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The management of migraine during pregnancy poses special problems because one wants to restrict exposure of the fetus to medications It can be stated that beta-adrenergic compounds and tricyclic antidepressants may be used safely in the small proportion of women whose headaches persist or intensify during pregnancy From a limited registry of patients who were given sumatriptan during pregnancy and from several small trials summarized by Fox and colleagues, no teratogenic effects or adverse effects on pregnancy arose, but triptan drugs should perhaps be used advisedly until their safety is con rmed For those women who use anticonvulsants as a means of headache prevention, it is recommended that the drugs be stopped prior to pregnancy or as soon as it is known that pregnancy has begun Cough and Exertional Headache A patient may complain of very severe, transient cranial pain on coughing, sneezing, laughing heartily, lifting heavy objects, stooping, and straining at stool Pain is usually felt in the front of the head, sometimes occipitally, and may be unilateral or bilateral As a rule, it follows the initiating action within a second or two and lasts a few seconds to a few minutes The pain is often described as having a bursting quality and may be of such severity as to cause the patient to cradle his head in his hands, thereby simulating the headache of acute subarachnoid hemorrhage Most often this syndrome takes the form of a benign idiopathic state that recurs over a period of several months to a year or two and then disappears In a report of 103 patients followed for 3 years or longer, Rooke found that additional symptoms of neurologic disease developed in only 10 Symonds emphasized the usual benignity of the condition The cause and mechanism have not been determined During the attack, the CSF pressure is normal Bilateral jugular compression may induce an attack, possibly because of traction on the walls of large veins and dural sinuses In a few instances, we have observed this type of headache after lumbar puncture or after a hemorrhage from an arteriovenous malformation Aside from a rare instance of subarachnoid hemorrhage, patients with cough or strain headache may occasionally be found to have serious intracranial disease; most often it has been traced to lesions of the posterior fossa and foramen magnum, arteriovenous malformation, Chiari malformation, platybasia, basilar impression, or tumor It may be necessary, therefore, to supplement the neurologic examination by appropriate CT and MRI Far more common, of course, are the temporal and maxillary pains that are due to dental or sinus disease, which may also be worsened by coughing A special variant of exertional headache is weight-lifter s headache It occurs either as a single event or repeatedly over a period of several months, but each episode of headache may last many hours or days, again raising the suspicion of subarachnoid hemorrhage The pain begins immediately or within minutes of heavy lifting If the pain resolves in an hour or less and there is no meningismus or sign of bleeding on the CT, we have foregone lumbar puncture and angiography but have suggested that weight lifting not be resumed for several weeks Athletes and runners in general seem to suffer exertional headaches quite often in our experience, and the episodes usually have migrainous features Indomethacin may be quite effective in controlling exertional headaches; this has been con rmed in controlled trials Useful alternatives are NSAIDs, ergot preparations, and phenelzine In a few of our patients, lumbar puncture appeared to resolve the problem in some inexplicable way. mvc show pdf in div . Net PDF Viewer Component | Iron Pdf
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mvc display pdf in partial view As well as I want to restrict the context menu in Pdf Viewer . ... There is a need for the application to display PDF file for user preview, which I did ... Headaches Related to Sexual Activity Lance has described 21 cases of this type of headache, 16 in males and 5 in females The headache took one of two forms: one in which headache of the tension type developed as sexual excitement increased and another in which a severe, throbbing, explosive headache occurred at the time of orgasm and persisted for several minutes or hours The latter headaches were of such abruptness and severity as to suggest a ruptured aneurysm, but the neurologic examination was negative in every instance, as was arteriography in 7 patients who were subjected to this procedure In 18 patients who were followed for a period of 2 to 7 years, no other neurologic symptoms developed Characteristically, the headache occurred on several consecutive occasions and then inexplicably disappeared In cases of repeated coital headache, indomethacin has been effective Of course, socalled orgasmic headache is not always benign; a hypertensive hemorrhage, rupture of an aneurysm or vascular malformation, or myocardial infarction may occur during the exertion of sexual intercourse Thunderclap Headache ( Crash Migraine ) As has been stated several times, the headache of subarachnoid hemorrhage due to rupture of a berry aneurysm is among the most abrupt and dramatic of cranial pains (see Chap 34) There are several reports regarding such pains as a warning leak of rupture and even reports suggesting that such headaches occur as a consequence of unruptured anuerysms (although subsequent studies suggest that this is highly unlikely); it was in relation to a case of this nature that the term thunderclap was introduced by Day and Raskin Patients on our services have offered descriptions such as being kicked in the back of the head A small number of such cases, as pointed out by Dodick, are due to pituitary apoplexy, cerebral venous thrombosis, cervical arterial dissection, hypertensive crisis, or intracranial hypotension To this list we would add diffuse arterial spasm, which may be idiopathic (Call-Fleming syndrome; see page 730) or the result of the adminstration of sympathomimetic or serotonergic drugs, including cocaine and medications for the treatment of migraine However, in a large proportion of patients with thunderclap headache, the pain is indistinguishable from that due to subarachnoid hemorrhage, even to the extent of being accompanied by vomiting and acute hypertension in a few cases The diagnosis is clari ed when, after lumbar puncture and various types of cerebral imaging to exclude bleeding and aneurysm, the pain resolves in hours or less and turns out to have no discernible cause That this is a benign condition has been con rmed by Wijdicks and colleagues, who followed 71 cases for over 3 years and found no serious cerebrovascular lesions For this reason, these cases have been presumed to be a form of migraine ( crash migraine ), partly on the basis of preceding or subsequent headaches and migrainous episodes in affected individuals; in our experience, not all of such patients have had migraine in the past Notable is a tendency for thunderclap headaches to recur Erythrocyanotic Headache On rare occasions, an intense, generalized, throbbing headache may occur in conjunction with ushing of the face and hands and numbness of the ngers (erythromelalgia) Episodes tend to be present on awakening from sound sleep This condition has been reported in a number of unusual settings: (1) in mastocytosis (in ltration of tissues by mast cells, which elaborate histamine, heparin, and serotonin); (2) with carcinoid tumors; (3) with serotonin-secreting tumors; (4) with some tumors of the. syncfusion pdf viewer mvc ASP.NET MVC - Export PDF Document From View Page - C# Corner
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