bluuebunny/crossref_metadata_2025 huggingface dataset:
Histamine Receptors in the Isolated Human Middle Meningeal Artery. A Comparison with Cerebral and Temporal Arteries
Authors: Ottosson Anders LP , Jansen Inger , Langemark Mikael , Olesen Jes , Edvinsson Lars
Published: March 2003

The subtypes of histamine receptors mediating dilatation of human meningeal arteries have been tested in vitro, using “selective” antagonists, and compared with cerebral and temporal arteries previously examined. Dilatory responses were tested after preconstriction with prostaglandin F2a. Both mepyramine and cimetidine caused a parallel shift to the right of the histamine concentration-response curve, suggesting the presence of both H1- and H2- receptors. Combined treatment with mepyramine and cimetidine caused further displacement of the concentration-response curve to the right. Schild analysis indicated pA2 values of 6.3 for cimetidine and 9.8 for mepyramine in situations of near complete blockade of either of the receptors. Both H1- and H2- receptors seem of importance for the histamine-induced dilatation in meningeal arteries and neither appear to dominate. The data considered in conjunction with our previous findings support the finding that experimental histamine-induced headache due to vasodilatation is intracranial of origin.
Prevalence of Headache at Preschool Age in An Unselected Child Population
Authors: Sillanpää Matti , Piekkala Paula , Kero Pentti
Published: March 2003

In a representative study of 5356 five-year-old children, 4405 (82.2%) could be traced for follow-up. Headache occurred in 861 (19.5%) of them; highly frequently in 0.2%, fairly frequently in 0.5%, less frequently in 4.3% and infrequently in 14.5%. Type of dwelling was the only predictor of housing standard, the risk of headache being about 1.5–fold in children living in other than one-family houses. Low economic status of the family, nursery day care and an increasing number of leisure activities were additional risk factors. Compared with infrequent or no headache, those with highly frequent or fairly frequent headache were at a 1.4–fold risk of temper tantrums. The risk of stomach ache was 8.9–fold in children with infrequent headache and 13.7–fold in those with fairly frequent or frequent headache compared with children with no headache.
Elevation of Plasma Vasopressin in Spontaneous Migraine
Authors: Hampton KK , Esack A , Peatfield RC , Grant PJ
Published: March 2003

Vasopressin is a vasoactive hormone secreted from the posterior pituitary. At low concentration its role is in regulating renal water excretion, but at higher concentrations it has a number of extrarenal actions, including effects on blood flow. To investigate the role of vasopressin in spontaneous migraine, paired samples were collected from 14 subjects (a) during an acute attack of spontaneous migraine, and (b) when symptom-free for at least seven days. During an attack, vasopressin was consistently raised (median (range) 3.5 (1.2–9.6) pg/ml v 0.5 (0.5–1.1) pg/ml, p < 0.001). The highest vasopressin concentration occurred in the only patient who vomited. The results suggest vasopressin rises during an attack of spontaneous migraine, and this may, in part, be related to emesis. In the majority, vasopressin levels only rose sufficiently to have some renal antidiuretic effect, although in some these levels could have been sufficient to cause alteration in peripheral blood flow. Release of vasopressin may be responsible for the facial pallor and antidiuresis observed in migraine.
Occipital Nerve Block in the Management of Headache and Cervical Pain
Authors: Gawel MJ , Rothbart PJ
Published: March 2003

The origins of chronic headache and the role of the greater occipital nerve in headache syndromes are reviewed. The anatomical pathways and physiological basis of these headaches are discussed with a view to synthesizing some current concepts of headache generation. Studies of occipital nerve blockade for treatment of headaches of various types are assessed and a retrospective analysis of our own experience is presented.
Sumatriptan in the Treatment of Acute Migraine With Aura
Authors: Banerjee M , Findley LJ
Published: March 2003

The efficacy of the selective 5HT1-like agonist sumatriptan in acute treatment of classical migraine (i.e. migraine with aura) was assessed in a double-blind, placebo-controlled, parallel group randomized trial. An oral dose of 200 mg was chosen on the basis of the efficacy rates achieved (70–85%) with 70–280 mg in open studies (1, 2). The dose of 200 mg was also chosen for the study because preliminary data from an oral pilot study indicated that efficacy increased with increasing dose up to 200 mg. Each patient was treated for a maximum of three separate attacks of migraine with aura within a three months' period. Three attacks were treated so that we could examine consistency of response across more than one attack. For attack 1,200 mg sumatriptan was significantly more effective, safe and well tolerated than placebo at relieving headache 2 h after treatment was given ( p = 0.023). In subsequent attacks, i.e. in attacks 2 and 3, there was no such significant effect of sumatriptan compared with placebo in relieving headache. This reduced efficacy of sumatriptan in the second and third attacks may be due to a high incidence of vomiting induced by the high dose of dispersible formulation and also by the bitter taste of the tablets. In addition, there was an increase in placebo response in attacks 2 and 3 compared to the first attack.
A Cortical Excitatory Wave May Cause Both The Aura and The Headache of Migraine
Authors: Hardebo Jan Erik
Published: March 2003

