Instant Remedies for Migraine

The Migraine And Headache Program

In this simple program you'll learn: 5 Body balancing techniques that free your diaphragm to do its actual job of pumping fresh air into your lungs. This will ensure that your body will have enough resources to do what needs to be done including healing your headaches. Simple breathing technique that boost your oxygen level. In a few minutes of practice, your blood may carry 20% more oxygen to your brain. This can immediately reduce even the worst headaches. Other breathing exercises that spread the oxygen delivered to the brain evenly. The parts of the brain that are often highly oxygen deprived will finally receive fresh oxygen on a plate. Simple head muscle exercises that remove tension from the muscles around the head such as the the jaw, the tongue, the throat, and the eyes. These exercises can quickly relieve tension from the head and eliminate headaches in just a few seconds. New revolutionary neck exercise that removes tension from the neck. Tension in the neck muscles does not only block blood flow to the brain, but will also not support the veins in pumping the blood which is their actual function. Some people experience blast of energy rushing up to their head after doing this exercise. More here...

The Migraine And Headache Program Summary


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Migraine and Cluster Headache

Migraine aura is well recognized as a cause of simple visual hallucinations complex dream-like visual hallucinations are less common. They are seen more frequently in migraine coma and in familial hemiplegic migraine. Rarely migraine-associated hallucinations may be of purely auditory nature, possibly reflecting a dysfunction of the temporal lobe due to ischemia 142, 143 . Olfactory, gustatory and other more complex hallucinations such as temporal-visual distortions have all been reported 144, 145 . Podoll and Robinson described the unusual case of auditory-visual synesthesia during migraine attacks the visual hallucinations consisted in a colored geometric figure induced by the sound of the alarm clock, which then disappeared with the alarm 146 . A few cases of recurrent lilliputian hallucinations during migraine attacks have been reported, although this type of hallucinations is usually associated with mesen-cephalic and or thalamic lesions (peduncular hallucinosis) 147 . Levitan et...


Primary headache syndromes Migraine see below Cluster, periodic, paroxysmal, brief, sharp, orbital headache that may awaken from sleep lacrimation. rhinorrhea. conjunctival injection, or unilateral Horner's syndrome Secondary causes of headaches fever, abnl neurologic exam. aura, duster-type headache Migraine Unilateral or bilateral, retro-orbital, throbbing or pulsatile headache lasts 4-72 h headache Common (64 ) headache without aura 5-HTi agonists (triptans) contraindic in Pts w complicated migraine. CAD. prior stroke combination of triptan < NSAID more efficacious than either single agent alone (jama 2007 297 1443)

Sources for Further Study

Strasburger, Victor C., and Robert T. Brown. Adolescent Medicine A Practical Guide. 2d ed. Philadelphia Lippincott-Raven, 1998. This book addresses the physical and psychosocial problems of teenagers that physicians are most likely to treat. The emphasis is on practical information. Applied diagnostic and treatment guidelines cover conditions such as asthma, diabetes mellitus, developmental problems, headaches, sexually transmitted diseases and pregnancy, depression, and eating disorders.

Why Do Clinicians Join Industry

Adverse event report frequency after a labeling change). More directly, occasionally, we have friends or relatives who benefit from the drugs that we develop. One of the authors of this chapter has been hugged to the point of assault by a complete stranger in Georgia (USA), a patient who judged him responsible for 'curing' her migraine. Neither protests that the reality is teamwork, nor perfume-induced sneezing, deterred this extraverted Southern lady

Models of Disease and Therapy

Many of the illnesses seen in office practice are not really diagnosed, just labeled (e.g., respiratory symptoms as a cold) or treated empirically. The causes of mental illness, cancer, and AIDS were scientifically unknown for years. Some disagreement still exists, for example, about the causes of AIDS.18 Neither does scientific medicine explain the impact of diseases and their treatments on people's lives as well as it explains the biology of the disease. For example, think of migraine, epilepsy, or insulin-dependent diabetes, or almost any serious disease, especially as it complicates the life of a child and his or her family.

Neurological complications

Stroke due to infarction is more frequent in younger children and those over 30 years, whereas haemorrhage is more common between 20 and 30 years. Stroke is rare in infants, increases to 1 in 100 patients per year between 2 and 9 years, and then diminishes to half of that incidence in older patients. Focal seizures or transient ischaemic attacks (TIAs) are common presenting symptoms of stroke, followed by hemiparesis, coma, speech or visual disturbances. The site of bleeding in haemorrhagic stroke is frequently subarachnoid, and these patients present with severe headache, vomiting and coma. Death can occur during the acute event, particularly with haemorrhagic stroke. Patients with neurological symptoms should be evaluated by computerized tomography (CT) or magnetic resonance imaging (MRI) to distinguish thrombosis from haemorrhage. Immediate exchange transfusion to lower HbS level to < 30 is required. Patients with haemorrhage may require surgical intervention to ligate accessible...

Medical Condition Category

Migraine with aura, at any age 4 Migraine without aura and age > 35 years 3 4* Headache without aura and age < 35 years 2 3 *This indicates that initiation of COCs is a category 3, but initiation of COCs after development of migraines is a category 4. Modified from WHO Medical Eligibility Criteria for Contraceptive Use. 3rd ed. Geneva Reproductive Health and Research World Health Organization, 2004. Women who might especially benefit from extended cycles are those who have symptoms exacerbated by their menses. This might include women with seizure disorders, endometriosis, menstrual headaches, premenstrual dysphoric disorder, menorrhagia or dysmenorrhea. By limiting the number of times a woman menstruates, one can also reduce the amount of suffering due to these conditions.

Role in Emotional Reactions

Tities of such drugs each time they are ingested in order to achieve the same emotional stimulation. Thus, with repeated usage, there is a decline in the overall emotional response. This decline in the euphoric effects of a drug is primarily the result of an increase in the opponent process, which can be characterized as the negative effects of the drug. This is presumably why habitual users experience severe physiological problems (for example, headaches or delirium tremens) upon termination of a drug.

