bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of the ICHD‐II Criteria in the Diagnosis of Pediatric Migraine
Authors: Hershey Andrew D. , Winner Paul , Kabbouche Marielle A. , Gladstein Jack , Yonker Marcy , Lewis Don , Pearlman Eric , Linder Steven L. , Rothner A. David , Powers Scott W.
Published: August 2010

Objective.—To evaluate the sensitivity of the new International Classification of Headache Disorders‐2nd edition (ICHD‐II) criteria in the diagnosis of childhood migraine and to propose specific criteria for the diagnosis of childhood migraine.

Background.—In 2004, ICHD‐II was adopted by the International Headache Society. The prior version had been criticized for its lack of sensitivity in diagnosing childhood headaches. ICHD‐II is felt to be an improvement as it provides for some differences between pediatric and adult migraine diagnosis in its footnotes, however, has yet to be validated. Clinically, it is the impression of many pediatric headache specialists that children's migraines are of shorter duration, tend to be bilateral rather than unilateral, and that children more often report either photophobia or phonophobia, rather than both.

Methods.—The characteristics of headache in 260 patients, ages 18 and under, clinically diagnosed with migraine at two large pediatric headache centers were compiled using standard intake questionnaires. Inter‐rater reliability in clinical diagnosis was determined by consensus of the clinical diagnosis. These data were analyzed applying the International Classification of Headache Disorders‐1st edition (ICHD‐I) and ICHD‐II criteria for migraine to determine sensitivity of migraine diagnosis in comparison with clinical impression. Each headache characteristic in ICHD‐II was analyzed individually to determine its effect on sensitivity of diagnosis.

Results.—183/260 patients (70.4%) met ICHD‐I criteria. 161/260 patients (61.9%) met the ICHD‐II criteria with a 4‐ to 72‐hour range. When the footnoted allowance of ICHD‐II for short duration (2 hours) was utilized, 187/260 patients (71.9%) met criteria, while this improved to 192/260 patients (73.9%) with 1‐hour duration. If duration was excluded, 210/260 patients (80.8%) met criteria. The most common reasons for patients not meeting the standard criteria were the requirement of unilateral location, headache duration and number of associated symptoms. Based on these observations, modified criteria were empirically derived and the sensitivity increased to 84.4%. Data were reanalyzed using the criteria of focal head pain, either bilateral or unilateral, shortened duration, and modified associated symptoms, which resulted in an improved sensitivity in migraine diagnosis of 84.4%.

Conclusions.—Modification of ICHD‐II criteria to include bilateral headache, headache duration of 1 to 72 hours, and nausea and/or vomiting plus two of five other associated symptoms (photophobia, phonophobia, difficulty thinking, lightheadedness, or fatigue), in addition to the usual description of moderate to severe pain of a throbbing or pulsating nature worsening or limiting physical activity, improved sensitivity of migraine diagnosis to 84.4%.
Serum S100β Protein in Children With Acute Recurrent Headache: A Potentially Useful Marker for Migraine
Authors: Papandreou Ourania , Soldatou Alexandra , Tsitsika Artemis , Kariyannis Catherine , Papandreou Thalia , Zachariadi Asimina , Papassotiriou Ioannis , P. Chrousos George
Published: August 2010

Objective.—To examine the role of glia‐derived S100β protein and to evaluate its use as a biochemical marker in childhood acute recurrent headache.

Methods.—Twenty‐five patients with acute recurrent headache (according to International Headache Society criteria) from our department's Headache Clinic were studied. Blood samples for measurement of serum S100β were drawn: (1) ≤3‐hour post pain attack from our patients and (2) from 23 healthy controls.

Results.—Of the 25 patients evaluated, 15 suffered from migraine and 10 from tension‐type headache (TTH). Statistical analysis of the mean values of S100β levels demonstrated a significant elevation in children with migraine headache, with values higher than those of both children with TTH and controls (P= .001).

Conclusions.—Our data suggest a direct relation between childhood migraine attacks and increased production of glial S100β protein. Serum S100β determination may be a useful biochemical marker for migraine in acute recurrent headache in childhood.
Tramadol/Acetaminophen for the Treatment of Acute Migraine Pain: Findings of a Randomized, Placebo‐Controlled Trial
Authors: Silberstein Stephen D. , Freitag Frederick G. , Rozen Todd D. , Kudrow David B. , Hewitt David J. , Jordan Donna M. , Fisher Alan C. , Rosenthal Norman R. ,   for the CAPSS‐223 Investigators
Published: August 2010

Objective.—To compare tramadol/acetaminophen (APAP) and placebo for the management of acute migraine pain.

Background.—Tramadol/APAP tablets reduced moderate‐to‐moderately severe acute pain in controlled studies of other painful conditions.

Methods.—This randomized, double‐blind, placebo‐controlled, parallel group study enrolled adults with migraine pain as per International Headache Society criteria. Subjects took tramadol/APAP (total dose, 75 mg/650 mg) or placebo for a typical migraine with moderate‐to‐severe pain. Severity of pain and migraine‐related symptoms were recorded before study medication and at 0.5, 1, 2, 3, 4, 6, and 24 hours after study medication.