Clinical and neurophysiological observations indicate that the symptoms of migraine aura result from the spread of an excitatory wave along the cortex from a primary focus. This excitation may start as consequence of information overload on a low threshold cortical area. The transient neuronal excitatory wave is followed by a longer lasting “depressive” wave, which involves a substantial reduction in cortical blood flow (with an active constriction of resistance vessels) and ionic changes and transmitter release into the extracellular fluid compartment. As a consequence, trigeminal pain fibre endings in cortical venules may become activated and, via branches (axon reflexes) along the venous vascular tree, also multiple endings in dural venules. This will induce a neurogenic inflammation in the vessel walls, primarily in dural venules, experienced as headache by the sufferer when sufficiently many fibres have become activated. The pain fibre endings are equipped with serotonin1D-like receptors, which upon stimulation suppress the inflammatory process. This scenario offers a rational explanation for the beneficial effect of the acute, and some of the prophylactic, medications used in migraine.
Sodium Valproate in The Prophylactic Treatment of Migraine: A Double-Blind Study Versus Placebo
Authors: Hering R , Kuritzky A
Published: March 2003

The efficacy of sodium valproate (Depalept) versus placebo in the treatment of migraine was evaluated in a double-blind randomized cross-over study in twenty-nine patients. The patients were divided into two groups each of which was alternately given 400 mg of sodium valproate B.I.d or placebo for eight weeks and then crossed over for an additional eight weeks. Our results show that in 86.2% of the patients sodium valproate was effective in preventing migraine or reducing the frequency, severity and duration of the attacks. In general, the drug was well tolerated and proved to be an effective treatment in migraine.
Migraine, Major Depression and Panic Disorder: A Prospective Epidemiologic Study of Young Adults
Authors: Breslau Naomi , Davis Glenn C
Published: March 2003

We examined prospectively the risk for major depression (MDD) and panic disorder in persons with prior history of migraine. A random sample of 995 young adults was interviewed in 1989 and reinterviewed in 1990. A history of migraine at baseline increased fourfold the risk for MDD during the follow-up interval. A history of any anxiety disorder exacerbated the risk for MDD in persons with migraine. Persons with a history of migraine were twelve times more likely to become cases of panic disorder than those with no history of migraine. The risk for MDD and/or panic disorder was unrelated to whether or not migraine was active during the year preceding the baseline interview or in remission for more than one year. The findings suggest that migraine, major depression and anxiety disorders might share common predispositions.
Migraine with Aura-Like Syndrome Due to Arteriovenous Malformation. The Clinical Value of Transcranial Doppler in Early Diagnosis
Authors: Silvestrini Mauro , Cupini Letizia Maria , Calabresi Paolo , Floris Roberto , Bernardi Giorgio
Published: March 2003

Arteriovenous malformations are an acknowledged cause of migraine that can long constitute the only clinical manifestation before bleeding. We describe two cases of patients suffering from symptoms like migraine with aura in whom arteriovenous malformations were detected by transcranial Doppler examination. We suggest that a screening of migraine patients to prevent bleeding from a possible underlying unruptured arteriovenous malformation could be performed by using transcranial Doppler, a non-invasive and low cost examination.
Unilateral Facial Pain as The First Symptom of Lung Cancer: Are There Diagnostic Clues?
Authors: Schoenen Jean , Broux René , Moonen Gustave
Published: March 2003

We describe three patients with unilateral facial pain due to non-metastatic lung cancer and review 11 published cases. Pain, most frequently located on the right side and around the ear, as well as digital clubbing can be clues to an early diagnosis. Compression of the vagus nerve by the tumour or by mediastinal adenopathy is most likely responsible for the facial pain and could play a role in pulmonary osteoarthropathy.
Headache Associated with Non-Cephalic Infections: Classification and Mechanisms
Authors: Marinis Milena De , Welch KMA
Published: March 2003

A classification of headache associated with non-cephalic infections is proposed. The classification is supported by published case series and reports. The head pain can be explained by direct activation of pain producing mechanisms by microorganisms or can be secondary to fever or to a combination of both.
Topographic Analysis of Steady-State Visual Evoked Potentials (SVEPs) in The Medium Frequency Range in Migraine With and Without Aura
Authors: Puca Franco M , Tommaso Marina de , Savarese Maria A , Genco Sergio , Prudenzano Addolorata
Published: March 2003

Topographic analysis of SVEPs in the medium frequencies range was performed in 30 migraineurs without aura, 20 migraineurs with aura and in 20 control subjects. The mean absolute power values of the fundamental component F1, the subharmonic F1/2 and the first harmonic F2, corrected by logarithmic transformation, were computed in each group and then compared using Student's t-test. The interhemispheric coherence of the F1 component was also evaluated. The 18, 21 and 27 Hz F1 components were increased in both migraineurs with and without aura, particularly in the temporo-parietal regions. The 24 Hz F1 component was augmented only in migraineurs without aura in the parieto-occipital regions in comparison with migraineurs with aura and controls. Migraine with aura patients had a reduced interhemispheric coherence mostly of 12 Hz and 15 Hz F1 components in frontal and temporo-parietal regions. Results of the study confirm abnormalities of SVEPs in migraineurs with and without aura. These consist of widespread increases of F1 components in the medium frequency range over the temporo-parietal regions.
The Blink Reflex in Migraine
Authors: Bánk J , Bense E , Király Cs
Published: March 2003