Brain and Implied Pain

We obtained behavioral indices of Pain and Control conditions Six Japanese pain-evoking mimic words were selected from the top six high frequency words (mean judgment for evoking affective pain was 92 ) for generating unpleasantness due to affective pain mimic words were zuki-zuki for throbbing pain with a pulsing sensation, ghan-ghan for splitting headache as if being continuously struck, kiri-kiri for stabbing pain with a feeling of being drilled into with something sharp,chiku-chikufor an intermittent pain akin to being struck by thorns, hiri-hiri for a lingering feeling of pain, zukin-zukin for continuous throbbing pain. These six words were selected based on previous scaling studies (n 290) using a multidimensional scaling and a method of magnitude estimation for affective pain 9 . In the psychophysical magnitude estimation task, observers were asked to assign numbers (from 1 to 100) according to the strength of their psychological impression (average evaluated value 80) 12 . We...

Inflight Medical Emergencies

An inflight medical emergency is defined as a medical occurrence requiring the assistance of the cabin crew. It may or may not involve the use of medical equipment or drugs, and may or may not involve a request for assistance from a medical professional travelling as a passenger on the flight. Thus it can be something as simple as a headache, or a vasovagal episode, or something major such as a myocardial infarction or impending childbirth.

Laboratory Diagnosis

The most serious sequela is neural paragoni-miasis, which often presents with headache and seizure and can also include motor and visual disturbances (Table 17.7). The average onset of symptoms is around 16 months, approximately 10 months after pulmonary symptoms. Prevalence estimates are difficult to make and range from 1 to 51 , depending on the population studied (Higashi et al., 1971). Among several studies, the incidence of headaches was 1-24 , while seizures occurred in 1-18 of patients. In case studies selected for CNS involvement, seizures, visual disturbances and motor deficits occur in the majority of patients (Higashi et al., 1971 Shih et al., 1958). Concurrent presentation of pulmonary and nervous system complaints ranged from 10 to 100 in different studies. In the absence of pulmonary symptoms, the index of suspicion for neural paragonimiasis may initially be quite low.

Clinical Manifestations

The clinical and pathologic features of this infection are poorly defined. Although most patients appear to be asymptomatic (Adolph et al., 1962 Woodman, 1955 Holmes et al., 1969 Clarke et al., 1971), a wide range of clinical manifestations have been ascribed to M. perstans (Baker et al., 1967 Strohschneider, 1956 Stott, 1962 Sondergaard, 1972 Foster, 1956 Bourguignon, 1937 Gelfand and Wessels, 1964 Dukes et al., 1968 Baird et al., 1988 Basset et al., 1991 Rubin et al., 1987), including transient angioedema and pruritus of the arms, face, or other parts of the body (analogous to the Calabar swellings of loiasis) and recurrent urticaria. Less commonly, fever, headache,

Meningococcal infection

A variety of clinical manifestations may be produced when human beings are infected with Neisseria meningitidis the typical clinical picture is of acute pyogenic meningitis with fever, headache, nausea and vomiting, neck stiffness, loss of consciousness and a characteristic petechial rash is often present. The wide spectrum of clinical manifestations ranges from fulminating disease with shock and circulatory collapse to relatively mild meningococcaemia without meningitis presenting as a febrile illness with a rash. The carrier state is common.

Hypothalamicpituitarygonad Axis

The prevalence of mood disorders in women, including premenstrual syndrome (PMS) and post-partum depression, also deserves mention. PMS is a cyclic recurrence of symptoms both somatic (oedema, fatigue, breast tenderness, headaches) and psychological (depression, irritability, and affective lability). The symptoms start following ovulation and disappear within the first day or two of menses, followed by a symptom-free interval between menses and the next ovulation. In some cases (5-10 ), symptoms may be severe enough to interfere with normal functioning, leading to the diagnosis of premenstrual dysphoric disorder (PMDD) 106 . GnRH agonists, which produce a clinical ovariectomy'' by down-regulation of GnRH

Defining severe preeclampsia

Pre-eclampsia is severe when it manifests itself with a systolic or diastolic BP exceeding 160 or 110 mmHg, respectively. Pre-eclampsia may also be severe when it involves a systolic or diastolic BP above 140 or 90 mmHg, respectively, accompanied by abnormal hemostasis or end-organ dysfunction, such as headache, visual disturbances, and right upper quadrant pain with nausea or vomiting. The criteria used to diagnose severe pre-eclampsia are listed in Table 25.1 (ACOG Practice Bulletin, 2001). Intrauterine growth restriction (IUGR) was excluded from the criteria in 2000 by the National High Blood Pressure in Pregnancy Working Group because of inconsistencies in its definition.

Multiattribute Utility Measures

Having assessed patient preferences or utilities for individual items, for example by using rating scales, SG or TTO, there remains the issue of how to combine them. Some schemes use utilities as a form of item weighting for forming a summary index. However, there are few grounds for assuming that a patient with vomiting, pain and headaches should score the same as the sum of the three individual utility scores. Multi-attribute theory is a method for investigating the utilities associated with health states represented by a combination of item-scores.

Clinical Features

Cerebral involvement by gnathosomiasis is probably quite common and is thought to be the most important parasitic disease of the central nervous system in Thailand. Patients present with myelitis, signs of encephalitis or hemiplegia. The case fatality rate is high, up to 12 . Cerebral gnathosomiasis can be differentiated from eosinophilic meningitis caused by Angiostrongylus cantonensis, as gnathosomiasis is suggested by focal neurological findings, often beginning with severe neuritic pain followed by paralysis, or multiple cranial nerves can be involved, whereas in Angiostrongylus, infection is characterised by low-grade fever, headache, meningitis and lowered cerebral function associated with cerebrospinal fluid (CSF) eosinophilia. Cranial nerve involvement is less common and, when it occurs, usually involves cranial nerves VII or VIII.

Dream Like Experiences During Wakefulness Hallucinations

Visual hallucinations during wakefulness, at sleep onset (hypnagogic hallucinations) and on awakening (hypnopompic hallucinations) can occur in normal subjects as well as in patients with migraine, epilepsy, mid-brain thalamic lesions (peduncular hallucinosis), lesions causing visual loss (Charles Bonnet syndrome), sleep paralysis, narcolepsy, and

Reactions due to white cell and platelet antibodies

Febrile reactions are most frequently due to sensitization to white cell antigens and more rarely to platelet antigens. Together with urticaria, these are the most common type of immuno-logical reaction to blood transfusion. Antibodies are directed usually against HLA antigens, or sometimes against granulocyte and platelet-specific antigens they are stimulated by previous transfusions or pregnancies. Cytokines released from white cells during storage may also be pyrogenic. Characteristically, the onset of the reaction is delayed until 30-90 min after the start of the transfusion (depending upon the strength of antibody and the speed of transfusion). A rise in temperature may be the sole symptom, but the recipient may suffer chills, headache or rigors. There is no associated hypotension, lumbar pain or chest discomfort. These reactions are usually only troublesome rather than dangerous, except in very sick patients or in the presence of very potent lymphocytotoxic HLA antibodies.