Results.—Efficacy analyses included 305 subjects (154 tramadol/APAP and 151 placebo). Treatment response was higher for tramadol/APAP than a placebo at 2 hours after dosing (55.8% vs. 33.8%,P< .001) and at every other assessment from 30 minutes (12.3% vs. 6.6%) through 6 hours (64.9% vs. 37.7%) (allP≤ .022). Subjects in the tramadol/APAP group were more likely than those in the placebo group to be pain‐free at 2 hours (22.1% vs. 9.3%), 6 hours (42.9% vs. 25.2%), and 24 hours (52.7% vs. 37.9%) (allP≤ .007). Two hours after dosing, moderate‐to‐severe symptoms that were less common for tramadol/APAP than placebo included photophobia (34.6% vs. 52.2%,P= .003) and phonophobia (34.3% vs. 44.9%,P= .008), but not migraine‐related nausea (38.5% vs. 29.4%,P= .681). Treatment‐related adverse events included nausea, dizziness, vomiting, and somnolence.

Conclusions.—Tramadol/APAP reduces the severity of pain, photophobia, and phonophobia associated with migraine headache, but does not reduce migraine‐associated nausea. Tramadol/APAP might be an appropriate option for the management of moderate‐to‐severe migraine headache.
Development and Validation of the Migraine Screen Questionnaire (MS‐Q)
Authors: Láinez Miguel J.A. , Domínguez Manuel , Rejas Javier , Palacios Gemma , Arriaza Encarnación , Garcia‐Garcia Margarida , Madrigal María
Published: August 2010

Aim.—To develop and evaluate the clinimetric properties of a new migraine screening questionnaire: the Migraine Screen Questionnaire (MS‐Q).

Background.—Migraine is a public health problem requiring screening programs and tools to ensure early detection.

Methods.—A questionnaire was developed based on the criteria of the International Headache Society (IHS) and a review of the literature by a committee of experts. Stage I: The original version of the MS‐Q was distributed by mail and completed by Pfizer employees and self‐administered to neurological patients; all subjects were afterward evaluated by a neurologist who was blinded to the MS‐Q results, to establish an independent IHS diagnosis. Stage II: A final version of the MS‐Q was administered to neurological patients to confirm clinimetric properties. Logistic regression and receiver–operator characteristic curve statistical methods were used and the 95% confidence interval, sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, were estimated.

Results.—Of the 605 subjects recruited, 465 were evaluable (325 in stage I and 140 in stage II). Of the original 15 items, 5 conformed the final version of the MS‐Q: frequency and intensity of headache; a duration of between 4 hours and 3 days; nausea; sensitivity to light/noise; and disability. A cutoff point of ≥4 points showed a sensitivity of 0.93 (95% CI = 0.87 to 0.99), specificity of 0.81 (95% CI = 0.72 to 0.91), PPV of 0.83 (95% CI = 0.75 to 0.91), and NPV of 0.92 (95% CI = 0.85 to 0.99). Cronbach's alpha coefficient = 0.82.

Conclusions.—The MS‐Q showed adequate validity and reliability, and it could be a good screening tool for application to clinical practice and research.
Stroke‐Related Headache: A Clinical Study in Lacunar Infarction
Authors: Arboix Adrià , García‐Trallero Olivia , García‐Eroles Luis , Massons Joan , Comes Emili , Targa Cecilia
Published: August 2010

Objective.—To describe the characteristics of headache related to lacunar stroke based on data collected from a prospective hospital‐based stroke registry over a 12‐year period. Demographics, clinical variables, and prognostic features of lacunar stroke in patients with and without headache are compared.

Background.—Stroke‐related headache has been largely investigated, but there is little clinical data on headache in individualized stroke subtypes.

Methods.—The cohort of 484 patients with lacunar infarction was selected. Forty‐five (9.3%) presented headache within a 72‐hour interval of stroke onset. Predictors of lacunar infarction with headache were assessed by logistic regression analysis.

Results.—The intensity of headache was mild in severity and poorly localized (diffuse or bilateral headache). Tension‐type headache was present in 36 patients (80%) and 9 patients (20%) presented nausea or vomiting while experiencing mild pulsating pain. The frequency of headache was 17% in patients with atypical lacunar syndrome, 12% in dysarthria‐clumsy hand, 11.5% in pure sensory stroke, 9.4% in sensorimotor stroke, and 7.1% in pure motor hemiparesis. When patients with lacunar infarction with and without headache were compared, female sex, diabetes mellitus, nausea and vomiting, and mesencephalic topography were significantly more frequent and dysarthria and frequency of symptom free at discharge were less frequent in the headache group. In the multivariate analysis, mesencephalic topography (odds ratio [OR] 16.62), nausea and vomiting (OR 13.27), sex female (OR 2.29), diabetes mellitus (OR 1.96), and age (OR 0.95) were predictors of lacunar infarction with headache.

Conclusions.—Headache at the onset of a lacunar infarction is uncommon. Mesencephalic topography, nausea and vomiting, female sex, diabetes, and age were independent variables significantly associated with lacunar infarction with headache. These findings contribute to knowledge of stroke‐related headache in patients with lacunes.
Effects of Noise and a Stressor on Head Pain
Authors: Martin Paul R. , Todd Juanita , Reece John
Published: August 2010

Objective.—Can causal relationships be established between negative affect (NA) and headaches, and noise (N) and headaches? Do NA and N interact to cause headaches? Do NA and N cause headaches by means of the same or different physiological mechanisms? Are the answers to these questions a function of diagnostic status?

Background.—A functional model of chronic headaches has been proposed that seeks to understand the variance in headaches by focusing on the controlling variables, that is, the antecedents and consequences. This study is one in a series investigating the immediate antecedents of headaches, namely the trigger factors.