The blink reflex is an objective and useful method to study the trigeminal system. It was recorded in 43 migraine patients and the findings compared with those of 31 healthy controls. The latencies of the R1 component were in the normal range in both groups. The R2 latencies ranged between 30 and 32 ms in the control group. In contrast, more than half of the patients with migraine had R2 latencies between 32 and 35 ms in the migraine group. Some migraine patients had latencies above 35 ms. The R2 latency was statistically significantly different between controls and migraineurs ( p < 0.0001). Our findings indicate that trigeminal afferents and/or polysynaptic pathway in brainstem may be altered in migraine.
The Role of 5–Hydroxytryptamine (5–HT) Receptor Subtypes and Plasticity in the 5–HT Systems in the Regulation of Nociceptive Sensitivity
Authors: Eide Per Kristian , Hole Kjell
Published: March 2003

This review shows that the role of 5–hydroxytryptamine (5–HT) in the regulation of nociception depends on the 5–HT receptor subtypes involved and on long-term functional changes in the 5–HT receptors. Stimulation of the 5–HT 1 receptors, as well as of the 5–HT 2 and 5–HT 3 receptors, may reduce nociceptive sensitivity. In addition, activation of 5–HT 2 and 5–HT 3 receptors may also enhance nociceptive sensitivity. Up- or down-regulation of the 5–HT receptors may result in long-lasting changes, plasticity, in the 5–HT systems. Lesioning of 5–HT neurons induces denervation supersensitivity to 5–HT, and prolonged stimulation of 5–HT receptors may produce subsensitivity to 5–HT. In the spinal cord denervation supersensitivity to 5–HT may depend on reduced release of substance P (SP). An increase in the release of SP, on the other hand, may reduce the effects of 5–HT receptor activation. Long-term treatment with antidepressants which are used in clinical pain therapy appears to up-regulate the 5–HT 1 receptors and to down-regulate the 5–HT 2 receptors.
Placebo-Controlled Clinical Trials with Ergotamine in the Acute Treatment of Migraine
Authors: Dahlöf Carl
Published: March 2003

Although oral ergotamine alone or in combination with caffeine is widely used for the acute treatment of migraine, there is little evidence that it is significantly more effective than placebo. There are no placebo-controlled data to support the use of aerosol or suppository formulations. In addition, the recommended doses of ergotamine cannot be justified. Each formulation of ergotamine now should be tested in clinical studies performed according to the IHS criteria for trial design and in migraine patients fulfilling the diagnostic criteria of the IHS. Until these clinical data are available, no dear recommendations can be given for the use of ergotamine in the acute treatment of migraine.
Episodic Cluster Headache From a Textbook of 1745: Van Swieten's Classic Description
Authors: Isler Hansruedi
Published: March 2003

The first description of cluster headache is usually attributed to authors who published between 1867 and 1939, but lately several researchers have found accounts dating back to the 18th or even the 17th century which are incomplete or do not account for cluster headache in the strict sense. However, Gerhard van Swieten gave a full description of a case of episodic cluster headache meeting the IHS criteria in 1745, in his textbook of clinical medicine, the mainstream textbook of Continental medicine in those years, since van Swieten was the founder of the then leading medical centre, the Vienna School. That the case was found again only in 1992 is due to the circumstance that it was published in Latin. It is presented here in an English translation facing the original Latin text.
Extracellular Recordings of Membrane Potential from Guinea-Pig Isolated Trigeminal Ganglion: Lack of Effect of Sumatriptan
Authors: O'Shaughnessy Celestine T , Connor Helen E , Feniuk Wasyl
Published: March 2003

The aim of this study was to investigate the effect of the anti-migraine drug and selective 5-HT1 receptor agonist, sumatriptan, on membrane potential of guinea-pig isolated trigeminal ganglion. Ganglia were divided into three longitudinally, placed in two-compartment baths and the d.c. potential between compartments was recorded extracellularly. Drugs were applied to the Krebs superfusion fluid of one compartment. KCI (3 mmol/1) and GABA (0.1 mmol/I) caused depolarization (0.30 ± 0.05 and 0.55 ± 0.08 mV respectively, n = 11–19). 5-HT (1–10 mmol/1) caused small depolarizations (0.06 ± 0.02. mV, n = 8) but sumatriptan (0.1–10 mmol/I) had no effect on trigeminal ganglion membrane potential. Collagenase pretreatment, to enhance desheathing, or modification of the composition of the Krebs solution failed to reveal any effect of sumatriptan. These data provide no evidence to suggest that sumatriptan inhibits neurotransmission in trigeminal ganglion. However, 5-HT1 receptors may be present in insufficient numbers in the trigeminal ganglion to elicit a change in membrane potential. Further studies are required to investigate the effect of sumatriptan at the level of the sensory nerve terminals within the intracranial vasculature, where 5-HT1 receptors may be concentrated.
Migrainous Infarction: The Charcot-Féré Syndrome?
Authors: Ramadan Nabih M
Published: March 2003

The writings of Charcot and Féré on migraine and its permanent complications are translated. They emphasize how the art of observation was considered of paramount importance in clinical neurology, as stated by Charcot on 28 February 1888: “Let someone say of a doctor that he really knows his physiology and anatomy, that he is dynamic-these are not the real compliments; but if you say he is an observer, a man who knows how to see, this is perhaps the greatest compliment one can make.” These writings also reveal that arteriolar vasoconstriction in migrainous infarction and the vascular theory of migraine are hypotheses generated over 100 years ago and still being tested by contemporary neurologists.
Prevalence of Headache in Tulp's Observationes Medicae (1641) with a Description of Cluster Headache
Authors: Koehler PJ
Published: March 2003

