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even years (hence the term cluster) However, in approximately 10 percent of patients, the headache has become chronic, persisting over years There are several associated vasomotor phenomena by which cluster headache can be identi ed: a blocked nostril, rhinorrhea, injected conjunctivum, lacrimation, miosis, and a ush and edema of the cheek, all lasting on average for 45 min (range 15 to 180 min) Some of our patients, when alerted to the sign, also report a slight ptosis on the side of the orbital pain; in a few, the ptosis has become permanent after repeated attacks The homolateral temporal artery may become prominent and tender during an attack, and the skin over the scalp and face may be hyperalgesic Most patients arise from bed during an attack and sit in a chair and rock or pace the oor, holding a hand to the side of the head The pain of a given attack may leave as rapidly as it began or may fade away gradually Almost always the same orbit is involved during a cluster of headaches as well as in recurring bouts During the period of freedom from pain, alcohol, which commonly precipitates headaches during a cluster, no longer has the capacity to do so The picture of cluster headache is usually so characteristic that it cannot be confused with any other disease, though those unfamiliar with it may entertain a diagnosis of migraine, trigeminal neuralgia, carotid aneurysm, temporal arteritis, or pheochromocytoma To be distinguished also are the Tolosa-Hunt syndrome of ocular pain and ocular motor paralysis (see further on) and the paratrigeminal syndrome of Raeder, which consists of paroxysms of pain somewhat like that of tic douloureux in the distribution of the ophthalmic and maxillary divisions of the fth nerve, in association with ocular sympathetic paralysis (ptosis and miosis but with preservation of facial sweating) Loss of sensation in a trigeminal nerve distribution and weakness of muscles innervated by the fth nerve are often added We have seen instances of head pain, particularly in women, in which the features of both cluster headache and Raeder syndrome could be recognized; no lesion in or near the trigeminal ganglion was found Variants of Cluster Headache Cases of paroxysmal pain behind the eye or nose or in the upper jaw or temple associated with blocking of the nostril or lacrimation and described under the titles of sphenopalatine (Sluder), petrosal, vidian, and ciliary neuralgia (Charlin or Harris, lower half headache) probably represent variants of cluster headache A similar head pain may occasionally be con ned to the lower facial, postauricular, or occipital areas Ekbom distinguished yet another lower cluster headache syndrome with infraorbital radiation of the pain, an ipsilateral partial Horner syndrome, and ipsilateral hyperhydrosis There is no evidence to support the separation of these neuralgias as distinct entities Chronic paroxysmal hemicrania is the name given by Sjaastad and Dale to a unilateral form of headache that resembles cluster headache in some respects but has several distinctive features Like cluster headaches, these are of short duration (2 to 45 min) and usually affect the temporo-orbital region of one side, accompanied by conjunctival hyperemia, rhinorrhea, and in some cases a partial Horner syndrome The acronym SUNCT has been applied to the condition (short-lasting unilateral neuralgiform attacks with conjunctival injection and tearing) Unlike cluster headache, however, the paroxysms occur many times each day, recur daily for long periods (the patient of Price and Posner had an average of 16 attacks daily for more than 40 years), and, most importantly, respond dra-. asp.net display pdf Spire. PDFViewer for ASP . NET - CodePlex Archive
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i wan to display pdf in browser i have done the part, but its not displaying pdf , its directly downloading pdf , i dont want like that i want to display ... matically to the administration of indomethacin, 25 to 50 mg tid Unlike the usual form of cluster headache, chronic paroxysmal hemicrania is more common in women than in men, in a ratio of 3:1 Of note, this variant may be symptomatic of lesions near the cavernous sinus (mainly pituitary adenoma) or in the posterior fossa; most cases are idiopathic Also known is a recurrent nocturnal headache in elderly individuals ( hypnic headache ), as described further on The relationship of the cluster headache to migraine remains conjectural No doubt the headaches in some persons have some of the characteristics of both, hence the terms migrainous neuralgia and cluster migraine (Kudrow) Lance and others, however, have pointed out differences that seem important to the present authors: ushing of the face on the side of a cluster headache and pallor in migraine; increased intraocular pressure in cluster headache, normal pressure in migraine; increased skin temperature over the forehead, temple, and cheek in cluster headache, decreased temperature in migraine; and notable distinctions in sex distribution, age of onset, rhythmicity, and other clinical features, as described above Cluster may be triggered in sensitive patients by the use of nitroglycerin and, as mentioned, by alcohol; the same occurs rarely in migraine The cause and mechanism of the cluster headache syndrome are unknown Gardner and coworkers originally postulated a paroxysmal parasympathetic discharge mediated through the greater super cial petrosal nerve and sphenopalatine ganglion These authors obtained inconsistent results by cutting the nerve, but others (Kittrelle et al) have reported that application of cocaine or lidocaine to the region of the sphenopalatine fossa (via the nostril) consistently aborts attacks of cluster headache Capsaicin, applied over the affected region of the forehead and scalp, may have the same effect Stimulation of the ganglion is said to reproduce the syndrome Kunkle, on the basis of a large personal experience, concluded that the pain arises from the internal carotid artery, in the canal through which it ascends in the petrous portion of the temporal bone In the course of an arteriogram, during which a patient with cluster headaches fortuitously developed an attack, Ekbom and Greitz noted a narrowing of the ipsilateral internal carotid artery This was interpreted as being due to swelling of the arterial wall, which in turn compromised the pericarotid sympathetic plexus and caused the Horner syndrome On somewhat speculative grounds, the cyclic nature of the attacks has been linked to the hypothalamic mechanism that governs the circadian rhythm At the onset of the headache, the region of the suprachiasmatic nucleus appears to be active on PET scanning (May et al) The fact that cluster headaches could be reproduced by the intravenous injection of 01 mg histamine (an early experimental technique for studying the mechanism of headache) led to the notion, popular for many years, that this form of headache was caused by the spontaneous release of histamine and gave rise to a form of treatment that consisted of desensitizing the patient by slow intravenous injections of this drug given daily for several weeks Experience has shown that this form of treatment accomplishes little It should be pointed out that the intravenous injection of histamine induces or worsens many forms of focal or generalized headache (due to fever, trauma, brain tumor) that are dependent on activation of pain-sensitive tissue around the vessels derived from the internal carotid artery Treatment The usual nocturnal attacks of cluster headache can be treated with a single anticipatory dose of ergotamine at bedtime. display pdf in iframe mvc PdfViewer for Asp.Net MVC in Common Topics General Discussions ...
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