Clinical Symptoms and History

Premenstrual syndrome is characterized by mood swings, depressed mood, irritability and or anxiety, which may be accompanied by physical symptoms. These symptoms occur exclusively during the luteal phase of the menstrual cycle. Common physical symptoms observed in PMS are breast tenderness, abdominal bloating, headache, and joint and muscle aches. The diagnosis of PMDD requires marked mood disturbance (depression, irritability, mood swings) as well as the presence of other emotional and or physical symptoms. Additionally, a significant

Endocrine imaging findings

Of primary hyperaldosteronism in pregnancy. Obstet. Gynecol., 86, 644. Basdogan, F., Visser, W., Struijk, P.C., et al. (2000). Automated cardiac output measurements by ultrasound are inaccurate at high cardiac outputs. Ultrasound Obstet. Gynecol., 15, 508-12. Belfort, M.A., Saade, G.R., Grunewald, C., et al. (1999). Association of cerebral perfusion pressure with headache in women with pre-eclampsia. Br. J. Obstet. Gynaecol., 106, 814-21. Burrows, R. F. and Kelton, J. G. (1990). Thrombocytopenia at delivery a prospective survey of 6715 deliveries. Am. J. Obstet. Gynecol., 162, 731-4. Connolly, G., Razak, A. R., Hayanga, A., Russell, A., McKenna, P., McNicholas, W.T. (2001). Inspiratory flow limitation during sleep in pre-eclampsia comparison with normal pregnant and nonpregnant women. Eur. Respir. J., 18, 672-6. Contreras, G., Gutierrez, M., Beroiza, T., et al. (1991). Ventilatory drive and respiratory muscle function in pregnancy. Am. Rev. Respir. Dis., 144, 837-41. Cunningham, F....

Beta receptor agonists

As has been mentioned, the pulmonary route has been used to achieve systemic delivery. A product containing ergotamine tartrate is available as an aerosolized dosage inhaler (360 pg per dose) and has the advantage of avoiding the delay in drug absorption due to gastric stasis associated with migraine. In vaccine delivery, aerosol administration of para-influenza Type 2 vaccine has been found to be more effective than subcutaneous injection49). Penicillin reaches the bloodstream in therapeutic quantities after pulmonary delivery, but kanamycin is poorly absorbed from the lung so can only be used for local drug delivery.

Motor Vehicle Accidents

A survivor of a serious motor vehicle accident may be afraid to ride in cars or may be such a jittery passenger that she becomes a pest to drive around with. She may develop a paralyzing preoccupation with physical symptoms or injuries resulting from the accident. She may suffer headaches and other aches and pain, even when no physical injury has occurred. Anxieties, irritability, and depression are common. She may be unable to read or watch stories of traffic accidents, hear traffic reports on the radio, or even tolerate automobile commercials on TV. Phobias to particular models of cars involved in the accident may develop, even to colors that remind her of the vehicles. Some patients develop a curious perceptual distortion in which cars or street corners appear closer then they actually are. The usual posttraumatic stress reactions of intrusive recollection and emotional numbing are typically seen. (p. 122)

Lithium Eskalith Eskalith CR Lithonate

Lithium toxicity is manifest by coarse tremor, stupor, ataxia, seizures, persistent headache, vomiting, slurred speech, confusion, incontinence, and arrhythmias. Toxicity may occur when a patient becomes ill and ceases to eat and drink normally, but continues to take lithium as prescribed. A patient who cannot eat and drink normally should temporarily discontinue lithium.

Mental Health and Violence

Primary care physicians should be aware of possible previous exposure to war, torture or other trauma and its impact on health. Recognising physical and psychological symptoms related to rape or to various forms of physical abuse, symptoms of PTSD or depression, and how there are being expressed in a specific society or ethnic group, is of prime importance. Very often, victims of organised violence will not present to doctors as such, but will come with common unspecific symptoms, such as headache, fatigue and general pain. It is only when trust, confidence and empathy are established, when the patient feels that the physician or the nurse is open to listening, that he or she will talk about traumatic experiences and then allow the therapeutic process to start.

Investigators of CSF proteins

Over a similar course of time another neurologist, Wallace Tourtellotte, working in Ann Arbor, Michigan, was amassing data to show that plaques of MS brain contained higher amounts of IgG than could be found in the corresponding CSF compared with parallel serum 1175,1176 , thus leading via a different route to the same seminal notion of local synthesis of IgG within the brain. On a more practical level, but nonetheless of fundamental relevance to clinical practice, there are still too few physicians who realize the value of Tourtellotte's little book Post-lumbar Puncture Headaches 1170 , in which he showed convincingly that the small size of the needle is more important than all of the other machinations which have been performed in vain attempts to alleviate the headache which sometimes follows lumbar puncture. Using the 'needle within a needle' technique 1171 the incidence of headache was not 30 per cent (as with an 18-gauge needle) or even 3 per cent (as with a 21-gauge needle),...

Amine Oxidasebased Biosensors For Monitoring Of Fish Freshness

Biogenic amines can act as possible biomarkers for control of food products 35-37 . Putrescine, cadaverine, tyramine and histamine are the most known compounds in this class, their concentration being a good indicator of fish, meat, and cheese freshness 3842 . Biogenic amines are generally produced by microbial decarboxylation of corresponding amino acids and their toxicological significance in food products is still unclear. However, they can cause severe effects, such as headache and facial flushing, even when consuming very small amounts of infested fermented beverages and or food 43, 44 . Many enzymatic methods have been developed for measuring biogenic amines in blood, biological tissues and food products 45-51 , most of them being based on amine oxidase (AO) which catalyses the following reaction (1)

Thrombotic thrombocytopenic purpura TTP

TTP requires three major factors for the diagnosis microangiopathic hemolytic anemia, thrombocytopenia, and some form of neurological involvement (which may be as mild as a slight headache or as severe as dense coma). TTP usually presents with a clinical pentad of features micro-angiopathic hemolytic anemia, fever, neurological disturbance, renal impairment and thrombocyto-penia. The neurological features of the syndrome may be transitory while mild hypertension and proteinuria may make the condition indistinguishable from HELLP syndrome. TTP does not, however, remit after delivery, whereas HELLP syndrome invariably resolves. Other diagnostic features that may help to distinguish between the two conditions include evidence of marked hemo-lysis on examination of the peripheral blood smear (this is more characteristic of TTP than HELLP). In most cases despite an extremely low platelet count, women with TTP will have a normal coagulogram (PT PTT Fibrinogen) and this may be useful in...