In 1641, Nicolaas Tulp, a well-known physician from Amsterdam, published his Observationes Medicae, in which medical knowledge and practice in that period is described in more than 200 systematically organized case histories. Next to symptomatic headaches he mentioned two different types of “recurring headache” based on the characteristics of the pain and reaction to contemporary treatment: migraine and, probably, cluster headache.
Prevalence of Frequent Headache in Young Finnish Adults Starting a Family
Authors: Aromaa Minna , Sillanpää Matti , Rautava Päivi , Helenius Hans
Published: March 2003

A questionnaire study on pre-pregnancy headache and its predictors was carried out in a representative sample of young adults expecting their first baby. The study was part of a major project on the competence of Finnish families. It included 1322 women and 1257 men, either married or cohabiting (in total, 1262 families), followed from their first contact with a maternity health care unit. A questionnaire was given separately to the women and men inquiring about their health and health behaviour, as well as about sociodemographic and psychosocial factors. The prevalence of frequent headache (at least one episode per month) was 34.3% in women, 19.3% in men and 47.1% in families. On multivariate analysis, after age-adjustment, the independent predictors of headache occurrence in women were depression, menstrual pain, responsibilities at work and psychosocial stress. The predictors in men were nervousness, psychosocial stress, lack of or irregular physical exercise and long-term disease, depression, responsibilities at work and insomnia.
Platelet-Rich Plasma Serotonin Levels in Tension-Type Headache and Depression
Authors: Leira Rogelio , Castillo Josè , Martinez Francisco , Prieto Josè Maria , Noya Manuel
Published: March 2003

We measured platelet-rich plasma (PRP) serotonin in patients suffering from tension-type headache, before and after treatment with amitriptyline, comparing them with a healthy control group and patients with untreated depression. We evaluated the severity of headache and depression in each group. PRP serotonin levels were higher in patients with headache than in controls and depressed patients. We observed a fall of PRP serotonin in patients with tension-type headache to similar levels after treatment as the depressed group. This fall was correlated with the improvement of headache but not with depression scales. Our data suggest that the rise of platelet serotonin levels in tension-type headache is related to pain and not depression.
A Critical Note on Psychophysiological Stress Research into Migraine Patients
Authors: Passchier J
Published: March 2003

The psychophysiological stress paradigm has been applied to detect pathways through which stress can induce migraine. We propose that the negative and inconsistent findings of previous studies can be ascribed to the restricted psychophysiological scope of these experiments, to insufficient operationalization of the concepts of stress, and to the lack of attention paid to the presence or absence of an attack after a stressful situation. Our present state of knowledge on the pathophysiology of migraine should form the basis for future psychophysiological research, which should focus on patients who are actually stressed and develop an attack afterwards.
Platelet 3H-Imipramine Binding and Sulphotransferase Activity in Primary Headache
Authors: Marazziti D , Bonuccelli U , Nuti A , Toni C , Pedri S , Palego L , Pavese N , Lucetti C , Muratorio A , Cassano GB
Published: March 2003

We investigated platelet 3H-imipramine (3H-IMI) binding, a putative peripheral serotonergic marker, and the activity of sulphotransferase (ST), an enzyme involved in the catabolism of catecholamines and phenolic compounds, in 14 patients suffering from migraine without aura (MWoA) and in 10 with tension-type headache (TH), as compared with a group of controls. The possible relationships between the biological parameters and clinical features were also examined. The results showed that the two groups of patients had a lower number of 3H-IMI binding sites and a lower activity of the thermolabile form of ST, which acts preferentially on monoamine substrates, than the healthy controls, with no intergroup differences. Significant correlations between psychopathological rating scales and characteristics of the illness were observed in the patients with TH. The decreased number of platelet 3H-IMI binding sites is suggestive of a presynaptic serotonergic dysfunction and confirms the involvement of 5HT in primary headaches. The reduced ST activity might produce changes in the level of sulphated biogenic amines, including dopamine and tyramine, which might have an additional role in the pathophysiology of some aspects of primary headache.
Opiate and Opioid Use in Patients With Refractory Headache
Authors: Ziegler DK
Published: March 2003

Opiate and opioid analgesics are commonly used for pain in general and presumably for headache. Codeine, oxycodone and propoxyphene, among the most commonly prescribed, do carry some risk of abuse, and their efficacy in headache patients has not been well studied. In many patients with other kinds of pain, however, both of neoplastic and non-neoplastic origin, chronic opiate use has been demonstrated to be of benefit without adverse side effects. The type of headache patient with intractable pain who needs frequent opiate analgesic and who does not develop addiction or drug abuse is an important subject for research.
International Headache Society Classification: Interobserver Reliability in the Diagnosis of Primary Headaches
Authors: Granella F , D'Alessandro R , Manzoni GC , Cerbo R , D'Amato C Colucci , Pini LA , Savi L , Zanferrari C , Nappi G
Published: March 2003

