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R B Lipton

Publications and source records attributed to R B Lipton.

At least 181 records · Page 10Linked to original sources
PubMed1994

Transient worsening of optic neuropathy as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease.

A 58-year-old woman developed neurologic and neuroophthalmologic manifestations of Lyme disease, including a radiculomyelitis, cranial neuritis and mild right optic neuropathy. Upon treatment with intravenous ceftriaxone a Jarisch-Herxheimer reaction occurred with encephalopathy, mild fever, worsening radiculomyelitis, and deterioration of her visual acuity. Intravenous methylprednisolone was given, and the visual acuity recovered over 72 hours. This case suggests that transient worsening of optic neuropathy can develop as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease.

Ceftriaxone↗
PubMed1994

Comorbidity of migraine: the connection between migraine and epilepsy.

Although an association between migraine and epilepsy has long been discussed, it has rarely been studied systematically. According to the evidence from the large epidemiologic study reviewed in this article, individuals with epilepsy are 2.4 times more likely to develop migraine than their relatives without epilepsy. Risk of migraine is elevated in patients with partial-onset and generalized-onset seizures. The comorbidity of migraine and epilepsy may be explained by a state of neuronal hyperexcitability that increases the risk of both disorders. Clinical and EEG features useful in the differential diagnosis of migraine and epilepsy as well as in the diagnosis of both conditions when they occur concurrently are reviewed. When migraine and epilepsy occur together, therapy with agents effective for both conditions should be considered.

Adult↗
PubMed1994

Overview of diagnosis and treatment of migraine.

Optimal migraine therapy begins with an accurate diagnosis and knowledge of the symptoms that the patient finds most disturbing. Pharmacologic treatment of migraine may be acute (abortive, symptomatic) or preventive (prophylactic); both approaches are frequently required in patients with frequent, severe headaches. Drugs for acute care consist of analgesics, antiemetics, anxiolytics, nonsteroidal anti-inflammatory drugs, ergots, steroids, major tranquilizers, narcotics, and selective serotonin agonists. Preventive agents include beta-blockers, calcium channel blockers, antidepressants, serotonin antagonists, and anticonvulsants. The choice of a preventive drug depends on side effect profiles and comorbid conditions. Behavioral interventions, such as biofeedback and relaxation techniques, are an important complement to pharmacologic therapy; however, drugs are the mainstay of migraine therapy. To ensure that therapy achieves optimal results, the individual patient's preferred approach to this debilitating problem must be considered carefully.

Adrenergic beta-Antagonists↗
PubMed1994

Migraine heterogeneity. Disability, pain intensity, and attack frequency and duration.

Data from population-based studies are summarized to characterize the full range and variability of the impact migraine has on the individual. Despite differences in methods and data collection in population-based studies describing disability, pain intensity, and attack frequency as well as the duration of migraine and other headaches, several patterns emerge. On average, migraine headaches are more disabling, more painful, and longer in duration than other types of headaches. Females report more pain and disability with headache than do males. Although disability measurements are important in demonstrating the effect of headache on both the individual and society, actual measurements often fall short. Most studies use only workdays lost as the sole measure of disability. Most migraineurs do not miss work while experiencing a headache; instead, they attempt to function on the job, with considerably reduced effectiveness. Computing only workdays lost does not account for impairment at work nor does it show the impact of migraine on other aspects of life. In addition, evidence suggests the presence of a pain intensity threshold for disability. Headache-related pain intensity below the threshold is not associated with disability. Despite the threshold of pain intensity for disability, a significant proportion of migraine sufferers report levels of pain intensity above the threshold in the absence of work-related disability. The grading of headache severity should be a composite that would permit a more complete image of the heterogeneity of migraine's effects and a more accurate idea of the need for healthcare services. This composite should include two areas: (1) more complete measures of life impact, encompassing daily activities in a number of domains, including work, family, and social activities; and (2) an assessment of pain intensity and attack frequency.

Adolescent↗
PubMed1994

Assessing headache severity. New directions.

