Response of non-migrainous headaches to chlorpromazine

Chlorpromazine, given intravenously, is a useful agent in the treatment of acute migraine headaches. Patients with more serious conditions, however, may also respond to this medication. In this paper we report two patients who were initially diagnosed as having migraine headaches and treated with chlorpromazine. Both experienced temporary pain relief and it was only after repeated presentations to the emergency department that their conditions--a subarachnoid hemorrhage and a subdural hematoma--were accurately diagnosed. Because of this, caution must be exercised before re-treating within a short period of time, a patient with recurrent headache. Strong consideration must be given to an alternate diagnosis and such a diagnosis should be actively sought should there be any suspicion of a non-migrainous cause for headache. It is only by doing so that we may avoid missing more serious and life-threatening conditions such as those with which our patients presented.     

Chronic daily headache: a time perspective

OBJECTIVE: To determine the development and outcome of chronic daily headache in 258 headache practice patients, consisting of 50 men and 208 women. Chronic daily headache was defined as headaches occurring on at least 5 days per week for at least 1 year. METHODS: Two hundred fifty-eight patients with headache were interviewed and evaluated. Ninety-one patients were contacted by telephone for follow-up. RESULTS: Twenty-two percent of the patients had daily headaches from the onset, and 78% initially experienced intermittent headaches. Of the patients with initially intermittent headaches, 19% experienced an abrupt transition into daily headaches and 81%, a gradual one. In the patients with gradual transition, the transition of the initial, intermittent headaches into daily headaches took an average of 10.7 years. The initial headaches were mild in 33% of the patients and severe in 67%. The severe headaches were associated with nausea and vomiting significantly more often than the mild ones. However, the daily headaches that these patients ultimately developed were the same, regardless of whether the initial headaches were mild or severe. The patients who gradually developed daily headaches from initially intermittent headaches were contacted to determine the outcome of their headaches. Of these patients, 33% continued to have daily headaches and 67% again experienced intermittent headaches. Of the latter group, 88% of the patients who now had migraine also had migraine initially.     

Psychosocial Functioning in Schoolchildren With Recurrent Headaches

The psychosocial functioning of 113 schoolchildren (8 to 15 years old) reporting headaches at least once a month was compared to a group of headache-free control subjects matched for sex and age. Thirteen percent of the headache sufferers had migraine headaches, 28% had episodic tension-type headaches, 30% had chronic tension-type headaches, and 29% had migraine coexisting with tension-type headaches.
Overall, the headache sufferers experienced more somatic complaints, stress, and psychological symptoms, in addition to being absent from school (due to illness), more often and reported fewer caring persons as compared to headache-free controls. Although few differences between the four headache groups emerged in the children's psychosocial functioning levels, children with migraine coexisting with tension-type headaches had significantly more frequent somatic complaints than those having episodic tension-type headaches. In addition, children with migraine or migraine coexisting with tension-type headaches were more often absent from school than those having tension-type headaches only. A significant but weak relationship between children's headache severity and their somatic complaints was noted.     