We assessed interobserver reliability of the International Headache Society (IBIS) classification for diagnosis of primary headaches. The study was performed on 103 patients consecutively seen at two Headache Centres. Each patient was given a structured interview recorded on videotape. Four experienced clinicians then reviewed the interviews separately and made a diagnosis of headache according to IHS criteria at the one- and two-digit levels. At both the one- and the two-digit level the agreement was substantial (Kappa = 0.74 and 0.65, respectively). The analysis of reliability for each of nine items necessary for diagnosis showed an agreement ranging from substantial (Kappa = 0.69) to almost perfect (Kappa = 0.89). Our results indicate that the IHS classification has a good reliability for the diagnosis of primary headaches at the one- and two-digit levels.
Abnormal Platelet Mitochondrial Function in Patients Affected by Migraine With and Without Aura
Authors: Sangiorgi S , Mochi M , Riva R , Cortelli P , Monari L , Pierangeli G , Montagna P
Published: March 2003

To investigate energy metabolism in migraine, we determined platelet mitochondrial enzyme activities in 40 patients with migraine with aura and in 40 patients with migraine without aura during attack-free intervals and in 24 healthy control subjects. NADH-dehydrogenase, citrate synthase and cytochrome-c-oxidase activities in both patient groups were significantly lower than in controls ( p < 0.01), while NADH-cytochrome-c-reductase activity was reduced only in migraine with aura ( p < 0.01). No alteration in succinate-dehydrogenase was observed. Monoamine-oxidase activity differed between sexes (p < 0.05) but within each sex group no difference was observed between patients and controls. We hypothesize that the defect in mitochondrial enzymes observed indicates a systemic impairment of mitochondrial function in migraine patients.
Chronic Daily Headache- One Disease Or Two.? Diagnostic Role of Serum Ionized Magnesium
Authors: Mauskop A , Altura BT , Cracco RQ , Altura BM
Published: March 2003

The entity of chronic daily headache (CDH) is well documented, but is not included in the current classification. We divided patients with CDH into groups with and without migrainous features. This division resulted in clearly distinguishable syndromes of daily migrainous headaches (DMH) and daily tension-type headaches (DTH). Family history of headaches was more common in patients with DMH. Patients in both groups had a high incidence of caffeine or drug overuse. The clinical division into DMH and DTH was supported by our finding of a higher incidence of disturbed magnesium (Mg) metabolism in patients with DMH. Of 26 patients with DMH, 8 (30.8%) had low serum ionized, but not total, Mg levels, and 16 (61.5%) had high ionized calcium/magnesium ratios. The corresponding numbers for the 22 patients with DTH were 1 (4.5%) and 8 (30.4%). These new laboratory measurements offer possible biological markers for the diagnosis of different headache syndromes.
Intracellular and Plasma Magnesium in Familial Hemiplegic Migraine and Migraine With and Without Aura
Authors: Smeets MC , Vernooy CB , Souverijn JHM , Ferrari MD
Published: March 2003

Familial hemiplegic migraine (FHM) is an autosomal dominant type of migraine and probably represents the most extreme end of migraine with aura. Reduced magnesium facilitates the development of spreading depression and possibly aura. Cellular magnesium levels are under genetic control. We hypothesized that FHM patients would have significantly reduced intracellular magnesium levels. We determined intracellular and plasma magnesium levels in blood of 38 afflicted and 11 non-afflicted members of three families with FHM and, in 32 migraine patients (9 with and 23 without aura) and 32 age and sex matched healthy controls. We found no significant differences between the magnesium levels in the five study groups. We conclude that reduced blood magnesium is unlikely to be related to migraine pathophysiology.
Psychopathology in Individuals with Post-Traumatic Headaches and Other Pain Types
Authors: Ham LP , Andrasik F , Packard RC , Bundrick CM
Published: March 2003

In this study, the psychological functioning of patients with chronic post-traumatic headache (PTH), chronic combination headache and chronic low back pain without headache, whose time of onset was similar, and a matched group of controls was investigated. The Symptom Checklist 90-Revised (SCL-90-R), State-Trait Anger Expression Inventory (STAXI), State-Trait Anxiety Inventory, Form Y (STAI-Y), and Beck Depression Inventory (BDI) were used to assess the degree of psychopathology. A MANOVA test indicated highly significant differences between groups. In general, the pain groups fell along a continuum with PTH subjects demonstrating the highest elevations, back pain subjects demonstrating the next highest elevations, and combination subjects demonstrating fewer elevations. A cluster analysis indicated that findings were best classified into four clusters, but no one pain diagnosis predominated in any cluster. Eighty-nine percent of controls were assigned to clusters 1 or 2, which revealed essentially normal scores on all tests. It is suggested that while chronic pain patients demonstrate more psychopathology than non-pain controls, a variety of coping styles exists within each pain group independent of diagnostic categorization.
Efficacy and Tolerability of Amitriptylinoxide in the Treatment of Chronic Tension-Type Headache: A Multi-Centre Controlled Study
Authors: Pfaffenrath V , Diener H-C , Isler H , Meyer C , Scholz E , Taneri Z , Wessely P , Zaiser-Kaschel H , Haase W , Fischer W
Published: March 2003