Other Biological Psychological and Social Responses and Consequences

Research has consistently shown that individuals diagnosed with PTSD have higher rates of medical services use and increased levels of fatigue, headaches, chest pains, gastrointestinal disorders, cardiovascular disorders, and impaired For rape or incest survivors, more frequent gastrointestinal distress, recurrent headaches, dysuria, vaginal discharge, and chronic abdominal pain (Felitti, 1991 Rimsza, Berg, & Locke, 1988)

Preeclampsia litigation

The causes of maternal or perinatal death or disability are illustrated in Tables 34.6 and 34.7. As noted in Table 34.6, the leading cause of maternal death or permanent brain injury was intracerebral hemorrhage due, in most cases, to uncontrolled hypertension. However, what is less well known is how many of these pre-eclamptic patients who presented to a physician's office or hospital with the complaint of a severe headache in association with hypertension had already had a pre-existing intracerebral bleed. Not infrequently, the sole manifestation of a prior bleed is a slow maternal heart rate and a widened pulse pressure due, in part, to an increase in intracranial pressure. Under these circumstances, the cerebral vascular response is designed to limit and prevent further bleeding by localized cerebral artery spasm and thrombosis. When medical therapy with agents such as magnesium sulfate or hydralazine is administered, the physiologic impact of these agents is frequently directed...

Links between the Health System and TBAs

Their training in danger signs has resulted in knowledge of such complications as breech, obstructed labor, placenta previa, and retained placenta, and of risk signs of edema, migraine, and short-birth interval. The TBAs also mentioned that they no longer make mothers push, as the women would get tired (Rivera 2001), and that they fear delivering a woman known to be at high risk due to legal problems (Rivera 2001), loss of reputation, and loss of their ability to refer to health establishments. Hence, perhaps out of improved knowledge of complications, fear of repercussions, or

Radioactive Iodine 131I Therapy Thyroid Remnant Ablation

With T4 withdrawal and in over 86 of those given rhTSH, who were treated, respectively, with an average of 4662 and 4403 MBq (126 and 119mCi) of 131I 119 . Another study found that 1110 MBq (30mCi) 131I given 48 hours instead of 24 hours after the last rhTSH injection failed to ablate the thyroid remnant when rhTSH was given 126 . Still another study showed that 1110 MBq (30 mCi) of 131I was successful when T4 was stopped the day before the first injection of rhTSH and started again the day after the 131I was administered, which was associated with a fall in urine iodine levels attributed to the 50 mg iodine content in a daily dose of T4 compared with the 5mg content of 131I 127 . Patients tolerate rhTSH well, with only occasional transient mild headache and nausea. This is extensively reviewed in Chapter 17 by Professors Pacini and Schlumberger.

Can we predict an eclamptic seizure

The relationship between hypertension, symptoms and signs of cortical irritability (headache, visual disturbances, nausea, vomiting, fever, hyperre-flexia) and seizures remains unclear and unpredictable. That said, the majority of women do have one or more antecedent symptoms prior to an eclamptic seizure. In a retrospective analysis of 383 cases of eclampsia in the United Kingdom, Douglas and Redman (1994) reported that 59 (227 383) of eclamptic patients experienced either a prodromal headache, visual disturbance (scoto-mata, amaurosis, blurred vision, diplopia, homo-nymous hemianopsia) or epigastric pain. In 38 (146 383) of cases, however, eclampsia was the first manifestation of pregnancy-related hypertensive disease.

Granulocyte and granulocytemacrophage colonystimulating factors

The advantages of PBSC donation for the donor include the avoidance of general anaesthesia, the less invasive procedure and the lack of hospitalization. Using this dose of G-CSF, the procedure is generally well tolerated but it is not a completely risk-free procedure. The commonest side-effects reported include bone pain (83 ), headache (39 ), fatigue (14 ) and nausea (12 ), which resolve rapidly with cessation of G-CSF therapy. More serious adverse effects have been reported in small numbers of patients (often using higher doses of G-CSF), including splenic rupture, severe pyogenic infection, exacerbation of ischaemic heart disease and precipitation of vaso-occlusive crisis in a patient with Hb SC disease. A number of relative contraindications of PBSC mobilization have been agreed, which include a history of autoimmune, inflammatory or thrombotic disease. There do not appear to be any long-term sequelae of a short course of G-CSF for PBSC mobilization. Studies investigating the...

General Adaptation Syndrome

The first stage begins when an individual becomes frightened, anxious, or even merely concerned. The body immediately undergoes numerous physical changes to cope with the stressor. Metabolism speeds up. Heart and respiration rates increase. The hormones epinephrine, norepinephrine, and cortisol are secreted. Sugar is released from the liver. The muscles tense. Blood shifts from the internal organs to the skeletal musculature. These and a host of other changes are aimed at helping the body cope, but the price paid for this heightened state of arousal typically includes symptoms such as headache, upset stomach, sleeplessness, fatigue, diarrhea, and loss of appetite. The body's increase in alertness and energy is accompanied by a lowered state of resistance to illness.

Classification Structure and Distribution of VGCCs

Channel identified five subunits, including a large a1-(200-260 kDa) subunit and four smaller ancillary subunits a2, P, y, and 5. The a1-subunit consists of four homologous repeats, each one composed of six transmembrane segments (Fig. 8). Located within the a1-subunit are the voltage sensor, gating machinery, channel pore, and multiple protein kinase A and cAMP-dependent-kinase phosphorylation sites. Since the first a1-subunit was cloned from skeletal muscle, at least seven isoforms have been identified, including the a1S, a1C, a1D, a1B, a1A, a1E, and a1G. The a1S-, a1C-, and a1D-subunits make up the L-type Ca2+ channels in skeletal muscle, cardiac muscle, and neurons, respectively. The a1B subunit is associated with N-type channels in neurons. The a1A-subunitis associated with both P- and Q-type neuronal channels, and the a1E-subunit with the R-type channels (Fig. 7). Finally, the a1G-subunit has been linked to T-type Ca2+ channels. Mutations in the a1-subunit of VGCCs are the...

