bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term Follow‐up of Relaxation Training for Pediatric Headache Disorders
Authors: Engel Joyce M. , Rapoff Michael A. , Pressman Alice Rogot
Published: May 2005

SYNOPSIS

The long‐term effects of relaxation training for pediatric headache disorders was determined for 17 of 20 original participants from a prospective control‐group experimental design study with random assignment to antogenic relaxation, progressive relaxation, autogenic plus progressive relaxation, or waiting list control groups. Long‐term follow‐up data were obtained at an average of 51 months post‐treatment.

All participants reported some increases in headache activity. Participants in the three relaxation treatment groups, however, had significantly more headache‐free days and less severe headache compared to the control group. There were no significant effects of treatment for headache duration, medication intake and rest time due to headache.

Twelve of the 13 treated participants indicated relaxation training was effective in relieving headaches, with 7 reporting they practiced relaxation exercises within the past month. The results generally support the long‐term benefits of relaxation in reducing headaches originating in childhood.
Propranolol in the Prophylaxis of Migraine ‐ Evaluation by Spectral Analysis of Beat‐to‐Beat Heart Rate Fluctuations
Authors: Zigelman Michel , Kuritzky Arieh , Appel Shlomo , Davidovitch Simha , Zahavi Izhar , Hering Rachel , Akselrod Solange
Published: May 2005

SYNOPSIS

Migraine patients seem to suffer from a continuous autonomic imbalance. Sympathetic instability, expressed by enhancedlow frequency fluctuations, which exists during the headache free intervals, was observed in our previous study by spectral analysis of heart rate (HR) fluctuations. Propranolol ‐ a beta adrenoceptor antagonist, is widely used in migraine prophylaxis.In order to specify and quantitate propranolol efficacy in migraine, spectral analysis of heart rate fluctuations was performedon 10 migraine patients before and during the treatment with propranolol. They were compared to 10 healthy control patientsand 6 migraine patients who Were treated for several months with propranolol and then discontinued the medication. The analysis was carried out on a 24h Holter ECG recording, which was performed for each subject during a headache freeinterval. Short 256 sec subtraces, taken every 30 min from the 24h ECG signal, were submitted to A/D conversion, R wavedetection and computation of heart rate power spectrum.

Propranolol achieved a marked effect, when comparing the power spectra of HR fluctuations in treated versus untreatedmigraine patients. A strong reduction (to normal level) in the low frequency HR fluctuations in the range below 0.1 Hz., wasapparent in patients treated with propranolol. Subjects who had received propranolol in the past and discontinued the drug,displayed a carry‐over effect of reduced fluctuations even 2‐3 months after its discontinuation. it seems that the propranololefficacy in migraine is associated with the mechanism of stabilizing the fluctuations within the frequency band related to sympathetic activity, hereby moderating the vascular instability in migraine.
Neurolysis of the Greater Occipital Nerve in Cervicogenic Headache. A Follow Up Study
Authors: Bovim Gunnar , Fredriksen Torbjørn A. , Stolt‐Nielsen Andreas , Sjaastad Ottar
Published: May 2005

SYNOPSIS

Entrapment of the greater occipital nerve (GON) in its peripheral course has been thought to be of possible pathogenic significance in cervicogenic headache. We have performed a “liberation” operation (“neurolysis”) of the nerve in the nuchalmusculature, with special attention to the trapezius insertion, and the follow‐up results in 50 patients are presented. Theimmediate effect of the operation was quite good, but the pain gradually recurred in the majority (46/50) of the patients.Eventually, all operated patients will probably have recurrence of pain episodes. Nevertheless, most patients claim that theoverall disability is less after the operation, and 40% actually want to undergo a new, identical procedure. The justification for doing a second “liberation” operation is clearly less than for a first operation. In our opinion, this operation should not be performed in patients with cervicogenic headache in general. The present study shows that other therapeutic approache sshould be searched for in cervicogenic headache.
Efficacy of an Individualized Outpatient Program in the Treatment of Chronic Post‐Traumatic Headache
Authors: Medina Jose L.
Published: May 2005

SYNOPSIS

Twenty patients disabled for work because of chronic post‐traumatic headaches were treated: 13 men, and seven women.Their ages ranged between 26 and 69 years (mean = 40.3). Their accidents occurred three months to eight years prior to theinitial visit (mean = 1.5 yrs.). Thirteen patients had concurrent spinal injuries.

They were assigned to an individualized program with emphasis on doctor‐patient relationship.

All patients received medications, biofeedback, and educational sessions. Thirteen patients with concurrent spinal injuriesreceived additionally therapeutic exercises and transcutaneous nerve stimulation. Five patients needed neuromuscularre‐education, and three, stress management. All sessions were individualized.

Patients attended the Center one to three times a week for three to 12 weeks (average = 9 weeks). The number oftreatment days ranged from six to 37 (average = 18.8 days). The average cost of the program for patients with headachealone was $3849.00; and for those with additional spinal injuries, $7030.00.

All patients improved: markedly, 14; moderately, four; end slightly, two patients. The improvement occurred within sevento 150 days (average = 48.7 days). Seventeen out of the 20 patients, (85%) returned to work within 21ndash;224 days (average = 111days).

