bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Image Abnormality in Migraine with Aura
Authors: Ziegler Dewey K , Batnitzky Solomon , Barter Ruth , McMillan John H
Published: March 2003

Cerebral magnetic resonance imaging (MRI) was performed on 18 patients with migraine characterized by aura consisting of both visual symptoms and paresthesias. Fifteen headache-free individuals of the same age range were used as controls. Records were randomized and read in blind fashion by two neuroradiologists. Small subcortical white matter lesions were seen in three migraine cases and two controls. In one migraine case cortical infarctions were seen. In two controls, small areas of increased density similar to those in migraine were seen. No consistent correlation of migraine or its duration with cerebral atrophy was found. It is concluded that identification of both these MRI findings (small subcortical white lesions and cerebral atrophy) as significantly associated with migraine is doubtful.
A Note on the Action of Glutamine on Cortical Spreading Depression
Authors: Maranhäo-Filho Péricles de Andrade , Leäo Aristides Azevedo Pacheco
Published: March 2003

Application of a solution of 1-glutamine, 75 mM, to the pia-arachnoid surface of the dorsolateral neocortex of rabbits under dial-urethane anaesthesia was found to reversibly render the tissue insusceptible to spreading depression. It is suggested that this amide may play a part in the opposition normally offered by the tissue to undergo spreading depression. Some evidence is adduced which seems to support this suggestion.
Influence of the Sympathetic Nervous System as Well as Trigeminal Sensory Fibres on Rat Dural Mast Cells
Authors: Keller JT , Dimlich RVW , Zuccarello M , Lanker L , Strauss TA , Fritts MJ
Published: March 2003

The dura mater has attracted considerable attention as an exquisitely sensitive tissue implicated as playing a role in various cephalalgias including vascular headache. Because of the potential clinical impact of the relationship/interaction of neural elements and mast cells the influence of sensory and autonomic nerve fibres on mast cells of the rat dura mater was studied. The trigeminal or superior cervical ganglion was electrically stimulated and the mast cells were examined. Wholemount supratentorial dural preparations were stained using berberine sulphate and the number of mast cells with intact vs dispersed granules counted. Unilateral stimulation of either ganglia resulted in a statistically significant increase in the percentage of mast cells with dispersed granules ipsilateral to the side of stimulation. These results support our idea that in addition to the trigeminal system the sympathetic nervous system must be considered as playing a role in the oedema pathophysiology of vascular headache.
Overlap of Migraine and Tension-Type Headache in the International Headache Society Classification
Authors: Messinger Harley B , Spierings Egilius LH , Vincent Arnaud JP
Published: March 2003

Using questionnaire data from two recent surveys, headache sufferers were classified as having either migraine, episodic, or chronic tension-type headache using the International Headache Society criteria. Of 410 subjects with a headache history of 2 years or more, 147 or 35.9% were assigned Code 1.7 (migrainous disorder not fulfilling the above criteria) or Code 2.3 (headache of the tension-type not fulfilling above criteria). In 79 of these 147 subjects (53.7%), either of the above codes would have been equally valid. Separate scores for “migraine” and “tension” symptoms may provide a way to handle this overlap and aid in choosing optimal therapy.
Is Intravenous Lidocaine Clinically Effective in Acute Migraine?
Authors: Reutens David C , Fatovich Daniel M , Stewart-Wynne Edward G , Prentice David A
Published: March 2003

We performed a prospective, randomized, double-blind, placebo-controlled trial of intravenous lidocaine (1 mg/kg) in the treatment of acute migraine. Thirteen subjects were randomly allocated to receive intravenous lidocaine and 12 received intravenous normal saline. Subjects scored the intensity of headache and nausea on separate visual analogue scales before the injection and at 10 and 20 min after injection. At 20 min, the mean pain intensity score was 80% of initial intensity in the lidocaine group and 82% in the placebo group. The difference was not statistically significant; at 20 min, the 95% confidence interval for the difference between the two groups in mean percentage of initial pain score was 2 ± 29%. At the dose studied, intravenous lidocaine has, at best, only a modest effect in acute migraine.
Indomethacin-Resistant Hemicrania Continua
Authors: Kuritzky A
Published: March 2003

