- Email: [email protected]
Intravenous mepivacaine in the management of tension — Type headache
INTRAVENOUS MEPIVACAINE IN THE MANAGEMENT OF TENSION - TYPE HEADACHE: 2* 1* 1 H. Kayser' B. Jdger , H. Munkel , Dept. of Anesthesiology and Pain '2 Clinic and Dept. of Surgery, St. Joseph-Hospital, 2850 Bremerhaven,FRG.
Poster 47 GREY Mon-Tues
1
Exhibit Hall Abs No
90 1 AIM OF INVESTIGATION: Relatively little is known about the effectiveness of IV local anesthetic infusions in the management of F! chronic pain states. Some publications report good results (l), others don't (2,3). To our knowledge there exists no double-blind study on the use of parenteral local anesthetic infusion in the treatment of acute and chronic headache, though some authors report analgesic responses in uncontrolled studies (4,5). The aim of our investigation was to prove the effectiveness of two different dosages of mepivacaine in relieving tension-type headache under controlled conditions. METHODS: 44 presenting out-patients with tension-type headache (Intern. Headache Classification No. 2.1 and 2.2) were accepted in a randomized double-blind study on the effectiveness of IV mepivacaine infusions. We examined the efficacy of a moderate dosage (0.2mg/kg body weight) and a high dosage (Img/kg body weight) in comparison with sham infusion given over 45 minutes. 6 infusions were applicated on 3 weeks running. The patients evaluated their current pain intensity by means of visual analog rating scales and a verbal rating scale over 72 hours after infusion. All complications and side-effects were duly recorded. RESULTS: No significant difference could be noticed between the two mepivacaine groups and placebo group with regard to analgesic potency and sedation. Patients of the 4mg/kg mepivacaine group showed a fairly higher amount of side-effects like vertigo and perioral numbness as a sign of moderate systemic toxic reaction. CONCLUSION: In patients with tension-type headache we do not expect an analgesic potency of mepivacaine infusions up to a dosage of 4mg/kg body weight given over 45 minutes. LITERATURE: (1) Kastrup, J. et al.: Pain 28, 69-75 (1987); (2) Edwards, W.T. et al.: Reg. Anesth. 10, l-6 (1985); (3) Kayser, H., Gerbershagen, H.U.: Anaesthesist 38 Suppl- 1, 107 (1989); (4) Rosner, S.: Headache 24, 50 (1984); (5) Sehhati-Chafai, Gh.: Pain Suppl. 4, S 79 (1987).
WARNING HEADACHE IN ANEURYSWAL SUBARACHNOID HERORRHAGE. I. Furuilr and K. Iwata* (SPON: T. Kurazawa), Department of Neurological Surgery, Aicbi Medical University, Aicbi, Japan.
rEi Abs No
91 !
Sore of patients with intracranial aneurysm have a history of slight headache prior to the clinically significant hemorrhage. The headache is termed as Early recognition of warning beadache. followed warning or sentinel headache. by surgery on the patients in excellent neurological condition, sbould provide a We studied retrospectively in our series of aneurysmal more favorable outcone. hemorrhage the characteristics of warning headache to aid early diagnosis and (1) Thirty-three% of surgical treatment before devasting major hemorrhage. patients with ruptured aneurysm showed a history of warning headache. The incidence was not varied with location of aneurysm (Acorn, NC, ICPC and Basilar (2) The incidence aneurysm) and was not different between male and female. decreased as age advanced (from 53% in the 4th decade to 14% in the 7tb decade). (3) The interval between warning headache and majer bemorrbage was 5 hours to 2 (4) Warning beadacbe was not so severe as ta months (average, 21 days). disturb sleep and was invariably perceived in tbe daytime. (5) Unlike the in headache due to major hemorrhage. the warning be,adacbe was usually localized and hardly referred to the occiput and nape. (6) There the temples and forehead, was no difference in the association of a history of hypertension between the patient with and witbout warning headache.
I j
Poster 47 GREY Mon-Tues
1
Exhibit Hall Abs No
90 1 AIM OF INVESTIGATION: Relatively little is known about the effectiveness of IV local anesthetic infusions in the management of F! chronic pain states. Some publications report good results (l), others don't (2,3). To our knowledge there exists no double-blind study on the use of parenteral local anesthetic infusion in the treatment of acute and chronic headache, though some authors report analgesic responses in uncontrolled studies (4,5). The aim of our investigation was to prove the effectiveness of two different dosages of mepivacaine in relieving tension-type headache under controlled conditions. METHODS: 44 presenting out-patients with tension-type headache (Intern. Headache Classification No. 2.1 and 2.2) were accepted in a randomized double-blind study on the effectiveness of IV mepivacaine infusions. We examined the efficacy of a moderate dosage (0.2mg/kg body weight) and a high dosage (Img/kg body weight) in comparison with sham infusion given over 45 minutes. 6 infusions were applicated on 3 weeks running. The patients evaluated their current pain intensity by means of visual analog rating scales and a verbal rating scale over 72 hours after infusion. All complications and side-effects were duly recorded. RESULTS: No significant difference could be noticed between the two mepivacaine groups and placebo group with regard to analgesic potency and sedation. Patients of the 4mg/kg mepivacaine group showed a fairly higher amount of side-effects like vertigo and perioral numbness as a sign of moderate systemic toxic reaction. CONCLUSION: In patients with tension-type headache we do not expect an analgesic potency of mepivacaine infusions up to a dosage of 4mg/kg body weight given over 45 minutes. LITERATURE: (1) Kastrup, J. et al.: Pain 28, 69-75 (1987); (2) Edwards, W.T. et al.: Reg. Anesth. 10, l-6 (1985); (3) Kayser, H., Gerbershagen, H.U.: Anaesthesist 38 Suppl- 1, 107 (1989); (4) Rosner, S.: Headache 24, 50 (1984); (5) Sehhati-Chafai, Gh.: Pain Suppl. 4, S 79 (1987).
WARNING HEADACHE IN ANEURYSWAL SUBARACHNOID HERORRHAGE. I. Furuilr and K. Iwata* (SPON: T. Kurazawa), Department of Neurological Surgery, Aicbi Medical University, Aicbi, Japan.
rEi Abs No
91 !
Sore of patients with intracranial aneurysm have a history of slight headache prior to the clinically significant hemorrhage. The headache is termed as Early recognition of warning beadache. followed warning or sentinel headache. by surgery on the patients in excellent neurological condition, sbould provide a We studied retrospectively in our series of aneurysmal more favorable outcone. hemorrhage the characteristics of warning headache to aid early diagnosis and (1) Thirty-three% of surgical treatment before devasting major hemorrhage. patients with ruptured aneurysm showed a history of warning headache. The incidence was not varied with location of aneurysm (Acorn, NC, ICPC and Basilar (2) The incidence aneurysm) and was not different between male and female. decreased as age advanced (from 53% in the 4th decade to 14% in the 7tb decade). (3) The interval between warning headache and majer bemorrbage was 5 hours to 2 (4) Warning beadacbe was not so severe as ta months (average, 21 days). disturb sleep and was invariably perceived in tbe daytime. (5) Unlike the in headache due to major hemorrhage. the warning be,adacbe was usually localized and hardly referred to the occiput and nape. (6) There the temples and forehead, was no difference in the association of a history of hypertension between the patient with and witbout warning headache.
I j