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Menstrually Related and Nonmenstrual Migraines in A
MENSTRUALLY RELATED AND NONMENSTRUAL MIGRAINES IN A FREQUENT MIGRAINE POPULATION: FEATURES, CORRELATES, AND ACUTE TREATMENT DIFFERENCES A dissertation presented to the faculty of the College of Arts and Sciences of Ohio University In partial fulfillment of the requirements for the degree Doctor of Philosophy Brenda F. Pinkerman March 2006 This dissertation entitled MENSTRUALLY RELATED AND NONMENSTRUAL MIGRAINES IN A FREQUENT MIGRAINE POPULATION: FEATURES, CORRELATES, AND ACUTE TREATMENT DIFFERENCES by BRENDA F. PINKERMAN has been approved for the Department of Psychology and the College of Arts and Sciences by Kenneth A. Holroyd Distinguished Professor of Psychology Benjamin M. Ogles Interim Dean, College of Arts and Sciences PINKERMAN, BRENDA F. Ph.D. March 2006. Clinical Psychology Menstrually Related and Nonmenstrual Migraines in a Frequent Migraine Population: Features, Correlates, and Acute Treatment Differences (307 pp.) Director of Dissertation: Kenneth A. Holroyd This research describes and compares menstrually related migraines as defined by recent proposed guidelines of the International Headache Society (IHS, 2004) to nonmenstrual migraines in a population of female migraineurs with frequent, disabling migraines. Migraines are compared by frequency per day of the menstrual cycle, headache features, use of abortive and rescue medications, and acute migraine treatment outcomes. In addition, this study explores predictors of acute treatment response and headache recurrence within 24 hours following acute migraine treatment for menstrually related migraines. Participants are 107 menstruating female migaineurs who met IHS (2004) proposed criteria for menstrually related migraines and completed headache diaries using hand-held computers. Diary data are analyzed using repeated measures logistic regression. The frequency of migraines is significantly increased during the perimenstrual period, and menstrually related migraines are of longer duration and greater frequency with longer lasting disability than nonmenstrual migraines. -
Migraine: Spectrum of Symptoms and Diagnosis
KEY POINT: MIGRAINE: SPECTRUM A Most patients develop migraine in the first 3 OF SYMPTOMS decades of life, some in the AND DIAGNOSIS fourth and even the fifth decade. William B. Young, Stephen D. Silberstein ABSTRACT The migraine attack can be divided into four phases. Premonitory phenomena occur hours to days before headache onset and consist of psychological, neuro- logical, or general symptoms. The migraine aura is comprised of focal neurological phenomena that precede or accompany an attack. Visual and sensory auras are the most common. The migraine headache is typically unilateral, throbbing, and aggravated by routine physical activity. Cutaneous allodynia develops during un- treated migraine in 60% to 75% of cases. Migraine attacks can be accompanied by other associated symptoms, including nausea and vomiting, gastroparesis, di- arrhea, photophobia, phonophobia, osmophobia, lightheadedness and vertigo, and constitutional, mood, and mental changes. Differential diagnoses include cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoenphalopathy (CADASIL), pseudomigraine with lymphocytic pleocytosis, ophthalmoplegic mi- graine, Tolosa-Hunt syndrome, mitochondrial disorders, encephalitis, ornithine transcarbamylase deficiency, and benign idiopathic thunderclap headache. Migraine is a common episodic head- (Headache Classification Subcommittee, ache disorder with a 1-year prevalence 2004): of approximately 18% in women, 6% inmen,and4%inchildren.Attacks Recurrent attacks of headache, consist of various combinations of widely varied in intensity, fre- headache and neurological, gastrointes- quency, and duration. The attacks tinal, and autonomic symptoms. Most are commonly unilateral in onset; patients develop migraine in the first are usually associated with an- 67 3 decades of life, some in the fourth orexia and sometimes with nausea and even the fifth decade. -
Hormonal Contraceptive Treatment May Reduce the Risk of Fibromyalgia in Women with Dysmenorrhea: a Cohort Study
