bluuebunny/crossref_metadata_2025 huggingface dataset:
Benign Paroxysmal Vertigo in Childhood: A Long‐term Follow‐up
Authors: Lindskog Ulla , Ödkvist Lars , Noaksson Lisbeth , Wallquist Jan
Published: March 2003

Benign paroxysmal vertigo in children is characterized by sudden attacks of vertigo lasting seconds or minutes. During the attack, the child has nystagmus and is unable to stand without support. Initially, the attacks are frequent, later slowly disappearing. Nineteen children who were diagnosed in 1975–1981 participated in a follow‐up study. Sixteen of them were examined with audiometry and electronystagmography. Age at onset was from 5 months to 8 years, and the symptoms disappeared after 3 months to 8 years. The follow‐up was performed 13 to 20 years after diagnosis. Twenty‐one percent developed migraine which is somewhat more than in a normal population of this age. Thirty‐nine percent had a family history of migraine which is a figure considerably lower than in a migraine population. None still had vertigo or a balance disorder. Our conclusion is that benign paroxysmal vertigo has a favorable outcome, and it is not a general precursor of migraine.
Chiari‐1 Malformation, Migraine, and Sudden Death
Authors: Ziegler Dewey K. , Mallonee William
Published: March 2003

Sudden death occurring in a young man with Chiari‐1 malformation after repeated attacks of headache and syncope that had been diagnosed as basilar migraine is reported. Autopsy revealed only Chiari malformation and syringomyelia. The ominous potential of syncope in this syndrome is emphasized.
Comprehensive/Tertiary Care for Headache: A 6‐Month Outcome Study
Authors: Saper Joel R. , Lake Alvin E. , Madden Scott F. , Kreeger Christopher
Published: March 2003

Objective.—To assess programwide (outpatient plus inpatient) outcome using prospective measures for the first 6 months of treatment at a comprehensive headache center.

Background.—There is little published data on the overall programwide efficacy of comprehensive, multidisciplinary treatment centers for severe, refractory headache disorders.

Methods.—For 1 week each month over a 2‐year period, all new patients completed an initial questionnaire noting frequency/severity of headaches and other headache‐relevant measures. A follow‐up version mailed at 6 months was returned by 218 of 421 patients (response rate 52%). Sixteen percent were treated both in and out of the hospital, with 84% treated as outpatients only. Patients had a mean of 2.50 medical visits after the initial evaluation, and 43% met with a psychologist.

Results.—Mean headache frequency dropped from 5.30 to 3.45 days per week (P<.00001), with severe headaches declining from 2.31 to 1.33 days per week (P<.00001). Sixty‐seven percent of the patients had at least a 50% reduction in headaches, with a mean percentage improvement per patient in severe headaches of 56% (median 67%). Emergent care visits within 6 months dropped from 4.39 to 1.67 (P<.00001). Days with significant headache‐related work impairment declined from 2.04 to 0.67 days per week (P<.00001), a net annualized reduction of 71.24 impaired workdays per year per patient. For full‐time workers, missed work days in 6 months dropped from 5.46 to 2.68 (P<.00261). The mean percentage improvement for headache‐impaired workdays was 67% (median 88%), and for work absence was 63% (median 100%). Total days incapacitated per week dropped from 1.72 to 0.89 (P<.00001), with a mean percentage improvement of 67% (median 91%). Significant treatment satisfaction was reported by 89%. A weighted Goal Attainment Scale based on the percentage of patients showing significant improvement in pain control, functioning, work performance, reliance on emergent care, depression, and satisfaction revealed an overall Goal Attainment score of 72%.

Conclusions.—Despite a mean of only 3.50 medical visits in a population of complex patients, significant improvement was demonstrated in several key economically relevant variables within 6 months of referral. If maintained over the long term, the results support the concept that matching intensity of treatment (comprehensive/tertiary care) to severity of illness (complex/refractory cases) is cost‐effective.
Low Interhemispheric and High Intrahemispheric EEG Coherence in Migraine
Authors: Koeda T. , Takeshima T. , Matsumoto M. , Nakashima K. , Takeshita K.
Published: March 2003

Twenty women with migraine were evaluated by EEG coherence analysis. In comparison with controls, the migrainous subjects showed lower interhemispheric coherence values at C3–C4 for the delta band (P=0.0030) and at F3–F4 (P=0.0055) and C3–C4 (P=0.0018) for the beta band frequency (Wilcoxon criterion). In contrast, 22 intrahemispheric coherence pairs were significantly higher in the migraine group than in the control group (P<0.01). The subjects with visual aura showed lower interhemispheric coherence at O1–O2 and T5–T6 for the alpha band than the subjects without the aura. Discriminant analysis revealed that 95% of the subjects with migraine and 85% of the controls were correctly classified into their proper groups. We suggest that EEG coherence analysis is a sensitive parameter in the detection of electrophysiological abnormalities in patients with migraine.
Coexistence of Chronic Paroxysmal Hemicrania and Benign Cough Headache
Authors: Mateo I. , Pascual J.
Published: March 2003

We report on the coexistence of both chronic paroxysmal hemicrania and cough headache in a middle‐aged woman. Typical chronic paroxysmal hemicrania and cough headache episodes appeared independently and responded to indomethacin. The possible pathophysiological significance of this concurrence of both types of indomethacin‐responsive pain is discussed.
Epidemiology of Migraine Among Students From Randomly Selected Secondary Schools in Lodz
Authors: Split Wojciech , Neuman Witold
Published: March 2003

