1/6. Pediatric dental treatment for children with headache.This case demonstrates the safe step by step approach to treatment of pediatric patients with muscle spasm headache. If there are any neurologic signs or the LiteSplint is not effective, then a laboratory orthopedic appliance therapy may not be effective and a neurologic referral is necessary. It is always required to review the latest physical exam with the parent and physician if the symptoms do not improve in an orderly sequence. The LiteSplint acts as a screening and diagnostic aid in determining the source of head pain. For very young patients (three to six years of age) who may not be able to easily tolerate an appliance, an extra heavy coating of flowable composite that can act as a sealant on the primary molars, e.g. Revolution, may open the bite enough to alleviate headache or earache symptoms. Dental clinicians can perform a valuable service for their patients if headaches from deep bite malocclusions can be diagnosed and treated at an early age.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Severe headache associated with occupational exposure to Stoddard solvent.We report a case of recurrent headaches in a woman with a workplace exposure to airborne (misted) lubricating fluid containing Stoddard solvent. For 2 months, the employee was seen by her family physician, a neurologist and an ophthalmologist. All attempted to diagnose the cause of and treat her headaches. Despite extensive testing, no etiology was discovered. Her headaches continued despite the use of medications. The employee, suspecting an occupational connection, changed the lubricating fluid at her workstation to a non-Stoddard solvent. Within 2 days she reported the complete resolution of her headaches with no further recurrences. A thorough occupational history and literature review supported exposure to Stoddard solvent as the probable source of her headaches.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Prolonged recovery from rebound headaches.OBJECTIVE: To document that some patients with rebound headache require prolonged complete avoidance of the pain relief medications which might cause the daily or almost daily headaches in order to achieve a goal of 6 consecutive headache-free days. BACKGROUND: Most articles on rebound headache imply that the patient improves after stopping the offending agents, but they fail to state the pattern of recovery, the time required for recovery, or the specific end point achieved. DESIGN: Selected from the histories of approximately 1000 patients with suspected rebound headache who have been seen in a university headache referral clinic are the records of four patients who kept careful headache diaries, followed the treatment protocol (with minimal noncompliance by two patients), and required more than 6 months to achieve our goal of 6 consecutive headache-free days. CONCLUSIONS: Hopefully, other physicians treating patients with suspected rebound headache will benefit from this report and will be able to better manage their patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Treatment of primary headache in the emergency department.BACKGROUND: Each year many patients present to an emergency department for treatment of acute primary headache. We investigated the diagnosis and clinical outcome of patients treated for primary headache in the emergency department. methods: patients treated for acute primary headache in the emergency department completed a questionnaire related to their headache symptoms, response to treatment, and ability to return to normal function. These responses were compared to the treating physicians' observations of the patient's condition at the time of discharge from the emergency department. RESULTS: Based on the questionnaire, 95% of the 57 respondents met International headache Society diagnostic criteria for migraine. Emergency department physicians, however, diagnosed only 32% of the respondents with migraine, while 59% were diagnosed as having "cephalgia" or "headache NOS" (not otherwise specified). All patients previously had taken nonprescription medication, and 49% had never taken a triptan. In the emergency department, only 7% of the patients received a drug "specific" for migraine (ie, a triptan or dihydroergotamine). Sixty-five percent of the patients were treated with a "migraine cocktail" comprised of a variable mixture of a nonsteroidal anti-inflammatory agent, a dopamine antagonist, and/or an antihistamine; 24% were treated with opioids. All 57 patients reported that after discharge they had to rest or sleep and were unable to return to normal function. Sixty percent of patients still had headache 24 hours after discharge from the emergency department. CONCLUSION: The overwhelming majority of patients who present to an emergency department with acute primary headache have migraine, but the majority of patients receive a less specific diagnosis and a treatment that is correspondingly nonspecific.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/6. Chronic daily headache: a rational approach to a challenging problem.Chronic daily headache (CDH) is a significant public health problem with 3 to 5% of the population worldwide experiencing daily or near-daily headaches. patients with CDH can be particularly challenging, and clinicians require a systematic approach to help guide investigations and management. The revised 2004 International headache Society classification Criteria introduces formalized criteria for several CDH disorders including chronic migraine and medication overuse headache as well as new daily persistent headache, hemicrania continua, hypnic headache, and sunct syndrome. Medication overuse is common in patients with CDH who present to physicians. Familiarity and comfort with drug-withdrawal and detoxification strategies is therefore essential. patients with chronic migraine and chronic cluster experience significant disability and diminished quality of life. The ability to manage these patients effectively is a rewarding clinical experience.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. neck-tongue syndrome and related (?) conditions.A search has been made for the neck-tongue syndrome. It started out with a systematic inquiry during the Vaga study of headache epidemiology during the years 1995-97. Two cases were detected relatively early during the study. This led to a scrutiny of such cases also in our hospital headache practice. The origin - and the basis of the study, nevertheless, was the Vaga study. In the Vaga study, where 1838 18-65-year-old parishioners were examined, there were four neck-tongue syndrome cases (N-TS), i.e. a prevalence of approximately 0.22%. N-TS may be more frequent than hitherto surmised. A variant was observed in one case; a young male: instead of numbness, a 'spasm' seemed to occur in the tongue. None of the four had at any time consulted their physician for their complaints. In our regular headache practice, two new cases were detected. In one of them and in one of the Vaga cases, there was a combination with ipsilateral cervicogenic headache (CEH). In N-TS, there may be both ipsilateral headache and upper extremity sensory phenomena, a constellation reminiscent of CEH. The possible pathogenetic relationship between N-TS and CEH is therefore discussed in some detail.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |