functional abdominal pain diagnosis were approached when they were symptomatic to complete the questionnaire (maximum 18 points). Responders who scored at least the 10-point cutoff value (sensitivity, 0.94; specificity, 0.92) underwent a diagnostic evaluation to establish their final diagnosis. The main outcome was the presence and prevalence of ACNES in a group of symptomatic patients diagnosed with functional abdominal pain. Of 535 patients, 304 (57%) responded; 167 subjects (31%) recently reporting symptoms completed the questionnaire. Of 23 patients who scored above the 10-point cutoff value, 18 were available for a diagnostic evaluation. In half of these subjects (n = 9) functional abdominal pain (including IBS) was confirmed. However, the other 9 patients were suffering from abdominal wall pain syndrome, 6 of whom were diagnosed with ACNES (3.6% prevalence rate of symptomatic subjects; 95% confidence interval, 1.7-7.6), whereas the remaining 3 harbored a painful lipoma, an abdominal herniation, and a painful scar. A clinically relevant portion of patients previously diagnosed with functional abdominal pain syndrome in a primary care environment suffers from an abdominal wall pain syndrome such as ACNES.

Recombinant Zoster (Shingles) Vaccine (RZV)

MedlinePlus

... the site of the injection Headache, muscle aches, fever, shivering, fatigue In clinical trials, most people got a ... people felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. About 1 out of ...

Orofacial pain: a guide for the headache physician.

PubMed

Shephard, Martina K; Macgregor, E Anne; Zakrzewska, Joanna M

2014-01-01

Orofacial pain represents a significant burden in terms of morbidity and health service utilization. It includes very common disorders such as toothache and temporomandibular disorders, as well as rare orofacial pain syndromes. Many orofacial pain conditions have overlapping presentations, and diagnostic uncertainty is frequently encountered in clinical practice. This review provides a clinically orientated overview of common and uncommon orofacial pain presentations and diagnoses, with an emphasis on conditions that may be unfamiliar to the headache physician. A holistic approach to orofacial pain management is important, and the social, cultural, psychological and cognitive context of each patient needs to be considered in the process of diagnostic formulation, as well as in the development of a pain management plan according to the biopsychosocial model. Recognition of psychological comorbidities will assist in diagnosis and management planning. © 2013 American Headache Society.

What clues are available for differential diagnosis of headaches in emergency settings?

PubMed

Mert, Ertan; Ozge, Aynur; Taşdelen, Bahar; Yilmaz, Arda; Bilgin, Nursel G

2008-04-01

The correct diagnosis of headache disorders in an emergency room is important for developing early management strategies and determining optimal emergency room activities. This prospective clinical based study was performed in order to determine demographic and clinical clues for differential diagnosis of primary and secondary headache disorders and also to obtain a classification plot for the emergency room practitioners. This study included 174 patients older than 15 years of age presenting in the emergency room with a chief complaint of headache. Definite headache diagnoses were made according to ICHD-II criteria. Classification and regression tree was used as new method for the statistical analysis of the differential diagnostic process. Our 174 patients with headache were diagnosed as basically primary (72.9%) and secondary (27.1%) headaches. Univariate analysis with cross tabs showed three important results. First, unilateral pain location caused 1.431-fold increase in the primary headache risk (p = 0.006). Second, having any triggers caused 1.440-fold increase in the primary headache risk (p = 0.001). Third, having associated co-morbid medical disorders caused 4.643-fold increase in the secondary headache risk (p < 0.001). It was concluded that the presence of comorbidity, the patient's age, the existence of trigger and relaxing factors, the pain in other body parts that accompanies headache and the quality of pain in terms of location and duration were all important clues for physicians in making an accurate differentiation between primary and secondary headaches.

An evidence-based approach to managing the anticoagulated patient in the emergency department.

PubMed

Hanlon, Dennis

2011-01-01

You start another busy shift with a double row of charts waiting to be seen. Your first patient is an elderly man who fell 1 hour prior to presentation. He did not lose consciousness, but he was dazed for a few minutes. He complains of a mild headache but denies any neck pain. He takes warfarin for valvular heart disease. He looks good and has no focal neurological complaints. His mental status is normal, he has a negative head CT scan, and his INR is 3.9. His family wants to take him home, which would help relieve some of the congestion in the ED, but you wonder what would be best. To observe and repeat imaging? Reverse his anticoagulation? Change his dosing regimen of warfarin? In the next room, you quickly evaluate a 51-year-old obese woman with nonspecific back and abdominal pain that started 24 hours before and has slowly progressed to become intolerable. She denies fever, chills, nausea, or vomiting. She is on the last day of a 5-day course of ciprofloxacin for a UTI. She takes warfarin for a pulmonary embolus that occurred 2 months prior. Her hematocrit is mildly decreased, and her white blood count is normal; however, the INR is 6.8. You wonder if her abdominal pain is related to the UTI, or if it could be somehow related to the prolonged INR. In fact, you wonder why her INR is so prolonged...

Patients with chronic tension-type headache demonstrate increased mechano-sensitivity of the supra-orbital nerve.

PubMed

Fernández-de-Las-Peñas, César; Coppieters, Michel W; Cuadrado, María Luz; Pareja, Juan A

2008-04-01

This study aimed to establish whether increased sensitivity to mechanical stimuli is present in neural tissues in chronic tension-type headache (CTTH). Muscle hyperalgesia is a common finding in CTTH. No previous studies have investigated the sensitivity of peripheral nerves in patients with CTTH. A blinded controlled study. Pressure pain thresholds (PPT) and pain intensity following palpation of the supra-orbital nerve (V1) were compared between 20 patients with CTTH and 20 healthy matched subjects. A pressure algometer and numerical pain rate scale were used to quantify PPT and pain to palpation. A headache diary was kept for 4 weeks to substantiate the diagnosis and record the pain history. The analysis of variance demonstrated significantly lower PPT for patients (0.86+/-0.13 kg/cm2) than controls (1.50+/-0.19 kg/cm2) (P<.001). Pain to palpation was also higher for patients (2.73+/-1.58) than controls (0.15+/-0.28) (P<.001). Within the CTTH group, intensity, frequency, and duration of the headaches were negatively correlated with PPT (rsor=0.72; P<.001). These findings reveal that mechanical hypersensitivity is not limited to muscles but also occurs in cranial nerves, and that the level of sensitization, either due to peripheral or central processes, is related to the severity of the primary headache.

Abdominal epilepsy as an unusual cause of abdominal pain: a case report.

PubMed

Yunus, Yilmaz; Sefer, Ustebay; Dondu, Ulker Ustebay; Ismail, Ozanli; Yusuf, Ehi

2016-09-01

Abdominal pain, in etiology sometimes difficult to be defined, is a frequent complaint in childhood. Abdominal epilepsy is a rare cause of abdominal pain. In this article, we report on 5 year old girl patient with abdominal epilepsy. Some investigations (stool investigation, routine blood tests, ultrasonography (USG), electrocardiogram (ECHO) and electrocardiograpy (ECG), holter for 24hr.) were done to understand the origin of these complaints; but no abnormalities were found. Finally an EEG was done during an episode of abdominal pain and it was shown that there were generalized spikes especially precipitated by hyperventilation. The patient did well on valproic acid therapy and EEG was normal 1 month after beginning of the treatment. The cause of chronic recurrent paroxymal abdominal pain is difficult for the clinicians to diagnose in childhood. A lot of disease may lead to paroxysmal gastrointestinal symptoms like familial mediterranean fever and porfiria. Abdominal epilepsy is one of the rare but easily treatable cause of abdominal pain. In conclusion, abdominal epilepsy should be suspected in children with recurrent abdominal pain.

Advances in the understanding of cluster headache.

PubMed

Leone, Massimo; Proietti Cecchini, Alberto

2017-02-01

Cluster headache is the worst primary headache form; it occurs in paroxysmal excruciatingly severe unilateral head pain attacks usually grouped in cluster periods. The familial occurrence of the disease indicates a genetic component but a gene abnormality is yet to be disclosed. Activation of trigeminal afferents and cranial parasympathetic efferents, the so-called trigemino-parasympathetic reflex, can explain pain and accompanying oculo-facial autonomic phenomena. In particular, pain in cluster headache is attributed, at least in part, to the increased CGRP plasma levels released by activated trigeminal system. Posterior hypothalamus was hypothesized to be the cluster generator activating the trigemino-parasympathetic reflex. Efficacy of monoclonal antibodies against CRGP is under investigation in randomized clinical trials. Areas covered: This paper will focus on main findings contributing to consider cluster headache as a neurovascular disorder with an origin from within the brain. Expert commentary: Accumulated evidence with hypothalamic stimulation in cluster headache patients indicate that posterior hypothalamus terminates rather than triggers the attacks. More extensive studies on the genetics of cluster headache are necessary to disclose anomalies behind the increased familial risk of the disease. Results from ongoing clinical trials in cluster headache sufferers using monoclonal antibodies against CGRP will open soon a new era.

Maintenance of Pain in Children with Functional Abdominal Pain

PubMed Central

Czyzewski, Danita I.; Self, Mariella M.; Williams, Amy E.; Weidler, Erica M.; Blatz, Allison M.; Shulman, Robert J.

2015-01-01

Objectives A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of three methods for assessing pain-stooling relations (i.e., diary, parent report, child report). Methods Seventy-six children (7–10-years-old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18–24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent-questionnaires were examined in relationship to the persistence of abdominal pain frequency. Results Children’s baseline anxiety was not related to persistence of pain frequency. However, children who displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. Conclusions The presence of IBS symptoms in school age children with functional abdominal pain appears to predict persistence of abdominal pain over time, while anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not. PMID:26301615

[Clinical Approach to Abdominal Pain as Functional Origin].

PubMed

Ryu, Han Seung; Choi, Suck Chei

2018-02-25

Abdominal pain is a common symptom that patients refer to a hospital. Organic causes should be differentiated in patients with abdominal pain and treatment should be administered in accordance with the causes. A meticulous history taking and physical examination are highly useful in making a diagnosis, and blood tests, imaging modalities, and endoscopy are useful for confirming diagnosis. However, in many cases, patients have functional disorders with no obvious abnormal findings obtained even if many diagnostic tests are performed. Patients with functional disorders usually complain the vague abdominal pain located in the center and other portions of the abdominal area. Although the most representative disease is irritable bowel syndrome, functional abdominal pain syndrome is currently researched as a new disease entity of functional abdominal pain. As various receptors related to functional abdominal pain have been discovered, drugs associated with those receptors are used to treat the disorders, and additional new drugs are vigorously developed. In addition, medical therapy with pharmacological or non-pharmacological psychiatric treatment is effective for treating functional abdominal pain.

Nonsteroidal Anti-Inflammatory Drugs: A survey of practices and concerns of pediatric medical and surgical specialists and a summary of available safety data

PubMed Central

2010-01-01

Objectives To examine the prescribing habits of NSAIDs among pediatric medical and surgical practitioners, and to examine concerns and barriers to their use. Methods A sample of 1289 pediatricians, pediatric rheumatologists, sports medicine physicians, pediatric surgeons and pediatric orthopedic surgeons in the United States and Canada were sent an email link to a 22-question web-based survey. Results 338 surveys (28%) were completed, 84 were undeliverable. Of all respondents, 164 (50%) had never prescribed a selective cyclooxygenase-2 (COX-2) NSAID. The most common reasons for ever prescribing an NSAID were musculoskeletal pain, soft-tissue injury, fever, arthritis, fracture, and headache. Compared to traditional NSAIDs, selective COX-2 NSAIDs were believed to be as safe (42%) or safer (24%); have equal (52%) to greater efficacy (20%) for pain; have equal (59%) to greater efficacy (15%) for inflammation; and have equal (39%) to improved (44%) tolerability. Pediatric rheumatologists reported significantly more frequent abdominal pain (81% vs. 23%), epistaxis (13% vs. 2%), easy bruising (64% vs. 8%), headaches (21% vs. 1%) and fatigue (12% vs. 1%) for traditional NSAIDs than for selective COX-2 NSAIDs. Prescribing habits of NSAIDs have changed since the voluntary withdrawal of rofecoxib and valdecoxib; 3% of pediatric rheumatologists reported giving fewer traditional NSAID prescriptions, and while 57% reported giving fewer selective COX-2 NSAIDs, 26% reported that they no longer prescribed these medications. Conclusions Traditional and selective COX-2 NSAIDs were perceived as safe by pediatric specialists. The data were compared to the published pediatric safety literature. PMID:20181090

Anterior Cutaneous Nerve Entrapment Syndrome in a Pediatric Patient Previously Diagnosed With Functional Abdominal Pain: A Case Report.

PubMed

DiGiusto, Matthew; Suleman, M-Irfan

2018-03-23

Chronic abdominal pain is common in children and adolescents but challenging to diagnose, because practitioners may be concerned about missing serious occult disease. Abdominal wall pain is an often ignored etiology for chronic abdominal pain. Anterior cutaneous nerve entrapment syndrome causes abdominal wall pain but is frequently overlooked. Correctly diagnosing patients with anterior cutaneous nerve entrapment syndrome is important because nerve block interventions are highly successful in the remittance of pain. Here, we present the case of a pediatric patient who received a diagnosis of functional abdominal pain but experienced pain remittance after receiving a trigger-point injection and transverse abdominis plane block.

Radiofrequency thermocoagulation of the thoracic splanchnic nerve in functional abdominal pain syndrome -A case report-.

PubMed

Choi, Ji-Won; Joo, Eun-Young; Lee, Sang-Hyun; Lee, Chul-Joong; Kim, Tae-Hyeong; Sim, Woo-Seok

2011-07-01

The thoracic splanchnic nerve block has been used in managing abdominal pain, especially for pains arising from abdominal cancers. A 27-year-old male patient who had a constant abdominal pain was referred to our clinic for pain management but had no organic disease. The numeric rating scale (NRS) for pain scored 7/10. We applied a diagnostic thoracic splanchnic nerve block under the diagnosis of functional abdominal pain syndrome. Since the block reduced the pain, we applied a radiofrequency thermocoagulation at the T11 and T12 vertebral level. Thereafter, his symptoms improved markedly with pain decreasing to an NRS score of 2-3/10. Hereby, we report a successful management of functional abdominal pain via radiofrequency thermocoagulation of the thoracic splanchnic nerves.

Effect of Different Meditation Types on Migraine Headache Medication Use.

PubMed

Wachholtz, Amy B; Malone, Christopher D; Pargament, Kenneth I

2017-01-01

Spiritual meditation has been found to reduce the frequency of migraines and physiological reactivity to stress. However, little is known about how introducing a spirituality component into a meditation intervention impacts analgesic medication usage. In this study, 92 meditation-naïve participants were randomly assigned to one of four groups: (1) Spiritual Meditation, (n = 25), (2) Internally Focused Secular Meditation (n = 23), (3) Externally Focused Secular Meditation (n = 22), or (4) Progressive Muscle Relaxation (n = 22); and practiced their technique for 20 min/day over 30 days while completing daily diaries. Headache frequency, headache severity, and pain medication use were assessed. Migraine frequency decreased in the Spiritual Meditation group compared to other groups (p < 0.05). Headache severity ratings did not differ across groups (p = ns). After adjusting for headache frequency, migraine medication usage decreased in the Spiritual Meditation group compared to other groups (p < 0.05). Spiritual Meditation was found to not affect pain sensitivity, but it does improve pain tolerance with reduced headache related analgesic medication usage.

[Differential diagnosis of abdominal pain].

PubMed

Frei, Pascal

2015-09-02

Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain.

Migraine Headaches

MedlinePlus

... Staying Safe Videos for Educators Search English Español Migraine Headaches KidsHealth / For Teens / Migraine Headaches What's in ... Prevented? Print en español Las migrañas What Are Migraines? Almost everyone gets headaches. You might feel pain ...

Delayed-onset post-traumatic headache after a motor vehicle collision: a case report

PubMed Central

Stupar, Maja; Kim, Peter SY

2007-01-01

Introduction Headaches are common after a motor vehicle accident (MVA). Post-traumatic headaches share many clinical symptoms including the clinical course of primary headaches. Secondary headaches (including those resulting from a subdural hematoma) are not as common, but should be considered in cases of post-traumatic events particularly if clinical symptoms progress. Clinical Features A case of a patient with a post-traumatic subdural hematoma demonstrates the importance of carefully examining, properly diagnosing and managing patients that experience headaches after MVAs. This patient presented with uncomplicated low back pain, neck pain and headache which progressed at one month to include focal neurological deficits. Since clinical examination alone may not be sufficient to diagnose secondary headaches, immediate referral to the emergency department may be required. Conclusion Primary contact practitioners should be aware of the various causes of headaches that result after a MVA. Headaches, which do not respond or progress, should be followed aggressively to determine their source. PMID:17657301

Differences in regional homogeneity between patients with Crohn's disease with and without abdominal pain revealed by resting-state functional magnetic resonance imaging

PubMed Central

Wu, Lu-Yi; Jin, Xiao-Ming; Wang, Si-Yao; Shi, Yin; Zhang, Jian-Ye; Zeng, Xiao-Qing; Ma, Li-Li; Qin, Wei; Zhao, Ji-Meng; Calhoun, Vince D.; Tian, Jie; Wu, Huan-Gan

2016-01-01

Abnormal pain processing in the central nervous system may be related to abdominal pain in patients with Crohn's disease (CD). The purpose of this study was to investigate changes in resting-state brain activity in CD patients in remission and its relationship with the presence of abdominal pain. Twenty-five CD patients with abdominal pain, 25 CD patients without abdominal pain, and 32 healthy subjects were scanned using a 3.0 T functional magnetic resonance imaging (fMRI) scanner. Regional homogeneity (ReHo) was used to assess resting-state brain activity. Daily pain scores were collected 1 week before fMRI scanning. We found that patients with abdominal pain exhibited lower ReHo values in the insula, middle cingulate cortex (MCC), and supplementary motor area, and higher ReHo values in the temporal pole. In contrast, patients without abdominal pain exhibited lower ReHo values in the hippocampal/parahippocampal cortex and higher ReHo values in the dorsomedial prefrontal cortex (all P<0.05, corrected). The ReHo values of the insula and MCC were significantly negatively correlated with daily pain scores for patients with abdominal pain (r=−0.53, P=0.008, and r=−0.61, P=0.002, respectively). These findings suggest that resting-state brain activities are different between remissive CD patients with and without abdominal pain, and that abnormal activities in insula and MCC are closely related to the severity of abdominal pain. PMID:26761381

Lactose and Fructose Intolerance in Turkish Children with Chronic Abdominal Pain.

PubMed

Yuce, Ozlem; Kalayci, Ayhan Gazi; Comba, Atakan; Eren, Esra; Caltepe, Gonul

2016-05-08

To investigate the prevalence of lactose and fructose intolerance in children with chronic abdominal pain. Hydrogen breath tests were done to detect lactose and fructose malabsorption in 86 children with chronic abdominal pain (44 irritable bowel syndrome, 24 functional abdominal pain and 17 functional abdominal pain syndrome as per Rome III criteria) presenting to a Pediatric Gastroentreology department. 14 (16.3%) of patients were diagnosed with lactose intolerance and 11 (12.8%) with fructose intolerance. Lactose and fructose intolerance in children can lead to chronic abdominal pain and symptoms improve with dietary modifications.

Psychological factors in childhood headaches.

PubMed

Farmer, Kathleen; Dunn, David; Scott, Eric

2010-06-01

Recurrent headaches in children are most often migraines and are based in a genetic predisposition with a low headache threshold. As with any pain experience, there is a large emotional component associated with an attack of migraines that grows in amplitude as the headaches become more frequent and resistant to medicine, sleep, or other agents that used to work. Childhood headaches are especially complicated for 3 reasons: (1) the parents' fear (communicated to the child that serious medical pathology underlies the head pain), (2) the lack of evidence-based pharmacologic treatment, and (3) the belief that these headaches are largely psychological. This article addresses the mystery surrounding childhood headaches by delving into the influence of school, friends, and family; the impact of divorce; the coping skills required for a child to manage a migrainous nervous system; the potential secondary gain from headaches; psychiatric comorbidities and how to treat them; and the role of psychological intervention. Copyright 2010 Elsevier Inc. All rights reserved.

[A case of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing triggered by mumps meningitis in a patient with recurrent primary stabbing headache].

PubMed

Unai, Yuki; Sato, Kenta

2018-03-28

A 32-year-old man with a 16-year history of recurrent primary stabbing headache was admitted to our hospital, owing to mumps meningitis. On day 2 of admission, he began experiencing episodes of unbearable intermittent stabbing pain, each lasting few seconds, with conjunctival injection and tearing, on the temporal side of the left orbit. We suspected trigeminal autonomic cephalgias, and administered non-steroidal anti-inflammatory drugs (NSAIDs), oxygen, and sumatriptan; however, the pain episodes persisted. Subsequently, after the start of intravenous lidocaine administration, the pain episodes stopped. We diagnosed a short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), triggered by mumps meningitis. This is a valuable case report, involving a patient with a history of primary stabbing headache who was diagnosed with SUNCT triggered by mumps meningitis.

Nummular headache update.

PubMed

Pareja, Juan A; Montojo, Teresa; Alvarez, Mónica

2012-04-01

Nummular headache is characterized by head pain exclusively felt in a rounded or elliptical area, typically 1 to 6 cm in diameter. The pain remains confined to the same symptomatic area, which does not change in shape or size with time. The symptomatic area may be localized in any part of the head but mostly in the parietal region. Rarely, the disorder may be multifocal, each symptomatic area keeping all the characteristics of nummular headache. The pain is generally mild or moderate, commonly described as oppressive or stabbing, and lasting minutes, hours, or days, with a remitting or unremitting pattern. Superimposed on the baseline pain, there may be spontaneous or triggered exacerbations. During and between symptomatic periods, the affected area may show variable combinations of hypoesthesia, dysesthesia, paresthesia, tenderness, and trophic changes. Nummular headache emerges as a primary disorder with a clear-cut clinical picture developed in a unique topography.

Cervicogenic headache: a critical review of the current diagnostic criteria.

PubMed

Leone, M; D'Amico, D; Grazzi, L; Attanasio, A; Bussone, G

1998-10-01

Opinions are divided on the use of the term cervicogenic headache (CGH) in cases with no evidence of cervical damage. According to Sjaastad et al. (1990), CGH is diagnosed from three features: (1) unilateral headache triggered by head/neck movements or posture; (2) unilateral headache triggered by pressure on the neck; (3) unilateral headache spreading to the neck and the homolateral shoulder/arm. Other characteristics are not essential for CGH diagnosis, including pain improvement after greater occipital nerve (GON)/C2 block. However, other authors give different definitions of CGH, and this may explain why reported frequencies for this headache vary so widely. In this paper we critically review the major diagnostic criteria of Sjaastad et al. for CGH in the light of clinical studies conducted at our institute and other literature findings. In a study of 500 headaches we found only two patients with unilateral headache triggered by head/ neck movements or posture, and no cases of neck pressure-induced headache. No clear-cut criteria are given in the literature for differentiating CGH trigger points from myofascial trigger points. In another study of 440 primary headache patients we found that in the unilateral long-lasting headache group (64 migraines and 10 tension-type headaches), a pain involving the occiput/neck was present in 30 migraine and seven tension headache patients; thus, according to the CGH major criteria, 10% (30/307) of 'migraines' and 7% (7/96) of 'tension headaches' could be diagnosed as CGH. However, one cannot exclude that the association of unilateral pain with posterior irradiation is due to the high prevalence of migraine, tension-type headache and chronic neck pain. The relation between CGH and whip-lash injury has been put in doubt by a recent study which found no difference in headache frequency between trauma and control groups and reported no specific headache pattern in the trauma group. Other reports suggest that, when it occurs, CGH usually disappears within a year of whip-lash, throwing doubt on the appropriateness of surgery for post-traumatic CGH. The lack of specificity of GON/C2 block as a treatment for CGH adds further difficulties to the diagnosis of this headache. We conclude that, although neck structures play a role in the pathophysiology of some headaches, clinical patterns indicating a neck-headache relationship have still not been adequately defined. We believe that further rigorous studies are needed to definitively confirm the validity of CGH as a nosological entity.

Chronic Abdominal Wall Pain.

PubMed

Koop, Herbert; Koprdova, Simona; Schürmann, Christine

2016-01-29

Chronic abdominal wall pain is a poorly recognized clinical problem despite being an important element in the differential diagnosis of abdominal pain. This review is based on pertinent articles that were retrieved by a selective search in PubMed and EMBASE employing the terms "abdominal wall pain" and "cutaneous nerve entrapment syndrome," as well as on the authors' clinical experience. In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall; in patients with previously diagnosed chronic abdominal pain who have no demonstrable pathological abnormality, this likelihood can rise as high as 30% . There have only been a small number of clinical trials of treatment for this condition. The diagnosis is made on clinical grounds, with the aid of Carnett's test. The characteristic clinical feature is strictly localized pain in the anterior abdominal wall, which is often mischaracterized as a "functional" complaint. In one study, injection of local anesthesia combined with steroids into the painful area was found to relieve pain for 4 weeks in 95% of patients. The injection of lidocaine alone brought about improvement in 83-91% of patients. Long-term pain relief ensued after a single lidocaine injection in 20-30% of patients, after repeated injections in 40-50% , and after combined lidocaine and steroid injections in up to 80% . Pain that persists despite these treatments can be treated with surgery (neurectomy). Chronic abdominal wall pain is easily diagnosed on physical examination and can often be rapidly treated. Any physician treating patients with abdominal pain should be aware of this condition. Further comparative treatment trials will be needed before a validated treatment algorithm can be established.

A comparative study of hepatitis caused by scrub typhus and viral hepatitis A in South Korea.

PubMed

Lee, Jun; Kim, Dong-Min; Yun, Na Ra; Byeon, Yu Mi; Kim, Young Dae; Park, Chan Guk; Kim, Man Woo; Han, Mi Ah

2011-11-01

We compared clinical features and laboratory findings of 104 patients with hepatitis A and 197 patients with scrub typhus. Nausea, vomiting, abdominal pain, hepatomegaly, and jaundice were common in patient with hepatitis A, and fever and headache were significantly more common in patients with scrub typhus. At presentation, an alanine aminotransferase (ALT) level ≥ 500 U/L was observed in 1% of scrub typhus patients and in 87.5% of hepatitis A patients (P < 0.001). A bilirubin level ≥ 1.3 mg/dL was observed in 16.8% of scrub typhus patients and 90.4% of hepatitis A patients. The ALT:lactate dehydrogenase ratio was ≤ 5 in 97.4% of the patients with scrub typhus and > 5 in 95.2% of those with hepatitis A (P < 0.001). Fever, headache, rash, and eschar are findings that indicate scrub typhus. An ALT level ≥ 500 U/L (adjusted odds ratio = 0.011) a bilirubin level ≥ 1.3 (adjusted odds ratio = 0.024), an ALT:lactate dehydrogenase ratio > 5, and hepatomegaly are indications of viral hepatitis A.

A Comparative Study of Hepatitis Caused by Scrub Typhus and Viral Hepatitis A in South Korea

PubMed Central

Lee, Jun; Kim, Dong-Min; Yun, Na Ra; Byeon, Yu Mi; Kim, Young Dae; Park, Chan Guk; Kim, Man Woo; Han, Mi Ah

2011-01-01

We compared clinical features and laboratory findings of 104 patients with hepatitis A and 197 patients with scrub typhus. Nausea, vomiting, abdominal pain, hepatomegaly, and jaundice were common in patient with hepatitis A, and fever and headache were significantly more common in patients with scrub typhus. At presentation, an alanine aminotransferase (ALT) level ≥ 500 U/L was observed in 1% of scrub typhus patients and in 87.5% of hepatitis A patients (P < 0.001). A bilirubin level ≥ 1.3 mg/dL was observed in 16.8% of scrub typhus patients and 90.4% of hepatitis A patients. The ALT:lactate dehydrogenase ratio was ≤ 5 in 97.4% of the patients with scrub typhus and > 5 in 95.2% of those with hepatitis A (P < 0.001). Fever, headache, rash, and eschar are findings that indicate scrub typhus. An ALT level ≥ 500 U/L (adjusted odds ratio = 0.011) a bilirubin level ≥ 1.3 (adjusted odds ratio = 0.024), an ALT:lactate dehydrogenase ratio > 5, and hepatomegaly are indications of viral hepatitis A. PMID:22049041

Can axial pain be helpful to determine surgical level in the multilevel cervical radiculopathy?

PubMed

Suh, Bo-Kyung; You, Ki Han; Park, Moon Soo

2017-01-01

Spine surgeons are required to differentiate symptomatic cervical disc herniation with asymptomatic radiographic herniation. Although the dermatomal sensory dysfunction of upper extremity is the most important clue, axial pain including cervicogenic headache and parascapular pain may be helpful to find surgical target level. However, there is no review article about the axial pain originated from cervical spondylotic radiculopathy and relieved by surgical decompression. The purpose is to review the literatures about the axial pain, which can be utilized in determining target level to be decompressed in the patients with cervical radiculopathy at multiple levels. Cervicogenic headaches of suboccipital headaches, retro-orbital pain, retro-auricular pain, or temporal pain may be associated with C2, C3, and C4 radiculopathies. The pain around scapula may be associated with C5, C6, C7, and C8 radiculopathies. However, there is insufficient evidence to make recommendations for the use in clinical practice because they did not evaluate sensitivity and specificity.

Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia.

PubMed

Kashikar-Zuck, Susmita; Zafar, Marium; Barnett, Kimberly A; Aylward, Brandon S; Strotman, Daniel; Slater, Shalonda K; Allen, Janelle R; Lecates, Susan L; Kabbouche, Marielle A; Ting, Tracy V; Hershey, Andrew D; Powers, Scott W

2013-12-01

Chronic pain in children is associated with significant negative impact on social, emotional, and school functioning. Previous studies on the impact of pain on children's functioning have primarily used mixed samples of pain conditions or single pain conditions (eg, headache and abdominal pain) with relatively small sample sizes. As a result, the similarities and differences in the impact of pain in subgroups of children with chronic pain have not been closely examined. To compare pain characteristics, quality of life, and emotional functioning among youth with pediatric chronic migraine (CM) and juvenile fibromyalgia (JFM). We combined data obtained during screening of patients for 2 relatively large intervention studies of youth (age range, 10 to 18 y) with CM (N=153) and JFM (N=151). Measures of pain intensity, quality of life (Pediatric Quality of Life; PedsQL, child and parent-proxy), depressive symptoms (Children's Depression Inventory), and anxiety symptoms (Adolescent Symptom Inventory-4-Anxiety subscale) were completed by youth and their parent. A multivariate analysis of covariance controlling for effects of age and sex was performed to examine differences in quality of life and emotional functioning between the CM and JFM groups. Youth with JFM had significantly higher anxiety and depressive symptoms, and lower quality of life in all domains. Among children with CM, overall functioning was higher but school functioning was a specific area of concern. Results indicate important differences in subgroups of pediatric pain patients and point to the need for more intensive multidisciplinary intervention for JFM patients.

The import of abdominal pain in adults with sickle cell disorder.

PubMed

Akinola, N O; Bolarinwa, R A; Faponle, A F

2009-03-01

The aetiology, clinical correlates and outcome of abdominal pain in Nigerian adults with sickle cell disorder (SCD) have not been extensively reported. To determine the prevalence of abdominal vasoocclusive crisis in sickle cell patients with abdominal pain and their clinical correlates if any. Clinical records of adults with SCD (Hb SS and Hb SC) attending the Haematology Outpatients' Clinic of the Obafemi Awolowo University Teaching Hospitals Complex, Southwest Nigerian, over a ten-year period, were reviewed. Demographic, clinical and laboratory data with respect to abdominal pain were retrieved. Data were analysed using appropriate descriptive and inferential statistics. A total of 154 records (128 Hb SS and 26 Hb SC) were available for assessment. The patients mean ages were 22.5 +/- 7.3 years (Hb SS patients) and 24.2 +/- 9.7 years (Hb SC patients) (p > 0.05). The prevalence of abdominal pain was 39.1% and 30.8% in Hb SS and Hb SC respectively (p > 0.05). Pain was commonly in the epigastrium; dull in 35% Hb SS, but peppery/burning in 37.5% Hb SC. All patients with abdominal vaso-occlusive crisis (VOC) had diffuse/generalised dull abdominal pains. A diagnosis of gastritis/peptic ulcer disease was made in 50% of Hb SC patients and 28% of Hb SS patients. Abdominal VOC was diagnosed in 26% Hb SS, but none in Hb SC patients. The size of the liver or spleen and the haematocrit of Hb SS patients did not correlate with the frequency of abdominal pain generally or abdominal VOC specifically. The prevalence rates and patterns of abdominal pain in Hb SS and Hb SC patients appear similar. Abdominal VOC characterised by diffuse/generalised dull abdominal pain occurred in only Hb SS patients and may be a marker of disease severity in these patients.

The local and referred pain from myofascial trigger points in the temporalis muscle contributes to pain profile in chronic tension-type headache.

PubMed

Fernández-de-Las-Peñas, César; Ge, Hong-You; Arendt-Nielsen, Lars; Cuadrado, Maria Luz; Pareja, Juan A

2007-01-01

To assess the local and referred pain areas and pain characteristics evoked from temporalis muscle trigger points (TrPs) in chronic tension-type headache (CTTH). Thirty CTTH patients and 30 age and sex-matched controls were studied. A headache diary was kept for 4 weeks to substantiate the diagnosis and record the pain history. Both temporalis muscles were examined for the presence of myofascial TrPs in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold were recorded. Referred pain was evoked in 87% and 54% on the dominant and nondominant sides in CTTH patients, which was significantly higher (P<0.001) than in controls (10% vs. 17%, respectively). Referred pain spread to the temple ipsilateral to the stimulated muscle in both patients and controls, with additional referral behind the eyes in most patients, but none in controls. CTTH patients reported a higher local [visual analog scale (VAS): 5.6+/-1.2 right side, 5.3+/-1.4 left side] and referred pain (VAS: 4.7+/-2 right side, 3.5+/-2.8 left side) intensity than healthy controls (VAS: 0.8+/-0.7 right side, 0.7+/-0.7 left side for local pain; and 0.3+/-0.2 right side, 0.4+/-0.3 left side for referred pain) in both temporalis muscles (both, P<0.001). The local and referred pain areas were larger in patients than in controls (P<0.001). Twenty-three out of 30 CTTH patients (77%) had active TrPs in the temporalis muscle leading to their usual headache (17 patients on the right side; 12 on the left side, whereas 6 with bilateral active TrPs). CTTH patients with active TrPs in either right or left temporalis muscle showed longer headache duration than those with latent TrPs (P=0.004). CTTH patients showed significantly (P<0.001) lower pressure pain threshold (1.1+/-0.2 right side, 1.2+/-0.3 left side) as compared with controls (2.5+/-0.5 right side, 2.6+/-0.4 left side). In CTTH patients, the evoked local and referred pain from active TrPs in the temporalis muscle and its sensory characteristics shared similar patterns as their habitual headache pain. Local and referred pain from active TrPs in the temporalis muscles may constitute one of the sources contributing to the pain profile of CTTH.

Abdominal pain - children under age 12

MedlinePlus

Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can describe it to you. Here are different kinds of pain: ...

Temporomandibular joint and muscle disorder-type pain and comorbid pains in a national US sample.

PubMed

Plesh, Octavia; Adams, Sally H; Gansky, Stuart A

2011-01-01

To compare prevalences of self-reported comorbid headache, neck, back, and joint pains in respondents with temporomandibular joint and muscle disorder (TMJMD)-type pain in the 2000-2005 US National Health Interview Survey (NHIS), and to analyze these self-reported pains by gender and age for Non-Hispanic (NH) Whites (Caucasians), Hispanics, and NH Blacks (African Americans). Data from the 2000-2005 NHIS included information on gender, age, race, ethnicity, education, different common types of pain (specifically TMJMD-type, severe headache/migraine, neck, and low back pains), changes in health status, and health care utilization. Estimates and test statistics (ie, Pearson correlations, regressions, and logistic models) were conducted using SAS survey analysis and SUDAAN software that take into account the complex sample design. A total of 189,977 people (52% female and 48% males, 73% NH Whites, 12% Hispanic, 11% NH Blacks, and 4% "Other") were included. A total of 4.6% reported TMJMD-type pain, and only 0.77% overall reported it without any comorbid headache/migraine, neck, or low back pains; also 59% of the TMJMD-type pain (n = 8,964) reported ⋝ two comorbid pains. Females reported more comorbid pain than males (odds ratio [OR] = 1.41, P < .001); Hispanic and NH Blacks reported more than NH Whites (OR = 1.56, P <.001; OR= 1.38, P <.001, respectively). In addition, 53% of those with TMJMD-type pain had severe headache/migraines, 54% had neck pain, 64% low back pain, and 62% joint pain. Differences in gender and race by age patterns were detected. For females, headache/migraine pain with TMJMD-type pain peaked around age 40 and decreased thereafter regardless of race/ethnicity. Neck pain continued to increase up to about age 60, with a higher prevalence for Hispanic women at younger ages, and more pronounced in males, being the highest in the non-Whites. Low back pain was higher in Black and Hispanic females across the age span, and higher among non-White males after age 60. Joint pain demonstrated similar patterns by race/ethnicity, with higher rates for Black females, and increased with age regardless of gender. TMJMD-type pain was most often associated with other common pains, and seldom existed alone. Two or more comorbid pains were common. Gender, race, and age patterns for pains with TMJMD-type pain resembled the specific underlying comorbid pain.

Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia.

PubMed

Ducic, Ivica; Hartmann, Emily C; Larson, Ethan E

2009-05-01

Occipital neuralgia is a headache syndrome characterized by paroxysmal headaches localizing to the posterior scalp. The critical diagnostic feature is symptomatic response to local anesthetic blockade of the greater or lesser occipital nerve. Further characterization is debated in the literature regarding the diagnosis and optimal management of this condition. The authors present the largest reported series of surgical neurolysis of the greater occipital nerve in the management of occipital neuralgia. A retrospective chart review was conducted to identify 206 consecutive patients undergoing neurolysis of the greater or, less commonly, excision of the greater and/or lesser occipital nerves. A detailed description of the procedure is presented, as is the algorithm for patient selection and timing of surgery. Preoperative and postoperative visual analogue pain scores and migraine headache indices were measured. Success was defined as a reduction in pain of 50 percent or greater. Of 206 patients, 190 underwent greater occipital nerve neurolysis (171 bilateral). Twelve patients underwent greater and lesser occipital nerve excision, whereas four underwent lesser occipital nerve excision alone. The authors found that 80.5 percent of patients experienced at least 50 percent pain relief and 43.4 percent of patients experienced complete relief of headache. Mean preoperative pain score was 7.9 +/- 1.4. Mean postoperative pain was 1.9 +/- 1.8. Minimum duration of follow-up was 12 months. There were two minor complications. Neurolysis of the greater occipital nerve appears to provide safe, durable pain relief in the majority of selected patients with chronic headaches caused by occipital neuralgia.

Abdominal pain in children with sickle cell disease.

PubMed

Rhodes, Melissa M; Bates, David Gregory; Andrews, Tina; Adkins, Laura; Thornton, Jennifer; Denham, Jolanda M

2014-02-01

The differential diagnosis of abdominal pain is broad in any child, and further complicated in children with sickle cell disease (SCD). Acute causes of abdominal pain may require emergent surgery, such as for appendicitis or obstruction caused by a bezoar. Rapid intervention is necessary and life-saving in children with SCD and acute splenic or hepatic sequestration. The majority of children with SCD presenting to the physician's office or emergency department will have subacute reasons for their abdominal pain, including but not limited to constipation, urinary tract infection, peptic ulcer disease, and cholecystitis. Vaso-occlusive pain often presents in children as abdominal pain, but is a diagnosis of exclusion. The case of a 10-year-old girl with intermittent abdominal pain is used as a starting point to review the pathophysiology, diagnosis, and treatment of the most acute and common causes of abdominal pain in children with SCD.

[A commonly seen cause of abdominal pain: abdominal cutaneous nerve entrapment syndrome].

PubMed

Solmaz, Ilker; Talay, Mustafa; Tekindur, Şükrü; Kurt, Ercan

2012-01-01

Although abdominal cutaneous nerve entrapment syndrome (ACNES) is accepted as a rare condition, it is a syndrome that should be diagnosed more commonly when the clinical signs cannot explain the cause of abdominal pain. Abdominal pain is commonly considered by physicians to be based on intra-abdominal causes. Consequently, redundant tests and consultations are requested for these patients, and unnecessary surgical procedures may be applied. Patients with this type of pain are consulted to many clinics, and because their definitive diagnoses cannot be achieved, they are assessed as psychiatric patients. Actually, a common cause of abdominal wall pain is nerve entrapment on the lateral edge of the rectus abdominis muscle. In this paper, we would like to share information about the diagnosis and treatment of a patient who, prior to presenting to us, had applied to different clinics for chronic abdominal pain and had undergone many tests and consultations; abdominal surgery was eventually decided.

Child with Abdominal Pain.

PubMed

Iyer, Rajalakshmi; Nallasamy, Karthi

2018-01-01

Abdominal pain is one of the common symptoms reported by children in urgent care clinics. While most children tend to have self-limiting conditions, the treating pediatrician should watch out for underlying serious causes like intestinal obstruction and perforation peritonitis, which require immediate referral to an emergency department (ED). Abdominal pain may be secondary to surgical or non-surgical causes, and will differ as per the age of the child. The common etiologies for abdominal pain presenting to an urgent care clinic are acute gastro-enteritis, constipation and functional abdominal pain; however, a variety of extra-abdominal conditions may also present as abdominal pain. Meticulous history taking and physical examination are the best tools for diagnosis, while investigations have a limited role in treating benign etiologies.

Pain, emotion, headache.

PubMed

Bussone, Gennaro; Grazzi, Licia; Panerai, Alberto E

2012-10-01

Pain has been considered as part of a defensive strategy whose specific role is to signal an immediate active danger to the organism. This definition fits well for acute pain. It does not work well, however, for chronic pain that is maintained even in absence of an ongoing, active threat. Currently, acute and chronic pain are considered to be separate conditions. What follows is a review of the different theories about pain and its history. Different hypotheses regarding pain mechanisms are illustrated. New data emerging from scientific research on chronic pain (migraine in particular) involving innovative imaging techniques are reported and discussed. © 2012 American Headache Society.

Headache associated with airplane travel: a rare entity.

PubMed

Cherian, Ajith; Mathew, Mini; Iype, Thomas; Sandeep, P; Jabeen, Afshan; Ayyappan, K

2013-01-01

Airplane travel headache is rare and has recently been described as a new form of headache associated with a specific situation. Of the 1,208 patients with primary headaches attending a tertiary care neurology hospital, two (0.16%) patients satisfied the criteria for headache related to airplane travel. Both the patients fulfilled the proposed diagnostic criteria for airplane travel headache. This unique headache had a mean duration of 24 minutes, localized to the medial supraorbital region described as having an intense jabbing or stabbing character that occurred exclusively and maximally during aircraft landing or take-off, following which pain intensity subsided . This rare headache felt on aircraft descent is probably due to the squeeze effect on the frontal sinus wall, when air trapped inside it contracts producing a negative pressure leading to mucosal edema, transudation and intense pain. Use of nasal decongestants either alone or in combination with naproxen sodium prior to ascent and descent abated the headache episodes. Awareness about this unique entity is essential to provide proper treatment and avoid patient suffering.

German Language Adaptation of the Headache Management Self-Efficacy Scale (HMSE-G) and Development of a New Short Form (HMSE-G-SF).

PubMed

Graef, Julia E; Rief, Winfried; French, Douglas J; Nilges, Paul; Nestoriuc, Yvonne

2015-01-01

This study aims to develop and validate a German version of French and colleagues' Headache Management Self-efficacy Scale and to construct an abbreviated form for use in behavioral headache research. Furthermore, the contribution of headache-specific self-efficacy to pain-related disability in German chronic headache sufferers was examined. Headache-specific self-efficacy refers to an individuals' confidence that they can engage in behaviors to either prevent headache episodes or to manage headache-related pain and disability. Self-efficacy beliefs have been shown repeatedly to be positively associated with psychological well-being, effective coping, and enhanced treatment outcomes. A cross-sectional sample of 304 individuals diagnosed with either migraine, chronic tension-type headache, or a combination of 2 or more headache disorders completed the German Headache Management Self-efficacy Scale and questionnaires assessing headache activity, pain-related coping, general self-efficacy, depression, and anxiety. Responsiveness of the scale was analyzed in a longitudinal subsample of 32 inpatients undergoing headache treatment. Finally, a short form was constructed and evaluated regarding psychometric properties. The German Headache Management Self-efficacy Scale showed good reliability (Cronbach's α = 0.87) as did the 6-item short form (Cronbach's α = 0.72). In the longitudinal sample, both versions showed a good ability to change over time (SRM= 0.52-1.16). Chronic headache patients with higher levels of self-efficacy reported lower levels of disability (r = -0.26 to -0.31). Multiple regression analyses revealed headache intensity and headache-specific self-efficacy as strongest predictors of headache-related disability (βself-efficacy  = -0.21, βintensity  = 0.26). Both the 25-item version and the 6-item version appear to be valid, reliable measures of self-efficacy beliefs. These scales will allow clinicians to identify headache sufferers with low levels of headache-specific self-efficacy with the goal of enhancing this expectancy for improvement. The new short form can help accomplish this goal without adding significantly to the burden of the self-report assessment batteries used in clinical settings. © 2015 American Headache Society.

Assessment of the efficacy and safety profiles of aspirin and acetaminophen with codeine: results from 2 randomized, controlled trials in individuals with tension-type headache and postoperative dental pain.

PubMed

Gatoulis, Sergio C; Voelker, Michael; Fisher, Matt

2012-01-01

Aspirin is a widely used NSAID that has been extensively studied in numerous conditions. Nonprescription analgesics, such as aspirin, are frequently used for a wide variety of common ailments, including conditions such as dental pain and tension-type headache. We sought to compare the efficacy and safety profiles of aspirin, acetaminophen with codeine, and placebo in the treatment of post-operative dental pain and tension-type headache. These were 2 randomized, double-blind, placebo-controlled, single-dose clinical trials that assigned participants (2:2:1) to receive either aspirin (1000 mg), acetaminophen (300 mg) with codeine (30 mg), or placebo. The primary efficacy end point was the sum of pain intensity differences from baseline (SPID) over 6 hours for the dental pain study and over 4 hours for the tension-type headache study. Other common analgesic measures, in addition to safety, were also evaluated. The results of the dental pain study for aspirin and acetaminophen with codeine suggest statistically significant efficacy for all measures compared with placebo at all time points. Aspirin provided statistically significant efficacy compared with acetaminophen with codeine for SPID(0-4) (P = 0.028). In the tension-type headache study, aspirin and acetaminophen with codeine provided statistically significant efficacy compared with placebo for SPID(0-4) and SPID(0-6) (P < 0.001) and for total pain relief (P < 0.001). There were no significant differences between aspirin and acetaminophen with codeine at any evaluation of SPID (P ≥ 0.070), complete relief (P ≥ 0.179), or time to meaningful relief (P ≥ 0.245). Regarding safety, there were no statistically significant differences between treatment groups in the incidence of adverse events in the dental pain and tension-type headache studies. These 2 randomized, double-blind, placebo-controlled studies demonstrate that treatment with aspirin (1000 mg) provides statistically significant analgesic efficacy compared with placebo use and comparable efficacy with acetaminophen (300 mg) with codeine (30 mg) therapy after impacted third molar extraction and in tension- type headache. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Chinook wind barosinusitis: an anatomic evaluation.