The purpose of the present study was to determine the prevalence of migraine among 2351 secondary school students aged 15 to 19 years. Six hundred fifty‐nine students (120 males and 539 females) complained of migraine, including 148 with additional tension‐type headache (mixed headache). Migraine with aura was diagnosed in 213 students (49 with mixed headache). The remaining 446 students (99 with mixed headache) had migraine without aura. In 83 students (16 with mixed headache), headaches were developing into migrainous states. In 237 students (56 with mixed headache), headaches were accompanied by dizziness. In 128 females (25 with mixed headache), interrelation between migraine and menstruation was found. Familial factors affecting the occurrence of migraine were noted in 536 students (127 with mixed headache). It was found that 28% of secondary school students aged 15 to 19 years suffer from migraine. Nine percent of them have migraine with aura and 19%, migraine without aura. The prevalence of migraine among secondary school students is about three times higher in females than in males. Migraine with tension‐type headache differs from pure migraine in respect of more numerous attacks within 1 year among females, and of more frequent occurrence of migraine with sensory aura among males.
Intranasal Lidocaine for Migraine: A Randomized Trial and Open‐Label Follow‐up
Authors: Maizels Morris , Geiger Ann M.
Published: March 2003

Objective.—To study the efficacy of intranasal lidocaine for the treatment of migraine when administered by subjects in a nonclinic setting.

Design.—A 1‐month, randomized, controlled, double‐blind trial, followed by a 6‐month open‐label follow‐up.

Setting.—Ambulatory subjects treating themselves outside of a medical setting.

Subjects.—One hundred thirty‐one adult subjects with migraine, diagnosed according to International Headache Society criteria, were enrolled in the study: 113 treated at least one headache in the controlled trial, and 74 treated at least one headache in the open‐label phase. All subjects were members of the Kaiser Permanente Southern California Medical Care Program and were recruited at two urban medical centers.

Intervention.—Intranasal lidocaine 4% or saline placebo 0.5 mL was dropped into the nostril on the side of the headache, or bilaterally for bilateral headache, according to study protocol.

Main Outcome Measures.—Trial: percent of headaches relieved to mild or none at 15 minutes and relapse of headache within 24 hours. Open‐label: percent of headaches relieved to mild or none at 15 and 30 minutes and relapse within 24 hours.

Results.—In the controlled trial, headache was relieved within 15 minutes in 34 (35.8%) of 95 subjects treated with 4% intranasal lidocaine compared with 8 (7.4%) of 108 subjects receiving placebo (P<.001). Headaches relapsed in 7 (20.6%) of 34 subjects treated with 4% intranasal lidocaine compared to 0 of 8 placebo subjects (P=.312). In the open‐label follow‐up, headaches were relieved in 129 (41.2%) of 313 episodes within 15 minutes and in 141 (57.6%) of 245 episodes after 30 minutes. Headaches relapsed in 28 (19.9%) of 140. The response did not diminish over time: 32 (62.8%) of 51 first headaches were relieved at 30 minutes and 10 (71.4%) of 14 seventh headaches were relieved. Relapse occurred in 28 (41.2%) of 129 headaches at a mean time (± SD) of 7.4 (± 6.6) hours.

Conclusion.—Intranasal lidocaine 4% provides rapid relief of migraine symptoms. For those subjects who do respond, the effect does not diminish over 6‐month follow‐up.
Recurrent Headache in Adolescents: Nonreferred Versus Clinic Population
Authors: Smith Mark Scott , Martin‐Herz Susanne Pelley , Womack William M. , McMahon Robert J.
Published: March 2003

Objective.—To compare headache activity, psychosocial measures, and cold pressor response between referred and nonreferred adolescents with frequent headache.

Design.—Thirteen boys and 19 girls with a mean age of 13.4 ± 0.9 years who had been referred to a hospital‐based behavioral treatment program for recurrent headache were compared with an age‐ and sex‐matched school‐based population of nonreferred students consisting of 31 adolescents with frequent headaches and 32 adolescents with infrequent or no headaches. All subjects completed the Spielberger State‐Trait Anxiety Inventory/Trait form, the Children's Depression Inventory, the Childhood Somatization Inventory, and measures of headache activity and related functional disability. Additionally, all subjects reported interval discomfort scores on a 40‐second cold pressor test with arm immersion in a 10°± 1°C cold water bath.

Results.—Subjects from both headache groups reported significantly more anxiety than those with infrequent or no headaches. The school‐based nonreferred adolescents reported more depressive symptoms than the clinic‐based referred subjects. In addition, the latter group reported headaches of longer duration and more school days missed due to headaches than both other groups. Whereas school‐based subjects and those with infrequent or no headaches reported relatively low initial cold pressor test scores and gradually reported increasing scores with time, clinic‐based subjects rated their discomfort as high at the initial interval report and maintained high levels throughout the test. No differences in somatization were found among groups.

Conclusion.—Although adolescents who seek behavioral treatment for recurrent headache do not report more psychological symptoms than nonreferred adolescents with frequent headaches, they report headaches of longer duration, miss more school days due to headache, and report higher initial sustained discomfort scores to a standardized noxious stimulus.
Life Event Stress and Headache Frequency Revisited
Authors: Reynolds David J. , Hovanitz Christine A.
Published: March 2003

Life stress is found to be related to headache frequency in some studies, but not others. Research designs that find a relationship between the two tend to evaluate young subjects and employ large sample sizes. The purpose of this study was to evaluate the relationship between headache frequency and life stress, while considering gender and age differences that may be present in the relationship. In addition, as depression or presence of headache at the time of assessment may influence the report of headache frequency, an attempt to control for these factors was employed.