Psychological Aspects of Thyroid Cancer

Thyroid cancer patients who had been treated with radiation were almost twice as likely to report an overall effect on their health as those who had not received radiation. Almost a quarter of the sample described symptoms that could be associated with thyroid dysregulation, for example dry skin hair loss poor concentration sleep disturbance fatigue weight change palpitations heat cold intolerance diarrhea constipation depression anxiety. Thyroid cancer survivors reported psychological problems, memory loss, and migraine headaches more frequently than survivors of other types of cancer. The authors conclude that the morbidity associated with a diagnosis of thyroid cancer is significantly more pronounced than generally understood 13 .

Altered Autoregulation Of Cerebral Blood Flow In Hypoxia

Abstract Acute mountain sickness (AMS) is a syndrome of headache, anorexia, nausea and fatigue, which commonly occurs with rapid ascent to high altitudes. The pathogenesis of AMS remains incompletely understood. A leading theory has been that AMS could be an early stage manifestation of high altitude cerebral edema, which sometimes complicates AMS and is of poor prognosis. There has indeed been recent reports of magnetic resonance imaging (MRI) evidence of hypoxia-induced reversible brain edema in healthy volunteers. Interestingly, in these studies, brain edema was both vasogenic and cytotoxic but with only the MRI cytotoxicity signals correlated to AMS symptomatology. Studies in volunteers exposed to normobaric or hypobaric hypoxic conditions have disclosed a hypoxia-induced alteration of the autoregulation of cerebral blood flow in proportion to the severity of oxygen deprivation and to AMS symptoms. The alteration of cerebral autoregulation contributes to breathing instability...

St Louis Encephalitis

More than 99 of infections with this virus are without symptoms. In clinical cases, the disease is characterised by fever, malaise, nausea and vomiting and headache. Aseptic meningitis or focal encephalitis, and cranial nerve The onset of illness is sudden with a nonspecific febrile illness including headache and lassitude. Visual disturbances may occur such as blurring of vision and diplopia. In the majority the illness lasts 4-7 days. A biphasic

Less Common Hepatobiliary Flukes

Metorchis conjunctus is in the same family as Opisthorchis and Clonorchis species but is only found in North America, where it normally infects wild carnivores and has been noted as a cause of death of sled dogs (Table 17.1). Human infection occurs rarely. Recently, an outbreak of acute illness caused by M. conjunctus was described in 19 people who ate raw fish near Montreal, Canada (MacLean et al., 1996). Many of the individuals had abdominal pain, fever, headache, weight loss and fatigue after an incubation period of 1-15 days. In addition, eosinophilia and elevated liver enzyme concen


The clinical picture is of abrupt onset of fever, malaise, headache, sore throat, myalgia, coryza and a dry cough lasting 2-5 days. The clinical features in children and in the elderly may differ in some respects and children may present with febrile convulsions, conjunctivitis, croup, otitis media, bronchitis and gastrointestinal symptoms. Diagnosis based on clinical presentation is difficult but more likely if influenza is known to be common in the community.

Dengue Fever

Dengue fever is characterised by sudden fever, headache, vomiting and severe muscle and bone pain of increasing severity. The fever is biphasic, remitting on day 3-5 of the illness, followed by a maculopapular or morbilliform rash, which spreads from the trunk to the limbs and face. This second phase of the illness, which is often accompanied by recurrence of fever, is associated with lym-phadenopathy, granulocytopenia and thrombocyto-penia. Minor mucocutaneous bleeding may occur. The fever lasts for 3-9 days and is self-limiting.


Commercial products which deliver drugs either buccally or sublingually are available for lorazepam for anxiety and insomnia, nicotine for smoking cessation and ergotamine for migraine treatment. The buccal route has been tried with variable degrees of success for several other drugs, including metronidazole, metoclopramide, phenazocine, propranolol, timolol, salbutamol, fenoterol and insulin. Calcium channel blockers (nifedipine, verapamil) both produce effects similar to oral doses when administered sublingually or buccally71 72. The buccal route has also been explored for the delivery of peptides since the mucosa is reported to lack surface-bound peptidases, and preliminary work in dogs demonstrated significant absorption of a hydrophobic lauroyl derivative of a tripeptide35. Thyrotropin-releasing hormone, vasopressin analogues and insulin have been investigated as potential candidates for buccal and sublingual drug delivery. Oxytocin can be delivered by the buccal route, but this...

Postoperative Period

The selective serotonin reuptake inhibitors (SSRIs) are generally safer choices than the older tricyclic medications, since the anticholinergic side effects may cause delirium or tachycardia. The tricyclics can cause blood pressure changes as well. The SSRIs do cause side effects such as gastrointestinal (GI) disturbances and headaches. Monoamine oxidase inhibitors (MAOIs) are best avoided because of the risk of hypertension. Ritalin can be another option, however. We have not found that it causes anorexia. Indeed, it may promote an increased appetite in some patients.


The primary features are the consequence of the host's immune response to adult filaria in the lymphatic channels. Acute disease is characterised by recurrent intermittent fever and eosinophilia, accompanied by systemic symptoms, such as headache, malaise and acute lymphadenitis and lymphangitis of the groin and axillae. Each attack lasts 3 15 days, and there may be several attacks each year. Eventually, after 10 15 years, the lymphatic channels are permanently damaged, and chronic disease supervenes. The incompetent lymphatics become fibrosed, and the nodes calcify. Lymph accumulates in tissues, producing lymphoedema and eventually elephantiasis. Secondary bacterial and fungal infection is common. Hydrocele, orchitis and epididymitis occur in men. Rarely an abnormal connection between ureter and thoracic duct results in chyluria.

Spotted Fever group

The incubation period is between 3 and 12 days after the tick-bite but a good 40 of patients are unaware of the tick bite episode. Young adult males are more commonly affected, with a seasonal peak in April to September in the USA. Prodromal symptoms of headache, malaise and high fever (39-40 C) are followed 3-4 days later by a maculopapular rash on wrists and ankles. This spreads centrally to affect the trunk and face. Palms and soles are usually involved. The rash becomes haemorrhagic and may become confluent. Acral gangrene may occur but 13 of patients may have no rash and in 20 it develops later in the illness. General examination may reveal hepatosplenomegaly, shock, altered consciousness and renal failure. Recovery usually occurs over 3 weeks, with fatality rates of 1.5-6 . Mortality is higher in the elderly, those with coexisting disease and those with no known tick bite or rash.

