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Biomedical subjects

Todd D Rozen

Publications and source records attributed to Todd D Rozen.

10 recordsLinked to original sources
PubMed2003

New daily persistent headache.

New daily persistent headache was first described by Vanast in 1986 as a benign form of chronic daily headache that improved without therapy. In the headache specialist's office, new daily persistent headache is anything but benign and is thought to be one of the most treatment refractory of all headache conditions. Little is known about this syndrome. It is unique in that the headache begins daily from onset, typically in a patient without a history of headache, and can continue for years without any sign of alleviation despite aggressive treatment. This article discusses the epidemiology, diagnostic criteria, clinical characteristics, and treatment strategies for new daily persistent headache.

Adolescent↗
PubMed2002

New treatments in cluster headache.

Cluster headache is the most severe headache syndrome known to humans. In most instances, this disorder is readily treatable when the correct medications are utilized at the correct dosages. Cluster treatment involves abortive, transitional, and preventive therapy strategies, all of which are discussed in this article.

Anesthetics, Local↗
PubMed2002

Interventional treatment for cluster headache: a review of the options.

There is no more severe pain than that sustained by a cluster headache sufferer. Surgical treatment of cluster headache should only be considered after a patient has exhausted all medical options or when a patient's medical history precludes the use of typical cluster abortive and preventive medications. Once a cluster patient is deemed a medical failure only those who have strictly side-fixed headaches should be considered for surgery. Other criteria for cluster surgery include pain localizing to the ophthalmic division of the trigeminal nerve, a psychologically stable individual, and absence of addictive personality traits. To understand the rationale behind the surgical treatment strategies for cluster, one must have a general understanding of the anatomy of cluster pathogenesis. The most frequently used surgical techniques for cluster are directed toward the sensory trigeminal nerve and the cranial parasympathetic system.

Clinical Protocols↗
PubMed2002

Hemiplegic cluster.

We report four cases of a new variant of cluster headache associated with hemiparesis. Clinical similarities with hemiplegic migraine suggest that hemiplegic cluster, too, may be a channelopathy. One of our patients had a family history suggestive of an autosomal dominant inheritance.

Adult↗
PubMed2002

Valsalva-induced cluster: a new subtype of cluster headache.

We report the case of a man who suffered from Valsalva-induced cluster headaches. The headaches deviated from classic cluster in that they were solely induced by activity involving the Valsalva maneuver, such as coughing and sneezing, and never occurred spontaneously. The attacks were prevented by treatment with indomethacin. This may be the first reported case of cluster that only occurs after a defined trigger and never spontaneously. It also may be the first cluster headache subtype that is indomethacin responsive.

Aged↗
PubMed2002

Olanzapine in the treatment of refractory migraine and chronic daily headache.

BACKGROUND: Olanzapine, a thienobenzodiazepine, is a new "atypical" antipsychotic drug. Olanzapine's pharmacologic properties suggest it would be effective for headaches, and its propensity for inducing acute extrapyramidal reactions or tardive dyskinesia is relatively low. We thus decided to assess the value of olanzapine in the treatment of chronic refractory headache. METHODS: We reviewed the records of 50 patients with refractory headache who were treated with olanzapine for at least 3 months. All previously had failed treatment with at least four preventative medications. The daily dose of olanzapine varied from 2.5 to 35 mg; most patients (n = 19) received 5 mg or 10 mg (n = 17) a day. RESULTS: Treatment resulted in a statistically significant decrease in headache days relative to baseline, from 27.5 +/- 4.9 before treatment to 21.1+/-10.7 after treatment (P <.001, Student t test). The difference in headache severity (0 to 10 scale) before treatment (8.7+/-1.6) and after treatment (2.2 +/- 2.1) was also statistically significant (P <.001). CONCLUSION: Olanzapine may be effective for patients with refractory headache, including those who have failed a number of other prophylactic agents. Olanzapine should receive particular consideration for patients with refractory headache who have mania, bipolar disorder, or psychotic depression or whose headaches previously responded to other neuroleptic medications.

Antipsychotic Agents↗
PubMedDate not supplied

Intravenous propofol in the treatment of refractory headache.

We analyzed the results of treating patients who had chronic daily headaches that were refractory to standard medications with repetitive low-dose boluses of intravenous propofol (2,6-diisopropylphenol). Patients were treated over a 1-year period at Thomas Jefferson University Hospital. A total of 18 patients were treated a total of 21 times. Over 90% of patients had at least some headache relief after treatment. The headache cycle was broken in eight patients. There were no complications. Intravenous propofol is safe and effective when used under monitored conditions and should be considered for patients who have refractory chronic daily headache and have failed other interventions.

Adult↗