Several self‐report measures of headache symptomatology, headache presence, depression, and life stress were completed by 1289 subjects. Negative life event stress was found to be modestly but significantly related to headache frequency. The relationship between the 2 variables was stronger for women than for men and, after the influence of depression and headache state was removed, the relationship between life stress and headache frequency remained significant only for women. In the oldest 10% of the sample, there was no evidence of a relationship between negative life event stress and headache frequency.
Validity and Reliability of the Migraine‐Specific Quality of Life Questionnaire (MSQ Version 2.1)
Authors: Martin Bradley C. , Pathak Dev S. , Sharfman Marc I. , Adelman James U. , Taylor Frederick , Kwong W. Jackie , Jhingran Priti
Published: March 2003

Objective.–To assess the scaling properties, reliability, and validity of the revised Migraine‐Specific Quality of Life Questionnaire (MSQ) (Version 2.1)

Background.–The MSQ is a disease‐specific, quality‐of‐life instrument with three hypothesized scales that has been developed, tested, and revised.

Methods.–The study used a multicenter, nondrug, prospective, parallel group, quasi‐experimental design. Patients with migraine were recruited at outpatient headache specialty practices and were administered the MSQ, the Medical Outcomes Study 36‐Item Short Form Health Survey (SF‐36), and migraine symptom questionnaires at baseline, 4 weeks, and 12 weeks. Internal consistency (Cronbach α) and 4‐week test‐retest reproducibility (intraclass correlation coefficients) were estimated to assess reliability. Construct validity was assessed using an adaptation of the Campbell and Fiske multitrait‐multimethod approach and by correlating MSQ scores with symptom measures.

Results.–A total of 267 subjects enrolled in the trial. The criteria for summated rating scales were all met. The internal consistency coefficients ranged from 0.86 to 0.96, and the intraclass correlation coefficients ranged from 0.57 to 0.63 across the three dimensions. As anticipated, the MSQ dimensions had low‐to‐modest correlations with the two component scores of the SF‐36 and were modestly to moderately correlated with migraine symptoms.

Conclusions.–The MSQ is a reliable instrument in the assessment of quality of life for patients with migraine with items that can be summed without weights. The MSQ has demonstrated evidence of construct validity.
Magnetic Resonance Imaging of Intracranial Hypotension Syndrome With Pathophysiological Correlation
Authors: Brightbill T.C. , Goodwin R. Scott , Ford Robert G.
Published: March 2003

Objective.–To correlate the pathophysiology of intracranial hypotension syndrome with abnormalities in the brain and spine found through magnetic resonance imaging.

Methods.–In a series of 11 patients with intracranial hypotension syndrome, brain magnetic resonance scans were evaluated for the thickness, distribution, morphology, and pattern of meningeal enhancement coincident with subdural fluid collections and the descent of the brain toward the skull base. Spinal magnetic resonance studies were reviewed for extra‐arachnoid fluid collections, meningeal enhancement, and distended epidural veins.

Results.–Diffuse, continuous dural‐arachnoid enhancement was present in all patients with abnormal brain studies. The dura was thickest in patients with very low intracranial pressures. Subdural fluid collections and descent of the brain were seen in patients with the thickest meninges and were not present in the absence of meningeal enhancement. Extra‐arachnoid or paraspinal fluid collections were found in all patients who had spinal magnetic resonance scans.

Conclusions.–In the brain, diffuse dural‐arachnoid enhancement is the most common imaging abnormality and is probably the earliest magnetic resonance manifestation of intracranial hypotension syndrome, while subdural fluid collections and descent of the brain are indicators of a more severe hypotensive state. Extra‐arachnoid fluid collections are common spinal imaging abnormalities.
Transient Global Amnesia, Migraine, Thalamic Infarct, Dihydroergotamine, and Sumatriptan
Authors: Pradalier A. , Lutz G. , Vincent D.
Published: March 2003

This case report describes an episode of transient global amnesia that occurred during a migraine attack, which had been treated with vasoconstrictors. Magnetic resonance imaging showed a small lesion with an ischemic appearance in the right thalamus.
Effect of Chronic Analgesic Exposure on the Central Serotonin System: A Possible Mechanism of Analgesic Abuse Headache
Authors: Srikiatkhachorn Anan , Tarasub Naovarut , Govitrapong Piyarat
Published: March 2003

Objective.–To investigate the effects of chronic analgesic exposure on the central serotonin system and the relationship between the serotonin system and the analgesic efficacy of nonnarcotic analgesics.

Methods.–Paracetamol was administered daily to adult male Wistar rats for a period of 15 or 30 days. Analgesic efficacy was measured by the tail flick test. After completion of the treatment protocol, the rats were humanely killed, and the frontal cortex and brain stem were isolated. Characteristics of the specific binding of the 5‐HT2A serotonin receptor and the serotonin transporter were studied using a radioligand binding technique. Platelet serotonin was determined by high‐performance liquid chromatography.