Design.—Twenty‐four subjects with migraine and 44 subjects with tension‐type headache were randomly assigned to one of four experimental conditions defined by the presence or absence of two antecedent challenges, a stressor (S) designed to induce NA and N.

Methods.—The S challenge consisted of difficult‐to‐solve anagrams accompanied by failure feedback. The N challenge consisted of 50 dB of white N. Laboratory sessions were divided into adaptation, baseline, challenge, and recovery phases. Responses were measured in terms of headache intensity ratings, forehead electromyographic activity, heart rate, blood pressure, and temporal pulse amplitude (TPA).

Results and Conclusions.—Both NA and N precipitated headaches. These two factors did not interact in triggering headaches. Headaches induced by N were associated with elevated TPA but headaches induced by NA were not associated with significant physiological changes. Diagnosis was not related to any of the outcomes.
The Neuropsychology of Recurrent Headache
Authors: O'Bryant Sid E. , Marcus Dawn A. , Rains Jeanetta C. , Penzien Donald B.
Published: August 2010

Headache is recognized as one of the most prevalent neurological disorders, and is the most frequently reported symptom following injury to the head, brain, or neck. Although studies of central nervous system abnormalities in headache sufferers have emerged in recent years, less is known about the associated functional impairments. The research literature addressing neuropsychological consequences of headache has been far from conclusive. Migraine has been most extensively studied, with some consistent evidence of subtle but potentially significant changes in cognition occurring during and between migraine episodes. It also appears likely that migraine patients with aura experience more neuropsychological deficits than those without aura. While the literature devoted to understanding the neurocognitive profile of migraine sufferers is growing, much less research has addressed the neuropsychology of tension‐type headache and posttraumatic headache (PTHA). There is some suggestion of poorer neuropsychological function in tension‐type headache than controls, but the evidence is inconclusive. The PTHA population is highly varied in degree and location of trauma, preexisting headache condition, and other injury‐related variables, allowing little generalization across studies. This paper summarizes research regarding the cognitive symptoms associated with migraine, tension‐type headache, and PTHA, provides an overview of the cognitive side effects of headache medications, and addresses clinical implications and priorities for future research.
Understanding Psychological Stress, Its Biological Processes, and Impact on Primary Headache
Authors: Nash Justin M. , Thebarge Ronald W.
Published: August 2010

Psychological stress is generally acknowledged to be a central contributor to primary headache. Stress results from any challenge or threat, either real or perceived, to normal functioning. The stress response is the body's activation of physiological systems, namely the hypothalamic‐pituitary‐adrenal axis, to protect and restore functioning. Chronic activation of the stress response can lead to wear and tear that eventually can predispose an individual to disease. There are multiple ways that stress and headache are closely related. Stress can (a) be a predisposing factor that contributes to headache disorder onset, (b) accelerate the progression of the headache disorder into a chronic condition, and (c) precipitate and exacerbate individual headache episodes. How stress impacts headache is not often understood. However, stress is assumed to affect primary headache by directly impacting pain production and modulation processes at both the peripheral and central levels. Stress can also independently worsen headache‐related disability and quality of life. Finally, the headache experience itself can serve as a stressor that compromises an individual's health and well‐being. With the prominent role that stress plays in headache, there are implications for the evaluation of stress and the use of stress reduction strategies at the various stages of headache disorder onset and progression. Future directions can help to develop a better empirical understanding of the pattern of the stress and headache connections and the mechanisms that explain the connections. Further research can also examine the interactive effects of stress and other factors that impact headache disorder onset, course, and adjustment.
Intracortical Inhibition and Facilitation in Migraine—A Transcranial Magnetic Stimulation Study
Authors: Siniatchkin Michael , Kröner‐Herwig Birgit , Kocabiyik Ebru , Rothenberger Aribert
Published: August 2010

Objective.—Migraine is a disease of altered cortical excitability between attacks. However, the mechanisms of abnormal excitability in migraine are insufficiently investigated. Hence, the aim of the study was to investigate intracortical inhibition/facilitation of the motor circuit in migraine.

Methods.—Sixteen women suffering from migraine without aura and 15 healthy women were investigated using a suprathreshold transcranial magnetic stimulation (TMS) in the paired‐pulse paradigm with long interstimulus intervals (ISI = 20, 60, 120 ms) and measurement of the cortical silent period.

Results.—We found no differences for the cortical silent period and for the long intracortical inhibition between the groups. Concerning intracortical facilitation, this ability was significantly more pronounced in patients suffering from migraine compared with healthy controls.

Conclusion.—Migraineurs produce an increased intracortical facilitation. The results may be discussed in line of glutamatergic mechanisms in migraine, which could be related to altered facilitation.
Must All Patients With Headaches Associated With Sexual Activity Fulfill ICHD‐2 Criteria?
Authors: Chakravarty Ambar
Published: August 2010

Primary headaches associated with sexual activity (more commonly referred to as Benign Sexual Headaches) are uncommon. The International Headache Society has provided diagnostic criteria for such forms of headaches. This article presents 2 case reports of headache occurring in close temporal association with sexual activity but which do not conform to the diagnostic criteria laid down in ICHD‐2. Nosological and other issues raised by these cases are discussed and inclusion of such cases within the rubric of Benign Sexual Headaches is argued.
Satisfaction With Current Migraine Therapy: Experience From 3 Centers in US and Sweden
Authors: Bigal Marcelo , Rapoport Alan , Aurora Sheena , Sheftell Fred , Tepper Stewart , Dahlof Carl
Published: August 2010

Objective.—To assess the level of satisfaction and determinants of satisfaction or dissatisfaction of patients presenting in tertiary care, in regard to their usual care (UC) for the acute treatment of migraine.

