bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement of cerebral oxygenation state in anaesthetized children using the INVOS 5100 cerebral oximeter
Authors: Dullenkopf Alexander , Frey Bernhard , Baenziger Oskar , Gerber Andreas , Weiss Markus
Published: June 2003

Background: Near‐infrared spectroscopy is a developing technique for monitoring cerebral oxygenation during anaesthesia. The aim of this study was to evaluate absolute values of cerebral oxygenation during stable anaesthesia conditions in otherwise healthy children using the recently introduced INVOS 5100 cerebral oximeter with a paediatric and adult sensor and to compare them with values obtained from the NIRO 300 oximeter.

Methods: Thirty paediatric surgical patients (aged 0.23–15.97 years) were studied during general anaesthesia with tracheal intubation and controlled ventilation. Comparative measurements of cerebral oxygenation were performed on the forehead with two probes within 10 min under stable cardiorespiratory and anaesthesia conditions. Cerebral oxygenation values (rSO2) obtained from the paediatric and adult INVOS 5100 sensors were compared with the tissue oxygenation index (TOI) obtained from the NIRO 300 cerebral oximeter using 4‐ and 5‐cm emitter‐detector separation.

Results: Cerebral rSO2 values and the TOI values both showed a large range of cerebral oxygenation in the children studied (rSO2: 59–95%, TOI: 48–85%). Cerebral rSO2 values measured by the INVOS 5100, particularly with the paediatric sensor, were significantly higher than the TOI values obtained from the NIRO 300 (P < 0.0001). Agreement between the INVOS and NIRO oximeter was poor.

Conclusion: The large range and the poor agreement of cerebral oxygenation values between the two oximeters makes it difficult to define a normal value. Cerebral oxygenation readings by these monitors, based on one single point measurement during anaesthesia, should be viewed with caution. Actually, there may be little indication for routine use of such monitoring during general anaesthesia.
Morphogenesis and growth of the soft tissue and cartilage of the vomeronasal organ in pigs
Authors: Salazar Ignacio , Lombardero Matilde , Cifuentes José M. , Quinteiro Pablo Sánchez , Alemañ Nuria
Published: June 2003

The morphology of the soft tissue and supporting cartilage of the vomeronasal organ of the fetal pig was studied from early stages to term. Specimens obtained from an abattoir were aged by crown‐to‐rump distance. Series of transverse sections show that some time before birth all structures – cartilage, connective tissue, blood vessels, nerves, glands and epithelia – are well developed and very similar in appearance to those of the adult. Furthermore, in transmission electron microscopy photomicrographs obtained at this stage the vomeronasal glands exhibit secretory activity.
Physical indicators of cartilage health: the relevance of compliance, thickness, swelling and fibrillar texture
Authors: Broom Neil D. , Flachsmann René
Published: June 2003

This study uses a bovine patella model to compare the relative merits of on‐bone compliance and thickness measurements, free‐swelling behaviour, and structural imaging with differential interference contrast (DIC) light microscopy to assess the biomechanical normality of the cartilage matrix. The results demonstrate that across a spectrum of cartilage tissues from immature, mature, through to mildly degenerate, and all with intact articular surfaces, there is a consistent pattern of increased free swelling of the isolated general matrix with age and degeneration. High swelling was always associated with major structural alterations of the general matrix that were readily imaged using DIC light microscopy. Conversely, for all tissue groups, no relationship was observed between thickness vs. compliance and compliance vs. general matrix swelling. Only in the proximal aspects of the normal mature and degenerate tissues was there a correlation between thickness and general matrix swelling. Free‐swelling measurements combined with fibrillar texture imaging using DIC light microscopy are therefore recommended as providing a reliable and quick method of assessing the biomechanical condition of the cartilage general matrix.
The distribution of Notch receptors and their ligands during articular cartilage development
Authors: Hayes A. J. , Dowthwaite G. P. , Webster S. V. , Archer C. W.
Published: June 2003

We examined the distribution of Notch family members and their ligands during the development of articular cartilage and the growth plate. Notch 1 was expressed by the chondrocytes of the developing articular surface but became increasingly restricted to the deeper layers after birth whilst expression of this family member was restricted to hypertrophic chondrocytes in the growth plate. Notch 2 and 4, Delta and Jagged 2 showed a broadly similar distribution, being present throughout the articular cartilage during development and becoming increasingly restricted to deeper layers with age. Hypertrophic chondrocytes within the growth plate also expressed Notch 2 and 4, Delta and Jagged 2 (which was also expressed in prehypertrophs). Notch 3 and Jagged 1 were absent from developing articular cartilage but were present in deeper layers at later time points (> 1 month) and both receptor and ligand were expressed in hypertrophic chondrocytes at all ages examined. These results highlight the complex Notch signalling interactions that result in the formation of the heterogeneous articular cartilage and allow for the co‐ordinated ossification and elongation of the growth plate. Mechanisms by which these processes are controlled are discussed in light of recent advances in the understanding of Notch signalling pathways.
A topographical study of mechanical and electrical properties of single myocytes isolated from normal guinea‐pig ventricular muscle
Authors: Wan X. , Bryant S. M. , Hart G.
Published: June 2003