Results.–Chronic paracetamol administration resulted in a significant decrease in the maximum number of 5‐HT2A binding sites and an increase in the maximum number of 5‐HT transporter binding sites in frontal cortical membrane (P<.001). Changes in the central 5‐HT system were associated with a rise in platelet 5‐HT levels. The degree of receptor downregulation, as well as transporter upregulation, became less evident after more prolonged drug administration. Readaptation of serotonin receptors and transporters coincided with the decrease in the analgesic efficacy of paracetamol, as well as a fall in platelet 5‐HT levels.

Conclusions.–These findings provide further evidence in support of an involvement of the 5‐HT system in the antinociceptive activity of simple nonnarcotic analgesics. Plasticity of this neurotransmitter system after chronic analgesic exposure may lead to the loss of analgesic efficacy and, in its more extreme form, may produce analgesic‐related painful conditions, for example, analgesic abuse headache.
Prolonged Recovery From Rebound Headaches
Authors: Warner John S.
Published: March 2003

Objective.—To document that some patients with rebound headache require prolonged complete avoidance of the pain relief medications which might cause the daily or almost daily headaches in order to achieve a goal of 6 consecutive headache‐free days.

Background.—Most articles on rebound headache imply that the patient improves after stopping the offending agents, but they fail to state the pattern of recovery, the time required for recovery, or the specific end point achieved.

Design.—Selected from the histories of approximately 1000 patients with suspected rebound headache who have been seen in a university headache referral clinic are the records of four patients who kept careful headache diaries, followed the treatment protocol (with minimal noncompliance by two patients), and required more than 6 months to achieve our goal of 6 consecutive headache‐free days.

Conclusions.—Hopefully, other physicians treating patients with suspected rebound headache will benefit from this report and will be able to better manage their patients.
Shared Mechanisms and Comorbidities in Neurologic and Psychiatric Disorders
Authors: Silberstein Stephen D.
Published: March 2003

Migraine may be comorbid with several other neurologic and psychiatric conditions, including mood disorders (eg, depression, anxiety, panic disorder), epilepsy, stroke, and essential tremor. Comorbidity presents physicians with opportunities and challenges for both diagnosis and treatment. All diseases must be considered, and therapeutic strategies may need to be modified to avoid potential drug interactions. Comorbidities also may provide clues to the pathophysiologies and any shared mechanisms of the two disorders. Longitudinal studies have demonstrated a bidirectional influence between migraine and major depression, but not between migraine and other severe headache. Migraine is strongly and consistently associated with panic disorder. The risk of migraine in epilepsy is increased particularly in individuals with head trauma, partial seizures, and a positive family history of migraine. The influence is bidirectional. There is also growing evidence of an association between migraine and stroke, particularly among women of childbearing age and individuals who experience migraine with aura. Lastly, a bidirectional association between migraine and essential tremor also exists. These findings suggest that migraine, major depression, epilepsy, and essential tremor share one or more common etiologies. Clinicians should be mindful of them as they design treatment strategies, and also should consider the use of a single pharmacologic agent that is effective for all conditions.
Headache in the Emergency Department
Authors: Morgenstern Lewis B. , Huber John C. , Luna‐Gonzales Hortencia , Saldin Kamaldeen R. , Grotta James C. , Shaw Sandi G. , Knudson Lindsay , Frankowski Ralph F.
Published: March 2003

Objective.—To perform an observational study of the demographics, clinical factors, and therapeutic efficacy in patients presenting to the emergency department with a chief complaint of headache.

Background.—Acute headache presentations to the emergency department are a therapeutic dilemma for physicians.

Methods.—Patients presenting with nontraumatic headache to the emergency department of Hermann Hospital in Houston, Texas, during a 16‐month period were prospectively ascertained by active and passive surveillance. The medical record was abstracted. Demographic and clinical information are presented with descriptive statistics. Relative benefit of individual therapies are compared with odds ratios (95% confidence intervals).

Results.—Of the 38 730 patients who were prospectively screened, 455 presented with a chief complaint of headache. Seventy‐six percent were women, and the mean age was 37 years. Non‐Hispanic whites were more likely diagnosed with migraine compared with Hispanics or African Americans (P<.001). Three percent had subarachnoid hemorrhage. Neurologist follow‐up was ordered in 10%. The median time in the emergency department was 265 minutes. With the initial treatment, 44% resolved, 47% improved, and 9% had no change; none worsened. In comparison with all other therapies used, there was a trend suggesting the superiority of antiemetics (odds ratio, 2.66; 95% confidence interval, 0.81 to 8.61). Acetaminophen was less helpful (odds ratio, 0.27; 95% confidence interval, 0.10 to 0.70). When comparing specific agents to therapies which could be used at home, antiemetics led to headache resolution most often (odds ratio, 3.18; 95% confidence interval, 1.40 to 7.22); ketorolac showed a similar trend (odds ratio, 2.05; 95% confidence interval, 0.86 to 4.89).

Conclusions.—Headache in the emergency department is a phenomena of young women who spend a long time waiting and receive many tests. A variety of therapies are used. Antiemetics may be especially useful for headache resolution.
Precipitating and Aggravating Factors of Migraine Versus Tension‐type Headache
Authors: Spierings Egilius L.H. , Ranke Anniek H. , Honkoop Peter C.
Published: March 2003

Objective.—We conducted the present study to determine whether there are headache precipitating and aggravating factors that differentiate migraine from tension‐type headache and headache precipitating and aggravating factors that differentiate tension‐type headache from migraine.