“Hemicrania Continua”, first described in 1984, is defined as a steady, non-paroxysmal, unilateral headache absolutely responsive to indomethacin. Four cases clinically compatible with “Hemicrania Continua” are described. All four cases were absolutely resistant to indomethacin treatment. It is concluded that “Hemicrania Continua” is a clinical entity which has an indomethacin-responsive subtype but is not strictly an indomethacin-responsive headache.
MMPI Profiles in Patients with Headache or Craniofacial Pain: A Comparative Study
Authors: Mongini Franco , Ferla Ermenegildo , Maccagnani Carla
Published: March 2003

Our purpose was to examine the MMPI profiles of 157 patients with chronic headache or facial pain. The following diagnostic groups were considered: tension-type headache ( n = 44); migraine+cluster headache + chronic paroxysmal hemicrania (20); trigeminal neuralgia (7); atypical facial pain (AFP) (33); temporomandibular joint dysfunction (TMJ) (53). There were two control groups: C1 of 27 healthy individuals and C2 of 18 patients with chronic pain located elsewhere. A “Pain Index” was calculated ( 0–10) which quantified pattern, duration and frequency of pain. The Italian MMPI abbreviated version was administered to all subjects. One-way Anova, the Duncan test and correlation analysis were performed. Of the diagnostic groups, AFP scored highest and TMJ lowest in all except three scales. In the AFP group, all neurotic scales scored above 70. The Pain Index correlated with higher scores on most scales. Chronic pain may lead to personality alterations, but some features of craniofacial pain correlate with specific personality disturbances.
Weekend Attacks in Migraine Patients: Caused by Caffeine Withdrawal?
Authors: Couturier EGM , Hering R , Steiner TJ
Published: March 2003

The principal reasons for a predominantly weekend incidence of migraine attacks are likely to be social or psychological in origin. There may be another factor. This study examines the use, and more importantly the way of use, of caffeine containing substances. We collected data by questionnaire from 151 consecutive Migraine Clinic patients with the diagnosis of migraine or tension type headache. Of the whole group, 21.9% claimed to have weekend attacks, with relatively more males than females. The males amongst these were all migraine patients, but 23% of the women suffered from tension-type headache. Patients with both a high daily caffeine intake and excessively delayed wakening at weekends (each defined as greater than the mean for the whole group) had a 69% risk of weekend headache. This compared with 4% in patients exceeding the mean in one only, and zero in those with moderate habits in both. These results support the idea that weekend attacks are linked to caffeine withdrawal. Sleeping in is not on its own a significant cause. We suggest that this possibility should be considered in clinical management of affected patients.
Pain Sensitivity and Pain Reactivity of Pericranial Muscles in Migraine and Tension-Type Headache
Authors: Göbel Hartmut , Weigle Lars , Kropp Peter , Soyka Dieter
Published: March 2003

We investigated whether experimentally determined, suprathreshold pain sensitivity of pericranial musculature in patients with tension-type headache differs from that of migraine patients or from that of healthy subjects. Furthermore, we looked to see whether differences could be found in the effects of experimental pain induction on EMG activity of pericranial musculature and whether subgroups could be discovered with higher and lower pericranial pain sensitivity within the three diagnostic groups in terms of neurophysiological, psychological and clinical variables. In 20 patients with tension-type headache, 23 patients with migraine without aura, and 29 healthy individuals experimental pain was induced in the temporal muscle by mechanical pressure; pain sensitivity in the entire metrically subdivided suprathreshold pain sensitivity range was measured. Surface EMG activity of pericranial muscles was determined before, during and after experimental pain induction. In addition, headache characteristics as well as personality and mood states were determined and recorded in a standardized fashion. There were no significant differences in pain sensitivity of pericranial musculature between the three groups. Patients with tension-type headache showed significantly higher EMG scores during suprathreshold pain stimulation than did migraine patients. EMG scores of healthy subjects fell between these two groups. With respect to pericranial tenderness significant differences in clinical, neurophysiological and psychological variables were found only between subgroups within the group of patients with tension-type headache. The results indicate that significant differences in the examined groups are found not in pain perception but in the processing or reaction to experimental headache stimuli. In patients with tension-type headache subgroups evolve based on pericranial pain sensitivity with quantitatively and/or qualitatively impaired reactions; for this reason diagnostic grouping according to the IHS classification seems to be pathophysiologically relevant. The intraindividual phasic comparison of pain reactions appears to be more important than the absolute interindividual tonic comparison.
Beta-Endorphin Concentrations in the Peripheral Blood Mononuclear Cells of Migraine and Tension-Type Headache Patients
Authors: Leone Massimo , Sacerdote Paola , D'Amico Domenico , Panerai Alberto E , Bussone Gennaro
Published: March 2003

