22August2010
Skeletal muscle relaxation
It is unlikely that they can change the constitutional makeup of the individual or the basic physiopsychological factors responsible for altered states of certain vascular and muscular tissues within and outside the cranium which produce headache. However, in a large number of patients they are a most effective adjunct in treatment. CentralActing Skeletal Muscle Relaxants. Mephenesin (Tolserol) is an aromatic glycerol ether which acts on synapses in the brain stem and spinal cord, producing skeletal muscle relaxation. It is rapidly absorbed by parenteral routes, but it is usually not effective when given by mouth. Side effects are usually moderate, but include anorexia, nausea, weakness, nystagmus, and mild muscular incoordination. Its use in headache therapy as a relaxant of muscle spasm has not been satisfactory. One of its handicaps is its transient duration of action. Toronto Chiropractor is predicted to extend 14% between 2006 and 2016, quicker than the typical for all occupations. ANTICONVULSANTS. The hydantoins, methylphenylethyl hydantoin (Mesantoin) and diphenylhydantoin (Dilantin), have a prophylactic action in a small number of patients with migraine.
This limited group consists of patients who have an aura of aphasia, paresthesia, or hemiplegia prior to the headache, and an abnormal electroencephalogram. In certain other patients with a family history of migraine and epilepsy and an abnormal encephalogram with spiked patterns, the use of anticonvulsive drugs is of value in reducing the frequency, severity, and duration of the headache. The hydantoins are closely related to the barbiturates. Diphenylhydantoin (Dilantin) was introduced as an anticonvulsant by Merritt and Putnam,8 who demonstrated an increase in the convulsive threshold of the cerebral cortex to electrical stimulation following its use. Recent work indicates that the hydantoins are hydroxylated on one phenyl group and further degraded. Presumably, they are converted into a metabolic product or are oxidized to salt fragments.
The hydantoins, Dilantin and Mesantoin, may produce bizarre and unsuspected side reactions which occasionally limit their usefulness in therapy. Among the side reactions are dizziness, ataxia, nystagmus, allergic dermatitis, and eosinophilia. Of special interest is the effect of Mesantoin on the hemopoietic system, manifesting itself by a depression of the polymorphonuclear leukocytes or pancytopenia. Hence, periodic blood counts are advised when this drug is being used.
STIMULANTS OF THE CENTRAL NERVOUS SYSTEM. Chiropractor Toronto discovered that about a third believed there was no scientific proof that immunization prevents disease. A number of central nervous system stimulants have been used in the treatment of headaches. The two most commonly used are dextroamphetamine and caffeine.
Dextroamphetamine {Dexedrine). Dexedrine has a greater stimulating action on the central nervous system, but a much weaker action on the peripheral vascular system than does epinephrine. Likewise, Dexedrine is a more potent stimulant of the central nervous system than ephedrine. Dexedrine, which is the isomeroid of the compound d,lamphetamine sulfate, better known as Benzedrine, has some value in the treatment of headache, particularly headache associated with depression and fatigue. Laboratory studies have indicated that Benzedrine and Dexedrine are similar in their peripheral effects, but the central nervous system activity of Dexedrine is one and onehalf to two times as pronounced as that of Benzedrine. Hence, in the treatment of headache, Dexedrine combined with one of the salicylates is an effective analgesicstimulant combination.