Amitriptyline is the medication of first choice in the treatment of chronic tension-type headache. In 197 patients with chronic tension-type headache (87M and 110F with a mean age of 38 ±13 (18–68)) efficacy and tolerability of 60–90 mg amitriptylinoxide (AO) were compared with 50–75 mg amitriptyline (AM) and placebo (PL) in a double-blind, parallel-group trial consisting of a four weeks' baseline phase and 12 weeks of treatment. The primary study endpoint was a reduction of at least 50% of the product of headache duration and frequency and a reduction of at least 50% in headache intensity. Statistics used were Fisher's exact test and analysis of variance. No significant difference emerged between AO, AM and PL with respect to the primary study endpoint. Treatment response occurred in 30.3% of the AO, 22.4% of the AM and 21.9% of the PL group. A reduction in headache duration and frequency of at least 50% was found in 39.4% on AO, in 25.4% on AM and in 26.6% on PL (PAO-PL = .1384, PAM-PL = 1.000, PAO-AM = .0973). A reduction in headache intensity of at least 50% was found in 31.8% on AO, in 26.9% on AM and in 26.6% on PL (PAO-PL = .5657, PAM-PL = 1.000, PAO-AM = .5715). Trend analysis with respect to a significant reduction of headache intensity ( p < 0.05) and the product of headache duration and frequency revealed a superior effect of AO. Adverse events occurred in 75.8% on AO, 82.1% on AM and 76.6% on PL (PAO-PL = 1.000, PAM-PL =.5188, PAO-AM = .4017). Neither depressive symptoms, measured by the SCL-90-R, nor study drug-related adverse events had any influence on the results.
Double-Blind Comparison of An Acetaminophen 400 mg-Codeine 25 mg Combination Versus Aspirin 1000 mg and Placebo in Acute Migraine Attack
Authors: Boureau F , Joubert JM , Lasserre V , Prum B , Delecoeuillerie G
Published: March 2003

The purpose of this study was to compare the efficacy and tolerance of a single dose of the acetaminophen 400 mg-codeine 25 mg combination (ACC) aspirin 1000 mg (A) and a placebo (P) for the treatment of acute migraine attack. The study design was randomized, multicentre, double-blind and double dummy with cross-over on three periods. Of the 198 patients who had three attacks 29.8%, 52.3% and 49.7% had recorded the complete or almost complete disappearance of the pain at 2 h after P, A and ACC respectively. When compared with the placebo, the difference was significant for the A and ACC. When complete disappearance of pain at 2 h was used as a criterion, no significant difference was observed. These results enabled the sensitivity of the evaluation criteria suggested for clinical trials of migraine attack to be discussed.
Migraine in Children – An Evaluation of the IHS Criteria
Authors: Metsähonkala L , Sillanpää M
Published: March 2003

The purpose of the present study was to compare the new criteria by the International Headache Society (IHS) with criteria for the definition of childhood migraine previously used. In particular, we considered the problem of the minimally acceptable headache duration in children. In a postal questionnaire, 36.5% of 3580 children 8–9 years old reported headache attacks. Ninety-five children (2.7%) fulfilled the IHS criteria. Three percent fulfilled the previously used migraine definition of Vahlquist. Some of the children in the latter group had considerably shorter headache attacks than those of the IHS patients, but otherwise their symptoms were very similar. When the IHS criterion of headache attack duration was lowered from a minimum of 2 h to 1 h, or omitted, the number of migraine patients increased from 95 to 114 and 127, respectively.
Neuropeptides in Migraine and Cluster Headache
Authors: Edvinsson L , Goadsby PJ
Published: March 2003

The cerebral circulation is invested by a rich network of neuropeptide Y (NPY) and noradrenaline containing sympathetic nerve fibers in arteries, arterioles and veins. However, the nerve supply of vasoactive intestinal peptide (VIP), substance P (SP) and calcitonin gene-related peptide (CGRP) containing fibers is sparse. While noradrenaline and NPY cause vasoconstriction, VIP, SP and CGRP are potent vasodilators. Stimulation of the trigeminal ganglion in cat and man elicits release of SP and CGRP. Subjects with spontaneous attacks of migraine show release of CGRP in parallel with headache. Cluster headache patients have release of CGRP and VIP during bouts. Treatment with sumatriptan aborts headache in migraine and cluster headache as well as the concomitant peptide release.
Decreased Collagen-Induced Platelet Aggregation and Increased Platelet Arginine Levels in Migraine: A Possible Link With The NO Pathway
Authors: D'Andrea G , Cananzi AR , Perini F , Alecci M , Zamberlan F , Hasselmark L , Welch KMA
Published: March 2003

We studied whole blood platelet aggregation induced by collagen, platelet activating factor (PAF) and measured basal platelet L-arginine (L-arg) levels, as an indirect index of the nitric oxide (NO) pathway in migraine. Migraine, both with and without aura groups, showed a reduced aggregation to collagen, but not to PAF, compared with control subjects. Platelet L-arg levels were significantly increased in migraine with aura sufferers, whereas the plasma levels were in the same range in migraineurs and controls. Platelet hyperesponsiveness to collagen stimulation in migraine may be linked to an increased availability of the amino acid precursor and an abnormal NO synthesis.
Ergotamine-Induced Headache can be Sustained by Sumatriptan Daily Intake
Authors: Catarci T , Fiacco F , Argentino C , Sette G , Cerbo R
Published: March 2003

We describe the case report of a migraine sufferer who developed ergotamine-induced headache and subsequently replaced ergotamine with daily sumatriptan (100 mg p.o.). The features of the headache were unchanged except for the presence of superimposed migraine-like headaches that occurred every 24 h.
Might Migraine Damage The Brain?
Authors: Chronicle E , Mulleners W
Published: March 2003