PubMed

Rudmik, Luke; Muzychuk, Adam; Oddone Paolucci, Elizabeth; Mechor, Brad

2009-01-01

Chinook, or föhn, is a weather phenomenon characterized by a rapid influx of warm, high-pressured winds into a specific location. Pressure changes associated with chinook winds induce facial pain similar to acute sinusitis. The purpose of this study was to determine the relationship between sinonasal anatomy and chinook headaches. Retrospective computed tomography (CT) sinonasal anatomy analysis of 38 patients with chinook headaches and 27 controls (no chinook headaches). The chinook headache status was blinded from the CT reviewer. Forty-one sinonasal anatomy variants, Lund-Mackay status, and sinus size (cm(3)) were recorded. There were three statistically significant sinonasal anatomy differences between patients with and without chinook headaches. The presence of a concha bullosa and sphenoethmoidal cell (Onodi cell) appeared to predispose to chinook headaches (p = 0.004). Chinook headache patients had larger maxillary sinus size (right, p = 0.015, and left, p = 0.002). The Lund-Mackay score was higher in the control patients (p = 0.003) indicating that chronic sinusitis does not play a role in chinook headaches. Chinook winds are a common source of facial pain and pressure. This is the first study to show that sinonasal anatomic variations may be a predisposing factor. Anatomic variants may induce facial pain by blocking the natural sinus ostia, thus preventing adequate pressure equilibrium.

Long-Term Safety and Efficacy of Lubiprostone in Opioid-induced Constipation in Patients with Chronic Noncancer Pain.

PubMed

Spierings, Egilius L H; Rauck, Richard; Brewer, Randall; Marcuard, Stefano; Vallejo, Ricardo

2015-08-29

Chronic opioid analgesic use often causes opioid-induced constipation (OIC). This open-label extension study evaluated the safety and efficacy of lubiprostone, a chloride channel (ClC-2) activator, for treatment of OIC in patients with chronic noncancer pain. Adults with OIC were enrolled from two 12-week, placebo-controlled, double-blind studies and received lubiprostone 24 μg twice daily for up to 9 months. OIC was defined as < 3 spontaneous bowel movements (SBMs)/week during the 2-week baseline period, of which ≥ 25% were characterized by hard to very hard stool consistency, subjectively incomplete evacuation, and/or moderate or worse straining. Inclusion criteria required consistent treatment with full opioid agonists ≥ 30 days prior to screening and throughout the study. All 439 patients who received lubiprostone were analyzed for safety and efficacy. Overall, 24.6% of patients reported treatment-related adverse events (AEs), most commonly nausea (5.0%), diarrhea (4.6%), headache (1.6%), and vomiting (1.4%). No treatment-related serious AEs were reported. Nausea and diarrhea each led to study discontinuation in 5 patients (1.1%); 2 cases each of nausea and diarrhea were rated as severe. Rescue medication usage decreased from month 1 (33.0%) to month 9 (18.6%). Mean weekly SBM frequency (1.4) was significantly increased from baseline at all months (P < 0.001, range 4.9 to 5.3). Straining, abdominal bloating, abdominal discomfort, stool consistency, constipation severity, and bowel habit regularity were significantly improved from baseline at all months (P < 0.001). Lubiprostone treatment was well tolerated and improved symptoms and signs of OIC in this 9-month, open-label study of patients with chronic noncancer pain. © 2015 World Institute of Pain.

Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain--a gender perspective.

PubMed

Bingefors, Kerstin; Isacson, Dag

2004-10-01

Headache and musculo-skeletal pain are major public health problems. Substantial proportions of the general population report that they experience pain problems that affect their work, daily living and social life. Epidemiological studies have consistently shown that the prevalence of most pain conditions is higher in women than in men. Cross-sectional survey in the county of Uppland, Sweden, 1995. Five thousand four hundred and four completed the questionnaire (response rate=68%). In these analyses for persons aged 20-64 years 4506 were included. Back pain (22.7%) and shoulder pain (21.0%) were the most commonly reported medical problems in the population with pain in arms/legs (15.7%) in fifth and headache (12.5%) in eight place. Major gender differences were found. The prevalence of pain conditions, especially headache, was higher among women. Women reported more severe pain. Co-morbidity between pain conditions and psychiatric and somatic problems was higher among women. Health-related quality of life (SF-36) differed by gender and type of pain condition. The physical dimensions of HRQoL were more affected by headache among men; psychological dimensions were more affected among women. Among both men and women, pain conditions were associated with poorer socioeconomic conditions and life-style factors but there were gender differences. Education and unemployment were important only among men while economical difficulties, half-time work and being married were associated with pain among women. Obesity, early disability retirement, long time sick-leave and lack of exercise were associated with pain conditions generally. Factors associated with pain conditions were unevenly distributed between genders. There are major differences between men and women in the prevalence and severity of self-reported pain in the population. Biological factors may explain some of the differences but the main explanation is presumably gender disparities in work, economy, daily living, social life and expectations between women and men. Although improved working conditions are of importance, deeper societal changes are needed to reduce the inequities in pain experiences between women and men.

Systematic Review of the Literature on Pain in Patients with Polytrauma Including Traumatic Brain Injury

PubMed Central

Dobscha, Steven K.; Clark, Michael E.; Morasco, Benjamin J.; Freeman, Michele; Campbell, Rose; Helfand, Mark

2010-01-01

Objective To review the literature addressing the assessment and management of pain in patients with polytraumatic injuries including traumatic brain injury (TBI) and blast-related headache, and to identify patient, clinician and systems factors associated with pain-related outcomes. Design Systematic review. Methods We conducted searches in MEDLINE of literature published from 1950 through July 2008. Due to a limited number of studies using controls or comparators, we included observational and rigorous qualitative studies. We systematically rated the quality of systematic reviews, cohort, and case-control design studies. Results One systematic review, 93 observational studies, and one qualitative research study met inclusion criteria. The literature search yielded no published studies that assessed measures of pain intensity or pain-related functional interference among patients with cognitive deficits due to TBI, that compared patients with blast-related headache with patients with other types of headache, or that assessed treatments for blast-related headache pain. Studies on the association between TBI severity and pain reported mixed findings. There was limited evidence that the following factors are associated with pain among TBI patients: severity, location, and multiplicity of injuries; insomnia; fatigue; depression; and post-traumatic stress disorder. Conclusions Very little evidence is currently available to guide pain assessment and treatment approaches in patients with polytrauma. Further research employing systematic observational as well as controlled intervention designs is clearly indicated. PMID:19818031

Psychometric properties of the Numeric Pain Rating Scale and Neck Disability Index in patients with cervicogenic headache.

PubMed

Young, Ian A; Dunning, James; Butts, Raymond; Cleland, Joshua A; Fernández-de-Las-Peñas, César

2018-01-01

Background Self-reported disability and pain intensity are commonly used outcomes in patients with cervicogenic headaches. However, there is a paucity of psychometric evidence to support the use of these self-report outcomes for individuals treated with cervicogenic headaches. Therefore, it is unknown if these measures are reliable, responsive, or result in meaningful clinically important changes in this patient population. Methods A secondary analysis of a randomized clinical trial (n = 110) examining the effects of spinal manipulative therapy with and without exercise in patients with cervicogenic headaches. Reliability, construct validity, responsiveness and thresholds for minimal detectable change and clinically important difference values were calculated for the Neck Disability Index and Numeric Pain Rating Scale. Results The Neck Disability Index exhibited excellent reliability (ICC = 0.92; [95 % CI: 0.46-0.97]), while the Numeric Pain Rating Scale exhibited moderate reliability (ICC = 0.72; [95 % CI: 0.08-0.90]) in the short term. Both instruments also exhibited adequate responsiveness (area under the curve; range = 0.78-0.93) and construct validity ( p < 0.001) in this headache population. Conclusions Both instruments seem well suited as short-term self-report measures for patients with cervicogenic headaches. Clinicians and researchers should expect at least a 2.5-point reduction on the numeric pain rating scale and a 5.5-point reduction on the neck disability index after 4 weeks of intervention to be considered clinically meaningful.

Chronic post-traumatic headache: clinical findings and possible mechanisms

PubMed Central

Defrin, Ruth

2014-01-01

Chronic post-traumatic headache (CPTHA), the most frequent complaint after traumatic brain injury (TBI), dramatically affects quality of life and function. Despite its high prevalence and persistence, the mechanism of CPTHA is poorly understood. This literature review aimed to analyze the results of studies assessing the characteristics and sensory profile of CPTHA in order to shed light on its possible underlying mechanisms. The search for English language articles published between 1960 and 2013 was conducted in MEDLINE, CINAHL, and PubMed. Studies assessing clinical features of headache after TBI as well as studies conducting quantitative somatosensory testing (QST) in individuals with CPTHA and in individuals suffering from other types of pain were included. Studies on animal models of pain following damage to peripheral tissues and to the peripheral and central nervous system were also included. The clinical features of CPTHA resembled those of primary headache, especially tension-type and migraine headache. Positive and negative signs were prevalent among individuals with CPTHA, in both the head and in other body regions, suggesting the presence of local (cranial) mechanical hypersensitivity, together with generalized thermal hypoesthesia and hypoalgesia. Evidence of dysfunctional pain modulation was also observed. Chronic post-traumatic headache can result from damage to intra- and pericranial tissues that caused chronic sensitization of these tissues. Alternatively, although not mutually exclusive, CPTHA might possibly be a form of central pain due to damage to brain structures involved in pain processing. These, other possibilities, as well as risk factors for CPTHA are discussed at length. PMID:24976746

Treatment by ultrasound-guided local infiltration in adhesion-related abdominal pain and intractable hiccups: A case report.

PubMed

Zhu, Dan; Gu, Zhi-Yong; Lin, Chia-Shiang; Nie, Fa-Chuan; Cui, Jian

2018-04-01

Abdominal pain and hiccups secondary to intra-abdominal adhesion are surgical complications that are often treated by painkillers and secondary surgeries with an unsatisfactory therapeutic effect. This study presents a new treatment method that uses ultrasound-guided local infiltration in peritoneal and abdominal wall adhesions in patients with hiccups and abdominal pain. A 62-year-old patient presented to our hospital with a history of intractable hiccups and abdominal pain for 30 years. Her abdominal examination revealed a scar with an approximate length of 10 cm on the abdominal umbilical plane; pressing the right scar area could simultaneously induce abdominal pain and hiccups. Intraperitoneal computed tomography examination clearly demonstrated that the bowel had no obvious expansion. Ultrasonographic examination found that peritoneal motility below the normal peritoneal adhesion regions was significantly slower than in the normal regions. The diagnosis of chronic postoperative pain syndrome was clear. The symptoms were significantly alleviated by a successful treatment with ultrasound-guided local infiltration in the peritoneal and abdominal wall scar adhesions. After 3 stages of hospitalization and 1 year of follow-up, the patient's abdominal wall pain was relieved by approximately 80% and hiccups were relieved by approximately 70%. The above treatment is a useful option for managing abdominal adhesion and accompanying pain or hiccups resulting from abdominal surgery. This method could ease the psychological and economic burden of patients and improve their quality of life.

Sumatriptan Injection

MedlinePlus

... injection is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine or cluster headaches. Sumatriptan does not prevent migraine ...

Short-lasting headache syndromes and treatment options.

PubMed

Rozen, Todd D

2004-08-01

A number of primary headache syndromes are marked by their short duration of pain. Many of these syndromes have their own unique treatment, so they must be recognized by practicing physicians. In this article, a number of the short-lasting headache disorders are reviewed, including chronic paroxysmal hemicrania, SUNCT syndrome, hypnic headache, exploding head syndrome, primary stabbing headache, and cough headache.

Headache with autonomic features in a child: cluster headache or contact-point headache?

PubMed

Mishra, Devendra; Choudhury, Krishna Kant; Gupta, Alok

2008-03-01

Headache and facial pain due to diseases of the nose and sinuses are not uncommon in children. However, nasal contact-point associated with headache is relatively uncommon and has unclear etiological significance. We herein report a child having headache with autonomic features and contact-point in the nose, and discuss the difficulties in diagnostic categorization.

Using eye movements to investigate selective attention in chronic daily headache.

PubMed

Liossi, Christina; Schoth, Daniel E; Godwin, Hayward J; Liversedge, Simon P

2014-03-01

Previous research has demonstrated that chronic pain is associated with biased processing of pain-related information. Most studies have examined this bias by measuring response latencies. The present study extended previous work by recording eye movement behaviour in individuals with chronic headache and in healthy controls while participants viewed a set of images (i.e., facial expressions) from 4 emotion categories (pain, angry, happy, neutral). Biases in initial orienting were assessed from the location of the initial shift in gaze, and biases in the maintenance of attention were assessed from the duration of gaze on the picture that was initially fixated, and the mean number of visits, and mean fixation duration per image category. The eye movement behaviour of the participants in the chronic headache group was characterised by a bias in initial shift of orienting to pain. There was no evidence of individuals with chronic headache visiting more often, or spending significantly more time viewing, pain images compared to other images. Both participant groups showed a significantly greater bias to maintain gaze longer on happy images, relative to pain, angry, and neutral images. Results are consistent with a pain-related bias that operates in the orienting of attention on pain-related stimuli, and suggest that chronic pain participants' attentional biases for pain-related information are evident even when other emotional stimuli are present. Pain-related information-processing biases appear to be a robust feature of chronic pain and may have an important role in the maintenance of the disorder. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Comparison of post-dural puncture headache and low back pain between 23 and 25 gauge Quincke spinal needles in patients over 60 years: randomized, double-blind controlled trial.

PubMed

Kim, Meehyoung; Yoon, Haesang

2011-11-01

Even though the use of a 25 gauge or smaller Quincke needle is recommended for spinal anesthesia to reduce post-dural puncture headache in Korea, lumbar puncture in older patients using a 25 gauge or smaller Quincke needle can be difficult. However, most previous studies concerning post-dural puncture headache have chosen children, parturients, and young adults as study participants. The study compared post-dural puncture headache, post-operative back pain, and the number of lumbar puncture attempts using a 23 or 25 gauge Quincke needle for spinal anesthesia of Korean patients >60-years-of-age. Randomized, double-blinded controlled trial. The 53 participants who underwent orthopedic surgery under spinal anesthesia were recruited by informed notices from December 2006 through August 2007 at a 200-bed general hospital located in Kyunggido. Inclusion criteria were an age >60 years, ASA I-II, and administration of patient controlled analgesia for the first 48 h post-operatively. The 53 patients were randomly allocated to either the experimental (23 gauge Quincke needle) or control group (25 gauge Quincke needle). All patients had 24 h bed rest post-operatively. Post-dural puncture headache was assessed by the Dittmann Scale and post-operative back pain was assessed by a visual analogue scale at 24, 48, and 72 h post-operatively. The statistical methods included the Mann-Whitney U-test and Spearman correlation. There were no differences in post-dural puncture headache, and post-operative back pain at 24, 48, and 72 h post-operatively, and no differences in the number of lumbar punctures, with the 23 and 25 gauge Quincke needle. Forty-eight hour post-operative back pain was positively associated with the number of lumbar punctures (p=.036) and age (p=.040). There were no statistically significant associations among post-dural puncture headache, the number of lumbar punctures, and 48 h post-operative back pain. Pre-operative back pain was positively associated with 48 h post-operative back pain (p<.001). The choice of a 23 or 25 gauge Quincke needle for spinal anesthesia has no significant influence on post-dural puncture headache and post-operative back pain for Korean patients greater than 60-years-of-age. The 23 gauge Quincke needle is an option for lumbar punctures in this patient population. Copyright © 2011 Elsevier Ltd. All rights reserved.

Helmet-induced headache among Danish military personnel.

PubMed

Rahmani, Zakia; Kochanek, Aneta; Astrup, Jesper Johnsen; Poulsen, Jeppe Nørgaard; Gazerani, Parisa

2017-12-01

External compression headache is defined as a headache caused by an external physical compression applied on the head. It affects about 4% of the general population; however, certain populations (e.g. construction workers and military personnel) with particular needs of headwear or helmet are at higher risk of developing this type of headache. External compression headache is poorly studied in relation to specific populations. This study aimed to investigate the prevalence and pattern of helmet-induced external compression headache among Danish military personnel of the Northern Jutland region in Denmark. Data acquisition was based on a custom-made questionnaire delivered to volunteers who used helmets in the Danish military service and who agreed to participate in this study. The military of the Northern Jutland region of Denmark facilitated recruitment of the participants. The questionnaires were delivered on paper and the collected (anonymous) answers (total 279) were used for further analysis. About 30% of the study participants reported headache in relation to wearing a military helmet. Headache was defined as a pressing pain predominantly in the front of the head with an average intensity of 4 on a visual analogue scale of 0 (no pain) to 10 (worst pain imaginable). It was also found that helmets with different designs influenced both the occurrence of headache and its characteristics. This study is the first to demonstrate the prevalence and pattern of compression headache among military personnel in North Jutland, Denmark. The findings of this study call for further attention to helmet-induced external compression headache and strategies to minimize the burden.

Vitamin D status in patients with musculoskeletal pain, fatigue and headache: a cross-sectional descriptive study in a multi-ethnic general practice in Norway.

PubMed

Knutsen, Kirsten Valebjørg; Brekke, Mette; Gjelstad, Svein; Lagerløv, Per

2010-09-01

To investigate vitamin D levels in patients with non-specific musculoskeletal pain, headache, and fatigue. A cross-sectional descriptive study. A health center in Oslo, Norway, with a multi-ethnic population. A total of 572 patients referred by a general practitioner (GP) for an examination of hypovitaminosis D who reported musculoskeletal pain, headache, or fatigue. The patients' native countries were: Norway (n = 249), Europe, America, and South-East Asia (n = 83), and the Middle East, Africa, and South Asia (n = 240). Both genders and all ages were included. Vitamin D levels (25-hydroxyvitamin D) in nmol/L. Hypovitaminosis D (25-hydroxyvitamin D < 50 nmol/L) was found in 58% of patients. One-third of ethnic Norwegians had hypovitaminosis D, while 83% of patients from the Middle East, Africa, and South Asia had hypovitaminosis D with minimal seasonal variation of levels. One in two women from these countries had a vitamin D level below 25 nmol/L. Mean vitamin D level was lower in patients with headaches compared with patients with other symptoms. Some 15% of patients with low (< 50 nmol/L) vitamin D levels reported headaches, compared with 5% of those with normal vitamin D levels. Our study shows a high prevalence of hypovitaminosis D in patients with non-specific musculoskeletal pain, headache, or fatigue for whom the GP had suspected a low vitamin D level. Hypovitaminosis D was not restricted to immigrant patients. These results indicate that GPs should maintain awareness of hypovitaminosis D and refer patients who report headaches, fatigue, and musculoskeletal pain with minimal sun exposure and a low dietary vitamin D intake for assessment.

Helicobacter pylori gastritis in a child with sickle cell anemia and recurrent abdominal pain.

PubMed

Kennedy, L; Mahoney, D H; Redel, C A

1997-01-01

Recurrent abdominal pain is a common complaint in children with sickle cell disease. Helicobacter pylori gastritis has recently been described in association with recurrent abdominal pain in children. A case report is given of a 16-year-old black male with hemoglobin SS disease presenting with recurrent abdominal pain and hematemesis. Endoscopic exam of the upper gastrointestinal tract revealed gastritis, and biopsy confirmed H. pylori infection. Serology studies demonstrated increased anti-H. pylori antibody titers. The young man responded well to treatment, with resolution of his symptoms. Helicobacter pylori infection is a new diagnostic consideration for children with recurrent abdominal pain and should be included in the differential diagnosis of children with sickle cell disease, especially when abdominal pain is recurrent and accompanied by vomiting. Larger case studies will be necessary to determine the true incidence of H. pylori in children with sickle cell disease and recurrent abdominal pain.

A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve.

PubMed

de Coo, Ilse; van Dijk, J Marc C; Metzemaekers, Jan D M; Haan, Joost

2017-04-01

The term "cluster-tic syndrome" is used for the rare ipsilateral co-occurrence of attacks of cluster headache and trigeminal neuralgia. Medical treatment should combine treatment for cluster headache and trigeminal neuralgia, but is very often unsatisfactory. Here, we describe a 41-year-old woman diagnosed with cluster-tic syndrome who underwent microvascular decompression of the trigeminal nerve, primarily aimed at the "trigeminal neuralgia" part of her pain syndrome. After venous decompression of the trigeminal nerve both a decrease in trigeminal neuralgia and cluster headache attacks was seen. However, the headache did not disappear completely. Furthermore, she reported a decrease in pain intensity of the remaining cluster headache attacks. This case description suggests that venous vascular decompression in cluster-tic syndrome can be remarkably effective, both for trigeminal neuralgia and cluster headache. © 2016 American Headache Society.

Abdominal Pain-Predominant Functional Gastrointestinal Disorders in Jordanian School Children.

PubMed

Altamimi, Eyad M; Al-Safadi, Mohammad H

2014-12-01

Recurrent abdominal pain (RAP) is a common complaint in children. Significant portion of them are of functional origin. This study aimed to assess the prevalence of abdominal pain-predominant functional gastrointestinal disorder (FGID) and its types in Jordanian school children. This is a school-based survey at south Jordan. Information using the self-reporting form of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-RIII) - the official Arabic translation - was collected. Classes from academic years (grades) 6 - 8 were selected. SPSS Statistical Package Version 17 (IBM, Armonk, NY, USA) was used. Categorical data were analyzed using Fisher's exact test, and continuous data were analyzed using t -test. P < 0.05 was considered significant. Five hundred questionnaires were distributed, and 454 returned answered (91%). Two hundred twenty-nine (50.8%) were males. The average age of participants was 12.7 years (11 - 15 years). One hundred sixteen (25.7%) had abdominal pain-predominant FGID. Seventy-nine (68%) of them were females. Forty-seven (10.6%) had irritable bowel syndrome (IBS). Thirty-six (8%), 17 (3.8%), 11 (2.4%) and five (1.1%) had abdominal migraine, functional abdominal pain, functional abdominal pain syndrome and functional dyspepsia, respectively. Abdominal pain-predominant FGID has become a major health issue in Jordanian children. One of four children between the ages of 11 and 15 years exhibits at least one abdominal pain-predominant FGID. The most common form of abdominal pain-predominant FGID in our children was IBS. Females are affected more often than males. Intestinal and extra-intestinal symptoms are seen regularly with abdominal pain-predominant FGIDs.

Developmental trajectories of paediatric headache - sex-specific analyses and predictors.

PubMed

Isensee, Corinna; Fernandez Castelao, Carolin; Kröner-Herwig, Birgit

2016-01-01

Headache is the most common pain disorder in children and adolescents and is associated with diverse dysfunctions and psychological symptoms. Several studies evidenced sex-specific differences in headache frequency. Until now no study exists that examined sex-specific patterns of change in paediatric headache across time and included pain-related somatic and (socio-)psychological predictors. Latent Class Growth Analysis (LCGA) was used in order to identify different trajectory classes of headache across four annual time points in a population-based sample (n = 3 227; mean age 11.34 years; 51.2 % girls). In multinomial logistic regression analyses the influence of several predictors on the class membership was examined. For girls, a four-class model was identified as the best fitting model. While the majority of girls reported no (30.5 %) or moderate headache frequencies (32.5 %) across time, one class with a high level of headache days (20.8 %) and a class with an increasing headache frequency across time (16.2 %) were identified. For boys a two class model with a 'no headache class' (48.6 %) and 'moderate headache class' (51.4 %) showed the best model fit. Regarding logistic regression analyses, migraine and parental headache proved to be stable predictors across sexes. Depression/anxiety was a significant predictor for all pain classes in girls. Life events, dysfunctional stress coping and school burden were also able to differentiate at least between some classes in both sexes. The identified trajectories reflect sex-specific differences in paediatric headache, as seen in the number and type of classes extracted. The documented risk factors can deliver ideas for preventive actions and considerations for treatment programmes.

Outpatient Combined Group and Individual Cognitive-Behavioral Treatment for Patients With Migraine and Tension-Type Headache in a Routine Clinical Setting.

PubMed

Christiansen, Sandra; Jürgens, Tim P; Klinger, Regine

2015-09-01

To test the long-term clinical effectiveness (follow-up at 3, 6 and 12 months) of an outpatient combined group and individual cognitive-behavioral treatment (CBT) for headache patients following standard medical care. A decrease in headache intensity, frequency, headache-specific impairment, depression, and change of pain-related cognitions was expected. The efficacy of CBT for primary headaches has been confirmed in research, yet the translation into clinical practice has remained untested thus far. In this single-group outcome study, 87 headache patients diagnosed with migraine and/or tension-type headache received (1) headache-specific medication for 10 weeks and (2) a subsequent CBT treatment made up of 13 individual and 12 group sessions consisting of psychoeducation, progressive muscle relaxation, coping strategies for pain and stress, and goal setting skills. Booster group sessions after 3 and 6 months were implemented to stimulate individual goal attainment, and follow-up measures were recorded up to 12 months. A significant decrease was found for all primary and secondary outcome criteria, ie, average headache intensity (prae M: 6.0, standard deviation [SD]: 1.5 vs follow-up [FU] 1 year M: 5.1, SD: 1.9), headache frequency (prae M: 16.0, SD: 9.5 vs FU 1 year M: 13.4, SD: 9.9), and catastrophizing (prae M: 3.4, SD: 1.0 vs FU 1 year M: 2.6, SD: 1.1). Coping strategies were increased (prae M: 3.4, SD: .9 vs FU 1 year M: 4.0, SD: 1.0). CBT treatment is a useful component within a routine clinical setting and can improve standard medical care thereby helping patients in managing their headache pain. © 2015 American Headache Society.

Acute abdomen in children due to extra-abdominal causes.

PubMed

Tsalkidis, Aggelos; Gardikis, Stefanos; Cassimos, Dimitrios; Kambouri, Katerina; Tsalkidou, Evanthia; Deftereos, Savas; Chatzimichael, Athanasios

2008-06-01

Acute abdominal pain in children is a common cause for referral to the emergency room and for subsequent hospitalization to pediatric medical or surgical departments. There are rare occasions when the abdominal pain is derived from extra-abdominal organs or systems. The aim of the present study was to establish the most common extra-abdominal causes of acute abdominal pain. The notes of all children (1 month-14 years of age) examined for acute abdominal pain in the Accident and Emergency (A&E) Department of Alexandroupolis District University Hospital in January 2001-December 2005 were analyzed retrospectively. Demographic data, clinical signs and symptoms, and laboratory findings were recorded, as well as the final diagnosis and outcome. Of a total number of 28 124 children who were brought to the A&E department, in 1731 the main complaint was acute abdominal pain. In 51 children their symptoms had an extra-abdominal cause, the most frequent being pneumonia (n = 15), tonsillitis (n = 10), otitis media (n = 9), and acute leukemia (n = 5). Both abdominal and extra-abdominal causes should be considered by a pediatrician who is confronted with a child with acute abdominal pain.

Racial/Ethnic and gender prevalences in reported common pains in a national sample.

PubMed

Plesh, Octavia; Adams, Sally H; Gansky, Stuart A

2011-01-01

To compare prevalences of self-reported temporomandibular joint and muscle disorders (TMJMD)-type pain, headaches, and neck and back pains in the 2000 to 2005 US National Health Interview Survey (NHIS) by gender and age for non-Hispanic Whites (Whites), Hispanics, and non-Hispanic Blacks (Blacks). Data from the 2000 to 2005 NHIS included information on gender, age, race, ethnicity, and different common types of pain specifically: TMJMD-type pain, severe headaches/migraine, neck, and low back pains. A total of 189,992 people were included: 52% female and 48% male, 73% White, 12% Hispanic, 11% Black, and 4% "Other." The overall prevalence of TMJMD-type pain was 4.6%; severe headaches/migraine was 15.4%; neck, 14.9%; and low back, 28.0%. Survey logistic regression models estimating race-specific, age-adjusted curves revealed race by age pain differences. For TMJMD-type pain, White females presented the highest prevalence at younger ages, decreasing after age 40. Prevalences for Hispanic and Black females, although lower at younger ages, increased up to age 60 and remained higher than Whites. Males showed less racial/ethnic and age variation. Severe headaches/migraines presented an age pattern similar to TMJMD-type pain for White females and little overall variation for males, but without racial differences. Neck pain showed some similarities to TMJMD-type pain: higher in Whites at younger ages, lower at older ages, with Hispanics having the highest rates after their 60's. For low back pain, the rates peaked around the sixth decade for all racial/ethnic groups. The patterns of TMJMD-type pain varied greatly within and across racial/ethnic groups by gender and across the adult lifespan. Similarities and differences for the other pains were noted.

Cervical facet arthropathy and occipital neuralgia: headache culprits.

PubMed

Hoppenfeld, J D

2010-12-01

Cervicogenic headache (CH) is pain referred from the neck. Two common causes are cervical facet arthropathy and occipital neuralgia. Clinical diagnosis is difficult because of the overlying features between primary headaches such as migraine, tension-type headache, and CH. Interventional pain physicians have focused on supporting the clinical diagnosis of CH with confirmatory blocks. The treatment of cervical facet arthropathy as the source of CH is best approached with a multidimensional plan focusing on physical therapy and/or manual therapy. The effective management of occipital neuralgia remains challenging, but both injections and neuromodulation are promising options.

Cortical plasticity between the pain and pain-free phases in patients with episodic tension-type headache.

PubMed

Chen, Bing; He, Yuan; Xia, Lei; Guo, Li-Li; Zheng, Jin-Long

2016-12-01

State-related brain structural alterations in patients with episodic tension-type headache (ETTH) are unclear. We aimed to conduct a longitudinal study to explore dynamic gray matter (GM) changes between the pain and pain-free phases in ETTH. We recruited 40 treatment-naïve ETTH patients and 40 healthy controls. All participants underwent brain structural scans on a 3.0-T MRI system. ETTH patients were scanned in and out of pain phases. Voxel-based morphometry analysis was used to determine the differences in regional gray matter density (GMD) between groups. Additional regression analysis was used to identify any associations between regional GMD and clinical symptoms. ETTH patients exhibited reduced GMD in the bilateral primary somatosensory cortex, and increased GMD in the bilateral anterior cingulate cortex (ACC) and anterior insula for the in pain phase compared with the out of pain phase. The out of pain phase of ETTH patients exhibited no regions with higher or lower GMD compared with healthy controls. GMD in the left ACC and left anterior insula was negatively correlated with headache days. GMD in the left ACC was negatively correlated with anxiety and depressive symptoms in ETTH patients. This is the first study to demonstrate dynamic and reversible GMD changes between the pain and pain-free phases in ETTH patients. However, this balance might be disrupted by increased headache days and progressive anxiety and depressive symptoms.

Oooh, Your Aching Head!

MedlinePlus

... syndrome (say: RYE SIN-drome). When Should You Go to a Doctor? Headaches are very rarely a ... is particularly painful when a headache doesn't go away easily when a headache follows an injury, ...

Effectiveness of physiotherapy for seniors with recurrent headaches associated with neck pain and dysfunction: a randomized controlled trial.

PubMed

Uthaikhup, Sureeporn; Assapun, Jenjira; Watcharasaksilp, Kanokwan; Jull, Gwendolen

2017-01-01

A previous study demonstrated that in seniors, the presence of cervical musculoskeletal impairment was not specific to cervicogenic headache but was present in various recurrent headache types. Physiotherapy treatment is indicated in those seniors diagnosed with cervicogenic headache but could also be adjunct treatment for those with cervical musculoskeletal signs who are suspected of having transitional headaches. This study aimed to determine the effectiveness of a physiotherapy program for seniors with recurrent headaches associated with neck pain and cervical musculoskeletal dysfunction, irrespective of the headache classification. This is a prospective, stratified, randomized controlled trial with blinded outcome assessment. Sixty-five participants with recurrent headache, aged 50-75 years, were randomly assigned to either a physiotherapy (n=33) or a usual care group (n=32). The primary outcome was headache frequency. Secondary outcomes were headache intensity and duration, neck pain and disability, cervical range of motion, quality of life, participant satisfaction, and medication intake. Participants in the physiotherapy group received 14 treatment sessions. Participants in the usual care group continued with their usual care. Outcome measures were recorded at baseline, 11 weeks, 6 months, and 9 months. This study was funded by a government research fund of $6,850. No conflict of interest is declared. There was no loss to follow-up for the primary outcome measure. Compared with usual care, participants receiving physiotherapy reported significant reductions in headache frequency immediately after treatment (mean difference -1.6 days, 95% confidence interval [CI] -2.5 to -0.6), at 6-month follow-up (-1.7 days, 95% CI -2.6 to -0.8), and at 9-month follow-up (-2.4 days, 95% CI -3.2 to -1.5), and significant improvements in all secondary outcomes immediately posttreatment and at 6- and 9-month follow-ups, (p<.05 for all). No adverse events were reported. Physiotherapy treatment provided benefits over usual care for seniors with recurrent headache associated with neck pain and dysfunction. Copyright © 2016 Elsevier Inc. All rights reserved.

Efficacy of topical Rose (Rosa damascena Mill.) oil for migraine headache: A randomized double-blinded placebo-controlled cross-over trial.

PubMed

Niazi, Maria; Hashempur, Mohammad Hashem; Taghizadeh, Mohsen; Heydari, Mojtaba; Shariat, Abdolhamid

2017-10-01

To evaluate the effect of topical formulation of Rosa damascena Mill. (R. damascena) oil on migraine headache, applying syndrome diffrentiation model. Forty patients with migraine headache were randomly assigned to 2 groups of this double-blind, placebo-controlled cross-over trial. The patients were treated for the first 2 consecutive migraine headache attacks by topical R. damascena oil or placebo. Then, after one week of washout period, cross-over was done. Pain intensity of the patients' migraine headache was recorded at the beginnig and ten-sequence time schadule of attacks up to 24h. In addition, photophobia, phonophobia, and nausea and/or vomitting (N/V) of the patients were recorded as secondary outcomes. Finally, gathered data were analysed in a syndrome differentiation manner to assess the effect of R. damascena oil on Hot- and Cold-type migraine headache. Mean pain intensity of the patients' migraine headache in the different time-points after R. damascena oil or placebo use, was not significantly different. Additionally, regarding mean scores of N/V, photophobia, and phonophobia severity of the patients, no significant differences between the two groups were observed. Finally, applying syndrome differentiation model, the mean score of migraine headache pain intensity turned out to be significantly lower in patients with "hot" type migraine syndrome at in 30, 45, 60, 90, and 120min after R. damascena oil application compared to "cold" types (P values: 0.001, 0.001, <0.001, <0.001, and 0.02; respectively). It seems that syndrome differentiation can help in selection of patients who may benefit from the topical R. damascena oil in short-term relief of pain intensity in migraine headache. Further studies of longer follow-up and larger study population, however, are necessitated for more scientifically rigorous judgment on efficacy of R. damascena oil for patients with migraine headache. Copyright © 2017 Elsevier Ltd. All rights reserved.

Triptans for acute cluster headache

PubMed Central

Law, Simon; Derry, Sheena; Moore, R Andrew

2014-01-01

Background Cluster headache is an uncommon, but severely painful and disabling condition, with rapid onset. Validated treatment options are limited, and first-line therapy includes inhaled oxygen. Alternative therapies such as intranasal lignocaine and ergotamine are not as commonly used and are less well studied. Triptans are successfully used to treat migraine attacks and, because of this, they may also be useful for cluster headache. Objectives To determine the efficacy and tolerability of triptans for the acute treatment of cluster headaches. Search methods We searched Cochrane CENTRAL, MEDLINE and EMBASE for studies through 22 January 2010. Selection criteria Randomised, double-blind, placebo-controlled studies of triptans for acute treatment of cluster headache episodes. Data collection and analysis Two review authors independently assessed study quality and extracted data. Numbers of participants with different levels of pain relief, requiring rescue medication and experiencing adverse events and headache-associated symptoms in treatment and control groups were used to calculate relative risk and numbers needed to treat (NNT) and harm (NNH). Main results All six included studies used a single dose of triptan to treat an attack of moderate to severe pain intensity. In total 231 participants received zolmitriptan 5 mg, 223 received zolmitriptan 10 mg, 131 received sumatriptan 6 mg, 88 received sumatriptan 12 mg, and 326 received placebo. Zolmitriptan was administered either orally or intranasally, and sumatriptan either subcutaneously or intranasally. Overall, the triptans studied were better than placebo for headache relief and pain-free responses, with an NNT of 2.4 for 15 minute pain relief with subcutaneous sumatriptan 6 mg (75% with sumatriptan and 32% with placebo), and 2.8 for 30 minute pain relief with intranasal zolmitriptan 10 mg (62% with zolmitriptan and 26% with placebo). Fewer participants need rescue medication with triptan than with placebo, but more experienced adverse events. Authors’ conclusions Zolmitriptan and sumatriptan are effective in the acute treatment of cluster headaches and may provide a useful treatment option, potentially offering convenience over oxygen therapy and a better safety and tolerability profile than ergotamine. Non-oral routes of administration are likely to provide better and more rapid responses. PMID:20393964

Pilot trial of osteopathic manipulative therapy for patients with frequent episodic tension-type headache.

PubMed

Rolle, Guido; Tremolizzo, Lucio; Somalvico, Francesco; Ferrarese, Carlo; Bressan, Livio C

2014-09-01

Osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) may be used for managing headache pain and related disability, but there is a need for high-quality randomized controlled trials to assess the effectiveness of this intervention. To explore the efficacy of OMTh for pain management in frequent episodic tension-type headache (TTH). Single-blind randomized placebo-controlled pilot study. Patients were recruited from 5 primary care settings. Forty-four patients who were affected by frequent episodic TTH and not taking any drugs for prophylactic management of episodic TTH were recruited. Patients were randomly allocated to an experimental or control group. The experimental group received corrective OMTh techniques, tailored for each patient; the control group received assessment of the cranial rhythmic impulse (sham therapy). The study included a 1-month baseline period, a 1-month treatment period, and a 3-month follow-up period. The primary outcome was the change in patient-reported headache frequency, and secondary outcomes included changes in headache pain intensity (discrete score, 1 [lowest perceived pain] to 5 [worst perceived pain]), over-the-counter medication use, and Headache Disability Inventory score. Forty patients completed the study (OMTh, n=21; control, n=19). The OMTh group had a significant reduction in headache frequency over time that persisted 1 month (approximate reduction, 40%; P<.001) and 3 months (approximate reduction, 50%; P<.001) after the end of treatment. Moreover, there was an absolute difference between the 2 treatment groups at the end of the study, with a 33% lower frequency of headache in the OMTh group (P<.001). This feasibility study demonstrated the efficacy of OMTh in the management of frequent episodic TTH, compared with sham therapy in a control group. Osteopathic manipulative therapy may be preferred over other treatment modalities and may benefit patients who have adverse effects to medications or who have difficulty complying with pharmacologic regimens. This protocol may serve as a model for future studies. © 2014 The American Osteopathic Association.

Effect of mental stress on cold pain in chronic tension-type headache sufferers.

PubMed

Cathcart, Stuart; Winefield, Anthony H; Lushington, Kurt; Rolan, Paul

2009-10-01

Mental stress is a noted contributing factor in chronic tension-type headache (CTH), however the mechanisms underlying this are not clearly understood. One proposition is that stress aggravates already increased pain sensitivity in CTH sufferers. This hypothesis could be partially tested by examining effects of mental stress on threshold and supra-threshold experimental pain processing in CTH sufferers. Such studies have not been reported to date. The present study measured pain detection and tolerance thresholds and ratings of supra-threshold pain stimulation from cold pressor test in CTH sufferers (CTH-S) and healthy Control (CNT) subjects exposed to a 60-min stressful mental task, and in CTH sufferers exposed to a 60-min neutral condition (CTH-N). Headache sufferers had lower pain tolerance thresholds and increased pain intensity ratings compared to controls. Pain detection and tolerance thresholds decreased and pain intensity ratings increased during the stress task, with a greater reduction in pain detection threshold and increase in pain intensity ratings in the CTH-S compared to CNT group. The results support the hypothesis that mental stress contributes to CTH through aggravating already increased pain sensitivity in CTH sufferers.

Muscle trigger point therapy in tension-type headache.

PubMed

Alonso-Blanco, Cristina; de-la-Llave-Rincón, Ana Isabel; Fernández-de-las-Peñas, César

2012-03-01

Recent evidence suggests that active trigger points (TrPs) in neck and shoulder muscles contribute to tension-type headache. Active TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with chronic and episodic tension-type headache forms. It seems that the pain profile of this headache may be provoked by referred pain from active TrPs in the posterior cervical, head and shoulder muscles. In fact, the presence of active TrPs has been related to a higher degree of sensitization in tension-type headache. Different therapeutic approaches are proposed for proper TrP management. Preliminary evidence indicates that inactivation of TrPs may be effective for the management of tension-type headache, particularly in a subgroup of patients who may respond positively to this approach. Different treatment approaches targeted to TrP inactivation are discussed in the current paper, focusing on tension-type headache. New studies are needed to further delineate the relationship between muscle TrP inactivation and tension-type headache.

Abdominal pain in adult sickle cell disease patients: a nigerian experience.

PubMed

Akingbola, T S; Kolude, B; Aneni, E C; Raji, A A; Iwara, K U; Aken'Ova, Y A; Soyannwo, O A

2011-12-01

Abdominal pain is a relatively frequent occurrence in sickle cell disease. The aetiology of abdominal pain in sickle cell disease is often difficult to diagnose clinically. Despite the frequent occurrence, diagnostic dilemma, and the need for an accurate, early diagnosis, abdominal pain in sickle cell disease has not been rigorously studied. We therefore sought to describe the different presentations and patterns of abdominal pain in persons with sickle cell disease. A prospective case series of 20 patients was done in which data was collected on demographic characteristics, hemoglobin electrophoresis patterns, a description of the abdominal pain including sites, severity, and type of pain, packed cell volume and the provisional and final diagnosis. Haemoglobin S patients were 17 in number constituting eightyfive percent (85%) of our study population whilst the rest 3 were Hb S+C. Most patients (70%) had one site of abdominal pain. The pain was mainly colicky or tightening, moderate to severe in nature and, in some cases, associated with vomiting. We did not find any significant difference between the steady state PCV and the PCV during the acute abdominal pain episodes. The final diagnosis showed that only 38.8% of the patients had vasoocclusive crises and the reliability index between the provisional diagnosis and the final diagnosis was 67%. Abdominal pain in sickle cell disease may present in different ways and it is important to recognize that the possible diagnoses are numerous. Not all cases are due to vasoocclusive crises. Early diagnosis and prompt treatment can be life saving.

Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report.

PubMed

Salvatori, Renata; Rowe, Robert H; Osborne, Raine; Beneciuk, Jason M

2014-06-01

Case report. Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.

National awareness campaign to prevent medication-overuse headache in Denmark.

PubMed

Carlsen, Louise Ninett; Westergaard, Maria Lurenda; Bisgaard, Mette; Schytz, Julie Brogaard; Jensen, Rigmor Højland

2017-01-01

Background Medication-overuse headache is prevalent, but in principle preventable. Objective To describe the Danish national awareness campaign for medication-overuse headache. Methods The Danish Headache Center, the Association of Danish Pharmacies, and headache patient organizations implemented a four-month medication-overuse headache awareness campaign in 2016. Target groups were the general public, general practitioners, and pharmacists. Key messages were: Overuse of pain-medication can worsen headaches; pain-medication should be used rationally; and medication-overuse headache is treatable. A range of communication technologies was used. A survey on the public's awareness of medication-overuse headache was conducted. Results The Danish adult population is 4.2 million. Online videos were viewed 297,000 times in three weeks. All 400 pharmacies received campaign materials. Over 28,000 leaflets were distributed. Two radio interviews were conducted. A television broadcast about headache reached an audience of 520,000. Forty articles were published in print media. Information was accessible at 32 reputable websites and five online news agencies. Three scientific papers were published. Information was available at an annual conference of general practitioners, including a headache lecture. The survey showed an increase in percentage of the public who knew about medication-overuse headache (from 31% to 38%). Conclusion A concerted campaign to prevent medication-overuse headache can be implemented through involvement of key stakeholders.

Temporomandibular Joint and Muscle Disorder (TMJMD) - type pain and Co-morbid Pains in a National US Sample

PubMed Central

Plesh, O; Adams, SH; Gansky, SA

2013-01-01

Aims To compare prevalences of self-reported comorbid headaches, neck, back, and joint pains in respondents with temporomandibular joint and muscle disorder (TMJMD)-type pain in the 2000–2005 US National Health Interview Survey (NHIS), and to analyze these self-reported pains by gender and age for Non-Hispanic (NH) Whites (Caucasians), Hispanics and NH Blacks (African Americans). Methods Data from the 2000–2005 NHIS included information on gender, age, race, ethnicity, education, different common types of pain (specifically: TMJMD-type, severe headache/migraine, neck, and low back pains), changes in health status; and health care utilization. Estimates and test statistics (i.e. Pearson correlations, regressions and logistic models) were conducted using SAS survey analysis and SUDAAN software that take into account the complex sample design. Results A total of 189,977 people: 52% female and 48% males; 73% NH Whites, 12% Hispanic, 11% NH Blacks and 4% “Other” were included. A total of 4.6% reported TMJMD-type pain and only 0.77% overall reported it without any comorbid headache/migraine, neck, or low back pains; also 59% of the TMJMD-type pain (N = 8,964) reported ≥two comorbid pain. Females reported more comorbid pain than males (odds ratio (OR) = 1.41, p <0.001), Hispanic and NH Blacks reported more than NH Whites (OR = 1.56, p <0.001; OR = 1.38, p <0.001, respectively). In addition, 53% of those with TMJMD-type pain had severe headache/migraines; 54% had neck pain, 64% low back pain and 62% joint pain. Differences in gender, race by age patterns were detected. For females, headache/migraine pain with TMJMD-type pain peaked around age 40 and decreased thereafter regardless of race/ethnicity. Neck pain continued to increase up to about age 60, with higher prevalence for Hispanic women at younger ages, and more pronounced in males, being the highest in the non-Whites. Low back pain was higher in Black and Hispanic females across the age span and higher among non-White males after age 60. Joint pain demonstrated similar patterns by race/ethnicity, which higher rates for Black females, and increased with age regardless of gender. Conclusions TMJMD-type pain was most often associated with other common pains, and seldom existed alone. Two or more comorbid pains were common. Gender, race, and age patterns for pains with TMJMD-type pain resembled the specific underlying comorbid pain. PMID:21837286

Cluster headache: present and future therapy.