Design/Methods.—Patients seen in 3 headache centers were assessed by means of 21 attributes related to their UC. Questions covered satisfaction with efficacy (including onset of relief, degree of relief, consistency of action, ease of use), tolerability (lack of side effects overall, CNS side effects, other side effects), and willingness to continue using the same medication and to change to another medication. All questions were answered on a 5‐point scale (where 1 was strongly agree, 2 was agree, 3 was neutral, 4 was disagree, and 5 was strongly disagree).

Results.—We assessed 183 subjects (74.8% women, mean age = 39.3 years). UC consisted, as a single drug or combination, of: triptan conventional tablets – 62%; triptan disintegrating tablets – 8%; sumatriptan nasal spray 9%; sumatriptan injection, 9%; nontriptans – 19.6%. Most (54%) had no benefit within the first hour of treatment. The maximum benefit took more than 1 hour to be reached in 69%, and more than 2 hours in 36%. After the maximum benefit had been reached, pain worsened in 61%. Although 58% were satisfied with the degree of relief, 37% were dissatisfied with the speed of effect, 50% with the recurrence of pain, and 42% with the need for a second dose. Most were satisfied with the tolerability (56%). Finally, most (79.7%) said they were willing to try another acute medication.

Conclusions.—An important subset of patients, including a large subgroup of patients using triptans, is dissatisfied with their UC. Clinical trials assessing patients' preference should be conducted to complement the information from clinical trials.
Patient‐Centered Outcomes for Frequent Headaches
Authors: Coeytaux Remy R. , Frasier Pamela Y. , Reid Alfred
Published: August 2010

Objective.—To identify clinical outcomes that headache sufferers consider meaningful.

Background.—Several standardized instruments have been developed to assess the severity of headaches and the impact of headaches on an individual's quality of life. To our knowledge, however, little research has been conducted to determine which of these many clinical endpoints are considered by headache sufferers themselves to be most important.

Methods.—We conducted 4 focus groups with patients with frequent headaches who had recently participated in a randomized clinical trial. Subjects were informed that the purpose of the focus groups was to help healthcare providers learn how to better recognize if their patients' headache conditions improved or worsened over time.

Results.—Five salient topics emerged from the discussions: (1) severity of pain associated with headaches; (2) definition of meaningful symptom relief; (3) uncertainty regarding timing and severity of headaches; (4) devaluation of the impact of headaches on sufferers; and (5) assessments of pain. Participants stated unambiguously that headache pain is one of the most important aspects of their headache experience. Each of the 4 groups agreed that an increase in the number of pain‐free days would be meaningful. Participants also reported that daily headache diaries are not overly burdensome to complete and that the diaries helped them identify useful trends over time.

Conclusions.—Our findings suggest that severity and frequency of headache pain are important clinical outcomes from patients' perspective, and that headache diaries are a feasible and useful method of assessing meaningful clinical change over time. Although standardized questionnaires that assess functional status, disability, or health‐related quality of life may help quantify patients' response to treatment for frequent headaches, participants in this study did not consider such questionnaires particularly informative. Further research is needed to validate headache diaries among patients with headache in the primary care setting.
Topiramate in Migraine Prophylaxis: Long‐Term Impact on Resource Utilization and Cost
Authors: Silberstein Stephen D. , Feliu Anthony L. , Rupnow Marcia F.T. , Blount Angela C. , Boccuzzi Stephen J.
Published: August 2010

Objective.—To evaluate the medical resource utilization and overall cost of care among patients treated with topiramate (TPM) for migraine prevention in a commercially insured population.

Background.—Preventive migraine therapy with TPM significantly reduces the frequency of migraine attacks. Limited data exist on the real‐world health care consumption associated with TPM therapy for migraine prevention.

Methods.—Data were obtained from a large geographically diverse integrated medical and pharmacy claims database representative of the commercially insured population. The date of the first TPM claim between July 2000 and December 2003 was considered the index date. Patients needed at least 1 triptan prescription (Rx) claim during the 6‐month preindex period, and ≥2 TPM Rx claims in the 12 months following index TPM Rx to be included in the analysis. Headache‐related inpatient and outpatient resource use were compared: preindex vs postindex period 1 (months 1‐6) and preindex vs postindex period 2 (months 7‐12). Subgroup analyses were conducted based on the triptan consumption during the 6‐month preindex period: Cohort L (low triptan users) with ≤36 triptan doses, and Cohort H (high triptan users) with >36 triptan doses.

Results.—The sample included 2645 plan members (1778 patients in Cohort L, and 867 patients in Cohort H). TPM utilization was associated with significantly less triptan utilization in the first (34.8 quantity dispensed; 7.5% decrease) and second (30.2; 19.6% decrease) follow‐up periods compared to the preindex period (37.6; both P < .0001). In postindex period 1, there was a 46% decrease in emergency department (ED) visits, 39% decrease in diagnostic procedures (eg, CT scans and MRIs), and a 33% decrease in hospital admission; physician office visits were unchanged. In postindex period 2, there was a 46% decrease in ED visits, 72% decrease in diagnostic procedures, 61% decrease in hospital admissions, and a 35% decrease in physician office visits. Decreases in resource use were observed in both cohorts L and H. Mean ± SD total headache‐related cost was $2118 ±$3406 per patient in the preperiod, versus $2450 ±$3318 in follow‐up period 1 and $2009 ±$3136 in follow‐up period 2.