Major regional differences in the electrical properties of myocytes from ventricular muscle have been described previously, on the basis of samples taken from a maximum of three regions in each heart. In order to define the topographical basis for such differences, we studied the electrical and mechanical properties of single myocytes isolated from 20 regions throughout the ventricles in the normal guinea‐pig heart. Single myocytes were isolated using an enzymatic dispersion method, and were studied under conditions that were close to physiological. Cell capacitance and action potentials were recorded using the switch‐clamp technique, and cell length and evoked shortening were measured using a photodiode array system. In the left ventricular free wall, mid‐myocardial cells were longer and had greater capacitative surface area than surface myocytes. There were transmural but not longitudinal differences in APD90 (action potential duration to 90% repolarization), with the longest APD90 in subendocardial and the shortest in subepicardial myocytes. We found a septum – left ventricular free wall – right ventricular free wall gradient, with the longest APD90 in the septum and the shortest in the right ventricular free wall. The regional distribution of APD90 was closely mirrored by relaxation time. Peak cell shortening was greater in subendocardial myocytes than in subepicardial myocytes in the left ventricular free wall, and in myocytes from the left side of the septum compared with the right. We concluded that the regional distribution of APD is closely and inversely related to the sequence of ventricular depolarization, and that the regional variations in cell shortening amplitude are related principally to reported regional variations in wall stress.
The cellular structure and lipid/protein composition of adipose tissue surrounding chronically stimulated lymph nodes in rats
Authors: Mattacks Christine A. , Sadler Dawn , Pond Caroline M.
Published: June 2003

To test the hypothesis that chronic immune stimulation of a peripheral lymph node induces the formation of additional mature adipocytes in adjacent adipose tissue, one popliteal lymph node of large male rats was stimulated by local injection of 10 µg or 20 µg lipopolysaccharide three times a week for 6 weeks. Adipocyte volumes in sites defined by their anatomical relations to the stimulated and homologous unstimulated popliteal lymph nodes were measured, plus adipocyte complement of the popliteal depot, and the lipid and protein content of adipocytes and adipose stroma. The higher dose of lipopolysaccharide doubled the mass of the locally stimulated lymph node and the surrounding adipose tissue enlarged by the appearance of additional mature adipocytes. Similar but smaller changes were observed in the popliteal adipose depot of the unstimulated leg and in a nodeless depot. The lipid content of the adipocytes decreased and that of the stroma increased dose‐dependently in all samples measured but the changes were consistently greater in the depot surrounding the stimulated lymph node. The protein content of both adipocytes and stroma increased in samples surrounding the stimulated node. We conclude that chronic immune stimulation of lymphoid tissues induces the formation of more adipocytes in the adjacent adipose tissue. These findings suggest a mechanism for the selective hypertrophy of lymphoid‐containing adipose depots in the HIV‐associated adipose redistribution syndrome.
Polyploid cells in the mouse ovary
Authors: Keighren Margaret A. , Macfadyen Leah P. , Hill Alan S. , Patek Charles E. , Telfer Evelyn E. , West John D.
Published: June 2003

Cell ploidy in the ovarian follicle and corpus luteum was investigated by DNA in situ hybridization to a reiterated, chromosome 3 transgene in mice that were hemizygous for the transgene. This approach was first validated by analysis of mouse kidney, pancreas and liver control tissues, which contain different frequencies of polyploid nuclei. Polyploid nuclei (with multiple hybridization signals) were seen in histological sections of both ovarian follicles and corpora lutea. The frequency of polyploid nuclei in follicles showed no consistent relationship with age (between 6 weeks and 10 months) but polyploid nuclei were significantly more abundant in corpora lutea than follicles (6.3% vs. 2.5%). This implies that production of polyploid cells is more closely associated with differentiation of ovarian follicles into corpora lutea than with the age of the female. Polyploidy tended to be more frequent in corpora lutea of mice that had mated even if they did not become pregnant. This study has highlighted the presence of polyploid cells in the mouse ovarian follicle and corpus luteum and has identified mating as a possible trigger for polyploidy in the corpus luteum. Further work is required to determine the physiological role of polyploid ovarian cells in reproduction.
Immunohistochemistry of the canine vomeronasal organ
Authors: Dennis J. C. , Allgier J. G. , Desouza L. S. , Eward W. C. , Morrison E. E.
Published: June 2003

The canine's olfactory acuity is legendary, but neither its main olfactory system nor its vomeronasal system has been described in much detail. We used immunohistochemistry on paraffin‐embedded sections of male and female adult dog vomeronasal organ (VNO) to characterize the expression of proteins known to be expressed in the VNO of several other mammals. Basal cell bodies were more apparent in each section than in rodent VNO and expressed immunoreactivity to anticytokeratin and antiepidermal growth factor receptor antibodies. The thin layer of neurone cell bodies in the sensory epithelium and axon fascicles in the lamina propria expressed immunoreactivity to neurone cell adhesion molecule, neurone‐specific beta tubulin and protein gene product 9.5. Some neurones expressed growth‐associated protein 43 (GAP43): and a number of those also expressed neurone‐specific beta tubulin‐immunoreactivity. Some axon fascicles were double labelled for those two proteins. The G‐protein alpha subunits Gi and Go, involved in the signal transduction pathway, showed immunoreactivity in the sensory cell layer. Our results demonstrate that the canine vomeronasal organ contains a population of cells that expresses several neuronal markers. Furthermore, GAP43 immunoreactivity suggests that the sensory epithelium is neurogenic in adult dogs.
Immunohistochemical localization of carbonic anhydrase isozymes in the rat carotid body
Authors: Yamamoto Yoshio , Fujimura Minako , Nishita Toshiho , Nishijima Kazutoshi , Atoji Yasuro , Suzuki Yoshitaka
Published: June 2003