An individualized outpatient program is very successful in the treatment of post‐traumatic headache.
Episodic Cluster Headache II: High Tobacco and Alcohol Consumption in Males1
Authors: Levi Richard , Edman Gunnar V. , Ekbom Karl , Waldenlind Elisabet
Published: May 2005

SYNOPSIS

Forty‐nine out of 51 consecutive male patients with episodic cluster headache were studied with regard to their smoking and drinking habits in general and in relation to cluster headache periods. Questionnaires were constructed for data regarding tobacco intake. Situation‐related smoking behavior was registered according toFrith (1971). Screening for alcohol over‐consumption was made using the Malmö modification of the brief Michigan Alcoholism Screening Test (Mm‐MAST).

Eighty‐three percent of the patients used tobacco on a regular basis at the time of the study, with an average consumption of 20 cigarettes per day. Only 3% had never used tobacco regularly. The smoking‐related desire to smoke in different situations was consistent with what is found in a general population of smokers.

Sixty‐seven percent of the patients had scores on the Mm‐MAST indicative of alcohol over‐consumption (i.e.heavy social drinking or alcoholism). During active headache periods 79% decreased their alcohol intake, whereas no consistent change in tobacco consumption was reported for the group as a whole. These findings were furthercorroborated by the fact that alcohol, but not tobacco intake, was reported by the majority of patients to elicit headache attacks during periods.

Thus, our study showed high alcohol and tobacco consumption to be prominent feature in male patients with episodic cluster headache. Since neither alcohol nor tobacco appear to have properties of ameliorating headache periods or attacks, the addictive behavior in our patients more likely reflects certain personality characteristics.
The Development of a Support Group Organization for Headache Sufferers
Authors: Klapper J. , Stanton J. , Seawell M.
Published: May 2005

SYNOPSIS

People with a wide variety of problems use support groups. We describe the development, structure and current functioning of a support group organization for headache sufferers, which has grown from ten members to 300 in four years. About one‐half of the members participate in ten currently functioning support groups. In addition to these support groups, the organizationplays an active role in the community by sponsoring public awareness seminars, publishing a quarterly newsletter, providing emergency treatment cards, and making knowledgeable speakers available to local business groups.

The membership has been described by means of a questionnaire. Information regarding medical history, impact of headaches on everyday functioning, and involvement with the organization is presented. Future directions of the organization are discussed.
Two Studies of the Non‐Pharmacological Treatment of Menstrually‐Related Migraine Headaches
Authors: Kim Mirihae , Blanchard Edward B.
Published: May 2005

SYNOPSIS

In order to evaluate the effect of non‐pharmacological treatment on menstrual and non‐menstrual migraine headache (HA), 2 studies have been conducted. In Study I which was a retrospective examination of between group reactions to non‐drug treatments, 37 self‐defined menstrual migraineurs and 62 non‐menstrual migraineurs showed comparable overall Improvement (reduction in HA activity) after treatment, but menstrual migraineurs maintained larger usage of medication across time than non‐menstrual migraineurs. In Study 2 which was aprospective examination of within subject reactions to non‐drug treatments, 15 carefully documented menstrual migraineurs again showed comparable levels of overall improvement but also showed that level of menstrual headache activity remained higher across time then non‐menstrual migraine HA. Because there were no interactions of time and type of migraine in either study, these results raise some questions about the existence of differential effectiveness of non‐pharmacological treatment of menstrual vs non‐menstrual migraine.
Headache Responses Following m‐Chlorophenylpiperazine in Bulimics and Controls
Authors: Brewerton Timothy D. , Murphy Dennis L. , Lesem Michael D. , Brandt Harry A. , Jimerson David C.
Published: May 2005

SYNOPSIS

We have previously reported that the serotonin (5‐HT) agonist meta‐chlorophenylpiperazine (m‐CPP) induced late occurring migraine‐like headaches in a group of patients with eating disorders and controls (n=52).1 In this report, we extend our analyses of these data and describe results indicating that headache responses following m‐CPP are greater in patients with bulimia nervosa than controls, regardless of the presence of anorexia nervosa or major depression. Although patients with severe migraine‐like headaches had higher peak m‐CPP levels than patients without severe headaches, these levels are not higher than other groups studied who did not get headaches. These findings suggest that post‐synaptic 5‐HT receptor sensitivity is altered in the vascular tissues of bulimic patients. Additional disturbances in 5‐HT function, perhaps presynaptic ones, may be associated with anorexia nervosa and major depression. Similar alterations in other 5‐HT pathways at or above the level of the hypothalamus may contribute to binge eating and other behavioral symptoms of bulimia nervosa. Further studies exploring the functional integrity of 5‐HT receptors and their subtypes are warranted in bulimic patients, as well as in patients with nonbulimic anorexia nervosa, minor and major depression without an eating disorder, and migraine and other headache patients.
Platelet Gamma‐Aminobutyric Acid Levels in Migraine and Tension‐Type Headache
Authors: Kowa Hisanori , Shimomura Tokio , Takahashi Kazuro
Published: May 2005

SYNOPSIS

Gamma‐aminobutyric acid (GABA) levels in platelets were measured in 19 patients with migraine (7 males and 12 females, average age: 36.5 years) and 27 patients with chronic tension‐type headache (TH; 9 males and 18 females, average age: 48.9 years). Twenty‐one normal healthy volunteers composed the control group (11 males and 10 females, average age 34.9 years). The GABA levels in platelets were determined using high performance liquid chromatography with fluorescent detection (HPLC‐FC). The GABA levels in platelets were 30.8 $plusmn; 11.7 pmol/109 platelets (mean ± S.D.) in the patients with migraine, 43.1 ± 11.8 pmol/109 platelets in the patients with TH and 34.7 ± 8.1 pmol/109 platelets in the healthy controls. The platelet GABA levels in the patients with TH were significantly higher than in the migraine patients end the healthy controls (p<0.05).