Conclusion.—In this sample of patients from a diverse set of health plans receiving TPM, significant decreases in resource use were observed within 6 months of TPM initiation, and this trend continued in follow‐up period 2. Although there was an initial increase in total headache‐related cost upon introduction of TPM (follow‐up period 1), the cost in follow‐up period 2 was lower than in the preindex period, suggesting that benefits of long‐term treatment with TPM can be achieved without increasing total cost.
A Case of Hypertrophic Pachymeningitis With Prolonged Headache, Attributable to Epstein–Barr Virus
Authors: Okuma Hirohisa , Kobori Satoko , Shinohara Yukito , Takagi Shigeharu
Published: August 2010

Hypertrophic pachymeningitis is a condition characterized by significant chronic inflammatory thickening of the cranial dura mater, frequently presenting with symptoms such as headache and cranial neuropathy. In this report, we describe a very rare case of hypertrophic pachymeningitis, considered to be attributable to Epstein–Barr virus (EBV), which was diagnosed in a patient who visited our hospital with a complaint of ongoing severe headaches. The diagnosis was based on positive specific serum EBV antibody titers, with VCA‐IgM levels of less than 1:10, VCA‐IgG levels of 1:160, and EBNA levels of 1:40, as well as on the results of magnetic resonance imaging of the head with contrast media.
Migraine and the Risk of Stroke, TIA, or Death in the UK (CME)
Authors: Becker Claudia , Brobert Gunnar P. , Almqvist Per M. , Johansson Saga , Jick Susan S. , Meier Christoph R.
Published: August 2010

Background.— Previous observational studies have reported a higher risk of stroke in migraine patients.

Objective.— We aimed to estimate the risk of stroke, transient ischemic attack (TIA), or death in migraineurs in the UK.

Method.— We conducted a population‐based follow‐up study within the General Practice Research Database from 1994 to 2001.

Results.— The relative risk (RR) of stroke in migraineurs compared with non‐migraineurs was 2.2 (95% confidence interval [CI] 1.7‐2.9). It was highest for patients with a migraine diagnosis recorded within 30 days prior to a stroke (odds ratio 11.1, 95% CI 5.69‐21.5). The RR of TIA in migraineurs compared with non‐migraineurs was 2.4 (95% CI 1.8‐3.3), the mortality of migraineurs was slightly decreased.

Conclusion.— In our study, the RR of developing a stroke or a TIA was doubled in migraineurs as compared with non‐migraineurs, while that for death was close to unity.
Prevalence of Vertigo, Dizziness, and Migrainous Vertigo in Patients With Migraine
Authors: Vuković Vlasta , Plavec Davor , Galinović Ivana , Lovrenčić‐Huzjan Arijana , Budišić Mislav , Demarin Vida
Published: August 2010

Objective.— The aim of this study was to determine the lifetime prevalence of vertigo and dizziness in patients with migraine as compared with controls and to establish the lifetime prevalence of migrainous vertigo.

Background.— Dizziness and vertigo are relatively frequent complaints in general population; however, the prevalence of migrainous vertigo has not been extensively studied so far.

Methods.— The study included 327 migraine patients and 324 controls who do not suffer from frequent headaches. The study and control group were assessed clinically and through diagnostic workup for having vertigo, dizziness, hypotension, and sideropenic anemia.

Results.— Vertigo or dizziness was experienced by 51.7% of migraine patients (MVL group) and 31.5% in the control group (CVL group), P < .0001. Among the MVL group, 23.2% of patients met the criteria for migrainous vertigo. There was no difference between the MVL group and CVL group in frequency of attacks or the pattern of symptom appearance in relation to head movement. Patients in the MVL group more frequently had hypotension, P = .011. Patients with migraine with aura significantly more often had migraine attacks in association with vertigo or dizziness, P < .0001.

Conclusion.— The lifetime prevalence of migrainous vertigo is relatively frequent in migraine patients, especially in migraine with aura.
Botulinum Toxin Type A and Divalproex Sodium for Prophylactic Treatment of Episodic or Chronic Migraine
Authors: Blumenfeld Andrew M. , Schim Jack D. , Chippendale Thomas J.
Published: August 2010

Objective.— To compare the efficacy and safety of botulinum toxin type A (BoNTA; BOTOX®: Allergan, Inc.) and divalproex sodium (DVPX; DEPAKOTE®: Abbott Laboratories) as prophylaxis in reducing disability and impact associated with migraine.

Background.— There is a need for effective, well‐tolerated prophylactic treatment of migraine.

Design/Methods.— This was a randomized, double‐blind, single‐center prospective study. Fifty‐nine patients received either BoNTA 100 U/placebo‐DVPX bid or placebo‐BoNTA/DVPX 250 mg bid. BoNTA/placebo injections were given at Day 0 and at Month 3. Patients were evaluated at Months 1, 3, 6, and 9.

Results.— Both treatments showed significant improvements in migraine disability scores and reductions in headache days and headache index. A trend to decreased headache severity was observed with BoNTA. A greater percentage of DVPX patients reported adverse events possibly related to treatment (DVPX 75.8% vs BoNTA 50%, P = .04) and discontinued because of adverse events (DVPX 27.6% vs BoNTA 3.3%, P = .012).