PubMed

Leone, Massimo; Giustiniani, Alessandro; Cecchini, Alberto Proietti

2017-05-01

Cluster headache is characterized by severe, unilateral headache attacks of orbital, supraorbital or temporal pain lasting 15-180 min accompanied by ipsilateral lacrimation, rhinorrhea and other cranial autonomic manifestations. Cluster headache attacks need fast-acting abortive agents because the pain peaks very quickly; sumatriptan injection is the gold standard acute treatment. First-line preventative drugs include verapamil and carbolithium. Other drugs demonstrated effective in open trials include topiramate, valproic acid, gabapentin and others. Steroids are very effective; local injection in the occipital area is also effective but its prolonged use needs caution. Monoclonal antibodies against calcitonin gene-related peptide are under investigation as prophylactic agents in both episodic and chronic cluster headache. A number of neurostimulation procedures including occipital nerve stimulation, vagus nerve stimulation, sphenopalatine ganglion stimulation and the more invasive hypothalamic stimulation are employed in chronic intractable cluster headache.

Two reports of flight-related headache.

PubMed

Nagatani, Kazuhiko

2013-07-01

Airplane headache is flight-related and appears during airplane landing and/or takeoff without accompanying symptoms. Intracranial and paranasal imaging studies reveal no abnormalities. The etiology is still uncertain, although sinus barotrauma has been proposed as a possible mechanism. 1) A 26-yr-old woman presented with recurring headache during each air travel since she was 22 yr old. Severe bursting pain suddenly manifested in the bilateral orbits and temples during airplane descent, with no accompanying additional symptoms. She had no unusual medical history. X-ray computed tomography (CT) scans showed no abnormalities except thickening of the nasal mucosa. Effective pain relief was obtained with over-the-counter nasal decongestant spray. 2) A 49-yr-old man presented with a 3-yr history of flight-related headache that appeared at airplane touchdown, when he had mental stress, or when he was suffering from a lack of sleep. Pain was of a severe jabbing quality, localized over the forehead with no additional accompanying symptoms. He had a past history of episodic tension-type headache. Intracranial and paranasal CT scan revealed no abnormalities. Headache ceased spontaneously within 40 min of the end of the flight and nonsteroidal anti-inflammatory drug premedication did not prevent the headache. Sinus barotrauma was thought to be a plausible explanation for the headache in Case 1. In Case 2, an anxiety disorder could be considered as an underlying etiology. The etiology of so-called airplane headache is probably protean and this should be taken into account when assessing cases of in-flight cephalalgia.

Melatonin for the treatment of irritable bowel syndrome

PubMed Central

Siah, Kewin Tien Ho; Wong, Reuben Kong Min; Ho, Khek Yu

2014-01-01

Irritable bowel syndrome (IBS) is a common disorder characterized by recurrent abdominal pain or discomfort, in combination with disturbed bowel habits in the absence of identifiable organic cause. Melatonin (N-acetyl-5-methoxytryptamine) is a hormone produced by the pineal gland and also large number by enterochromaffin cells of the digestive mucosa. Melatonin plays an important part in gastrointestinal physiology which includes regulation of gastrointestinal motility, local anti-inflammatory reaction as well as moderation of visceral sensation. Melatonin is commonly given orally. It is categorized by the United States Food and Drug Administration as a dietary supplement. Melatonin treatment has an extremely wide margin of safety though it may cause minor adverse effects, such as headache, rash and nightmares. Melatonin was touted as a potential effective candidate for IBS treatment. Putative role of melatonin in IBS treatment include analgesic effects, regulator of gastrointestinal motility and sensation to sleep promoter. Placebo-controlled studies in melatonin suffered from heterogeneity in methodology. Most studies utilized 3 mg at bedtime as the standard dose of trial. However, all studies had consistently showed improvement in abdominal pain, some showed improvement in quality of life of IBS patients. Melatonin is a relatively safe drug that possesses potential in treating IBS. Future studies should focus on melatonin effect on gut mobility as well as its central nervous system effect to elucidate its role in IBS patients. PMID:24627586

[Gallbladder contractility in children with functional abdominal pain or irritable bowel syndrome].

PubMed

Iwańczak, Franciszek; Siedlecka-Dawidko, Jolanta; Iwanczak, Barbara

2013-07-01

III Rome Criteria of functional gastrointestinal disorders in children, distinguished the disturbances with abdominal pain, to which irritable bowel syndrome, functional abdominal pains, functional dyspepsia and abdominal migraine were included. THE AIM OF THE STUDY was sonographic assessment of the gallbladder and its contractility in functional abdominal pain and irritable bowel syndrome in children. The study comprised 96 children aged 6 to 18 years, 59 girls and 37 boys. Depending on diagnosis, the children were divided into three groups. 38 children with functional abdominal pain constituted the first group, 26 children with irritable bowel syndrome were included to the second group, the third group consisted of 32 healthy children (control group). Diagnosis of functional abdominal pain and irritable bowel syndrome was made based on the III Rome Criteria. In irritable bowel syndrome both forms with diarrhea (13) and with constipation (13) were observed. Anatomy and contractility of the gallbladder were assessed by ultrasound examination. The presence of septum, wall thickness, thick bile, vesicle volume in fasting state and 30th and 60th minute after test meal were taken into consideration. Test meal comprised about 15% of caloric requirement of moderate metabolism. Children with bile stones and organic diseases were excluded from the study. Thickened vesicle wall and thick bile were present more frequently in children with irritable bowel syndrome and functional abdominal pain than in control group (p < 0.02). Fasting vesicle volume was significantly greater in children with functional abdominal pain than in irritable bowel syndrome and control group (p = 0.003, p = 0.05). Vesicle contractility after test meal was greatest in children with functional abdominal pain. Evaluation of diminished (smaller than 30%) and enlarged (greater then 80%) gallbladder contractility at 30th and 60th minute after test meal demonstrated disturbances of contractility in children with irritable bowel syndrome and functional abdominal pain. In children with functional abdominal pain and irritable bowel syndrome disturbances of gallbladder anatomy, fasting volume and contractility after test meal were demonstrated. The observed disturbances require further studies for explanation of their role in functional gastrointestinal disturbances with abdominal pain in children.

Treating Chronic Tension-type Headache Not Responding to Amitriptyline Hydrochloride With Paroxetine Hydrochloride: A Pilot Evaluation

PubMed Central

Holroyd, Kenneth A.; Labus, Jennifer S.; O'Donnell, Francis J.; Cordingley, Gary E.

2007-01-01

Context In some individuals, chronic tension-type headache fails to respond to tricyclic antidepressant medications that often serve as first-line therapy. Objective To evaluate the clinical efficacy of paroxetine hydrochloride for chronic tension-type headache not responding to amitriptyline hydrochloride. Design and Setting Open-label trial of paroxetine conducted at 2 outpatient sites in Ohio. Participants and Intervention Thirty-one adults (mean age, 37 years; 20 women) with chronic tension-type headache (mean, 25 headache days per month) who had failed to respond (less than 30% improvement) to treatment with either amitriptyline (n = 13) or matched placebo (n = 18). All participants were treated with paroxetine (up to 40 mg per day) in a 9-month protocol. Outcome Measures Monthly headache index calculated as the mean of pain ratings (0 to 10 scale) recorded by participants in a diary 4 times per day, number of days per month with at least moderate pain (pain rating of 5 or greater), and analgesic medication use. Results In patients who had not responded to amitriptyline, paroxetine failed to reduce chronic tension-type headaches or analgesic medication use. In patients who had not responded to placebo, paroxetine produced modest reductions in chronic tension-type headaches and analgesic use. Conclusions We found no evidence that chronic tension-type headaches that failed to respond to tricyclic antidepressant therapy with amitriptyline improved when subsequently treated with paroxetine. More support was found for the efficacy of paroxetine in patients with chronic tension-type headaches who had failed to respond to placebo. PMID:14511278

Evidence of Diplopia in Children's Headache Drawings Helps to Differentiate Pseudotumor Cerebri From Migraine.

PubMed

Lee, Erica B; Edelman, Fredrick S; Stafstrom, Carl E

2018-02-01

This study aimed to determine whether children's headache drawings can distinguish between pseudotumor cerebri and migraine. Headache features associated with pseudotumor cerebri (pseudotumor; idiopathic intracranial hypertension) are nonspecific and are difficult to distinguish clinically from migraines. Children's headache drawings have a high predictive value for migraine versus nonmigraine headaches. We hypothesized that drawings could help to differentiate pediatric headaches due to pseudotumor cerebri from those associated with migraines. Children aged six to 18 years old attending university hospital pediatric neurology clinics were asked to draw a picture of how their headache feels. From our database of children's headache drawings, pictures by children with clinically diagnosed pseudotumor were compared with migraine drawings. Headache drawings of 21 children (16 females) with pseudotumor were compared with those of 518 children with migraine. Pseudotumor drawings depicted a variety of symptoms including pounding pain (n = 11), pressure-like pain (n = 3), photophobia (3), dizziness (1), and recumbency (1). Severe pain indicators included hammers, bombs, anvil, and vise grip. Positive visual phenomena included scintillations, scotomata, or blurring (n = 8). Negative visual phenomena included field defects (n = 2). Pseudotumor drawings were similar to migraine drawings except that 6 of 21 pseudotumor drawings (28.6%) depicted diplopia (crossed eyes, double images), whereas only three of 518 migraine drawings (0.6%) depicted diplopia (P < 0.000001). Diplopia was depicted in a significantly higher percentage of pseudotumor drawings than migraine drawings. In all other respects, headache drawings by children with pseudotumor cerebri were similar to those drawn by children with migraine. Copyright © 2017 Elsevier Inc. All rights reserved.

The efficacy of oral habit modification on headache.

PubMed

Agha-Hosseini, Farzaneh; Sheykhbahaei, Nafiseh; Mirzaii-Dizgah, Iraj; Fatehi, Farzad

2017-12-01

Headache is the most common complaint of patients suffering from temporomandibular joint disorders (TMDs). Thus, temporomandibular joint (TMJ) examinations maybe necessary in patients with headache. Considering the high prevalence of bruxism and TMDs in patients with headache the effects of conservative TMD treatment on headache should be assessed. Patients were questioned about headaches in the past three months. Those responding affirmatively to this question were examined for TMD and bruxism. After the examinations, 219 patients remained in the study and received self-management instructions. Patients were requested to modify oral habits except when eating or sleeping. The degree of pain (visual analogue scale), headache disability index (HDI), frequency of headaches (FH) per month and TMD intensity were evaluated. The median levels of pain, HDI, FH, and TMD intensity were 8, 44, 8, and 7, respectively, before modifying oral habits and decreased to 4, 24, 2, and 3, respectively, after intervention. These decreases were statistically significant. Having patients maintain free space between the teeth and relax muscles can be an efficient method to treat headache and TMD, especially when repeated frequently.

Chronic abdominal wall pain and ultrasound-guided abdominal cutaneous nerve infiltration: a case series.

PubMed

Kanakarajan, Saravanakumar; High, Kristina; Nagaraja, Ravi

2011-03-01

Chronic abdominal wall pain occurs in about 10-30% of patients presenting with chronic abdominal pain. Entrapment of abdominal cutaneous nerves at the lateral border of the rectus abdominis muscle has been attributed as a cause of abdominal wall pain. We report our experience of treating such patients using ultrasound-guided abdominal cutaneous nerve infiltration. We conducted a retrospective audit of abdominal cutaneous nerve infiltration performed in the period between September 2008 to August 2009 in our center. All patients had received local anesthetic and steroid injection under ultrasound guidance. The response to the infiltration was evaluated in the post-procedure telephone review as well as in the follow-up clinic. Brief pain inventory (BPI) and numerical rating scale pain scores were collated from two points: the initial outpatient clinic and the follow up clinic up to 5 months following the injection. Nine patients had abdominal cutaneous nerve injections under ultrasound guidance in the period under review. Six patients reported 50% pain relief or more (responders) while three patients did not. Pain and BPI scores showed a decreasing trend in responders. The median duration of follow-up was 12 weeks. Ultrasound can reliably be used for infiltration of the abdominal cutaneous nerves. This will improve the safety as well as diagnostic utility of the procedure. Wiley Periodicals, Inc.

[Modifiable risk factors for primary headache. A systematic review].

PubMed

Albers, L; Ziebarth, S; von Kries, R

2014-08-01

Strategies to prevent primary headaches could be very beneficial, especially given that primary headaches can lead to the development of chronic headache. In order to establish headache prevention strategies, the modifiable risk factors for primary headaches need to be identified. A systematic literature search on the risk factors for primary headaches was conducted independently by two persons using the databases MEDLINE and Embase. Further inclusion criteria were observational studies in adult general populations or case-control studies, where the effect sizes were reported as odds ratios or where the odds ratios could be calculated from the given data. In all, 24 studies were included in the analysis. There was a large amount of heterogeneity among the studies concerning headache acquisition, headache classification, and risk factors for headache development. Independent of headache trigger and definition of headache, the association between headache and the risk factor "stress" was very high: The meta-analysis shows an overall effect of 2.26 (odds ratio; 95 %-CI = [1.79; 2.85]). Studies evaluating neck and shoulder pain also report a strong association with headache; however, these results could not be summarized in a meta-analysis. Equally, the overall effects of smoking and coffee consumption on headaches could not be verified because the effect sizes were rather small and predominantly noticeable only at higher doses. A strong association between headache and the risk factors stress and neck and shoulder pain was confirmed. The effect sizes of smoking and coffee consumption on headaches were rather small.

Systemic classification for a new diagnostic approach to acute abdominal pain in children.

PubMed

Kim, Ji Hoi; Kang, Hyun Sik; Han, Kyung Hee; Kim, Seung Hyo; Shin, Kyung-Sue; Lee, Mu Suk; Jeong, In Ho; Kim, Young Sil; Kang, Ki-Soo

2014-12-01

With previous methods based on only age and location, there are many difficulties in identifying the etiology of acute abdominal pain in children. We sought to develop a new systematic classification of acute abdominal pain and to give some helps to physicians encountering difficulties in diagnoses. From March 2005 to May 2010, clinical data were collected retrospectively from 442 children hospitalized due to acute abdominal pain with no apparent underlying disease. According to the final diagnoses, diseases that caused acute abdominal pain were classified into nine groups. The nine groups were group I "catastrophic surgical abdomen" (7 patients, 1.6%), group II "acute appendicitis and mesenteric lymphadenitis" (56 patients, 12.7%), group III "intestinal obstruction" (57 patients, 12.9%), group IV "viral and bacterial acute gastroenteritis" (90 patients, 20.4%), group V "peptic ulcer and gastroduodenitis" (66 patients, 14.9%), group VI "hepatobiliary and pancreatic disease" (14 patients, 3.2%), group VII "febrile viral illness and extraintestinal infection" (69 patients, 15.6%), group VIII "functional gastrointestinal disorder (acute manifestation)" (20 patients, 4.5%), and group IX "unclassified acute abdominal pain" (63 patients, 14.3%). Four patients were enrolled in two disease groups each. Patients were distributed unevenly across the nine groups of acute abdominal pain. In particular, the "unclassified abdominal pain" only group was not uncommon. Considering a systemic classification for acute abdominal pain may be helpful in the diagnostic approach in children.

Can palpation-induced muscle pain pattern contribute to the differential diagnosis among temporomandibular disorders, primary headaches phenotypes and possible bruxism?

PubMed

Costa, Yuri-Martins; Porporatti, André-Luís; Calderon, Patrícia-dos-Santos; Conti, Paulo-César-Rodrigues; Bonjardim, Leonardo-Rigoldi

2016-01-01

The evaluation of possible differences in the distribution or characteristics of palpation-induced pain in the masticatory muscles could be valuable in terms of diagnostic assessment. The aim of this study was to evaluate the impact of different combinations of anterior temporalis (AT) and masseter palpation-induced pain in the diagnostic of temporomandibular disorder (TMD), primary headaches and bruxism. A total of 1200 dental records of orofacial pain adult patients were analyzed. The outcomes were dichotomously classified (presence/absence) as following: a) AT and/or masseter palpation-induced pain; b) myogenous TMD; c) temporomandibular joint (TMJ) arthralgia (arthrogenous TMD); d) migraine; e) tension-type headache (TTH); f) self-reported bruxism. Binomial logistic regression model (α = 5%) was applied to the data considering the palpation-induced muscle pain as the dependent variable. Mean age (SD) were 35.7 years (13.4) for 635 included dental records (83% females). Myogenous and arthrogenous TMD, migraine, TTH and bruxism were mainly associated with, respectively, masseter palpation-induced pain (p<0.001 - OR=5.77, 95%CI 3.86-8.62), AT or masseter palpation-induced pain (p<0.001 - OR=2.39, 95%CI 1.57-3.63), bilateral AT palpation-induced pain (p<0.001 - OR=2.67, 95%CI 1.64-4.32), masseter and AT palpation-induced pain (p=0.009 - OR=1.62, 95%CI 1.12-2.33) and bilateral masseter palpation-induced pain (p=0.01 - OR=1.74, 95%CI 1.13-2.69). Palpation-induced pain in the masticatory muscles may play a role in the differential diagnosis among painful TMD, primary headaches and bruxism.

Psychiatric comorbidity in new daily persistent headache: A cross-sectional study.

PubMed

Uniyal, R; Paliwal, V K; Tripathi, A

2017-07-01

New daily persistent headache (NDPH) is a type of chronic daily headache. NDPH can have migrainous (NDPH-CM) or tension-type character (NDPH-CTTH). Recently, NDPH patients have shown to have associated anxiety and depression. We compared anxiety, depressive symptoms, somatization and pain catastrophization among NDPH, healthy controls and patients with chronic low-back pain and between NDPH-CM and NDPH-CTTH. We assessed the study population for depressive symptoms by Patient Health Questionnaire-9, anxiety by Generalized Anxiety Disorder Scale - 7, somatoform disorder using DSM IV (TR) criteria and pain catastrophizing by using Pain Catastrophizing Scale. Fifty-five patients each with NDPH (mean age 28.24 ± 12.05 years, 45.5% females) and age/sex matched healthy individuals and patients with chronic low-back pain were enrolled. Among NDPH patients, somatoform disorder was seen in 32.7%, severe anxiety in 65.5%, severe depressive symptoms in 40%, significant pain catastrophization in 85.5%. NDPH patients had significantly higher frequency of all psychiatric co-morbidities as compared to healthy controls and patients with chronic low-back pain. NDPH-CM patients had significantly higher frequency of depression and pain catastrophizing behaviour as compared to NDPH-CTTH. Anxiety, depressive symptoms, somatization and pain catastrophizing were significantly more prevalent in NDPH when compared to healthy individuals and patients with chronic low back pain. Such effects should be sought for, as they might contribute to refractoriness to treatment. Anxiety, depressive symptoms, somatization and pain catastrophizing were significantly more prevalent in new daily persistent headache when compared to healthy individuals and patients with chronic low back pain. Such effects should be sought for, as they might contribute to refractoriness to treatment. © 2017 European Pain Federation - EFIC®.

Laparoscopy In Unexplained Abdominal Pain: Surgeon's Perspective.

PubMed

Abdullah, Muhammad Tariq; Waqar, Shahzad Hussain; Zahid, Muhammad Abdul

2016-01-01

Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon's perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients.

Functional Abdominal Pain: "Get" the Function, Loose the Pain.

PubMed

Draeger-Muenke, Reinhild

2015-07-01

Functional abdominal pain is a mind-body, psychosocial, and self-reinforcing experience with significant consequences for the sufferer and the surrounding support network. The occurrence of unpredictable symptoms and their severity add an element of dread and feeling out-of-control to daily life and often reduce overall functioning in a downward spiral. Two clinical presentations of functional abdominal pain are offered in this article (composites to protect confidentiality) dealing with abdominal pain syndrome and abdominal migraines. The treatment demonstrates the use of hypnotic principles for self-regulation, exploration, and meaning-making. Hypnosis treatment is conducted in combination with mindfulness-based interventions and Traditional Chinese Medicine's (TCM) teachings regarding abdominal health and illness. The clinical examples illustrate medical findings that suggest children with early life stress and an early onset of gastrointestinal somatization may not simply outgrow their functional abdominal pain but may suffer into adulthood.

Blastocystis Hominis and Chronic Abdominal Pain in Children: Is there an Association between Them?

PubMed

Toro Monjaraz, Erick Manuel; Vichido Luna, Miguel Angel; Montijo Barrios, Ericka; Cervantes Bustamante, Roberto; Zárate Mondragón, Flora; Huante Anaya, Alfonso; Cadena León, José; Mendez, Monserrat Cazares; López Ugalde, Martha; Ramirez Mayans, Jaime A

2017-08-03

Chronic abdominal pain has many etiologies, one of them being parasites. The aim of this study was to find an association between chronic abdominal pain in children and Blastocystis hominis (Bh). Clinical files of patients with Bh and functional abdominal pain were reviewed. A comparison was made between patients who showed an improvement of their symptoms and those who did not. Out of the 138 patients who had functional abdominal pain and Bh, 37 patients did not receive any treatment (26.8%), while 101 received it and were treated with different antimicrobial agents (73.2%); regarding the improvement of symptoms, a statistically significant difference (p < 0.001) was observed. Chronic abdominal pain in children has different etiologies; however, we have documented through this work that it is appropriate to provide antimicrobial treatment for patients with Bh and chronic abdominal pain. © The Author [2017]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Abdominal pain localization is associated with non-diarrheic Rome III functional gastrointestinal disorders.

PubMed

Bouchoucha, M; Fysekidis, M; Devroede, G; Raynaud, J-J; Bejou, B; Benamouzig, R

2013-08-01

Abdominal pain is common in patients with functional bowel disorders (FBDs). The aim of this study was to characterize the predominant sites of abdominal pain associated with FBD subtypes, as defined by the Rome III criteria. A total of 584 consecutive patients attending FBD consultations in a tertiary center participated in the study. Stool form, abdominal pain location (nine abdominal segments), and pain intensity (10-point Likert scale) during the previous week were recorded. Logistic regression analysis was used to characterize the association of abdominal pain sites with specific FBD subtypes. FBDs were associated with predominant pain sites. Irritable bowel syndrome (IBS) with constipation was associated with pain in the left flank and patients were less likely to report pain in the right hypochondrium. Patients with functional constipation reported pain in the right hypochondrium and were less likely to report pain in the left flank and left iliac site. IBS with alternating constipation and diarrhea was associated with pain in the right flank, and unsubtyped IBS with pain in the hypogastrium Patients with functional abdominal pain syndrome reported the lower right flank as predominant pain site. Patients with unspecified FBDs were least likely to report pain in the hypogastrium. Patients with functional diarrhea, IBS with diarrhea, or functional bloating did not report specific pain sites. The results from this study provide the basis for developing new criteria allowing for the identification of homogeneous groups of patients with non-diarrheic FBDs based on characteristic sites of pain. © 2013 John Wiley & Sons Ltd.

Αn uncommon coexistence of primary sexual, cough and exercise headaches: the first three cases from Greece.

PubMed

Bougea, A; Constantinides, V; Anagnostou, E; Kararizou, E

2015-01-01

The "other primary headaches" encompasses a group of uncommon but distinct headache disorders. The coexistence of their subforms such as primary sexual and exercise headache is not a new phenomenon, but in association with cough headache is rather uncommon. Report of cases: We report three cases with a rare coexistence of primary cough, exercise and associated with sexual activity headache. Indomethacin was effective in all patients. The leading pathophysiological explanation involves a rapid rise in intra-abdominal pressure exertional factors or an inappropriate reaction in the cerebral vasculature. Further studies are needed to confirm a common pathogenic mechanism in these patients. Τhe coexistence of these headaches needs to be taken into account in the final classification that is expected to be available in 2016. Hippokratia 2015; 19 (4): 369-371.

ABDOMINAL PAIN IN ADULT SICKLE CELL DISEASE PATIENTS: A NIGERIAN EXPERIENCE

PubMed Central

Akingbola, T.S.; Kolude, B.; Aneni, E.C.; Raji, A.A.; Iwara, K.U.; Aken’Ova, Y.A.; Soyannwo, O.A.

2011-01-01

Background: Abdominal pain is a relatively frequent occurrence in sickle cell disease. The aetiology of abdominal pain in sickle cell disease is often difficult to diagnose clinically. Despite the frequent occurrence, diagnostic dilemma, and the need for an accurate, early diagnosis, abdominal pain in sickle cell disease has not been rigorously studied. Objective: We therefore sought to describe the different presentations and patterns of abdominal pain in persons with sickle cell disease. Methods: A prospective case series of 20 patients was done in which data was collected on demographic characteristics, hemoglobin electrophoresis patterns, a description of the abdominal pain including sites, severity, and type of pain, packed cell volume and the provisional and final diagnosis. Results: Haemoglobin S patients were 17 in number constituting eightyfive percent (85%) of our study population whilst the rest 3 were Hb S+C. Most patients (70%) had one site of abdominal pain. The pain was mainly colicky or tightening, moderate to severe in nature and, in some cases, associated with vomiting. We did not find any significant difference between the steady state PCV and the PCV during the acute abdominal pain episodes. The final diagnosis showed that only 38.8% of the patients had vasoocclusive crises and the reliability index between the provisional diagnosis and the final diagnosis was 67%. Conclusion: Abdominal pain in sickle cell disease may present in different ways and it is important to recognize that the possible diagnoses are numerous. Not all cases are due to vasoocclusive crises. Early diagnosis and prompt treatment can be life saving. PMID:25161492

Pain in adolescents and its risk factors: A case-control study.

PubMed

Agüero, Gonzalo; Salmain, Soledad; Manzur, Belén; Berner, Enrique

2018-04-01

The most common painful syndromes (headache, abdominal pain and musculoskeletal pain) develop or worsen during adolescence and are a common reason for consultation. Evaluate the association of age, sex, obesity, pubertal development, schooling level, employment and family structure with consultation for pain in adolescents. Case-control study conducted between February 1st, 2014 and June 30th, 2015. ages 10 to 20 years, both sexes, consultation for pain (cases), or a checkup and/or school physical (controls). χ 2 test and Student" s tests were used. Odds ratios (OR) were calculated. A binary logistic regression model was constructed to independently assess each pain-related variable. A total of 4224 medical records were evaluated; 237 cases and 468 controls were included. Adolescents with pain exhibited: greater age (p < 0.0001; OR 2.3; 95% CI: 1.63.2); greater number of females (p < 0.0001; OR 2.24; 95% CI: 1.61-3.12); greater pubertal development (p < 0.0035; OR 2.16; 95% CI: 1.33.6); greater school dropout level (p < 0.0001; OR 13.4; 95% CI: 3.9-42.9); greater employment levels (p < 0.0001; OR 3.04; 95% CI: 1.7-5.3). Only age, female sex and school dropout were independently associated with consultation for pain. There were no significant differences with obesity and family structure. Older age, female sex and school dropout were independent risk factors in consultation for pain in adolescents. Puberty and employment were associated, but were not found to be independent risk factors. Sociedad Argentina de Pediatría.

Pain as the only manifestation of internal carotid artery dissection.

PubMed

Biousse, V; Woimant, F; Amarenco, P; Touboul, P J; Bousser, M G

1992-10-01

Internal carotid artery dissection is a major cause of ischemic stroke in the young. Pain is the leading symptom and is associated with other focal signs such as Horner's syndrome and painful tinnitus or with signs of cerebral or retinal ischemia. We report two patients with angiographically confirmed extracranial internal carotid artery dissection presenting with cephalic pain as the only manifestation. The first patient had a diffuse headache and a latero-cervical pain lasting for 12 days, reminiscent of carotidynia. The second patient experienced an exploding headache suggestive of subarachnoid hemorrhage, which was ruled out by computed tomography of the head and cerebrospinal fluid study. These patients demonstrate that recognition of carotid artery dissection as a cause of carotidynia and headache suggestive of subarachnoid hemorrhage may permit an earlier diagnosis and possibly the prevention of a stroke through the use of anticoagulation.

Grey zones in the diagnosis of adult migraine without aura based on the International Classification of Headache Disorders-III beta: exploring the covariates of possible migraine without aura.

PubMed

Ozge, Aynur; Aydinlar, Elif; Tasdelen, Bahar

2015-01-01

Exploring clinical characteristics and migraine covariates may be useful in the diagnosis of migraine without aura. To evaluate the diagnostic value of the International Classification of Headache Disorders (ICHD)-III beta-based diagnosis of migraine without aura; to explore the covariates of possible migraine without aura using an analysis of grey zones in this area; and, finally, to make suggestions for the final version of the ICHD-III. A total of 1365 patients (mean [± SD] age 38.5±10.4 years, 82.8% female) diagnosed with migraine without aura according to the criteria of the ICHD-III beta were included in the present tertiary care-based retrospective study. Patients meeting all of the criteria of the ICHD-III beta were classified as having full migraine without aura, while those who did not meet one, two or ≥3 of the diagnostic criteria were classified as zones I, II and III, respectively. The diagnostic value of the clinical characteristics and covariates of migraine were determined. Full migraine without aura was evident in 25.7% of the migraineurs. A higher likelihood of zone I classification was shown for an attack lasting 4 h to 72 h (OR 1.560; P=0.002), with pulsating quality (OR 4.096; P<0.001), concomitant nausea⁄vomiting (OR 2.300; P<0.001) and photophobia⁄phonophobia (OR 4.865; P<0.001). The first-rank determinants for full migraine without aura were sleep irregularities (OR 1.596; P=0.005) and periodic vomiting (OR 1.464; P=0.026). However, even if not mentioned in ICHD-III beta, the authors determined that motion sickness, abdominal pain or infantile colic attacks in childhood, associated dizziness and osmophobia have important diagnostic value. In cases that do not fulfill all of the diagnostic criteria although they are largely consistent with the characteristics of migraine in clinical terms, the authors believe that a history of infantile colic; periodic vomiting (but not periodic vomiting syndrome); recurrent abdominal pain; the presence of motion sickness or vertigo, dizziness or osmophobia accompanying the pain; and comorbid atopic disorder are characteristics that should to be discussed and considered as additional diagnostic criteria (covariates) in the preparation of the final version of ICHD-III.

School Nurses on the Front Lines of Medicine: An Adolescent Female Student with Severe Abdominal Pain.

PubMed

Olympia, Robert P; Brady, Jodi

2016-09-01

Abdominal pain is a common chief complaint encountered by school nurses. This article explains the etiology of abdominal pain in children and adolescents, describes the office assessment, and delineates life-threatening conditions associated with severe abdominal pain that may prompt the school nurse to transfer the student to a local emergency department. © 2016 The Author(s).

Slipping rib syndrome: a place for sonography in the diagnosis of a frequently overlooked cause of abdominal or low thoracic pain.

PubMed

Meuwly, Jean-Yves; Wicky, Stephan; Schnyder, Pierre; Lepori, Domenico

2002-03-01

To describe the sonographic appearance of a poorly recognized cause of low thoracic or upper abdominal pain. Three sonographic descriptions of slipping rib syndrome are presented. The 3 patients had abnormal mobility of a cartilaginous rib, which could slip over an adjacent rib during abdominal muscle contraction. Slipping rib syndrome should be considered in patients with histories of upper abdominal or low thoracic pain of unknown origin. We suggest that high-resolution sonography of the costal margin should be added to abdominal sonography in cases of nonspecific abdominal pain.

Orofacial pain and headaches associated with exfoliation glaucoma.

PubMed

Noma, Noboru; Iwasa, Mayumi; Young, Andrew; Ikeda, Mariko; Hsu, Yung-Chu; Yamamoto, Maasa; Inoue, Kenji; Imamura, Yoshiki

2017-12-01

Exfoliation syndrome is the most common identifiable cause of open-angle glaucoma. The authors report a case of exfoliation glaucoma in a patient who had orofacial pain. A 77-year-old woman was treated at the orofacial pain clinic for left-sided facial pain and headaches of 7 months' duration. Her cataracts and open-angle glaucoma had been diagnosed approximately 3 years earlier. Her main symptoms were orofacial pain, eye redness, inflammation of the eyelids, and eyelid edema. Magnetic resonance imaging showed no evidence of intracranial or extracranial pathology. Hemicrania continua was considered as a possible diagnosis. Indomethacin was prescribed but did not affect her headaches. She then went to an ophthalmologist to rule out secondary headaches. Intraocular pressure was 13 millimeters of mercury in the right eye and 67 mm Hg in the left eye. The ophthalmologist made a diagnosis of exfoliation glaucoma, and the patient underwent surgical treatment for the glaucoma and cataracts. After surgery, she was free of symptoms, and intraocular pressure was 15 mm Hg in the left eye. During differential diagnosis, dentists need to consider intraoral and systemic conditions that can mimic odontogenic or orofacial pain disorders in the patient's medical history and that have a higher incidence associated with the patient's age. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

Abdominal Pain (Stomach Pain), Short-Term

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Episodic Syndromes That May Be Associated With Migraine: A.K.A. "the Childhood Periodic Syndromes".

PubMed

Gelfand, Amy A

2015-01-01

Previously called "childhood periodic syndromes that are commonly precursors of migraine" in International Headache Classification of Headache Disorders (ICHD)-II, these disorders were renamed "episodic syndromes that may be associated with migraine" in ICHD-III beta. The specific disorders reviewed in this article include: benign paroxysmal torticollis, benign paroxysmal vertigo, abdominal migraine, and cyclical vomiting syndrome, as well as infantile colic, which was recently added under the appendix section in ICHD-III beta. © 2015 American Headache Society.

Analgesic effects of an ethanol extract of the fruits of Xylopia aethiopica (Dunal) A. Rich (Annonaceae) and the major constituent, xylopic acid in murine models.

PubMed

Woode, Eric; Ameyaw, Elvis O; Boakye-Gyasi, Eric; Abotsi, Wonder K M

2012-10-01

Fruit extracts of Xylopia aethiopica are used traditionally in the management of pain disorders including rheumatism, headache, colic pain, and neuralgia. Little pharmacological data exists in scientific literature of the effect of the fruit extract and its major diterpene, xylopic acid, on pain. The present study evaluated the analgesic properties of the ethanol extract of X. aethiopica (XAE) and xylopic acid (XA), in murine models. XAE and XA were assessed in chemical (acetic acid-induced abdominal writhing and formalin tests), thermal (Tail-flick and Hargreaves thermal hyperalgesia tests), and mechanical (Randall-Selitto paw pressure test) pain models. XAE and XA exhibited significant analgesic activity in all the pain models used. XAE (30-300 mg kg(-1), p.o.) and XA (10-100 mg kg(-1), p.o.) inhibited acetic acid-induced visceral nociception, formalin- induced paw pain (both neurogenic and inflammatory), thermal pain as well as carrageenan-induced mechanical and thermal hyperalgesia in animals. Morphine (1-10 mg kg(-1), i.p.) and diclofenac (1-10 mg kg(-1), i.p.), used as controls, exhibited similar anti-nociceptive activities. XAE and XA did not induce tolerance to their respective anti-nociceptive effects in the formalin test after chronic administration. Morphine tolerance did not also cross-generalize to the analgesic effects of XAE or XA. These findings establish the analgesic properties of the ethanol fruit extract of X. aethiopica and its major diterpene, xylopic acid.

Side-locked headaches: an algorithm-based approach.

PubMed

Prakash, Sanjay; Rathore, Chaturbhuj

2016-12-01

The differential diagnosis of strictly unilateral hemicranial pain includes a large number of primary and secondary headaches and cranial neuropathies. It may arise from both intracranial and extracranial structures such as cranium, neck, vessels, eyes, ears, nose, sinuses, teeth, mouth, and the other facial or cervical structure. Available data suggest that about two-third patients with side-locked headache visiting neurology or headache clinics have primary headaches. Other one-third will have either secondary headaches or neuralgias. Many of these hemicranial pain syndromes have overlapping presentations. Primary headache disorders may spread to involve the face and / or neck. Even various intracranial and extracranial pathologies may have similar overlapping presentations. Patients may present to a variety of clinicians, including headache experts, dentists, otolaryngologists, ophthalmologist, psychiatrists, and physiotherapists. Unfortunately, there is not uniform approach for such patients and diagnostic ambiguity is frequently encountered in clinical practice.Herein, we review the differential diagnoses of side-locked headaches and provide an algorithm based approach for patients presenting with side-locked headaches. Side-locked headache is itself a red flag. So, the first priority should be to rule out secondary headaches. A comprehensive history and thorough examinations will help one to formulate an algorithm to rule out or confirm secondary side-locked headaches. The diagnoses of most secondary side-locked headaches are largely investigations dependent. Therefore, each suspected secondary headache should be subjected for appropriate investigations or referral. The diagnostic approach of primary side-locked headache starts once one rule out all the possible secondary headaches. We have discussed an algorithmic approach for both secondary and primary side-locked headaches.

Psychometric Properties of the Psychosocial Assessment Tool-Chronic Pain Version in Families of Children With Headache.

PubMed

Woods, Kristine; Ostrowski-Delahanty, Sarah

2017-07-01

Children with headache disorders are at increased psychosocial risk, and no validated screening measures exist to succinctly assess for risk. This study examined the psychometric properties of the Psychosocial Assessment Tool-Chronic Pain, a previously adapted screening measure of risk, in a retrospective sample of families of children diagnosed with headaches. Participants included 127 children and caregivers presenting for behavioral health evaluation of headache. Children and their primary caregivers completed several psychosocial assessment measures. Internal consistency for the Psychosocial Assessment Tool-Chronic Pain total score was high (α = 0.80), and all subscale scores had moderate to high internal consistency (α = 0.597-0.88), with the exception of the caregiver beliefs subscale (α = 0.443). The total score and the majority of subscale scores on the Psychosocial Assessment Tool-Chronic Pain were correlated with caregiver- and child-reported scores on study measures. The results demonstrate that the Psychosocial Assessment Tool-Chronic Pain has adequate psychometric properties, and because of the brief administration time, ease of scoring, and accessibility of the measure, it is a promising measure of screening for psychosocial risk in this population.

Evaluation of the Analgesic Activity of the Methanolic Stem Bark Extract of Dialium Guineense (Wild)

PubMed Central

Ezeja, MI; Omeh, YS; Ezeigbo, II; Ekechukwu, A

2011-01-01

Background: Dialium guineense is a medicinal plant used by some communities of Enugu-Ezike in Enugu State, Nigeria for treatment of fever, headache and other diverse ailments. Objectives: The present study evaluated the analgesic activity of the methanolic stem bark extract of the plant. Method: Acetic acid-induced abdominal constriction or writhing, tail immersion and hot plate analgesic models in albino Wistar mice were used for the study. Three test doses (250, 500, 1000 mg/kg body weight) of the extract were administered orally by gastric gavage. The activity was compared with a standard reference drug, acetylsalicylic acid (aspirin) (400 mg/kg) and negative control. The results were analysed by SPSS version 17 using ANOVA and Post Hoc Duncan. Result: In the acetic acid-induced writhing reflex model, D. guineense extract and the reference drug significantly (P =0.014 - 0.002) decreased the mean total number of abdominal constriction in the mice in a dose dependent fashion. The percentage inhibition of the abdominal constriction reflex was increased dose dependently from 0% in the negative control group to 71% at the highest dose of the extract (1000mg/kg). In the tail immersion model the extract at the dose of 1000 mg/kg significantly (P = 0. 048) increased the pain reaction time (PRT) while in hot plate model the extract and drug also significantly (P = 0.048 - 0.05) increased the mean PRT at the doses of 500 and 1000 mg/kg. The dose of 250 mg/kg showed no analgesic activity in tail immersion and hot plate models. Conclusion: Dialium guineense demonstrated significant analgesic activity that may be mediated through peripheral pain mechanism. PMID:23209955

Evaluation of the analgesic activity of the methanolic stem bark extract of dialium guineense (wild).

PubMed

Ezeja, Mi; Omeh, Ys; Ezeigbo, Ii; Ekechukwu, A

2011-01-01

Dialium guineense is a medicinal plant used by some communities of Enugu-Ezike in Enugu State, Nigeria for treatment of fever, headache and other diverse ailments. The present study evaluated the analgesic activity of the methanolic stem bark extract of the plant. Acetic acid-induced abdominal constriction or writhing, tail immersion and hot plate analgesic models in albino Wistar mice were used for the study. Three test doses (250, 500, 1000 mg/kg body weight) of the extract were administered orally by gastric gavage. The activity was compared with a standard reference drug, acetylsalicylic acid (aspirin) (400 mg/kg) and negative control. The results were analysed by SPSS version 17 using ANOVA and Post Hoc Duncan. In the acetic acid-induced writhing reflex model, D. guineense extract and the reference drug significantly (P =0.014 - 0.002) decreased the mean total number of abdominal constriction in the mice in a dose dependent fashion. The percentage inhibition of the abdominal constriction reflex was increased dose dependently from 0% in the negative control group to 71% at the highest dose of the extract (1000mg/kg). In the tail immersion model the extract at the dose of 1000 mg/kg significantly (P = 0. 048) increased the pain reaction time (PRT) while in hot plate model the extract and drug also significantly (P = 0.048 - 0.05) increased the mean PRT at the doses of 500 and 1000 mg/kg. The dose of 250 mg/kg showed no analgesic activity in tail immersion and hot plate models. Dialium guineense demonstrated significant analgesic activity that may be mediated through peripheral pain mechanism.

Allergy-related diseases and recurrent abdominal pain during childhood - a birth cohort study.

PubMed

Olén, O; Neuman, Å; Koopmann, B; Ludvigsson, J F; Ballardini, N; Westman, M; Melén, E; Kull, I; Simrén, M; Bergström, A

2014-12-01

Allergy and immune dysregulation may have a role in the pathophysiology of recurrent abdominal pain of functional origin, but previous studies of allergy-related diseases and abdominal pain have contradictory results. To examine the association between allergy-related diseases or sensitisation during childhood and abdominal pain at age 12 years. In this birth cohort study of 4089 children, parents answered questionnaires regarding asthma, allergic rhinitis, eczema and food hypersensitivity ('allergy-related diseases') at ages 0,1,2,4,8 and 12 years. Blood for analyses of allergen-specific IgE was sampled at 4 and 8 years. At 12 years, the children answered questions regarding abdominal pain. Children with coeliac disease or inflammatory bowel disease were excluded. Associations were examined using multivariable logistic regression. Among 2610 children with complete follow-up, 9% (n = 237) reported abdominal pain at 12 years. All allergy-related diseases were associated with concurrent abdominal pain at 12 years and the risk increased with increasing number of allergy-related diseases (P for trend <0.001). Asthma at 1 and 2 years and food hypersensitivity at 8 years were significantly associated with abdominal pain at 12 years. There was an increased risk of abdominal pain at 12 years in children sensitised to food allergens at 4 or 8 years, but in stratified analyses, this was confined to children whose parents had not reported food hypersensitivity at time of sensitisation. Allergy-related diseases as well as sensitisation to food allergens were associated with an elevated risk of abdominal pain, and the risk increased with the number of allergy-related diseases. © 2014 John Wiley & Sons Ltd.

Diagnosis and management of headache attributed to airplane travel.

PubMed

Mainardi, Federico; Maggioni, Ferdinando; Lisotto, Carlo; Zanchin, Giorgio

2013-03-01

The headache attributed to airplane travel, also named "airplane headache", is characterized by the sudden onset of a severe head pain exclusively in relation to airplane flights, mainly during the landing phase. Secondary causes, such as upper respiratory tract infections or acute sinusitis, must be ruled out. Although its cause is not thoroughly understood, sinus barotrauma should be reasonably involved in the pathophysiological mechanisms. Furthermore, in the current International Classification of Headache Disorders, rapid descent from high altitude is not considered as a possible cause of headache, although the onset of such pain in airplane travellers or aviators has been well known since the beginning of the aviation era. On the basis of a survey we conducted with the courteous cooperation of people who had experienced this type of headache, we proposed diagnostic criteria to be added to the forthcoming revision of the International Classification of Headache Disorders. Their formal validation would favour further studies aimed at improving knowledge of the pathophysiological mechanisms involved and at implementing preventative measures.

Rigorously defined hemicrania continua presenting bilaterally.

PubMed

Southerland, Andrew M; Login, Ivan S

2011-10-01

Hemicrania continua (HC) is a headache syndrome characterized by continuous, unilateral head pain, autonomic features, and a complete therapeutic response to indomethacin. Although HC is classified as a unique entity among primary headache disorders, it clearly shares features with other primary headaches, including trigeminal autonomic cephalalgias, and chronic daily headaches, such as chronic migraine and chronic tension-type headache. In addition, the diagnosis is often delayed secondary to a relatively low incidence and the occurrence of some phenotypic variability as found in previous case series. A 62-year-old woman presented with 5 months of unremitting, bilateral headache with significant autonomic symptoms during exacerbations of pain. Neurological examination and imaging studies were normal. After failure to respond to numerous previous therapeutic medicines and interventions, she experienced complete resolution following administration of indomethacin and eventual remission on sustained treatment. This case demonstrates that hemicrania continua with requisite autonomic features can occur in a purely bilateral form. Although the definitive aspects of HC continue to evolve, a bilateral headache meeting the current criteria warrants a therapeutic trial of indomethacin.

Unusual causes of abdominal pain: sickle cell anemia.

PubMed

Ahmed, Shahid; Shahid, Rabia K; Russo, Linda A

2005-04-01

Sickle cell disease is characterized by chronic hemolytic anemia and vaso-occlusive painful crises. The vascular occlusion in sickle cell disease is a complex process and accounts for the majority of the clinical manifestation of the disease. Abdominal pain is an important component of vaso-occlusive painful crises. It often represents a substantial diagnostic challenge in this population of patients. These episodes are often attributed to micro-vessel occlusion and infarcts of mesentery and abdominal viscera. Abdominal pain due to sickle cell vaso-occlusive crisis is often indistinguishable from an acute intra-abdominal disease process such as acute cholecystitis, acute pancreatitis, hepatic infarction, ischemic colitis and acute appendicitis. In the majority of cases, however, no specific cause is identified and spontaneous resolution occurs. This chapter will focus on etiologies, pathophysiology and management of abdominal pain in patients with sickle cell disease.

Systemic Classification for a New Diagnostic Approach to Acute Abdominal Pain in Children

PubMed Central

Kim, Ji Hoi; Kang, Hyun Sik; Han, Kyung Hee; Kim, Seung Hyo; Shin, Kyung-Sue; Lee, Mu Suk; Jeong, In Ho; Kim, Young Sil

2014-01-01

Purpose With previous methods based on only age and location, there are many difficulties in identifying the etiology of acute abdominal pain in children. We sought to develop a new systematic classification of acute abdominal pain and to give some helps to physicians encountering difficulties in diagnoses. Methods From March 2005 to May 2010, clinical data were collected retrospectively from 442 children hospitalized due to acute abdominal pain with no apparent underlying disease. According to the final diagnoses, diseases that caused acute abdominal pain were classified into nine groups. Results The nine groups were group I "catastrophic surgical abdomen" (7 patients, 1.6%), group II "acute appendicitis and mesenteric lymphadenitis" (56 patients, 12.7%), group III "intestinal obstruction" (57 patients, 12.9%), group IV "viral and bacterial acute gastroenteritis" (90 patients, 20.4%), group V "peptic ulcer and gastroduodenitis" (66 patients, 14.9%), group VI "hepatobiliary and pancreatic disease" (14 patients, 3.2%), group VII "febrile viral illness and extraintestinal infection" (69 patients, 15.6%), group VIII "functional gastrointestinal disorder (acute manifestation)" (20 patients, 4.5%), and group IX "unclassified acute abdominal pain" (63 patients, 14.3%). Four patients were enrolled in two disease groups each. Conclusion Patients were distributed unevenly across the nine groups of acute abdominal pain. In particular, the "unclassified abdominal pain" only group was not uncommon. Considering a systemic classification for acute abdominal pain may be helpful in the diagnostic approach in children. PMID:25587522

Sleep, chronic pain, and opioid risk for apnea.