The possible role of GABA in headache is discussed. We consider that TH may be a state of neuronal hyperexcitability similar to migraine and that GABA in the platelets of patients during TH attacks may be elevated to counterbalance it. Alternatively, we suggest that the rise of GABA levels in platelets is related to emotional factors, such as depression, in the TH patients. Further studies must be undertaken concerning the relationship between platelet GABA levels and headache.
Olfaction in Migraineurs
Authors: Hirsch Alan R.
Published: May 2005

SYNOPSIS

Many investigators have described olfactory dysfunction among migraineurs. Olfactory stimuli can precipitate migraine, and olfactory hallucinations can occur as auras of migraines or as part of the symptom complex. Despite many reports linking olfactory phenomena and migraine, no evaluations of the olfactory abilities of migraineurs have been documented. To begin such assessments, sixty‐seven consecutive migraine patients were given Pyridine odor threshold tests. Twelve of them (18%) scored as hyposmic or anosmic. In comparison, 1% of the general population of the U.S. is hyposmic or anosmic. Aside from possible diagnostic or methodological error, several possibilities may account for our result: migraine may induce olfactory pathology; olfactory pathology may induce migraine, or; a common pathogen may induce both olfactory dysfunction and migraine. The association of migraine with the emotional component of the limbic system has long been recognized, and our results strengthen its association with the olfactory component as well. Headache patients should be tested for olfactory loss and warned of such risks as inability to detect gas leaks and spoiled food.
Hemicrania Continua: Attacks May Alternate Sides
Authors: Newman Lawrence C. , Lipton Richard B. , Russell Marjorie , Solomon Seymour
Published: May 2005

SYNOPSIS

Hemicrania continua (HC) is characterized by a continuous unilateral headache of moderate severity, occurring in 2 patterns; a continuous form in which headaches persist continuously without remission for years, and a remitting form, consisting of headache phases separated by periods of pain‐free remission. The remitting form of HC must be distinguished from other cyclical headache disorders such as episodic paroxysmal hemicrania and episodic cluster headache. Characteristically, the headache of HC is unilateral and without sideshift. We now report a case of HC in which headaches alternate sides.
Psychometric Characteristics of the Headache‐Specific Locus of Control Scale
Authors: VandeCreek Larry , Min D. , O'Donnell Francis
Published: May 2005

SYNOPSIS

Martin and colleagues have described their development of a Headache‐Specific Locus of Control scale (HSLC) which contains 11 items for each of its three subscales: internal, health care professional, and chance orientations. In this replication study, we gathered data from patients who came to a Headache Clinic in a medical center (n = 151) and from a comparison sample (n = 192). Factor analysis and alpha coefficients were similar to those reported by Martin. Only small correlations were found between the subscale scores although some of them were statistically significant. This suggests that the HSLC is a psychometrically competent instrument. Additionally, mean scores of its three subscales differentiated the patient population from those whose headaches were less severe and thus did not seek help
Childhood Onset Cluster Headaches
Authors: Maytal Joseph , Lipton Richard B. , Solomon Seymour , Shinnar Solomo
Published: May 2005

SYNOPSIS

Cluster headaches are rare in childhood. We identified 35 patients with cluster headaches starting at or before 18 years of age, including 7 patients with onset prior to age 10. All patients met the criteria of the International Headache Society for episodic or chronic cluster headaches. Patients experienced cluster headaches for as long as 20 years before seeking medical attention and required many medical contacts to establish the correct diagnosis. The clinical features f cluster headaches during childhood were similar to those which typically occur in adult life. Cluster headache patterns changed over 18 years of follow up.The frequency and duration of cluster periods increased in 14 subjects. The frequency of single headache attacks during cluster periods also increased in a similar number of subjects.

We conclude that cluster headaches starting in childhood or adolescence closely resemble the adult form of the disease. In many patients, the frequency and duration of cluster periods and the frequency of the individual headache episodes increased over time. Cluster headache represent a treatable under‐recognized cause of severe headache in childhood and adolescence.
Naproxen Sodium Versus Ergotamine Tartrate in the Treatment of Acute Migraine Attacks
Authors: Treves T.A. , Streiffler M. , Korczyn A.D.
Published: May 2005