The rat carotid body was immunohistochemically stained for carbonic anhydrase I, II and III (CA‐I, CA‐II and CA‐III). Immunoreactivity for CA‐I was distributed in type I cells, type II cells and nerve bundles. Smooth muscle cells and endothelial cells of blood vessels were also strongly stained for CA‐I. CA‐II immunoreactivity was distinctly positive in type I cells and nerve bundles. Vascular smooth muscle cells were weakly positive, and type II cells were negative for CA‐II. CA‐III immunoreactivity was identified in type I cells and vascular smooth muscle cells. Our results suggest that carbonic anhydrase isozymes in type I cells play an important role in chemoreception for hypercapnia. Immunoreactivities for CA‐I and CA‐II in the nerve fibres may participate in the synergic action of carotid sinus nerve between hypoxic and hypercapnic stimuli.
Medical Consultation for Migraine: Results From the American Migraine Study
Authors: Lipton Richard B. , Stewart Walter F. , Simon David
Published: June 2003

Background.—Migraine headaches are often disabling but usually responsive to treatment. Nonetheless, many people with migraine never consult a doctor for headaches. In a sample of the US population, we sought to determine the proportion of active migaineurs who ever consulted a doctor for headache and to identify the headache characteristics and sociodemographic factors associated with consulting.

Method.—A mailed questionnaire survey was sent to 15 000 US households, selected from a panel to be representative of the US population. Of 20 468 eligible respondents ranging in age from 12 to 80 years, 2479 met a case definition for migraine. We mailed a second questionnaire to all migraineurs identified on the first survey and achieved a 69.4% response rate. The second survey assessed headache characteristics, patterns of medical care use, medication use, and method of payment for health care.

Results.—Sixty‐eight percent of female and 57% of male migraineurs reported having ever consulted a doctor for headache. Consultation was more likely with increasing age and in women who ever married. In females, several headache characteristics including pain intensity, number of migraine symptoms, attack duration, and disability were associated with consultation. Of those who never consult, 61% report severe or very severe pain and 67% report severe disability or the need for bed rest with their headaches.

Conclusion.—The results of this survey indicate that a significant proportion of migraine sufferers never consult doctors for their headaches. Given that a large proportion of persons who never consult report high levels of pain and disability, these data suggest that there are opportunities to appropriately increase health care utilization for migraine. Given that 40% of migraineurs who have ever consulted do not report a physician diagnosis of migraine, there is a need to improve headache diagnosis and/or doctor‐patient communication about migraine.
Headache and Analgesic Use in Sweden
Authors: Antonov Karolina , Isacson Dag
Published: June 2003

In this study, patterns of analgesic use among persons with headache in the general Swedish population were analyzed in association with health factors, health care utilization, sociodemographic factors, and life‐style.

Data from the Swedish Survey of Living Conditions for the 2‐year period 1988 through 1989 were used. In this survey, a probability sample of the Swedish population aged 16 years and older was interviewed. Persons with headache were identified by the question, “Have you (during the last 2 weeks) had recurrent headache or migraine?” Analgesic use was defined by the question, “Have you (during the last 2 weeks) used prescription or nonprescription analgesics?” Persons who answered both these questions were included in the present study, yielding a study population of 11 975 persons.

Sixteen percent of all women and 8.2 percent of all men reported headache. Seventy‐four percent of all women with headache reported analgesic use as compared to 64% of all men with headache. Analgesic use increased with increasing age among women but not men. While few of the studied factors were associated with analgesic use among persons with headache, the associations found differed by gender. Poor social network and musculoskeletal pain were associated with analgesic use among men with headache; age, being underweight, and visits to a physiotherapist were associated with analgesic use among women with headache.

Those studying medication use among persons with headache might consider including these factors in future studies to help better understand the mechanisms behind the decision to use or avoid analgesics.
Acute Treatment of Periodic Severe Headache: Comparison of Three Outpatient Care Facilities
Authors: Linbo L. , Bartleson J.D. , Morgan‐Thompson D. , Greff L. , Naessens J.M.
Published: June 2003

We compared treatment of patients with episodic, severe, migraine‐vascular headaches in three outpatient settings associated with a major medical center: the Charlton Outpatient Therapy Center (COTC), a dedicated transfusion and injection facility which provides treatment based on physician orders written in advance of the patient's visit; a walk‐in Urgent Care Center (UCC); and a traditional hospital emergency trauma unit (ETU).

For a 7‐month period in 1995, all patient visits for acute migraine headache to the COTC, UCC, and ETU were reviewed. Data collected included the treatment and charges. After the study period, a sample of patients was surveyed regarding their outcome and satisfaction with care at each of the three facilities.

During the study period, 15 patients visited the COTC 446 times for the treatment of acute migraine, 80 patients visited the UCC 233 times, and 182 patients visited the ETU 238 times. The average charges per visit were $39.93 for the COTC, $57.28 for the UCC, and $317.71 for the ETU. Average time spent in order to obtain care was 35 minutes in the COTC, 62 minutes in the UCC, and 105 minutes in the ETU. Intramuscular meperidine with either promethazine or hydroxyzine was the most commonly administered treatment in all three settings. Patients treated in the COTC reported greater satisfaction than the patients seen in the UCC or ETU.