PubMed

Marshansky, Serguei; Mayer, Pierre; Rizzo, Dorrie; Baltzan, Marc; Denis, Ronald; Lavigne, Gilles J

2017-07-19

Pain is an unwelcome sleep partner. Pain tends to erode sleep quality and alter the sleep restorative process in vulnerable patients. It can contribute to next-day sleepiness and fatigue, affecting cognitive function. Chronic pain and the use of opioid medications can also complicate the management of sleep disorders such as insomnia (difficulty falling and/or staying asleep) and sleep-disordered breathing (sleep apnea). Sleep problems can be related to various types of pain, including sleep headache (hypnic headache, cluster headache, migraine) and morning headache (transient tension type secondary to sleep apnea or to sleep bruxism or tooth grinding) as well as periodic limb movements (leg and arm dysesthesia with pain). Pain and sleep management strategies should be personalized to reflect the patient's history and ongoing complaints. Understanding the pain-sleep interaction requires assessments of: i) sleep quality, ii) potential contributions to fatigue, mood, and/or wake time functioning; iii) potential concomitant sleep-disordered breathing (SDB); and more importantly; iv) opioid use, as central apnea may occur in at-risk patients. Treatments include sleep hygiene advice, cognitive behavioral therapy, physical therapy, breathing devices (continuous positive airway pressure - CPAP, or oral appliance) and medications (sleep facilitators, e.g., zolpidem; or antidepressants, e.g., trazodone, duloxetine, or neuroleptics, e.g., pregabalin). In the presence of opioid-exacerbated SDB, if the dose cannot be reduced and normal breathing restored, servo-ventilation is a promising avenue that nevertheless requires close medical supervision. Copyright © 2017 Elsevier Inc. All rights reserved.

Irritable bowel syndrome and functional abdominal pain in five-year-old children are related to lifestyle.

PubMed

Uusijärvi, Agneta; Alm, Johan; Lindblad, Frank; Olén, Ola

2016-08-01

Abdominal pain of functional origin is very common in childhood, and environmental factors are thought to be of aetiologic importance. The anthroposophic lifestyle has dietary and lifestyle characteristics that may influence child health, and this study aimed to assess the effect of such lifestyles on abdominal pain of functional origin. A prospective Swedish lifestyle cohort (n = 470) was followed from birth to five years of age. Family lifestyles were characterised through questionnaires. Abdominal pain was defined as irritable bowel syndrome or functional abdominal pain according to the Rome III criteria and measured with parental questionnaires and interviews at the age of five. The prevalence of abdominal pain was 15%. Children were more likely to have abdominal pain at five years of age if their family had a partly anthroposophic lifestyle, with an adjusted odds ratio (OR) of 2.61 (95% CI 1.15-5.93), or an anthroposophic lifestyle, with an adjusted OR of 2.34 (95% CI 0.96-5.70). A family lifestyle with anthroposophic characteristics was associated with an increased risk of abdominal pain in five-year-old children. The mechanisms for this increase were unclear, but we speculate that there may have been different prerequisites for coping with stressors. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients

PubMed Central

Srinath, Arvind I.; Goyal, Alka; Zimmerman, Lori A.; Newara, Melissa C.; Kirshner, Margaret A.; McCarthy, F. Nicole; Keljo, David; Binion, David; Bousvaros, Athos; DeMaso, David R.; Youk, Ada; Szigethy, Eva M.

2015-01-01

Background Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) Evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD, (2) Determine predictors of abdominal pain in Crohn’s disease (CD) and ulcerative colitis (UC). Methods 765 patients ages 9–17 with IBD seen over 3 years at two sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms. Results 217 patients with IBD (161 CD, 56 UC) were depressed. 163 (120 CD, 43 UC) patients had complete API scores. In CD, abdominal pain was associated with depression (r=0.33; p<0.001), diarrhea (r=0.34; p=0.001), ESR (r=0.22; p=0.02), low albumin (r=0.24; p=.01), weight loss (r=0.33; p=0.001), and abdominal tenderness (r=0.38, p=0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (p=0.03), weight loss (p=0.04), and abdominal tenderness (p=0.01) predicted pain for CD patients. In UC, pain was associated with depression (r=0.46; p=0.002) and nocturnal stools (r=.32; p=.046). In the multivariate model with these significant correlates 23% of the variance was explained, and only depression (p=0.02) predicted pain. Conclusions The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications. PMID:24983975

Clinical Presentation and Care of Patients with Ebola Virus Disease in the China Ebola Treatment Unit, Liberia.

PubMed

Shao, Xiaoping; Ren, Weizheng; Zhou, Feihu

2017-01-24

In order to evaluate the clinical characteristics of confirmed Ebola Virus Disease (EVD) patients admitted to the China Ebola Treatment Unit (China ETU) between January 2015 and March 2015, we retrospectively analyzed clinical symptoms, treatment, and epidemiologic features of 5 patients with confirmed EVD, and reviewed the relevant medical literature. Of these, 3 patients survived, and 2 died. The time interval from the onset of symptoms to the negative PCR test for Ebola virus in the 3 survivors was 14-18 days. All survivors reported direct contact with confirmed EVD patients up to 21 days prior to admission. All patients developed a fever, fatigue, and anorexia. Fever was generally the first symptom to develop, followed by a gastrointestinal phase characterized by vomiting/nausea (3 cases, 60%), diarrhea (3 cases), and abdominal pain (4 cases, 80%). Three patients (60%) reported joint pain, muscle pain, and conjunctival hemorrhage, respectively, and 2 patients (40%) developed a headache. We concluded that strict isolation and interruption of the route of transmission were required for suspected or confirmed EVD patients. The main treatment strategies were supportive care, maintenance of blood volume and electrolyte balance, and the prevention of complications.

Somatization symptoms and hypochondriacal features in the general population.

PubMed

Rief, W; Hessel, A; Braehler, E

2001-01-01

The principal goal of this study is to examine the base rates of somatoform symptoms and of hypochondriacal features in the general population. A representative sample of 2050 persons in Germany was examined by use of screening for somatoform symptoms and the Whiteley Index. The most frequent somatoform symptoms were back pain, joint pain, pain in extremities, and headache, as well as abdominal symptoms (bloating or intolerance of several foods) and cardiovascular symptoms (palpitation). People reported a mean of two somatization symptoms of DSM-IV somatization disorder (SD) during the prior 2 years. Strong age and medium gender effects were found for most somatoform symptoms, as well as for composite indices. However, the sex ratio suggested in DSM-IV for SD seems to be an overestimation. Hypochondriacal features showed only small sex differences but, again, pronounced age effects. In contrast to low rates for SD, the base rates for somatization and hypochondriacal features were high and represented the health care relevance of subthreshold syndromes. We present base rates of hypochondriacal and somatization features that may be important facets in the development of classification criteria and in the interpretation of health care expenditure.

Pesticide poisoning in Costa Rica during 1996.

PubMed

Leveridge, Y R

1998-02-01

A retrospective study at the Poison Control Center of Costa Rica describes the pattern of pesticide poisoning that occurred during 1996. A total of 1274 pesticide exposures were reported. Occupational exposures were the most frequent (38.5%), followed by accidental situations (33.8%) and suicidal attempts (22.5%). The male to female ratio was 2.4:1. Eighty-percent of the patients had symptoms at the moment of the consult. Organophosphates, carbamates and bipyridyliums were the agents mostly involved (46%); clinical findings with these products were nausea, vomiting, abdominal pain, dizziness and headache. Calls came mainly from hospitals and clinics (75%) followed by home calls (18.2%). Education of the users of pesticides and the community in general is essential to creating an awareness of the toxicity of these agents and to reduce morbidity cases.

Hypereosinophilia, neurologic, and gastrointestinal symptoms after bee-pollen ingestion.

PubMed

Lin, F L; Vaughan, T R; Vandewalker, M L; Weber, R W

1989-04-01

A patient developed hypereosinophilia (13,440 cells per cubic millimeter) 6 weeks after beginning the ingestion of bee pollen. Symptoms included generalized malaise, headache, nausea, abdominal pain diarrhea, generalized pruritus, and decreased memory. Evaluation revealed no other known cause for the patient's hypereosinophilia, which resolved after bee-pollen ingestion was stopped. The product contained a mixture of entomophilous and anemophilous pollens to which the patient was skin test positive. An open challenge with the bee pollen later reproduced the presenting symptoms with a concomitant rise of the eosinophil count from 207 to 890 cells per cubic millimeter. The patient has since remained well avoiding bee pollen. This study strongly suggests that hypereosinophilia with attendant pathophysiologic disturbances may be an adverse reaction to bee-pollen ingestion in atopic individuals.

Increased auditory startle reflex in children with functional abdominal pain.

PubMed

Bakker, Mirte J; Boer, Frits; Benninga, Marc A; Koelman, Johannes H T M; Tijssen, Marina A J

2010-02-01

To test the hypothesis that children with abdominal pain-related functional gastrointestinal disorders have a general hypersensitivity for sensory stimuli. Auditory startle reflexes were assessed in 20 children classified according to Rome III classifications of abdominal pain-related functional gastrointestinal disorders (13 irritable bowel syndrome [IBS], 7 functional abdominal pain syndrome; mean age, 12.4 years; 15 girls) and 23 control subjects (14 girls; mean age, 12.3 years) using a case-control design. The activity of 6 left-sided muscles and the sympathetic skin response were obtained by an electromyogram. We presented sudden loud noises to the subjects through headphones. Both the combined response of 6 muscles and the blink response proved to be significantly increased in patients with abdominal pain compared with control subjects. A significant increase of the sympathetic skin response was not found. Comorbid anxiety disorders (8 patients with abdominal pain) or Rome III subclassification did not significantly affect these results. This study demonstrates an objective hyperresponsivity to nongastrointestinal stimuli. Children with abdominal pain-related functional gastrointestinal disorders may have a generalized hypersensitivity of the central nervous system. Copyright 2010 Mosby, Inc. All rights reserved.

Complete hydatidiform mole with a surviving coexistent twin in a woman with sickle cell disease: a case report.

PubMed

Mahmoud, Mohamad S; Merhi, Zaher

2007-06-01

Twin pregnancy with an apparently healthy fetus and complete hydatidiform mole (CHMTF) is a rare condition. We present the first reported case in a woman with sickle cell disease. An 18-year-old woman, para 1, gravida 0, with sickle cell disease was diagnosed at 19 weeks as having a complete molar pregnancy with a coexistent live fetus. The patient presented with abdominal pain, nausea, headaches, body aches, joint pain and chest pain on 2 different occasions. She denied having vaginal bleeding. Whether the patient was having a sickle cell crisis or molar pregnancy symptoms (i.e., thyrotoxicosis) was not clear. She was given intravenous hydration and pain management. All her symptoms resolved, confirming sickle cell crisis as the final diagnosis. The pregnancy was uneventful until 35 weeks, when oligohydramnios prompted induction of labor. Suction curettage was performed after delivery for removal of the molar pregnancy. The patient did not show any evidence of persistent trophoblastic disease 2 months after delivery. CHMTF in sickle cell disease patients is challenging. Adequate intravenous hydration and pain management should be started when one suspects a crisis. If the symptoms resolved, thyrotoxicosis due to the molar pregnancy is unlikely. In addition to proper medical management, proper counseling of the patient and close monitoring of both fetus and mother should be undertaken.

Effect of Training Supervision on Effectiveness of Strength Training for Reducing Neck/Shoulder Pain and Headache in Office Workers: Cluster Randomized Controlled Trial

PubMed Central

Gram, Bibi; Andersen, Christoffer; Zebis, Mette K.; Bredahl, Thomas; Pedersen, Mogens T.; Mortensen, Ole S.; Jensen, Rigmor H.; Andersen, Lars L.; Sjøgaard, Gisela

2014-01-01

Objective. To investigate the effect of workplace neck/shoulder strength training with and without regular supervision on neck/shoulder pain and headache among office workers. Method. A 20-week cluster randomized controlled trial among 351 office workers was randomized into three groups: two training groups with the same total amount of planned exercises three times per week (1) with supervision (3WS) throughout the intervention period, (2) with minimal supervision (3MS) only initially, and (3) a reference group (REF). Main outcome is self-reported pain intensity in neck and shoulder (scale 0–9) and headache (scale 0–10). Results. Intention-to-treat analyses showed a significant decrease in neck pain intensity the last 7 days in 3MS compared with REF: −0.5 ± 0.2 (P < 0.02) and a tendency for 3WS versus REF: −0.4 ± 0.2 (P < 0.07). Intensity of headache the last month decreased in both training groups: 3WS versus REF: −1.1 ± 0.2 (P < 0.001) and 3MS versus REF: −1.1 ± 0.2 (P < 0.001). Additionally, days of headache decreased 1.0 ± 0.5 in 3WS and 1.3 ± 0.5 in 3MS versus REF. There were no differences between the two training groups for any of the variables. Conclusion. Neck/shoulder training at the workplace reduced neck pain and headache among office workers independently of the extent of supervision. This finding has important practical implications for future workplace interventions. PMID:24701581

Self-reported aural symptoms, headache and temporomandibular disorders in Japanese young adults.

PubMed

Akhter, Rahena; Morita, Manabu; Ekuni, Disuke; Hassan, Nur Mohammad Monsur; Furuta, Michiko; Yamanaka, Reiko; Matsuka, Yoshizo; Wilson, David

2013-02-06

To investigate the associations of aural symptoms, headache and depression with the presence of temporomandibular disorder (TMD) symptoms in a young adult population in Japan. A personal interview survey was conducted on first-year university students (n = 1,930) regarding symptoms of TMD, aural problems, headache, shoulder pain and depression. Logistic regression was applied to assess the associations of these problems with the presence of TMD symptoms after controlling for age and gender. Among the 1,930 students, 543 students exhibited TMD symptoms and were classified into 7 groups: clicking only (Group I, n = 319), pain in the TMJ only (Group II, n = 21), difficulty in mouth opening only (Group III, n = 18), clicking and pain (Group IV, n = 29), clicking and difficulty in mouth opening (Group V, n = 48), difficulty in mouth opening and pain (Group VI, n = 11), and combination of three symptoms (Group VII, n = 97). The control group (n = 1,387) were subjects without any TMD symptoms. After adjusting for age and gender, a strong association was observed between TMD symptoms (Group II and IV) and tinnitus (OR = 12.1 and 13.2, respectively). TMD symptoms (Group I, II and III) were also associated with vertigo and headache. Otalgia and depression were significantly associated with the presence of clicking only. TMD symptoms were significantly correlated to aural symptoms and headache. A functional evaluation of the stomatognathic system should be considered in subjects with unexplained aural symptoms and headache.

Headache Attributed to Airplane Travel: A Review of Literature.

PubMed

Nierenburg, Hida; Jackfert, Katelin

2018-06-14

Headaches due to airplane travel are rare but documented in the literature. We aim to provide a review of diagnostic criteria and treatment for this condition. Several cases of this syndrome have been reported since it was first described in 2004. Airplane headache is classified as unilateral, stabbing, orbito-frontal pain, lasting under 30 min, and occurs during ascent or descent of a plane. Patients with this condition can develop anxiety and fear of flying given the intensity and severity of the pain. The pathophysiology of this syndrome is unknown, but theories include suspected barotrauma given changes in barometric pressure during ascent and descent. There are no randomized controlled trials regarding treatment, but case reports suggest headache prevention with pre-treatment with naproxen, decongestants, and triptans prior to air travel. Some non-pharmacological therapies reported include Valsalva maneuvers, chewing, relaxation techniques, and pressure at the pain area. As more cases of headache attributed to airplane travel are reported, epidemiological data can be obtained to further understand the incidence and prevalence of this condition, which can lead to improved treatment options for patients.

Habituation and sensitization in primary headaches

PubMed Central

2013-01-01

The phenomena of habituation and sensitization are considered most useful for studying the neuronal substrates of information processing in the CNS. Both were studied in primary headaches, that are functional disorders of the brain characterized by an abnormal responsivity to any kind of incoming innocuous or painful stimuli and it’s cycling pattern over time (interictal, pre-ictal, ictal). The present review summarizes available data on stimulus responsivity in primary headaches obtained with clinical neurophysiology. In migraine, the majority of electrophysiological studies between attacks have shown that, for a number of different sensory modalities, the brain is characterised by a lack of habituation of evoked responses to repeated stimuli. This abnormal processing of the incoming information reaches its maximum a few days before the beginning of an attack, and normalizes during the attack, at a time when sensitization may also manifest itself. An abnormal rhythmic activity between thalamus and cortex, namely thalamocortical dysrhythmia, may be the pathophysiological mechanism subtending abnormal information processing in migraine. In tension-type headache (TTH), only few signs of deficient habituation were observed only in subgroups of patients. By contrast, using grand-average responses indirect evidence for sensitization has been found in chronic TTH with increased nociceptive specific reflexes and evoked potentials. Generalized increased sensitivity to pain (lower thresholds and increased pain rating) and a dysfunction in supraspinal descending pain control systems may contribute to the development and/or maintenance of central sensitization in chronic TTH. Cluster headache patients are chrarcterized during the bout and on the headache side by a pronounced lack of habituation of the brainstem blink reflex and a general sensitization of pain processing. A better insight into the nature of these ictal/interictal electrophysiological dysfunctions in primary headaches paves the way for novel therapeutic targets and may allow a better understanding of the mode of action of available therapies. PMID:23899115

Mechanisms and management of functional abdominal pain.

PubMed

Farmer, Adam D; Aziz, Qasim

2014-09-01

Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain. © The Royal Society of Medicine.

Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case.

PubMed

Santos, Jaime Martinez; Kaderali, Zul; Spears, Julian; Rubin, Laurence A; Marotta, Thomas R

2015-05-29

Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis. 2015 BMJ Publishing Group Ltd.

Pilot Randomized Controlled Trial of Internet-delivered Cognitive-Behavioral Treatment for Pediatric Headache

PubMed Central

Law, Emily F.; Beals-Erickson, Sarah E.; Noel, Melanie; Claar, Robyn; Palermo, Tonya M.

2015-01-01

Objective To evaluate the feasibility and preliminary effectiveness of an Internet-delivered cognitive-behavioral therapy (CBT) intervention for adolescents with chronic headache. Background Headache is among the most common pain complaints of childhood. Cognitive-behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache due to poor access, which has led to consideration of alternative delivery modalities such as the Internet. Methods We used a parallel arm randomized controlled trial design to evaluate the feasibility and preliminary effectiveness of an Internet-delivered family-based CBT intervention, Web-Based Management of Adolescent Pain (Web-MAP). Adolescents were eligible for the trial if they were a new patient being evaluated in a specialized headache clinic, between the ages of 11–17 years old, and had recurrent headache for three months or more as diagnosed by a pediatric neurologist. Eighty-three youth enrolled in the trial. An online random number generator was used to randomly assign participants to receive Internet CBT adjunctive to specialized headache treatment (n = 44) or specialized headache treatment alone (n = 39). The primary treatment outcome was headache days. Results Youth and parents in the Internet CBT group demonstrated high levels of engagement with the web program and reported satisfaction with the intervention. Multi-level modeling was used to conduct hypothesis testing for continuous outcomes. For our primary treatment outcome of headache days, adolescents reported a statistically significant reduction in headache days from baseline to post-treatment and baseline to three-month follow-up in both treatment conditions (main effect for time F(2, 136) = 19.70, p < .001). However, there was no statistically significant difference between the Internet CBT group and the specialized headache treatment group at post-treatment or follow-up (group x time interaction F(2, 134) = .94, p = .395). For our secondary treatment outcomes, findings from multilevel modeling (MLM) showed that adolescents in both groups demonstrated statistically significant improvement headache pain intensity, activity limitations, depressive symptoms and parent protective behaviors from baseline to post-treatment and these gains were maintained at three-month follow-up. Adolescent anxiety symptoms and sleep did not change during the study period for either group. There were no statistically significant group differences on any secondary outcomes at post-treatment or follow-up (p > 0.05 for all outcomes). No adverse events were reported. Conclusion Although adjunctive Internet CBT did not lead to additional benefit in this population, future research should evaluate whether it is an effective intervention for adolescents with headache who are unable to access specialized headache treatment. PMID:26316194

The association of mast cells and serotonin in children with chronic abdominal pain of unknown etiology

PubMed Central

2010-01-01

Background Abdominal pain of unknown origin affects up to 20% of school-aged children. Evaluation of children is symptom-based without clear guidelines to investigate molecular mechanisms of abdominal pain. Aberrant molecular mechanisms may increase intestinal permeability leading to interactions between the immune and nervous systems, subclinical inflammation, and visceral pain. This study evaluated the association between interleukin-6 (IL-6), mast cell infiltrates, and serotonin (5-HT) levels in gastrointestinal (GI) biopsies, with perceived abdominal pain in a pediatric cohort. Methods Clinical data and biopsy samples from pediatric patients (n = 48) with chronic abdominal pain, with and without inflammation were included. Formalin-fixed paraffin-embedded GI biopsies were sectioned and immunohistochemistry performed for IL-6 and 5-HT; mast cells were identified with toluidine blue stain. Histological findings were compared to self-reported abdominal pain between groups. Results There was significantly greater IL-6 immunoreactivity in biopsies with confirmed histologic inflammation (p = 0.004). There was a greater number of mast cells per HPF in non-inflammatory biopsies (3.5 ± 2.9) compared to the inflammatory biopsies (2.6 ± 1.8) p = 0.049. The non-inflammatory biopsy group was significantly less likely to respond to standard treatment as evidenced by higher pain reports (p = .018). Mast cells (p = .022) and 5-HT (p = .02) were significantly related to abdominal pain scores. Conclusions A potential association between self-reported abdominal pain, number of mast cells, and 5-HT levels, which may contribute to perceived GI pain in pediatric patients may exist. PMID:20964845

Migraine may be a risk factor for the development of complex regional pain syndrome

PubMed Central

Peterlin, BL; Rosso, AL; Nair, S; Young, WB; Schwartzman, RJ

2014-01-01

The aim was to assess the relative frequency of migraine and the headache characteristics of complex regional pain syndrome (CRPS) sufferers. CRPS and migraine are chronic, often disabling pain syndromes. Recent studies suggest that headache is associated with the development of CRPS. Consecutive adults fulfilling International Association for the Study of Pain criteria for CRPS at a pain clinic were included. Demographics, medical history, and pain characteristics were obtained. Headache diagnoses were made using International Classification of Headache Disorders, 2nd edn criteria. Migraine and pain characteristics were compared in those with migraine with those without. ANOVA with Tukey post hoc tests was used to determine the significance of continuous variables and Fisher’s exact or χ2 tests for categorical variables. The expected prevalence of migraine and chronic daily headache (CDH) was calculated based on age- and gender-stratified general population estimates. Standardized morbidity ratios (SMR) were calculated by dividing the observed prevalence of migraine by the expected prevalence from the general population. The sample consisted of 124 CRPS participants. The mean age was 45.5 ± 12.0 years. Age-and gender-adjusted SMRs showed that those with CRPS were 3.6 times more likely to have migraine and nearly twice as likely to have CDH as the general population. Aura was reported in 59.7% (74/124) of participants. Of those CRPS sufferers with migraine, 61.2% (41/67) reported the onset of severe headaches before the onset of CRPS symptoms Mean age of onset of CRPS was earlier in those with migraine (34.9 ± 11.1 years) and CDH (32.5 ± 13.4 years) compared with those with no headaches (46.8 ± 14.9 years) and those with tension-type headache (TTH) (39.9 ± 9.9 years), P < 0.05. More extremities were affected by CRPS in participants with migraine (median of four extremities) compared with the combined group of those CRPS sufferers with no headaches or TTH (median 2.0 extremities), P < 0.05. The presence of static, dynamic and deep joint mechanoallodynia together was reported by more CRPS participants with migraine (72.2%) than those with no headaches or TTH (46.2%), P ≤ 0.05. Migraine may be a risk factor for CRPS and the presence of migraine may be associated with a more severe form of CRPS. Specifically: (i) migraine occurs in a greater percentage of CRPS sufferers than expected in the general population; (ii) the onset of CRPS is reported earlier in those with migraine than in those without; and (iii) CRPS symptoms are present in more extremities in those CRPS sufferers with migraine compared with those without. In addition, as we also found that the presence of aura is reported in a higher percentage of those CRPS sufferers with migraine than reported in migraineurs in the general population, further evaluation of the cardiovascular risk profile of CRPS sufferers is warranted. PMID:19614690

Stress and sleep duration predict headache severity in chronic headache sufferers.

PubMed

Houle, Timothy T; Butschek, Ross A; Turner, Dana P; Smitherman, Todd A; Rains, Jeanetta C; Penzien, Donald B

2012-12-01

The objective of this study was to evaluate the time-series relationships between stress, sleep duration, and headache pain among patients with chronic headaches. Sleep and stress have long been recognized as potential triggers of episodic headache (<15 headache days/month), though prospective evidence is inconsistent and absent in patients diagnosed with chronic headaches (≥15 days/month). We reanalyzed data from a 28-day observational study of chronic migraine (n=33) and chronic tension-type headache (n=22) sufferers. Patients completed the Daily Stress Inventory and recorded headache and sleep variables using a daily sleep/headache diary. Stress ratings, duration of previous nights' sleep, and headache severity were modeled using a series of linear mixed models with random effects to account for individual differences in observed associations. Models were displayed using contour plots. Two consecutive days of either high stress or low sleep were strongly predictive of headache, whereas 2 days of low stress or adequate sleep were protective. When patterns of stress or sleep were divergent across days, headache risk was increased only when the earlier day was characterized by high stress or poor sleep. As predicted, headache activity in the combined model was highest when high stress and low sleep occurred concurrently during the prior 2 days, denoting an additive effect. Future research is needed to expand on current findings among chronic headache patients and to develop individualized models that account for multiple simultaneous influences of headache trigger factors. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Predicting persistence of functional abdominal pain from childhood into young adulthood.

PubMed

Horst, Sara; Shelby, Grace; Anderson, Julia; Acra, Sari; Polk, D Brent; Saville, Benjamin R; Garber, Judy; Walker, Lynn S

2014-12-01

Pediatric functional abdominal pain has been linked to functional gastrointestinal disorders (FGIDs) in adulthood, but little is known about patient characteristics in childhood that increase the risk for FGID in young adulthood. We investigated the contribution of gastrointestinal symptoms, extraintestinal somatic symptoms, and depressive symptoms in pediatric patients with functional abdominal pain and whether these predicted FGIDs later in life. In a longitudinal study, consecutive new pediatric patients, diagnosed with functional abdominal pain in a subspecialty clinic, completed a comprehensive baseline evaluation of the severity of their physical and emotional symptoms. They were contacted 5 to 15 years later and evaluated, based on Rome III symptom criteria, for abdominal pain-related FGIDs, including irritable bowel syndrome, functional dyspepsia, functional abdominal pain syndrome, and abdominal migraine. Controlling for age, sex, baseline severity of abdominal pain, and time to follow-up evaluation, multivariable logistic regression was used to evaluate the association of baseline gastrointestinal, extraintestinal somatic, and depressive symptoms in childhood with FGID in adolescence and young adulthood. Of 392 patients interviewed an average of 9.2 years after their initial evaluation, 41% (n = 162) met symptom criteria for FGID; most met the criteria for irritable bowel syndrome. Extraintestinal somatic and depressive symptoms at the initial pediatric evaluation were significant predictors of FGID later in life, after controlling for initial levels of GI symptoms. Age, sex, and abdominal pain severity at initial presentation were not significant predictors of FGID later in life. In pediatric patients with functional abdominal pain, assessment of extraintestinal and depressive symptoms may be useful in identifying those at risk for FGID in adolescence and young adulthood. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

Period Pain

MedlinePlus

... cycle. Many women have painful periods, also called dysmenorrhea. The pain is most often menstrual cramps, which ... as lower back pain, nausea, diarrhea, and headaches. Period pain is not the same as premenstrual syndrome (PMS). ...

Wide abdominal rectus plication abdominoplasty for the treatment of chronic intractable low back pain.

PubMed

Oneal, Robert M; Mulka, Joseph P; Shapiro, Paul; Hing, David; Cavaliere, Christi

2011-01-01

A previous report demonstrated that the wide abdominal rectus plication abdominoplasty is an effective treatment modality in select patients with low back pain who failed to achieve relief with conservative therapy. The authors studied eight female patients who presented with chronic low back pain and marked lower abdominal wall muscular laxity. All had failed to respond to conservative management for their chronic back pain. They all underwent wide abdominal rectus plication abdominoplasty. Patient selection and details of the procedure are discussed. There were no significant complications in this series, and all the patients had prompt and prolonged alleviation of their back pain. Length of follow-up ranged from 2 to 11 years. Changes in the biomechanics of the lower abdominal musculature as a result of the wide abdominal rectus plication abdominoplasty are discussed in the context of increasing spinal stability, leading to an alleviation of chronic low back pain. An argument is made that this abdominoplasty procedure produces a spine-stabilizing effect by (1) tightening the muscles of the lateral abdominal complex and thus increasing intraabdominal pressure and (2) increasing the efficiency of these muscles so that their effectiveness as spine stabilizers is increased. Even though this is a small series, the fact that all the patients sustained long-term alleviation of their preoperative chronic back pain suggests that the wide abdominal rectus plication abdominoplasty should be considered as an option for patients with weak lower abdominal muscles and intractable low back pain who have failed conservative management.

Abdominal Assessment.

PubMed

Fritz, Deborah; Weilitz, Pamela Becker

2016-03-01

Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care.

Headache during airplane travel ("airplane headache"): first case in Greece.

PubMed

Kararizou, Evangelia; Anagnostou, Evangelos; Paraskevas, George P; Vassilopoulou, Sofia D; Naoumis, Dimitrios; Kararizos, Grigoris; Spengos, Konstantinos

2011-08-01

Headache related to airplane flights is rare. We describe a 37-year-old female patient with multiple intense, jabbing headache episodes over the last 3 years that occur exclusively during airplane flights. The pain manifests during take-off and landing, and is located always in the left retro-orbital and frontotemporal area. It is occasionally accompanied by dizziness, but no additional symptoms occur. Pain intensity diminishes and disappears after 15-20 min. Apart from occasional dizziness, no other symptoms occur. The patient has a history of tension-type headache and polycystic ovaries. Blood tests and imaging revealed no abnormalities. Here, we present the first case in Greece. We review the current literature on this rare syndrome and discuss on possible pathophysiology and the investigation of possible co-factors such as anxiety and depression.

Multimodal Chiropractic Care for Pain and Disability in a Patient Diagnosed With Ehlers-Danlos Syndrome-Hypermobility Type: A Case Report.

PubMed

Strunk, Richard G

2017-06-01

The purpose of this article is to describe the clinical response to multimodal chiropractic treatment of a patient diagnosed with Ehlers-Danlos syndrome, hypermobility type (EDS-HT), and chronic pain. A 22-year-old woman presented with severe chronic neck and low back pain, headaches, and bilateral hand pain and stiffness. In addition to these pain complaints, the patient had a family history of EDS, weekly or daily recurring joint dislocations, and upper and lower extremity joint hypermobility. As a result of her significant history and examination findings, which met the Brighton and Villefranche criteria, she was diagnosed with EDS-HT. Treatment primarily consisted of low force joint manipulative therapy and soft tissue therapy intermittently over 21 months concurrently with conventional and complementary medical care. Multiple outcome questionnaires were administered pragmatically at follow-up intervals of 3, 5½, 8½, 19, and 21 months, including but not limited to the Headache and Neck Disability Indices and the Oswestry Low Back Questionnaire. The patient had clinically meaningful improvements on the Neck Disability Index, the Headache Disability Index, and the Revised Oswestry after 3, 5½, 8½, and 21 months from baseline. This patient with EDS-HT had clinically meaningful decreases in disability, headache, and spine pain after a course of multimodal chiropractic care combined with conventional and complementary medical care.

Bilateral widespread mechanical pain hypersensitivity as sign of central sensitization in patients with cluster headache.

PubMed

Fernández-de-Las-Peñas, César; Ortega-Santiago, Ricardo; Cuadrado, María L; López-de-Silanes, Carlos; Pareja, Juan A

2011-03-01

To investigate bilateral widespread pressure pain hyperalgesia in deep tissues over symptomatic (trigemino-cervical) and nonsymptomatic (distant pain-free) regions in patients with cluster headache (CH). Central sensitization is claimed to play a relevant role in CH. No study has previously searched for widespread pressure hyperalgesia in deep tissues over both symptomatic (trigemino-cervical) and nonsymptomatic (distant pain-free) regions in patients with CH. Sixteen men (mean age: 43 ± 11 years) with CH in a remission phase and 16 matched controls were recruited. Pressure pain thresholds (PPTs) were bilaterally measured over the supra-orbital (V1), infra-orbital (V2), mental (V3), median (C5), radial (C6), and ulnar (C7) nerves, C5-C6 zygapophyseal joint, mastoid process, and tibialis anterior muscle by an assessor blinded to the subjects' condition. The results showed that PPT levels were significantly decreased bilaterally in patients with CH as compared with healthy controls (all sites, P < .001). A greater degree of sensitization over the mastoid process (P < .001) and a lower degree of sensitization over the tibialis anterior muscle (P < .01) was found. Our findings revealed bilateral widespread pressure pain hypersensitivity in patients with CH confirming the presence of central sensitization mechanisms in this headache condition. © 2010 American Headache Society.

New daily-persistent headache versus tension-type headache.

PubMed

Robbins, Matthew S; Crystal, Sara C

2010-12-01

New daily-persistent headache (NDPH) and chronic tension-type headache (CTTH) are two forms of primary chronic daily headache of long duration that often are similar in their headache manifestations. NDPH distinguishes itself from CTTH and the other forms of chronic daily headache by its continuous head pain from onset. However, despite formalized criteria that specify NDPH must resemble the acute onset of a headache identical to that of CTTH, NDPH commonly has migraine features. Here, we review the available literature on NDPH and compare its clinical features, epidemiology, prognosis, inciting factors, and treatment to CTTH.

Chronic daily headache in children and adolescents: science and conjecture.

PubMed

Connelly, Mark; Bickel, Jennifer

2013-01-01

SUMMARY Chronic daily headache comprises a group of headache disorders in which headaches occur almost daily or continuously over several months. Although chronic daily headache is one of the most common chronic pain disorders in pediatrics, data on pathophysiological mechanisms and relative efficacy of treatments remain sparse. In this review, we aim to provide contemporary information on classification, epidemiology, etiology and treatment of pediatric chronic daily headache based on extant empirical data when available, or general consensus in the field when not.

Masticatory sensory-motor changes after an experimental chewing test influenced by pain catastrophizing and neck-pain-related disability in patients with headache attributed to temporomandibular disorders.

PubMed

La Touche, Roy; Paris-Alemany, Alba; Gil-Martínez, Alfonso; Pardo-Montero, Joaquín; Angulo-Díaz-Parreño, Santiago; Fernández-Carnero, Josué

2015-03-05

Recent research has shown a relationship of craniomandibular disability with neck-pain-related disability has been shown. However, there is still insufficient information demonstrating the influence of neck pain and disability in the sensory-motor activity in patients with headache attributed to temporomandibular disorders (TMD). The purpose of this study was to investigate the influence of neck-pain-related disability on masticatory sensory-motor variables. An experimental case-control study investigated 83 patients with headache attributed to TMD and 39 healthy controls. Patients were grouped according to their scores on the neck disability index (NDI) (mild and moderate neck disability). Initial assessment included the pain catastrophizing scale and the Headache Impact Test-6. The protocol consisted of baseline measurements of pressure pain thresholds (PPT) and pain-free maximum mouth opening (MMO). Individuals were asked to perform the provocation chewing test, and measurements were taken immediately after and 24 hours later. During the test, patients were assessed for subjective feelings of fatigue (VAFS) and pain intensity. VAFS was higher at 6 minutes (mean 51.7; 95% CI: 50.15-53.26) and 24 hours after (21.08; 95% CI: 18.6-23.5) for the group showing moderate neck disability compared with the mild neck disability group (6 minutes, 44.16; 95% CI 42.65-45.67/ 24 hours after, 14.3; 95% CI: 11.9-16.7) and the control group. The analysis shows a decrease in the pain-free MMO only in the group of moderate disability 24 hours after the test. PPTs of the trigeminal region decreased immediately in all groups, whereas at 24 hours, a decrease was observed in only the groups of patients. PPTs of the cervical region decreased in only the group with moderate neck disability 24 hours after the test. The strongest negative correlation was found between pain-free MMO immediately after the test and NDI in both the mild (r = -0.49) and moderate (r = -0.54) neck disability groups. VAFS was predicted by catastrophizing, explaining 17% of the variance in the moderate neck disability group and 12% in the mild neck disability group. Neck-pain-related disability and pain catastrophizing have an influence on the sensory-motor variables evaluated in patients with headache attributed to TMD.

Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study.

PubMed

Donmez, Turgut; Erdem, Vuslat Muslu; Uzman, Sinan; Yildirim, Dogan; Avaroglu, Huseyin; Ferahman, Sina; Sunamak, Oguzhan

2017-03-01

Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups. Anesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in CSEA group (25% vs . 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2% vs . 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group. CSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA.

Stress and tension-type headache mechanisms.

PubMed

Cathcart, Stuart; Winefield, Anthony H; Lushington, Kurt; Rolan, Paul

2010-10-01

Stress is widely demonstrated as a contributing factor in tension-type headache (TTH). The mechanisms underlying this remain unclear at present. Recent research indicates the importance of central pain processes in tension-type headache (TTH) pathophysiology. Concurrently, research with animals and healthy humans has begun to elucidate the relationship between stress and pain processing in the central nervous system, including central pain processes putatively dysfunctional in TTH. Combined, these two fields of research present new insights and hypotheses into possible mechanisms by which stress may contribute to TTH. To date, however, there has been no comprehensive review of this literature. The present paper provides such a review, which may be valuable in facilitating a broader understanding of the central mechanisms by which stress may contribute to TTH.

Randomized Trial of Adding Parenteral Acetaminophen to Prochlorperazine and Diphenhydramine to Treat Headache in the Emergency Department.

PubMed

Meyering, Stefan H; Stringer, Ryan W; Hysell, Matthew K

2017-04-01

Headaches represent over three million emergency department (ED) visits per year, comprising 2.4% of all ED visits. There are many proposed methods and clinical guidelines of treating acute headache presentations. However, data on intravenous acetaminophen usage in these settings are lacking. In this study, we sought to determine the efficacy of intravenous (IV) acetaminophen as an adjunct to a standard therapy for the treatment of patients who present to the ED with a chief complaint of "headache." We conducted a single site, randomized, double-blind, placebo-controlled trial investigating the clinical efficacy of IV acetaminophen as an adjunct to a standard therapy with prochlorperazine and diphenhydramine for the treatment of patients who present to the ED with a chief complaint of "headache" or variants thereof. (See below for variants). The primary outcome measure of the efficacy of parenteral acetaminophen as an adjunct treatment for headache in addition to a standard therapy was a threshold two-point reduction in visual analog scale (VAS) pain scores on a 1-10 level at 90 minutes. Secondary outcomes measures included assessment of decreased requirement of "rescue" pain medicines, defined as any analgesic medications outside of diphenhydramine, prochlorperazine and acetaminophen, with particular interest to potential opioid-sparing effects with parenteral acetaminophen. Additional secondary outcome measure included time to disposition from arrival in the ED. For the acetaminophen group the initial mean pain score was 8.67, for the placebo group 8.61. At 90 minutes pain score was 2.23 for the acetaminophen group and 3.99 for placebo (p<0.01, 95% confidence interval (CI) [0.8%-16%]. Of 45 patients in each group, we observed at least a threshold two-point decrease in pain score 36/45 (80%) with acetaminophen vs. 25/45 (55%) with placebo (p <0.01) 95% CI [5%-41%], number needed to treat (NNT) = 4). Secondary outcome measure did not demonstrate a difference in length of stay (161 minutes for acetaminophen arm and 159 minutes for placebo). However, 17/45 (38%) of patients who received IV acetaminophen required rescue analgesia, opposed to 24/45 (53%) of patients in the placebo group (p=0.13) 95% CI [-5%-34%]. IV acetaminophen when used with prochlorperazine and diphenhydramine to treat acute headaches in the ED resulted in statistically significant pain reduction compared with prochlorperazine and diphenhydramine alone as measured by both threshold of lowering VAS pain score by at least two points (NNT = 4) and overall decline in VAS pain score. Further study is required to validate these results.

Linear headache: a recurrent unilateral head pain circumscribed in a line-shaped area

PubMed Central

2014-01-01

Background A headache circumscribed in a line-shaped area but not confined to the territory of one particular nerve had ever been described in Epicrania Fugax (EF) of which the head pain is moving and ultrashort. In a 25-month period from Feb 2012 to Mar 2014, we encountered 12 patients with a paroxysmal motionless head pain restricted in a linear trajectory. The head pain trajectory was similar to that of EF, but its all other features obviously different from those of EF. We named this distinctive but undescribed type of headache linear headache (LH). Methods A detailed clinical feature of the headache was obtained in all cases to differentiate with EF, trigeminal autonomic cephalalgias (TACs) and cranial neuralgia. Similarities and differences in clinical features were compared between LH and migraine. Results The twelve LH patients (mean age 43.9 ± 12.2) complained of a recurrent, moderate to severe, distending (n = 9), pressure-like (n = 3) or pulsating (n = 3) pain within a strictly unilateral line-shaped area. The painful line is distributed from occipital or occipitocervical region to the ipsilateral eye (n = 5), forehead (n = 6) or parietal region (n = 1). The pain line has a trajecory similar to that of EF but no characteristics of moving. The headache duration would be ranged from five minutes to three days, but usually from half day to one day in most cases (n = 8). Six patients had the accompaniment of nausea with or without vomiting, and two patients had the accompaniment of ipsilateral dizziness. The attacks could be either spontaneous (n = 10) or triggered by noise, depression and resting after physical activity (n = 1), or by stress and staying up late (n = 1). The frequency of attacks was variable. The patients had well response to flunarizine, sodium valproate and amitriptyline but not to carbamazepine or oxcarbazepine. LH is different from EF, trigeminal autonomic cephalalgias (TACs) and cranial neuralgia, but it had couple of features similar to that of migraine. Conclusions The clinical picture of LH might be a subtype of migraine, or represent a novel syndrome. PMID:24966056

Linear headache: a recurrent unilateral head pain circumscribed in a line-shaped area.

PubMed

Wang, Yu; Tian, Miao-Miao; Wang, Xian-Hong; Zhu, Xiao-Qun; Liu, Ying; Lu, Ya-Nan; Pan, Qing-Qing

2014-06-26

A headache circumscribed in a line-shaped area but not confined to the territory of one particular nerve had ever been described in Epicrania Fugax (EF) of which the head pain is moving and ultrashort. In a 25-month period from Feb 2012 to Mar 2014, we encountered 12 patients with a paroxysmal motionless head pain restricted in a linear trajectory. The head pain trajectory was similar to that of EF, but its all other features obviously different from those of EF. We named this distinctive but undescribed type of headache linear headache (LH). A detailed clinical feature of the headache was obtained in all cases to differentiate with EF, trigeminal autonomic cephalalgias (TACs) and cranial neuralgia. Similarities and differences in clinical features were compared between LH and migraine. The twelve LH patients (mean age 43.9 ± 12.2) complained of a recurrent, moderate to severe, distending (n = 9), pressure-like (n = 3) or pulsating (n = 3) pain within a strictly unilateral line-shaped area. The painful line is distributed from occipital or occipitocervical region to the ipsilateral eye (n = 5), forehead (n = 6) or parietal region (n = 1). The pain line has a trajecory similar to that of EF but no characteristics of moving. The headache duration would be ranged from five minutes to three days, but usually from half day to one day in most cases (n = 8). Six patients had the accompaniment of nausea with or without vomiting, and two patients had the accompaniment of ipsilateral dizziness. The attacks could be either spontaneous (n = 10) or triggered by noise, depression and resting after physical activity (n = 1), or by stress and staying up late (n = 1). The frequency of attacks was variable. The patients had well response to flunarizine, sodium valproate and amitriptyline but not to carbamazepine or oxcarbazepine. LH is different from EF, trigeminal autonomic cephalalgias (TACs) and cranial neuralgia, but it had couple of features similar to that of migraine. The clinical picture of LH might be a subtype of migraine, or represent a novel syndrome.

Computerized tomography-guided sphenopalatine ganglion pulsed radiofrequency treatment in 16 patients with refractory cluster headaches: Twelve- to 30-month follow-up evaluations.

PubMed

Fang, Luo; Jingjing, Lu; Ying, Shen; Lan, Meng; Tao, Wang; Nan, Ji

2016-02-01

Sphenopalatine ganglion percutaneous radiofrequency thermocoagulation treatment can improve the symptoms of cluster headaches to some extent. However, as an ablation treatment, radiofrequency thermocoagulation treatment also has side effects. To preliminarily evaluate the efficacy and safety of a non-ablative computerized tomography-guided pulsed radiofrequency treatment of sphenopalatine ganglion in patients with refractory cluster headaches. We included and analysed 16 consecutive cluster headache patients who failed to respond to conservative therapy from the Pain Management Center at the Beijing Tiantan Hospital between April 2012 and September 2013 treated with pulsed radiofrequency treatment of sphenopalatine ganglion. Eleven of 13 episodic cluster headaches patients and one of three chronic cluster headaches patient were completely relieved of the headache within an average of 6.3 ± 6.0 days following the treatment. Two episodic cluster headache patients and two chronic cluster headache patients showed no pain relief following the treatment. The mean follow-up time was 17.0 ± 5.5 months. All patients enrolled in this study showed no treatment-related side effects or complications. Our data show that patients with refractory episodic cluster headaches were quickly, effectively and safely relieved from the cluster period after computerized tomography-guided pulsed radiofrequency treatment of sphenopalatine ganglion, suggesting that it may be a therapeutic option if conservative treatments fail. © International Headache Society 2015.

Occipital neuralgia with and without migraine: difference in pain characteristics and risk factors.

PubMed

Sahai-Srivastava, Soma; Zheng, Ling

2011-01-01

We conducted this study to identify differences in presentation and symptomatology between patients with isolated occipital neuralgia (ON) and patients with ON who also had migraine headache (ON + M). Occipital neuralgia is an uncommon cause of headaches. Very little is known about the pain characteristics and associated features of patients with ON + M and whether these pain characteristics differ from those of patients with isolated ON. We studied 35 consecutive patients presenting with ON to the University of Southern California headache clinic. All patients met International Headache Society criteria for diagnosis of ON. Patients completed a questionnaire designed for this study. We also collected demographic data, including age, gender, and ethnicity. Twenty patients had ON + M and 15 had isolated ON. There was no difference in age, gender or ethnicity between patients with ON + M and those with isolated ON. Patients with ON + M had significantly more complaints of pain traveling to the scalp and presence of scalp tenderness and tingling compared with patients with isolated ON; 25% patients in the ON + M group described the pain as "dull" whereas none of the isolated ON group reported this characteristic. There was higher use of chiropractors and massage therapy in patients from ON + M group than from isolated ON. There may be significant differences in pain characteristics for patients with ON + M and those for patients with isolated ON. The data indicate that patients with migraine should also be screened for symptoms of ON, as there may be similarities in presentation. The clinical implications of distinguishing ON + M and isolated ON include differences in treatment regimen, avoidance of inappropriate use of medical resources, and differences in long-term outcomes. © 2010 American Headache Society.