Headache is a heterogeneous condition that varies widely in global severity and in severity of individual attacks. Whereas recent efforts have focused on improving the diagnostic criteria for classifying headache, less effort has been directed toward developing reliable, valid, and clinically useful methods of assessing the impact or severity of headache. Existing measures of severity include one or more of the following weaknesses: (1) only pain intensity is assessed or the measure is incomplete in other ways, (2) measures have little or no prognostic value for relevant outcomes, (3) the reliability or the validity of the measure has not been assessed, or (4) the measure is too cumbersome for clinical practice or field research. We describe a brief, simple method for grading the severity of headache, the Chronic Pain Index, which assumes that a continuum of pain intensity and disability is the underlying dimension of severity. Along this continuum, lower levels of severity are differentiated by pain intensity and higher levels by interference with function. The prognostic value of the results from a seven-item questionnaire for grading headache severity is compared with that of alternative measures. The Chronic Pain Index showed the strongest independent cross-sectional and prospective correlation with measures of headache impact, depression, and use of healthcare services. These results support the potential utility of brief methods of assessing headache severity and exemplify the importance of including measures of interference with function when assessing severity.

Headache↗
PubMed1994

Migraine classification and diagnosis. International Headache Society criteria.

In 1988, the International Headache Society (IHS) classification committee published operational diagnostic criteria for a broad range of headache disorders, including migraine. These criteria have been translated into more than 10 languages, providing uniform terminology for clinical practice, multinational clinical trials, and biologic and epidemiologic research. The criteria have also been evaluated in a limited number of field studies intended to address their reliability, validity, comprehensiveness, and generalizability. The IHS criteria for migraine provide one method for targeting a group of headache patients in need of care.

Humans↗
PubMed1994

Migraine. Identifying and removing barriers to care.

The high levels of pain and disability associated with undiagnosed migraine or inadequate treatment of migraine offer a potential target for healthcare intervention. Both the individual patient and society are affected by decisions regarding which migraine sufferers are most in need of medical care. Pain is the most important symptom for the individual patient, but disability may be the most important consequence of migraine for an increasingly cost-conscious society. These two perspectives are the components of a migraine severity or impact measure being developed to define migraine sufferers most in need of care. The criteria for developing screening programs provide a context for evaluating healthcare interventions for migraine. Barriers to effective care occur on at least three levels: many people with migraine do not consult doctors; consulters may not receive the correct diagnosis; and even when the correct diagnosis is made, many migraineurs do not receive effective treatment. Screening and impact measures may help both to improve diagnosis and to determine which migraineurs are most in need of care. Public and physician education, screening, and impact measures might circumvent many of the barriers to effective care for people with migraine.

Health Services Accessibility↗
PubMed1993

Determinants of incident non-insulin-dependent diabetes mellitus among blacks and whites in a national sample. The NHANES I Epidemiologic Follow-up Study.

The excess incidence of non-insulin-dependent diabetes mellitus noted among African Americans in the past two decades may be attributable to variations in the distribution of specific risk factors, or the impact of these risk factors may differ by ethnicity or sex. Over the 16 years (1971-1987) of the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, 880 incident cases of diabetes mellitus developed among 11,097 white and black participants who were between the ages of 25 and 70 years at baseline. There were substantial differences among the four race/sex groups with respect to age at baseline, as well as marked differences in the distribution of several major risk factors for diabetes, including obesity, subscapular and triceps skinfold thickness, blood pressure, income, activity, and educational level. The age-adjusted incidence of diabetes over the course of the study was 15.0% among black women, while it was 10.9% among black men. White women and men experienced similar, more moderate risks of 7.0% and 6.9%, respectively. The 100% excess risk among black women and the 50% excess among black men can in large measure explain the recent marked increase in diabetes rates in the black community. Furthermore, at nearly every level of obesity, blacks had a higher risk of diabetes than whites, suggesting that other factors contributed to risk. A significant interaction between race and body mass index (weight (kg)/height(m)2) was likewise demonstrated in multivariate analysis. Baseline age, race, body mass index, and ratio of subscapular skinfold to triceps skinfold were significantly related to incident diabetes, both overall and in separate models for men and women; in the entire cohort and in women alone, blood pressure, activity level, and education also contributed to risk. Other interactions were tested but were not found to be important. Despite sampling difficulties and inconsistencies in the data, the NHANES I Epidemiologic Follow-up Study provides evidence that the associations of anthropometric and sociodemographic variables with diabetes may vary among subgroups which have different mean levels and distributions of these risk factors.