A dedicated outpatient facility with extended hours of operation and the capability of treating acute headache patients with parenteral medications based on standing orders has provided a community of migraine sufferers with cost‐effective care.
Hyperbaric Oxygen in the Treatment of Migraine With Aura
Authors: Wilson Judy R. , Foresman Brian H. , Gamber Russell G. , Wright Timothy
Published: June 2003

Cephalalgia is one of the most common medical complaints and the search continues for relief. Early treatments for migraine included inhalation of 100% oxygen. It has been theorized that the increased levels of oxygen in the blood act as an alpha‐adrenergic agent to alleviate headache pain through vasoconstriction and local metabolic effects. The presence of muscle tenderness during some migraine headaches has also been established. The purpose of this study was to document relief of cephalalgia through use of a visual analog pain scale, algometry, and manual palpation. Female subjects with confirmed migraine were randomly assigned to begin with either the control (100% oxygen, no pressure) or hyperbaric treatment (100% oxygen, pressure). Manual palpation and algometry of 10 sites were done, bilaterally, by a trained specialist. Pain was evaluated with a visual analog scale. Resolution of tenderness and edema following both treatments was observable by manual palpation while algometry showed no differences between the two. Subjective pain was significantly decreased following hyperbaric oxygen treatment but not following the control treatment. Results suggest that hyperbaric oxygen treatment reduces migraine headache pain and that the patient's subjective assessment was the best indicator of relief.
Stress, Headache, and Physiological Disregulation: A Time‐Series Analysis of Stress in the Laboratory
Authors: Davis Paul A. , Holm Jeffrey E. , Myers Tricia C. , Suda Kim T.
Published: June 2003

This study examined the stress‐headache relationship from a disregulation framework by monitoring both physiological responses (eg, pulse, blood volume, skin resistance, and EMG) and self‐reported responses to a stressful event in tension and migraine headache sufferers, as well as in headache‐free controls. Responses were analyzed via time‐series analyses to determine whether self‐reports of stress were correlated with physiological measures of stress. It was hypothesized that tension and migraine headache sufferers would show fewer significant correlations than control participants between their self‐reports of stress and physiological activity. Data analyses supported this hypothesis for tension headache sufferers, but generally not for migraine headache sufferers. The most compelling support for the hypothesis in tension headache sufferers came from the cross‐correlations between self‐reported stress and pulse rate.
Trigeminal Neuralgic‐Type Pain and Vascular‐Type Headache Due to Gustatory Stimulus
Authors: Helcer Monica , Schnarch Ariel , Benoliel Rafael , Sharav Yair
Published: June 2003

We present a case of facial pain associated with sweet stimulus. An immediate, electriclike, short, unilateral pain was evoked by strong sweet gustatory stimulation. This was followed 6 to 8 hours later by a bilateral severe headache associated with bilateral tearing, rhinorrhea, periorbital swelling, flushing, and photophobia that lasted up to 2 days. The immediate pain that was experimentally induced with 2.5 grams of sucrose placed on the tongue could be abolished with carbamazepine. However, carbamazepine did not prevent the headache complex that appeared 6 to 8 hours later. Conversely, a trial with indomethacin abolished the late‐onset headache, but not the immediate neuralgic‐type pain. The independent nature of these pains suggests different pathophysiological mechanisms which are discussed.
Cluster Headache Associated With Parainfluenza Virus, Preceded and Succeeded by Migraine
Authors: Blanchard Bradford M.
Published: June 2003

A serologically proven case of parainfluenza viral infection was associated with the onset and disapearance of cluster headache. The patient had long‐standing migraine that ceased during the cluster headache period and recurred when the latter stopped. Possibly, the virus was neurally transmitted to the trigeminal‐autonomic system, creating an inflammatory response that transiently precipitated cluster headache and obliterated migraine.
The Long‐term Tolerability and Efficacy of Oral Zolmitriptan (Zomig, 31X90) in the Acute Treatment of Migraine. An International Study
Authors: Cady Roger K. ,   The International 311C90 Long‐term Study Group
Published: June 2003

This international open‐label study evaluated the tolerability and efficacy of zolmitriptan (Zomig®, 311C90), a selective 5‐HT1B/1D receptor agonist in the long‐term treatment of multiple migraine attacks. Patients who had previously participated in placebo‐controlled zolmitriptan studies were recruited. A total of 2058 patients treated 31 579 migraine attacks (average 15 per patient), for up to 1 year. Twenty‐six percent of attacks treated with a single zolmitriptan 5‐mg dose were associated with at least one adverse event (24% treated with two doses). The most frequent adverse events induded asthenia (14% of patients), nausea (12%), somnolence (10%), dizziness (11%), and paresthesia (11%). The rank order of the most common adverse events was not influenced by sex, age, or number of zolmitriptan doses taken and was similar between attacks 1 and 45. The majority of adverse events (59%) occurred within 2 hours of dosing, were of either mild (59%) or moderate (35%) intensity, of 4 hours' duration or less (67%), and required no further action (94%).