[Evaluation of anger expression, school functioning and a level of anxiety in children and adolescents with functional abdominal pain].

PubMed

Marczyńska, Paulina; Kowalkowska, Katarzyna; Kuczyńska, Renata; Czerwionka-Szaflarska, Mieczysława; Krogulska, Aneta

Psychosocial conditions may have influence on the occurrence of functional abdominal pain. Anxiety, school-related difficulties and suppression of emotions negatively impact on the psychosocial condition of a child and could impede its treatment. The analysis of the psychosocial determinants of functioning of children and adolescents with functional abdominal pain. Meterial and methods: The study group comprised 58 patients (12 boys and 46 girls) from 9 to 17 years of age (av. 13.34±2.14 years) with functional abdominal pain, diagnosed according to the III Roman Criteria, and the control group of 58 healthy children in adequate age, of Bydgoszcz primary and secondary schools. The test method utilised The Anger Regulation and Expression Scale (SEG), The State-Trait Anxiety Inventory for Children (STAIC) and Me and My School Questionnaire. Analysing the results of scale SEG between the group of children with functional abdominal pain and healthy children, significant differences were observed in the scale of external anger (p=0.045). There were no differences between the group of children with functional abdominal pain and the comparative one in terms of Me and My School Inventory scale (p> 0.05). In the group of healthy adolescents, the average of motivation differed significantly from the result of the adolescents with functional abdominal pain (p=0.031). There were no differences between the group of children and adolescents with abdominal pain and the healthy ones in terms of the performance in STAIC scales (p>0.05). 1. Healthy children compared to children with functional abdominal pain more openly express negative emotions, such as anger and irritation, which can cause reduced tendency to the somatization of symptoms. 2. Symptoms of young people with functional abdominal pain intensify reluctance to fulfill school duties and heighten fear of school, depending on the speed of activation of the autonomic nervous system.

Phase I safety, pharmacokinetic and pharmacodynamic evaluation of the vascular disrupting agent ombrabulin (AVE8062) in patients with advanced solid tumors.

PubMed

Sessa, Cristiana; Lorusso, Patricia; Tolcher, Anthony; Farace, Françoise; Lassau, Nathalie; Delmonte, Angelo; Braghetti, Antonio; Bahleda, Rastislav; Cohen, Patrick; Hospitel, Marie; Veyrat-Follet, Christine; Soria, Jean-Charles

2013-09-01

The vascular disrupting agent ombrabulin rapidly reduces tumor blood flow and causes necrosis in vivo. A phase I dose-escalation study was designed to determine the recommended phase II dose (RP2D) of single-agent ombrabulin administered once every three weeks in patients with advanced solid malignancies. Ombrabulin (30-minute infusion) was escalated from 6 to 60 mg/m2, with RP2D cohort expansion. Safety, tumor response, pharmacokinetics, and pharmacodynamic biomarkers were evaluated. Eleven dose levels were evaluated in 105 patients. Two patients had dose-limiting toxicities in cycle 1 during escalation: grade 3 abdominal pain at 50 mg/m2, grade 3 tumor pain/grade 3 hypertension at 60 mg/m2, and the RP2D was 50 mg/m2 (39 patients). Common toxicities were headache, asthenia, abdominal pain, nausea, diarrhea, transient hypertension, anemia, and lymphopenia. No clinically significant QTc prolongations or left ventricular ejection fraction (LVEF) decreases occurred. Ombrabulin was rapidly converted to its active metabolite RPR258063 (half-life 17 minutes and 8.7 hours, respectively), both having dose-proportional exposure. Weak inhibition of CYP2C19-mediated metabolism occurred at the clinical doses used and there was no effect on CYP1A2 and CYP3A4. A patient with rectal cancer had a partial response and eight patients had stable disease lasting four months or more. Circulating endothelial cells (CEC), VEGF, and matrix metalloproteinase (MMP)-9 levels increased significantly six to 10 hours postinfusion in a subset of patients. The recommended schedule for single-agent ombrabulin is 50 mg/m2 every 3 weeks. CECs, VEGF, and MMP-9 are potential biomarkers of ombrabulin activity. ©2013 AACR.

Serenoa repens (saw palmetto): a systematic review of adverse events.

PubMed

Agbabiaka, Taofikat B; Pittler, Max H; Wider, Barbara; Ernst, Edzard

2009-01-01

Serenoa repens (W. Bartram) Small, also known as saw palmetto, is one of the most widely used herbal preparations for the treatment of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Although a number of randomized controlled trials (RCTs) and systematic reviews of the efficacy of S. repens for the treatment of LUTS and BPH have been published, no systematic review on its drug interactions or adverse events currently exists. This review assesses all available human safety data of S. repens monopreparations. Systematic literature searches were conducted from date of inception to February 2008 in five electronic databases; reference lists and our departmental files were checked for further relevant publications. Information was requested from spontaneous reporting schemes of the WHO and national safety bodies. Twenty-four manufacturers/distributors of S. repens preparations and four herbalist organizations were contacted for additional information. No language restrictions were imposed. Only reports of adverse events in humans from monopreparations of S. repens were included. Data from all articles, regardless of study design, reporting adverse events or interactions were independently extracted by the first author and validated by the second. Forty articles (26 randomized controlled trials, 4 non-randomized controlled trials, 6 uncontrolled trials and 4 case reports/series) were included. They suggest that adverse events associated with the use of S. repens are mild and similar to those with placebo. The most frequently reported adverse events are abdominal pain, diarrhoea, nausea, fatigue, headache, decreased libido and rhinitis. More serious adverse events such as death and cerebral haemorrhage are reported in isolated case reports and data from spontaneous reporting schemes, but causality is questionable. No drug interactions were reported. Currently available data suggest that S. repens is well tolerated by most users and is not associated with serious adverse events. The majority of adverse events are mild, infrequent and reversible, and include abdominal pain, diarrhoea, nausea and fatigue, headache, decreased libido and rhinitis. We found no evidence for drug interactions with S. repens. However, higher quality reporting of adverse events is essential if safety assessments are to be improved in future.

Positive or negative fructose breath test results do not predict response to fructose restricted diet in children with recurrent abdominal pain: results from a prospective randomized trial.

PubMed

Wirth, S; Klodt, C; Wintermeyer, P; Berrang, J; Hensel, K; Langer, T; Heusch, A

2014-09-01

To perform a prospective, blinded, randomized interventional trial in patients with recurrent abdominal pain. The primary endpoint was to determine the abdominal pain intensity after 2 weeks of fructose restricted diet. Secondary endpoints were changes of pain frequency and a secondary symptom score (SSS). 103 individuals with recurrent abdominal pain for more than 3 months were randomized. 51 patients were allocated to group A (diet) and 52 to group B (no diet). 2 weeks later the patients underwent hydrogen breath test and were assigned to the test positive or negative group to identify patients with fructose malabsorption. 2 weeks after intervention the pain score decreased significantly from a median 5.5 in group A to 4 and did not change significantly in group B (5.3 to 5). In group A both patients with positive and negative breath tests had a significant lower pain score (-2 and -1.75, respectively). Frequency of abdominal pain decreased in both groups but without significant difference, SSS improved only in group A from median 6 to 3.5. Positive breath test was no predicting factor, neither was abdominal pain during the test. Fructose restricted diet in children and adolescents with recurrent abdominal pain may be of benefit to improve both abdominal pain symptoms and other secondary symptoms. Since a negative breath test result does not exclude a positive response to fructose restriction, the hydrogen breath test does not seem to be the appropriate diagnostic mean to predict the response to the diet. © Georg Thieme Verlag KG Stuttgart · New York.

Systematic review: interventions for abdominal pain management in inflammatory bowel disease.

PubMed

Norton, C; Czuber-Dochan, W; Artom, M; Sweeney, L; Hart, A

2017-07-01

Abdominal pain is frequently reported by people with inflammatory bowel disease (IBD), including in remission. Pain is an under-treated symptom. To systematically review evidence on interventions (excluding disease-modifying interventions) for abdominal pain management in IBD. Databases (MEDLINE, EMBASE, PsycInfo, CINAHL, Scopus, Cochrane Library) were searched (February 2016). Two researchers independently screened references and extracted data. Fifteen papers were included: 13 intervention studies and two cross-sectional surveys. A variety of psychological, dietary and pharmacological interventions were reported. Four of six studies reported pain reduction with psychological intervention including individualised and group-based relaxation, disease anxiety-related Cognitive Behavioural Therapy and stress management. Both psychologist-led and self-directed stress management in inactive Crohn's disease reduced pain compared with controls (symptom frequency reduction index=-26.7, -11.3 and 17.2 at 6-month follow-up, respectively). Two dietary interventions (alcoholic drinks with high sugar content and fermentable carbohydrate with prebiotic properties) had an effect on abdominal pain. Antibiotics (for patients with bacterial overgrowth) and transdermal nicotine patches reduced abdominal pain. Current and past cannabis users report it relieves pain. One controlled trial of cannabis reduced SF-36 and EQ-5D pain scores (1.84 and 0.7, respectively). These results must be treated with caution: data were derived from predominantly small uncontrolled studies of moderate to low quality. Few interventions have been tested for IBD abdominal pain. The limited evidence suggests that relaxation and changing cognitions are promising, possibly with individualised dietary changes. There is a need to develop interventions for abdominal pain management in IBD. © 2017 John Wiley & Sons Ltd.

Aura in Cluster Headache: A Cross-Sectional Study.

PubMed

de Coo, Ilse F; Wilbrink, Leopoldine A; Ie, Gaby D; Haan, Joost; Ferrari, Michel D

2018-06-22

Aura symptoms have been reported in up to 23% of cluster headache patients, but it is not known whether clinical characteristics are different in participants with and without aura. Using validated web-based questionnaires we assessed the presence and characteristics of attack-related aura and other clinical features in 629 subjects available for analysis from an initial cohort of 756 cluster headache subjects. Participants who screened positive for aura were contacted by telephone for confirmation of the ICHD-III criteria for aura. Typical aura symptoms before or during cluster headache attacks were found in 44/629 participants (7.0%) mainly involving visual symptoms (61.4%). Except for lower alcohol consumption and higher prevalence of frontal pain in participants with aura, no differences in clinical characteristics were found compared with participants without aura. At least 7.0% of the participants with cluster headache in our large cohort reported typical aura symptoms, which most often involved visual symptoms. No major clinical differences were found between participants with and without aura. © 2018 The Authors. Headache: The Journal of Head and Face Pain published by Wiley Periodicals, Inc. on behalf of American Headache Society.

Maintenance of pain in children with functional abdominal pain

USDA-ARS?s Scientific Manuscript database

A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdomina...

Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis.

PubMed

Korterink, Judith J; Diederen, Kay; Benninga, Marc A; Tabbers, Merit M

2015-01-01

We aimed to review the literature regarding epidemiology of functional abdominal pain disorders in children and to assess its geographic, gender and age distribution including associated risk factors of developing functional abdominal pain. The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsychInfo databases were systematically searched up to February 2014. Study selection criteria included: (1) studies of birth cohort, school based or general population samples (2) containing data concerning epidemiology, prevalence or incidence (3) of children aged 4-18 years (4) suffering from functional abdominal pain. Quality of studies was rated by a self-made assessment tool. A random-effect meta-analysis model was used to estimate the prevalence of functional abdominal pain in childhood. A total of 58 articles, including 196,472 children were included. Worldwide pooled prevalence for functional abdominal pain disorders was 13.5% (95% CI 11.8-15.3), of which irritable bowel syndrome was reported most frequently (8.8%, 95% CI 6.2-11.9). The prevalence across studies ranged widely from 1.6% to 41.2%. Higher pooled prevalence rates were reported in South America (16.8%) and Asia (16.5%) compared to Europe (10.5%). And a higher pooled prevalence was reported when using the Rome III criteria (16.4%, 95% CI 13.5-19.4). Functional abdominal pain disorders are shown to occur significantly more in girls (15.9% vs. 11.5%, pooled OR 1.5) and is associated with the presence of anxiety and depressive disorders, stress and traumatic life events. Functional abdominal pain disorders are a common problem worldwide with irritable bowel syndrome as most encountered abdominal pain-related functional gastrointestinal disorder. Female gender, psychological disorders, stress and traumatic life events affect prevalence.

Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis

PubMed Central

Korterink, Judith J.; Diederen, Kay; Benninga, Marc A.; Tabbers, Merit M.

2015-01-01

Objective We aimed to review the literature regarding epidemiology of functional abdominal pain disorders in children and to assess its geographic, gender and age distribution including associated risk factors of developing functional abdominal pain. Methods The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsychInfo databases were systematically searched up to February 2014. Study selection criteria included: (1) studies of birth cohort, school based or general population samples (2) containing data concerning epidemiology, prevalence or incidence (3) of children aged 4-18 years (4) suffering from functional abdominal pain. Quality of studies was rated by a self-made assessment tool. A random-effect meta-analysis model was used to estimate the prevalence of functional abdominal pain in childhood. Results A total of 58 articles, including 196,472 children were included. Worldwide pooled prevalence for functional abdominal pain disorders was 13.5% (95% CI 11.8-15.3), of which irritable bowel syndrome was reported most frequently (8.8%, 95% CI 6.2-11.9). The prevalence across studies ranged widely from 1.6% to 41.2%. Higher pooled prevalence rates were reported in South America (16.8%) and Asia (16.5%) compared to Europe (10.5%). And a higher pooled prevalence was reported when using the Rome III criteria (16.4%, 95% CI 13.5-19.4). Functional abdominal pain disorders are shown to occur significantly more in girls (15.9% vs. 11.5%, pooled OR 1.5) and is associated with the presence of anxiety and depressive disorders, stress and traumatic life events. Conclusion Functional abdominal pain disorders are a common problem worldwide with irritable bowel syndrome as most encountered abdominal pain-related functional gastrointestinal disorder. Female gender, psychological disorders, stress and traumatic life events affect prevalence. PMID:25992621

Pain management in patients with inflammatory bowel disease: insights for the clinician

PubMed Central

Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C.

2012-01-01

Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients’ lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population. PMID:22973418

The buffering effect of family functioning on the psychological consequences of headache.

PubMed

Mohammadi, Somayyeh; Zandieh, Sara; Dehghani, Mohsen; Assarzadegan, Farhad; Sanderman, Robbert; Hagedoorn, Mariët

2017-02-01

The current study aimed to examine whether high family functioning mitigates the association between headache intensity and distress. The sample consisted of 124 patients with chronic or recurrent headache. Patients completed validated questionnaires about headache intensity, family functioning, and distress. Hierarchical regression analyses were performed to examine the interaction between headache intensity and family functioning on distress. Headache intensity was positively associated with distress (r = .28, p = .002). As hypothesized, family functioning moderated this association (B = -.01, p = .023). More specifically, the positive association between headache intensity and distress was significant only among patients with lower family functioning (B = .01, p < .001) and not among patients with higher levels of family functioning (B = .006, p = .075). Functional families appear to buffer the distress level in patients; they showed relatively low levels of distress regardless of the severity of their headache. In contrast, patients with dysfunctional families who experienced more pain reported more distress, presumably because they did not receive adequate help and support from these families. This study underlines the importance of a broader perspective on family dynamics in coping with pain.

Somatization symptoms in pediatric abdominal pain patients: relation to chronicity of abdominal pain and parent somatization.

PubMed

Walker, L S; Garber, J; Greene, J W

1991-08-01

Symptoms of somatization were investigated in pediatric patients with recurrent abdominal pain (RAP) and comparison groups of patients with organic etiology for abdominal pain and well patients. Somatization scores were higher in RAP patients than well patients at the clinic visit, and higher than in either well patients or organic patients at a 3-month followup. Higher somatization scores in mothers and fathers were associated with higher somatization scores in RAP patients, but not in organic or well patients. Contrary to the findings of Ernst, Routh, and Harper (1984), chronicity of abdominal pain in RAP patients was not significantly associated with their level of somatization symptoms. Psychometric information about the Children's Somatization Inventory is presented.

Functional abdominal pain syndrome treated with Korean medication.

PubMed

Son, Chang-Gue

2014-06-01

A 37-year-old female patient with chronic and stubborn abdominal pain had been hospitalized five times in three Western hospitals, but no effects were observed. No abnormalities were found in blood tests, gastrointestinal endoscopy, sonogram, and computed tomography of the abdomen, except mild paralytic ileus. The patient decided to rely on Korean medicine as an inpatient. She was diagnosed with functional abdominal pain syndrome, and her symptom differentiation was the " Yang deficiency of spleen and kidney ." A herbal drug, Hwangikyeji-tang , along with moxibustion and acupuncture, was given to the patient. Abdominal pain and related symptoms were reduced radically within 16 days of treatment. This report shows a therapeutic potential of Korean medicine-based treatment for functional abdominal pain syndrome.

Overlap between functional abdominal pain disorders and organic diseases in children.

PubMed

Langshaw, A H; Rosen, J M; Pensabene, L; Borrelli, O; Salvatore, S; Thapar, N; Concolino, D; Saps, M

2018-04-02

Functional abdominal pain disorders are highly prevalent in children. These disorders can be present in isolation or combined with organic diseases, such as celiac disease and inflammatory bowel diseases. Intestinal inflammation (infectious and non-infectious) predisposes children to the development of visceral hypersensitivity that can manifest as functional abdominal pain disorders, including irritable bowel syndrome. The new onset of irritable bowel syndrome symptoms in a patient with an underlying organic disease, such as inflammatory bowel disease, is clinically challenging, given that the same symptomatology may represent a flare-up of the inflammatory bowel disease or an overlapping functional abdominal pain disorder. Similarly, irritable bowel syndrome symptoms in a child previously diagnosed with celiac disease may occur due to poorly controlled celiac disease or the overlap with a functional abdominal pain disorder. There is little research on the overlap of functional abdominal disorders with organic diseases in children. Studies suggest that the overlap between functional abdominal pain disorders and inflammatory bowel disease is more common in adults than in children. The causes for these differences in prevalence are unknown. Only a handful of studies have been published on the overlap between celiac disease and functional abdominal pain disorders in children. The present article provides a review of the literature on the overlap between celiac disease, inflammatory bowel disease, and functional abdominal pain disorders in children and establish comparisons with studies conducted on adults. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

Functional abdominal pain in childhood: background studies and recent research trends.

PubMed

Levy, Rona L; van Tilburg, Miranda A L

2012-01-01

The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominal pain, and also summarizes the primary related findings from the authors' research program. Specific areas discussed based on work within the authors' group include familial illness patterns, genetics, traits, and mechanisms or processes related to abdominal pain. Topics covered from research published in the past five years include prevalence and cost, longitudinal follow-up, overlap with other disorders, etiology and mechanisms behind functional abdominal pain and treatment studies. It is hoped that findings from this work in abdominal pain will be interpreted as a framework for understanding the processes by which other pain phenomena and, more broadly, reactions to any physical state, can be developed and maintained in children. The present article concludes with recommendations for clinical practice and research.

Benign Headache Management in the Emergency Department.

PubMed

Long, Brit J; Koyfman, Alex

2018-04-01

Headache is a common complaint managed in the emergency department (ED), with emergency physicians focusing on evaluation for life-threatening conditions while treating pain and nausea. This review evaluates the treatment of benign, primary headaches in the ED, with recommendations provided based on the literature. Headaches are a major cause of disability in the United States and a common condition managed in the ED. The primary objectives of emergency evaluation of these patients include evaluation for a life-threatening, secondary cause of headache, with treatment of primary headaches. Close evaluation for a secondary cause of headache include consideration of red flags and focused neurologic examination. The diagnosis of primary headaches is clinical. Literature has evaluated medication efficacy in headache treatment, with antidopaminergic medications demonstrating high rates of efficacy when used in combination with nonsteroidal inflammatory drugs or acetaminophen. Dexamethasone can be used for the reduction of headache recurrence. If dehydration is present, intravenous fluids should be provided. Diphenhydramine is not recommended for analgesia but may reduce akathisia associated with prochlorperazine. Ketamine, propofol, and nerve blocks demonstrate promise. Triptan agents are also efficacious, provided absence of contraindications. Most patients are appropriate for discharge with pain improvement. A variety of medications is available for the treatment of primary headaches in the ED. Antidopaminergic agents demonstrate the highest efficacy and should be provided with acetaminophen and nonsteroidal inflammatory drugs. Dexamethasone may reduce headache recurrence. Other treatments include ketamine, propofol, and nerve blocks. Published by Elsevier Inc.

Bacterial infections in childhood: A risk factor for gastrointestinal and other diseases?

PubMed

Schwille-Kiuntke, Juliane; Unverdorben, Alexandra; Weimer, Katja; Schlarb, Angelika Anita; Gulewitsch, Marco Daniel; Ellert, Ute; Enck, Paul

2015-02-01

There is evidence for post-infectious irritable bowel syndrome (PI-IBS) in adults, but little is known about PI-IBS in children. The nationwide representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) assessed children's health. We identified 643 children (50.1% males) in the KiGGS cohort (N = 15,878, 51% males) with a history of Salmonella infection. The number was validated comparing this group with the known infection statistics from the Robert Koch-Institute registry. We compared this group to the remaining KiGGS cohort (n = 12,951) with respect to sociodemographic characteristics, pain and quality of life. To check for specificity, we repeated the comparisons with a group with a history of scarlet fever. Infection statistics predicted 504 cases of Salmonella infection in the KiGGS cohort, indicating high validity of the data. In children between 3 and 10 years with a history of Salmonella infection, significantly more abdominal pain (31.7% versus 21.9%, p < 0.001) and headache (27.2% versus 15.1%, p < 0.001) were reported. This group showed lower quality of life (p < 0.001). Comparison to a group of scarlet fever-infected children revealed poor specificity of the data. Differences found between children with and without Salmonella infection reveal the role of gastrointestinal infection in the development of post-infectious abdominal problems, but poor specificity may point toward a psychosocial ("somatization") rather than a Salmonella-specific mechanism.

Lead toxicity as an etiology for abdominal pain in the emergency department.

PubMed

Moriarity, Risa S; Harris, James T; Cox, Robert D

2014-02-01

Abdominal pain is an uncommon presentation of lead toxicity in the emergency department (ED). However, making the diagnosis is important in avoiding unnecessary testing and the long-term sequelae of lead toxicity. To illustrate possible presentations of abdominal pain secondary to lead toxicity and highlight the importance of taking a thorough patient history. We report 2 patients who presented to the ED with abdominal pain and underwent extensive evaluations that did not reveal an etiology. At follow-up visits, their occupational histories revealed possible lead exposures from working for a bullet-recycling company. Tests revealed that each patient had extremely high lead levels and they were both treated for lead toxicity. Their abdominal pain resolved as their lead levels decreased. These cases demonstrate a rare but significant cause of abdominal pain in the ED. Although history-taking in the ED is necessarily brief, these cases underscore the importance of obtaining an occupational history. Copyright © 2014 Elsevier Inc. All rights reserved.

MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes.

PubMed

Spalluto, Lucy B; Woodfield, Courtney A; DeBenedectis, Carolynn M; Lazarus, Elizabeth

2012-01-01

Clinical diagnosis of the cause of abdominal pain in a pregnant patient is particularly difficult because of multiple confounding factors related to normal pregnancy. Magnetic resonance (MR) imaging is useful in evaluation of abdominal pain during pregnancy, as it offers the benefit of cross-sectional imaging without ionizing radiation or evidence of harmful effects to the fetus. MR imaging is often performed specifically for diagnosis of possible appendicitis, which is the most common illness necessitating emergency surgery in pregnant patients. However, it is important to look for pathologic processes outside the appendix that may be an alternative source of abdominal pain. Numerous entities other than appendicitis can cause abdominal pain during pregnancy, including processes of gastrointestinal, hepatobiliary, genitourinary, vascular, and gynecologic origin. MR imaging is useful in diagnosing the cause of abdominal pain in a pregnant patient because of its ability to safely demonstrate a wide range of pathologic conditions in the abdomen and pelvis beyond appendicitis. © RSNA, 2012.

Improving pain management of abdominal pain in children presenting to the paediatric emergency department: a pre-post interventional study.

PubMed

Williams, Suzanne; Holzhauser, Kerri; Bonney, Donna; Burmeister, Elizabeth; Gilhotra, Yuri; Oliver, Randall; Gordon, Kerry

2012-08-01

In 2007, the Mater Children's Hospital Emergency Department participated in the Emergency Care Pain Management Initiative funded by the National Health and Medical Research Council National Institute of Clinical Studies (NHMRC-NICS). The findings of this NHMRC-NICS research across eleven paediatric emergency departments highlighted deficits in pain management of abdominal pain. Specifically pain assessment, timeliness of analgesia, and pain management guidelines were found to be lacking. In response to the NICS report local practice was reviewed and a pilot research project undertaken to develop a clinical guideline for the pain management of abdominal pain in children presenting to the emergency department. The guideline was developed by an expert panel and trialled using a pre and post intervention design. The results demonstrated improved compliance to assessment and documentation of pain scores and assimilation of the best practice principles recommended in the guideline. This project raised local awareness in the pain management of abdominal pain and provides baseline information for future improvement. The guideline has been trialled in the clinical setting of paediatric emergency and has the potential to improve pain management practices in children presenting to the emergency department with abdominal pain. Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

Agreement of parents and children on characteristics of pediatric headache, other pains, somatic symptoms, and depressive symptoms in an epidemiologic study.

PubMed

Kröner-Herwig, Birgit; Morris, Lisette; Heinrich, Marion; Gassmann, Jennifer; Vath, Nuria

2009-01-01

The objective of the present study was to assess the concordance between parent and child report regarding different domains of pediatric health, headache in particular. In addition, the influence of potential moderator variables on the agreement between parents and children was examined. In an epidemiologic study on a randomly drawn sample of households with at least 1 child in the family between 7 and 14 years of age (community registries), various pediatric health disturbances (headache, other pains, somatic symptoms, and depression/anxiety) were assessed via both child (from the age of 9 y on) and parent report (n=3461). A relatively high parent-child agreement (sigmaM=0.61) was found regarding the variable headache frequency, whereas consensus regarding other pains was, for the most part, markedly lower. The lowest agreement (sigmaM=0.27) was found for depression/anxiety symptoms. A moderator analysis (with age, sex, and parental headache) between child and parent failed to reveal significant differences regarding the degree of agreement between the 2 data sources. Children reported more frequent and more severe symptoms in all health domains. The examined potential moderator variables did not elucidate processes underlying the differences in child and parent agreement. There is no convincing evidence that the children's appraisal is less valid than their parents'. In summary, parents' reports cannot be viewed as a substitute for children's reports in pediatric pain and health assessment. Instead, each perspective represents a unique subjective reality and as such, both are of importance for research on pediatric pain and other health variables.

Retro-orbital tumour--an uncommon cause of headache in pregnancy.

PubMed

Roberts, L J; Goucke, C R

2001-06-01

Retro-orbital tumour was the cause of headache and neuropathic facial pain in a 31-year-old pregnant woman. The diagnosis had been overlooked as a result of a long history of migraine. There was exacerbation of the pain throughout the pregnancy, particularly in the third trimester. Pharmacological agents commonly used to manage neuropathic pain states were relatively contraindicated due to potential adverse effects on the fetus. Cognisant of such limitations imposed by pregnancy, we used multimodal therapy in an attempt to control the pain. This included morphine, paracetamol, amitriptyline, ketamine and psychological support. The management challenges are described.

[Diagnostic imaging and acute abdominal pain].

PubMed

Liljekvist, Mads Svane; Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

2015-01-19

Acute abdominal pain is a common clinical condition. Clinical signs and symptoms can be difficult to interpret, and diagnostic imaging may help to identify intra-abdominal disease. Conventional X-ray, ultrasound (US) and computed tomography (CT) of the abdomen vary in usability between common surgical causes of acute abdominal pain. Overall, conventional X-ray cannot confidently diagnose or rule out disease. US and CT are equally trustworthy for most diseases. US with subsequent CT may enhance diagnostic precision. Magnetic resonance seems promising for future use in acute abdominal imaging.

Review article: the functional abdominal pain syndrome.

PubMed

Sperber, A D; Drossman, D A

2011-03-01

Functional abdominal pain syndrome (FAPS) is a debilitating disorder with constant or nearly constant abdominal pain, present for at least 6 months and loss of daily functioning. To review the epidemiology, pathophysiology and treatment of FAPS. A literature review using the keywords: functional abdominal pain, chronic abdominal pain, irritable bowel syndrome and functional gastrointestinal disorders. No epidemiological studies have focused specifically on FAPS. Estimates of prevalence range from 0.5% to 1.7% and tend to show a female predominance. FAPS pathophysiology appears unique in that the pain is caused primarily by amplified central perception of normal visceral input, rather than by enhanced peripheral stimulation from abdominal viscera. The diagnosis of FAPS is symptom-based in accordance with the Rome III diagnostic criteria. These criteria are geared to identify patients with severe symptoms as they require constant or nearly constant abdominal pain with loss of daily function and are differentiated from IBS based on their non-association with changes in bowel habit, eating or other gut-related events. As cure is not feasible, the aims of treatment are reduced suffering and improved quality of life. Treatment is based on a biopsychosocial approach with a therapeutic patient-physician partnership at its base. Therapeutic options include central nonpharmacological and pharmacological modalities and peripheral modalities. These can be combined to produce an augmentation effect. Although few studies have assessed functional abdominal pain syndrome or its treatment specifically, the treatment strategies outlined in this paper appear to be effective. © 2011 Blackwell Publishing Ltd.

Nose and headache: what have we learned? Naso e cefalee: cosa abbiamo imparato.

PubMed

Pipolo, Carlotta; Portaleone, Sara; Felisati, Giovanni

2011-05-01

Sinonasal involvement in secondary headache has long been interpreted as sinusitis and overestimation has been a problem in the past. In the last 20 years, the innovative interpretation of contact points between the lateral nasal wall and the septum as triggering cause of facial pain via the trigeminovascular system has gained importance in nasal secondary headaches. Also in this case, the prevalence and relevance has been misinterpreted in the beginning, undermining the success rate of pain improvement after surgical removal of these contact points. Therefore, studies have started to concentrate on the need of suitable preoperative evaluation to define the ideal, responsive candidate for surgical management of this form of headache. This article analyzes the outcome of these studies and tries to highlight the need for long-term follow-up to finally determine the relevance of surgical treatment for this particular headache form.

Joint hypermobility and headache: understanding the glue that binds the two together--part 1.

PubMed

Neilson, Derek; Martin, Vincent T

2014-09-01

Heritable connective tissue disorders (HCTD) present with a wide array of findings, including headache. Because of their unusual substrate, headaches in HCTD can derive from both common and uncommon circumstances. Literature review. Ehlers-Danlos hypermobile type can be recognized by multiple joint findings and its tendency to progress to a multisystem chronic pain syndrome. Ehlers-Danlos classic type also manifests joint laxity and similar pain complaints, but is differentiated by its skin laxity and fragility. Ehlers-Danlos vascular type presents the most severe risk due to blood vessel and hollow organ rupture. Marfan syndrome demonstrates skeletal abnormalities, lens dislocations, and aortic root dilation that can result in dissection. In a headache patient, recognizing the presence of an HCTD improves the strategy for diagnosis and management. A brief review of findings related to joints, skin, and arteries may prompt further investigation into the HCTDs. © 2014 American Headache Society.

[Yersiniosis as a cause of acute tubulointerstitial nephritis and acute renal failure--case report].

PubMed

Runowski, Dariusz; Szymoniak, Norbert; Zaniew, Marcin; Piatkowska-Kopczyk, Małgorzata; Wozniak, Aldona; Kroll, Paweł; Zachwieja, Jacek

2005-01-01

Tubulointerstitial nephritis (TN) is a heterogenous disease, where disturbances of the interstitial tissue and renal tubules are found. Different immunological and nonimmunological mechanisms initiated by infectious and non-infectious factors may lead to TN. A case of 13-years-old girl with primary diagnosis of acute pyelonephritis is presented. The abdominal pain, headache, pain in lumbar region and intermittent fever with loss of appetite were observed in this girl a few weeks before admission. Microcytic anemia, proteinuria and glucosuria, azotemia and elevated markers of inflammatory response were found. In ultrasound examination heterogenous cortex echogenicity of both kidneys and disturbances in parenchymal blood flow were observed. In renal scintigraphy the discriminated catch index was found. Kidney biopsy revealed the edema of the interstitial space with mononuclear and lymphocyte infiltration. The diagnosis of TN was established upon the history, clinical examination, results of laboratory tests, kidney imaging and biopsy. After steroid and doxycycline treatment an improvement and normalization of the results of laboratory tests were observed. It seems to be justified to consider Yersinia infection as a cause of acute tubulointerstitial nephritis.

Laughing headache with giant pacchionian granulations.

PubMed

Giraud, Pierric; Segal, Olivier; Chauvet, Sylvie

2013-04-01

Laughing is recognized as a provoking factor for headache, certainly underestimated among the general population and few cases have been published to date. We report a single case of severe headache, provoked almost exclusively by outbursts of laughing, where venous magnetic resonance imaging revealed the presence of giant Pacchioni granulations in both right and transverse sinuses. Reviewing published cases of laughing headache, we discuss possible mechanisms of pain and the role of giant Pacchionian granulations. © 2013 American Headache Society.

Prevalence and determinants of headaches in Hawaii: the Hilo Women's Health Study.

PubMed

Reza, Angela; Sievert, Lynnette Leidy; Rahberg, Nichole; Morrison, Lynn A; Brown, Daniel E

2012-07-01

Headache frequency has been associated with ethnicity, menopause, abdominal obesity and stress. To examine the prevalence and determinants of headaches in the multi-ethnic community of Hilo, Hawaii. A random sample of 1824 women aged 16-100 was recruited by postal survey; 206 women aged 45-55 were recruited for clinical measures. Both studies queried the presence/absence of headaches during the past 2 weeks. The clinical study also examined migraines and tension headaches. Headaches were examined in relation to demographic, reproductive and lifestyle variables, stress, symptoms and anthropometric measures. Headache prevalence was 47%. Japanese women were less likely to report headaches compared to women of European descent, but, after controlling for measures of stress, Japanese women were at a higher risk for headaches. Post-menopausal women were half as likely to report headaches compared with pre-menopausal women. Women with children younger than 18 were 4-times as likely to report migraines compared with women who did not have children younger than 18. Standardized measures of daily hassles, life and job satisfaction were not associated with headaches. The relationship between headaches and having young children suggests that the everyday stress of family life is a headache risk. This may be particularly true in Hilo, Hawaii, where the value of family is culturally prioritized.

Analgesic effects of an ethanol extract of the fruits of Xylopia aethiopica (Dunal) A. Rich (Annonaceae) and the major constituent, xylopic acid in murine models

PubMed Central

Woode, Eric; Ameyaw, Elvis O.; Boakye-Gyasi, Eric; Abotsi, Wonder K. M.

2012-01-01

Background: Fruit extracts of Xylopia aethiopica are used traditionally in the management of pain disorders including rheumatism, headache, colic pain, and neuralgia. Little pharmacological data exists in scientific literature of the effect of the fruit extract and its major diterpene, xylopic acid, on pain. The present study evaluated the analgesic properties of the ethanol extract of X. aethiopica (XAE) and xylopic acid (XA), in murine models. Materials and Methods: XAE and XA were assessed in chemical (acetic acid-induced abdominal writhing and formalin tests), thermal (Tail-flick and Hargreaves thermal hyperalgesia tests), and mechanical (Randall-Selitto paw pressure test) pain models. Results: XAE and XA exhibited significant analgesic activity in all the pain models used. XAE (30-300 mg kg-1, p.o.) and XA (10-100 mg kg-1, p.o.) inhibited acetic acid-induced visceral nociception, formalin- induced paw pain (both neurogenic and inflammatory), thermal pain as well as carrageenan-induced mechanical and thermal hyperalgesia in animals. Morphine (1-10 mg kg-1, i.p.) and diclofenac (1-10 mg kg-1, i.p.), used as controls, exhibited similar anti-nociceptive activities. XAE and XA did not induce tolerance to their respective anti-nociceptive effects in the formalin test after chronic administration. Morphine tolerance did not also cross-generalize to the analgesic effects of XAE or XA. Conclusions: These findings establish the analgesic properties of the ethanol fruit extract of X. aethiopica and its major diterpene, xylopic acid. PMID:23248562

Longitudinal trends in the treatment of abdominal pain in an academic emergency department.

PubMed

Cinar, Orhan; Jay, Loni; Fosnocht, David; Carey, Jessica; Rogers, LeGrand; Carey, Adrienne; Horne, Benjamin; Madsen, Troy

2013-09-01

Abdominal pain is a top chief complaint of patients presenting to Emergency Departments (ED). Historically, uncertainty surrounded correct management. Evidence has shown adequate analgesia does not obscure the diagnosis, making it the standard of care. We sought to evaluate trends in treatment of abdominal pain in an academic ED during a 10-year period. We prospectively evaluated a convenience sample of patients in an urban academic tertiary care hospital ED from September 2000 through April 2010. Adult patients presenting with a chief complaint of abdominal pain were included in this study. Analgesic administration rates and times, pain scores, and patient satisfaction at discharge were analyzed to evaluate trends by year. There were 2,646 patients presenting with abdominal pain who were enrolled during the study period. Rates of analgesic administration generally increased each year from 39.9% in 2000 to 65.5% in 2010 (p value for trend <0.001). Similarly, time to analgesic administration generally decreased by year, from 116 min in 2000 to 81 min in 2009 (p < 0.001). There was no improvement in mean pain scores at discharge by year (p = 0.27) and 48% of patients during the 10-year period still reported moderate to severe pain at discharge. Patient satisfaction with pain treatment increased from a score of 7.1 to 9.0 during the study period (p < 0.005), following the trend of increase in analgesic administration. In patients presenting to the ED with abdominal pain, analgesia administration increased and time to medication decreased during the 10-year period. Despite overall improvements in satisfaction, significant numbers of patients presenting with abdominal pain still reported moderate to severe pain at discharge. Copyright © 2013 Elsevier Inc. All rights reserved.

Neuromodulation for cephalgias

PubMed Central

Rasskazoff, Serge Y.; Slavin, Konstantin V.

2013-01-01

Headaches (cephalgias) are a common reason for patients to seek medical care. There are groups of patients with recurrent headache and craniofacial pain presenting with malignant course of their disease that becomes refractory to pharmacotherapy and other medical management options. Neuromodulation can be a viable treatment modality for at least some of these patients. We review the available evidence related to the use of neuromodulation modalities for the treatment of medically refractory craniofacial pain of different nosology based on the International Classification of Headache Disorders, 2nd edition (ICHD-II) classification. This article also reviews the scientific rationale of neuromodulation application in management of cephalgias. PMID:23682340

Brief mindfulness-based therapy for chronic tension-type headache: a randomized controlled pilot study.

PubMed

Cathcart, Stuart; Galatis, Nicola; Immink, Maarten; Proeve, Michael; Petkov, John

2014-01-01

Mindfulness-based therapy (MBT) has been demonstrated to be effective for reducing chronic pain symptoms; however, the use of MBT for Chronic Tension-Type Headache (CTH) exclusively has to date not been examined. Typically, MBT for chronic pain has involved an 8-week program based on Mindfulness Based Stress Reduction. Recent research suggests briefer mindfulness-based treatments may be effective for chronic pain. To conduct a pilot study into the efficacy of brief MBT for CTH. We conducted a randomized controlled trial of a brief (6-session, 3-week) MBT for CTH. Results indicated a significant decrease in headache frequency and an increase in the mindfulness facet of Observe in the treatment but not wait-list control group. Brief MBT may be an effective intervention for CTH.

Common Functional Gastroenterologic Disorders Associated With Abdominal Pain

PubMed Central

Bharucha, Adil E.; Chakraborty, Subhankar; Sletten, Christopher D.

2016-01-01

Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in a variety of peripheral (eg, postinfectious inflammation, luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be very helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids. PMID:27492916

Integrative care for pediatric patients with pain.

PubMed

Young, Lari; Kemper, Kathi J

2013-07-01

Although pediatric patients with chronic pain often turn to complementary therapies, little is known about patients who seek academic integrative pediatric care. The study design comprised abstraction of intake forms and physician records from new patients whose primary concern was pain. The study setting was an academic pediatric clinic between January 2010 and December 2011. Of the 110 new patients, 49 (45%) had a primary concern about headache (20), abdominal pain (18), or musculoskeletal pain (11). The average age was 13±4 years, and 37% were male. Patients reported an average pain level of 6±3 on a 10-point scale, and most reported more than one kind of pain; parents had an average of 7±3 health concerns per child, including fatigue (47%), mood or anxiety (45%), constipation/diarrhea (41%), and/or sleep problems (35%). Most patients (57%) were referred by specialists; 71% were taking prescription medications; and 53% were taking one or more dietary supplements at intake. Of those tested, most (61%) had suboptimal vitamin D levels. All families wanted additional counseling about diet (76%), exercise (66%), sleep (58%), and/or stress management (81%). In addition to encouraging continued medical care (100%) and referral to other medical specialists (16%), frequent advice included continuing or initiating dietary supplements such as vitamins/minerals (80%), omega-3 fatty acids (67%), and probiotics (31%). Stress-reducing recommendations included biofeedback (33%), gratitude journals (16%), and yoga/t'ai chi (8%). Other referrals included acupuncture (24%) and massage (20%). Patients who have chronic pain and who present to an integrative clinic frequently have complex conditions and care. They are interested in promoting a healthy lifestyle, reducing stress, and using selected complementary therapies. Patients with chronic pain who seek integrative care may benefit from the kind of coordinated, integrated, comprehensive care provided in a medical home.

Functional abdominal pain in childhood: Background studies and recent research trends

PubMed Central

Levy, Rona L; van Tilburg, Miranda AL

2012-01-01

The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominal pain, and also summarizes the primary related findings from the authors’ research program. Specific areas discussed based on work within the authors’ group include familial illness patterns, genetics, traits, and mechanisms or processes related to abdominal pain. Topics covered from research published in the past five years include prevalence and cost, longitudinal follow-up, overlap with other disorders, etiology and mechanisms behind functional abdominal pain and treatment studies. It is hoped that findings from this work in abdominal pain will be interpreted as a framework for understanding the processes by which other pain phenomena and, more broadly, reactions to any physical state, can be developed and maintained in children. The present article concludes with recommendations for clinical practice and research. PMID:23248815

Imperforate Hymen - a rare cause of acute abdominal pain and tenesmus: case report and review of the literature

PubMed Central

Mwenda, Aruyaru Stanley

2013-01-01

Imperforate hymen is a rare condition that presents with amenorrhea, cyclical abdominal pains and urine retention among pubertal girls. A 14 year old girl with imperforate hymen underwent hymenotomy for hematocolpometra, having presented with abdominal pains and tenesmus. PMID:24009804

Abdominal Pain in Children: From the Eternal City to the Examination Room.

PubMed

Zeiter, Donna K

2017-06-01

Abdominal pain is a common presenting symptom in children. The differential diagnosis of abdominal pain is extensive; however, a vast majority of patients ultimately are diagnosed with functional abdominal pain disorders. Functional gastrointestinal disorders are defined using the recently released Rome IV criteria. These are not diagnoses of exclusion. If there are no alarm signs, the diagnosis may be made with a focused evaluation. Treatment of these disorders requires a biopsychosocial approach to the disorder and an individualized and multipronged treatment plan. Copyright © 2017 Elsevier Inc. All rights reserved.

Exercise-induced bilateral rectus sheath hematomas presenting as acute abdominal pain with scrotal swelling and pressure: case report and review.

PubMed

Auten, Jonathan D; Schofer, Joel M; Banks, Steven L; Rooney, Timothy B

2010-04-01

Rectus sheath hematoma (RSH) is an uncommon but significant cause of acute abdominal pain in patients presenting to the Emergency Department. RSHs are often misdiagnosed as other more common causes of abdominal pain. This case describes a 23-year-old male presenting with acute abdominal pain, scrotal swelling, and associated scrotal pressure. The case highlights the uniqueness of this particular presentation and the clinical features, risk factors, diagnosis, and treatment of RSH. Published by Elsevier Inc.

Helicobacter pylori infection, serum pepsinogens, and pediatric abdominal pain: a pilot study.

PubMed

Kassem, Eias; Naamna, Medhat; Mawassy, Kadri; Beer-Davidson, Gany; Muhsen, Khitam

2017-08-01

The significance of Helicobacter pylori (H. pylori) infection in pediatric abdominal pain remains poorly recognized. We examined associations of H. pylori infection and serum pepsinogens (PGs), as non-invasive markers of gastritis, with pediatric abdominal pain. A case-control study was conducted among 99 children aged 5-17 years admitted to one hospital for abdominal pain (cases) without an apparent organic reason. Using enzyme-linked immunosorbent assays, sera were tested and compared with 179 controls for anti-H. pylori immunoglobulin G (IgG) antibodies and PGI and PGII levels. Multivariable analysis was performed to adjust for potential confounders. H. pylori IgG sero-positivity was 34.3 and 36.3% in cases and controls, respectively, P = 0.7. H. pylori-infected children had higher median PGI and PGII levels and a lower PGI/PGII ratio than uninfected children. Cases infected with H. pylori had a higher median PGII level (P < 0.001) and lower PGI/PGII ratio (P = 0.036) than controls infected with H. pylori. The percentage of cases with PGII ≥7.5 μg/L, as indication for antral inflammation, was higher than in controls: 58.6 versus 44.7%, P = 0.027. Children with PGII levels ≥7.5 μg/L had increased risk for abdominal pain: adjusted prevalence ratio 1.73 [95% confidence intervals 1.02, 2.93], P = 0.039. Children with increased serum PGII levels, as an indication of gastritis, are more likely to have abdominal pain. Serum PGs can be a useful non-invasive marker for gastritis, in evaluating children with severe abdominal pain with no apparent organic reason. What is Known: • The significance of Helicobacter pylori infection in pediatric abdominal pain remains debated. • Serum pepsinogens (PGs), non-invasive markers of gastric inflammation, were rarely utilized in assessing the association between H. pylori in pediatric abdominal pain of unknown origin. What is New: • High serum PGII level, as an indication of gastritis, rather than H. pylori infection itself, was associated with increased risk for abdominal pain. • Serum PGs can be a useful biomarker for gastritis in evaluating children with severe abdominal pain with no apparent organic reason.

Rhinocerebral Mucor circinelloides infection in immunocompromised patient following yogurt ingestion.

PubMed

Lazar, Stephen P; Lukaszewicz, Jennifer M; Persad, Kamleish A; Reinhardt, John F

2014-08-01

The purpose of this case report is to illustrate the cause of this patient's headache and sinus pain in the setting of a unique environmental exposure: the patient ingested yogurt only days before presentation. This particular brand of yogurt caused controversy in early September 2013 when the manufacturer voluntarily recalled all flavors. The yogurt was found to be contaminated with Mucor circinelloides. The recall was triggered by the FDA, after receiving many complaints from consumers affected by temporary gastrointestinal symptoms such as abdominal cramping, diarrhea, and nausea. This patient was diagnosed with Rhinocerebral mucormycosis through fungal culture of the affected area. He was specifically colonized with Mucor circinelloides, a variant that rarely causes disease in humans. According to a literature review, only eight cases of mucormycosis in adults caused by this strain were documented before 2009.