SYNOPSIS

A double‐blind parallel study compared the efficacy and safety of naproxen sodium (NPX) and ergotamine tartrate (ERG) as abortive therapy for acute headache in 79 patients with classical or common migraine. The design study was of the double‐blind design. Forty‐two patients completed the study. Discontinuation of treatment was generally due to lack of efficacy or adverse reactions. NPX was significantly better than ERG in the overall efficacy of treatment rated by the patients (p < 004). NPX was comparable to ERG in reducing the severity and duration of the headache and its associated symptoms. In classical migraine, NPX was better than ERG in alleviating the severity of headache. Patients in the NPX group tended to use less rescue medication. There was no significant difference in the frequency of side‐effects reported by the patients under NPX or ERG. This study demonstrates that NPX is as safe as ERG, and somewhat more effective in acute migraine attacks (although the difference is not statistically significant) and that migrainous patients tend to prefer NPX to ERG in treating their acute migraine headaches.
Fear of Pain in Recurrent Headache Sufferers
Authors: Hursey Karl G. , Jacks S. Daniel
Published: May 2005

SYNOPSIS

We investigated the role of fear of pain in headache sufferers using the Fear of Pain Questionnaire (FPQ). Seventy‐six headache sufferers and 58 controls completed the FPQ and measures of depression, anxiety, and anger. Headache sufferers also completed measures of stress‐related physical symptoms and coping with pain. We found that the FPQ has excellent internal consistency as well as good concurrent and construct validity indicated by the high correlations between the FPQ subscales and both anxiety and depression but low correlations with anger. There were marked differences between headache sufferers and controls on the FPQ; headache sufferers showed much greater fear of severe and medical pain and lower fear of minor pain. Fear of pain was generally not related to headache characteristics such as frequency, severity, or duration. On the other hand, it was related to headache impact such as disruption of pleasurable activities. These results are consistent with models of chronic pain disorders which emphasize the role of fear of pain over the nociceptive intensity of the pain stimulus.
The Prevalence of Cerebral Damage Varies With Migraine Type: A MRI Study
Authors: Fazekas F. , Koch M. , Schmidt R. , 0ffenbacher H. , Payer F. , Freidl W. , Lechner H.
Published: May 2005

SYNOPSIS

Studies on the prevalence of MRI signal abnormalities in the brains of migraineurs have yielded controversial results. In order to provide further data on this issue we reviewed the MRI scans of 38 migraine patients without current neurologic symptoms (mean age 35.8 ± 11.9 years). In addition, we compared the findings in those 24 migraineurs under 50 years without major cerebrovascular risk factors (mean age 30.1 ± 9.0 years) to that in 14 headache and risk factor free volunteers (mean age 37.8 ± 5.3 years). Overall, focal areas of hyperintense signal were seen in 15 (39%) patients. They were present on both proton density and T2‐weighted spin‐echo sequences. Lesion prevalence varied according to the type of headache (18% in migraine without aura, 53% in migraine with typical aura, 38% in basilar migraine). The subset of migraine patients under 50 years exhibited MRI signal abnormalities more than twice as often as controls (33% vs. 14%). Punctate white matter hyperintensities were the predominant finding and were seen in 10 of 15 individuals with MRI lesions. More striking signal abnormalities consisted of symmetrical areas of hyperintensity lateral to the posterior horns in two 24 year old patients and of extensive white matter damage with lacunar infarcts in a 59 year old woman.

Our findings confirm a higher prevalence of MRI lesions in a mixed group of migraineurs than in headache free individuals. Signal abnormalities are most often non‐specific, however their occurrence relates to the type of migraine.
The Relationship of Ovarian Steroids, Headache Activity and Menstrual Distress: A Pilot Study With Female Migraineurs
Authors: Beckham Jean C. , Krug Linda M. , Penzien Donald B. , Johnson Cheryl A. , Mosley Thomas H. , Meeks G. Rodney , Pbert Lori A. , Prather Rita C.
Published: May 2005

SYNOPSIS

Fourteen female volunteers who met diagnostic criteria for migraine headache monitored their headache activity and menstrual distress symptoms for one menstrual cycle. Serum estradiol and progesterone levels, and menstrual distress measures were collected at four points of the menstrual cycle: menstrual, ovulatory, luteal and premenstrual. Results indicated that one patient (7.1%) had menstrual migraine, 10 patients (71.4%) had menstrually‐related headache and 3 (21.4%) had migraine headache unrelated to their menstrual cycle: subsequent analyses were conducted with the first two groups. Headache activity for the sample was highest during the premenstrual phase. Headache activity during the luteal and premenstrual phases was related to luteal phase progesterone levels. Menstrual distress was highest during the menstrual and premenstrual phases of the cycle, and these symptoms were related to higher estradiol levels, higher estradiol/progesterone ratios, and increased headache activity. These results indicated that for women with menstrual migraine or menstrually‐related migraine, luteal progesterone levels may be significantly associated with headache activity, and estradiol and the estradiol/progesterone ratio may be significantly related to menstrual distress during the pre‐menstrual phase of the cycle. The estradiol/progesterone ratio was not more related to headache or menstrual distress than either of these ovarian hormones alone. Suggestions for future research in this area are offered.
Migraine‐associated Dizziness
Authors: Cutrer F. Michael , Baloh Robert W.
Published: May 2005

