John R. Graham

A classification of headache: Ad Hoc Committee on Classification of Headache

THE TERM HEADACHE commonly denotes head pain from brow level up. This outline defines headaches somewhat broadly; it covers both painful and nonpainful discomforts of the entire head, including the face and upper nucha. Since so much that a man describes as headache may be any abnormal head sensation, it is essential for proper treatment to determine whether the complaint is actually one of pain. A useful scheme for the classification of the varieties of headache is one based on pain mechauisms. The divisions rest on experimental and clinical data, together with reasonable inference; the story is far from complete. Yet the arrangement can serve as a framework for diagnostic criteria for the major clinical types of headache and by emphasis on basic mechanisms it offers a logical approach to the planning of therapeutic trials. For convenience, short and simple names are suggested for certain major entities and are indicated in boldface type. Essential in the study of headache in most instances is an appraisal of its close link to the patient’s situation, activities, and attitudes. Sometimes in obvious ways, more often in subtle ones, headache may be the principal manifestation of temporary or sustained dif6culties in life adjustment. These relationships are notably evident in Croups I through V.

HEADACHE DURING HEMODIALYSIS

THE REGULAR Occurrence of severe headache during hemodialysis in a young woman being treated in the Dialysis Unit of Lemuel Shattuck Hospital caused serious problems in the medical management of the patient. This led to the observation that a considerable number of patients suffered headache in a similar fashion during hemodialysis and stimulated the initiation of the present investigation. The material herewith presented deals only with the epidemiology of this complaint and includes such observations as the frequency and nature of the headaches, their relation to the hemodialysis procedure, the medical history of the affected patients, and a discussion of future avenues for research and treatment. Detailed investigation of the biochemical, physiologic and other changes which evolve from the first part of the study as possible etiologic mechanisms will hopefully be the subject of a future report. In addition to the attempt to find a solution to the cause and treatment of headache for the dialysis patient, it seems worthwhile to utilize the unusual opportunity offered by the laboratory setting in which these headaches occur to study the nature and mechanisms of headache itself.

Vascular diseases, mortality, and migraine in the parents of migraine patients

To determine if people with migraine are at increased risk of certain vascular diseases, a retrospective cohort study of the middle-aged and elderly parents of migraine patients was carried out. Questionnaires about diseases in each of their parents were sent to migraine patients who had one parent with and one without migraine. Parents with migraine were compared to parents without migraine of the same sex within narrow age groups. The frequency of high blood pressure is estimated to be 1.7 times greater in people with migraine than in people without (p < 0.05). The risk of heart attack also is increased for people with migraine and is most evident below age 70 years, but the risk of stroke is not appreciably increased. For each sex, people with migraine tend to die at younger ages than people without migraine.

Aerosol ergotamine tartrate for migraine and Horton's syndrome.

ERGOTAMINE tartrate is still the most reliable agent for relief of the migraine attack. It is similarly useful in Hortons syndrome, which many classify as a variant of migraine. Numerous factors n...

The relationship of headache occurrence to barometric pressure

A total of 75 people residing in the metropolitan Boston area who had frequently recurring headaches kept a headache diary for one month beginning March 1975. Data were also collected about barometric pressure during this time. We found that the probability of headache severity on any day was independent of the effects of time. An inference of this, supported by other findings in this study, is that headache occurrence is minimally affected by time-related phenomena such as barometric pressure readings or changes..

Seven common headache profiles.

THE CAUSES of headache are so multitudinous that the physician confronted by a patient suffering from this complaint may find it useful to bear in mind a graphic representation of the clinical profiles of certain headache syndromes. One such profile may be constructed in the mind of the examiner by an analysis from the history of the features of a given attack of headache, and a second profile, as important a s the first, may be made which presents the natural history of these attacks in relation to significant events in the patient’s life. The profile of an individual attack is drawn from such facts in the patient’s story as time of the clay at which the attack is apt to occur; the duration of the attack itself in seconds, minutes, hours, or days; severity of the pain; the speed with which the pain reaches its peak after onset and its subsequent fluctuations in manner of offset; the nature of the pain, its location, and its response to therapeutic agents, posture, and trigger mechanisms; some of the tests which Dr. Kunkle described and physiologic alterations; and associated symptoms and their timing in reference to the headache. The lifetime profile of the patient’s headache may be drawn from a detailed account of the variations in frequency and severity of the actufl attacks as they occur over the years in relation to significant milestones and events in the patient’s career. These include family history of headache, as mentioned by Dr. Ostfeld; headache equivalents or forerunners, such as car sickness and cyclic vomiting attacks; puberty; high school and college; years spent in the Armed Services; marriage; pregnancy; trnvel and vacations; stressful situations; disease conditions such as peptic ulcer, rnlitis, hypertension, and jaundice; and operatioils. For the profiles to be formed into a true portrait, a thorough acquaintance with the patient’s general, medical, emotional, and social history is required. That such profiles in in-

Headaches, Drugs and Dermatology

Patient One was carsick as a child and had a strong family history of migraine in both parents and in one of six siblings. Her first migraine headache occurred at the age of eighteen while she was working overtime during training as an operating room nurse. Although the headache had begun, she continued to work. It persisted for two days as a right-sided, supra-orbital and occipital throbbing pain which was accompanied by nausea and vomiting. Almost all of her subsequent headaches have been of this type. Many of them have a prodrome of flashing lights. Her headaches were particularly bad at the time of her menses.

Endocardial Fibrosis Associated with Methysergide Therapy.

Excerpt Methysergide is probably causally related to the development of cardiac lesions in some patients taking this drug for headaches. We report our observations of the development and progress o...

Homo Sapiens Erectus Has a Headache

MICHELANGELO’S ADAM There is much to suggest that Man survived amongst the other creatures of the world because he is both smart and erect. Were it not for his superb selfprogramming computer of a brain, the freedom of his dexterous upper extremities to make tools and throw weapons, the elevated position of his sentient eyes, ears, and nose, and his ability to deliver information and express feelings by a remarkable combination of sounds and facial movements, he would not have survived long in the jungle. Small wonder, then, that his head, which houses these vital sources of thought, perception, and communication, holds the highest place not only in his body but also in his concept of himself. The signal importance of Man’s head to Man, makes it to him a source of particularly severe distress or pain, when it fails to work rightly or measure up to the demands placed upon it. Apart from the pain that any part of the body may create when it is injured, some organs cause pain as a result of being overburdened; pain arising from such inadequate responses to excessive demands or function may occur in many organs. The total significance of the pain, in terms of human distress, however, is related to the vital importance of the function that is being overtaxed. A charley horse in the thigh hurts but is not the cause for despair unless it happens just before the final, deciding game of the season. Angina pectoris not only hurts but also speaks to the owner of death and brings fear; headache is often a cranial angina. It bespeaks failure of the highest of Man’s functions to achieve their goals and brings despair, depression, and anxiety as well as a strong desire to escape from the “slings and arrows of outrageous fortune.” Thus, head pain may strike not only when the head is smitten or bleeds or is inflamed, but also when its complicated machinery malfunctions under pressure, or when failure, anger, guilt, and fear are crystallized into a pain in the mansion of their origin.

Plasma 18 Hydroxy- II - Deoxycorticosterone In Dialysis Patients With Headache

SYNOPSIS