Diagnosis at dusk: malignant hypertension and phaeochromocytoma in a 6-year-old girl.

PubMed

Corcoran, John; Bird, Chris; Side, Lucy; Lakhoo, Kokila; Ryan, Fiona

2008-02-01

Phaeochromocytoma is a rare catecholamine-secreting tumour that may arise at any age, but is particularly unusual in childhood. The case of a 6-year-old girl who presented with a prolonged history of general malaise, headaches and abdominal pain is reported. On examination, she was noted to have malignant hypertension. Subsequent imaging of the abdomen demonstrated a left adrenal mass, with the diagnosis of phaeochromocytoma being confirmed by serial raised urinary metanephrines. Sympathetic blockade was established prior to definitive surgical treatment, resulting in complete resolution of the patient's symptoms and hypertension. Genetic screening of the family has since identified a previously undocumented missense mutation in the patient's VHL gene. The case raises the importance of routine measurement of blood pressure in all paediatric patients regardless of age, presentation or other factors.

A case of histamine fish poisoning in a young atopic woman.

PubMed

Wilson, Ben J; Musto, Richard J; Ghali, William A

2012-07-01

Histamine fish poisoning, also known as scombroid poisoning, is a histamine toxicity syndrome that results from eating specific types of spoiled fish. Although typically a benign syndrome, characterized by self-limited flushing, headache, and gastrointestinal symptoms, we describe a case unique in its severity and as a precipitant of an asthma exacerbation. A 25-year-old woman presented to the emergency department (ED) with one hour of tongue and face swelling, an erythematous pruritic rash, and dyspnea with wheezing after consuming a tuna sandwich. She developed abdominal pain, diarrhea and hypotension in the ED requiring admission to the hospital. A diagnosis of histamine fish poisoning was made and the patient was treated supportively and discharged within 24 hours, but was readmitted within 3 hours due to an asthma exacerbation. Her course was complicated by recurrent admissions for asthma exacerbations.

An outbreak of scombroid fish poisoning in a kindergarten.

PubMed

Wu, Shu-Fen; Chen, Walter

2003-01-01

We report an outbreak of scombroid poisoning at one kindergarten on September 25, 1997. There were 94 cases. The onset of symptoms of scombrotoxin after ingestion of fish is rapid (40 to 50 minutes after consumption). Clinical manifestation consisted of hyperemia, particularly on the face and neck (94.7%), nausea and vomiting (17.0%), abdominal pain (17.0%), pruritus (4.3%), headache and dizziness (4.3%) and diarrhea (3.2%). The duration of symptoms was 3 hours on average. Most patients responded to antihistamine very well. The poisoning was caused by the ingestion of spoiled scombroid fish. The tissues of scombroid fish had undergone a number of changes provoked by bacteria and the uncooked fish containing 2,104 ppm of histamine whereas cooked fish containing 1,980 ppm (198 mg/100 gm) of histamine was found in this accident.

Health practices, problems, and needs in a population of Micronesian adolescents.

PubMed

Mayer, P A; Bauman, K A

1986-09-01

Saipan, one of many islands of the Pacific Trust Territory, depends on the United States for its medical care. The limited resources on the island have resulted in little medical attention for adolescents. This study surveyed 519 Saipan adolescents to determine their health practices, problems, and needs. Although these teenagers rarely saw physicians, they commonly reported health problems such as headaches, abdominal pain, and dental cavities. In the psychosocial arena, their problems involved parents, girlfriends/boyfriends, school, and suicidal thoughts. The health topics found to be of most interest included sex education, jobs, suicide prevention, drugs, and birth control. The most popular methods for learning about these subjects were books, movies, films, and school classes. There were high reported incidences of drug and alcohol problems among boys, and thoughts about suicide in all respondents.

Radiology preparedness in ebola virus disease: guidelines and challenges for disinfection of medical imaging equipment for the protection of staff and patients.

PubMed

Mollura, Daniel J; Palmore, Tara N; Folio, Les R; Bluemke, David A

2015-05-01

The overlap of early Ebola virus disease (EVD) symptoms (eg, fever, headache, abdominal pain, diarrhea, emesis, and fatigue) with symptoms of other more common travel-related diseases (eg, malaria, typhoid fever, pneumonia, and meningococcemia) may result in delayed diagnosis of EVD before isolation of infected patients. Radiology departments should consider policies for and approaches to decontamination of expensive and potentially easily damaged radiology equipment. In addition, the protection of radiology personnel must be considered during the work-up phase of undiagnosed EVD patients presenting to emergency departments. The purpose of this article is to consider the effect of EVD on radiology departments and imaging equipment, with particular consideration of guidelines currently available from the Centers for Disease Control and Prevention that may be applicable to radiology. (©) RSNA, 2015.

[Trigemino-autonomic headache syndromes].

PubMed

Busch, V; May, A

2003-01-01

This review describes the characteristics of some rare severe primary headache syndromes without any structural lesions, which are summarized as the trigemino-autonomic headaches. Pain in these syndromes is associated with autonomic symptoms such as conjunctival injection, lacrimation, rhinorrhoe, ptosis or eyelid edema. This article summarizes the diagnostics, epidemiology and therapy of these conditions.

Botulinum Toxin Type a as a Therapeutic Agent against Headache and Related Disorders.

PubMed

Luvisetto, Siro; Gazerani, Parisa; Cianchetti, Carlo; Pavone, Flaminia

2015-09-23

Botulinum neurotoxin A (BoNT/A) is a toxin produced by the naturally-occurring Clostridium botulinum that causes botulism. The potential of BoNT/A as a useful medical intervention was discovered by scientists developing a vaccine to protect against botulism. They found that, when injected into a muscle, BoNT/A causes a flaccid paralysis. Following this discovery, BoNT/A has been used for many years in the treatment of conditions of pathological muscle hyperactivity, like dystonias and spasticities. In parallel, the toxin has become a "glamour" drug due to its power to ward off facial wrinkles, particularly frontal, due to the activity of the mimic muscles. After the discovery that the drug also appeared to have a preventive effect on headache, scientists spent many efforts to study the potentially-therapeutic action of BoNT/A against pain. BoNT/A is effective at reducing pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain and bladder pain. In 2010, regulatory approval for the treatment of chronic migraine with BoNT/A was given, notwithstanding the fact that the mechanism of action is still not completely elucidated. In the present review, we summarize experimental evidence that may help to clarify the mechanisms of action of BoNT/A in relation to the alleviation of headache pain, with particular emphasis on preclinical studies, both in animals and humans. Moreover, we summarize the latest clinical trials that show evidence on headache conditions that may obtain benefits from therapy with BoNT/A.

Botulinum Toxin Type A as a Therapeutic Agent against Headache and Related Disorders

PubMed Central

Luvisetto, Siro; Gazerani, Parisa; Cianchetti, Carlo; Pavone, Flaminia

2015-01-01

Botulinum neurotoxin A (BoNT/A) is a toxin produced by the naturally-occurring Clostridium botulinum that causes botulism. The potential of BoNT/A as a useful medical intervention was discovered by scientists developing a vaccine to protect against botulism. They found that, when injected into a muscle, BoNT/A causes a flaccid paralysis. Following this discovery, BoNT/A has been used for many years in the treatment of conditions of pathological muscle hyperactivity, like dystonias and spasticities. In parallel, the toxin has become a “glamour” drug due to its power to ward off facial wrinkles, particularly frontal, due to the activity of the mimic muscles. After the discovery that the drug also appeared to have a preventive effect on headache, scientists spent many efforts to study the potentially-therapeutic action of BoNT/A against pain. BoNT/A is effective at reducing pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain and bladder pain. In 2010, regulatory approval for the treatment of chronic migraine with BoNT/A was given, notwithstanding the fact that the mechanism of action is still not completely elucidated. In the present review, we summarize experimental evidence that may help to clarify the mechanisms of action of BoNT/A in relation to the alleviation of headache pain, with particular emphasis on preclinical studies, both in animals and humans. Moreover, we summarize the latest clinical trials that show evidence on headache conditions that may obtain benefits from therapy with BoNT/A. PMID:26404377

[The etiological aspects of acute abdominal pain in children].

PubMed

Dinu, C A; Moraru, D

2011-01-01

The study of the etiological aspects of acute abdominal pain in children, in order to perceive the clinical-etiological correlations and the disorders distribution related to age, gender and the origin of the patients. The criteria for including patients were age (between 0 and 18 years) and the presence of acute abdominal pain before or during the consultation with the physician. The research on acute abdominal pain in children was performed on the level of the Surgery and Pediatrics II clinical departments of the "Sf. Ioan" Children's Emergency Clinical Hospital in Galati, between 01.01.2009 - 01.01.2011. The clinical study performed on the patients registered in the studied groups focused on the identification, the evaluation of the symptoms of acute abdominal pain in children, diagnosing and treating it. The criteria for excluding patients were an age older than 18 years or the absence of acute abdominal pain as a symptom before or during the examination. The statistical analysis used the descriptive and analytical methods. The data was centralized and statistically processed in M.S.EXCEL and S.P.S.S. databases. The patients with acute abdominal pain represent a percentage of 92.9% (2358 cases) of the total number of patients who suffer from abdominal pain (N=2537). The highest frequency of cases is represented by acute appendicitis (1056 cases - 44.8%). In the 5-18 years age group, acute appendicitis, mesenteric lymphadenitis, ovarian follicular cysts, acute pyelenophritis and salpingitis are predominant. In the 0-4 years age group gastroenteritis, acute pharyngitis, reactive hepatitis and lower digestive bleeding are predominant. In females, acute appendicitis, gastroenteritis, gastroduodenitis and cystitis are predominant, whereas in males, peritonitis, sepsis through E. coli, the contusion of the abdominal wall and acute pharyngitis are predominant.

Functional abdominal pain.

PubMed

Grover, Madhusudan; Drossman, Douglas A

2010-10-01

Functional abdominal pain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits, or menstrual periods (Drossman Gastroenterology 130:1377-1390, 2006), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently confused with irritable bowel syndrome and other functional GI disorders in which abdominal pain is associated with eating and bowel movements. FAPS also differs from chronic abdominal pain associated with entities such as chronic pancreatitis or chronic inflammatory bowel disease, in which the pain is associated with peripherally acting factors (eg, gut inflammation or injury). Given the central contribution to the pain experience, concomitant psychosocial disturbances are common and strongly influence the clinical expression of FAPS, which also by definition is associated with loss of daily functioning. These factors make it critical to use a biopsychosocial construct to understand and manage FAPS, because gut-directed treatments are usually not successful in managing this condition.

Naratriptan

MedlinePlus

Naratriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine. Naratriptan does not prevent migraine attacks or reduce ...

Sumatriptan

MedlinePlus

Sumatriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine. Sumatriptan does not prevent migraine attacks or reduce ...

Eletriptan

MedlinePlus

Eletriptan is used to treat the symptoms of migraine headaches (severe throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine. Eletriptan does not prevent migraine attacks or reduce ...

Almotriptan

MedlinePlus

Almotriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine. Almotriptan does not prevent migraine attacks or reduce ...

Rizatriptan

MedlinePlus

Rizatriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine. Rizatriptan does not prevent migraine attacks or reduce ...

Zolmitriptan

MedlinePlus

Zolmitriptan is used to treat the symptoms of migraine headaches (severe throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine. Zolmitriptan does not prevent migraine attacks or reduce ...

Frovatriptan

MedlinePlus

Frovatriptan is used to treat the symptoms of migraine headaches (severe throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine. Frovatriptan does not prevent migraine attacks or reduce ...

Provider Communication Regarding Psychosocial Factors Predicts Pain Beliefs in Parent and Child

PubMed Central

Sood, Erica; Pinder, Wendy; Pendley, Jennifer S.; Fisher, Alicia O.; Wali, Prateek D.; del Rosario, Fernando

2017-01-01

Objective To examine the role of provider communication about psychosocial causes of abdominal pain and recommendations for psychosocial intervention during a gastroenterology clinic visit in predicting families’ causal beliefs and perceptions of treatment acceptability. Method Participants were 57 children with a diagnosed or suspected abdominal pain-related functional gastrointestinal disorder (FGID) presenting for an outpatient gastroenterology follow-up visit and their accompanying parent. Children and parents completed questionnaires assessing child anxiety and abdominal pain severity, recall of provider communication about causes of abdominal pain and recommendations for intervention, their own causal beliefs about pain, and perceived acceptability of cognitive behavioral therapy (CBT) and standard medical treatment (SMT) after reading descriptions of each treatment. Providers completed a questionnaire assessing their perceptions and communication about the causes of the child’s abdominal pain and perceived acceptability of CBT. Results Provider communication about psychosocial causes and interventions was reported infrequently by parents, children, and providers. Parents rated psychosocial causes for abdominal pain as less likely than physical causes, and children and parents rated CBT as less acceptable than SMT. Parents’ recall of provider communication about psychosocial causes was associated with their own causal beliefs about pain and their perceived acceptability of CBT. Children’s and parents’ recall of provider recommendations for psychosocial intervention was associated with their perceived acceptability of CBT. Conclusion Results highlight the importance of provider communication about psychosocial contributors to abdominal pain and psychosocial interventions for children with FGIDs. Medical and mental health providers can partner to deliver care to children with FGIDs using a biopsychosocial approach. PMID:27035693

Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia.

PubMed

Ducic, Ivica; Felder, John M; Endara, Matthew

2012-01-01

To demonstrate that occipital nerve injury is associated with chronic postoperative headache in patients who have undergone acoustic neuroma excision and to determine whether occipital nerve excision is an effective treatment for these headaches. Few previous reports have discussed the role of occipital nerve injury in the pathogenesis of the postoperative headache noted to commonly occur following the retrosigmoid approach to acoustic neuroma resection. No studies have supported a direct etiologic link between the two. The authors report on a series of acoustic neuroma patients with postoperative headache presenting as occipital neuralgia who were found to have occipital nerve injuries and were treated for chronic headache by excision of the injured nerves. Records were reviewed to identify patients who had undergone surgical excision of the greater and lesser occipital nerves for refractory chronic postoperative headache following acoustic neuroma resection. Primary outcomes examined were change in migraine headache index, change in number of pain medications used, continued use of narcotics, patient satisfaction, and change in quality of life. Follow-up was in clinic and via telephone interview. Seven patients underwent excision of the greater and lesser occipital nerves. All met diagnostic criteria for occipital neuralgia and failed conservative management. Six of 7 patients experienced pain reduction of greater than 80% on the migraine index. Average pain medication use decreased from 6 to 2 per patient; 3 of 5 patients achieved independence from narcotics. Six patients experienced 80% or greater improvement in quality of life at an average follow-up of 32 months. There was one treatment failure. Occipital nerve neuroma or nerve entrapment was identified during surgery in all cases where treatment was successful but not in the treatment failure. In contradistinction to previous reports, we have identified a subset of patients in whom the syndrome of postoperative headache appears directly related to the presence of occipital nerve injuries. In patients with postoperative headache meeting diagnostic criteria for occipital neuralgia, occipital nerve excision appears to provide relief of the headache syndrome and meaningful improvement in quality of life. Further studies are needed to confirm these results and to determine whether occipital nerve injury may present as headache types other than occipital neuralgia. These findings suggest that patients presenting with chronic postoperative headache should be screened for the presence of surgically treatable occipital nerve injuries. © 2012 American Headache Society.

Changes in Clinical Parameters in Patients with Tension-type Headache Following Massage Therapy: A Pilot Study

PubMed Central

Moraska, Albert; Chandler, Clint

2008-01-01

Complementary and alternative medicine approaches to treatment for tension-type headache are increasingly popular among patients, but evidence supporting its efficacy is limited. The objective of this study was to assess short term changes on primary and secondary headache pain measures in patients with tension-type headache (TTH) receiving a structured massage therapy program with a focus on myofascial trigger point therapy. Participants were enrolled in an open label trial using a baseline control with four 3-week phases: baseline, massage (two 3-week phases) and follow-up. Twice weekly, 45-minute massage sessions commenced following the baseline phase. A daily headache diary was maintained throughout the study in which participants recorded headache incidence, intensity, and duration. The Headache Disability Index was administered upon study entry and at 3-week intervals thereafter. 18 subjects were enrolled with 16 completing all headache diary, evaluation, and massage assignments. Study participants reported a median of 7.5 years with TTH. Headache frequency decreased from 4.7±0.7 episodes per week during baseline to 3.7±0.9 during treatment period 2 (P<0.001); reduction was also noted during the follow-up phase (3.2±1.0). Secondary measures of headache also decreased across the study phases with headache intensity decreasing by 30% (P<0.01) and headache duration from 4.0±1.3 to 2.8±0.5 hours (P<0.05). A corresponding improvement in Headache Disability Index was found with massage (P<0.001). This pilot study provides preliminary evidence for reduction in headache pain and disability with massage therapy that targets myofascial trigger points, suggesting the need for more rigorously controlled studies. PMID:19119396

OnabotulinumtoxinA for the treatment of headache.

PubMed

Ashkenazi, Avi; Blumenfeld, Andrew

2013-09-01

Botulinum toxin, a potent muscle relaxant, has been found to have analgesic effects in patients with various pain syndromes. Both in vitro and in vivo studies showed the ability of the toxin to block the release of pain neurotransmitters, such as substance P, glutamate, and calcitonin gene-related peptide. The effect of the toxin, and specifically of one of its serotypes, botulinum neurotoxin type A, on headaches, has been extensively studied. This serotype is available in the United States in 3 forms, including as onabotulinumtoxinA. Data from clinical trials confirmed the efficacy, safety, and tolerability of onabotulinumtoxinA in the prophylactic treatment of chronic migraine, the most severe and debilitating type of migraine, in adults. The drug was approved by the Food and Drug Administration for this indication in 2010. The drug was not found to be effective for episodic migraine or tension-type headache. Noncontrolled studies suggest the efficacy of the toxin for headache associated with craniocervical dystonia. Proper injection technique and appropriate patient selection are essential for achieving positive results after treatment with onabotulinumtoxinA. The recommended injection paradigm combines a fixed site/fixed dose and follow the pain approaches, with the toxin injected to multiple sites of the head and neck, at a total dose of 155U-195U. The treatment is given at intervals of 12 weeks on average. The efficacy of onabotulinumtoxinA for some headaches, its long duration of action, and its favorable adverse effect profile make it a viable treatment option for the appropriate headache patients. The drug may be particularly suitable for patients who cannot tolerate, or are not compliant with, the daily intake of oral headache preventive drugs. © 2013 American Headache Society.

Does somatostatin have a role to play in migraine headache?

PubMed

Lambert, Geoffrey A; Zagami, Alessandro S

2018-06-01

Migraine is a condition without apparent pathology. Its cardinal symptom is the prolonged excruciating headache. Theories about this pain have posited pathologies which run the gamut from neural to vascular to neurovascular, but no observations have detected a plausible pathology. We believe that no pathology can be found for migraine headache because none exists. Migraine is not driven by pathology - it is driven by neural events produced by triggers - or simply by neural noise- noise that has crossed a critical threshold. If these ideas are true, how does the pain arise? We hypothesise that migraine headache is a consequence of withdrawal of descending pain control, produced by "noise" in the cerebral cortex. Nevertheless, there has to be a neural circuit to transform cortical noise to withdrawal of pain control. In our hypothesis, this neural circuit extends from the cortex, synapses in two brainstem nuclei (the periaqueductal gray matter and the raphe magnus nucleus) and ultimately reaches the first synapse of the trigeminal sensory system. The second stage of this circuit uses serotonin (5HT) as a neurotransmitter, but the neuronal projection from the cortex to the brainstem seems to involve relatively uncommon neurotransmitters. We believe that one of these is somatostatin (SST). Temporal changes in levels of circulating SST mirror the temporal changes in the incidence of migraine, particularly in women. The SST 2 receptor agonist octreotide has been used with some success in migraine and cluster headache. A cortical to PAG/NRM neural projection certainly exists and we briefly review the anatomical and neurophysiological evidence for it and provide preliminary evidence that SST may the critical neurotransmitter in this pathway. We therefore suggest that the withdrawal of descending tone in SST-containing neurons, might create a false pain signal and hence the headache of migraine. Copyright © 2018. Published by Elsevier Ltd.

Controlled outcome studies of child clinical hypnosis.

PubMed

Adinolfi, Barbara; Gava, Nicoletta

2013-09-01

Background Hypnosis is defined as "as an interaction in which the hypnotist uses suggested scenarios ("suggestions") to encourage a person's focus of attention to shift towards inner experiences". Aim of the work The focus of this review is to summarize the findings of controlled outcome studies investigating the potential of clinical hypnosis in pediatric populations. We will examine the following themes: anesthesia, acute and chronic pain, chemotherapy-related distress, along with other specific medical issues. Results Hypnosis is an effective method to reduce pain and anxiety before, during and after the administration of anesthetics, during local dental treatments, invasive medical procedures and in burn children. Hypnosis can be successfully used to manage recurrent headaches, abdominal pain, irritable bowel syndrome and chemotherapy-related distress. Hypnosis has an important role in managing symptoms and improving the quality of life of children suffering from asthma and cystic fibrosis and in facilitating the treatment of insomnia in school-age children. Finally, hypnosis can be effectively used for the treatment of some habitual disorders such as nocturnal enuresis and dermatologic conditions, including atopic dermatitis and chronic eczema Conclusions Clinical hypnosis seems to be a useful, cheap and side-effects free tool to manage fear, pain and several kinds of stressful experiences in pediatric populations. Children who receive self-hypnosis trainings achieve significantly greater improvements in their physical health, quality of life, and self-esteem.

Using clinical symptoms to predict adverse maternal and perinatal outcomes in women with preeclampsia: data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study.

PubMed

Yen, Tin-Wing; Payne, Beth; Qu, Ziguang; Hutcheon, Jennifer A; Lee, Tang; Magee, Laura A; Walters, Barry N; von Dadelszen, Peter

2011-08-01

Preeclampsia is a leading cause of maternal morbidity. The clinical challenge lies in predicting which women with preeclampsia will suffer adverse outcomes and would benefit from treatment, while minimizing potentially harmful interventions. Our aim was to determine the ability of maternal symptoms (i.e., severe nausea or vomiting, headache, visual disturbance, right upper quadrant pain or epigastric pain, abdominal pain or vaginal bleeding, and chest pain or dyspnea) to predict adverse maternal or perinatal outcomes. We used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a multicentre, prospective cohort study designed to investigate the maternal risks associated with preeclampsia. Relative risks and receiver operating characteristic (ROC) curves were assessed for each preeclampsia symptom and outcome pair. Of 2023 women who underwent assessment, 52% experienced at least one preeclampsia symptom, with 5.2% and 5.3% respectively experiencing an adverse maternal or perinatal outcome. No symptom and outcome pair, in either of the maternal or perinatal groups, achieved an area under the ROC curve value > 0.7, which would be necessary to demonstrate a discriminatory predictive value. Maternal symptoms of preeclampsia are not independently valid predictors of maternal adverse outcome. Caution should be used when making clinical decisions on the basis of symptoms alone in the preeclamptic patient.

Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review.

PubMed

Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue

2014-11-01

Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. A systematic review was conducted. The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma formation and physical function. A total of 50 publications were identified; 42 publications were excluded leaving eight publications counting a total of 578 patients for analysis. Generally, the scientific quality of the studies was poor. Use of abdominal binder revealed a non-significant tendency to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases with the use of abdominal binders. Reduction of pulmonary function during use of abdominal binders has not been revealed. Abdominal binders reduce post-operative psychological distress, but their effect on post-operative pain after laparotomy and seroma formation after ventral hernia repair remains unclear. Due to the sparse evidence and poor quality of the literature, solid conclusions may be difficult to make, and procedure-specific, high-quality randomised clinical trials are warranted.

[Implementationof a low FODMAP dietforfunctional abdominal pain].

PubMed

Baranguán Castro, María Luisa; Ros Arnal, Ignacio; García Romero, Ruth; Rodríguez Martínez, Gerardo; Ubalde Sainz, Eduardo

2018-04-20

The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. A table was designed in which foods were classified according to their FODMAP content, as well as a 'Symptoms and Stools Diary'. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41-3.33] versus 2 [IQR: 1.33-6.33] daily episodes, P=.024), less pain severity compared to baseline (1.41cm [IQR: 0.32-5.23] versus 4.63cm [IQR: 2.51-6.39] measured by 10-cm Visual Analogue Scale, P=.035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods. Copyright © 2018. Publicado por Elsevier España, S.L.U.

Abdominal Pain After Roux-En-Y Gastric Bypass for Morbid Obesity.

PubMed

Mala, Tom; Høgestøl, Ingvild

2018-05-01

Roux-en-Y gastric bypass is widely used as treatment of morbid obesity. Weight loss, effects on obesity-related co-morbidities and quality of life are well documented post Roux-en-Y gastric bypass. Other outcome measures are less well studied. This review explores aspects of prevalence, diagnostic evaluations, etiology, and treatment of abdominal pain specific to Roux-en-Y gastric bypass. The review is based on PubMed searches and clinical experience with Roux-en-Y gastric bypass. Symptoms in the early postoperative phase (<30 days) were not included. Based on limited evidence, up to about 30% of the patients may perceive recurrent abdominal pain post Roux-en-Y gastric bypass in the long term. A substantial subset of patients will need health-care evaluation for acute abdominal pain and hospital admission. The etiology of abdominal pain is heterogeneous and includes gallstone-related disease, intestinal obstruction, anastomotic ulcerations and strictures, intestinal dysmotility, dysfunctional eating, and food intolerance. Surgical treatment and guidance on diet and eating habits may allow symptom relief. The cause of pain remains undefined for a subset of patients. Impact of abdominal pain post Roux-en-Y gastric bypass on the perception of well-being, quality of life, and patient satisfaction with the procedure needs to be further evaluated and may be influenced by complex interactions between new symptoms post Roux-en-Y gastric bypass and relief of pre-existing symptoms. Abdominal pain should be part of follow-up consultations post Roux-en-Y gastric bypass. Future studies should focus on combined evaluations before and after surgery to enlighten potential casual relationships between abdominal pain and Roux-en-Y gastric bypass.

Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood.

PubMed

Horvath, A; Dziechciarz, P; Szajewska, H

2011-06-01

A lack of reliable treatments for abdominal pain-related functional gastrointestinal disorders prompts interest in new therapies. To evaluate systematically the effect of Lactobacillus rhamnosus GG (LGG) for treating abdominal pain-related functional gastrointestinal disorders in children. MEDLINE, EMBASE, CINAHL, the Cochrane Library, trial registries and proceedings of major meetings were searched for randomised controlled trials (RCTs) evaluating LGG supplementation in children with abdominal pain-related functional gastrointestinal disorders based on the Rome II or Rome III criteria. Risk of bias was assessed for generation of the allocation sequence, allocation concealment, blinding and follow-up. Compared with placebo, LGG supplementation was associated with a significantly higher rate of treatment responders (defined as no pain or a decrease in pain intensity) in the overall population with abdominal pain-related functional gastrointestinal disorders (three RCTs, n = 290; risk ratio, RR 1.31, 95% CI 1.08-1.59, number needed to treat, NNT 7, 95% CI 4-22) and in the irritable bowel syndrome (IBS) subgroup (three RCTs, n = 167; RR 1.70, 95% CI 1.27-2.27, NNT 4, 95% CI 3-8). However, no difference was found in the rate of treatment responders between children with functional abdominal pain or functional dyspepsia who received placebo or LGG. The intensity of pain was significantly reduced in the overall study population and in the IBS subgroup. The frequency of pain was significantly reduced in the IBS subgroup only. The use of Lactobacillus rhamnosus GG moderately increases treatment success in children with abdominal pain-related functional gastrointestinal disorders, particularly among children with IBS. © 2011 Blackwell Publishing Ltd.

Congenital heart disease manifested as acute abdominal pain.

PubMed

Macha, Mahender; Gupta, Dipin; Molina, Ezequiel; Palma, Jon; Rothman, Steven

2007-06-12

We present a case of a 53-year-old man with complaints of severe abdominal pain and nausea. Emergency department abdominal workup was non-diagnostic. Physical examination revealed signs of right- and left-heart failure. A past medical history of dysrhythmias and chronic abdominal complaints prompted hospital admission. Subsequent right heart catheterization revealed a significant left-to-right shunt. CT scan of the chest and angiography confirmed the diagnosis of an abnormal ascending vein between the innominate vein and the left superior pulmonary vein. After the anomalous vein was ligated, the patient's abdominal pain resolved.

Propranolol (Cardiovascular)

MedlinePlus

... is also used to prevent angina (chest pain), migraine headaches, and to improve survival after a heart ... paroxetine (Brisdelle, Paxil, Pexeva); fluconazole (Diflucan); medications for migraine headaches such as rizatriptan (Maxalt) and zolmitriptan (Zomig); ...

Breath tests and irritable bowel syndrome

PubMed Central

Rana, Satya Vati; Malik, Aastha

2014-01-01

Breath tests are non-invasive tests and can detect H2 and CH4 gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath. These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome (IBS)-type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H2 breath testing to determine the presence or absence of bacterial overgrowth. If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients. PMID:24976698

Social problem-solving, perceived stress, depression and life-satisfaction in patients suffering from tension type and migraine headaches.

PubMed

Eskin, Mehmet; Akyol, Ali; Çelik, Emine Yilmaz; Gültekin, Bülent Kadri

2013-08-01

This study aimed at investigating social problem solving, perceived stress, depression, and life-satisfaction in patients with tension type and migraine headaches. Forty-nine migraine and 42 tension type headache patients (n = 91) consenting to participate were compared to a total of 49 matched healthy control group. Participants filled in a questionnaire consisting self-report measures of problem solving, perceived stress, depression and life satisfaction. They were also asked about headache duration, frequency, pain severity, psychiatric treatment and sense of control in one's life. T-tests, chi-square, analysis of variance, logistic regression analysis and Pearson product moment correlation coefficient procedures were used to analyze the data. Tension type headache patients reported having had more frequent headaches than the migraine patients but migraine patients reported having had more intense pain than the tension type headache patients. Instances of psychiatric treatment were more common among tension type headache patients than the migraine and the control group. Compared to the healthy controls, headache patients displayed a deficiency in problem solving, higher levels of perceived stress and depression. Levels of problem solving skills in headache patients were related inversely to depression, perceived stress and the number of negative life events but problem solving skills of headache patients was related positively to life-satisfaction. The findings from this study suggested that cognitive behavioral problem solving therapy or training might be a viable option for reducing levels of stress and depression, and to increase life-satisfaction in patients suffering from primary headache. © 2013 The Scandinavian Psychological Associations.

Combined analgesics in (headache) pain therapy: shotgun approach or precise multi-target therapeutics?

PubMed

Straube, Andreas; Aicher, Bernhard; Fiebich, Bernd L; Haag, Gunther

2011-03-31

Pain in general and headache in particular are characterized by a change in activity in brain areas involved in pain processing. The therapeutic challenge is to identify drugs with molecular targets that restore the healthy state, resulting in meaningful pain relief or even freedom from pain. Different aspects of pain perception, i.e. sensory and affective components, also explain why there is not just one single target structure for therapeutic approaches to pain. A network of brain areas ("pain matrix") are involved in pain perception and pain control. This diversification of the pain system explains why a wide range of molecularly different substances can be used in the treatment of different pain states and why in recent years more and more studies have described a superior efficacy of a precise multi-target combination therapy compared to therapy with monotherapeutics. In this article, we discuss the available literature on the effects of several fixed-dose combinations in the treatment of headaches and discuss the evidence in support of the role of combination therapy in the pharmacotherapy of pain, particularly of headaches. The scientific rationale behind multi-target combinations is the therapeutic benefit that could not be achieved by the individual constituents and that the single substances of the combinations act together additively or even multiplicatively and cooperate to achieve a completeness of the desired therapeutic effect.As an example the fixed-dose combination of acetylsalicylic acid (ASA), paracetamol (acetaminophen) and caffeine is reviewed in detail. The major advantage of using such a fixed combination is that the active ingredients act on different but distinct molecular targets and thus are able to act on more signalling cascades involved in pain than most single analgesics without adding more side effects to the therapy. Multitarget therapeutics like combined analgesics broaden the array of therapeutic options, enable the completeness of the therapeutic effect, and allow doctors (and, in self-medication with OTC medications, the patients themselves) to customize treatment to the patient's specific needs. There is substantial clinical evidence that such a multi-component therapy is more effective than mono-component therapies.

Combined analgesics in (headache) pain therapy: shotgun approach or precise multi-target therapeutics?

PubMed Central

2011-01-01

Background Pain in general and headache in particular are characterized by a change in activity in brain areas involved in pain processing. The therapeutic challenge is to identify drugs with molecular targets that restore the healthy state, resulting in meaningful pain relief or even freedom from pain. Different aspects of pain perception, i.e. sensory and affective components, also explain why there is not just one single target structure for therapeutic approaches to pain. A network of brain areas ("pain matrix") are involved in pain perception and pain control. This diversification of the pain system explains why a wide range of molecularly different substances can be used in the treatment of different pain states and why in recent years more and more studies have described a superior efficacy of a precise multi-target combination therapy compared to therapy with monotherapeutics. Discussion In this article, we discuss the available literature on the effects of several fixed-dose combinations in the treatment of headaches and discuss the evidence in support of the role of combination therapy in the pharmacotherapy of pain, particularly of headaches. The scientific rationale behind multi-target combinations is the therapeutic benefit that could not be achieved by the individual constituents and that the single substances of the combinations act together additively or even multiplicatively and cooperate to achieve a completeness of the desired therapeutic effect. As an example the fixesd-dose combination of acetylsalicylic acid (ASA), paracetamol (acetaminophen) and caffeine is reviewed in detail. The major advantage of using such a fixed combination is that the active ingredients act on different but distinct molecular targets and thus are able to act on more signalling cascades involved in pain than most single analgesics without adding more side effects to the therapy. Summary Multitarget therapeutics like combined analgesics broaden the array of therapeutic options, enable the completeness of the therapeutic effect, and allow doctors (and, in self-medication with OTC medications, the patients themselves) to customize treatment to the patient's specific needs. There is substantial clinical evidence that such a multi-component therapy is more effective than mono-component therapies. PMID:21453539

Citalopram Treatment of Pediatric Recurrent Abdominal Pain and Comorbid Internalizing Disorders: An Exploratory Study

ERIC Educational Resources Information Center

Campo, John V.; Perel, James; Lucas, Amanda; Bridge, Jeff; Ehmann, Mary; Kalas, Catherine; Monk, Kelly; Axelson, David; Birmaher, Boris; Ryan, Neal; Di Lorenzo, Carlo; Brent, David A.

2004-01-01

Objective: To assess the potential efficacy, tolerability, and safety of citalopram in the treatment of functional pediatric recurrent abdominal pain and comorbid internalizing disorders. Method: Twenty-five clinically referred children and adolescents with recurrent abdominal pain aged 7 to 18 years, inclusive, participated in a 12-week,…

Menarche? A Case of Abdominal Pain and Vaginal Bleeding in a Preadolescent Girl.

PubMed

Riney, Lauren C; Reed, Jennifer L; Kruger, Laura L; Brody, Alan J; Pomerantz, Wendy J

2015-11-01

Abdominal pain is one of the most common complaints in the pediatric ED. Because of the broad range of potential diagnoses, it can pose challenges in diagnosis and therapy in the preadolescent girl. An 11-year-old previously healthy girl presented to our pediatric ED with fever, decreased appetite, vaginal bleeding, and abdominal pain. Initial evaluation yielded elevated creatinine levels, leukocytosis with bandemia, elevated inflammatory markers, and urine concerning for a urinary tract infection. She began receiving antibiotics for presumed pyelonephritis and was admitted to the hospital. After worsening respiratory status and continued abdominal pain, a computed tomography scan was obtained and a pelvic foreign body and abscess were identified. Adolescent gynecology was consulted for examination under anesthesia for abscess drainage and foreign body removal. A foreign body in the vagina or uterus can present as vaginal discharge, vaginal bleeding, abdominal pain, dysuria, or hematuria. Because symptoms can be diverse, an intravaginal or uterine foreign body should be considered in the preteen female patient presenting to the ED with abdominal pain. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Rectus sheath block: successful use in the chronic pain management of pediatric abdominal wall pain.

PubMed

Skinner, Adam V; Lauder, Gillian R

2007-12-01

Seven pediatric patients (aged 11-16 years) with chronic abdominal wall pain are presented who gained significant relief from a rectus sheath block (RSB). We describe the case histories and review the relevant literature for this technique. The etiology of the abdominal wall pain was considered to be abdominal cutaneous nerve entrapment, iatrogenic peripheral nerve injury, myofascial pain syndrome or was unknown. All patients showed significant initial improvement in pain and quality of life. Three patients required only the RSB to enable them to be pain-free and return to normal schooling and physical activities. Two children received complete relief for more than 1 year. In the majority of cases, the procedure was carried out under general anesthesia as a daycase procedure. Local anesthetic and steroids were used. This is the first report of the successful use of this technique in the chronic pain management setting in children.

Response of cervicogenic headaches and occipital neuralgia to radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerve.

PubMed

Hamer, John F; Purath, Traci A

2014-03-01

This article investigates the degree and duration of pain relief from cervicogenic headaches or occipital neuralgia following treatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves. It also addresses the procedure's complication rate and patient's willingness to repeat the procedure if severe symptoms recur. This is a single-center retrospective observational study of 40 patients with refractory cervicogenic headaches and or occipital neuralgia. Patients were all referred by a headache specialty clinic for evaluation for radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves. After treatment, patients were followed for a minimum of 6 months to a year. Patient demographics and the results of radiofrequency ablation were recorded on the same day, after 3-4 days, and at 6 months to 1 year following treatment. Thirty-five percent of patients reported 100% pain relief and 70% reported 80% or greater pain relief. The mean duration of improvement is 22.35 weeks. Complication rate was 12-13%. 92.5% of patients reported they would undergo the procedure again if severe symptoms returned. Radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerve can provide many months of greater than 50% pain relief in the vast majority of recipients with an expected length of symptom improvement of 5-6 months. © 2014 American Headache Society.

Nucleus caudalis lesioning: Case report of chronic traumatic headache relief

PubMed Central

Sandwell, Stephen E.; El-Naggar, Amr O.

2011-01-01

Background: The nucleus caudalis dorsal root entry zone (DREZ) surgery is used to treat intractable central craniofacial pain. This is the first journal publication of DREZ lesioning used for the long-term relief of an intractable chronic traumatic headache. Case Description: A 40-year-old female experienced new-onset bi-temporal headaches following a traumatic head injury. Despite medical treatment, her pain was severe on over 20 days per month, 3 years after the injury. The patient underwent trigeminal nucleus caudalis DREZ lesioning. Bilateral single-row lesions were made at 1-mm interval between the level of the obex and the C2 dorsal nerve roots, using angled radiofrequency electrodes, brought to 80°C for 15 seconds each, along a path 1 to 1.2 mm posterior to the accessory nerve rootlets. The headache improved, but gradually returned. Five years later, her headaches were severe on over 24 days per month. The DREZ surgery was then repeated. Her headaches improved and the relief has continued for 5 additional years. She has remained functional, with no limitation in instrumental activities of daily living. Conclusions: The nucleus caudalis DREZ surgery brought long-term relief to a patient suffering from chronic traumatic headache. PMID:22059123

Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing.

PubMed

Noe, Joshua D; Li, B U K

2009-05-01

Recurrent abdominal pain is a common chronic complaint that presents to your office. The constant challenge is one of detecting those with organic disease from the majority who have a functional pain disorder including functional dyspepsia, irritable bowel syndrome, functional abdominal pain, and abdominal migraine. Beginning with a detailed history and physical exam, you can: 1) apply the symptom-based Rome III criteria to positively identify a functional disorder, and 2) filter these findings through the diagnostic clues and red flags that point toward specific organic disease and/or further testing. Once a functional diagnosis has been made or an organic disease is suspected, you can initiate a self-limited empiric therapeutic trial. With this diagnostic approach, you should feel confident navigating through the initial evaluation, management, and consultation referral for a child or adolescent with recurrent abdominal pain.

Sumatriptan Nasal Spray

MedlinePlus

... spray is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine. Sumatriptan does not prevent migraine attacks or reduce ...

Zolmitriptan Nasal Spray

MedlinePlus

... spray is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied ... that cause pain, nausea, and other symptoms of migraine. Zolmitriptan does not prevent migraine attacks or reduce ...

Plain abdominal radiography in acute abdominal pain; past, present, and future

PubMed Central

Gans, Sarah L; Stoker, Jaap; Boermeester, Marja A

2012-01-01

Several studies have demonstrated that a diagnosis based solely on a patient’s medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain. Traditionally, imaging workup starts with abdominal radiography. However, numerous studies have demonstrated low sensitivity and accuracy for plain abdominal radiography in the evaluation of acute abdominal pain as well as various specific diseases such as perforated viscus, bowel obstruction, ingested foreign body, and ureteral stones. Computed tomography, and in particular computed tomography after negative ultrasonography, provides a better workup than plain abdominal radiography alone. The benefits of computed tomography lie in decision-making for management, planning of a surgical strategy, and possibly even avoidance of negative laparotomies. Based on abundant available evidence, major advances in diagnostic imaging, and changes in the management of certain diseases, we can conclude that there is no place for plain abdominal radiography in the workup of adult patients with acute abdominal pain presenting in the emergency department in current practice. PMID:22807640

Pain intensity and abdominal muscle activation during walking in patients with low back pain: The STROBE study.

PubMed

Kim, Si-Hyun; Park, Kyue-Nam; Kwon, Oh-Yun

2017-10-01

Nonspecific low back pain (LBP) is a common musculoskeletal problem that is intensified during physical activity. Patients with LBP have been reported to change their abdominal muscle activity during walking; however, the effects of pain intensity, disability level, and fear-avoidance belief on this relationship have not been evaluated. Thus, we compared abdominal muscle activity in patients with LBP and asymptomatic controls, and assessed the impact of pain intensity, disability level, and fear-avoidance belief.Thirty patients with LBP divided into groups reporting low (LLBP) and high-pain intensity low back pain (HLBP), and 15 participants without LBP were recruited. LBP patients' self-reported pain intensity, disability, and fear-avoidance belief were recorded. To examine abdominal muscle activity (rectus abdominis [RA], internal [IO], and external oblique [EO] muscles) during walking, all subjects walked at a self-selected speed. Abdominal muscle activity (RA, IO, and EO) was compared among groups (LLBP, HLBP, and controls) in different phases of walking (double support vs swing). Relationships between abdominal muscle activity and clinical measures (pain intensity, disability, fear-avoidance belief) were analyzed using partial correlation analysis.Right IO muscle activity during walking was significantly decreased in LLBP and HLBP compared with controls in certain walking phase. Partial correlation coefficients showed significant correlations between fear-avoidance belief and right EO activity (r = .377, P < .05) and between disability index and left IO activity (r = .377, P < .05) in patients with LBP. No significant difference was found in abdominal muscle activity in walking between patients with LLBP and HLBP (P > .05).This study demonstrated decreased IO muscle activity during certain walking phases in LLBP and HLBP compared with asymptomatic participants. Although altered IO muscle activity during walking was observed in patients with LBP, no changes were found with other abdominal muscles (EO, RA). Thus, these results provide useful information about abdominal muscle activity during walking in patients with LBP.

Transcranial direct current stimulation (tDCS) and its influence on analgesics effectiveness in patients suffering from migraine headache.

PubMed

Przeklasa-Muszyńska, Anna; Kocot-Kępska, Magdalena; Dobrogowski, Jan; Wiatr, Maciej; Mika, Joanna

2017-08-01

Headache is one of the most common conditions troubling nearly 45% of the world's population. Migraine headache itself, being more common among women, affects 7-18% of people. As much as 20-30% of the population report accompanying aura and neurological symptoms. In many cases, migraine headache can be effectively treated with suitably selected pharmacotherapies which include drugs used in symptomatic treatment. Frequent occurrence of the condition is treated with prophylaxis, which often fails. Neuromodulating methods are part of the multidirectional treatment and they may be valuable complement to pharmacotherapy. Our study evaluates the impact of the transcranial direct current stimulation (tDCS) on the consumption of drugs and on pain conditions (frequency, duration, intensity). We recruited 50 patients with migraine headache (30 with aura, 20 without aura) refractory to pharmacological therapy. In 30 patients (18 with aura, 12 without aura) previous unsatisfactory treatment was supplemented with tDCS performed tenfold. 20 patients (12 with aura, 8 without aura) from a control group were treated with pharmacological methods The observation continued for 30 days after the stimulation. After tDCS, a reduction in the consumption of analgesics and triptans was reported. Additionally, we monitored pain intensity decrease during pain episodes, duration of episodes and the number of pain days. The subjective assessment of pain reduction in migraine patients encompassed 36-40% after tDCS much more effective in comparison to group with only pharmacotherapy (10-12.5%). The study suggests that tDCS may be safe and useful clinical tool in migraine prophylaxis and treatment. Copyright © 2017 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

How and when to refer patients diagnosed with secondary headache and other craniofacial pain in the Emergency Department and Primary Care: Recommendations of the Spanish Society of Neurology's Headache Study Group.

PubMed

Gago-Veiga, A B; Díaz de Terán, J; González-García, N; González-Oria, C; González-Quintanilla, V; Minguez-Olaondo, A; Santos-Lasaosa, S; Viguera Romero, J; Pozo-Rosich, P

2017-09-01

When secondary headache is suspected and the patient is referred to the emergency department or to the outpatient neurology clinic, it is important to know which are the appropriate complementary examinations to perform and the suitable referral pathway for patients to follow. In order to establish recommendations on this matter, the Spanish Society of Neurology's Headache Study Group (GECSEN) has decided to issue a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgias. Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with GECSEN's Executive Committee. For practical reasons, the document was divided into 2 articles: the first focuses on primary headaches and craniofacial neuralgias and this second article on secondary headaches and other craniofacial pain. In order for the recommendations to be helpful for daily practice, they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists. We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Effects of listening to music on pain intensity and pain distress after surgery: an intervention.

PubMed

Vaajoki, Anne; Pietilä, Anna-Maija; Kankkunen, Päivi; Vehviläinen-Julkunen, Katri

2012-03-01

To evaluate the effects of music listening on pain intensity and pain distress on the first and second postoperative days in abdominal surgery patients and the long-term effects of music on the third postoperative day. Music has been found to relieve pain intensity in surgery patients. There are only a few studies on music intervention in abdominal surgery. Music intervention studies assessing multidimensional pain such as pain intensity and pain distress are also scarce. Prospective clinical study with two parallel groups. Patients undergoing elective abdominal surgery (n = 168) were divided into either a music group (n = 83) or a control group (n = 85). Patients assessed pain intensity and pain distress in bed rest, during deep breathing and in shifting position once in the evening of the operation day and on the first and second postoperative days in the morning, at noon and in the evening. On the third postoperative day, the patients assessed their pain intensity and pain distress only once. In the music group, the patients' pain intensity and pain distress in bed rest, during deep breathing and in shifting position were significantly lower on the second postoperative day compared with control group of patients. On the third postoperative day, when long-term effects of music on pain intensity and pain distress were assessed, there were no significant differences between music and control groups. This study demonstrates that the use of music alleviates pain intensity and pain distress in bed rest, during deep breathing and in shifting position after abdominal surgery on the second postoperative day. Music intervention is safe, inexpensive and easily used to improve the healing environment for abdominal surgery patients. Music intervention should be offered as an adjunct alternative to pharmacological pain relief after abdominal surgery in nursing practice. © 2011 Blackwell Publishing Ltd.