SYNOPSIS

We reviewed the clinical histories, examinations and results of quantitative vestibular testing in 91 patients with migraine‐associated dizziness. Nausea and vomiting, hypersensitivity to motion and postural Instability accompanied the dizziness. In the majority of patients, the temporal profile of the dizziness was more typical of the headache phase of migraine than of the aura phase. Nineteen patients (20.9%) had unilateral hypoexcitability to caloric stimulation, which represents a modestly increased risk of damage to the peripheral vestibular apparatus. We propose two separate pathophysiologic mechanisms for the production of dizziness with migraine: Short‐duration vertiginous attacks lasting minutes to 2 hours and temporally associated with headache are due to the same mechanism as other aura phenomena (spreading wave of depression and/or transient vasospasm). Longer‐duration attacks of vertigo and motion sickness lasting days, with or without headache, result from the release of neuroactive peptides into peripheral and central vestibular tructures, causing an increased baseline firing of primary afferent neurons and increased sensitivity to motion.
Handling of 5‐Hydroxytryptamine by Platelets in Migraine
Authors: MacGregor E.A. , Bird N. , Ranson R. , Ridler C. , Wilkinson M.I.P.
Published: May 2005

SYNOPSIS

There is little dispute that a link exists between 5‐hydroxy‐tryptamine (5HT) and migraine but the exact mechanism of an attack has yet to be established.

The handling of 5HT by the platelet is regarded as a simple model of the handling of 5HT by nerve terminals. If differences are seen in how the platelets from migraineurs handle 5HT compared to those from a control population, it is possible that a similar difference exists in the nerve terminal.

The Haemostatometer allows the rapid and simultaneous in vitro assessment of platelet function (shear‐induced haemostasis), coagulation and thrombolysis from non anticoagulated blood samples. In this study, a baseline comparison of haemostasis was made on 20 migraineurs between attacks and 20 controls. No differences were found in the results from each of the two groups. 5μM of 5HT was then added to blood taken from 10 migraineurs and 10 controls and the recordings were repeated. Again, no differences were found between the results from the two groups. In blood taken from both migraineurs and controls, the effect of 5HT was to significantly enhance clotting time and clot lysis. No effect was seen on primary aggregation. The possible reasons for and significance of these findings is discussed.
Clinical Features of Chronic Daily Headache
Authors: Solomon Seymour , Lipton Richard B. , Newman Lawrence C.
Published: May 2005

SYNOPSIS

Patients with chronic daily headaches are commonly encountered in headache specialty centers but their clinical characteristics have rarely been documented. We studied 100 consecutive patients with chronic daily headache to determine their presenting characteristics and other associated features.

Half of the patients described their headache as a steady ache but throbbing pain was reported in about one third. About half estimated the degree of pain as moderate but one third claimed the typical pain was severe. A consistently unilateral site was noted in only 2 percent. Associated features characteristic of migraine were often noted: including photophobia (37 percent), phonophobia (42 percent), and nausea (24 percent). Many also reported aggravating and ameliorating factors commonly associated with migraine.

We conclude that the manifestations of chronic daily headache are extremely diverse, probably reflecting the heterogeneous mechanisms which underlie this condition.
Minor Stressful Life Events (Daily Hassles) in Chronic Primary Headache: Relationship with MMPI Personality Patterns
Authors: De Benedittis G. , Lorenzetti A.
Published: May 2005

SYNOPSIS

This study investigated the relationship between minor life events (i.e. daily hassles) and personality patterns from selected scales of MMPI in the persistence of primary headache in 83 patients. Comparisons between headache subgroups indicated that tension‐type headache patients are much more likely than those with migraine to have experienced high level of microstress (hassles density),with mixed headache in between. Tension‐type headache patients reported higher MMPI scores on scales 1, Hypochondriasis (somatic concern), scale 3, Hysteria (denial) and scale 7, Psychasthenia (anxiety), but not on scale 2 (Depression), than migrainous patients. In addition, individuals with high level of microstress appeared to be more depressed and anxious than low‐stress headache patients, scoring significantly higher on MMPI scales 2 (Depression) and 7 (Psychasthenia). As no significant differences due to sex, age, headache history and status, except for the headache density (i.e. severity x frequency) appeared, it is likely that high‐stress levels are due, at least in part, to greater density of pain, rather than to discrete headache syndromes.

Our findings support the notion that depressed mood and anxiety may account for a third intervening variable in the relationship between chronic headache and life stress.
Lithium Inhibits Substance P and Vasoactive Intestinal Peptide‐Induced Relaxations on Isolated Porcine Ophthalmic Artery
Authors: Vincent Maurice B.
Published: May 2005

SYNOPSIS

Lithium is currently a major drug used as a treatment for effective disorders and cluster headache, among other conditions. Its mechanism of action remains unknown. The trigeminovascular system may be involved in the pathophysiology of cluster headache and related diseases by liberating neuropeptides such as substance P (SP) and calcitonin gene‐related peptide (CGRP) in the eye‐forehead region. The objective of this study was to investigate whether or not a low concentration of lithium may interfere with peptidergic neurotransmission at this level. Vasoactive intestinal peptide (VIP), SP, CGRP, capsaicin, and SP+CGRP concentration‐response relaxation curves were obtained in the presence and absence of 2 x 10‐4 M lithium in isolated porcine ophthalmic arteries. Lithium inhibited the SP and VIP, but not the CGRP responses. Capsaicin‐ (a neurotoxin causing release of stored sensory neuropeptides) induced relaxations were partially inhibited by lithium. it is concluded that lithium may interfere with SP and VIP‐induced relaxation. If SP and VIP are of pathogenic significance in cluster headache, lithium may possibly work by counteracting unwanted effects of such peptides.
Menstrual Migraine Without Aura: Cortical Excitability to Magnetic Stimulation
Authors: Bettucci D. , Cantello R. , Gianelli M. , Naldi P. , Mutani R.
Published: May 2005

SYNOPSIS

The purpose of the present study was the evaluation of the excitability threshold and the central motor conduction time (CCT) studied by means of electromagnetic cortical stimulation in tan subjects affected by menstrual migraine without aura, both in the ictal end the interictal period.