Tick typhus

The clinical features of the tick-borne typhus diseases (Table 9.3) are very similar and usually milder than those of Rocky Mountain spotted fever. Fatal cases are rare. The initial lesion develops at the site of the tick bite with an erythematous papule, which vesiculates and develops an overlying eschar, also called 'tache noir' (Figure 9.6) and local lymphadenopathy. Fever and headache develop and after about 5 days a widespread exan-them evolves, which usually involves the palms and soles. This is an erythematous maculopapular eruption but may become haemorrhagic.

Epidemic Typhus

The incubation time is 7-14 days. Prodromal symptoms consist of headache, fever, and malaise and after 4-7 days a rash develops in the majority of patients. Crops of erythematous macules appear on the trunk and spread centrifugally but spare the palms and soles. Conjunctival haemorrhage may be a feature. The skin lesions progress to purpuric lesions and gangrene of extremities may occur.


This is an acute delayed transient response to UV radiation and the clinical features are easily identified by travellers. These include erythema and tenderness, but severe cases manifest with blistering, oedema and pain. Systemic symptoms of headache and malaise are common. Prevention with adequate sunscreens is most important. The acute treatment consists of topical cor-ticosteroids, cool wet dressings, systemic aspirin, and bed rest away from direct, reflected, or refracted sunlight.


Typhoid vaccine is currently available in two formulations, oral and by injection. Immunisation with a single 0.5 ml dose for both children over the age of 18 months and adults, administered intramuscularly, provides 70 protection against infection, indicating that adjunct methods of protection, including strict observance of food and water precautions, are necessary. The vaccine is associated with a suboptimal response in infants under the age of 18 months as the polysaccharide vaccine is not T-cell dependent. A booster dose is required at 3-yearly intervals in the United Kingdom (2-yearly for the United States) for those at continued risk. The availability of polysaccharide vaccines has resulted in a decline in the reactogenicity of typhoid vaccine, although some vaccinees do experience pain at the site of injection, a slight fever and headache lasting for 24 h.


The most frequent clinical picture is an ill patient who reports sudden onset of fever in association with pleuritic chest pain and other nonspecific symptoms such as headache, vomiting and diarrhoea. Cough soon develops, which is initially dry but often followed by haemoptysis. The presentation may be much more subtle in elderly and immunocompromised patients. Physical examination reveals signs consistent with consolidation. Pleural effusion may also be detectable. These findings are confirmed by chest X-ray, which usually shows consolidation filling all or most of a lobe. S. pneumoniae is not a classic abscess-producing organism, and lung abscess should raise suspicion of other pathology such as bronchial obstruction or pulmonary infarction. Most patients with pneumococcal pneumonia have a leucocytosis. Some patients, however, have a low leucocyte count, which indicates a very poor prognosis (Balakrishnan etal., 2000). Abnormal liver function tests are also a common finding.


This is a serious condition which may be primary, secondary or postdecompression. Primary collapse occurs with little or no warning. There is a feeling of apprehension, pallor of the skin and a cold sweat, which may be followed by a faint. Secondary collapse is similar, but is preceded by some other form of decompression sickness, usually chokes or severe bends. This is the commonest form of collapse. Postdecompres-sion collapse occurs after return to ground level, usually within 4 h, but it can occur after many hours. It may be preceded by headache, nausea or a feeling of malaise. Decompression collapse is uncommon but, should it occur, it must be treated as a medical emergency. If it occurs in flight, land as quickly as possible and seek urgent specialist assistance and immediate transfer to a hyper-baric chamber facility.


As a consequence, quality of life was maintained and was much better during rhTSH than during hypothyroidism. Patient preference for rhTSH over withdrawal is universal. Side effects were minimal, being observed in less than 10 of patients, and consisted mainly of mild and transient nausea and headache, and no patient developed detectable anti-rhTSH antibodies.

Drug Prophylaxis

Anyone prescribed acetazolamide should be warned about potential side-effects, which are common, but generally mild in nature. Mild diuresis and paraesthesiae tend to diminish with continued use, and carbonated beverages may taste flat. Other side-effects include nausea, drowsiness and headache. Most of these side-effects result from the uptake of the drug in the central nervous system (CNS) related drugs with little CNS penetration, such as benzolamide, prevent AMS and have fewer side-effects, but are not generally available. Acet-azolamide is a sulfa drug and carries the usual precautions about hypersensitivity. 1994), and is generally reserved for situations when acet-azolamide is contraindicated. The mechanism of action is unknown but, unlike acetazolamide, dexamethasone does not aid acclimatisation. Doses of 4mg every 8-12 h are usually recommended, starting the day prior to ascent. Aspirin has also been used prophylactically to prevent high-altitude headache. For mild AMS, rest...

Affective Disorders

This wide variance in prevalence, it is reasonably certain that depressive disorders are one of the most common mental disorders among refugees and IDPs. The disorders maybe of a low-grade prolonged type (dysthymia) or be more severe but shorter in duration (major depressive disorder). At times, there may not be a manifest disorder but only certain symptoms of depression like sadness, lethargy, low mood, fatigue and headache. Although the majority of the studies have reported just the prevalence of major depressive disorder, some have listed symptoms that were found to be more common in some cultures, and that reflected cultural manifestation of depression. Asian refugees have been found to report somatic rather than affective symptoms 45 . Headache was found to be the commonest expression of depressive symptoms in some studies 46 . Certain cultural expressions of sadness, such as Bebatchel a culture-dependent depressive state indicating a deep worrying sadness not visible to others...


Headache Headache has long been recognized as a harbinger of eclampsia. The precise mechanism of these headaches is not certain although hypertensive encephalopathy, cerebral vasospasm and abnormal cerebral perfusion pressure are intimately involved (Belfort et al. 1999). However, pre-eclampsia can develop in women with pre-existing headache disorders. All pre-eclamptic women should be questioned about underlying or pre-existing medical problems, including headaches. A previous history of headaches similar in kind to the present headache should suggest a primary headache syndrome. Vascular or tension headaches often begin in childhood and migraine headaches most commonly have their onset around puberty. The temporal course of the pre-existing headache syndrome may also be helpful for establishing or confirming a diagnosis. Migraine headaches usually begin while awake, often have a prodrome or aura and characteristically build over minutes to hours. Vascular, or tension, headaches...