[Possibilities of preventive therapy in frequent episodic tension-type headache].

PubMed

Tabeeva, G R; Fokina, N M

2016-01-01

To study the efficacy and safety of tenoten in the preventive treatment of frequent episodic tension-type headache (FETHA) compared to patients treated with pain relievers. A study included 60 patients with FETHA. Patients of the main group (n=30) received tenoten in addition to standard treatment. The study comprised 3 visits: beginning of treatment, after one month and after three months. All patients underwent physical and clinical/neurological examinations. In each visit, treatment efficacy was assessed according the following parameters: VAS scores (0-10) for assessment of pain and tension in pericranial muscles in 6 standard points, mean frequency and duration of the headache episode, quality of life indices, Beck depression scores, Spilberger trait and state anxiety, autonomic symptom severity, parameters of sleep disorders, frequency of adverse effects, CGI scores (0-7). Tenoten as a preventive medication reduced the frequency of headache episodes that allowed to diagnose patients with rare episodic tension-type headache in the end of treatment. At the same time, there was a significant reduction in headache intensity during the episode and decrease in amount of analgesics used by the patients.

Manual therapy in adults with tension-type headache: A systematic review.

PubMed

Cumplido-Trasmonte, C; Fernández-González, P; Alguacil-Diego, I M; Molina-Rueda, F

2018-03-07

Tension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension-type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension-type headache. We conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients' well-being and improving the outcome measures analysed. Manual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension-type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach. Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Central sensitization in tension-type headache--possible pathophysiological mechanisms.

PubMed

Bendtsen, L

2000-06-01

The aim of the present thesis was to investigate the pathophysiology of chronic tension-type headache with special reference to central mechanisms. Increased tenderness to palpation of pericranial myofascial tissues is the most apparent abnormality in patients with tension-type headache. A new piece of equipment, a so-called palpometer, that makes it possible to control the pressure intensity exerted during palpation, was developed. Thereafter, it was demonstrated that the measurement of tenderness could be compared between two observers if the palpation pressure was controlled, and that the Total Tenderness Scoring system was well suited for the scoring of tenderness during manual palpation. Subsequently, it was found that pressure pain detection and tolerance thresholds were significantly decreased in the finger and tended to be decreased in the temporal region in chronic tension-type headache patients compared with controls. In addition, the electrical pain threshold in the cephalic region was significantly decreased in patients. It was concluded that the central pain sensitivity was increased in the patients probably due to sensitization of supraspinal neurones. The stimulus-response function for palpation pressure vs. pain was found to be qualitatively altered in chronic tension-type headache patients compared with controls. The abnormality was related to the degree of tenderness and not to the diagnosis of tension-type headache. In support of this, the stimulus-response function was found to be qualitatively altered also in patients with fibromyalgia. It was concluded that the qualitatively altered nociception was probably due to central sensitization at the level of the spinal dorsal horn/trigeminal nucleus. Thereafter, the prophylactic effect of amitriptyline, a non-selective serotonin (5-HT) reuptake inhibitor, and of citalopram, a highly selective 5-HT reuptake inhibitor, was examined in patients with chronic tension-type headache. Amitriptyline reduced headache significantly more than placebo, while citalopram had only a slight and insignificant effect. It was concluded that the blockade of 5-HT reuptake could only partly explain the efficacy of amitriptyline in tension-type headache, and that also other actions of amitriptyline, e.g. reduction of central sensitization, were involved. Finally, the plasma 5-HT level, the platelet 5-HT level and the number of platelet 5-HT transporters were found to be normal in chronic tension-type headache. On the basis of the present and previous studies, a pathophysiological model for tension-type headache is presented. According to the model, the main problem in chronic tension-type headache is central sensitization at the level of the spinal dorsal horn/trigeminal nucleus due to prolonged nociceptive inputs from pericranial myofascial tissues. The increased nociceptive input to supraspinal structures may in turn result in supraspinal sensitization. The central neuroplastic changes may affect the regulation of peripheral mechanisms and thereby lead to, for example, increased pericranial muscle activity or release of neurotransmitters in the myofascial tissues. By such mechanisms the central sensitization may be maintained even after the initial eliciting factors have been normalized, resulting in the conversion of episodic into chronic tension-type headache. Future basic and clinical research should aim at identifying the source of peripheral nociception in order to prevent the development of central sensitization and at ways of reducing established sensitization. This may lead to a much needed improvement in the treatment of chronic tension-type headache and other chronic myofascial pain conditions.

Common Functional Gastroenterological Disorders Associated With Abdominal Pain.

PubMed

Bharucha, Adil E; Chakraborty, Subhankar; Sletten, Christopher D

2016-08-01

Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia and depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in various peripheral (eg, postinfectious inflammation and luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Nitroglycerin-induced changes in facial skin temperature: 'cold nose' as a predictor of headache?

PubMed

Zaproudina, Nina; Närhi, Matti; Lipponen, Jukka A; Tarvainen, Mika P; Karjalainen, Pasi A; Karhu, Jari; Airaksinen, Olavi; Giniatullin, Rashid

2013-11-01

Nitroglycerin (NTG) often induces headaches when used to treat cardiac diseases. Such property of NTG has been widely used in modelling of migraine-like headaches. However, background reasons, predisposing to the development of NTG-headache, are less studied. The main aim of our study was to find, using NTG model, easily accessible markers of the vascular changes associated with headache. Because changes in the blood flow alter the local skin temperature (Tsk), we studied the relationship between the regional changes in the facial Tsk and NTG-induced headaches. Tsk was measured with infrared thermography in 11 healthy women during 3 h after sublingual NTG administration. NTG caused headache in five women, and four of them were the first-degree relatives of migraine patients. Notably, before NTG administration, subjects in the headache group had lower Tsk values, especially in the nose area, than women in the pain-free group (n = 6). NTG-induced headache was associated with a long-lasting increase of Tsk over the baseline. In sharp contrast, in the pain-free group, the Tsk reduced and returned rapidly to the baseline. Thus, the low baseline level and greater increase of regional Tsk correlated with the incidence of headache that supports a role of greater vascular changes in headache happening on the basis of the dissimilarities in vascular tone. An easily accessible phenomenon of 'cold nose' may indicate background vascular dysfunctions in individuals with predisposition to headache. Facial infrared thermography, coupled with NTG administration, suggests a novel temporally controlled approach for non-invasive investigation of vascular processes accompanying headaches. © 2013 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Headaches and Sinus Disease

MedlinePlus

... region where migraine sufferers experience pain as well. MIGRAINE IS THE MOST COMMON TRUE DIAGNOSIS IN PATIENTS ... of patients who meet the diagnostic criteria for migraine headaches are self-diagnosed or diagnosed by their ...

Botulinum toxin a in the treatment of chronic tension-type headache with cervical myofascial trigger points: a randomized, double-blind, placebo-controlled pilot study.

PubMed

Harden, R Norman; Cottrill, Jerod; Gagnon, Christine M; Smitherman, Todd A; Weinland, Stephan R; Tann, Beverley; Joseph, Petra; Lee, Thomas S; Houle, Timothy T

2009-05-01

To evaluate the efficacy of botulinum toxin A (BT-A) as a prophylactic treatment for chronic tension-type headache (CTTH) with myofascial trigger points (MTPs) producing referred head pain. Although BT-A has received mixed support for the treatment of TTH, deliberate injection directly into the cervical MTPs very often found in this population has not been formally evaluated. Patients with CTTH and specific MTPs producing referred head pain were assigned randomly to receive intramuscular injections of BT-A or isotonic saline (placebo) in a double-blind design. Daily headache diaries, pill counts, trigger point pressure algometry, range of motion assessment, and responses to standardized pain and psychological questionnaires were used as outcome measures; patients returned for follow-up assessment at 2 weeks, 1 month, 2 months, and 3 months post injection. After 3 months, all patients were offered participation in an open-label extension of the study. Effect sizes were calculated to index treatment effects among the intent-to-treat population; individual time series models were computed for average pain intensity. The 23 participants reported experiencing headache on a near-daily basis (average of 27 days/month). Compared with placebo, patients in the BT-A group reported greater reductions in headache frequency during the first part of the study (P = .013), but these effects dissipated by week 12. Reductions in headache intensity over time did not differ significantly between groups (P = .80; maximum d = 0.13), although a larger proportion of BT-A patients showed evidence of statistically significant improvements in headache intensity in the time series analyses (62.5% for BT-A vs 30% for placebo). There were no differences between the groups on any of the secondary outcome measures. The evidence for BT-A in headache is mixed, and even more so in CTTH. However, the putative technique of injecting BT-A directly into the ubiquitous MTPs in CTTH is partially supported in this pilot study. Definitive trials with larger samples are needed to test this hypothesis further.

Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific).

PubMed

Krismer, M; van Tulder, M

2007-02-01

Low back pain (LBP) is defined as pain localised between the 12th rib and the inferior gluteal folds, with or without leg pain. Most cases are non-specific, but in about 10% of cases a specific cause is identified. Red flags are typical signs or symptoms that are frequently associated with specific LBP. Yellow flags are prognostic factors associated with a more unfavourable and often chronic disabling course of the disease. LBP has a lifetime prevalence of 60-85%. At any one time, about 15% of adults have LBP. LBP poses an economic burden to society, mainly in terms of the large number of work days lost (indirect costs) and less so by direct treatment costs. A substantial proportion of individuals with chronic LBP has been found to have chronic widespread pain. LBP is often associated with other pain manifestations such as headache, abdominal pain and pain in different locations of the extremities. Widespread pain is associated with a worse prognosis compared to localised LBP. Treatment targets are reduction of pain and better activity/participation, including prevention of disability as well as maintainance of work capacity. The evidence from selected and appraised guidelines, systematic reviews and major clinical studies was classified into four levels, level Ia being the best level with evidence from meta-analysis of randomised controlled trials. Key recommendations (level Ia): fitness programmes and advice to stay active can reduce pain, improve function and can prevent LBP becoming chronic. Simple analgesics, NSAIDs and muscle relaxants can reduce pain and can improve and maintain function. Maintaining physical activity, avoiding rest and manual therapy can reduce pain and maintain and restore function in acute LBP. Behavioural treatment can prevent LBP becoming chronic. Aerobic fitness and endurance training, behavioural treatment and multi-disciplinary treatment programmes can reduce pain and can improve/maintain function in chronic LBP.

Treatment of tension-type headache with articulatory and suboccipital soft tissue therapy: A double-blind, randomized, placebo-controlled clinical trial.

PubMed

Espí-López, Gemma V; Gómez-Conesa, Antonia; Gómez, Anna Arnal; Martínez, Josep Benítez; Pascual-Vaca, Angel Oliva; Blanco, Cleofás Rodríguez

2014-10-01

This study researches the effectiveness of two manual therapy treatments focused on the suboccipital region for tension-type headache. A randomized double-blind clinical trial was conducted over a period of four weeks with a follow-up at one month. Eighty-four patients with a mean age of 39.7 years (SD 11.4) with tension-type headache were assigned to 4 groups which included the following manual therapy treatment: suboccipital soft tissue inhibition; occiput-atlas-axis global manipulation; combination of both techniques; and a control group. The primary assessment consisted of collecting socio-demographic data and headache characteristics in a one-month base period, data such as age, gender, severity of pain, intensity and frequency of headache, among other. Outcome secondary assessment were: impact of headache, disability, ranges of motion of the craniocervical junction, frequency and intensity of headache, and pericranial tenderness. In the month prior to the study, average pain intensity, was rated at 6.49 (SD 1.69), and 66.7% subjects suffered headaches of moderate intensity. After 8 weeks, statistically significant improvements were noted. OAA manipulative treatment and combined therapy treatments proved to be more effective than suboccipital soft tissue inhibition for tension-type headache. The treatment with suboccipital soft tissue inhibition, despite producing less significant results, also has positive effects on different aspects of headache. Copyright © 2014 Elsevier Ltd. All rights reserved.

THE EFFECT OF BODY AWARENESS THERAPY AND AEROBIC EXERCISES ON PAIN AND QUALITY OF LIFE IN THE PATIENTS WITH TENSION TYPE HEADACHE.

PubMed

Sertel, Meral; Bakar, Yeşim; Şimşek, Tülay Tarsuslu

2017-01-01

This study is to investigate the effect of Body Awareness Therapy (BAT) and Aerobic Exercises on pain and quality of life in patients with Tension-Type Headache (TTH). Sixty individuals with TTH diagnosis who referred Neurologist were incorporated into study. The individuals were randomly grouped into 3 as BAT (n=20), aerobic exercise (n=20) and control group (n=20). Pain severity of the individuals was evaluated by Visual Analog Scale (VAS) and pain diary, disability with ache; by Pain Disability Index (PDI) and Headache Impact Tests (HIT) and quality of life was evaluated by SF-36. Subsequent to first assessments, 3 sessions of 60 minutes per week throughout 6 weeks totally. When the groups were compared at the end of the study, a significant decrease was observed in VAS, PDI and HIT values in the individuals in the BAT and aerobic exercise groups. With the individuals in group BAT and aerobic exercise all parameters of quality of life were observed to be increased significantly. BAT and aerobic exercise programs to be applied on TTH patients were concluded to be important in decreasing the pain, in increasing the quality of life and in reducing pain-related daily constraints of the individuals.

Female cluster headache in the United States of America: what are the gender differences? Results from the United States Cluster Headache Survey.

PubMed

Rozen, Todd D; Fishman, Royce S

2012-06-15

To present results from the United States Cluster Headache Survey regarding gender differences in cluster headache demographics, clinical characteristics, diagnostic delay, triggers, treatment response and personal burden. Very few studies have looked at the gender differences in cluster headache presentation. The United States Cluster Headache Survey is the largest study of cluster headache sufferers ever completed in the United States and it is also the largest study of female cluster headache patients ever presented. The total survey consisted of 187 multiple choice questions which dealt with various issues related to cluster headache including: demographics, clinical characteristics, concomitant medical conditions, family history, triggers, smoking history, diagnosis, treatment response and personal burden. A group of questions were specifically targeted to female cluster headache patients. The survey was placed on a website from October to December 2008. For all survey responders the diagnosis of cluster headache needed to be made by a neurologist but there was no validation of the headache diagnosis by the authors. 1134 individuals completed the survey (816 male, 318 female). Key Points that define the differences between female and male cluster headache include: a. Age of onset: women develop cluster headache at an earlier age than men and are more likely to develop a second peak of cluster headache onset after 50 years of age. b. Family history: woman cluster headache sufferers are more likely to have a family history of both cluster headache and migraine and have an increased familial risk of Parkinson's disease. c. Comorbid conditions: female cluster headaches sufferers are significantly more likely to experience depression and have asthma than males. d. Aura issues: aura with cluster headache is equally common in both sexes, but aura duration is shorter in women. Women are much more likely to experience sensory, language and brainstem auras. e. Pain location: cluster headache pain is typically retro-orbital in location in both sexes but women are significantly more likely to experience cluster headache pain in the jaw, cheek and ear than men. f. Associated symptoms: women with cluster headache develop more “migrainous” associated symptoms than men, especially nausea and they are also more likely to have self-injurious behavior than men. g. Triggers: women with cluster headache are much less likely to have alcohol trigger a headache, but are significantly more likely to have “migrainous” triggers for their cluster headaches than men. h. Smoking issues: women are much less likely to have a smoking history than male cluster headache sufferers, more likely to have never smoked prior to cluster headache onset. i. Cycle issues: spring and fall are the most common time to start a cluster headache cycle in both sexes. Women are statistically significantly less likely to start a cluster headache cycle in the months of October–December than men. Women have more attacks per day and higher pain intensity nighttime attacks than men. j. in regard to acute treatment women statistically were less response to sumatriptan injectable and nasal spray than men, but statistically more likely to respond to inhaled lidocaine. There was equal efficacy in the sexes to inhaled oxygen but slower response in women. For preventive treatment no significant gender differences were noted, but overall women were less responsive to almost all preventives than men. k. Diagnostic delay: there remains a significant diagnostic delay for cluster headache patients in both sexes but women were more likely to be diagnosed after 10 years of symptom onset than males and significantly fewer women were diagnosed correctly at an initial physician visit than men. l. Female specific issues: cluster headache does not appear to be influenced by menses or menopause but 50% of the survey responders stated their headaches improved with pregnancy. Cluster headache does not appear to alter fertility rates in female cluster headache sufferers. m. Personal burden: cluster headache causes significantly more personal burden in women than men with more loss of employment and/or need of disability, as well as more homebound days. Overall women and men with cluster headache have a similar presentation but there are some distinct differences that have been suggested in smaller studies of female cluster headache that we have now verified, while some of our study conclusions have not been shown previously. One major limitation to the study is a lack of validation of diagnosis. A substantial false positive cluster headache diagnosis rate, especially in females, cannot be excluded by the study methods utilized. Copyright © 2012 Elsevier B.V. All rights reserved.

Headache attributed to airplane travel ('airplane headache'): clinical profile based on a large case series.

PubMed

Mainardi, F; Lisotto, C; Maggioni, F; Zanchin, G

2012-06-01

The 'headache attributed to airplane travel', also named 'airplane headache' (AH), is a recently described headache disorder that appears exclusively in relation to airplane flights, in particular during the landing phase. Based on the stereotypical nature of the attacks in all reported cases, we proposed provisional diagnostic criteria for AH in a previously published paper. Up to now 37 cases have been described in the literature. After our paper was disseminated via the Internet, we received several email messages from subjects around the world who had experienced such a peculiar headache. Their cooperation, by completing a structured questionnaire and allowing the direct observation of three subjects, enabled us to carry out a study on a total of 75 patients suffering from AH. Our survey confirmed the stereotypical nature of the attacks, in particular with regard to the short duration of the pain (lasting less than 30 minutes in up to 95% of the cases), the clear relationship with the landing phase, the unilateral pain, the male preponderance, and the absence of accompanying signs and/or symptoms. It is conceivable to consider barotrauma as one of the main mechanisms involved in the pathophysiology of AH. The observation that the pain appears inconstantly in the majority of cases, without any evident disorder affecting the paranasal sinuses, could be consistent with a multimodal pathogenesis underlying this condition, possibly resulting in the interaction between anatomic, environmental and temporary concurrent factors. This is by far the largest AH case series ever reported in the literature. The diagnostic criteria that we previously proposed proved to be valid when applied to a large number of patients suffering from this condition. We support its recognition as a new form of headache, to be included in the forthcoming update of the International Headache Society Classification, within '10. Headache attributed to disorder of homoeostasis'. Its formal validation would favour further studies aimed at improving the understanding of its pathophysiology and implementing preventative measures.

Ketamine Infusions for Treatment Refractory Headache.

PubMed

Pomeroy, Jared L; Marmura, Michael J; Nahas, Stephanie J; Viscusi, Eugene R

2017-02-01

Management of chronic migraine (CM) or new daily persistent headache (NDPH) in those who require aggressive outpatient and inpatient treatment is challenging. Ketamine has been suggested as a new treatment for this intractable population. This is a retrospective review of 77 patients who underwent administration of intravenous, subanesthetic ketamine for CM or NDPH. All patients had previously failed aggressive outpatient and inpatient treatments. Records were reviewed for patients treated between January 2006 and December 2014. The mean headache pain rating using a 0-10 pain scale was an average of 7.1 at admission and 3.8 on discharge (P < .0001). The majority (55/77, 71.4%) of patients were classified as acute responders defined as at least 2-point improvement in headache pain at discharge. Some (15/77, 27.3%) acute responders maintained this benefit at their follow-up office visit but sustained response did not achieve statistical significance. The mean length of infusion was 4.8 days. Most patients tolerated ketamine well. A number of adverse events were observed, but very few were serious. Subanesthetic ketamine infusions may be beneficial in individuals with CM or NDPH who have failed other aggressive treatments. Controlled trials may confirm this, and further studies may be useful in elucidating more robust benefit in a less refractory patient population. © 2016 American Headache Society.

AAPT Diagnostic Criteria for Chronic Abdominal, Pelvic, and Urogenital Pain: Irritable Bowel Syndrome.

PubMed

Zhou, QiQi; Wesselmann, Ursula; Walker, Lynn; Lee, Linda; Zeltzer, Lonnie; Verne, G Nicholas

2018-03-01

In conjunction with the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration and the American Pain Society, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society Pain Taxonomy (AAPT) initiative strove to develop the characteristics of a diagnostic system useful for clinical and research purposes across disciplines and types of chronic pain conditions. After the establishment of these characteristics, a working group of clinicians and clinical and basic scientists with expertise in abdominal, pelvic, and urogenital pain began generating core diagnostic criteria and defining the related extraintestinal somatic pain and other symptoms experienced by patients. Systematic diagnostic criteria for several common abdominal, pelvic, and urogenital pain conditions are in development. In this report, we present the proposed AAPT criteria for irritable bowel syndrome (IBS), the most common chronic, noncancer abdominal pain condition. A systematic review and synthesis was conducted to complement the Rome IV Diagnostic Criteria for IBS. Future efforts will subject these proposed AAPT criteria to systematic empirical evaluation of their feasibility, reliability, and validity. The AAPT IBS criteria are part of an evidence-based classification system that provides a consistent vocabulary regarding diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms of the disorder. A similar approach is being applied to other chronic and often debilitating abdominal, pelvic, and urogenital pain conditions. The AAPT's goal is to develop an evidence-based taxonomy for chronic pain on the basis of a consistently applied multidimensional framework, and encourage experts to apply this taxonomy to specific chronic pain conditions. In this report, the taxonomy is applied to IBS, a chronic abdominal pain condition. Copyright © 2018. Published by Elsevier Inc.

Use of analgesics in young adults as a predictor of health care utilization and pain prevalence: Israel defense forces experience.

PubMed

Dorfman, Karina; Komargodski, Olga; Magnezi, Racheli; Lifshitz, Stanislav; Tzur, Dorit; Yavnai, Nirit; Ifergane, Gal

2017-06-01

Pain evaluation in large community studies is difficult. Analgesics can be a useful tool in estimating pain-related conditions in which analgesic use is highly regulated. In this study, we evaluated analgesics consumption patterns of regular Israel Defense Force soldiers. We have performed a historical cohort study of 665,137 young adults during active duty in 2002 to 2012. Analgesics were prescribed to 518,242 (78%) soldiers, mostly for musculoskeletal pain (69.3%), abdominal pain (12.7%), and headache (12.1%). Acute (1-14 days), subacute (15-90), and chronic (>90 days) analgesic use episodes were experienced by 396,987 (59.7%), 74,591 (11.2%), and 46,664 (7%) of the population. In a multivariate model, predictors for chronic analgesics use were as follows: low intelligence, service in a combat supporting unit, previous pain diagnosis, male sex, Israeli nativity, low socioeconomic status, and high body mass index. Low intelligence had the highest odds ratio for chronic analgesic consumption (2.1) compared with other predictors. Chronic analgesic use was associated with a significant increase in health care utilization cost per year (911$ per soldier vs 199$ for nonusers), increased sick leave days per year (7.09 vs 0.67 for nonusers), and higher dropout rate from combat units (25% vs 9.2% for nonusers). Chronic use of analgesics is common among young adults, and it is an important predictor for unsuccessful military service and high health care utilization costs. Further studies in other setups are indicated.

Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study

PubMed Central

Erdem, Vuslat Muslu; Uzman, Sinan; Yildirim, Dogan; Avaroglu, Huseyin; Ferahman, Sina; Sunamak, Oguzhan

2017-01-01

Purpose Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. Methods Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups. Results Anesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in CSEA group (25% vs. 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2% vs. 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group. Conclusion CSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA. PMID:28289667

Recurrent abdominal pain in children: a clinical approach.

PubMed

Quek, S H

2015-03-01

The term 'recurrent abdominal pain', or RAP, refers mainly to the duration of painful period and frequency of pain. The commonly accepted duration is at least three months in the preceding period, and over this three-month period, there are at least three episodes of pain that are severe enough to affect the daily activities of the affected patients. Over the years, with advances in medical technology and better understanding of the pathophysiology of abdominal pain, more and more organic causes have been identified. However, the most common cause of RAP in children is still functional in origin.

Trends in Post-Concussive Symptom Reporting Following Mild Traumatic Brain Injury in Operation Iraqi Freedom

DTIC Science & Technology

2011-04-01

complaints on the PDHA were examined and included pain (headache, back, joint, muscle), memory problems, sleep problems, and tinnitus . The PDHA also... aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for...PCS). 6-8 Common PCS symptoms include headache, tinnitus , sleep problems, chronic pain and cognitive deficits. 8 In 2004, the World Health

Headache and mechanical sensitization of human pericranial muscles after repeated intake of monosodium glutamate (MSG).

PubMed

Shimada, Akiko; Cairns, Brian E; Vad, Nynne; Ulriksen, Kathrine; Pedersen, Anne Marie Lynge; Svensson, Peter; Baad-Hansen, Lene

2013-01-24

A single intake of monosodium glutamate (MSG) may cause headache and increased muscle sensitivity. We conducted a double-blinded, placebo-controlled, crossover study to examine the effect of repeated MSG intake on spontaneous pain, mechanical sensitivity of masticatory muscles, side effects, and blood pressure. Fourteen healthy subjects participated in 5 daily sessions for one week of MSG intake (150 mg/kg) or placebo (24 mg/kg NaCl) (randomized, double-blinded). Spontaneous pain, pressure pain thresholds and tolerance levels for the masseter and temporalis muscles, side effects, and blood pressure were evaluated before and 15, 30, and 50 min after MSG intake. Whole saliva samples were taken before and 30 min after MSG intake to assess glutamate concentrations. Headache occurred in 8/14 subjects during MSG and 2/14 during placebo (P = 0.041). Salivary glutamate concentrations on Day 5 were elevated significantly (P < 0.05). Pressure pain thresholds in masseter muscle were reduced by MSG on Day 2 and 5 (P < 0.05). Blood pressure was significantly elevated after MSG (P < 0.040). In conclusion, MSG induced mechanical sensitization in masseter muscle and adverse effects such as headache and short-lasting blood pressure elevation for which tolerance did not develop over 5 days of MSG intake.

Health outcomes in US children with abdominal pain at major emergency departments associated with race and socioeconomic status.

PubMed

Wang, Louise; Haberland, Corinna; Thurm, Cary; Bhattacharya, Jay; Park, K T

2015-01-01

Over 9.6 million ED visits occur annually for abdominal pain in the US, but little is known about the medical outcomes of these patients based on demographics. We aimed to identify disparities in outcomes among children presenting to the ED with abdominal pain linked to race and SES. Data from 4.2 million pediatric encounters of abdominal pain were analyzed from 43 tertiary US children's hospitals, including 2.0 million encounters in the emergency department during 2004-2011. Abdominal pain was categorized as functional or organic abdominal pain. Appendicitis (with and without perforation) was used as a surrogate for abdominal pain requiring emergent care. Multivariate analysis estimated likelihood of hospitalizations, radiologic imaging, ICU admissions, appendicitis, appendicitis with perforation, and time to surgery and hospital discharge. Black and low income children had increased odds of perforated appendicitis (aOR, 1.42, 95% CI, 1.32- 1.53; aOR, 1.20, 95% CI 1.14 - 1.25). Blacks had increased odds of an ICU admission (aOR, 1.92, 95% CI 1.53 - 2.42) and longer lengths of stay (aHR, 0.91, 95% CI 0.86 - 0.96) than Whites. Minorities and low income also had lower rates of imaging for their appendicitis, including CT scans. The combined effect of race and income on perforated appendicitis, hospitalization, and time to surgery was greater than either separately. Based on race and SES, disparity of health outcomes exists in the acute ED setting among children presenting with abdominal pain, with differences in appendicitis with perforation, length of stay, and time until surgery.

Abdominal Pain in the Geriatric Patient.

PubMed

Magidson, Phillip D; Martinez, Joseph P

2016-08-01

With an aging population, emergency department clinicians can expect an increase in geriatric patients presenting with abdominal pain. Compared with younger patients, this patient population is less likely to present with classic symptoms, physical examination findings, and laboratory values of abdominal disease. However, the morbidity and mortality associated with elderly patients presenting with abdominal pathologic conditions are significant. For this reason, the clinician must be familiar with some subtle and not so subtle differences when caring for the geriatric patient with abdominal pain to ensure timely diagnosis and appropriate treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Rectal sensory threshold for pain is a diagnostic marker of irritable bowel syndrome and functional abdominal pain in children.

PubMed

Halac, Ugur; Noble, Angela; Faure, Christophe

2010-01-01

To evaluate the diagnostic value of the rectal sensory threshold for pain (RSTP) in children and adolescents with chronic abdominal pain. Fifty-one patients (25 girls; median age 14.2 years; range 8.4-17.6) with abdominal pain >2 months underwent a series of rectal distensions with an electronic barostat. RSTP and viscerosomatic referrals were assessed. Three months after the barostat, the final diagnosis was documented. Thirty-five patients had a functional gastrointestinal disorder (FGID) (irritable bowel syndrome or functional abdominal pain), and 16 had an organic disease. RSTP was lower in the FGID group than in the organic disease group (25.4mm Hg vs 37.1mm Hg; P = .0002). At the cutoff of 30mm Hg, the RSTP measurement for the diagnosis of FGID had a sensitivity of 94% and a specificity of 77%. Both groups similarly reported aberrant viscerosomatic projections. In children, RSTP is a diagnostic marker of irritable bowel syndrome and functional abdominal pain. Viscerosomatic referrals are similar in children with FGID and organic diseases.

Sickle cell 'girdle syndrome' progressing to ischaemic colitis and colonic perforation.

PubMed

Qureshi, A; Lang, N; Bevan, D H

2006-02-01

Abdominal pain of presumed vasocclusive origin, often termed 'girdle syndrome' because of the circumferential distribution of the pain, is common in sickle cell anaemia (SCA). Evidence of progression to bowel infarction is rare. A 27-year-old man with SCA developed chest and abdominal pain unresponsive to opiate analgesia. Abdominal X-ray showed dilated bowel loops because of partial obstruction. Despite reduction of HbS to 23% by automated red cell exchange, abdominal pain worsened. A CT scan was the most informative investigation and showed free peritoneal air. He underwent emergency hemicolectomy and reversible ileostomy formation. Histology of the resected colon was consistent with acute ischaemic colitis. Early surgical intervention remains essential in SCA when abdominal pain does not respond to maximal therapy including red cell exchange: as this case illustrates, sickle girdle syndrome has the capacity to progress to irreversible ischaemic colitis and necrotic perforation of the bowel wall.

Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components.

PubMed

Probyn, Katrin; Bowers, Hannah; Mistry, Dipesh; Caldwell, Fiona; Underwood, Martin; Patel, Shilpa; Sandhu, Harbinder Kaur; Matharu, Manjit; Pincus, Tamar

2017-08-11

To assess the effect of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventions PARTICIPANTS: People living with migraine and/or tension-type headache INTERVENTIONS: Non-pharmacological educational or psychological self-management interventions; excluding biofeedback and physical therapy.We assessed the overall effectiveness against usual care on headache frequency, pain intensity, mood, headache-related disability, quality of life and medication consumption in meta-analysis.We also provide preliminary evidence on the effectiveness of intervention components and delivery methods. We found a small overall effect for the superiority of self-management interventions over usual care, with a standardised mean difference (SMD) of -0.36 (-0.45 to -0.26) for pain intensity; -0.32 (-0.42 to -0.22) for headache-related disability, 0.32 (0.20 to 0.45) for quality of life and a moderate effect on mood (SMD=0.53 (-0.66 to -0.40)). We did not find an effect on headache frequency (SMD=-0.07 (-0.22 to 0.08)).Assessment of components and characteristics suggests a larger effect on pain intensity in interventions that included explicit educational components (-0.51 (-0.68 to -0.34) vs -0.28 (-0.40 to -0.16)); mindfulness components (-0.50 (-0.82 to -0.18) vs 0.34 (-0.44 to -0.24)) and in interventions delivered in groups vs one-to-one delivery (0.56 (-0.72 to -0.40) vs -0.39 (-0.52 to -0.27)) and larger effects on mood in interventions including a cognitive-behavioural therapy (CBT) component with an SMD of -0.72 (-0.93 to -0.51) compared with those without CBT -0.41 (-0.58 to -0.24). Overall we found that self-management interventions for migraine and tension-type headache are more effective than usual care in reducing pain intensity, mood and headache-related disability, but have no effect on headache frequency. Preliminary findings also suggest that including CBT, mindfulness and educational components in interventions, and delivery in groups may increase effectiveness. PROSPERO 2016:CRD42016041291. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Salmonella Infections

MedlinePlus

... reptiles like snakes, turtles, and lizards. Symptoms include Fever Diarrhea Abdominal cramps Headache Possible nausea, vomiting, and ... be serious. The usual treatment is antibiotics. Typhoid fever, a more serious disease caused by Salmonella, is ...

Intravenous Sodium Valproate for Acute Pediatric Headache.

PubMed

Sheridan, David; Sun, Benjamin; O'Brien, Patricia; Hansen, Matthew

2015-10-01

Headaches are common in the pediatric population, and increase in prevalence with age. The abortive medications currently used have a number of potential side effects. Sodium valproate (VPA) has been shown to be effective for acute treatment in the adult population, but no data exist in the pediatric population. The objective of this study was to evaluate the effectiveness of VPA for acute pediatric headache in the emergency department. This was a retrospective case series of all patients <19 years of age treated in the pediatric emergency department (PED) at two tertiary care pediatric hospitals and with a final diagnosis of migraine or headache who received parenteral VPA. Data collected included patient demographics, pain reduction, length of stay, and final disposition. From July 2010 to February 2014, there were 16 patients who received VPA for acute headache in the PED; 4 were excluded. Eighty-three percent were discharged home. Mean length of stay in the PED before VPA was 395 min, and 120 min after VPA administration. Patients achieved a 17% mean pain score reduction before VPA and approximately an additional 40% mean pain reduction after VPA infusion. VPA appears to be an effective agent for acute pediatric headache in this small series. Patients responded well to VPA in a relatively short amount of time. Further studies are needed to evaluate its effectiveness in combination with other first-line medications or as a single agent. Copyright © 2015 Elsevier Inc. All rights reserved.

Mometasone Nasal Spray

MedlinePlus

... nausea, or vomiting nosebleeds headache sore throat increased menstrual pain muscle or joint pain sinus pain weakness diarrhea ... weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and ...

Why Do I Have Pain?

MedlinePlus

... and Sprains Are a Pain What Is an Ear Infection? Headaches How Do Pain Relievers ... All information on KidsHealth® is for educational purposes only. For specific medical advice, diagnoses, and treatment, ...

An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report.

PubMed

Shimodaira, Masanori; Kitano, Tomohiro; Kibata, Minoru; Shirahata, Kumiko

2013-01-18

Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient's left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma.

Mesenteric Torsion as a Cause of Late Abdominal Pain after Gastric Bypass Surgery.

PubMed

Frederiksen, Sven G; Ekelund, Mikael

2016-04-01

Gastric bypass (GBP) has been the most common surgical way to treat obesity and its comorbidities. Late abdominal pain may occur by gastro-jejunal ulcers, gallstones, internal herniation or, rarely, intussusception. In an area with more than 1000 GBPs performed yearly, three patients with primary small bowel volvulus causing abdominal pain and requiring emergency or semi-urgent surgery were identified. Patients' histories, radiology, and surgery performed are presented. Weight loss followed by mesenteric narrowing of the root and thus relative elongation may make rotation of the small bowel mesentery possible. Such a torsion might be an overlooked differential diagnosis in obscure abdominal pain after GBP.

Chronic Intussusception Caused by Diffuse Large B-Cell Lymphoma in a 6-Year-Old Girl Presenting with Abdominal Pain and Constipation for 2 Months.

PubMed

Choi, Sun-Hee; Han, Sang-Ah; Won, Kyu Yeoun

2016-02-01

The classical triad of abdominal pain, vomiting, and bloody stool is absent in chronic intussusception for more than 2 weeks. Here, we report a 6-year-old female with recurrent abdominal pain for 2 months. Ultrasonography of the abdomen revealed an ileocolic-type intussusception. The lesion accompanying the tight fibrous adhesion was treated by resection and ileocolic anastomosis. It was diagnosed as intussusception with diffuse large B-cell lymphoma. A high index of suspicion for abdominal pain in children should result in the correct diagnosis and appropriate management.

Validation of the diagnostic score for acute lower abdominal pain in women of reproductive age.

PubMed

Jearwattanakanok, Kijja; Yamada, Sirikan; Suntornlimsiri, Watcharin; Smuthtai, Waratsuda; Patumanond, Jayanton

2014-01-01

Background. The differential diagnoses of acute appendicitis obstetrics, and gynecological conditions (OB-GYNc) or nonspecific abdominal pain in young adult females with lower abdominal pain are clinically challenging. The present study aimed to validate the recently developed clinical score for the diagnosis of acute lower abdominal pain in female of reproductive age. Method. Medical records of reproductive age women (15-50 years) who were admitted for acute lower abdominal pain were collected. Validation data were obtained from patients admitted during a different period from the development data. Result. There were 302 patients in the validation cohort. For appendicitis, the score had a sensitivity of 91.9%, a specificity of 79.0%, and a positive likelihood ratio of 4.39. The sensitivity, specificity, and positive likelihood ratio in diagnosis of OB-GYNc were 73.0%, 91.6%, and 8.73, respectively. The areas under the receiver operating curves (ROC), the positive likelihood ratios, for appendicitis and OB-GYNc in the validation data were not significantly different from the development data, implying similar performances. Conclusion. The clinical score developed for the diagnosis of acute lower abdominal pain in female of reproductive age may be applied to guide differential diagnoses in these patients.

Validation of the Rome III criteria and alarm symptoms for recurrent abdominal pain in children.

PubMed

Gijsbers, Carolien F M; Benninga, Marc A; Schweizer, Joachim J; Kneepkens, C M Frank; Vergouwe, Yvonne; Büller, Hans A

2014-06-01

Rome criteria were formulated to define functional gastrointestinal disorders (Rome III criteria, 2006) excluding organic diagnoses when alarm symptoms were absent. The aims of the study were to validate the Rome III criteria as to their capacity to differentiate between organic and functional abdominal pain and to assess the role of alarm symptoms in this differentiation. During 2 years all of the patients (ages 4-16 years) presenting with recurrent abdominal pain (Apley criteria) and referred to secondary care were included. Clinical diagnoses were based on protocolized evaluation and intervention with 6-month follow-up. Alarm symptoms were registered. Rome III criteria for functional pain syndromes were assigned independently. Descriptive statistical analyses were performed. In 200 patients (87 boys, mean age 8.8 years), organic (17%), functional (40%), combined organic and functional (9%), spontaneous recovery (27%), and other (8%) clinical diagnoses were established. Alarm symptoms were found in 57.5% (organic causes 56%, functional causes 61%). The evaluation for Rome symptom clusters revealed symptoms of irritable bowel syndrome in 27%, functional dyspepsia in 15%, functional abdominal pain in 28%, functional abdominal pain syndrome in 14.5%, and no pain syndrome in 15.5%. Rome diagnoses, based on symptoms and absence of alarm symptoms, predicted functional clinical diagnosis with sensitivity 0.35 (95% confidence interval 0.27-0.43), specificity 0.60 (0.46-0.73), positive predictive value 0.71 (0.61-0.82), and negative predictive value of 0.24 (0.17-0.32). The Rome III criteria for abdominal pain are not specific enough to rule out organic causes. Alarm symptoms do not differentiate between organic and functional abdominal pain.

Neck and shoulder disorders in medical secretaries. Part I. Pain prevalence and risk factors.

PubMed

Kamwendo, K; Linton, S J; Moritz, U

1991-01-01

420 medical secretaries took part in a cross-sectional study at examining the prevalence of musculoskeletal disorders as well as the relationship between neck and shoulder pain and possible risk factors. Sixty-three percent had experienced neck pain sometime during the previous year and while 15% had suffered almost constant pain 32% had experienced neck pain only occasionally. Shoulder pain during the previous year had been experienced by 62%, 17% had suffered almost constant pain while 29% experienced pain only occasionally. Fifty-one percent had experienced low back pain. Age and length of employment were significantly related to neck and shoulder pain. Furthermore, working with office machines 5 hours or more per day was associated with a significantly increased risk for neck pain (OR 1.7), shoulder pain (OR 1.9) and headache (OR 1.8). Finally, a poorly experienced psychosocial work environment was significantly related to headache, neck, shoulder and low back pain. The results of this study suggest that work with office machines as well as the psychosocial work environment are important factors in neck and shoulder pain.

The research gap in chronic paediatric pain: A systematic review of randomised controlled trials.

PubMed

Boulkedid, R; Abdou, A Y; Desselas, E; Monégat, M; de Leeuw, T G; Avez-Couturier, J; Dugue, S; Mareau, C; Charron, B; Alberti, C; Kaguelidou, F

2018-02-01

Chronic pain is associated with significant functional and social impairment. The objective of this review was to assess the characteristics and quality of randomized controlled trials (RCTs) evaluating pain management interventions in children and adolescents with chronic pain. We performed a systematic search of PubMed, Embase and the Cochrane Library up to July 2017. We included RCTs that involved children and adolescents (3 months-18 years) and evaluated the use of pharmacological or non-pharmacological intervention(s) in the context of pain persisting or re-occurring for more than 3 months. Methodological quality was evaluated using the Cochrane Risk of Bias (ROB) Tool. A total of 58 RCTs were identified and numbers steadily increased over time. The majority were conducted in single hospital institutions, with no information on study funding. Median sample size was 47.5 participants (Q1,Q3: 32, 70). Forty-five percent of RCTs included both adults and children and the median of the mean ages at inclusion was 12.9 years (Q1,Q3: 11, 15). Testing of non-pharmacological interventions was predominant and only 5 RCTs evaluated analgesics or co-analgesics. Abdominal pain, headache/migraine and musculoskeletal pain were the most common types of chronic pain among participants. Methodological quality was poor with 90% of RCTs presenting a high or unclear ROB. Evaluation of analgesics targeting chronic pain relief in children and adolescents through RCTs is marginal. Infants and children with long-lasting painful conditions are insufficiently represented in RCTs. We discuss possible research constraints and challenges as well as methodologies to circumvent them. There is a substantial research gap regarding analgesic interventions for children and adolescents with chronic pain. Most clinical trials in the field focus on the evaluation of non-pharmacological interventions and are of low methodological quality. There is also a specific lack of trials involving infants and children and adolescents with long-lasting diseases. © 2017 European Pain Federation - EFIC®.

Effects of physical therapy and relaxation techniques on the parameters of pain in university students with tension-type headache: A randomised controlled clinical trial.

PubMed

Álvarez-Melcón, A C; Valero-Alcaide, R; Atín-Arratibel, M A; Melcón-Álvarez, A; Beneit-Montesinos, J V

2018-05-01

Non-pharmacological treatments help control tension-type headache; however, evidence about their effectiveness is still limited. This study evaluates the effectiveness of physical therapy based on cervical spine kinesiotherapy and posture correction exercises compared to a programme of relaxation techniques only (Schultz's Autogenic Training, AT). Tension-type headache is very common among university students. We randomly selected 152 university students with a diagnosis of tension-type headache according to the criteria of the International Headache Society. Eighty-four were women (55.3%) and 68 were men (44.7%). Mean age was 20.42±2.36 years. The study design is a randomised controlled trial of a non-pharmacological intervention with a blinded evaluation of response variables. We compared the results of two independent samples: AT was used in one of the groups while the other group received AT plus cervical spine kinesiotherapy and posture correction training. Patients recorded any changes in the parameters of pain (frequency, intensity, and duration) and drug consumption in a headache diary before treatment, at 4 weeks, and at 3 months. Both interventions achieved a decrease in all the parameters of pain; however, decreases in frequency and intensity were more significant in the combined treatment group (P<0.01) (d=0.4). Such active, non-invasive therapies as AT and cervical spine kinesiotherapy, and especially the combination of both, effectively reduce tension-type headache by preventing and managing the potential psychophysical causes of this disorder. Future research should aim to assess the long-term effects of these interventions. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Chiropractic: MedlinePlus Health Topic

MedlinePlus

... visit chiropractors for treatment of low back pain , neck pain, and headaches . NIH: National Center for Complementary and ... of Low-Back... Article: Changes in female veterans' neck pain following chiropractic care at... Article: The Use of ...

Effect of music on pain, anxiety, and patient satisfaction in patients who present to the emergency department in Turkey.

PubMed

Parlar Kilic, Serap; Karadag, Gulendam; Oyucu, Serpil; Kale, Ozlem; Zengin, Suat; Ozdemir, Emine; Korhan, Esra Akin

2015-01-01

The objective of this study is to evaluate the effect of music therapy on pain, anxiety, and patient satisfaction in patients who present to the emergency department in Turkey. This controlled and experimental study was conducted in the emergency department of a hospital in Turkey between July and October 2012. The study sample consisted of 200 patients in total, 100 forming the intervention group and 100 being the control group, who fell under color code green in the triage system and came with complaints of pain due to nausea/vomiting and diarrhea, abdominal pain, headaches, and joint pain. A questionnaire, the State Anxiety Scale, and the Visual Analog Scale to measure the patients' level of pain were used in the study. The questionnaires of the intervention group were administered after playing the music. When the intervention and control groups were compared, it was observed that there was a significant decrease in the VASP and STAI-S scores in favor of the intervention group. It was observed that 21.0% of the patients in the intervention group were very pleased to hear music in the emergency department, 58% of them were moderately or at least a little pleased, and 21.0% were not pleased at all. The results showed that music therapy had a positive effect in terms of reducing the severity of pain and the level of anxiety in patients, that only a very small portion of the patients were not pleased to listen to music in the emergency department. © 2014 The Authors. Japan Journal of Nursing Science © 2014 Japan Academy of Nursing Science.

Hemicrania continua: Case series presenting in an orofacial pain clinic.

PubMed

Hryvenko, Iryna; Cervantes-Chavarría, Andrés R; Law, Alan S; Nixdorf, Donald R

2018-01-01

Aim of investigation Hemicrania continua (HC) is an uncommon primary headache and little is known of the characteristics of such patients managed in an orofacial pain setting. This study provides clinical features of HC, its association with other disorders, and treatment outcomes of patients managed in the TMD and Orofacial Pain Clinic at the University of Minnesota. Methods A retrospective review of patient records was undertaken. Inclusion criteria were a diagnosis of HC and confirmation at follow-up. Results Six of the 1617 new patients seen between 2015 and 2017 met the selection criteria. Four patients presented with "facial pain", one with "toothache" and one with "jaw pain". All were female with mean age 55 ± 10.5 years (range = 41-69). Headache characteristics included unilateral (R:L = 1:1) pain of moderate intensity with severe exacerbations in the distribution of V 1 (1/6), V 1  + V 2 (3/6) and V 1  + V 2  + V 3 (2/6). Lacrimation and photophobia were the most common associated symptoms. Patient presentations were complicated by multiple medical and comorbid diagnoses. All were diagnosed with temporomandibular disorder (TMD). Indomethacin alone was sufficient for adequate headache control in 2/6 patients with several add-on medications providing sustained pain relief. Conclusions Comorbid pain conditions can be expected in patients with HC presenting to orofacial pain clinics. Symptom presentation varies, and multimodal treatment approach is necessary for success.