Adult↗
PubMed1993

Pathological markers associated with normal aging and dementia in the elderly.

We investigated the associations of pathological markers of Alzheimer's disease (AD) and diffuse Lewy body disease as well as possible markers of vascular dementia with cognitive function in a sample of 20 nondemented and 35 demented subjects (median age of both groups, 88 years) who had been studied prospectively for 4.0 +/- 2.1 years. Very old demented subjects almost always had nonneuritic senile plaques, but over half had no neuritic senile plaques and little other AD pathology. Five subjects had cortical Lewy bodies; all were demented. We propose that hippocampal sclerosis, leukoencephalopathy, and multiple lacunae are possible markers of vascular dementia. When grouped together, these markers were significantly associated with dementia and occurred in 40% of demented subjects. As the relative frequency of neuritic markers of AD (and possibly AD itself) declines in the tenth decade, vascular dementia may become an increasingly important type of dementia.

Aged↗
PubMed1993

Headaches in the elderly.

Headache prevalence and etiology vary dramatically with age. The prevalence of primary headache disorders, such as migraine and cluster, declines with age, while the prevalence of secondary headache disorders, such as temporal arteritis and mass lesions, increases. In evaluating elderly patients with new onset of headache, a high index of suspicion for organic disease is required. Headache symptomatology also varies with age. For example, migraine may evolve into a pattern of chronic daily headache, or auras may occur in the absence of headache (late-life migraine accompaniments). A careful longitudinal headache history is therefore important. Headache management is also influenced by age. Elderly people are more susceptible to medication side effects and are often treated with several drugs. Medications may cause headaches and drug interactions may complicate therapy. For these reasons, age of onset and duration of illness are critical headache features that guide the subsequent approach to diagnosis and treatment.

Aged↗
PubMed1993

Headache and cortisol responses to m-chlorophenylpiperazine are highly correlated.

The serotonin receptor agonist m-chlorophenylpiperazine (m-CPP) stimulates the release of cortisol and prolactin, and induces migraine-like headaches. We have studied the neuroendocrine and headache responses to m-CPP in 8 subjects with migraine and 10 normal subjects. Each subject underwent two challenge tests, one with 0.25 mg/kg PO of m-CPP and the other with placebo, administered in a double-blind crossover format. Serial measurements of serum cortisol, prolactin, and m-CPP levels were made at 30-min intervals for 210 min following ingestion of the medication. The incidence and severity of headache was assessed by a structured telephone interview after each test. We confirmed that m-CPP stimulates the release of cortisol and prolactin, and may induce headache, in both migraine subjects and normal controls. The cortisol response as well as ratings of headache severity and duration directly correlated with plasma levels of m-CPP. There were highly significant associations between the cortisol response and both headache severity and duration, independent of m-CPP plasma levels. We did not find statistically significant differences between the migraine and normal subjects in terms of their neuroendocrine or headache responses to m-CPP.

Adult↗
PubMed1993

Episodic paroxysmal hemicrania: 3 new cases and a review of the literature.

Episodic paroxysmal hemicrania (EPH) is a rare, benign disorder characterized by discrete bouts of hemicranial headaches separated by periods of pain-free remissions. EPH is frequently mistaken for episodic cluster headache because they have similar temporal profiles and clinical features. EPH is differentiated from cluster headaches by an increased frequency and a shorter duration of individual attacks. Establishing the diagnosis of EPH is important because of its unique response to treatment with indomethacin and not standard anti-cluster headache medications.

Adult↗
PubMed1993

Epidemiology of migraine.