Methods.—We interviewed 38 patients with migraine and 17 patients with tension‐type headache (diagnosed using International Headache Society criteria) by telephone, using a questionnaire. The questionnaire inquired about the following precipitating and aggravating headache factors: (1) physical activity, (2) straining, (3) bending over, (4) stress/tension, (5) coughing/sneezing, (6) fatigue, (7) reading, (8) driving, (9) lack of sleep, (10) specific foods/drinks, (11) alcohol, (12) not eating on time, (13) smoke, (14) smell, (15) light, (16) noise, (17) menstruation, and (18) weather.

Results.—The most common precipitating factors acknowledged by both groups of patients were stress/tension, not eating on time, fatigue, and lack of sleep. Weather, smell, smoke, and light were the precipitating factors that differentiated migraine from tension‐type headache. Excluding those factors that are part of the International Headache Society migraine diagnosis, the aggravating factors were straining, bending over, and smell. We found no precipitating or aggravating factors differentiating tension‐type headache from migraine.

Conclusion.—Apparently there are precipitating and aggravating factors differentiating migraine from tension‐type headache but not vice versa. It is interesting that three of the migraine‐specific precipitating factors (ie, weather, smell, and smoke) involve the nose/sinus system, suggesting a greater significance of this system in headache than is generally considered.
Development of a Brief 24‐Hour Adolescent Migraine Functioning Questionnaire
Authors: Hartmaier Susan L. , DeMuro‐Mercon Carla , Linder Steven , Winner Paul , Santanello Nancy C.
Published: March 2003

The objective was to develop a brief questionnaire to assess short‐term functioning decrements in adolescents with acute migraine. One hundred twenty‐three potential items were generated by literature review and by interviewing adolescent migraineurs and migraine specialists. To reduce the items, 127 adolescents were asked to identify which items affected their daily functioning in the 24 hours following onset of a migraine, and to rate them on a 5‐point scale from “not very important” to “extremely important.” Reduction to an 18‐item questionnaire was performed by evaluating subject‐perceived importance (number of times an item was chosen times mean importance score) in combination with principal components factor analysis. Five domains were identified: (1) activities, (2) social functioning, (3) cognitive functioning, (4) migraine headache symptoms, and (5) emotional functioning. Questions regarding school loss and school performance during a migraine were added to the final questionnaire as a separate outcome measure. The correlation between the five domains as measured by the Spearman correlation coefficient ranged from 0.17 to 0.49 suggesting some, but minimal, overlap. Cronbach alpha for individual domains ranged from .50 to .84. The questionnaire was pilot‐tested in 12 adolescent migraineurs to determine ease of administration and comprehension and revised to improve clarity.
Extending the Efficacy of a Thermal Biofeedback Treatment Package to the Management of Tension‐type Headaches in Children
Authors: Arndorfer Richard E. , Allen Keith D.
Published: March 2003

This study explored the efficacy of a thermal biofeedback treatment package as an intervention with children with tension‐type headaches. In a within‐subject, time‐lagged, multiple baseline design, five children, aged 8 to 14 years, were assigned to baselines of varying lengths prior to receiving treatment. Treatment was introduced sequentially across subjects and involved six thermal biofeedback treatment visits. Parents were also given guidelines for how best to encourage children to independently use the biofeedback skills. Data confirm that the participants learned the handwarming skill, practiced the skill on a regular basis during treatment, and independently used the skills to manage their pain. All participants demonstrated clinically significant reductions in one or more headache parameters (frequency, duration, intensity) following treatment. At 6‐month follow‐up, four of the five participants were headache‐free. Although the thermal biofeedback treatment package was generally effective for these children with tension‐type headaches, the specific type of headache experienced by each child appeared to influence the specific response to treatment. In addition, no single measure of headache activity was the best indicator of response to treatment. The efficacy of the thermal biofeedback treatment package is supported as an alternative treatment for children suffering from tension‐type headaches.
Hypertensive Encephalopathy Presenting With Thunderclap Headache
Authors: Tang‐Wai David F. , Phan Thanh G. , Wijdicks Eelco F. M.
Published: March 2003

A 68‐year‐old woman presented with thunderclap headache, which led to a search for subarachnoid hemorrhage. Both computerized tomography of the head and cerebrospinal fluid examination were normal. Magnetic resonance imaging revealed abnormalities in the white matter in the parieto‐occipital regions. There was no aneurysm on magnetic resonance angiography. Treatment of hypertension led to resolution of the posterior leukoencephalopathy. Hypertensive encephalopathy with reversible posterior leukoencephalopathy can present as a thunderclap headache.
Prevalence of Migraine in Patients With Systemic Lupus Erythematosus
Authors: Glanz Bonnie I. , Venkatesan Aradhana , Schur Peter H. , Lew Robert A. , Khoshbin Shahram
Published: March 2003

Objective.—To determine the prevalence of migraine in patients with systemic lupus erythematosus (SLE), and to examine the relationships between headache type and other clinical, serologic, and treatment features of the disease.

Background.—Headaches are common in SLE and are a significant source of patient disability. The exact prevalence of headaches in patients with SLE is unknown. The classification of headache syndromes in SLE is also unclear. Previous studies were based on small numbers of patients and the headache types and criteria to define headache types varied widely.