Journal of Personalized Medicine Article Hormonal Contraceptive Treatment May Reduce the Risk of Fibromyalgia in Women with Dysmenorrhea: A Cohort Study Cheng-Hao Tu 1,* , Cheng-Li Lin 2, Su-Tso Yang 3,4, Wei-Chih Shen 5,6 and Yi-Hung Chen 1,7,8,* 1 Graduate Institute of Acupuncture Science, China Medical University, Taichung 404333, Taiwan 2 Management Office for Health Data, China Medical University Hospital, Taichung 404332, Taiwan; [email protected] 3 Department of Medical Imaging, China Medical University Hospital, Taichung 404332, Taiwan; [email protected] 4 School of Chinese Medicine, China Medical University, Taichung 404333, Taiwan 5 Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung 404332, Taiwan; [email protected] 6 Department of Computer Science and Information Engineering, Asia University, Taichung 413305, Taiwan 7 Traditional Chinese Medicine Research Center, China Medical University, Taichung 404333, Taiwan 8 Department of Photonics and Communication Engineering, Asia University, Taichung 41354, Taiwan * Correspondence: [email protected] (C.-H.T.); [email protected] (Y.-H.C.); Tel.: +886-4-22053366 (C.-H.T.) (ext. 3336) Received: 17 November 2020; Accepted: 11 December 2020; Published: 14 December 2020 Abstract: Dysmenorrhea is the most common gynecological disorder for women in the reproductive age. Study has indicated that dysmenorrhea might be a general risk factor of chronic pelvic pain and even chronic non-pelvic pain, such as fibromyalgia. We used the Longitudinal Health Insurance Database 2000 from the Taiwan National Health Research Institutes Database to investigate whether women with dysmenorrhea have a higher risk of fibromyalgia and whether treatment of dysmenorrhea reduced the risk of fibromyalgia. -
Cluster Headacheheadache
ClusterCluster HeadacheHeadache 1 OBJECTIVESOBJECTIVES Describe the clinical features and diagnosis of cluster headache Discuss the pathogenesis of cluster pain and autonomic features Review acute and preventive therapy Overview of new treatment horizons for refractory chronic cluster 2 IHSIHS CLASSIFICATIONCLASSIFICATION Cluster headache n Episodic type (80%) n Chronic type (20%) (Cluster period lasts for more than one year without remission or remission lasts less than 14 days) Episodic Chronic IHS Headache Classification Committee. Cephalalgia. 2004. Although the unique clinical features of cluster headache (CH) have been recognized since the 17th century, the striking periodicity was not articulated until the 1940s. The term “cluster headache” was coined in the 1950s, and since then the International Headache Society (IHS) has identified and classified two major temporal patterns of CH (1). The episodic type (ECH), by far the most common (90%), is characterized by discrete attack and remission phases. The chronic type (CCH) is defined by attacks that occur daily for more than one year without remission or with remission periods lasting less than 14 days. Cluster headache is rare (about 0.4% of the general population), and it predominates in males, although recent studies indicate that the rate in females is rising (2). Onset can occur at any age but usually begins between 30 and 50 years of age (3). In contrast to migraine headache, genetics in cluster headache is not thought to be important, although recent studies have shown a positive family history in about 7% of patients with cluster headache. When compared with prevalence of CH in the general population, first-degree relatives have about a 14-fold increased risk of developing CH. -
HEADACHES and ME/CFS INTRODUCTION Headaches Are Often Reported by People with ME/CFS
MANAGEMENT FILE the ME association by DR CHARLES SHEPHERD, our medical adviser This leaflet is based on an article which first appeared in the ME Association’s quarterly ME Essential magazine. MEA membership costs £18 a year for people living in the UK/BFPO. For contact details, see foot of this page. February 2020 HEADACHES AND ME/CFS INTRODUCTION Headaches are often reported by people with ME/CFS. They also form part of the symptom list for most diagnostic criteria for ME/CFS. But headaches can obviously have other causes – physical and psychological – as well. WHAT CAUSES HEADACHES? Doctors classify headaches as being sides of the head – as if a rubber band arteries in the head and neck. primary where there is no obvious link has been stretched around it. Common Temporal arteritis is a medical to an underlying medical problem, or causes include stress, depression, lack emergency that requires urgent treat- secondary where there is a clear link. of proper sleep, skipping meals, not ment with high-dose steroids. drinking enough fluid and alcohol. Primary headaches include: Headaches in women can be caused Secondary headaches are caused by Cluster headaches by hormonal problems – including an existing medical problem. Some of An excruciatingly painful headache taking the contraceptive pill, going these are serious, which is why you must that causes intense pain around one through the menopause, pregnancy, see your doctor if you have severe or eye. Cluster headaches are fairly rare and as part of period pain. persistent headaches. and tend to occur in clusters for a It’s also worth noting that a headache month or two, sometimes around the Common causes, which are normally is the most common symptom of same time each year. -