Following an initial 5‐mg dose of zolmitriptan, the 2‐hour headache response rate (reduction in headache pain from moderate or severe before treatment to mild or no pain at 2 hours posttreatment) was 81% in patients treating moderate and severe attacks (19 639 of 24 161). Patients were pain‐free at 2 hours in 55% of all attacks (16 510 of 29 808). The efficacy of zolmitriptan was not influenced by age, sex, weight, use of prophylactic antimigraine medication, or association of attacks with menstruation. Analysis of the overall population and a subgroup who treated 30 or more migraine attacks showed that zolmitriptan was consistently effective across attacks. Overall, 67% of patients who treated five or more attacks reported zolmitriptan to be effective in 80% to 100% of attacks. Zolmitriptan produced meaningful migraine relief and improvement in normal activity impairment in 73% and 78% of moderate and severe attacks, respectively. Patients treated recurrence of moderate or severe headache with a second zolmitriptan dose in 32% of attacks which responded to the first dose within 2 hours. Where required, a second zolmitriptan 5‐mg dose for treatment of recurrence produced a headache response rate of 90% at 2 hours postdose. Thus, zolmitriptan 5 mg (plus an optional second 5‐mg dose for treatment of recurrence) is well tolerated and effective in the acute treatment of multiple migraine attacks over periods up to 1 year.
Efficacy and Safety of Sumatriptan Tablets (25 mg, 50 mg, and 100 mg) in the Acute Treatment of Migraine: Defining the Optimum Doses of Oral Sumatriptan
Authors: Pfaffenrath V. , Cunin G. , Sjonell G. , Prendergast S.
Published: June 2003

That sumatriptan tablets are effective and well tolerated in the acute treatment of migraine has been established, but the relationship between dose and efficacy has not been adequately defined to date in clinical trials. This multinational double‐blind trial (N=1003) in which patients treated up to three migraine attacks with sumatriptan 25 mg, 50 mg, 100 mg, or placebo, with a second independently randomized dose for headache recurrence, evaluated the efficacy and tolerability of three doses of sumatriptan. The results demonstrate that all doses of sumatriptan were superior (P<0.05) to placebo in reducing moderate or severe predose headache to mild or no headache 4 hours postdose for each of the three treated attacks; sumatriptan 50 mg and 100 mg were each superior (P<0.05) to sumatiptan 25 mg 4 hours postdose for two of three attacks. Sumatriptan (all doses) was similarly effective at relieving nausea and photophobia or phonophobia or both and at reducing clinical disability. Headache recurrence was experienced by similar proportions of patients across treatment groups (35% to 48% after placebo; 26% to 39% after sumatriptan). Relief of recurrent headache 2 hours after the second dose of study medication occurred in greater percentages of patients using any dose of sumatriptan compared with patients using placebo to treat recurrence. The incidence of adverse events with 25‐mg and 50‐mg sumatriptan tablets was similar to the incidence with placebo and lower than the incidence with 100‐mg sumatriptan tablets. These data provide the first demonstration from a large well‐controlled clinical trial that both the 50‐ and 100‐mg doses are more effective than the 25‐mg dose and that the 50‐mg dose is associated with a lower incidence of adverse events than the 100‐mg dose.
Presentation of Chronic Daily Headache: A Clinical Study
Authors: Spierings Egilius L.H. , Schroevers Maya , Honkoop Peter C. , Sorbi Marjolijn
Published: June 2003

We studied the presentation of chronic daily headache in 258 patients from a private headache practice, 50 men and 208 women. Chronic daily headache was defined as headaches, occurring at least 5 days per week for at least 1 year.

Seventy‐seven percent of the patients experienced the onset of headache before the age of 30. The daily headaches were present on awakening in the morning or came about in the course of the morning in 79% of the patients. In 53%, they were worst in the afternoon or evening. The headaches awoke the patients at night at least once per week in 36%. At least twice per week, they were associated with nausea in 35% of the patients and with vomiting in 9%. Common aggravating factors included light, physical activity, bending over, noise, stress or tension, and menstruation. Ninety‐four percent of the patients experienced severe headaches in addition to the daily headaches. In 63%, the severe headaches occurred 10 days per month or less. The daily caffeine intake of the patients averaged 170 mg, and the daily analgesic intake, 1860 mg of aspirin equivalents.
Chronic Paroxysmal Hemicrania and Hemicrania Continua: Lack of Efficacy of Sumatriptan
Authors: Antonaci Fabio , Pareja Juan A. , Caminero Ana B. , Sjaastad Ottar
Published: June 2003

Attacks of chronic paroxysmal hemicrania are prevented by the continuous administration of indomethacin. Sumatriptan, an agonist of 5‐HT1‐like receptors, has proven effective in the treatment of cluster headache attacks. There are clear clinical similarities between chronic paroxysmal hemicrania and cluster headache. A natural consequence of these considerations would be to establish whether chronic paroxysmal hemicrania also responds similarly to sumatriptan. Since hemicrania continua is another unilateral headache responsive to indomethacin, it would be meaningful to also include hemicrania continua in such a study. Sumatriptan, 6 mg subcutaneous, was tried in an open fashion in 7 patients (6 women and 1 man) with chronic paroxysmal hemicrania and 7 patients (5 women and 2 men) with hemicrania continua. In chronic paroxysmal hemicrania, the mean interval between the last three attacks prior to sumatriptan treatment (40 ± 23 minutes) was not statistically different from the mean interval between the three attacks subsequent to sumatriptan treatment of an attack (32 ± 20 minutes). In none of the patients did the mean duration of the “test attack” decrease as compared to the attacks antedating the test attach (25 ± 11 minutes and 19 ± 9 minutes, respectively) (P=0.027, Wilcoxon). In 2 patients with chronic paroxysmal hemicrania, placebo (saline) administration did not lead to any change in the interval between attacks.