Bacterial infections in childhood: A risk factor for gastrointestinal and other diseases?

PubMed Central

Unverdorben, Alexandra; Weimer, Katja; Schlarb, Angelika Anita; Gulewitsch, Marco Daniel; Ellert, Ute; Enck, Paul

2015-01-01

Background There is evidence for post-infectious irritable bowel syndrome (PI-IBS) in adults, but little is known about PI-IBS in children. The nationwide representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) assessed children’s health. Objective and methods We identified 643 children (50.1% males) in the KiGGS cohort (N = 15,878, 51% males) with a history of Salmonella infection. The number was validated comparing this group with the known infection statistics from the Robert Koch-Institute registry. We compared this group to the remaining KiGGS cohort (n = 12,951) with respect to sociodemographic characteristics, pain and quality of life. To check for specificity, we repeated the comparisons with a group with a history of scarlet fever. Results Infection statistics predicted 504 cases of Salmonella infection in the KiGGS cohort, indicating high validity of the data. In children between 3 and 10 years with a history of Salmonella infection, significantly more abdominal pain (31.7% versus 21.9%, p < 0.001) and headache (27.2% versus 15.1%, p < 0.001) were reported. This group showed lower quality of life (p < 0.001). Comparison to a group of scarlet fever-infected children revealed poor specificity of the data. Conclusion Differences found between children with and without Salmonella infection reveal the role of gastrointestinal infection in the development of post-infectious abdominal problems, but poor specificity may point toward a psychosocial (“somatization”) rather than a Salmonella-specific mechanism. PMID:25653857

Aerophagia among Sri Lankan schoolchildren: epidemiological patterns and symptom characteristics.

PubMed

Devanarayana, Niranga M; Rajindrajith, Shaman

2012-04-01

Aerophagia is a functional gastrointestinal disorder characterised by repetitive air swallowing, abdominal distension, belching, and flatulence. In severe cases, it can lead to pneumoperitonium, volvulus of the colon, and intestinal perforation. Little is known about the epidemiology and clinical profile of affected children. The main objective of the present study was to assess the epidemiology of aerophagia in 10- to 16-year-olds in Sri Lanka. A school-based cross-sectional survey was conducted in 8 randomly selected schools in 4 randomly selected provinces in Sri Lanka. Data were collected using a pretested, self-administered questionnaire, which was distributed in an examination setting and collected on the same day. Trained research assistants were present during completion of the questionnaire, for any required clarification. Aerophagia was diagnosed using the Rome III criteria. In the present study, aerophagia was seen in 163 (7.5%) of the 2163 children evaluated. The prevalence was higher in older children (10.5% in 15-year-olds) and no sex difference was observed (boys 8.2% vs girls 6.8%, P>0.05). Intestinal-related (abdominal pain, nausea, and anorexia) and extraintestinal symptoms (headache, limb pain, sleeping difficulty, photophobia, and lightheadedness) were more prevalent among affected children (P<0.05). A higher percentage of affected children were found to be exposed to stressful events when compared with controls (P<0.05). The present study highlights the high prevalence of aerophagia among Sri Lankan children and adolescents. This condition is more common in those exposed to emotional stress. Intestinal-related symptoms and extraintestinal somatic symptoms are frequently seen in affected children.

Don't Judge a Book by Its Cover: Factitious Disorder Imposed on Children-Report on 2 Cases

PubMed Central

Faedda, Noemi; Baglioni, Valentina; Natalucci, Giulia; Ardizzone, Ignazio; Camuffo, Mauro; Cerutti, Rita; Guidetti, Vincenzo

2018-01-01

Factitious Disorder Imposed on Another (FDIA), also known as Munchausen Syndrome by Proxy (MSbP) is a very serious form of child abuse. The perpetrator, usually the mother, invents symptoms or causes real ones in order to make her child appear sick. Usually this is due to a maladaptive disorder or to an excessive of attention-seeking on her part. We report here two new cases of FDIA. The first one is a 9-year-old boy with a history of convulsive episodes, reduced verbal production, mild psychomotor disorder and urological problems who underwent several invasive procedures and hospitalizations before a diagnosis of FDIA was made. The second is a 12 year-old girl with headache, abdominal pain, lipothymic episodes, seizures and a gait impairment, who was hospitalized in several hospitals before an FDIA was diagnosed. PMID:29721488

Episodic spontaneous hypothermia: a periodic childhood syndrome.

PubMed

Ruiz, Cynthia; Gener, Blanca; Garaizar, Carmen; Prats, José M

2003-04-01

Episodic spontaneous hypothermia is an infrequent disorder, with unknown pathogenic mechanisms. A systemic cause or underlying brain lesion has not been found for the disease. We report four new patients, 3-9 years old, with episodic hypothermia lower than 35 degrees C, marked facial pallor, and absent shivering. The episodes could last a few hours or four days, and recurred once a week or every 2-3 months. Two patients also demonstrated bradycardia, mild hypertension, and somnolence during the events; in one of them, profuse sweating was also a feature, and all four presented with either headache, a periodic childhood syndrome, or both (recurrent abdominal pain, cyclic vomiting, or vertigo). Three patients reported a family history of migraine. Neurologic examination, endocrine function, and imaging studies were normal. Migraine prophylactic therapy was of moderate efficacy. Spontaneous resolution was observed in one patient. The clinical characteristics of the syndrome allow for its inclusion as a childhood periodic syndrome related to migraine.

Adolescent Fatigue, POTS, and Recovery: A Guide for Clinicians

PubMed Central

Kizilbash, Sarah J.; Ahrens, Shelley P.; Bruce, Barbara K.; Chelimsky, Gisela; Driscoll, Sherilyn W.; Harbeck-Weber, Cynthia; Lloyd, Robin M.; Mack, Kenneth J.; Nelson, Dawn E.; Ninis, Nelly; Pianosi, Paolo T.; Stewart, Julian M.; Weiss, Karen E.; Fischer, Philip R.

2018-01-01

Many teenagers who struggle with chronic fatigue have symptoms suggestive of autonomic dysfunction that may include lightheadedness, headaches, palpitations, nausea, and abdominal pain. Inadequate sleep habits and psychological conditions can contribute to fatigue, as can concurrent medical conditions. One type of autonomic dysfunction, postural orthostatic tachycardia syndrome, is increasingly being identified in adolescents with its constellation of fatigue, orthostatic intolerance, and excessive postural tachycardia (more than 40 beats/min). A family-based approach to care with support from a multidisciplinary team can diagnose, treat, educate, and encourage patients. Full recovery is possible with multi-faceted treatment. The daily treatment plan should consist of increased fluid and salt intake, aerobic exercise, and regular sleep and meal schedules; some medications can be helpful. Psychological support is critical and often includes biobehavioral strategies and cognitive–behavioral therapy to help with symptom management. More intensive recovery plans can be implemented when necessary. PMID:24819031

The use of medicinal plants in self-care in the Agonlin region of Benin.

PubMed

Allabi, Aurel Constant; Busia, Kofi; Ekanmian, Vital; Bakiono, Fidèle

2011-01-07

To investigate the extent and type of medicinal plants used in self-care by the inhabitants of the Agonlin community in the Republic of Benin. A semi-structured questionnaire was used to interview a total of one thousand mothers. The prevalence rate of the use of herbal medicines in self-care was found to be 51.04%. One hundred and fourteen (114) plant species belonging to 69 families were reported, each with their local names, medicinal use, and parts used. Of all the indications of the identified plants, fever, headache, abdominal pain, and vomiting were the most frequently reported, with malaria treatment recording the highest usage of plant remedies (22%). The plant part most frequently used was the leaves. This study showed that self-care using medicinal plants is a major part of health care in the Agonlin area. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Dichloroacetate treatment for mitochondrial cytopathy: long-term effects in MELAS.

PubMed

Mori, Masato; Yamagata, Takanori; Goto, Tamako; Saito, Shigeko; Momoi, Mariko Y

2004-10-01

The long-term effects of the sodium salt of dichloroacetic acid (DCA) were evaluated in four patients with mitochondrial encephalomyelopathy with lactic acidosis and stroke-like episodes (MELAS) carrying A3243G mutation. Oral administration of DCA in MELAS patients was followed for an average of 5 years 4 months. Serum levels of lactate and pyruvate were maintained at around 10 and 0.6 mg/dl, respectively. Serum levels of DCA were 40-136 microg/ml. Symptoms responding to treatment included persistent headache, abdominal pain, muscle weakness, and stroke-like episodes. In contrast, no improvements in mental status, deafness, short stature, or neuroelectrophysiological findings were observed. Adverse effects included mild liver dysfunction in all patients, hypocalcemia in three and peripheral neuropathy in one. None of these adverse events was severe enough to require discontinuation of treatment. To determine suitable indications for DCA therapy, analysis of many more patients who have undergone DCA administration is required.

[Child poisoning after ingestion of a wild apiaceae: a case report].

PubMed

Durand, M-F; Pommier, P; Chazalette, A; de Haro, L

2008-02-01

Apiaceae family (formerly Umbelliferae) contains several highly toxic species, including Poison Hemlock (Conium maculatum), Water Hemlock (Cicuta virosa) and Hemlock Water Dropwort (Oenanthe crocata) which are the three main poisonous Apiaceae species growing in France. Thinking he was identifying wild carrots, an 11-year-old boy without previous history ingested the root from a wild Apiaceae. One hour later, he was confused, had drowsiness, headache as well as abdominal pain, vomiting and diarrhoea. Upon hospital admission, myosis, ophtalmoplegia and a moderate rhabdomyolysis were noted. The patient recovered after 24 h of symptomatic treatments. In this case, the description of the ingested plant allowed to identify the Apiaceae family but not the species involved. The geographical location (Southern France in a humid area), the clinical features and the aspect of the ingested root, with an orange secretion led to implicate Oenanthe crocata as the origin of this unusual poisoning.

Irritable Bowel Syndrome: Yoga as Remedial Therapy

PubMed Central

Kavuri, Vijaya; Raghuram, Nagarathna; Malamud, Ariel; Selvan, Senthamil R.

2015-01-01

Irritable bowel syndrome (IBS) is a group of symptoms manifesting as a functional gastrointestinal (GI) disorder in which patients experience abdominal pain, discomfort, and bloating that is often relieved with defecation. IBS is often associated with a host of secondary comorbidities such as anxiety, depression, headaches, and fatigue. In this review, we examined the basic principles of Pancha Kosha (five sheaths of human existence) concept from an Indian scripture Taittiriya Upanishad and the pathophysiology of a disease from the Yoga approach, Yoga Vasistha's Adhi (originated from mind) and Vyadhi (ailment/disease) concept. An analogy between the age old, the most profound concept of Adhi-Vyadhi, and modern scientific stress-induced dysregulation of brain-gut axis, as it relates to IBS that could pave way for impacting IBS, is emphasized. Based on these perspectives, a plausible Yoga module as a remedial therapy is provided to better manage the primary and secondary symptoms of IBS. PMID:26064164

[The physician as Sherlock Holmes. Accident, murder by poisoning or suicide?].

PubMed

Penning, R

2001-12-06

Any case of unclear or atypical clinical presentation must arouse a suspicion of poisoning. Although pathognomonic findings are rare, there may nevertheless be an accumulation of signs and symptoms. These include impairment of consciousness, vertigo, headache, circulatory disorders, cramps/convulsions, vomiting, diarrhea and abdominal pains. Forensic terminology differentiates between outside influence, self-poisoning and accidental poisoning. In the former case, substances are used that are deadly in small amounts, and are unremarkable in appearance, smell and taste. The poisons used by suicides are usually commonly used poisonous substances that are freely available to purchasers. For forensic purposes, it is essential that specimens of blood, urine or stomach contents be obtained for toxicological investigations. Inspection of the corpse must routinely include a search for unusual signs (e.g. traces of powder around the mouth, foam at the mouth and nose, desiccation, unusual postmortem lividity, hair loss, etc.).

Field trial on the treatment of fasciolopsiasis with praziquantel.

PubMed

Bunnag, D; Radomyos, P; Harinasuta, T

1983-06-01

Eight-five of 816 (10.7%) students attending a primary school in Central Thailand were examined and found infected with Fasciolopsis buski. All of students ate fresh water lily stems and most ate other fresh water plants including caltrop, water cress and morning glory. The 85 students were given praziquantel in randomized single doses of 15, 25 or 40 mg/kg body weight. Side effects were mild and transient and consisted of headache, dizziness, nausea, sleepiness, abdominal discomfort, anorexia, diarrhea, epigastric pain, vomiting and lassitude. Those receiving the highest dosages had more side effects than students in the other 2 groups. Large blisters were observed on the tegument of F. buski passed in feces and this was believed to be caused by the drug. The authors recommend a single dose of praziquantel in a dosage of 15 mg/kg of body weight for the treatment of parasitosis.

Radiology Preparedness in Ebola Virus Disease: Guidelines and Challenges for Disinfection of Medical Imaging Equipment for the Protection of Staff and Patients

PubMed Central

Palmore, Tara N.; Folio, Les R.; Bluemke, David A.

2015-01-01

The overlap of early Ebola virus disease (EVD) symptoms (eg, fever, headache, abdominal pain, diarrhea, emesis, and fatigue) with symptoms of other more common travel-related diseases (eg, malaria, typhoid fever, pneumonia, and meningococcemia) may result in delayed diagnosis of EVD before isolation of infected patients. Radiology departments should consider policies for and approaches to decontamination of expensive and potentially easily damaged radiology equipment. In addition, the protection of radiology personnel must be considered during the work-up phase of undiagnosed EVD patients presenting to emergency departments. The purpose of this article is to consider the effect of EVD on radiology departments and imaging equipment, with particular consideration of guidelines currently available from the Centers for Disease Control and Prevention that may be applicable to radiology. © RSNA, 2015 PMID:25654616

False positive malaria rapid diagnostic test in returning traveler with typhoid fever.

PubMed

Meatherall, Bonnie; Preston, Keith; Pillai, Dylan R

2014-07-09

Rapid diagnostic tests play a pivotal role in the early diagnosis of malaria where microscopy or polymerase chain reaction are not immediately available. We report the case of a 39 year old traveler to Canada who presented with fever, headache, and abdominal pain after visiting friends and relatives in India. While in India, the individual was not ill and had no signs or symptoms of malaria. Laboratory testing upon his return to Canada identified a false positive malaria rapid diagnostic (BinaxNOW® malaria) result for P. falciparum with coincident Salmonella Typhi bacteraemia without rheumatoid or autoimmune factors. Rapid diagnostic test false positivity for malaria coincided with the presence or absence of Salmonella Typhi in the blood. Clinicians should be aware that Salmonella Typhi infection may result in a false positive malaria rapid diagnostic test. The mechanism of this cross-reactivity is not clear.

[Leptospirosis in children of Libreville: difficult diagnosis, apropos of 1 case].

PubMed

Koko, J; Moussavou, A; Orima, C; Seilhan, C; Lemba-Abaka, A; Damas, S

2001-12-01

Leptospirosis is a widespread zoonosis, which is diagnosed less frequently in children than might be expected from the level of exposure to hazards, especially in tropical areas. A 15 1/2-year-old Gabonese boy was admitted following five days of fever, headache, myalgia, abdominal pain, diarrhea, intestinal bleeding, jaundice and conjunctival suffusion. Laboratory data showed abnormal liver and renal function tests, and diagnosis of Plasmodium falciparum malaria was confirmed by thin blood smear. The patient did not clinically improve despite antimalarial treatment and then leptospirosis was suspected. Serologic tests were performed and leptospirosis was later confirmed. Antibiotic treatment (cefuroxim) was given. The outcome was good, liver and renal tests returned to normal in a few days. In tropical area, leptospirosis should be considered in children who are diagnosed with either an unexplained fever, a pseudo-influenza syndrome, or jaundice with hepatorenal involvement and gastrointestinal bleeding.

Tobacco, Nicotine, and Headache.

PubMed

Taylor, Frederick R

2015-01-01

Migraineurs variably attribute the cause of their headache to tobacco exposure, whereas tobacco is often stated to cause headache-related disability worldwide. Given tobacco's physiological and emotional addictiveness and migraine's substantial economic impact, improved functionality can be difficult for those with migraine exposed to tobacco products. Environmental tobacco exposure in indoor spaces and workplaces is associated with exacerbation of headache. Avoidance of headache triggers is included in most comprehensive migraine treatment programs, yet tobacco awareness, avoidance, or coping is rarely emphasized as part of that regimen. The aims of this study were to examine the various types of tobacco products to which headache sufferers are exposed and the known basic mechanisms by which tobacco (nicotine) exposure promotes headache pain, and to review the extensive literature on tobacco related to headache with a detailed descriptive narrative providing the basis for conclusions regarding association of noncluster headache-related tobacco exposure. Tobacco-related recommendations are offered. MEDLINE, EMBASE, and Google Scholar databases were searched without yearly restriction through the date of submission (May 2015), using the MeSH terms "tobacco," "tobacco products," "smoking," "tobacco use," "headache," and "headache disorders." The selection of articles was not limited to English studies or to humans. Articles were excluded when "headache" and "tobacco" were not both mentioned with data provided. Case series were included. Bibliographies of all articles were screened for additional relevant articles. Although migraineurs worldwide report tobacco smoke among triggers, it is rarely among the highest in frequency, and biases abound with predominantly noncontrolled retrospective data. Prospective population-based diary data are extremely limited, and no controlled trials exist to confirm a cause and effect for headache of any type. Although some studies are nonsupportive and even conflicting, headache, pain, and tobacco exposure currently remain associated. Conflicting data support the validity of patient-reported environmental tobacco exposure as a headache trigger. Prospective controlled studies are needed, but unlikely to be performed, to determine the extent that tobacco influences the headache process, in addition to other under-recognized factors. Meanwhile, because of numerous other negative health effects, decreased tobacco exposure should be recommended to headache patients of all ages in hopes of decreasing disability and improving functionality. © 2015 American Headache Society.

Single-Dose Pharmacokinetic Study of Tramadol Extended-Release Tablets in Children and Adolescents.

PubMed

Vandenbossche, Joris; Van Peer, Achiel; Richards, Henry

2016-09-01

Combined analyses from 2 open-label, phase-1 studies-the pharmacokinetic profile of tramadol and its metabolite (M1) following a single oral dose of tramadol extended release (ER) (25 to 100 mg) in children (7 to 11 years old; study 1: n = 37) and adolescents (12 to 17 years old; study 2: n = 38) with painful conditions-were historically compared with that of healthy adults following similar dosing. The dose-normalized area under the curve (DN AUC0-24h ) and maximum concentration (DN Cmax ) of tramadol and of M1 in children and in adolescents were lower than those in adults (children vs adults: tramadol, DN AUC0-24h 82.19%; DN Cmax 80.38%, P = .0031; M1, DN AUC0-24h 51.19%, DN Cmax 52.68%, P < .0001; adolescents vs adults: tramadol, DN AUC0-24h 89.56%, DN Cmax 84.01%; M1, DN AUC0-24h 85.28%, DN Cmax 83.03%, P = .0004). The arithmetic mean terminal elimination t1/2 of tramadol in children and adolescents was comparable to that in adults (children 8.4 hours; adolescents 8.5 hours; adults 7.9 hours). The most frequently reported (≥5% of participants) treatment-emergent adverse events in children included headache, upper abdominal pain and constipation, and in adolescents were headache, nausea, dizziness, and stomach discomfort. Multiple factors may have contributed to these observations, including a higher proportion of children (56%) who may have a lower activity of CYP2D6, resulting in reduced clearance of tramadol. © 2016, The American College of Clinical Pharmacology.

Lactobacillus reuteri DSM 17938 in the Treatment of Functional Abdominal Pain in Children: RCT Study.

PubMed

Jadrešin, Oleg; Hojsak, Iva; Mišak, Zrinjka; Kekez, Alemka Jaklin; Trbojević, Tena; Ivković, Lana; Kolaček, Sanja

2017-06-01

Beneficial therapeutic effect of probiotics has been reported in children with the irritable bowel syndrome (IBS) but not consistently in other functional abdominal pain-related disorders. The aim of the present study was to investigate the effect of Lactobacillus reuteri DSM 17938 in the treatment of functional abdominal pain (FAP) and IBS in children. Children (age 4-18 years) referred to pediatric gastroenterologist at Children's Hospital Zagreb from May 2012 to December 2014, diagnosed as FAP or IBS, were randomized to receive L reuteri DSM 17938 10⁸ CFU daily or placebo. The study was a prospective, randomized, double-blind, placebo-controlled parallel study. Symptoms were evaluated using Wong-Baker FACES pain rating scale for pain and Bristol scale for stool shape and consistence. Data were analyzed for 55 children (26 in the intervention group and 29 in the placebo group). Children in the intervention group had significantly more days without pain (median 89.5 vs 51 days, P = 0.029). Abdominal pain was less severe in children taking probiotics during the second month (P < 0.05) and fourth month (P < 0.01). The 2 groups did not differ in the duration of abdominal pain, stool type, or absence from school. Both groups experienced significant reduction in the severity of abdominal pain from first to fourth month, with the reduction more prominent in the intervention group (P < 0.001 vs P = 0.004). Administration of L reuteri DSM 17938 was associated with a possible reduction of the intensity of pain and significantly more days without pain in children with FAP and IBS.

Pediatric Abdominal Pain: An Emergency Medicine Perspective.

PubMed

Smith, Jeremiah; Fox, Sean M

2016-05-01

Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes. Copyright © 2016 Elsevier Inc. All rights reserved.

Pain stress and headache.

PubMed

Panerai, Alberto E

2012-05-01

The association between pain and stress is an old one, but still it is not really clear who comes first. Pain induces stress, and stress induces pain. Pain is part of our homeostatic system and in this way is an emotion, i.e., it tells us that something is out-of-order (control), and emotion drives our behavior and one behavior is stress response. Stress comes from ourselves: the imagination we have or would like to have of us, from the image others give of us, from the goals we assume it is necessary to reach for our well-being or the goals others want us to fulfill. Stress comes from our social condition and the condition we would like, stress comes from dangerous situations we cannot control. Headache easily fits in the picture.

Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress.

PubMed

Devanarayana, Niranga Manjuri; Mettananda, Sachith; Liyanarachchi, Chathurangi; Nanayakkara, Navoda; Mendis, Niranjala; Perera, Nimnadi; Rajindrajith, Shaman

2011-12-01

Functional gastrointestinal disorders (FGD) are common among children, but little is known regarding their prevalence in developing countries. We assessed the prevalence of abdominal pain-predominant FGD, in addition to the predisposing factors and symptomatology, in Sri Lankan children. A cross-sectional survey was conducted among a randomly selected group of 10- to 16-year-olds in 8 randomly selected schools in 4 provinces in Sri Lanka. A validated, self-administered questionnaire was completed by children independently in an examination setting. FGD were diagnosed using Rome III criteria. A total of 2180 questionnaires were distributed and 2163 (99.2%) were included in the analysis (1189 [55%] boys, mean age 13.4 years, standard deviation 1.8 years). Of them, 270 (12.5%) had at least 1 abdominal pain-predominant FGD. Irritable bowel syndrome (IBS) was seen in 107 (4.9%), functional dyspepsia in 54 (2.5%), functional abdominal pain in 96 (4.4%), and abdominal migraine (AM) in 21 (1.0%) (2 had AM and functional dyspepsia, 6 had AM and IBS). Extraintestinal symptoms were more common among affected children (P < 0.05). Abdominal pain-predominant FGD were higher in girls and those exposed to stressful events (P < 0.05). Prevalence negatively correlated with age (r = -0.05, P = 0.02). Abdominal pain-predominant FGD affects 12.5% of children ages 10 to 16 years and constitutes a significant health problem in Sri Lanka. IBS is the most common FGD subtype present. Abdominal pain-predominant FGD are higher in girls and those exposed to emotional stress. Prevalence of FGD decreased with age. Extraintestinal symptoms are more frequent in affected children.

Traumatic stressors and post-traumatic stress disorder symptoms in headache patients.

PubMed

de Leeuw, Reny; Schmidt, John E; Carlson, Charles R

2005-01-01

The aim of this study was to assess the prevalence of significant traumatic stressors and post-traumatic stress disorder (PTSD) symptoms in a headache population. Several recent publications have emphasized the relationship between life stressors and/or daily hassles and recurrent headaches. However, little is known about the prevalence and impact of major traumatic stressors in patients with recurrent headaches. Eighty patients with either migraine or tension-type headache completed a PTSD checklist. Data were compared with those from patients with chronic masticatory muscle pain of similar intensity and duration. Almost 64% of the headache patients reported one or more major traumatic stressors. This percentage was not significantly different from that of the comparison group, and fell within the broad range reported for exposure to traumatic stressors in epidemiologic studies with nonpatient populations. One out of 6 patients in the total headache sample, and 1 out of 4 of those reporting a traumatic stressor, reported symptoms suggestive of current PTSD. The prevalence of current PTSD-like symptomatology reported by the headache patients was comparable to that of the comparison group of the present study, but higher than that reported for the general population in the available literature printed in English. Traumatic stressors most often reported were not related to direct physical trauma, but rather associated with loss or serious illness of a loved one. Exposure to traumatic events in patients with a primary diagnosis of recurrent headaches is similar to that reported for chronic masticatory muscle pain patients or nonpatient populations. However, symptoms consistent with a diagnosis of current PTSD appear to be more frequent in patients with recurrent headaches than reported in the scientific literature printed in English for nonpatient populations. Screening for PTSD symptomatology is recommended as part of the routine clinical evaluation of headache.

Gastric trichobezoar: abdominal mass in a child with sickle cell disease.

PubMed

Sciarretta, Jason D; Bond, Sheldon J

2011-11-01

Abdominal pain is a frequent occurrence among the pediatric population and can be a diagnostic challenge. Trichobezoar is a differential diagnosis that is often neglected. Different from previously reported cases, we present a 3-year-old girl with sickle cell disease with complaints of acute abdominal pain, suspecting sickle cell splenic sequestration. The child presented to the emergency department with sharp epigastric pain and an associated palpable upper abdominal mass. This case illustrates a large obstructing gastric trichobezoar and summarizes both the diagnostic modalities and treatment.

Abdominal Pain in the Geriatric Patient.

PubMed

Leuthauser, Amy; McVane, Benjamin

2016-05-01

Abdominal pain in the elderly can be a challenging and difficult condition to diagnose and treat. The geriatric population has significant comorbidities and often takes polypharmacy that can mask symptoms. The presentation of common conditions can be different than that in the younger population, often lacking the traditional indicators of disease, making it of pivotal importance for the clinician to consider a wide differential during their workup. It is also important to consider extra-abdominal abnormality that may manifest as abdominal pain. Copyright © 2016 Elsevier Inc. All rights reserved.

Treatment of tension-type headache: from old myths to modern concepts.

PubMed

Barbanti, P; Egeo, G; Aurilia, C; Fofi, L

2014-05-01

Tension-type headache (TTH) is the second most common human disease, accounting for intense disability, high costs and numerous workdays lost. Tension-type headache is less simple and easy-to-treat than commonly thought. Antidepressants, despite their poor tolerability, are still the first-choice drugs for preventing TTH. The most widely studied non-pharmacological approach to TTH, cognitive-behavioral techniques, effectively relieve pain only in selected patients. The most frequently used and recommended treatments for acute TTH, NSAIDs and paracetamol have scarce efficacy as documented by their low therapeutic gain over placebo in the 2-h pain-free response. Their effectiveness may be increased by a more proper use and by the adjunction of caffeine, antiemetics, myorelaxants or tranquillizers but the risk of medication-overuse headache must be considered. Hence, the need for more effective and tailored treatments in TTH remains.

Quantitative and qualitative testing of DARWeb: An online self-guided intervention for children with functional abdominal pain and their parents.

PubMed

Nieto, Rubén; Boixadós, Mercè; Hernández, Eulàlia; Beneitez, Imma; Huguet, Anna; McGrath, Patrick

2018-06-01

The main objective of this study was to preliminary explore the effects of DARWeb on different outcomes. A Quasi-experimental, one-group, pretest-posttest design was used. Parents and children were asked to complete questionnaires and questions (separately) about quality of life, abdominal pain severity, and satisfaction. Semi-structured interviews with families were also performed. This study focuses on 17 families. Results showed that parent's ratings of children's abdominal pain severity were significantly lower after finishing the intervention and at the 3-month follow-up, and quality of life scores had increased significantly after 3 months. From children's ratings, mean abdominal pain severity scores were significantly lower after the intervention compared to the preintervention assessment. Both parents and children were quite satisfied with the intervention. In qualitative interviews, families suggested that DARWeb helped them to give less importance to pain and to learn coping strategies. In conclusion, this study showed the potential usefulness of DARWeb for children with functional abdominal pain and for their parents.

Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents.

PubMed

Kaminski, Angela; Kamper, Adrian; Thaler, Kylie; Chapman, Andrea; Gartlehner, Gerald

2011-07-06

Abdominal pain-related functional gastrointestinal disorders (FGIDs) are among the most common medical problems in paediatric medicine. Frequently, physicians prescribe antidepressants as a second-line treatment for children and adolescents with FGIDs. To date, the evidence on the benefits and harms of antidepressants for the treatment of abdominal pain-related FGIDs has not been assessed systematically. The primary objectives were to conduct a systematic review to evaluate the efficacy and safety of antidepressants for the treatment of abdominal pain-related FGIDs in children and adolescents. We searched The Cochrane Library, PubMed, EMBASE, IPA, CINAHL, PsycINFO, ISI Web of Science, Biosis Previews and the International Clinical Trials Registry Platform of the World Health Organization with appropriate filters (from inception to January 31, 2011). For efficacy we included double-blind, randomised controlled trials (RCTs) of antidepressants for treatment of abdominal pain-related FGIDs in children and adolescents 18 years or younger. Open-label and uncontrolled experimental studies, as well as observational studies were eligible for the assessment of harms. The minimum study duration was 4 weeks. The minimum study size was 30 participants. Two authors independently assessed all abstracts and full text articles, and rated the risk of bias for included studies. Data were extracted independently by one author and checked for accuracy by another author. Data were analysed using RevMan 5. Two RCTs (123 participants), both using amitriptyline, met the pre-specified inclusion criteria. These studies provided mixed findings on the efficacy of amitriptyline for the treatment of abdominal pain-related FGIDs. The larger, publicly-funded study reported no statistically significant difference in efficacy between amitriptyline and placebo in 90 children and adolescents with FGIDs after 4 weeks of treatment. On intention-to-treat (ITT)- analysis, 59% of the children reported feeling better in the amitriptyline group compared with 53% in the placebo group (RR 1.12; 95% CI: 0.77 to 1.63; P = 0.54). The risk of bias for this study was rated as low.The second RCT enrolled 33 adolescents with irritable bowel syndrome. Patients receiving amitriptyline experienced greater improvements in the primary outcome, overall quality of life, at weeks 6, 10, and 13 compared with those on placebo (P= 0.019, 0.004, and 0.013, respectively). No effect estimates were calculated for the quality of life outcome because mean quality of life scores and standard deviations were not reported. For most secondary outcomes no statistically significant differences between amitriptyline and placebo could be detected. The risk of bias for this study was rated as unclear for most items. However, it was rated as high for other bias due to multiple testing. The results of this study should be interpreted with caution due to the small number of patients and multiple testing.The larger study reported mild adverse events including fatigue, rash and headache and dizziness. On ITT analysis, 4% of the amitriptyline group experienced at least one adverse event compared to 2% of the placebo group. There was no statistically significant difference in the proportion of patients who experienced at least one adverse event (RR 1.91; 95% CI 0.18 to 20.35; P = 0.59). The smaller study reported no adverse events. The methods of adverse effects assessment was poorly reported in both studies and no clear conclusions on the risks of harms of amitriptyline can be drawn. Clinicians must be aware that for the majority of antidepressant medications no evidence exists that supports their use for the treatment of abdominal pain-related FGIDs in children and adolescents. The existing randomised controlled evidence is limited to studies on amitriptyline and revealed no statistically significant differences between amitriptyline and placebo for most efficacy outcomes. Amitriptyline does not appear to provide any benefit for the treatment of FGIDs in children and adolescents. Studies in children with depressive disorders have shown that antidepressants can lead to substantial, sometimes life-threatening adverse effects. Until better evidence evolves, clinicians should weigh the potential benefits of antidepressant treatment against known risks of antidepressants in paediatric patients.

The effect of abdominal drawing-in exercise and myofascial release on pain, flexibility, and balance of elderly females.

PubMed

Yu, Seong Hun; Sim, Yong Hyeon; Kim, Myung Hoon; Bang, Ju Hee; Son, Kyung Hyun; Kim, Jae Woong; Kim, Hyun Jin

2016-10-01

[Purpose] This study is designed to compare the effects of abdominal drawing-in exercise and myofascial release on pain, flexibility, and balance of elderly females. [Subjects and Methods] Forty elderly females aged 65 or older who had complained of low back pain for three months or longer were selected as the subjects. They were randomly and equally assigned to either an abdominal drawing-in group or a myofascial release group. The subjects conducted exercise three times per week, 40 minutes each time, for eight weeks. As evaluation tools, visual analogue scale for pain, remodified schober test for flexibility, and upright posture with eye opening on hard platform, upright posture with eye closing on hard platform, upright posture with eye opening on soft platform, upright posture with eye closing on soft platform using tetrax for balance were used. [Results] The abdominal drawing-in exercise group saw significant difference in pain and balance after the exercise compared to before the exercise. The myofascial release group saw significant difference in pain and flexibility after exercise compared to before the exercise. [Conclusion] The above study showed that abdominal drawing-in exercise affected elderly females regarding pain and balance and myofascial release influenced their pain and flexibility.

Diet-induced changes in n-3- and n-6-derived endocannabinoids and reductions in headache pain and psychological distress.

PubMed

Ramsden, Christopher E; Zamora, Daisy; Makriyannis, Alexandros; Wood, JodiAnne T; Mann, J Douglas; Faurot, Keturah R; MacIntosh, Beth A; Majchrzak-Hong, Sharon F; Gross, Jacklyn R; Courville, Amber B; Davis, John M; Hibbeln, Joseph R

2015-08-01

Omega-3 and omega-6 fatty acids are biosynthetic precursors of endocannabinoids with antinociceptive, anxiolytic, and neurogenic properties. We recently reported that targeted dietary manipulation-increasing omega-3 fatty acids while reducing omega-6 linoleic acid (the H3-L6 intervention)-reduced headache pain and psychological distress among chronic headache patients. It is not yet known whether these clinical improvements were due to changes in endocannabinoids and related mediators derived from omega-3 and omega-6 fatty acids. We therefore used data from this trial (N = 55) to investigate 1) whether the H3-L6 intervention altered omega-3- and omega-6-derived endocannabinoids in plasma and 2) whether diet-induced changes in these bioactive lipids were associated with clinical improvements. The H3-L6 intervention significantly increased the omega-3 docosahexaenoic acid derivatives 2-docosahexaenoylglycerol (+65%, P < .001) and docosahexaenoylethanolamine (+99%, P < .001) and reduced the omega-6 arachidonic acid derivative 2-arachidonoylglycerol (-25%, P = .001). Diet-induced changes in these endocannabinoid derivatives of omega-3 docosahexaenoic acid, but not omega-6 arachidonic acid, correlated with reductions in physical pain and psychological distress. These findings demonstrate that targeted dietary manipulation can alter endocannabinoids derived from omega-3 and omega-6 fatty acids in humans and suggest that 2-docosahexaenoylglycerol and docosahexaenoylethanolamine could have physical and/or psychological pain modulating properties. ClinicalTrials.gov (NCT01157208) PERSPECTIVE: This article demonstrates that targeted dietary manipulation can alter endocannabinoids derived from omega-3 and omega-6 fatty acids and that these changes are related to reductions in headache pain and psychological distress. These findings suggest that dietary interventions could provide an effective, complementary approach for managing chronic pain and related conditions. Published by Elsevier Inc.

Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: A randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures.

PubMed

Emanuelsson, Peter; Gunnarsson, Ulf; Dahlstrand, Ursula; Strigård, Karin; Stark, Birgit

2016-11-01

The primary aim of this prospective, randomized, clinical, 2-armed trial was to evaluate the risk for recurrence using 2 different operative techniques for repair of abdominal rectus diastasis. Secondary aims were comparison of pain, abdominal muscle strength, and quality of life and to compare those outcomes to a control group receiving physical training only. Eighty-six patients were enrolled. Twenty-nine patients were allocated to retromuscular polypropylene mesh and 27 to double-row plication with Quill technology. Thirty-two patients participated in a 3-month training program. Diastasis was evaluated with computed tomography scan and clinically. Pain was assessed using the ventral hernia pain questionnaire, a quality-of-life survey, SF-36, and abdominal muscle strength using the Biodex System-4. One early recurrence occurred in the Quill group, 2 encapsulated seromas in the mesh group, and 3 in the suture group. Significant improvements in perceived pain, the ventral hernia pain questionnaire, and quality of life appeared at the 1-year follow-up with no difference between the 2 operative groups. Significant muscular improvement was obtained in all groups (Biodex System-4). Patient perceived gain in muscle strength assessed with a visual analog scale improved similarly in both operative groups. This improvement was significantly greater than that seen in the training group. Patients in the training group still experienced bodily pain at follow-up. There was no difference between the Quill technique and retromuscular mesh in the effect on abdominal wall stability, with a similar complication rate 1 year after operation. An operation improves functional ability and quality of life. Training strengthens the abdominal muscles, but patients still experience discomfort and pain. Copyright © 2016 Elsevier Inc. All rights reserved.

Childhood functional abdominal pain: mechanisms and management.

PubMed

Korterink, Judith; Devanarayana, Niranga Manjuri; Rajindrajith, Shaman; Vlieger, Arine; Benninga, Marc A

2015-03-01

Chronic abdominal pain is one of the most common clinical syndromes encountered in day to day clinical paediatric practice. Although common, its definition is confusing, predisposing factors are poorly understood and the pathophysiological mechanisms are not clear. The prevailing viewpoint in the pathogenesis involves the inter-relationship between changes in hypersensitivity and altered motility, to which several risk factors have been linked. Making a diagnosis of functional abdominal pain can be a challenge, as it is unclear which further diagnostic tests are necessary to exclude an organic cause. Moreover, large, well-performed, high-quality clinical trials for effective agents are lacking, which undermines evidence-based treatment. This Review summarizes current knowledge regarding the epidemiology, pathophysiology, risk factors and diagnostic work-up of functional abdominal pain. Finally, management options for children with functional abdominal pain are discussed including medications, dietary interventions, probiotics and psychological and complementary therapies, to improve understanding and to maximize the quality of care for children with this condition.

Headache and mechanical sensitization of human pericranial muscles after repeated intake of monosodium glutamate (MSG)

PubMed Central

2013-01-01

Background A single intake of monosodium glutamate (MSG) may cause headache and increased muscle sensitivity. We conducted a double-blinded, placebo-controlled, crossover study to examine the effect of repeated MSG intake on spontaneous pain, mechanical sensitivity of masticatory muscles, side effects, and blood pressure. Methods Fourteen healthy subjects participated in 5 daily sessions for one week of MSG intake (150 mg/kg) or placebo (24 mg/kg NaCl) (randomized, double-blinded). Spontaneous pain, pressure pain thresholds and tolerance levels for the masseter and temporalis muscles, side effects, and blood pressure were evaluated before and 15, 30, and 50 min after MSG intake. Whole saliva samples were taken before and 30 min after MSG intake to assess glutamate concentrations. Results Headache occurred in 8/14 subjects during MSG and 2/14 during placebo (P = 0.041). Salivary glutamate concentrations on Day 5 were elevated significantly (P < 0.05). Pressure pain thresholds in masseter muscle were reduced by MSG on Day 2 and 5 (P < 0.05). Blood pressure was significantly elevated after MSG (P < 0.040). Conclusion In conclusion, MSG induced mechanical sensitization in masseter muscle and adverse effects such as headache and short-lasting blood pressure elevation for which tolerance did not develop over 5 days of MSG intake. PMID:23565943

[Analgesic abuse and psychiatric comorbidity in headache patients].

PubMed

Radat, F; Irachabal, S; Swendsen, J; Henry, P

2002-01-01

Headache patients frequently overuse analgesic medications: 20% of the patients from headache centers is concerned by this problem, which has been estimated to occur in four percent of the community migrainers. Frequent use of various types of headache medication may paradoxically cause an increase in headache attack frequency as well as their chronicisation due to potentially complex mechanisms of sensitization. Patients will enter into a self- perpetuating cycle of daily headaches and use of symptomatic medications which can lead to addiction and to social and occupational impairement. Indeed, many patients will experience pharmacological tolerance and dependence but also by some kind of craving. International Headache Society qualify these patients as abusers referring mostly to the amount of substance ingested. Hence patients are labelled analgesic abusers . However, as many of these analgesic medications contained psychotropic substances (i.e. caffeine, codeine.), these patients may fulfill DSM IV criteria of dependance. Nevertheless, the dependance criteria should be adapted to chronic pain patients. Indeed, if pharmacological dependence and tolerance criteria are easy to apply in such patients, it is not the case for the criteria a great deal of time spent to obtain substances, to use substances or to recover from substances effects . As analgesic medications are legally obtained from medical practitioners, drug seeking behaviours are mostly: obtaining medications from multiple providers, repeating episodes of prescription loss and multiplying requests for early refills. Moreover the detrimental effects of analgesic abuse on psychosocial functioning is likely to be related to pain rather than to medication overuse. Finally the best indicator of addictive behaviors in such patients, is the loss of control over the use of analgesic medication despite the adverse consequences over pain. Comorbidity with addiction to other substances has never been specifically scrutinized in this population, but it is well documented that chronic pain patients have high rates of addiction with various types of substances. Moreover, it is well documented that these patients are at higher risk for anxious (panic disorders and phobic disorders) and depressive disorders than non abusing headache patients. Anxiety and depressive scores are related to both the chronicity of headaches, and the amount of analgesic intake. Therefore, this comorbidity is possibly related to psychoactive substance use but there is no prospective study concerning chronological link between the anxious and depressive disorders and analgesic abuse. The presence of personality disorders in these patients is poorly documented, with the exception of neuroticism, which probably reflects the anxious and depressive comorbidity. Clinical findings show that a subgroup of patients needs an hospitalisation to succeed in withdrawal. They appears likely to be dependant on several types of drugs, to present with fear of pain itself, and to present with cluster B personality disorders, whereas another subgroup is specifically dependant on one type of drug, present with fear of pain induced impairement, and present with cluster C personality disorders. Those patients, when becoming aware of dependance, succeed in withdrawal at home, without the need of an hospitalization. The analgesic medication overuse and dependance can also be considered as a maladjusted strategy to manage pain (with prevalent passive and avoidant coping strategies). More research is required focusing on psychopathological aspects of analgesic overuse and dependance, to improve withdrawal modalities and to reduce the rate of relapses.

Glial Attenuation With Ibudilast in the Treatment of Medication Overuse Headache: A Double-Blind, Randomized, Placebo-Controlled Pilot Trial of Efficacy and Safety.

PubMed

Johnson, Jacinta L; Kwok, Yuen H; Sumracki, Nicole M; Swift, James E; Hutchinson, Mark R; Johnson, Kirk; Williams, Desmond B; Tuke, Jonathon; Rolan, Paul E

2015-10-01

Medication overuse headache (MOH) is a condition bordering between a chronic pain condition and a substance dependence disorder. Activation of immunocompetent glial cells in the central nervous system has been linked to both pathological pain and drug addiction/reward. Preclinically, ibudilast attenuates glial activation and is able to reduce neuropathic pain and markers of substance dependence. We therefore hypothesized ibudilast would reduce headache burden and opioid analgesic requirements in patients with opioid overuse headache. To determine if treatment with ibudilast provides a greater reduction in headache index than placebo in MOH patients consuming opioids. Participants with MOH who were using opioids were randomized via computer-generated code to ibudilast 40 mg or placebo twice daily for 8 weeks in a double-blind, parallel groups study. Before randomization participants completed a 4-week baseline headache diary. During treatment, headache diary data collection continued and participants attended 4 study visits during which quantitative sensory testing was performed. Blood samples for immune biomarker analyses were collected before and after treatment in a subgroup of participants. Thirty-four participants were randomized, 13 of 15 randomized to ibudilast and 17 of 19 randomized to placebo completed treatment. Ibudilast was generally well-tolerated with mild, transient nausea reported as the most common adverse event (66.7% vs 10.5% in placebo group). Results are shown as mean (SD). At the end of treatment no differences in the primary outcome average daily headache index (placebo 62 [44] vs ibudilast 77 [72] groups, difference -15, CI -65 to 35 h × numerical rating scale), or secondary outcomes headache frequency (placebo 23 [8.1] vs ibudilast 24.5 [6.2], difference -1.5, CI -7.7 to 4.8 days/month) and opioid intake (placebo 20.6 [43] vs ibudilast 19 [24.3], difference 1.6, CI -31.5 to 34.8 mg morphine equivalent) were observed between placebo and ibudilast groups. Using the current dosing regimen, ibudilast does not improve headache or reduce opioid use in patients with MOH without mandated opioid withdrawal. However, it would be of interest to determine in future trials if ibudilast is able to improve ease of withdrawal during a forced opioid down-titration when incorporated into an MOH detoxification program. © 2015 American Headache Society.

Spontaneous Trigeminal Allodynia in Rats: A Model of Primary Headache

PubMed Central

Oshinsky, Michael L.; Sanghvi, Menka M.; Maxwell, Christina R.; Gonzalez, Dorian; Spangenberg, Rebecca J.; Cooper, Marnie; Silberstein, Stephen D.

2014-01-01

Animal models are essential for studying the pathophysiology of headache disorders and as a screening tool for new therapies. Most animal models modify a normal animal in an attempt to mimic migraine symptoms. They require manipulation to activate the trigeminal nerve or dural nociceptors. At best, they are models of secondary headache. No existing model can address the fundamental question: How is a primary headache spontaneously initiated? In the process of obtaining baseline periorbital von Frey thresholds in a wild-type Sprague-Dawley rat, we discovered a rat with spontaneous episodic trigeminal allodynia (manifested by episodically changing periorbital pain threshold). Subsequent mating showed that the trait is inherited. Animals with spontaneous trigeminal allodynia allow us to study the pathophysiology of primary recurrent headache disorders. To validate this as a model for migraine, we tested the effects of clinically proven acute and preventive migraine treatments on spontaneous changes in rat periorbital sensitivity. Sumatriptan, ketorolac, and dihydroergotamine temporarily reversed the low periorbital pain thresholds. Thirty days of chronic valproic acid treatment prevented spontaneous changes in trigeminal allodynia. After discontinuation, the rats returned to their baseline of spontaneous episodic threshold changes. We also tested the effects of known chemical human migraine triggers. On days when the rats did not have allodynia and showed normal periorbital von Frey thresholds, glycerol trinitrate and calcitonin gene related peptide induced significant decreases in the periorbital pain threshold. This model can be used as a predictive model for drug development and for studies of putative biomarkers for headache diagnosis and treatment. PMID:22963523