Methods.—Four hundred fourteen patients meeting American College of Rheumatology criteria for the diagnosis of SLE were sent the University of California, San Diego Migraine Questionnaire. Patients who completed the questionnaire had their medical records reviewed for constitutional, respiratory, cardiac, vascular, skin, musculoskeletal, other neuropsychiatric, hematologic, renal, and immunologic manifestations of the disease. Recent corticosteroid, nonsteroidal anti‐inflammatory drug, antimalarial, and immunosuppressive medications were also recorded.

Results.—One hundred eighty‐six patients completed the questionnaire. Sixty‐two percent of patients reported headaches: 39% met diagnostic criteria for migraine and 23% met criteria for nonmigrainous headache. Of the patients with migraine, 56% met criteria for migraine without aura and 44% met criteria for migraine with aura. There were no significant associations between headache type and other clinical, serologic, or treatment features of the disease.

Conclusions.—There is a high prevalence of migraine in patients with SLE, and patients should be routinely evaluated for migraine symptoms.
A History of Migraine Is Not A Risk Factor to Develop an Ischemic Stroke in the Elderly
Authors: Mosek Amnon , Marom Ronella , Korczyn Amos D. , Bornstein Natan
Published: March 2003

Objective.—To assess the prevalence of migraine in elderly patients hospitalized with ischemic stroke compared with vascular and nonvascular control groups.

Background.—Migraine is a disease with a presumed vascular mechanism. While migraine is a common complaint of young victims of ischemic stroke, it is unclear whether a current or past history of migraine constitutes a risk factor for developing an ischemic stroke in the elderly.

Methods.—We obtained current and past headache history from 100 consecutive patients hospitalized with ischemic stroke (aged 60 years or older) and compared the results with 100 patients hospitalized due to acute myocardial infarction and 100 hospitalized patients with no vascular disease.

Results.—The sex and the age of the patients did not differ among the groups. The lifetime prevalence of migraine (8% of the patients with ischemic stroke, 8% of the nonvascular controls, and 15% of the patients with acute myocardial infarction) or of all types of headaches (27%, 30%, and 15%, respectively), did not differ significantly between the groups.

Conclusions.—Based on the reported history, elderly migraineurs are not at increased risk to develop ischemic stroke.
Occipital Condyle Syndrome
Authors: Capobianco David J. , Brazis Paul W. , Rubino Frank A. , Dalton Jon N.
Published: March 2003

Objective.—Review the clinical features of occipital condyle syndrome.

Background.—Occipital condyle syndrome consists of unilateral occipital region pain associated with ipsilateral 12th cranial nerve paresis. It is typically due to metastasis to the skull base and is underdiagnosed.

Design.—We report a retrospective case series of 11 patients (8 men, 3 women), aged 32 to 72 years.

Results.—Eleven cases of occipital condyle syndrome were identified. All patients complained of severe occipital region pain. In addition, 2 patients complained of ipsilateral ear or mastoid pain, 2 noted associated vertex pain, and 2 had frontal region pain. Six of the 11 cases involved the right side. In all patients, the occipital pain was ipsilateral to the 12th nerve paresis. All patients were mildly dysarthric, and 3 had dysphagia. In 7 of the 11 patients, occipital region pain preceded the hypoglossal paresis by several days to 10 weeks. On examination, tenderness to palpation of the occipital region was noted in all patients. All 11 patients had unilateral hypoglossal paresis. Skull films were abnormal in 2 of 5 patients for whom they were obtained, and tomograms were abnormal in 1 of 2 patients. High‐quality computed tomography, bone scanning, and magnetic resonance imaging were abnormal in all cases in which they were performed. Nine patients had a known primary malignancy. The most common malignancies were breast cancer in women (2 of 3) and prostate cancer in men (4 of 8). In 2 patients, occipital condyle syndrome was the initial manifestation of a metastatic lesion. Radiation therapy was the treatment of choice for the occipital region pain.

Conclusion.—Occipital condyle syndrome is a rare, but stereotypic syndrome. Early detection has important therapeutic implications. Evaluation of the craniovertebral junction with special attention to the occipital condyles should be a routine part of all brain and cervical spine radiologic examinations, and the possibility of occipital condyle syndrome, particularly when patients have persistent occipital pain and a history of cancer, should be considered.
Potential Validity of Conducting Research on Headache in Internet Populations
Authors: Lenert Leslie A. , Looman Theodora , Agoncillo Teodora , Nguyen Mihn , Sturley Ann , Jackson Christy M.
Published: March 2003

Objective.—While it is technically feasible to conduct migraine research on the Internet, can one be sure that the subjects who participate actually have the disorder? We examined this issue in 109 sequential subjects in an Internet study of migraineurs' symptoms.

Background.—The increasing use of the Internet by the US population provides an opportunity for using this medium in clinical research, but, to be useful, the results of such research must be valid and generalizable.

Methods.—Using postings to Internet newsgroups of migraineurs, we recruited subjects to a migraine research site. We examined reported symptoms by comparing them with the International Headache Society's criteria for diagnosis of migraine and by subjective review by a neurologist. We also attempted to contact the subject's primary care physicians to confirm their diagnosis.

Results.—We found considerable evidence for the validity of the participants' self‐reported diagnoses. Most subjects with professed migraine reported quality of pain (97%) and associated symptoms (92%) consistent with that diagnosis, and review of their symptoms and questionnaire responses by the neurologist suggested that almost all subjects (97%) had migraine. Personal physicians confirmed a diagnosis of migraine in 90% of con‐ senting subjects (n=49).