There was a mild, but statistically significant reduction in visual analog scale values for headache intensity in hemicrania continua (P=0.04, Wilcoxon). There was no clear, ie, clinically meaningful, reduction in visual analog scale values in any particular patient with hemicrania continua. Taken together, these results seem to show that sumatriptan is of no benefit in chronic paroxysmal hemicrania, but may have a partial efficacy in hemicrania continua. However, the latter effect is clinically unimportant This minor difference in regard to the clinical effect may, nevertheless, be of some interest pathogenetically, indicating minor differences between the two headaches. The lack of sumatriptan effect in chronic paroxysmal hemicrania clearly and markedly strengthens the nonalignment concept in regard to chronic paroxysmal hemicrania and cluster headache.
Tolfenamic Acid Rapid Release Versus Sumatriptan in the Acute Treatment of Migraine: Comparable Effect in a Double‐Blind, Randomized, Controlled, Parallel‐Group Study
Authors: Myllylä Vilho V. , Havanka Hannele , Herrala Lauri , Kangasniemi Pentti , Rautakorpi Ilkka , Turkka Jukka , Vapaatalo Heikki , Eskerod Ole
Published: June 2003

The efficacy and safety of tolfenamic acid and oral sumatriptan in the acute treatment of migraine was studied at five neurological centers in Finland. One hundred forty‐one patients experiencing 289 migraine attacks, fulfilling the diagnostic criteria for migraine with or without aura as defined by the International Headache Society, were randomized.

For first attacks, 77% of patients receiving tolfenamic acid experienced a reduction of the initial severe or moderate headache to mild or no headache after 2 hours, as compared to 79% in the sumatriptan group and 29% in the placebo group. No significant difference was found between active treatments (P=0.85, 95% Cl [−22%, 18%]), however, both active treatments were significantly better than placebo; P=0.001, 95% Cl (26%, 69%) for tolfenamic acid and P=0.001, 95% Cl (28%, 71%) for sumatriptan. For second attacks, results were similar with 70% of patients receiving tolfenamic acid experiencing relief, as compared to 64% in the sumatriptan group and 39% in the placebo group.

No significant differences were observed in accompanying symptoms.

Both drugs were well tolerated with the frequency of adverse events; 30% for tolfenamic acid and 41% for sumatriptan, a nonsignificant difference.

In this study, tolfenamic acid and oral sumatriptan are comparably effective in the acute treatment of migraine. When comparably effective, factors like individual effect, tolerance, and cost of treatment should be considered when prescribing migraine medication.
Initial Exploration of Pulsing Electromagnetic Fields for Treatment of Migraine
Authors: Sherman Richard A. , Robson Linda , Marden Linda A.
Published: June 2003

Two studies were conducted during which 23 patients with chronic migraine were exposed to pulsing electromagnetic fields over the inner thigh. In an open study, 11 subjects kept a 2‐week headache log before and after 2 to 3 weeks of exposure to pulsing electromagnetic fields for 1 hour per day, 5 days per week. The number of headaches per week decreased from 4.03 during the baseline period to 0.43 during the initial 2‐week follow‐up period and to 0.14 during the extended follow‐up which averaged 8.1 months. In a double‐blind study, 9 subjects kept a 3‐week log of headache activity and were randomly assigned to receive 2 weeks of real or placebo pulsing elactromagnetic field exposures as described above. They were subsequently switched to 2 weeks of the other mode, after which they kept a final 3‐week log. Three additional subjects in the blind study inadvertently received half‐power pulsing electromagnetic field exposures. The 6 subjects exposed to the actual device first showed a change in headache activity from 3.32 per week to 0.58 per week. The 3 subjects exposed to only half the dose showed no change in headache activity. Large controlled studies should be performed to determine whether this intervention is actually effective.
Relationships Between Arousal‐Related Moods and Episodic Tension‐Type Headache: A Biopsychological Study
Authors: Cathcart Stuart , Pritchard Donald
Published: June 2003

An exploratory study was conducted examining arousal‐related moods and episodic tension‐type headache. Twelve subjects meeting International Headache Society criteria for episodic tension‐type headache and 12 headache‐free controls recorded headache activity and mood eight times daily for 14 consecutive days. Moods were measured using the Activation‐Deactivation Adjective Check List, a self‐report list that subjectively represents general arousal along two dimensions of Tension and Energy. Headache subjects had higher Tension levels than controls even in the absence of pain, and greater variation in this dimension as well. Within the headache group, Tension during pain‐free periods was significantly lower than when experiencing headache, and was correlated with headache activity. The results were taken to support Thayer's (1989) biopsychological model of mood and arousal, and are discussed in terms of the model's heuristic value for general arousal and headache research.
Social Environment and Headache in 8‐ to 9‐Year‐Old Children: A Follow‐up Study
Authors: Metsähonkala Liisa , Sillanpää Matti , Tuominen Juhani
Published: June 2003

We studied the occurrence of migraine and nonmigrainous headache and the factors associated with headache in a group of 3580 children. These children belong to a 1‐year age cohort which has been followed since birth. When the children were 8 to 9 years old, data on their headaches were gathered through a postal questionnaire. Ninety‐five of the children (2.7%) had migraine and 977 (27.3%) reported nonmigrainous headache at the age of 8 to 9 years. Thirty‐four percent of the children with migraine had already had headache at the age of 5 years.