Levels of b-endorphin in peripheral blood mononuclear cells have been studied as a new approach to investigating opioid tone in migraine and tension-type headache. Sixty-one patients with migraine without aura, 39 with migraine with aura and 23 with episodic tension-type headache were compared with 37 healthy controls. Peripheral blood samples were taken from patients not enduring headache attacks and not undergoing prophylactic treatment. A significant reduction in peripheral blood mononuclear cell b-endorphin concentrations was observed in migraine patients with and without aura, but not in tension-type headache patients. Altered transmitter modulation to peripheral blood mononuclear cells may be the cause of this alteration, which could be part of a more diffuse opioid system derangement in migraine subjects.
Comparative Effects of The Antimigraine Drugs Sumatriptan and Ergotamine on The Distribution of Cardiac Output in Anaesthetized Pigs
Authors: Boer Marinus O Den , Somers JAE , Saxena PR
Published: March 2003

The haemodynamic effects of sumatriptan, a 5-HT 1 -like receptor agonist, and ergotamine, an agonist at a-adrenergic, dopamine as well as 5-HT receptors, were compared using intracardiac injection of radioactive microspheres of different sizes in anaesthetized pigs. Ergotamine (0.02 mg-kg-1 ) and sumatriptan (0.3 mg. kg-1 ) decreased systemic vascular conductance and cardiac output. Only ergo-famine raised arterial blood pressure. Both sumatriptan and ergotamine decreased arteriovenous anastomotic, but not capillary, blood flow in the head and body skin. Arteriovenous and capillary blood flow in the dura mater and nasal mucosa and capillary blood flow in the brain, kidneys, adrenals, intestine, heart, spleen and muscle remained unchanged. However, kidney conductance was decreased by both drugs, spleen conductance by sumatriptan and heart, liver and adrenal conductances were decreased by ergotamine. Thus, both sumatriptan and ergotamine constricted arteriovenous anastomoses in the skin, but not in the dura mater or nasal mucosa. Ergotamine constricted the vasculature more than sumatriptan, although both drugs may differentially decrease vascular conductances in some organs.
Headache in Ischemic Cerebrovascular Disease. Part I: Clinical Features
Authors: Mitsias Panayiotis , Ramadan Nabih M
Published: March 2003

Headache is a common, although under-emphasized, feature of ischemic cerebrovascular disease. In this review, we summarize the literature on the clinical features of headache in ischemic cerebrovascular disease (Part I) and elaborate upon the underlying mechanisms of the head pain (Part II-December issue).
Prevalence of Adult Migraine in General Practice
Authors: Winhem Janette
Published: March 2003

In 1968 the International Headache Society presented new criteria for the diagnosis of migraine. We used these criteria in a questionnaire to assist in the diagnosis of migraine. The questionnaire was answered by 230 patients in four general practices, We found a migraine prevalence of 11.7%. More than 70% of migraine patients had 12 or more attacks per year, and the length of attack varied between 4 and 24 h in 60% of them. The majority of migraineurs went to bed during the attack and 55% had stayed away from work due to migraine during the last year. The results of this study are in agreement with others. Migraine is an appreciable economic concern due to frequent short absenteeism from work.
Spreading Oligemia in the Migraine Aura-Most Likely an Artifact Due to Scattered Radiation
Authors: Olsen Tom Skyhøj
Published: March 2003

