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Biomedical subjects

Elizabeth Loder

Publications and source records attributed to Elizabeth Loder.

28 records · Page 2Linked to original sources
PubMed2002

Naratriptan in the prophylaxis of cluster headache.

A 36-year-old man with cluster headache refractory to trials of standard prophylactic treatment and only partially responsive to parenteral sumatriptan and inhaled oxygen was admitted to an inpatient pain unit. The diagnosis of cluster headache was confirmed by direct observation of a typical attack. Despite efforts at prophylaxis, the patient continued to experience three to four severe headaches per day. Attempts to control his headaches with scheduled parenteral dihydroergotamine were successful, but headaches recurred when the medication was tapered, and continuous or intermittent use of parenteral dihydroergotamine was not felt to be a practical option for the patient. Naratriptan 2.5 mg twice daily completely abolished his headaches, which recurred when the medication was discontinued. No electrocardiographic or laboratory abnormalities were observed during treatment, and the patient reported no side effects.

Adult↗
PubMed2002

Volume and nature of telephone calls in a specialty headache practice.

BACKGROUND: No information exists regarding the contribution of patient-related telephone calls to the burden of headache practice. OBJECTIVE: To identify the nature and volume of patient-related telephone calls to a specialty headache practice over a 1-month period. DESIGN AND METHODS: The characteristics of all patient-related calls to a single headache practitioner occurring during July 2001 were documented. Information was obtained on the caller, reason for call, length of call, timing and day of call, stated importance of call, patient's principal headache diagnosis, and principal comorbid psychiatric disorder, if any. RESULTS: One hundred sixty-five outpatient headache-related calls were received in July 2001, 3.17 for every hour of headache clinic scheduled. A total of 65% of all calls was generated by just 36% of callers. Of the 32 patients who placed more than one call during the study period, 50% had chronic daily headache, 53% had a personality disorder, and 38% had both. Twenty-seven percent of all calls were placed by someone other than the patient, 58% involved requests for medication refills, and 17% reported a new symptom or medication side effect. Over half of all calls were placed on Mondays and Tuesdays. Relatively few occurred outside work hours; 18% of calls characterized as "emergency" and 36% of calls characterized as urgent involved requests for controlled substances. Most of these calls were placed by patients with personality disorders. None of the 11 calls characterized as emergency calls was judged so by the physician; only 19% of the urgent calls were judged so by the physician. CONCLUSIONS: Telephone calls contribute substantially to the burden of caring for patients in a specialty headache practice. Patients with chronic daily headache and personality disorders contribute disproportionately to this telephone burden. Efforts to identify such patients at presentation and educate them regarding appropriate telephone use seem to be warranted.

Ambulatory Care Facilities↗
PubMed2002

Women and headache: a treatment approach based on life stages.

Effective headache management in women requires an understanding of the unique epidemiologic and pathophysiologic factors affecting women. We present preventive, abortive, and nonpharmacologic approaches to headache treatment that vary with the chronologic and hormonal stages of a woman's life, with special attention to headache during pregnancy and later in life.

Adolescent↗
PubMed2001

Menstrual Migraine.

Slightly less than half of women with migraine report that menstruation is an important trigger of headache episodes. However, it is rare that menstruation is the only trigger for a patient and its importance as a trigger may be over- emphasized. Accurate diagnosis requires a prospectively kept diary of information showing a consistent and mechanistically valid temporal correlation between migraine attacks and menstrual periods. Abnormal central nervous system response to normal fluctuations in hormones is the likely underlying cause of menstrual migraine. Patients with menstrual migraine do not generally have hormonal abnormalities. Currently available abortive therapy works well for menstrual-related migraine attacks. For the small subset of women for whom this is not the case, and whose menstrual periods and associated headaches are predictable, pre-emptive treatment of the expected headache with scheduled perimenstrual use of a number of agents can be helpful. A hormonal trigger for migraine headache does not mean that treatment must also be hormonal in nature. Choice of therapy depends on the frequency of menstrual migraine, predictability of menstrual periods, patient preference, and cost. For the small group of women with refractory menstrual migraine, hormonal therapy can be tried, with the understanding that the quality of evidence for these interventions is low and their risk to benefit ratios not established. The perimenstrual use of triptan medications is currently being investigated for the treatment of menstrual migraine. Preliminary results are inconclusive, and until further evidence regarding the efficacy, safety, practicality, and cost effectiveness of this approach is available, their routine use in this manner for menstrual migraine is not recommended.

Journal Article↗
PubMedDate not supplied

Use of botulinum toxins for chronic headaches: a focused review.

Botulinum toxin has been shown to effectively treat several types of pain associated with neurologic disorders. It has recently been evaluated for the treatment of various types of headaches. In studies of migraine headache, chronic daily headache (more than 15 days of headache per month), tension-type headache, and post-whiplash headache, patients have reported decreased pain after treatment with botulinum toxin type A. A more recently available preparation, botulinum toxin type B, has also been shown to provide relief to patients with transformed migraine headache and post-whiplash headache. Additional study is under way to determine the effectiveness of botulinum toxin for the treatment of chronic cluster headaches. Although the pathophysiology of headache is incompletely understood, muscle tension may trigger or aggravate migraine headaches. Botulinum toxin, which reduces muscle hyperactivity, may reduce headache pain by decreasing muscle tension. It may also provide peripheral and central neurogenic effects and reduce inflammation. Large, rigorously controlled trials of botulinum toxin are needed to better characterize its effects on various types of headaches and its role as a therapeutic agent. Current data suggest that botulinum toxin is safe and does not produce systemic effects associated with other types of headache treatments.

Botulinum Toxins↗
PubMedDate not supplied

Biomarkers in migraine: their promise, problems, and practical applications.

Biomarkers are physical signs or laboratory measurements that "occur in association with a pathological process and have putative diagnostic and/or prognostic utility." Biomarkers hold considerable promise for understanding and intervening in the disease process of migraine. They may permit recognition of individuals at risk of developing migraine, improve the timing, accuracy, and precision of migraine diagnosis, and serve as indicators of treatment response and disease progression. Furthermore, they hold great promise for research. At the same time, there are important limitations to the use of biomarkers in migraine, including problems with validity, reliability, accuracy, and precision. Legal, ethical, and cost considerations are also important. This review describes the potential uses and limitations of biomarkers in migraine diagnosis, treatment, and research.

Animals↗
PubMedDate not supplied

Headache attributed to psychiatric disorder: a case series.

The association between psychiatric illness and headache is widely recognized. However, cases in which psychiatric disorders are the principal cause of headache are believed to be rare. "Headache attributed to psychiatric disorder" is a new category of secondary headache in the 2004 revision of the International Classification of Headache Disorders. The authors describe six patients in whom a psychiatric disorder is the most plausible cause of headache; most meet the new criteria or candidate criteria for headache attributed to a psychiatric disorder. The revised headache classification system appropriately recognizes headaches attributed to psychiatric disorder as a form of secondary headache.

Adolescent↗