Children with migraine and children with nonmigrainous headache both reported more often being bullied in school, stress in school, and problems in getting along with other children than children without headache. The association of stress in school with headache was strongest in girls with migraine, even though they reported the least difficulties in school subjects. As many as one third of the boys with migraine reported that they had problems with peer relationships.
Time Required for Improvement of an Analgesic Rebound Headache
Authors: Warner John S.
Published: June 2003

There is typically delayed improvement in analgesic rebound headache after the offending agents have been discontinued. This case history documents that, at times, it might be necessary to omit medications for 6 months until the almost daily headaches cease.
Practicability and Acceptance of Subcutaneous Self‐administration of the Selective Serotonin Agonist Sumatriptan
Authors: Göbel Hartmut , Baar H. , Beiküfner H.D. , Böhme K. , Beckmann‐Reinhold A.
Published: June 2003

To cater to the special situation of much reduced oral bio‐availability which occurs in severe migraine attacks with pronounced nausea and vomiting, sumatriptan can also be used in a subcutaneous form that can be self‐administered. The aim of this study was to analyze the practicability and acceptance of a method of self‐administration (“Glaxo‐Pen”) for treatment of severe migraine attacks by subcutaneous injection of sumatriptan. The Glaxo‐Pen was compared with the conventional autoinjector for subcutaneous administration of sumatriptan. The multicenter study was conducted under practical conditions by 150 office‐based physician in Germany. Patients who commonly suffered from severe migraine attacks were given a careful explanation of how to use the device (“Glaxo‐Pen”) for self‐administration of subcutaneous sumatriptan and were able to practice using it under guidance.They were given a Glaxo‐Pen with two sumatriptan refills to take with them for treating their own migraine attacks. The patients used a headache diary to document administration outside the practice session. A total of 376 patients were included in the study.

The major findings were that 80% of the patients rated the Glaxo‐Pen “very easy” or “easy” to use, and only 6.4% rated it “difficult” or “very difficult.” Compared with the conventional autoinjector, the Glaxo‐Pen was rated “much better” or “better” by 77.9% of patients. Only 8.5% considered the Glaxo‐Pen “worse” or “much worse” than the conventional autoinjector. The figures show that the great majority of patients found it easy to use sumatriptan for treating severe migraine attacks by self‐administration under practical conditions. Thus, especially for patients who suffer from severe nausea, vomiting, or diarrhea during migraine attacks, this method of delivery is an easily used means of arresting migraine attacks.
Serotonergic, Catecholaminergic, and Cardiovascular Reactions to Mental Stress in Female Migraine Patients. A Controlled Study
Authors: Stronks Dirk L. , Tulen Joke H. M. , Verheij René , Boomsma Frans , Fekkes Durk , Pepplinkhuizen Lolke , Mantel Geert W. H. , Passchier Jan
Published: June 2003

This study aimed at the combined assessment of the serotonergic and sympathetic nervous system reactions of migraine patients before, during, and after the induction of mental stress in order to detect the possible role of these reactions in inducing a migraine attack. The responses to mental stress of the migraine patients were compared to a group of patients suffering from tension headache and a control group. Activation of the sympathoadrenomedullary system due to mental stress was successfully induced in the migraine patients (n=23), in the tension headache patients (n=18), and in the control group (n=22). The results of this study present evidence of increased cardiovascular activity in migraine patients as compared to nonmigraineurs. However, no evidence was found of a specific serotonergic, sympathoadrenomedullary, or cerebrovascular response of migraine patients to mental stress as compared to nonmigraineurs.
Rizatriptan (MAXALT) for the Acute Treatment of Migraine and Migraine Recurrence. A Placebo‐Controlled, Outpatient Study
Authors: Teall Judith , Tuchman Michael , Cutler Neal , Gross Michael , Willoughby Ernest , Smith Betty , Jiang Kai , Reines Scott , Block Gilbert ,   Rizatriptan 022 Study Group
Published: June 2003

Rizatriptan is a novel 5‐HT1B/1D agonist which is rapidly absorbed after oral administration. The efficacy and tolerability of oral rizatriptan (5 mg and 10 mg) were examined in this multicenter, double‐blind, outpatient study of 1473 migraineurs which featured randomized, placebo‐controlled treatment of migraine recurrences. On experiencing moderate or severe migraine headaches, patients rated headache severity prior to dosing and at 30‐minute intervals for 2 hours after dosing. Onset of effect was seen as early as 30 minutes after dosing with rizatriptan 10 mg. At 2 hours postdose, the percentage of patients with pain relief was significantly higher after rizatriptan 5 mg (62%) or 10 mg (71%) compared with placebo (35%). Complete relief was also significantly higher after rizatriptan 5 mg (33%) and 10 mg (42%) compared with placebo (10%). In patients experiencing headache recurrence after initial benefit, further relief was obtained in 71% with rizatriptan 5 mg (placebo 54%) and in 82% with rizatriptan 10 mg (placebo 44%). Complete relief of recurrent headache was obtained in 36% with rizatriptan 5 mg, 49% with rizatriptan 10 mg, and 15% with placebo (P<0.05). The most common drug‐related adverse experiences were dizziness, somnolence, asthenia/fatigue, and nausea (the incidences of which were low and dose related). There was no increase in the incidence of adverse experiences after use of up to three doses of rizatriptan within 24 hours. We conclude that both doses of rizatriptan are effective and well tolerated in the acute treatment of migraine and migraine recurrence, with the l0‐mg dose preferred as it is more effective with a faster onset of action.
5‐HT1B Receptor Polymorphism and Clinical Response to Sumatriptan
Authors: MaassenVanDenBrink Antoinette , Vergouwe Monique N. , Ophoff Roel A. , Saxena Pramod R. , Ferrari Michel D. , Frants Rune R.
Published: June 2003