Recent debate concerning the interpretation of studies of regional cerebral blood flow in migraine has re-emphasized that cerebral ischaemia may occur during attacks of migraine with aura. In this article we suggest that the presence of ischaemia during attacks makes it possible that migraine with aura causes neuronal damage in the long term. We argue that damage is likely to occur in the primary visual cortex, given that a recent high-resolution rCBF study has found flow reductions confined to this area. Furthermore, we hypothesize that the extent to which rCBF is reduced in migraine with aura is sufficient to cause damage only to GABA-ergic inhibitory interneurons in layer IV of this cortex. In animal models, similar cells are known to be selectively vulnerable to damage as a result of hypoxic conditions. Evidence consistent with our hypothesis is provided by recent studies of visual function in migraine. Some clinical and pathophysiological implications of this hypothesis are discussed.
Sex-Hormone-Related Events in Migrainous Females. A Clinical Comparative Study Between Migraine With Aura and Migraine Without Aura
Authors: Cupini LM , Matteis M , Troisi E , Calabresi P , Bernardi G , Silvestrini M
Published: March 2003

In this study, the relationship between hormonal-related events and migraine with aura (MA) and without aura (MO) was investigated. Subjects included 268 women suffering from MA (88) and MO (180). Data were collected on the relationship between sex-hormone-related events and migraine. Migraine during menses was observed in a significantly higher percentage of MO than MA patients ( p < 0.03). Menstrual migraine was significantly more common in MO than in MA patients ( p < 0.01). Migraine began during pregnancy in a significantly higher percentage of MA than of MO patients ( p < 0.01). No significant difference was observed between the two groups of patients regarding the onset of migraine at menarche, after menopause, in the postpartum period or during the early cycles of oral contraceptives. Also, both groups of patients showed a similar migraine course during pregnancy, oral contraceptive use and menopause. Eight patients with coexisting migraine with aura and migraine without aura attacks reported the appearance of the aura symptom for the first time in the early cycles of oral contraceptive intake. These findings suggest that gonadal hormone fluctuation may influence both types of migraine.
Initially Migraine-Like Manifestation of a Ruptured Spinal Arteriovenous Malformation
Authors: Maggioni F , Rossi P , Casson S , Fiore D , Zanchin G
Published: March 2003

We report the case of a 23–year-old woman who presented with migraine-like symptoms and was found to have a spinal arteriovenous malformation.
Migraine Headaches in Adolescents: A Student Population-Based Study in Monreale
Authors: Raieli V , Raimondo D , Cammalleri R , Camarda R
Published: March 2003

We assessed the prevalence of migraine headaches in an epidemiological survey of an 11 to 14-year-old student population. Migraine headaches were classified on the basis of questionnaires and neurological examination using the operational diagnostic criteria of the International Headache Society. Prevalence of migraine without aura (IHS code 1.1) was 2.35%; that of migraine with aura (IHS code 1.2) was 0.62%. Migraine without aura was equally distributed among males and females, whereas migraine with aura was preponderant in the female cohort. The prevalence of migraine headaches in males was constant through the ages studied, whereas the prevalence of migraine headaches in females reached a peak at age 12 and plateaued over the following two years. Although the new IHS classification criteria of migraines are reliable and exhaustive, some subcriteria may not be valid in a juvenile population. For instance, the duration of the pain in young migraineurs is often briefer than in adults, and the intensity of pain was almost always described as moderate or severe. Therefore, in order to increase the reliability and comprehensiveness of the IHS classification, minor modifications should be made.
Migraine Patients Experience Poorer Subjective Well-Being/Quality of Life Even Between Attacks
Authors: Dahlöf CGH , Dimenäs E
Published: March 2003

The aim of the present study was to compare the general well-being of migraine patients between attacks with that of an age- and sex-matched control group. One hundred and forty-five consecutive and eligible patients at the Gothenburg Migraine Clinic were asked about their well-being and their complaints. Using three self-administered standardized questionnaires, the Minor Symptoms Evaluation Profile (MSEP), Subjective Symptoms Assessment Profile (SSAP) and the Psychological General Well-Being (PGWB) Index, evaluable responses were obtained from 138 migraine patients. Compared with control subjects, migraineurs perceived more symptoms and greater emotional distress as well as disturbed contentment, vitality and sleep. It is concluded that the general well-being of the migraine patient is impaired, even between the attacks.
Cervicogenic Headache: A Personal View
Authors: Pearce JMS
Published: March 2003

Cervicogenic headache describes pain referred along the upper three cervical roots and is a common source of headache in the over tittles. A review of clinical features, anatomy, and investigations using neural blockade shows several clinical pictures. Diseases of the cranio-vertebral junction, e.g. syringomyelia, and tonsilar descent, can produce mechanical or hydrodynamic head and neck pain. Pre-existent migraine and tension headache may be precipitated or aggravated by cervical spondylosis, but the anatomical mechanism is unclear. Headaches which arise from and are primarily caused by disorders in the cervical spine are exemplified by spondylosis and acute whiplash injury, but are usually transient. Evidence for a cervicogenic mechanism of chronic whiplash headache is, however, lacking.
Response Measures in the Acute Treatment of Migraine
Authors: Skovlund E , Flaten O
Published: March 2003