Conclusions.—The validity of self‐reported diagnosis of migraine does not appear to be an obstacle to conducting research in subject populations on the Internet.
Children's Ibuprofen Suspension for the Acute Treatment of Pediatric Migraine
Authors: Lewis Donald W. , Kellstein David , Dahl Georg , Burke Bonnie , Frank L. M. , Toor S. , Northam R. S. , White L. W. , Lawson L.
Published: March 2003

Objective.—To compare the efficacy of a single over‐the‐counter dose (7.5 mg/kg, p.o.) of children's ibuprofen suspension vs. placebo for the acute treatment of pediatric migraine.

Background.—Migraine occurs in 4% of young children. There is a paucity of controlled clinical research in the treatment of childhood migraine and there are currently no approved drugs in the USA for treatment of migraine in children 12 years of age. The purpose of this study is to assess the efficacy and tolerability of a single OTC dose of ibuprofen suspension for the acute treatment of childhood migraine.

Methods.—Prospective, double‐blind, placebo‐controlled, parallel group, randomized study of children 6‐12 yrs with migraine (I.H.S.‐R1997) treating 1 attack with a 7.5 mg/kg liq. ibuprofen vs matching placebo. Efficacy measures: (1) Headache severity based upon a 4 pt scale (severe, mod., mild, no headache) at 30, 60, 90, 120, 180 and 240 minutes post dose, and (2) nausea, vomiting, and photo/phonophobia at 120 min. The 1° endpoint was cumulative % of responders (severe or mod. headache reduced to mild or none) by 120 minutes. Secondary endpoints were headache recurrence within 4‐24 hours and need for rescue medicines within 4 hours.

Results.—138 enrolled; 84 treated/completed diary. 45 active agent, 39 placebo. The 2 groups were comparable (active: placebo) ‐ Ages: 9: 9.1, gender boy/girl ‐ 1.25: 1.6, and diagnosis: migraine w/o aura ‐ 86%: 79%. Concomitant use of prophylactic Rx: 24%: 10% (Table 3).

Endpoint
Ibuprofen (N=45)
Placebo (N=39)
P‐value

Cum. % responders, 2 hr (1° endpoint)
76%
53%
0.006

2 pt. improvement in severity, 2 hr
27 (62%)
11 (28%)
0.004

Median pain score at 2 hr
2
3
<0.02

Headache recurrence (within 4‐24 hr)
8 (18%)
14 (36%)
0.06

Need for rescue medication
1 (2%)
15 (38%)
<0.001

Nausea was eliminated in 60% of the ibuprofen treated patients and 39% of the placebo group (p<0.001). Vomiting, photophobia and phonophobia had marginal, but not statistically significant, decreases at 2 hours. A striking gender difference was noted (Table 4):

Endpoint
Ibuprofen
Placebo
P‐value

Cum. % responders
76%
53%
0.006

BOYS
84%
43.4
<0.0006

GIRLS
65%
66.7
0.8

Headache recurrence
5
13
<0.005

BOYS
0
8
<0.001

GIRLS
5
5
NS

No AE's were reported.

Conclusion.—Children's ibuprofen suspension at an OTC dose of 7.5 mg/kg is an effective and well‐tolerated agent for pain relief in the acute treatment of childhood migraine, particularly in boys. There is a striking difference in gender response rates and placebo responder rates between girls and boys. The boys responded at a statistically significant rate, and girls failed to do so because of a very high placebo responder rate. Multi‐center trials are recommended.
Further Evaluation of Rizatriptan in Menstrual Migraine: Retrospective Analysis of Long‐term Data
Authors: Silberstein Stephen D. , Massiou Helene , McCarroll Kathleen A. , Lines Christopher R.
Published: March 2003

Objective.—To determine the long‐term efficacy of oral rizatriptan 10‐mg wafers in the treatment of menstrual migraine attacks.

Methods.—Data from an extension study where patients with migraine used rizatriptan 10 mg to treat moderate or severe migraine attacks occurring over periods of up to 6 months were included in a retrospective analysis. Patients used a diary card to record details of each migraine attack and onset of menstruation. Attacks in women were classified as menstrual or nonmenstrual according to 3 time windows relative to onset of menstruation (day 0): −3 to +3 days (7‐day window), −2 to + 2 days (5‐day window), and 0 to +1 days (2‐day window). The analysis looked at the efficacy of rizatriptan 10 mg by menstrual category of attack for each definition on three measures: pain relief at 2 hours (reduction of pain to mild or none), pain free at 2 hours, 24‐hours sustained pain free (pain free at 2 hours with no headache recurrence and no use of additional medications from 2 to 24 hours).

Results.—Ninety‐five women used rizatriptan 10 mg to treat a total of 1,839 attacks. The percentage of menstrual attacks was 30% for the –3 to +3 days definition, 23% for the −2 to +2 days definition, and 11% for the 0 to +1 days definition. Rizatriptan 10 mg was equally effective in menstrual and nonmenstrual migraine attacks regardless of the definition used. For example, using the −3 to +3 days definition, 78% of menstrual migraine attacks were relieved at 2 hours after dosing compared with 78% of nonmenstrual attacks. Pain relief rates for the other definitions were as follows: −2 to +2 days, menstrual  =  78%, nonmenstrual  =  78%; 0 to +1 days, menstrual  =  79%, and nonmenstrual  =  78%. No differences between menstrual and nonmenstrual attacks were found for the 2‐hour pain free and 24‐hour sustained pain free measures for any of the three definitions.

