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- Title
SECONDARY HEADACHES.
- Authors
Millson, David S.; Tepper, Stewart J.
- Abstract
Murata Y, Yamagata M, Ogata S, Shimizu K, Ikeda Y, Hirayama J, Yamada H. The influence of early ambulation and other factors on headache after lumbar myelography. J Bone Joint Surg Br. 2003;85:531-534. In order to determine the influence of early ambulation and other factors on headaches occurring after lumbar myelography we randomised 207 patients (127 men and 80 women) into two groups. Following the investigation, we allowed the 101 patients (65 men and 36 women) in group A to sit or stand freely, while we confined the 106 patients (62 men and 44 women) in group B to bed for 20 hours. The nine patients in group B who could not maintain bed rest were excluded. There was no significant difference between the two groups as regards the prevalence of spinal headache (8.9% in group A v 14.4% in group B). Patients who reported headaches, however, were significantly more likely to be women (18.7%) than men (73%), be younger (mean age 45 years v 56 years), have a higher cerebrospinal pressure before removal of fluid (mean values 172 v 137 mm H2O) and a lower systolic (mean values 120 v 134 mmHg) and diastolic blood pressure. We conclude that, although other factors may be associated with headaches, late ambulation is not effective in preventing spinal headaches after lumbar myelography. Comment: The only proven way to prevent spinal headache after lumbar puncture that I have ever read is to use special blunt-end needles such as Sprotte needles, which need to be special ordered, but which markedly reduce this complication. SJT Uddin AB. Drug-induced pseudotumor cerebri. Clin Neuropharmacol. 2003;26:236-238. Summary: Pseudotumor Cerebri (PTC) is an uncommon disorder whose etiology is largely unknown, although its association with steroid withdrawal, hypervitaminosis A, and the use of the tetracycline group of drugs has been well documented. We report here a case in which a patient on chronic divalproex therapy for a seizure disorder developed PTC. Changing his antiepileptic medication from divalproate to topiramate effected a remission of PTC symptoms while maintaining his seizure-free status. It is recommended that physicians treating epilepsy, vascular headaches, or mood disorders with divalproate consider the diagnosis of PTC when their patients complain of new onset of headaches or an increase in frequency or severity of existing headaches-especially those associated with a visual disturbance-to prevent permanent visual loss. Comment: I have been prescribing valproate since 1978, and have not seen this adverse event before, but given our need as headache clinicians to recognize pseudotumor and our frequent use of valproate, it is worth noting. SJT Leung M, Hollander Y, Brown GR. Pretreatment with ibuprofen to prevent electroconvulsive therapy-induced headache. J Clin Psychiatry. 2003;64:551-553. Background: Although electroconvulsive therapy (ECT) has been widely recognized as an effective treatment for severe depression and various other psychiatric illnesses, adverse effects have been frequently reported, especially a high incidence of headache. Analgesics, such as acetaminophen, narcotics, or nonsteroidal anti-inflammatory drugs (NSAIDs), are commonly used to treat ECT-induced headache. The objective of this study was to determine whether pretreatment with ibuprofen would prevent the onset or decrease the severity of headache that occurs after ECT. Method: All inpatients on the psychiatric units who required ECT treatment were asked to participate in the study. Thirty-four patients were randomly assigned to receive either ibuprofen, 600 mg, or placebo orally 90 minutes prior to the initial ECT session, with the alternate treatment given for the second ECT treatment. Patients were asked to complete a questionnaire prior to and after the first 2 ECT treatments regarding the pattern, severity, and onset of headache. Severity of the headache was measured on a visual analogue scale (VAS). Results: Ten patients experienced headache in neither treatment arm, while 7 patients experienced headache in both treatment arms. Eleven patients experienced headache with placebo but not with ibuprofen, while 2 patients experienced headache with ibuprofen but not with placebo. Ibuprofen was significantly more effective than placebo in preventing the onset of headache post-ECT ( P= .022). The mean +/− SD VAS headache scores were 1.49 +/− 1.54 and 0.54 +/− 0.91 in the placebo and ibuprofen arms, respectively. Ibuprofen was significantly more effective than placebo in reducing the severity of ECT-induced headache ( P= .007). Conclusion: Ibuprofen premedication reduced the frequency and severity of headache post-ECT and should be considered for appropriate patients who suffer from ECT-induced headache. Comments: Anyone who has taken care of patients with ECT (electroconvulsive therapy)-induced headache has the impression that the headaches that follow ECT meet International Headache Society criteria for migraine. I have used dihydroergotamine or triptans to prevent ECT headache, but this study suggests a nonsteroidal anti-inflammatory drug can be quite effective, and neither dihydroergotamine nor triptans have been studied prospectively for this secondary headache. SJT
- Subjects
HEADACHE; THERAPEUTICS; IBUPROFEN; ELECTROCONVULSIVE therapy; DRUGS
- Publication
Headache: The Journal of Head & Face Pain, 2004, Vol 44, Issue 3, p299
- ISSN
0017-8748
- Publication type
Abstract
- DOI
10.1111/j.1526-4610.2004.04068_4.x