The patients were chosen from among a group of 254 outpatients affected by migraine, diagnosed according to the International Headache Society criteria.1 The control group consisted of ten healthy female subjects. As far as CCTs were concerned no differences emerged between patients and controls. However In the patient group we found a significant increase in the excitability threshold values, both in the ictal and the interictal period, and in both hemispheres. If confirmed, the Increased excitability threshold may be a useful neurophysiological correlate of migraine without aura.
Chronic Naloxone Administration, a Potential Treatment for Migraine, Enhances Morphine‐Induced Miosis
Authors: Nicolodi Maria , Sicuteri Federigo
Published: May 2005

SYNOPSIS

The degree and duration of miosis, induced by low doses of parenteral morphine (65 mcg/Kg i.m.) before end after ten days of naloxone treatment, were evaluated in eleven volunteers affected by migraine without aura. Morphine induced miosis was significantly more Intense and persistent after chronic naloxone treatment than before the drug was administered. In another group of seven volunteers suffering from migraine without aura, no differences between morphine‐induced miosis, prior to and after a ten‐day treatment with placebo, were observed. In addition, a third group of fifty‐four subjects, suffering from migraine without aura, underwent three‐month naloxone treatment (150 mcg/Kg/i.m./day). All subjects Included in the third group, were partially or totally refractory to conventional therapy. Pupillopharmacological results indicate that the benefit gained from chronic administration of the opiate antagonist may be related to some type of naloxone‐induced supersensitivity of the opioid receptor population.
Does a History of Maternal Migraine or Depression Predispose Children to Headache and Stomach‐ache?
Authors: Mortimer M. J. , Kay J. , Jaron A. , Good P. A.
Published: May 2005

SYNOPSIS

The Incidence of the life time history of both maternal mi‐graine and depression were assessed in children with headache, migraine, recurrent abdominal pain and abdominal migraine. An epidemiological survey of 1,104 children registered with a general practice was undertaken. The Incidence of maternal migraine and depression agreed with previous estimates. Children with migraine had a greater proportion of mothers with a history of migraine than those who experienced headache alone compared with controls. The survey showed that mothers with depression predisposed their children to headache but not specifically migraine. A history of maternal depression and migraine was significantly more common and proportionately higher in children with abdominal migraine and recurrent abdominal pain.
Migraine: An Informative Method Of Communication
Authors: MacGregor E.A. , Blau J.N.
Published: May 2005

SYNOPSIS

The Keypad Audience Response System can be used to obtain simultaneous Information from a large number of people in an audience. Answers to specific questions are transmitted from a keypad (pressed by each participant) to a computer. The results are displayed on a screen within 20 seconds, expressed as percentages of total responses to each question and presented as bar diagrams or pie charts.

At a meeting of the British Migraine Association, over 100 migraineurs learned how their attacks differed from, or resembled those of others. The speakers were able to clarify and discuss both questions and answers which confirmed previous findings about attack duration, prodromes, postdromes, effect of pregnancy, oral contraceptives and the menopause. Three new points emerged which merit further study:

1. Hormone replacement therapy aggravated migraine in 42% of women, 27% noted an improvement, end 31% observed no alteration.

2. Twenty‐five percent prefer to sit up during an attack.

3. Seven percent reported prolonged attacks (3–7 days).

The use of keypads at seminars or lectures is valuable in promoting enthusiastic audience participation, and the understanding of the diverse symptoms and manifestations of a condition. Although observations cannot be extrapolated to a wider population because all audience are a selected group, new points requiring research may be highlighted.
Bilateral Occipital Lobe Infarction in Acute Migraine: Clinical, Neurophysiological, and Neuroradiological Study.
Authors: Ganji S. , Williams Warren , Furlow Jennifer
Published: May 2005

SYNOPSIS

A woman having common migraine attacks coincident with an asymmetrical bilateral occipital lobs infarction that spared the brainstem and cerebellum underwent these studies: serial electroencephalography, brainstem auditory, visual end somatosensory evoked potentials, magnetic resonance imaging of the brain and cerebral arteriography. The patient's vision improved greatly during a one‐year followup. The absence of risk factors for stroke suggested that migraine caused the infarction in the posterior circulation network. The pathophysiological mechanisms of stroke in migraine remains speculative.
Non‐Pharmacological Treatment of Headache: Is Less More?
Authors: Primavera JP , Kaiser RS
Published: May 2005

SYNOPSIS

A twenty‐six article review of the literature pertaining to non‐pharmacological treatment of headache was undertaken. The data supports no significant difference in the efficacy of hypnosis, biofeedback and relaxation training. These studies demonstrated no relationship between hypnotizability or capacity for temperature elevation and headache Improvement. The literature reviewed suggests the mechanism for improvement with non‐pharmacological treatment may be physiologically nonspecific, with patient age, perceived locus of control and motivation likely to predict successful treatment. Home‐based, minimal therapist contact, biofeedback and relaxation treatment appear to work as effectively as intensive clinic‐based treatment.
Incidence of Headache and Severity of Head Injury
Authors: Yamaguchi Michio
Published: May 2005

SYNOPSIS

The relationship between the incidence of post‐traumatic headache and the severity of head injury has been a controversial issue. The milder the head injury, the more frequently severe headache is noted as a symptom. To investigate this relationship, 121 civilians were investigated using simplified classifications of the grade of headache, type of injury (mild or severe), cervical X‐ray and head CT findings, and clinical history. All the subjects were claiming compensation for work‐related injuries.