Women's issues of migraine in tertiary care

OBJECTIVES: To document the frequency and types of symptoms of migraine in a large group of female migraineurs in tertiary care. Background.-Hormonal changes remain a significant accompaniment in the life cycle of the female migraineur. Little is documented on the relationship of women's issues to other features of migraine or to the lives of patients with migraine. Successful management of migraine mandates attention to women's issues from menarche to beyond menopause. The more information available to this end, the more confidently the clinician can prognosticate, guide, and treat the female patient. METHODS: Women's issues were evaluated in 504 women with migraine diagnosed according to the criteria of the International Headache Society (codes 1.1 and 1.2). The variables graded on a scale of 0 to 3 at the initial visit included premenstrual syndrome, menopausal symptoms, use of birth control pills, use of hormone replacement therapy, hormonal triggering of headaches, worsening of headaches with birth control pills or hormone replacement therapy, headaches with menses only, headaches with menses and at other times, headaches in pregnancy, headaches unchanged in pregnancy, headaches worse in pregnancy, and headaches better in pregnancy. These variables were stratified by age and headache diagnosis. RESULTS: Premenstrual syndrome was reported in 68.7% of patients, menopausal symptoms in 29.0%, and headaches attributed to birth control pills or hormone replacement therapy in 24.4% of patients. Sixty-four point nine percent of women had headaches with menses as well as at other times, while 3.4% of women had headaches exclusively with menses. A pregnancy was reported in 61.3% of the women; 20.4% did not experience headache in pregnancy. Of the 79.6% who did experience headache, 17.8% reported that headaches improved in pregnancy, 27.8% reported headaches to be unchanged, and 34% reported a worsening of headaches. Hormone replacement therapy or birth control pills triggered headaches in 64% of the study group. Patients with 100% aura were significantly different from patients with 0% aura, being less likely to have headaches worsening with birth control pills or hormone replacement therapy (P <.01) and more likely to have headaches occurring during pregnancy (P <.05). When patients with 100% aura were matched for age, headache frequency, use of birth control pills or hormone replacement therapy, and use of prophylactic medications with patients having 0% aura, the former were significantly less likely to have menopausal symptoms (P <.05), less likely to have headaches worsening with birth control pills or hormone replacement therapy (P <.01), and more likely to have headaches occurring only during pregnancy (P <.05). CONCLUSIONS: This study provides a documentation of women's issues in a large cohort of patients. Stratification by headache type, presence of aura, and age refine the study.     

Headaches amongst pool players

BACKGROUND: Pool-players' headache is a newly described entity. We studied the prevalence and risk factors for the development of headaches amongst pool players. METHODS: We obtained demographic information, history of pre-existing headaches, frequency and duration of pool-playing, history of pre-existing headaches and their subtypes, competitive pool-playing and worsening or development of headaches amongst pool-players at 2 pool centers. Univariate and multivariate analyses were performed and statistical significance was set at P < .05. RESULTS: Two hundred and three players, of mean age 22.6 (SD 7.7 years), participated in this study. Of the 21 respondents who reported headaches when playing pool, 11 (52.4%) had pre-existing headaches and 10 (47.6%) had no pre-existing headaches. Age and history of pre-existing headaches were significantly associated with worsening of headaches. CONCLUSION: Pool-players are susceptible to the development of headaches. Avoidance and reduction in the frequency of pool-playing may reduce the frequency of headaches amongst pool players.     

Development of chronic daily headache: a clinical study

We studied the development of chronic daily headache in 258 headache practice patients, 50 men and 208 women. Chronic daily headache was defined as headaches occurring at least 5 days per week for at least 1 year. Twenty-two percent of the patients had daily headaches from the onset, and 78% initially experienced intermittent headaches. Of the patients with initially intermittent headaches, 19% experienced an abrupt transition into daily headaches and 81% a gradual one. The distribution of the age of daily headache onset was the same in the patients with daily headaches from the onset and in those with initially intermittent headaches but with abrupt transition into daily headaches. The distribution of the circumstances of daily headache onset was also the same in the groups. The most common circumstance of abrupt onset of daily headaches was head, neck, or back injury, in 61% caused by a motor vehicle accident. In the patients with initially intermittent headaches but with gradual transition into daily headaches, the transition took an average of 10.7 years.     

The Influence of Pain State on Physiological Reactivity of Tension Headache Sufferers

SYNOPSIS
This study compared physiological reactivity to stress of subjects who frequently experience tension headaches and subjects who rarely get headaches. Physiological measures were Frontal and Trapezius muscle tension and Heart Rate. Subjects prone to headaches and subjects not prone to headaches did not differ on any variable, although there was a trend for subjects who were prone to headaches to have the highest Frontal muscle tension levels. For further analyses, subjects prone to headaches were separated into two groups: Subjects with headache during the psychophysiological assessment and subjects who were headache-free during the assessment. Only subjects who were prone to tension headaches and who were actually experiencing a headache at the assessment had significantly higher Frontal muscle tension than controls who were not prone to headaches. These results suggest greater attention needs to be paid to the subjects' current headache state in research on the psychophysiology of headache.     