The view that “spreading oligemia” reflects spreading depression in the human brain during the migraine aura is based on a defective analysis of CBF data where the most important methodological source of error (scattered radiation) has been ignored. When scattered radiation is taken into account it appears that CBF in the low flow area during the migraine aura is reduced to the ischemic level. There is no reason to believe that “spreading” of the low flow area occurs. Most likely the blood flow decreases in an area of fixed size. All available CBF evidence in fact lends support to “the vascular theory” of migraine pathogenesis.
On Serotonin and Migraine: A Clinical and Pharmacological Review
Authors: Ferrari Michel D , Saxena Pramod R
Published: March 2003

Migraine patients have chronically low systemic 5-HT, predisposing them to develop migrainous headache once an attack has been initiated. Changes in platelet 5-HT content are not causally related, but reflect similar changes at a neuronal level. Stimulation of vascular 5-HT1 receptors, probably located in the vessel wall within the dural vascular bed, may alleviate the headache and associated symptoms, but does not interact with earlier mechanisms within the pathophysiological cascade. These receptors are of an as yet unidentified 5-HT1 subtype, closely resembling, but not identical to 5-HT1D receptors. Activation of these receptors results in vasoconstriction, inhibiting depolarization of sensory perivascular afferents within the trigemino-vascular system and thus stopping the headache. Additional inhibition of the release of vasoactive neuropeptides may be involved, but seems to be of only secondary clinical importance.
Exteroceptive Suppression Periods in Jaw-Closing Muscles. Variability and Relation to Experimental Pain and Sustained Muscle Contraction
Authors: Bendtsen Lars , Jensen Rigmor , Brennum Jannick , Arendt-Nielsen Lars , Olesen Jes
Published: March 2003

The duration of the late exteroceptive suppression period (ES2) of temporal muscle EMG activity has been reported to be reduced in patients suffering from chronic tension-type headache. Methods of recording and analysing ES2 have varied between centers and reproducibility of results within subjects, although insufficiently studied, has generally been poor. ES2 was investigated in 30 healthy subjects, using a computerized technique of recording, rectifying and averaging the EMG signals. Hour to hour and week to week variations of ES2 durations were calculated, and the influence of pain during a cold pressor test and of sustained muscle contraction on ES2 durations was investigated. The intra-individual variation of ES2 durations was 16.0% from hour to hour and 20.7% from week to week. The inter-individual variation was 36.7%. The present method for analysis of ES2 periods proved to be reliable, as the intra-observer variation was 4.2% and the inter-observer variation 4.6%. ES2 periods were significantly shorter on the first compared to the second day of examination ( p = 0.006) and during experimental pain ( p = 0.0005). We recommend the use of the computerized averaging technique in future studies and caution against the dependence of results upon factors such as conditioning and pain.
Basilar Migraine with Electroencephalographic Findings of Occipital Spike-Wave Complexes: A Long-Term Study in Seven Children
Authors: Romanis Filippo De , Buzzi M Gabriella , Assenza Salvatore , Brusa Livia , Cerbo Rosanna
Published: March 2003

Basilar migraine is characterized by headache preceded by prodromal symptoms and signs of posterior cerebral circulation dysfunction. Few studies have focused on EEG findings in this condition or on the prognosis of occipital spike-wave complexes observed in either migraine or epilepsy. We now report a long-term follow-up (8–16 years) in seven children affected by basilar migraine who had EEG findings of occipital spike-wave complexes. Basilar migraine resolved and the EEG became normal in all subjects during the observation period, as did migraine with aura and seizures which developed in some of the patients after basilar migraine attacks ceased.
Hemi-Field Pattern Reversal Visual Evoked Potentials in Migraine
Authors: Tsounis Stephanos , Milonas John , Gilliam Frank
Published: March 2003