In the mildly injured group, 46/64 patients complained of severe headache, while only 19/57 had severe headache in the severely injured group (p<0.001). Abnormal findings on the cervical X‐ray films including degenerative changes were more frequent in the severe headache group (p<0.02). CT abnormalities correlated positively with the severity of head injury (p<0.001), but showed an inverse relationship with the incidence of headache (p<0.01). Mentally impaired patients also complained of headache less frequently (p<0.01). On the basis of these results, possible organic mechanisms related to the pathogenesis of post‐traumatic headache are discussed.
Assessment of Chronic Refractory Headache: The Role of the MMPI‐2
Authors: Kurman Rochelle G. , Hursey Karl G. , Mathew Ninan T.
Published: May 2005

SYNOPSIS

We investigated the utility of the newly revised version of the Minnesota Multiphasic Personality Inventory, the MMPI‐2, for assessing psychopathology in three diagnostic headache groups, Post Traumatic, Status Migrainosus, and Status Migrainosus with Analgesic Rebound. We also investigated whether distinct clusters of headache sufferers could be identified using the MMPI‐2 clinical scales, and whether these clusters coincide with headache diagnosis. Eighty‐one patients in treatment at the Houston Headache Clinic were diagnosed and administered the MMPI‐2. Significant levels of psychopathology were found in all three diagnostic groups. Furthermore, Cluster Analysis identified three clusters of patients with equal proportions of patients from the three diagnostic groups. Cluster I patients were abnormally high on many MMPI‐2 clinical scales; Cluster 2 patients showed more moderate elevations, and Cluster 3 patients had essentially normal profiles. We concluded that the MMPI‐2 offers additional information not available through medical diagnosis alone. Thus, it is crucial to include psychological assessment in any comprehensive evaluation of chronic headache patients. Further implications for treatment planning and effectiveness are discussed.
Cerebral Blood Flow in Migraine with Aura: A Transcranial Doppler Sonography Study
Authors: Totaro Rocco , Matteis Giorgio De , Marini Carmine , Prencipe Massimiliano
Published: May 2005

SYNOPSIS

Transcranial Doppler sonography examination was performed on 44 patients with migraine with aura and 88 controls. All patients were investigated in headache‐free periods and 10 of them also during a migraine attack. During the headache‐free period a not significant increase of mean flow velocity in patients compared to controls was obtained. The pulsatility index (PI) mean values were also higher in patients than in controls and the differences were significant in the MCA (p<0.05). No difference between right and left side was observed. During the attack the mean flow velocity (MFV) decreased in all arteries but the decrease was significant only in MCA and ACA (p<0.05). The mean PI increased in all arteries but not significantly. These variations were observed both on the headache and contralateral side. Nevertheless, the MFV decrease in all arteries was observed in four patients only. In four patients the MFV decrease was found in the anterior arteries and the MFV increase in the posterior arteries, while in two patients the MFV increase was observed both in the anterior and posterior arteries. The correlation between the variations of MFV values during the attacks and the time interval from the onset of attacks showed that the PCA and BA flow velocities were increased in patients examined between 0.5 and 3 hours, while an increase in MCA and ACA flow velocities were observed only in patients examined after 1.5 hours.
Self‐Administration of Parenteral Ketorolac Tromethamine for Head Pain
Authors: Turkewitz L. Jay , Casaly Joseph S. , Dawson Gregory A. , Wirth Oliver , Hurst Reina J. , Gillette Pamela L.
Published: May 2005

SYNOPSIS

Sixty‐one separate self‐injections of ketorolac tromethamine (ToradolÒ) by 16 patients diagnosed with episodic migraine with or without aura were evaluated over a 90‐day period for safety, efficacy of painreduction, and the ability of this therapy program to prevent the necessitation of emergency room acute care. Prior to initiation of treatment, patients were formally instructed on intramuscular injection techniques by a member of our nursing staff. Patients were instructed to call upon the onset of a severeheadache interfering with daily functioning and, then, were permitted to proceed with the injection. Headache intensity ratings were collected prior to injection and intermittently for the following twenty‐four hours. The results demonstrate safety and efficacy of this form of therapy. A significant percent of ketorolac usages (64%) resulted in a good response and significant reduction in head pain. Twenty‐three percent of ketorolac usages resulted in a mild response and only 13% of usages provided no relief. Furthermore, 13% of all usages failed to prevent the necessitation for emergency room treatment. The results are discussed in terms of the impact of self‐injection on pain relief and substantial cost‐reduction by decreasing emergency room utilization.
Outpatient Repetitive Intravenous Dihydroergotamine
Authors: Robbins Lawrence , Remmes Anne
Published: May 2005

SYNOPSIS

The efficacy of the repetitive intravenous dihydroergotamine (DHE) inpatient protocol for refractory headache is wellestablished. We conducted a retrospective and prospective study of long‐term headache patients at our clinic toevaluate this regimen in an outpatient setting.