Conclusions.— Both BoNTA and DVPX significantly reduced disability associated with migraine; BoNTA had a favorable tolerability profile compared with DVPX.
Bilateral Carotid Artery Dissection After Dental Work
Authors: Siwiec Robert M. , Solomon Glen D.
Published: August 2010

Carotid artery dissection has been reported to occur spontaneously and after many types of neck trauma. A case patient is presented who developed a right‐sided oculosympathetic palsy and was found to have bilateral carotid artery dissection after she visited her dentist. To the best of our knowledge, this case represents the first report of bilateral carotid dissection following dental work.
Concepts and Mechanisms of Migraine Chronification
Authors: Bigal Marcelo E. , Lipton Richard B.
Published: August 2010

Migraine is a chronic recurrent disorder with episodic manifestations that is progressive in some individuals. Migraine progresses clinically, physiologically, and anatomically. Progression may be a consequence of the mechanisms that generate the migraine attacks (eg, cortical spreading depression) or it may be a function of the activations generated by the attacks (eg, lesions in the periaqueductal gray area), a hypothesis supported by the increase in lesions with attack frequency. Progression may also be partially explained by common genetic or environmental risk factors. Finally, migraine with aura is associated with an elevated Framingham score and with risk factors for cardiovascular disease. Research on this issue is in its infancy and cautions are necessary before extrapolating this information into clinical practice.
Risk Factors for Headache Chronification
Authors: Scher Ann I. , Midgette Lynn A. , Lipton Richard B.
Published: August 2010

About 4% of the adult population and about 1% to 2% of children experience chronic attacks on a daily or near daily basis. While there is uncertainty about the biological mechanisms that lead to headache “chronification,” the epidemiologic literature has provided some insight into modifiable and nonmodifiable factors that appear to influence risk of headache progression. This review summarizes the evidence from population‐based studies related to the chronic daily headache phenotype, natural history, and risk factors that may influence incidence, prevalence, or prognosis.
Stress and Headache Chronification
Authors: Houle Timothy , Nash Justin M.
Published: August 2010

In this special section, the concept of stress has been linked to the chronification of headache and is considered to be one of several likely mechanisms for the progression of an otherwise episodic disorder to a chronic daily phenomenon. The present review discusses the concept of stress and describes the mechanisms through which stress could influence headache progression. The hypothesized mechanisms include stress serving as a unique trigger for individual attacks, as a nociceptive activator, and as a moderator of other mechanisms. Finally, the techniques used in the screening and management of stress are mentioned in the context of employing strategies for the primary, secondary, or tertiary prevention of headache progression.
Orthostatic Headache as the Presenting Symptom of Cervical Spine Metastasis
Authors: Kim Ji Hyun , Choi Jeong‐Yoon , Kim Ho‐Jung , Oh Kyungmi
Published: August 2010

Orthostatic headache is a key symptom of intracranial hypotension; however, not all orthostatic headaches are caused by cerebrospinal fluid leaks leading to intracranial hypotension. We report here the unusual case of a 68‐year‐old man presenting with orthostatic headache in which compression of the C3 spinal nerve root by metastatic tumor invasion may contribute to the development of his orthostatic headache.
Heart Rate Recovery in Migraine and Tension‐Type Headache
Authors: Yerdelen Deniz , Acil Tayfun , Goksel Basak , Karatas Mehmet
Published: August 2010

Objective.— There are reports proposing that migraine and tension‐type headache (TTH) may affect the autonomic nervous system (ANS). Abnormalities in both sympathetic and parasympathetic nervous system have been suggested in migraineurs. However, in TTH, reports on the ANS function are limited and only associated with sympathetic system. Techniques for evaluating parasympathetic activity are more limited when compared with sympathetic function. Hence, the aim of the study was to measure heart rate recovery (HRR), an index of vagal activity, in migraine, TTH, and control subjects.

Methods.— Forty‐seven episodic migraine, 10 episodic TTH, 11 chronic TTH, and 25 control subjects underwent exercise tolerance test according to modified Bruce protocol, and HRR at 1 minute and 3 minutes (HRR1 and HRR3) were calculated.

Results.— The HRR 1 and 3 were found to be similar in 3 groups of subjects. However, resting heart rate of migraine and chronic TTH were found to be higher than episodic TTH, but not different from the control group.

Consclusion.— These results suggest that parasympathetic function has not been affected in migraine and TTH patients. However, sympathetic tonus, which is evaluated by resting heart rate, is higher in migraine and chronic TTH than in episodic TTH.
Hypnic Headache Responsive to Low‐Dose Topiramate: A Case Report
Authors: Autunno Massimo , Messina Corrado , Blandino Anita , Rodolico Carmelo
Published: August 2010

This is a clinical report of a 63‐year‐old woman, with a 3‐year history of severe episodes of hypnic headache responding to low‐doses of topiramate (25 mg at bedtime). Topiramate has been used at the dosage of 100 mg/day for hypnic headache prevention in one recent case report with benefit. This report confirms the efficacy of topiramate in hypnic headache even using low‐dose regimen therapy.
Meta‐Analysis of the Efficacy and Safety of Zolmitriptan in the Acute Treatment of Migraine
Authors: Chen Li‐Chia , Ashcroft Darren M.
Published: August 2010

Objective.— To assess the relative efficacy and safety of zolmitriptan in the treatment of acute migraine attacks.