Migraine epidemiology presents methodological challenges, partially simplified by the use of the new International Headache Society (IHS) Classification. Most previously published migraine studies were clinic-based, which introduces bias since less than 5% of migraineurs consult specialists. A series of population-based studies of migraine prevalence and incidence, based on the new operational IHS criteria, are now available and are reviewed, along with the migraine personality, comorbid psychiatric conditions and neuropsychological impairment. Migraine headaches are now divided into those with aura (classic migraine) and those without aura (common migraine). Headache occurs in about 91% of men and 96% of women, migraine occurs in about 6% of men and 18% of women (one-year prevalence). Migraine is most common in the third decade of life and in lower socioeconomic groups. It is associated with an increased prevalence of depression and panic attacks.

Adolescent↗
PubMed1993

Reliability in headache diagnosis.

The reliability of headache diagnosis using the criteria of the International Headache Society (IHS) has not been well studied. One definition of reliability refers to the reproducibility of diagnoses assigned to the same individual at different times. Reproducibility of diagnosis should be assessed using different clinicians at different times, with or without specific diagnostic instruments. A diagnosis may be unreliable because of variability in diagnostic criteria, in the clinical information used to assign diagnoses, or in the interpretation and application of clinical information to a given set of diagnostic criteria. Reliable diagnostic methods are essential to the development of valid diagnostic methods, as well as for the identification of headache risk factors, biological markers, and effective treatments. An approach to studying the reliability of the International Headache Society criteria is outlined, modeled after the extensive studies conducted in the area of psychiatric diagnosis.

Evaluation Studies as Topic↗
PubMed1993

Migraine headache: epidemiology and health care utilization.

Population-based studies of headache can help inform the development of diagnostic criteria. In population-based studies, migraine has been consistently revealed as a common disabling condition that affects males and females of all ages. From data obtained in a national survey of the United States population, we show that the prevalence of migraine and the frequency of attacks increase as household income decreases. Disability from attacks is not related to income. In contrast, physician diagnosis is more likely as household income increases. Moreover, physician diagnosis is more likely among females, older cases, those more likely to experience disability, and migraine sufferers reporting nausea (males), vomiting, and visual and sensory aura. Analysis of our data leads us to conclude that the symptoms most strongly associated with diagnosis may provide the greatest concern and interest on the part of physicians to make a diagnosis, even though other migraine-related symptoms are more common in the population and in clinical settings. Finally, among migraine sufferers with severe disability, a very large proportion do not receive the benefits of medical diagnosis and treatment. Though most migraine sufferers use OTC medications, given the frequency and associated disability of their migraine attacks, current therapy appears unsatisfactory.

Adolescent↗
PubMed1993

A headache clinic-based approach to field trials of the International Headache Society criteria.

Criteria for the diagnosis of headache disorders have recently been developed but require empirical validation. We present an approach to the evaluation of headache criteria in a headache clinic: define the group of headache sufferers to be studied, obtain data used in establishing the diagnosis, apply the diagnostic criteria and assess their usefulness. In applying this method to a group of patients with chronic daily headache, we found that approximately one-third would not fit the current criteria for chronic tension-type headache. We conclude that empiric validation of headache criteria based on subjective data is a complex and iterative process. Operational criteria for headache diagnosis to be used by primary care physicians should be validated in that setting and ideally should be relatively simple.

Chronic Disease↗
PubMed1993

Validity of family history data on severe headache and migraine.

This study evaluated the validity of family history data on severe headache and migraine obtained from adult probands with epilepsy in a family study of seizure disorders. We compared the probands' reports of severe headaches and migraines in their parents and full siblings with symptom-based diagnoses based on self-reports. Overall sensitivity was 48% for severe headache and 44% for migraine. When we used reports of severe headaches to screen for migraine headaches in the relatives, sensitivity was 56%. These results indicate that severe headache and migraine are underreported in family history interviews with first-degree relatives. To obtain accurate information on headaches in families for clinical practice and genetic research, direct interviews with each relative may be required.

Adult↗