Chronic Fatigue Syndrome (CFS) Disease Fact Sheet Series
WISCONSIN DIVISION OF PUBLIC HEALTH Department of Health Services Chronic Fatigue Syndrome (CFS) Disease Fact Sheet Series What is chronic fatigue syndrome? Chronic fatigue syndrome (CFS) is a recently defined illness consisting of a complex of related symptoms. The most characteristic symptom is debilitating fatigue that persists for several months. What are the other symptoms of CFS? In addition to profound fatigue, some patients with CFS may complain of sore throat, slight fever, lymph node tenderness, headache, muscle and joint pain (without swelling), muscle weakness, sensitivity to light, sleep disturbances, depression, and difficulty in concentrating. Although the symptoms tend to wax and wane, the illness is generally not progressive. For most people, symptoms plateau early in the course of the illness and recur with varying degrees of severity for at least six months and sometimes for several years. What causes CFS? The cause of CFS is not yet known. Early evidence suggested that CFS might be associated with the body's response to an infection with certain viruses, however subsequent research has not shown an association between an infection with any known human pathogen and CFS. Other possible factors that have been suspected of playing a role in CFS include a dysfunction in the immune system, stress, genetic predisposition, and a patient’s psychological state. Is CFS contagious? Because the cause of CFS remains unknown, it is impossible to answer this question with certainty. However, there is no convincing evidence that the illness can be transmitted from person to person. In fact, there is no indication at this time that CFS is caused by any single recognized infectious disease agent. -
A Retrospective, Epidemiological Review of Hemiplegic Migraines in a Military Population
MILITARY MEDICINE, 00, 0/0:1, 2019 A Retrospective, Epidemiological Review of Hemiplegic Migraines in a Military Population Downloaded from https://academic.oup.com/milmed/advance-article-abstract/doi/10.1093/milmed/usz040/5382215 by AMSUS Member Access user on 22 April 2019 CPT Brian A. Moore, USAR*†; Willie J. Hale*; Paul S. Nabity†; CAPT Tyler R. Koehn, MC, USAF‡; Donald McGeary†; Lt Col Alan L. Peterson, BSC USAF (Ret.)*†§ ABSTRACT Introduction: Headaches are one of the world’s most common disabling conditions. They are also both highly prevalent and debilitating among military personnel and can have a significant impact on fitness for duty. Hemiplegic migraines are an uncommon, yet severely incapacitating, subtype of migraine with aura for which there has been a significant increase amongst US military personnel over the past decade. To date, there has not been a scientific report on hemiplegic migraine in United States military personnel. Materials and Methods: The aim of this study was to provide an overview of hemiplegic migraine, to analyze data on the incidence of hemiplegic migraine in US military service members, and to evaluate demographic factors associated with hemiplegic migraine diagnoses. First time diagnoses of hemiplegic migraine were extracted from the Defense Medical Epidemiological Database according to ICD-9 and ICD-10 codes for hemiplegic migraine. One sample Chi-Square goodness of fit tests were conducted on weighted demographic samples to determine whether significant proportional differences existed between gender, age, military grade, service component, race, and marital status. Results: From 1997 to 2007 there were no cases of hemiplegic migraine recorded in the Defense Medical Epidemiological Database. -
Migraine Headache Prophylaxis Hien Ha, Pharmd, and Annika Gonzalez, MD, Christus Santa Rosa Family Medicine Residency Program, San Antonio, Texas
