Headache and migraine

The causes of most headaches fall into three categories  

Tension the most common cause of headache, thought to be due to pericranial muscle contraction. It is often psychogenic in origin and caused or made worse by tension, anxiety or fatigue. 

Vascular, caused by dilatation or constriction of blood vessels in the brain and cranium headaches associated with febrile Illnesses are caused by vasodilatation. Migraine is also believed to be vascular in origin, at least in part, although neurochemical pathology also appears to be involved. 

The clinical features of the main types of headache are outlined in Table 4.1. 

Frequency/timing Recurrent associated with menstrual cycle or at certain times, e.g. weekends Migraine 

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The use of feverfew as a medicinal plant can be traced back to the earliest written record of the Herbals, the Greek herbal Materia Medica by Dios-corides. Later herbal writers are thought to have used the Materia Medica as a source of information and feverfew was described by Dodoens in 1619, by Gerard in 1636 and Culpeper in 1650. Their descriptions of the properties of the plant became more extensive and the conditions for which feverfew was reputed to be beneficial can be divided into three main areas (1) fever, headache and migraine (2) women s conditions such as difficulties in labour, threatened miscarriages and the regulation of menstruation (3) the relief of stomach-ache, toothache and insect bites [1]. 

Increased body temperature, pyrexia (both intra- and postpartum), and chills are thought to result from central stimulation of temperature regulatory centers by prostaglandins (102,103). Headache and migraine are the most common adverse effects on the central nervous system (5,104). 

Guarana contains tannins and has been used to treat diarrhea. It also contains a high concentration of caffeine, which, in conjunction with the alkaloids theobromine and theophylline, gives guarana diuretic and stimulant properties. Guarana is used to treat fatigue, mild depression, headache, and migraine. 

Communities near pulp mills Inhalation Mean annual total reduced sulfur concentrations 2-3 pg/ m 24-b average concentration 0-56 pg/ rtP, maximum 1-h concentration 155 pg/ m1 Daily Reported increased incidence of respiratory system symptoms (irritation, cough) and CNS symptoms (headache and migraine) significant increase only for headache and migraine. Communities exposed to relatively high concentrations of other malodorous sulfur compounds. Partti-Pellinin et al. 1996 (South Karelia Air Pollution Study)... 

The effects of hydroxyzine 50 mg/day, buspirone 20 mg/day, and placebo have been studied in 244 patients with generalized anxiety disorder in a double-bhnd placebo-controlled study (16). Hydroxyzine (n = 81) was considerably better than placebo (n = 81), and buspirone (n = 82) was intermediate. The main adverse effects were headache and migraine with buspirone (6.1 versus 4.9% with hydroxyzine and 1.2% with placebo). Somnolence occurred in 9.9% with hydroxyzine, 4.9% with buspirone, and none with placebo. Dizziness occurred in 6.1% with buspirone, none with hydroxyzine, and 2.5% with placebo. 

Monosodium glutamate (MSG) One of the most common and devastating additives found in our food, MSG increases acidity in our bodies. Research on the toxic effects of MSG in its many disguises is substantial and warrants an entire book on its own. Adverse health effects range from headaches and migraines to asthma, breathing difficulties, and digestive troubles, to name a few. Do yourself a favor and avoid this additive at any cost. 

Folk healers prescribe kava everywhere the drink is consumed. Island pharmacists gather various parts of the plant, including the root, leaves, bark, stems, and their juices. Treatments include infusions and also poultices of leaf, stem, or root applied to the body. Observers have recorded uses of kava to treat a range of conditions. These include urogenital and menstrual problems, headaches and migraines, asthma and other respiratory problems, toothache, boils, sores and wounds, conjunctivitis, both diarrhea and constipation, earache, sore throat, sleeping difficulties, leprosy and other skin diseases, and more (Lebot etal., 1992 Kilham, 1996). Kava, occasionally, served also as an abortifacient (Riesenberg, 1968). 

Ibuprofen is especially effective in treating certain kinds of pain and inflammation, including those associated with menstrual cramps, various kinds of arthritis, headaches and migraines, pain from injuries and surgery, and discomfort associated with influenza and gout. 

Waldenlind E, Ross SB, Saaf J, Ekbom K, Wetterberg L. Concentration and uptake of 5-hydroxytryptamine in platelets from cluster headache and migraine patients. Cephalalgia 1985 5(1) 45-54. 

The aerosol container has enjoyed commercial success ia a wide variety of product categories. Insecticide aerosols were iatroduced ia the late 1940s. Additional commodities, including shave foams, hair sprays, antiperspirants, deodorants, paints, spray starch, colognes, perfumes, whipped cream, and automotive products, followed ia the 1950s. Mediciaal metered-dose aerosol products have also been developed for use ia the treatment of asthma, migraine headaches, and angiaa. 

Various pain states (e.g. headache, toothache and migraine), primarily pathophysiological inflammatory pain, e.g. rheumatic pain and pain caused by bone metastases... 

These dm are primarily used in the treatment of hypertension (see the Summary Drug Table Adrenergic Blocking Drugs also see Chap. 39) and certain cardiac arrhythmias (abnormal rhythm of the heart), such as ventricular arrhythmias or supraventricular tachycardia They are used to prevent reinfarction in patients with a recent myocardial infarction (1—4 weeks after MI). Some of these dm have additional uses, such as the use of propranolol for migraine headaches and nadolol for angina pectoris. 

Divalproex sodium is comprised of sodium valproate and valproic acid. The delayed-release and extended-release formulations are converted in the small intestine into valproic add, which is the systemically absorbed form. It was developed as an antiepileptic drug, but also has efficacy for mood stabilization and migraine headaches. It is FDA-approved for the treatment of the manic phase of bipolar disorder. It is generally equal in efficacy to lithium and some other drugs for bipolar mania. It has particular utility in bipolar disorder patients with rapid cycling, mixed mood features, and substance abuse comorbidity. Although not FDA-approved for relapse prevention, studies support this use, and it is widely prescribed for maintenance therapy. Divalproex can be used as monotherapy or in combination with lithium or an antipsychotic drug.31... 

S.5.5.2.3 Historical controls Since many clinical trials are conducted in the same diseases, with the same control treatments there is an obvious desire to make the most use of this potentially valuable information. Can we compare the results of a new treatment in a group of patients with a group of control patients extracted from a historical database For example, suppose we are testing a new treatment for migraine headache and 60% of patients improve in the first 2 h post-treatment, compared to 30% in a group of historical control patients treated who had been treated with the current gold standard. Are we able to conclude that the new treatment is preferable to the gold standard ... 

The selective serotonin reuptake inhibitors (SSRI) have been used in adults for a wide variety of disorders, including major depression, social anxiety (social phobia), generalized anxiety disorder (GAD), eating disorders, premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder (PTSD), panic, obsessive-compulsive disorder (OCD), trichotillomania, and migraine headaches. Some of the specific SSRI agents have an approved indication in adults for some of these disorders, as reviewed later in this chapter. The SSRIs have also been tried in children and in adults for symptomatic treatment of pain syndromes, aggressive or irritable ( short fuse ) behavior, and for self-injurious and repetitive behaviors. This chapter will review general aspects of the SSRIs and discuss their approved indications in children and adolescents. 

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