Background.— Zolmitriptan is a second‐generation triptan developed for the treatment of migraine. Numerous randomized controlled trials (RCTs) have been carried out to compare different dosages and formulations of zolmitriptan against other treatments for acute migraine.

Methods.— Random effects meta‐analysis of 24 RCTs, including 15,408 patients suffering from acute migraine attacks. Subgroup analyses compared differences in response between different dosages and formulations of zolmitriptan, and other triptan comparators.

Results.— Zolmitriptan 2.5 mg tablet was found to be as effective as almotriptan 12.5 mg, eletriptan 40 mg, sumatriptan 50 mg and 100 mg and more effective than naratriptan 2.5 mg in terms of 2‐hour pain‐free rates. Likewise, zolmitriptan 5 mg tablet was as effective as sumatriptan 50 mg and 100 mg in 2‐hour pain‐free rates. Compared against zolmitriptan 2.5 mg tablet, eletriptan 80 mg was more effective in achieving headache relief, pain‐free and sustained pain‐free responses, and rizatriptan 10 mg was more effective in terms of sustained pain‐free rates. Zolmitriptan 2.5 mg tablet was associated with a lower risk of adverse events than eletriptan 80 mg but higher risk than naratriptan 2.5 mg and rizatriptan 10 mg. Zolmitriptan 5 mg tablet was superior to zolmitriptan 2.5 mg tablet in achieving 1‐ and 2‐hour pain‐free response. There were no significant differences in 1‐ and 2‐hour headache relief and adverse event rates between the different formulations of zolmitriptan 2.5 mg.

Conclusions.— Zolmitriptan 2.5 mg tablet is an effective treatment for acute attacks of migraine showing similar efficacy to almotriptan 12.5 mg, eletriptan 40 mg, and sumatriptan 50 mg, and being more effective than naratriptan 2.5 mg in terms of pain‐free response at 2 hours post dose. Zolmitriptan 2.5 mg tablet was also as effective as rizatriptan 10 mg in terms of headache relief and pain‐free response but less effective in terms of sustained pain‐free response.
A Migraine Prophylaxis Educational Intervention in a Medicaid Population
Authors: Owens Christopher , Pugmire Brooke , Owens Kimball
Published: August 2010

Objectives.— To assess migraine prophylactic drug utilization in the Idaho Medicaid population and to evaluate responsiveness of practitioners to an educational intervention from the Idaho Medicaid Drug Utilization Review (DUR) Program.

Background.— While established guidelines recommend migraine prophylactic therapies for defined patient populations and several drugs have demonstrated efficacy, their actual utilization is reportedly low.

Methods.— Profiles for Idaho Medicaid patients were reviewed retrospectively to identify candidates for migraine prophylactic therapy based on excessive triptan utilization. Use of a prophylactic agent was then characterized for these patients, and an educational mailing was sent to practitioners directly involved in the care of patients who did not appear to be using prophylaxis. Patient profiles were again assessed 6 months following the mailing to determine if a trial of a prophylactic drug had been attempted.

Results.— A total of 1909 patients were identified as having at least one claim for a triptan drug in the year studied. Of these patients, 360 appeared to be candidates for prophylaxis, but 154 had no record of prophylactic drug use. In the 6 months following the intervention mailing, 27 of the 91 non‐prophylaxis patients (30%) who were still active clients of Idaho Medicaid and who had seen their physician during that time, appeared to have been given a trial of a migraine prophylactic drug.

Conclusions.— Following an educational intervention for Idaho Medicaid patients identified through retrospective DUR, a trial of a migraine prophylactic drug was initiated for approximately one‐third of potential candidates.
Memantine and NMDA Antagonism for Chronic Migraine: A Potentially Novel Therapeutic Approach?
Authors: Spengos Konstantinos , Theleritis Christos , Paparrigopoulos Thomas
Published: August 2010

We present the case of a woman with chronic migraine who unexpectedly reported full remission of headache after memantine, an NMDA receptor antagonist, was administered for treating concomitant mild cognitive impairment. An underlying dose‐dependent effect of memantine on headache symptoms in chronic daily headache and chronic migraine could be assumed.
The Antidepressant and Antiinflammatory Effects of Rolipram in the Central Nervous System
Authors: Zhu Jie , Mix Eilhard , Winblad Bengt
Published: August 2010

Rolipram is a selective inhibitor of phosphodiesterases (PDE) IV, especially of the subtype PDE IVB. These phosphodiesterases are responsible for hydrolysis of the cyclic nucleotides cAMP and cGMP, particularly in nerve and immune cells. Consequences of rolipram‐induced elevation of intracellular cAMP are increased synthesis and release of norepinephrine, which enhance central noradrenergic transmission, and suppress expression of proinflammatory cytokines and other mediators of inflammation. In humans and animals rolipram produces thereby a variety of biological effects. These effects include attenuation of endogenous depression and inflammation in the central nervous system (CNS), both effects are of potential clinical relevance. There are some discrepancies betweenin vitroandin vivoeffects of rolipram, as well as between results obtained in animal models and clinical studies. The clinical use of rolipram is limited because of its behavioral and other side effects. Newly developed selective PDE IV inhibitors with presumably higher potency and lower toxicity are currently under investigation.
Recent Developments in the Discovery of Novel Adenosine Kinase Inhibitors: Mechanism of Action and Therapeutic Potential
Authors: McGaraughty Steve , Cowart Marlon , Jarvis Michael F.
Published: August 2010