Chronic post-traumatic headaches classified and compared with natural headaches

This study sought to determine whether chronic post-traumatic headaches are different from or identical to the naturally occurring headaches. The chronic post-traumatic headaches of 48 patients were classified, as if they were natural headaches, by the diagnostic criteria of the International Headache Society. Thirty-six patients' headaches (75%) were chronic tension-type headache, 10 (21%) were migraine without aura , and 2 (4%) were unclassifiable. The characteristics and accompaniments of the headaches within each diagnostic group were then compared to those in a control group with natural headaches of the same type. No notable differences between the post-traumatic and control groups were found. Hence, chronic post-traumatic headaches have no special features, but are symptomatically identical to either chronic tension-type headache or migraine without aura (in this series of patients). This identity suggests that post-traumatic headaches are generated by the same processes causing the natural headaches, not by intracranial derangement from head blows or jolts.     

Effects of noise and a stressor on head pain

OBJECTIVE: Can causal relationships be established between negative affect (NA) and headaches, and noise (N) and headaches? Do NA and N interact to cause headaches? Do NA and N cause headaches by means of the same or different physiological mechanisms? Are the answers to these questions a function of diagnostic status? BACKGROUND: A functional model of chronic headaches has been proposed that seeks to understand the variance in headaches by focusing on the controlling variables, that is, the antecedents and consequences. This study is one in a series investigating the immediate antecedents of headaches, namely the trigger factors. DESIGN: Twenty-four subjects with migraine and 44 subjects with tension-type headache were randomly assigned to one of four experimental conditions defined by the presence or absence of two antecedent challenges, a stressor (S) designed to induce NA and N. METHODS: The S challenge consisted of difficult-to-solve anagrams accompanied by failure feedback. The N challenge consisted of 50 dB of white N. Laboratory sessions were divided into adaptation, baseline, challenge, and recovery phases. Responses were measured in terms of headache intensity ratings, forehead electromyographic activity, heart rate, blood pressure, and temporal pulse amplitude (TPA). RESULTS AND CONCLUSIONS: Both NA and N precipitated headaches. These two factors did not interact in triggering headaches. Headaches induced by N were associated with elevated TPA but headaches induced by NA were not associated with significant physiological changes. Diagnosis was not related to any of the outcomes.     

Relationship between sleep apnoea syndrome,snoring and headaches

There is still a controversy regarding the relationship between sleep apnoea syndrome and headaches, especially morning headaches. Our objectives were: (i) to compare the prevalence and the clinical data of headaches in sleep apnoea syndrome (SAS) and control (snorers) groups defined by polysomnographic recording; (ii) to analyse the clinical improvement of headaches with appropriate treatment; and (iii) to correlate headaches with mood disorders, and nocturnal respiratory and architectural sleep parameters in order to understand the underlying pathophysiological mechanisms. This is a prospective study of 324 consecutive patients referred to our sleep centre for snoring. Of these, 312 patients who underwent sleep polysomnography were finally included. Patients and controls were interviewed about their medical past, headache history and clinical characteristics, their daytime sleepiness (Epworth's sleepiness scale) and their mood disorders (Zerssen's scale). Follow-up of patients with headaches (SAS and control groups), treated or not, was also assessed. According to our definition of SAS, patients were dissociated in SAS (n=164) and snorers (n=148). Fifty-three SAS patients had headaches, of whom 58.5% (n=30) suffered from morning headaches. However, there was no statistical difference between the two groups concerning the prevalence and the clinical characteristics of headaches. In addition, headaches and morning headaches were not correlated with nocturnal respiratory and architectural sleep parameters, nor with excessive daytime sleepiness, but were strongly correlated with mood disorders. In 36 SAS patients, headaches improved under treatment, but this was not statistically different from what was found among untreated snorers. Headaches and morning headaches are common in patients with SAS but may be considered as a non-specific symptom. The underlying mechanisms are not fully elucidated but depression could play an important role. Despite this absence of specificity, the treatment of SAS, especially nasal continuous positive airway pressure, leads to an improvement in headaches in several cases.     