A study of hemi-field pattern reversal visual evoked potentials recorded in the interictal phase was carried out in 44 patients (22 with migraine with aura, 22 without aura) in order to determine whether migraine patients with or without aura and with headaches with strong unilateral predominance, either left or right, exhibit abnormalities after hemi-field stimulation. No differences of P100 latency were found between them and a group of 20 normal individuals, between patients suffering from migraine with aura and migraine without aura and between the affected and the non-affected side of the head. Only in a subgroup of 14 patients with headaches constantly lateralized to a single side, either left or right, was the P100 latency significantly shorter on the affected side ( p < 0.001, t-test) compared with the contralateral non-affected side. The results indicate that in both types of migraine there is a common underlying pathogenetic mechanism and the affected retrochiasmatic optic radiation has an increased response to sensory input modulation.
No Significant Effect of An “Atraumatic” Needle on Incidence of Post-Lumbar Puncture Headache or Traumatic Tap
Authors: Lenaerts M , Pepin J-L , Tombu S , Schoenen J
Published: March 2003

We compared the incidence of post-lumbar puncture headache and of red blood cells in the first CSF sample (traumatic tap) in 35 inpatients punctured with a standard 20 G Yale needle and in 26 patients punctured with Sprotte's “atraumatic” needle. No significant difference was found between the two groups in incidence of headache or in frequency of traumatic taps.
Trigeminal Neuralgia With Chronic Paroxysmal Hemicrania: the CPH-tic Syndrome
Authors: Hannerz Jan
Published: March 2003

A case of chronic paroxysmal hemicrania-tic syndrome is described. The chronic paroxysmal hemicrania (CPH) was controlled with indomethacin and the trigeminal neuralgia with a glycerol blockade. The trigeminal neuralgia reappeared four years after the blockade and was then treated successfully with corticosteroids. Six months later, when indomethacin was stopped, the trigeminal neuralgia recurred and resolved again with corticosteroids. We suggest that the CPH-tic syndrome is due to periorbital venous vasculitis. To our knowledge this is the first reported case of this disorder.
Arterial Supersensitivity to Nitric Oxide (Nitroglycerin) in Migraine Sufferers
Authors: Thomsen Lars L , Iversen Helle K , Brinck Thomas A , Olesen Jes
Published: March 2003

The sensitivity to nitroglycerin-induced dilatation of large intracranial arteries was studied in 17 patients with migraine without aura, 17 age and sex-matched healthy subjects and 9 patients with episodic tension-type headache. Nitroglycerin in the doses of 0.015, 0.03, 0.25 and 0.5 μg/kg/min was successively infused for 15 min per dose. Blood velocity (Vmean) in the middle cerebral artery (MCA) was recorded with transcranial Doppler before and at the end of every infusion period, and 30 and 60 min after end of the last infusion. In all three groups Vmean decreased with increasing doses ( p < 0.001). The response was more pronounced in migraine patients at the two higher doses ( p < 0.05). Since nitroglycerin acts as an exogenous source of nitric oxide (NO), these data support that NO supersensitivity may be an important molecular mechanism of migraine pain.
Plasma Serotonin Increase During Episodes of Tension-Type Headache
Authors: Jensen R , Hindberg I
Published: March 2003

The mechanisms of tension-type headache remain to be determined. Biochemical abnormalities have been rarely demonstrated. We performed a controlled study of 5-hydroxytryptamine (SHT) in platelet poor plasma obtained from 13 female patients during and between episodes of tension-type headache. The 5HT concentration in patients free of headache was not different from controls, whereas a significant increase in 5HT concentration was seen during headache ( p < 0.02.). This finding is attributed to release of 5HT from platelets or disordered 5HT metabolism during headache attacks, possibly related to pain in the latter case. We conclude that 5HT may be involved in the pathogenesis of tension-type headache but by different mechanisms than migraine.
Extracervical Symptoms After Whiplash Trauma
Authors: Magnússon T
Published: March 2003

Thirty-eight patients with late whiplash syndrome were investigated with regard to symptoms which conform with the criteria for other specific diagnoses. All had pain and tender points in the neck and 37 (97.4%) suffered from headache. Seven patients (18.4%) had occipital neuralgia in accordance with the IHS criteria and 16 (42.1%) if the IASP criteria were used. Four patients (10.5%) had oromandibular dysfunction, 20 (52.6%) had periarticular shoulder disorder, and 12 (31.6%) had thoracic outlet syndrome. Five (13.2%) had chronic mechanical low back pain and two (5.3%) segmental instability of the lumbar spine. Four (10.5%) had symptoms concurring with the diagnosis of fibromyalgia. It is concluded that many of the symptoms of patients that suffer from late whiplash syndrome conform with the criteria of other specific diagnoses.
CO2 Measurements During Transcranial Doppler Examinations in Headache Patients: Methodological Considerations
Authors: Thomsen LL , Iversen HK
Published: March 2003