Migraine Headache Prophylaxis Hien Ha, PharmD, and Annika Gonzalez, MD, Christus Santa Rosa Family Medicine Residency Program, San Antonio, Texas Migraines impose significant health and financial burdens. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications. Preventive medication therapy reduces migraine frequency, severity, and headache-related distress. Preventive therapy may also improve quality of life and prevent the progression to chronic migraines. Some indications for preventive therapy include four or more headaches a month, eight or more headache days a month, debilitating headaches, and medication- overuse headaches. Identifying and managing environmental, dietary, and behavioral triggers are useful strategies for preventing migraines. First-line med- ications established as effective based on clinical evidence include divalproex, topiramate, metoprolol, propranolol, and timolol. Medications such as ami- triptyline, venlafaxine, atenolol, and nadolol are probably effective but should be second-line therapy. There is limited evidence for nebivolol, bisoprolol, pindolol, carbamazepine, gabapentin, fluoxetine, nicardipine, verapamil, nimodipine, nifedipine, lisinopril, and candesartan. Acebutolol, oxcarbazepine, lamotrigine, and telmisartan are ineffective. Newer agents target calcitonin gene-related peptide pain transmission in the migraine pain pathway and have recently received approval from the U.S. Food and Drug Administration; how- ever, more studies of long-term effectiveness and adverse effects are needed. The complementary treatments petasites, feverfew, magnesium, and riboflavin are probably effective. Nonpharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy also have good evidence to support their use in migraine prevention. (Am Fam Physician. 2019; 99(1):17-24. -
Stroke Mimickers and the Atypical Stroke Patient
9/10/2012 Stroke Mimickers and the Atypical Stroke Patient Bruce Lo, MD, RDMS Associate Professor, EVMS Chief, Department of Emergency Medicine Sentara Norfolk General Disclosures None Objectives Examine atypical presentation of stroke and stroke mimics in the acute setting Create an algorithm for evaluating those with potential stroke mimickers Describe pitfalls in evaluating patients with potential stroke mimickers 1 9/10/2012 No Brainer! WHAT ABOUT STROKE? 2 9/10/2012 Background Physician Misdiagnosis: up to 20% Misdiagnosed as stroke: up to 20% EMS (1995) 28% misdiagnosed as stroke (2008) 83% Sensitivity; 42% PPV Protocol Violations 30% EM 5% Neurologist 31%* Admitted (possible) stroke patient – stroke mimickers Mimics: Seizures, encephalopathy, sepsis Stroke 2006; 37:769-775 Use of tPA 3 9/10/2012 Tsivgoulis et al. Stroke 2011 - 10x more likely to be sued for NOT giving tPA - 5x cases successfully sued for NOT giving tPA Liang et al. Annals of EM 2008 Stroke Mimickers Neurological Conditions Cardiovascular Disorders Seizure with Todd’s paralysis Syncope Brain Tumor HTN Encephalopathy Demyelinating disorder (eg MS) Psychiatric Disorders Myasthenia Gravis Conversion Disorder Bell’s Palsy Malingering Complicated Migraines Facticious Disorder Infectious Conditions Inner Ear Conditions Viral encephalitis Labyrinthitis Basilar meningitis (eg TB) Vestibular neuronitis Brain Abscess BPV Metabolic Severe hyponatremia Hepatic encephalopathy Hypoglycemia Hyperglycemic hyperosmolar nonketotic state 4 9/10/2012 General Principles -
Effects of the Menstrual Cycle on Medical Disorders
REVIEW ARTICLE Effects of the Menstrual Cycle on Medical Disorders Allison M. Case, MD; Robert L. Reid, MD xacerbation of certain medical conditions at specific phases of the menstrual cycle is a well-recognized phenomenon. We review the effects of the menstrual cycle on medical conditions, including menstrual migraine, epilepsy, asthma, rheumatoid arthritis, irritable bowel syndrome, and diabetes. We discuss the role of medical suppression of ovulationE using gonadotropin-releasing hormone agonists in the evaluation and treatment of these disorders. Peer-reviewed publications from English-language literature were located via MEDLINE or from bibliographies of relevant articles. We reviewed all review articles, case reports and series, and therapeutic trials. Emphasis was placed on diagnosis and therapy of menstrual cycle– related exacerbations of disease processes. Abrupt changes in the concentrations of circulating ovar- ian steroids at ovulation and premenstrually may account for menstrual cycle–related changes in these chronic