Chronic paroxysmal hemicrania-like headaches in a child: response to a headache diary

Chronic paroxysmal hemicrania and cluster headache are both characterized by recurrent, severe, unilateral headaches accompanied by symptoms and signs of autonomic dysfunction. They are differentiated by the frequency, duration, and medication responsiveness of the headaches. Both occur in childhood, although such reports are rare. A 6-year-old boy presented with chronic paroxysmal hemicrania-like headaches. Through the use of a headache diary, his headaches were found to follow stressful events and resolved shortly after the introduction of the diary. Precipitation of chronic paroxysmal hemicrania-like headaches by stress has not been previously reported. We recommend the use of a headache diary as both an aid to diagnosis and an initial nonpharmacological therapeutic intervention for children with such headaches.     

Headaches Associated With Nasal Obstruction Due to Deviated Nasal Septum

A deviated nasal septum not only can cause a blocked nose, but may also be associated with headaches. This study evaluates the nature of these headaches, the effect of submucous resection of the nasal septum, and the factors associated with postoperative headache relief. Deviated nasal septa were corrected by submucous resection in 99 men and 17 women. Patients were studied at 4 to 48 months (mean 18 months) postoperatively. Fifty-five of the 116 patients studied (47.4%) had preoperative recurring headaches. Thirty-five of the 55 patients with headaches (63.6%) experienced relief (complete or partial) of their headaches at a mean follow-up period of 18 months. Patients were more likely to be relieved of their headaches following submucous resection if the headaches were most intense over the frontal region, pressure like in nature, and if the submucous resection resulted in relief of nasal obstruction. It is possible that headaches recur in the long term, and it is postulated that central mechanisms play a role.     

The Relationship of Cocaine to Headache in Polysubstance Abusers

SYNOPSIS
In a questionnaire survey of inpatient polysubstance abusers it was found that cocaine relieved migraine-type headaches much more often in chronic headache sufferers than in those with only occasional headaches (p < .05). However, cocaine could also bring on headaches after several hours, both in chronic headache sufferers and in those not subject to headaches. The fasts that cocaine may relieve headache immediately, and also may precipitate headaches several hours after use, suggests that the well-known vasoconstrictive actions of cocaine may be responsible. Migraineurs seem more susceptible to some of these effects of cocaine than are people without chronic headaches.     

Phenothiazines inhibit cholesteryl ester formation in J 774 monocyte-like cells

The effect of phenothiazines (trifluoperazine and chlorpromazine) on cholesteryl ester metabolism has been investigated in J 774 mouse monocyte-macrophages. The incorporation of oleic acid into cholesteryl ester and the activity of acylcoenzyme A: cholesterol-O-acyltransferase were strongly decreased in cells pretreated for 24 h with trifluoperazine or chlorpromazine. Furthermore, trifluoperazine or chlorpromazine decreased the degradation of acetylated low density lipoprotein by J 774 cells. When cell homogenates were preincubated in vitro with trifluoperazine or chlorpromazine, a marked inhibition of acylcoenzyme A: cholesterol-O-acyltransferase activity was observed. In cells incubated with acetylated low density lipoprotein loaded with radiolabeled cholesteryl-linoleate, trifluoperazine and chlorpromazine dramatically reduced the radioactivity recovered in cholesteryl esters. The radioactivity recovered in free cholesterol was also decreased, but to a lesser extent. These results suggest that phenothiazines could efficiently antagonize cholesteryl ester accumulation in macrophages by at least two different mechanisms: a reduction of modified LDL catabolism, and a direct inhibition of the enzyme acylcoenzyme A: cholesterol-O-acyltransferase.     

Gas-chromatographic analysis for chlorpromazine and some of its metabolites in human serum, with use of a nitrogen detector.

We describe a gas-chromatographic method for measuring chlorpromazine and its metabolites chlorpromazine sulfoxide, mono-N-desmethylchlorpromazine, and di-N-desmethylchlorpromazine at therapeutic concentrations in human serum, with use of a nitrogen detector. The compounds are extracted from serum at pH 10.5 into hexane/isoamyl alcohol, re-extracted into dilute HCl, and then extracted into hexane after alkalinization of the HCl. The N-desmethylated metabolites are measured as their respective N-trifuloracetyl derivatives; the parent drug and its sulfoxide are measured as the unchanged bases. Promazine is the internal standard. As little as 5 micrograms of chlorpromazine, 20 micrograms of chlorpromazine sulfoxide, 20 micrograms of mono-N-desmethylchlorpromazine, and 10 micrograms of di-N-desmethylchlorpromazine per liter can be measured in 2-mL samples of serum. The within-run coefficients of variation for assays of these drugs at 100 micrograms/L are 2.7%, 5.6%, 5.1%, and 5.3%, respectively. The procedure was applied to patients receiving therapeutic doses of chlorpromazine and to patients who had ingested an overdose of chlorpromazine.     