Conclusion.—Rizatriptan 10‐mg wafers were equally effective in the treatment of menstrual and nonmenstrual migraine attacks occurring over 6 months, regardless of the precise definition of menstrual association used and even when the outcome criteria were very stringent. These data provide further evidence that triptans are effective treatments for menstrual migraine.
Ergotamine and Dihydroergotamine: History, Pharmacology, and Efficacy
Authors: Silberstein Stephen D. , McCrory Douglas C.
Published: March 2003

Ergotamine and dihydroergotamine share structural similarities with the adrenergic, dopaminergic, and serotonergic neurotransmitters. As a result, they have wide‐ranging effects on the physiologic processes that they mediate. Ergotamine and dihydroergotamine are highly potent at the 5‐HT1B and 5‐HT1D antimigraine receptors and, as a consequence, the plasma concentrations that are necessary to produce the appropriate therapeutic and physiologic effects are very low. The broad spectrum of activity at other monoamine receptors is responsible for their side effect profile (dysphoria, nausea, emesis, unnecessary vascular effects). Both ergotamine and dihydroergotamine have sustained vasoconstrictor actions. In acute migraine treatment, their mechanisms of action involve constricting the pain‐producing intracranial extracerebral blood vessels at the 5‐HT1B receptors and inhibiting the trigeminal neurotransmission at the peripheral and central 5‐HT1D receptors. The scientific evidence for efficacy is stronger for dihydroergotamine than for ergotamine. Their wide use is based on long‐term experience.
Temporal Epileptogenesis: Localizing Value of Scalp and Subdural Interictal and Ictal EEG Data
Authors: Blume Warren T. , Holloway Giannina M. , Wiebe Samuel
Published: March 2003

Summary:  Purpose: To determine the value of scalp epileptiform EEG data and subdural interictal spikes in localizing temporal epileptogenesis among patients requiring invasive recordings. For this delineation, we related such factors to site of subdural seizure origin in 27 consecutive patients.

Methods: Patients with temporal lobe epilepsy whose noninvasive lateralizing data were inconclusive and therefore required subdural electroencephalography were studied. All patients had (a) 24‐h scalp telemetered EEGs, (b) adequate bitemporal subdural placements with an inferomesial line extending from a posterior burr hole anteriorly to <2.5 cm from anterior uncus and a lateral line reaching within 2.5 cm of the temporal tip, and (c) ≥2 subdurally recorded seizures.

Results: Three hundred one (96%) of 314 subdurally recorded clinical seizures involving all 27 patients arose from a discrete focus; 266 (85%) arose from mesial temporal regions, which was the origin of the majority of seizures in 24 (89%) patients. The majority of subdural seizures arose ipsilateral to the majority of scalp EEG spikes in 22 (81%) of 27, and most subdural seizures of 15 (75%) of 20 arose ipsilateral to scalp seizures. Lateralization of interictal subdural spikes correlated with that of subdural seizures in 74–92% of patients, depending on the method of spike compilation; for example, most subdural seizures arose from the same lobe of most consistent principal temporal spikes in 92% of patients. These indices of epileptogenesis also appeared more commonly on the side of effective (≥90% improvement) temporal lobectomy than contralaterally in the following proportions: most consistent principal subdural spikes, 86% of patients ipsilateral vs. 9% contralateral; scalp‐recorded clinical seizures, 55% vs. 18%; scalp EEG spikes, 45% vs. 9%.

Conclusions: Even among patients whose scalp data are sufficiently complex to require invasive recording for clarification, lateralization of temporal scalp interictal and ictal epileptiform activity and subdural interictal spikes should be included when assessing the side of temporal epileptogenesis.
Lamotrigine Therapy of Epilepsy in Tuberous Sclerosis
Authors: Franz David Neal , Tudor Cynthia , Leonard Jennifer , Egelhoff John C. , Byars Anna , Valerius Kristin , Sethuraman Gopalan
Published: March 2003

Summary:  Purpose: Lamotrigine (LTG), a newer antiepileptic drug (AED), has activity against both partial‐onset and generalized seizures. Its reported benefits for behavior, and its effectiveness in Lennox–Gastaut syndrome and other forms of refractory epilepsy, make it a logical choice for treatment of epilepsy in tuberous sclerosis complex (TSC). We present our experience with LTG therapy of epilepsy in 57 patients with TSC.

Methods: Patients fulfilled the diagnostic criteria for clinically definite TSC. LTG was initiated and increased until improvement in seizure frequency was noted, intolerable side effects occurred, or maximal doses were reached. Seizure frequency and behavioral changes were recorded during LTG therapy and compared with those prior to the introduction of LTG.

Results: Twenty‐four (42%) were seizure free, and 21 (37%) had a >50% reduction in seizure frequency. Eighteen (32%) had subjectively improved behavior and/or alertness with daily activities. Thirty‐eight (67%) had no change in this regard, whereas one (2%) became worse. Responders were more likely to not have a history of infantile spasms, and to have experienced only partial seizures (p < 0.05). Otherwise no phenotypic correlations with response were apparent.

Conclusions: Among patients with TSC and epilepsy, LTG was effective and well tolerated, including as initial monotherapy. Improved alertness and behavior were apparent in many patients. The incidence of side effects is similar to that reported for other pediatric populations with symptomatic partial epilepsy. The usefulness of LTG in TSC may relate to an underlying defect of glutamatergic neurotransmission in partial epilepsy.