morphinans and Headache

The present treatment for acute attacks of headache is empiric. Intramuscular nalbuphine (Nubain) and hydroxyzine (Vistaril) were assessed for pain relief in a prospective, double-blind clinical trial. Ninety-four patients were assigned randomly to treatment groups receiving nalbuphine 10 mg, nalbuphine 10 mg plus hydroxyzine 50 mg, hydroxyzine 50 mg, or placebo. The treatment groups were found to be adequately homogenous with regard to age, sex, type and duration of headaches, and history of prior narcotic use. All data were analyzed by one-way analysis of variance. Patients who had headaches diagnosed as other than classic migraine had significantly greater pain relief with nalbuphine compared to placebo (P less than .01). The combination of nalbuphine and hydroxyzine was not significantly more effective than other treatment groups. In 20 patients with classic migraine, none of the treatment regimens significantly outperformed placebo. There were no clinically significant adverse effects attributed to the study drugs. These findings are similar to others that showed a lack of efficacy of kappa receptor agonists in classic migraineurs. Nalbuphine appears to be clinically useful in other types of severe headache. This study does not support the routine addition of hydroxyzine for presumed synergistic effect.

Topics: Adult; Clinical Trials as Topic; Double-Blind Method; Female; Headache; Humans; Hydroxyzine; Injections, Intramuscular; Male; Middle Aged; Morphinans; Nalbuphine; Prospective Studies

Topics: Administration, Oral; Adolescent; Adult; Aged; Analgesia; Clinical Trials as Topic; Female; Headache; Humans; Male; Middle Aged; Morphinans; Nausea; Pentazocine; Placebos; Time Factors; Vomiting

Self-treatment of chronic headache with suppositories containing paracetamol and acetylsalicylic acid may lead to serious complications. We report the radiological features of five cases of rectal stenosis following the use of such suppositories. The role of the double-contrast barium enema in suggesting the diagnosis of this complication of a chronic and often unrecognized self-treatment is emphasized.

Topics: Adult; Analgesics; Barium Sulfate; Constriction, Pathologic; Contrast Media; Enema; Female; Headache; Humans; Morphinans; Pneumoradiography; Rectal Diseases; Rectum; Self Medication; Suppositories

Topics: Accidents; Acepromazine; Etorphine; Headache; Humans; Male; Morphinans; Nalorphine; Syncope; Vertigo; Veterinary Medicine

Topics: Administration, Oral; Adult; Cyclazocine; Cyclopropanes; Dose-Response Relationship, Drug; Headache; Heroin; Heroin Dependence; Humans; Methadone; Morphinans; Narcotic Antagonists; Reflex, Pupillary; Substance-Related Disorders; Time Factors