Flunarizine Is Effective in Prophylaxis of Headache Associated With Scleroderma

Migraine-like headaches may occasionally be seen in patients with scleroderma. The mechanism of these headaches is not well established but may be secondary to central "Raynaud's phenomenon". We report a patient with such headaches that responded dramatically to the centrally acting calcium channel blocker, flunarizine. We suggest that flunarizine should be considered in the management of patients with scleroderma and migraine-like headaches.     

Other primary headaches

Most primary headaches are classified into a few categories, such as migraine or muscle contraction headache, and patients suffering from these headaches are common. On the other hand, other primary headaches are very rare. In this section entitled "Other primary headaches", eight headaches, including primary stabbing headache, primary cough headache, primary exertional headache, primary headache associated with sexual activity, hypnic headache, primary thunderclap headache, hemicrania continua, and new daily-persistent headache, are described. Some characteristics of other primary headaches are common in symptomatic headaches, such as subarachnoid hemorrhage or arterial dissection. Therefore, careful evaluations including neuroimaging are necessary to exclude organic diseases.     

Air Pollution: Bay Area

Background: This investigation was undertaken to study: a) the adsorption characteristics of chlorpromazine to activated charcoal and its formulations Carbomix® powder and Ultracarbon® tablets at gastric pH; b) the effect on chlorpromazine adsorption of polyethylene glycol and its combination with electrolyte lavage solution; c) the effect of the order of addition of polyethylene glycol-electrolyte lavage solution. Method: Ion selective electrode potentiometry, based on the selective, direct and continuous response of a chlorpromazine-ion selective electrode to the concentration of the free drug, was used. Successive additions ofmicrovolumes of a chlorpromazine solution were made into a charcoal slurry in acidic medium ofpH 1.2 with measurement of the chlorpromazine-ion selective electrode potential at equilibrium. Results: The maximum adsorption capacity values of activated charcoal, Carbomix and Ultracarbon, were 297,563, and 382?mg/g respectively, while the affinity constant values were 40.2, 70.4, and 40.5 L/g, respectively. The adsorption of chlorpromazine to each of the Ultracarbon and Carbomix components was compared to the total adsorption of the formulations. The addition of polyethylene glycol-electrolyte lavage solution causes a slight desorption of chlorpromazine from activated charcoal at gastric pH, more pronounced when polyethylene glycol-electrolyte lavage solution follows the addition of activated charcoal, suggesting the possibility of a nonspecific binding of chlorpromazine to polyethylene glycol. The amount of chlorpromazine adsorbed to Carbomix and Ultracarbon was not significantly affected at gastric pH by the presence of polyethylene glycol or polyethylene glycol-electrolyte lavage solution added either concurrently or sequentially to these formulations.     

Ictal Epileptic Headache: A Review of Current Literature and Differentiation From Migralepsy and Other Epilepsies

Ictal headaches are increasingly becoming the focus of research as more data demonstrate headaches existing as a sole manifestation of an epileptic event. Due to the difficulty in diagnosing the event as an epileptic phenomenon as opposed to a migraine, the condition is often misdiagnosed. This paper seeks to review the current published literature on ictal epileptic headaches as well as provide differentiation between ictal headaches and similarly presenting conditions. In doing so, we hope to improve the diagnosis of ictal headaches and thus improve patient care. We review two case studies that exemplify the potential of multiple conditions with comparable symptoms to ictal headaches, and discuss how to differentiate the variable diagnoses. As of the writing of this paper, there is no universally agreed upon set of features of ictal headaches; however, reviewing the current literature, there do seem to be several features that should be noted when treating patients. More research on the pathophysiology of ictal epileptic headaches needs to be done before the condition can be fully understood.