The 5‐HT1 receptor agonist, sumatriptan, is highly effective in the treatment of migraine. Some patients, however, do not respond or experience recurrence of the headache. In addition, some patients report chest symptoms after sumatriptan. We investigated whether these different responses could be attributed to genetic diversity of the 5‐HT1B receptor, which most likely mediates the therapeutic action and the coronary side effects of sumatriptan. Allele frequencies of two polymorphisms in the 5‐HT1B receptor gene (G861C and T‐261G) were investigated in migraine patients with consistently good response to sumatriptan (n=14), with no response (n=12), with recurrence of the headache (n=12), with chest symptoms (n=13), and in patients without chest symptoms (n=27). Allele frequencies (G:0.74; C:0.26 at nt 861 and T:0.39; G:0.61 at nt ‐261) did not differ between patient groups, indicating that genetic diversity of the 5‐HT1B receptor does not seem to be involved in the different clinical responses to sumatriptan.
Psychological Well‐being in Older Adults Suffering From Chronic Headache
Authors: Jelicic Marko , Kempen Gertrudis I.J.M. , Passchier Jan
Published: June 2003

Objective.—The aim of this study was to examine two components of psychological well‐being—life satisfaction and effective well‐being—in community‐dwelling elderly with (n=321) and without chronic headache (n=4955).

Methods.—A checklist of chronic medical conditions was used to determine whether respondents were suffering from headache. Cantril's ladder was employed to measure life satisfaction. The subscale, Mental Health, from the MOS SF‐20 was used to assess affective well‐being.

Results.—Headache sufferers reported lower life satisfaction as well as lower affective well‐being. However, the difference in life satisfaction between the two groups disappeared after controlling for comorbidity. The difference in affective well‐being disappeared after controlling for neuroticism.

Conclusions.—Lower life satisfaction in patients with chronic headache is caused by more comorbid diseases in the headache group. Lower affective well‐being in headache sufferers is due to higher levels of neuroticism in the headache group.
Development and Validation of the Migraine‐Specific Quality of Life Questionnaire
Authors: Jhingran Priti , Osterhaus Jane T. , Miller David W. , Lee Jeffrey T. , Kirchdoerfer Leonard
Published: June 2003

This paper describes the development and validation of a migraine‐specific quality‐of‐life instrument that is capable of measuring health‐related quality‐of‐life impairments attributed to migraine. Item selection, item reduction, and pretesting and finalization of items during the instrument development phase resulted in a total of 16 questions which were incorporated into the Migraine‐Specific Quality of Life Questionnaire (Version 1:0) (©1992 Glaxo Wellcome Inc). Three meaningful dimensions were hypothesized: Role Function‐Restrictive, Role Function‐Preventive, and Emotional Function. In the instrument validation phase, the Migraine‐Specific Quality of Life Questionnaire was mailed to 1109 migraine patients, providing a response rate of 45% (n=458). Initial psychometric evaluation of the questionnaire indicated that it possessed adequate reliability with Cronbach's alpha for the three dimensions ranging between 0.70 to 0.85. The Migraine‐Specific Quality of Life Questionnaire possessed adequate content and criterion validity. All but three items satisfied the test of construct validity. In conclusion, the Migraine‐Specific Quality of Life Questionnaire has acceptable psychometric properties and can be used to estimate the effect of migraine and its treatment on the patient's health‐related quality of life.
Melatonin‐Responsive Headache in Delayed Sleep Phase Syndrome: Preliminary Observations
Authors: Nagtegaal J.E. , Smits M.G. , Swart A.C.W. , Kerkhof G.A. , van der Meer Y.G.
Published: June 2003

The occurrence of headache and its change after treatment with melatonin 5 mg were studied in 30 patients with delayed sleep phase syndrome. The medication was taken 5 hours before the endogenous nocturnal plasma melatonin concentration had reached 10 pg/mL.

Three women (aged 14, 14, and 23 years) suffered from chronic tension‐type headache. Their headache disappeared within 2 weeks after the start of treatment with melatonin. One 54‐year‐old man suffered from disabling migraine attacks without aura, twice a week. After starting melatonin treatment, only three migraine attacks were reported in 12 months. Ever since his 4Os, a 60‐year‐old man complained of cluster headache episodes lasting about 2 months, twice a year. In the year since starting melatonin treatment, only one 5‐day cluster episode occurred.

Nocturnal melatonin secretion in the patients with delayed sleep phase syndrome and headache did not differ significantly from that in the patients with the sleep disorder but without headache.

Melatonin may be helpful in patients with headache who are suffering from delayed sleep phase syndrome. Its effectiveness may be due to modification of vascular and nociceptive systems or to its chronobiological action which adjusts the patient's biological clock to his/her life‐style.