Pain ratings from 268 migraine patients have been used to compare the visual analogue scale (VAS) and a four-point verbal rating scale. All patients completed pain ratings on both scales at the beginning of a migraine attack and 4 h after starting treatment with sumatriptan or placebo. The VAS scores showed large variability within each category on the verbal rating scale. A common way of analysing pain in migraine studies is to classify patient response as a success or failure based on the score on the four-point verbal rating scale. In this study, the statistical power of analysing response either as “success or failure” or by means of the VAS score has been investigated by stochastic simulation. The simulations showed that the two response measures resulted in approximately equal power.
Low-Dose Ibuprofen in Self-Medication of Mild to Moderate Headache: A Comparison with Acetylsalicylic Acid and Placebo
Authors: Nebe J , Heier M , Diener HC
Published: March 2003

A double-blind, threefold crossover, double-dummy trial was performed, investigating the efficacy of 200 mg ibuprofen compared with 500 mg acetylsalicylic acid and placebo in patients who usually treated their headaches with over-the-counter drugs. Ninety-five patients suffering from mild to moderate migraine or episodic tension-type headache were included. Seventy-seven patients entered the intention-to-treat analysis and 65 completed all three treatments. For the main response criterion, a minimum 50% decrease of headache intensity on a visual analogue scale at I h after treatment, ibuprofen was significantly superior to acetylsalicylic acid and placebo. This was true for migraine attacks and tension-type headache episodes. Towards the end of the observation period (150 min), the differences between ibuprofen and acetylsalicylic acid were no longer significant. In conclusion, ibuprofen was at least equivalent to acetylsalicylic acid and superior to placebo.
Painful Vein Overdistension in Migraine Patients: No Relationship With Serotoninergic Parameters
Authors: Panconesi A , Curradi C , Leoncini G , Anselmi B , Franchi G
Published: March 2003

Overdistension of the hand-forearm veins after a period of ischaemia-induced stasis causes local pain in a high percentage of migraineurs, but never in healthy subjects. To investigate the mechanism of such pain, we compared 5-hydroxytryptamine (5HT) whole blood levels and hand vein 5HT reactivity of migraine subjects who did experience pain during venous overdistension to those who did not. No differences were found in whole blood 5HT levels or in the venoconstrictor activity of 5HT between subjects experiencing pain and those who did not. No correlation was found between whole blood 5HT levels and the degree of 5HT-induced venoconstriction. Our results suggest that, if platelets are considered as a model of central antinociceptive 5HT neurons, pain appearance is not due to reduced 5HT at a central level and, therefore, to increased perception of peripheral nociceptive stimuli. Moreover, the similar 5HT venoconstrictive effect (indirect marker of venous tone and, therefore, of venous distensibility) seems to indicate that a mechanical factor is not involved in pain appearance during the HAVD test.
Ketoprofen, Paracetamol and Placebo in the Treatment of Episodic Tension-Type Headache
Authors: Dahlof CGH , Jacobs LD
Published: March 2003

The aim of the study was to assess the efficacy and tolerability of a single oral dose of ketoprofen 25 mg in comparison with single doses of ketoprofen 2 × 25 mg, paracetamol 500 mg and 1,000 mg, and placebo in the treatment of episodic tension-type headache. The study was conducted as a single centre, double-blind, randomized, placebo-controlled, five-period, within-patient comparative trial in outpatients with episodic tension-type headache according; to the International Headache Society's diagnostic criteria. Each patient had to treat five attacks of episodic tension-type headache with a single dose of each of the tested medications with a minimum interval o 72 h between two attacks. Details of the attack and response to treatment were recorded on a diary card Altogether 30 patients treated 5 attacks and 2, 3, 1 and 4 patients treated 4, 3, 2 and 1 attack, respectively, The primary variable was decrease in headache pain intensity from baseline to 2 h after intake, evaluated by means of a 100 mm visual analogue scale. Ketoprofen 50 mg was significantly better than placebo an paracetamol for this main criterion. Neither of the paracetamol groups differed from the placebo group, Only a few adverse events were reported, usually of mild or moderate severity, with no difference between the treatments. Ketoprofen 50 mg may be considered an effective and well tolerated analgesic in the treatment of episodic tension-type headache of moderate or severe intensity.
Primary Low Cerebrospinal Fluid Pressure Syndrome With Galactorrhea: Findings at MR Imaging
Authors: Sawada A , Morita N , Yoshida S , Yamamoto M , Hashimoto K
Published: March 2003

A case of primary low cerebrospinal fluid (CSF) pressure syndrome with galactorrhea is reported. Magnetic resonance imaging demonstrated diffusely enhanced meninges, edematous brain, and enlarged pituitary gland. Coincidental enlargement of pituitary gland and edematous brain due to low CSF pressure compressed the pituitary portal system. The 1ow-perfused anterior lobe of pituitary gland would be the mechanism of galactorrhea.
Differential Sensitivity to Morphine Challenge in Migraine Sufferers and Headache-Exempt Subjects
Authors: Nicolodi M
Published: March 2003

The effectiveness of a therapeutic dose of morphine in relieving migraine attacks was compared with placebo. Morphine was no more effective than placebo and provoked severe side effects. When low-dose morphine was administered to normal non-headache controls and migraineurs when headache-free, physical and psychologic reactions were induced only in migraineurs. On pupillometric study, only migraineurs had defective morphinemiosis. It is suggested that the observed clinical phenomena in response to morphine can be explained by differences in expression and sensitivity of some opioid receptor subtypes in migraine.