conditions. Accurate documentation of symptoms on a menstrual calendar allows identification of women with cyclic alterations in disease activity. Medical suppression of ovula- tion using gonadotropin-releasing hormone agonists can be useful for both diagnosis and treat- ment of any severe, recurrent menstrual cycle–related disease exacerbations. Arch Intern Med. 1998;158:1405-1412 The menstrual cycle, an event that punctu- Several theories have been proposed to ates the lives of most women, may be asso- explain these menstrual cycle–related effects ciated with diverse physical, psychological, on existing disease processes, including fluc- and behavioral changes. Not surprisingly, it tuations in levels of sex steroids, cyclic alter- plays a significant role in women’s health and ations in the immune system, and changing disease. -
Migraine and Tension Headache Guideline
Migraine and Tension Headache Guideline Major Changes as of May 2021 .................................................................................................................... 2 Medications Not Recommended for Headache Treatment .......................................................................... 2 Background ................................................................................................................................................... 2 Diagnosis Red flag warning signs ........................................................................................................................... 3 Differential diagnosis .............................................................................................................................. 3 Imaging ................................................................................................................................................... 3 Migraine versus tension headache ......................................................................................................... 4 Medication overuse headache ................................................................................................................ 4 Menstruation-related migraine ................................................................................................................ 4 Tension Headache Acute treatment ...................................................................................................................................... 5 Prophylaxis ............................................................................................................................................ -
Headaches in Woman
11 Headaches in Women Randolph W. Evans Women have headaches more commonly than men. The preva- lence of migraine is 18% of women and 6% of men. This gender ratio increases from menarche, peaks at 42 years of age, and then declines. For young women the incidence of migraine with aura peaks between the ages of 12 and 13 (14.1/1,000 person- years), and migraine without aura peaks between the ages of 14 and 17 (18.9/1,000 person-years) (1). Table 11-1 provides the life- time prevalence of various headaches in women and men. Estrogen levels are a key factor in the increased prevalence of migraine in women. Evidence includes the following: migraine prevalence increases at menarche; estrogen withdrawal during menstruation is a common migraine trigger; estrogen administra- tion in oral contraceptives and hormone replacement therapy can trigger migraines; migraines typically decrease during the second and third trimesters of pregnancy, when estrogen levels are high; migraines are common immediately postpartum, with the precipi- tous drop in estrogen levels; and migraines generally improve with physiological menopause. Exactly how changes in estrogen levels influence migraine is not understood. Among numerous effects, fluctuations in estrogen levels can result in changes in prostaglandins and the uterus, prolactin release, opioid regula- tion, and melatonin secretion. These fluctuations can also cause changes in neurotransmitters, including the catecholamines, noradrenaline, serotonin, dopamine, and endorphins (2). This chapter reviews some important headache issues for women, including menstrual migraine, menopause and migraine, oral contraceptive use in migraineurs, and headaches during pregnancy and postpartum. MENSTRUAL MIGRAINE The reported prevalence of menstrual migraine varies from 4% to 73%, depending on the criteria used for the timing of the attack.