Adenosine (ADO) is an endogenous inhibitory neuromodulator that limits cellular excitability in response to tissue trauma and inflammation. Adenosine kinase (AK; EC 2.7.1.20) is the primary metabolic enzyme regulating intra‐ and extracellular concentrations of ADO. AK inhibitors have been shown to significantly increase ADO concentrations at sites of tissue injury and to provide effective antinociceptive, antiinflammatory, and anticonvulsant activity in animal models. Structurally novel nucleoside and non‐nucleoside AK inhibitors that demonstrate high specificity for the AK enzyme compared with other ADO metabolic enzymes, transporters, and receptors have recently been synthesized. These compounds have also demonstrated improved cellular and tissue penetration compared with earlier tubercidin analogs. These compounds have been shown to exert beneficial effects in animal models of pain, inflammation and epilepsy with reduced cardiovascular side effects compared with direct acting ADO receptor (P1) agonists, thus supporting the hypothesis that AK inhibitors can enhance the actions of ADO in a site‐and event‐specific fashion.
Ensaculin (KA‐672. HCl): A Multitransmitter Approach to Dementia Treatment
Authors: Hoerr Robert , Noeldner Michael
Published: August 2010

Ensaculin, a novel benzopyranone substituted with a piperazine moiety, showed memory‐enhancing effects in paradigms of passive and conditioned avoidance in both normal and artificially amnesic rodents. It exhibited neuroprotective activities in an NMDA toxicity model and neurotrophic effects in primary cultured rat brain cells. The compound could be characterized as a weak NMDA receptor–operated channel blocker. In receptor‐binding studies, ensaculin was found to have high affinities to serotonergic 5‐HT1Aand 5‐HT7receptors, adrenergic α1, and dopaminergic D2and D3receptors. Due to its unique pharmacodynamic profile, ensaculin may have potential as an antidementia agent acting on various transmitter systems.
The 19th Annual National Neurotrauma Society Symposium, A Satellite to 31st Annual Meeting of the Society for Neuroscience San Diego Marriott Hotel and Marina, San Diego, CA November 9–10, 2001
Authors: Scriabine Alexander
Published: August 2010

The 19th Annual National Neurotrauma Symposium was held as a satellite meeting to the 31st Annual Meeting of the Society for Neuroscience in San Diego, CA on November 9 and 10, 2001. The symposium consisted of 18 lectures, each of 25 min duration, 10 short open communications, and 255 posters. Over 400 scientists and students participated. The symposium was sponsored by the Medical College of Virginia. It was supported financially by the National Institute of Neurological Disorders and Stroke, National Institute for Child Health & Human Development, Acorda Therapeutics, DuPont Pharmaceutical Co., Guilford Pharmaceuticals, Pfizer, Kent Waldrep National Paralysis Foundation and The Ameritec Foundation. The abstracts from this symposium were published in the J. of Neurotrauma, Vol. 18, No. 10, 2001.

This report covers oral and poster presentations, which dealt with the new therapeutic approaches to head and spinal cord trauma, with potential targets for new drugs and with new methods for evaluation of potential drugs for the treatment of neurotrauma.
Selective Estrogen Receptor Modulators: Tissue Actions and Potential for CNS Protection
Authors: Littleton‐Kearney M. T. , Ostrowski N. L. , Cox D. A. , Rossberg M. I. , Hurn P. D.
Published: August 2010

Significant physiologic changes occur during menopause. Evidence exists to suggest that estrogen may be neuroprotective under specific conditions. However, there are limitations in the neuroprotection afforded by standard hormone therapy. Accordingly, alternative agents with selected estrogenic effects may hold even greater promise rather than conventional hormone replacement therapy for the prevention and treatment of CNS injury. Recently, a variety of selective estrogen receptor modulators (SERMs) have been developed to retain the favorable and minimize the adverse side effects of estrogens. This review focuses on the CNS and known neuroprotective effects of two specific SERMs, raloxifene and arzoxifene. Recent studies hint that raloxifene and arzoxifene are neuroprotective and may preserve some elements of cognitive function. However, the mechanism of action is not well described and it is unclear if the beneficial effects of SERMs rely on activation of estrogen receptors.
Valproate: Past, Present, and Future
Authors: Johannessen Cecilie U. , Johannessen Svein I.
Published: August 2010

Preclinical studies have been carried out during the past four decades to investigate the different mechanisms of action of valproate (VPA). The mechanisms of VPA which seem to be of clinical importance include increased GABAergic activity, reduction in excitatory neurotransmission, and modification of monoamines. These mechanisms are discussed in relation to the various clinical uses of the drug. VPA is widely used as an antiepileptic drug with a broad spectrum of activity. In patients, VPA possesses efficacy in the treatment of various epileptic seizures such as absence, myoclonic, and generalized tonic‐clonic seizures. It is also effective in the treatment of partial seizures with or without secondary generalization and acutely instatus epilepticus.

The pharmacokinetic aspects of VPA and the frequent drug interactions between VPA and other drugs are discussed. The available methods for the determination of VPA in body fluids are briefly evaluated.

At present, investigations and clinical trials are carried out and evaluated to explore the new indications for VPA in other conditions such as in psychiatric disorders, migraine and neuropathic pain. Furthermore, the toxicity of VPA, both regarding commonly occurring side effects and potential idiosyncratic reactions are described. Derivatives of VPA with improved efficacy and tolerability are in development.