Pyrantel is a pyrimidine with a wide spectrum of anthelminthic activity. It acts in a similar way to levamisole. It is poorly absorbed from the gastrointestinal tract, with more than half of the dose found unchanged in the faeces (Kimura and Kume, 1971). It is active against Enterobius vermicularis, hookworm and Ascaris lumbricoides and is indicated for the treatment of these infections. Cure rates of 80-100 can be achieved with a single dose of 10mg kg, although results with Necator americanus are nearer 80 , but only with a dose of 20 mg kg for 3 days (Sinniah and Sinniah, 1981 Chege et al., 1974). The drug is well tolerated and most side-effects are transient and mild mainly abdominal pain, nausea, diarrhoea, headache and vomiting. A transient elevation of liver transaminases may be detected. Curiously, pyrantel antagonises the effects of piperazine in vitro and potentiates the effect of levamisole in pigs, but the mechanism of this interaction is unknown.


Dosage regimens (Moens et al., 1978). High cure rates are also achieved in ancylostomiasis but variable results are obtained in Necator infection (Lucas and Oduntan, 1972). The side-effect profile is favourable, with most adverse events noted being mild typically nausea, vomiting, abdominal pain and headache (Lionel et al., 1969), although with prolonged treatment, using the drug as an immunomodulator for blood disorders, renal failure, vasculitis and photo-sensitivity have been reported (Amery and Butterworth, 1983). Its relatively narrow spectrum of activity means that its use is mainly limited to monoinfections with Ascaris.


Most seizures occur prior to delivery although 40 of women will fit within 24 h of delivery. Eclampsia may be preceded by prodromal symptoms of headache and visual disturbances (blurred vision, photopsia, scotomata and diplopia) (Duncan et al., 1989). The blood pressure at the time of seizure activity varies from levels that are mildly elevated or even normal although they more commonly have moderate to severe hypertension (Lindheimer, 1996). Seizure activity is, however, associated with a sharp increase in blood pressure and decreased peripheral oxygen saturation levels. This is important because severe hypertension has been linked to the risk of cerebrovascular hemorrhage.

Subdural haematoma

Subacute Worsening headaches 7-14 days after trauma, altered mental status, motor weakness. Chronic 'The great neurological imitator' can present with headache, confusion, language difficulties, psychiatric symptoms, difficulty walking, focal weakness or hemiparesis, seizures. There may or may not be a history of fall or trauma hence have low index of suspicion.


Thus, influenza may have an incidence of 15 for the months December-April 1999 in the UK, whereas the prevalence of influenza in the UK probably ranges between 0 and 10 on any given day. Perinatal (and maternal) mortality rates are usually stated annually and for specified country or region. These are thus measures of incidence. The proportion of a population that will experience at least one seizure or one migraine attack in their lives is a measure of incidence and would likely be expressed as a number per thousand (or per hundred thousand) person-years, whereas the proportion of a population suffering from epilepsy or migraine during the year 2000 is an expression of prevalence.

Other Conditions

T2-weighted MR imaging has been utilized in a number of other conditions including, for example, head injury (Yanagawa et al., 2000 Wardlaw and Statham, 2000 Hadley et al., 1988 Gentry et al., 1988), cerebral infections (Bailes et al., 1982 Thurnher et al., 1997), migraine (Ferbert et al., 1991 Soges et al., 1988), psychiatric disorders


A primary goal for structuralism was to identify the basic elements of consciousness. Titchener reasoned that any science requires an observation of its subject matter, and psychology was no different. As detailed in Titch-ener's classic work Experimental Psychology A Manual of Laboratory Practice (4 vols., 1901-1905), introspection involved the systematic analysis and reporting of conscious experiences by highly trained researchers. Such individuals were trained to report on the most basic of sensory experiences and to avoid the stimulus error of reporting perceptual interpretations. For example, to report seeing an apple or having a headache would be a stimulus error. It would be more accurate, psychologically, to report seeing a roundish, red object or experiencing a throbbing sensation of moderate intensity in the lower right part of the head. This methodology was used by Wundt, but Wundt emphasized quantitative judgments (such as size, weight, duration, or intensity), whereas in...

Clinical Disease

Migration of schistosomulae in the venous system, arterial bed and specific venous beds may be associated with mechanical and inflammatory changes in the lung and liver but generally is also asymptomatic. As worms mature in the liver, migrate to the small venules and begin to lay eggs, a second form of acute schistosomiasis may be observed, termed Katayama fever (Warren, 1973a). Symptoms generally have an acute onset, 3-6 weeks after a heavy exposure to cercariae. Spiking fever with chills, myalgia, headache, diarrhea, fatigue and weight loss are observed. Nausea, vomiting and cough are common. Occasionally, hepatosplenic enlargement is seen. Large patches of urticaria may also be seen on various parts of the body.

Improving Demand

Noting that problems still remained with referral after the first intervention study, MacGillivray went on to develop and test a mother-held card identifying six particular signs and symptoms of hypertension that should be acted upon by immediately going to the health center or local midwife. These were frontal headache, epigastric pain, dimness of vision or seeing spots or flashes, edema, vomiting during the last trimester of pregnancy, and antepartum hemorrhage (another problem for which women should seek care not related to pregnancy-induced hypertension). The card was to be given to women during their first antenatal care visit. A poster with similar messages was hung in all primary- and secondary-care antenatal clinics. Selected for the trial was St. Ann's parish, which had 3,500 births annually and high eclampsia rates that seemed to be on the rise.


A history of intermittent and or paroxysmal hypertension, headaches, palpitations, hyperhidro-sis, or tremor associated with anxiety should suggest pheochromocytoma. These women may also report visual disturbances, chest or abdominal pain or unusual reactions to medications mediating catecholamines. With extreme hypertension they may also experience convulsions or intracra-nial hemorrhage. Unexplained myocardial infarction in a pregnant woman should prompt a search for pheochromocytoma. Although most authorities suggest that pregnancy does not affect the disease, the increased cardiac output and blood volume, as well as the mechanical effects of the third-trimester uterus, may exacerbate the signs and symptoms of pheochromocytoma. The additional vascular stimulation and stress associated with labor and delivery may also induce a hypertensive crisis. Pheochromocytoma diagnosed in pregnancy may be treated either surgically or medically. Ninety percent of these tumors are located in the...