Treatment consisted of oral metoclopramide and four doses of DHE, with the total dose equaling 4 mg.,administered over two days. Patients were followed for up to 10 weeks while they continued to receive prophylacticmedication. Responsiveness was rated in terms of decreased frequency or severity of headache: excellent (75% to100%), moderate (50–75%), mild (25–50%), and none (0–25%).

In the retrospective study, 69% (43/62) of patients with chronic daily muscle‐contraction‐type headache and severemigraine had an excellent response at two days. An excellent or moderate response was sustained over three weeks in65% (32/49) of the study group (13 patients were dropped from the study for failing to comply with record keepingrequirements). At the 6‐ and 10‐week follow‐up evaluations, the majority of patients (76% and 70%, respectively)reported mild or no relief.

Among patients with refractory daily headache or frequent severe migraine studied prospectively, 80% (28/35)reported an excellent response at two days. After six weeks, 66% (23/35) showed excellent or moderate relief. For bothgroups combined, 73% (71/97) of patients showed an excellent response to DHE at two days, with 43% (33/77)sustaining excellent or moderate relief at six weeks. Side effects, including nausea, leg cramps, facial flushing,increased blood pressure, diarrhea, burning at the injection site, and tightness in the throat and/ or chest, were generallymild and transient. Side effects were milder with outpatient DHE versus our experience with inpatient DHE.

Outpatient repetitive IV DHE treatment offers flexibility in the management of severe headache. Our studiesdemonstrate the safety and efficacy of this regimen.
Unilateral Headache with Features of Hemicrania Continua and Cervicogenic Headache ‐ A Case Report
Authors: Rothbart Peter
Published: May 2005

SYNOPSIS

A case is presented which has features of Cervicogenic Headache and of Hemicrania Continua. A sudden maneuver of the neck and later a greater occipital nerve block, both resulted in relief of the pain. A cervical cause is suggested.
Flunarizine in Migraine: A Double‐blind Placebo‐controlled Study (in a Saudi Population)
Authors: Deeb S. M. AI , Biary N. , Bahou Y. , Jaberi M. AI , Khoja W.
Published: May 2005

SYNOPSIS

We evaluated the effect of flunarizine (Fz) (10 mg/d) on migraine in e double‐blind placebo‐controlled design. The attacks' frequency, duration, severity and associated symptoms were compared before and after treatment. Forty‐two patients completed a three‐month trial period; 21 patients received Fz and 21 placebo, Statistical analysis showed no significant difference between Fz and placebo (p>0.051. In this study Fz was not more efficient than placebo in migraine.
Low Concentrations of Lithium and Cyclooxygenase Inhibitors Enhance Endothelin‐1 (ET‐1)‐Induced Contractions in Human Temporal Artery, but not in Porcine Ophthalmic Artery
Authors: Bakken I. J. , Vincent M. B. , White L. R. , Cappelen J. , Skaanes K. O. , Sjaastad O.
Published: May 2005

SYNOPSIS

Endothelins are a recently discovered group of potent vasoconstrictor peptides synthesized by endothelial cells and other tissues in various species, which seem to participate in the regulation of vascular tonus. Abnormalities in vasoactivity in the head may be an important event in headache pathophysiology, although the mechanisms responsible for such constrictions and/or dilations are not known. The endothelium and its constrictor peptide, endothelin, may play a key role in such mechanisms. Of the various drugs used in the treatment of headache, lithium is an accepted treatment for cluster headache, and indomethacin is the drug of choice for the associated condition chronic paroxysmal hemicrania. The mechanism of action of these drugs in these headaches is not known. Due to the possible involvement of endothelin in headache disorders, the objective of this study was to verify the effects of lithium and cyclooxygenase inhibitors (indomethacin, acetylsalicylic acid and naproxen) on endothelin‐1 (ET‐1)‐induced contractions in isolated human temporal arteries and porcine ophthalmic arteries. It was found that all drugs increased the (ET‐1)‐induced contractions in human temporal arteries. Conversely, there were no significant changes induced by the drugs in porcine ophthalmic arteries. These results are consistent with the variation of activity often seen in different vascular beds and between species. The potential importance of such reactions for the understanding of vascular changes putatively involved in headache development and treatment is discussed.
MRI of Intracranial Arteries in Nitroglycerin Induced Cluster Headache Attacks
Authors: Hannerz Jan , Greitz Dan
Published: May 2005

SYNOPSIS

Eight patients with episodic cluster headache, five in active episode, three out of episode, were investigated as to diameters of intracranial arteries before and after nitroglycerin (NG) administration. The diameter of all intracranial carotids were increased about 10 minutes after NG, although more in the patients in episode than in patients out of episode. The dilatation remained for the next 60 minutes in the patients who did not get a cluster headache attack. There was a normalization of the diameters of the internal carotid arteries compared to the initial values, at maximum pain in all patients who got a cluster headache attack. Similar changes were also found in the basilar arteries. The findings support the hypothesis of a constriction of intracranial arteries at maximum pain in cluster headache attacks to stop the pain.