Anal fissure

Medical Chemical sphincterotomy by the topical application of 0.2 glyceryl trinitrate ointment. This releases local nitric oxide that mediates smooth muscle relaxation, reducing spasm and allowing healing (major side-effect is headache). Other agents that have been shown to be effective are topical calcium channel blocker, diltiazem and injections of botulinum toxin. Pain relief is given in the form of local anaesthetic gel (1 lignocaine) applied before defecation. Laxatives may be necessary (stool softeners or bulk laxatives) to relieve straining. General advice on the avoidance of constipation should be given (e.g. a high-fibre diet, water intake and appropriate exercise).


Cause of eosinophilia a history of immersion in fresh water in Africa, the Middle East or in much of the Far East or South America should always be sought. Only a minority of patients recall having 'swimmer's itch' 24-48 h after bathing in infected water, caused by the initial penetration of skin by the schistosomule. As the earlier case report illustrated, acute schistosomiasis may cause symptoms in nonimmune travellers 3-8 weeks later as the larvae begin to mature and to excrete eggs, which elicit an eosinophilic response. Patients experience fever, transient urticarial rashes, headache, a dry cough and malaise (Katayama fever) (Colebunders et al., 1998). Hepatosplenomegaly is occasionally found and transitory nonspecific infiltrates may be seen on chest X-ray (Cooke et al., 1999). High levels of eosinophilia ( > 1 x 109li) are common at this stage but specific diagnostic tests are usually negative. The condition settles and the patient may then remain asymptomatic or subsequently...


Sodium stibogluconate and meglumine antimonate are considered equivalent when dosed on the basis of their Sbv content, although bio-availability may vary among lots. They are administered intravenously or intramuscularly at a dose of 20 mg Sbv body weight daily. Sbv does not accumulate in persons with normal renal function. Side effects such as myalgias, arthralgias, fatigue, nausea, malaise and headache are common. Amylase and lipase elevations occur in the majority of recipients. Clinically apparent pancreatitis develops in some it is particularly common among persons with chronic renal insufficiency. Sbv can adversely affect the heart. It produces non-specific ST-T wave changes and QTc prolongation. Shock and sudden death have been reported in persons who were receiving more than the recommended daily dose of 20 mg Sbv body weight. Lower doses of Sbv are sometimes used in older recipients, particularly those with underlying cardiac problems. Infrequent side-effects include rash,...


ANS If one wishes to be certain that a patient has no difficulty in visual acuity, both near and far must be tested. Certainly, testing far vision alone is insufficient for the middle age patient who reports headaches, fatigue and blurred vision on reading up close. Near testing must be performed to evaluate for presbyopia. Similarly, when a teenager reports difficulty seeing distant objects, near vision testing is insufficient. Sometimes, the physician is selectively interested in determining whether the patient has a non-refractive error (e.g., visual loss from acute ocular trauma). Under such conditions it may suffice to test either near or far vision as the finding of normal vision for either would rule out visual loss from such a condition. In general, it is best to test both near and far vision.


Nicotine nasal spray (Nicotrol NS) is available by prescription and is a good choice for heavy smokers or patients who have failed treatment with nicotine gum or patch. It delivers a high level of nicotine, similar to smoking. Nicotine nasal spray increases the rate of sustained abstinence. The spray is used 6-8 weeks, at 1-2 doses per hour (one puff in each nostril). Tapering over about 6 weeks. Side effects include nasal and throat irritation, headache, and eye watering.


The use of suppositories is probably one of the clearest examples of cross-cultural differences in the approach to pharmaceuticals. A surgeon on a famous ocean liner has commented that 'Part of the problem of stocking one's pharmacy is that one needs three times as many drugs as when working on land tablets for the Brits, shots (injectables) for the Yanks, and suppositories for the French ' However, the route of administration is eminently logical, e.g. for the acute treatment of migraine, where drugs are often vomited.

P falciparum

Most non-immune individuals present with falciparum malaria within 2 months of departure from a malaria-endemic area, but in semiimmune individuals and those taking malaria prophylaxis, symptomatic malaria may not develop for many months. The minimum time to developing symptoms after entering a malaria-endemic area is 7-8 days. Patients usually present with fever and headache but may have a variety of other symptoms, including cough, myalgia, arthralgia, abdominal pain, nausea, vomiting, diarrhoea, photophobia and altered conscious state. The fever may occur every 48 hours or continuously with intermittent peaks. The clinical presentation can vary substantially, depending on the level of parasitaemia and the immune status of the patient. Atypical presentations, leading to misdiagnosis as gastroenteritis, hepatitis or urinary infection are common. Asymptomatic parasitaemia is a frequent finding in semi-immune adults, hence the detection of parasites in peripheral blood should not abort...

Assessment of mother

It became clear that this was not necessary and a stepwise approach was developed. Initially, a history is taken to assess maternal wellbeing and maternal appreciation of fetal movements. Any symptoms, such as headache, abdominal pain, nausea, flu-like symptoms and visual disturbances should be taken seriously and the management is guided by this. If they are significant, admission to hospital is mandatory. If all is well, four blood pressure readings are taken, 30min apart, and averaged to assess the average blood pressure level. The reason for this is that blood pressure is an inherently variable parameter and the average gives a better idea of what the true blood pressure is (Pickering, 1993). Urine is tested for the presence of protein. A CTG (NST) is normally carried out at the same time while the woman is waiting to have her blood pressure checked. It was found that 60 of women attending an ADU will have no clinical symptoms, normal blood pressure averages, no proteinuria...

Carbon Monoxide

Metabolic Activation Carbon Tet

A level of 60 carboxyhaemoglobin will normally be fatal even for a few minutes, and if not fatal may cause permanent damage it is rare to find a blood level of greater than 80 carboxyhaemoglobin. At a level of 20 carboxyhaemoglobin there may be no obvious symptoms but the ability to perform tasks can be impaired. When the level reaches 20-30 the victim may have a headache, raised pulse rate, a dulling of the senses and a sense of weariness. At levels of 30-40 the symptoms will be the same but more pronounced, the blood pressure will be low and exertion may lead to faintness. At 40-60 carboxyhaemoglobin there will be weakness and incoordination, mental confusion and a failure of memory. At concentrations of 60 carboxyhaemoglobin and above, the victim will be unconscious and will suffer convulsions. There are many other clinical features nausea, vomiting, pink skin, mental confusion, agitation, hearing loss, hyperpyrexia, hyperventilation, decrease in light sensitivity, arrhythmias,...

101 Power Tips For Preventing and Treating Headaches

101 Power Tips For Preventing and Treating Headaches

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