Transcranial Doppler (TCD) examinations are increasingly being used in studies of headache pathophysiology. Because blood velocity is highly dependent on pCO2, these parameters should be measured simultaneously. The most common way of performing measurements during TCD examinations is as end-tidal pCO2 witch a capnograph. When patients are nauseated and vomit, as in migraine, the mask or mouthpiece connected to the capnograph represents a problem. We therefore evaluated whether a transcutaneous pCO2 electrode was as useful as the capnograph for pCO2 measurements in TCD examinations. We conclude that this is not the case, and recommend capnographic end-tidal pCO2 measurements during TCD examinations. However, transcutaneous pCO2 measurements may represent a supplement to spot measurements of end-tidal pCO2 in stable conditions when long-term monitoring is needed, and the mask or mouthpiece of the capnograph has to be taken on and off between recordings.
Self-Treatment of Acute Migraine with Subcutaneous Sumatriptan Using an Auto-Injector Device: Comparison With Customary Treatment in An Open, Longitudinal Study
Authors: Schoenen J , Bulcke J , Caekebeke J , Dehaene I , Keyser J De , Hildebrand G , Joffroy A , Laloux P , Louis P , Monseu G , Pierre P , Vanderlinden C , Sautois D , Vandenberghe A
Published: March 2003

In a multicenter open longitudinal clinical trial where 479 patients suffering from migraine with or without aura were recruited, patients treated at home one to three migraine attacks with their customary treatment, and subsequently, over a 3-month period, one to three migraine attacks with (5 mg sumatriptan sc using an auto-injector. The headache response to customary treatment was 19% at 1 h and 30.5% at 2 h, and was not significantly different when only attacks treated “adequately” according to accepted treatment recommendations were considered: 16% at 1 h and 35% at 2 h. In contrast, 69% and 82% of patients treated with 6 mg sumatriptan sc had mild headache or no headache at 1 and 2 h respectively, regardless of migraine type or duration of symptoms prior to treatment. Other migraine symptoms (nausea, vomiting, photo- and phonophobia) were effectively treated with sumatriptan. Recurrence of migraine was observed in 31% of patients and was well controlled by a second injection of sumatriptan. It is concluded that 6 mg sumatriptan sc, self-administered using an auto-injector, is well tolerated and more effective than most currently used acute treatments for migraine in a population of severely affected patients consulting a neurologist.
Demonstration of Neuropeptide Containing Nerves and Vasomotor Responses to Perivascular Peptides in Human Cerebral Arteries
Authors: Edvinsson L , Jansen I , Sa M Cunha e , Gulbenkian S
Published: March 2003

A rich supply of nerve fibers containing neuropeptide Y-like (NPY-LI) and tyrosine hydroxylase-like immunoreactivity was seen in human cerebral arteries, arterioles and veins. Only a sparse supply of vasoactive intestinal polypeptide (VIP-LI), substance P (SP-LI), and calcitonin gene-related peptide (CGRP-LI) was demonstrated in the walls of human cerebral vessels. In isolated ring segments of human cerebral arteries, NPY and noradrenaline caused vasoconstriction but did not potentiate each other. VIP, peptide histidine methionine, SP, neurokinin A, and CGRP relaxed arteries precontracted by prostaglandin F2a. The degree of innervation and the vasomotor responses are discussed in relation to migraine pathophysiology.
Carotid Pain During Percutaneous Angioplasty (PTA). Pathophysiology and Clinical Features
Authors: Munari LM , Belloni G , Moschini L , Mauro A , Pezzuoli G , Porta M
Published: March 2003

Stretching of the internal carotid artery during percutaneous transluminal angioplasty (PTA) may be associated with transient neck, facial or cranial pain. We report a series of 53 cases who received PTA. Cervical pain occurred in 51% of patients, with a radiation to face and scalp in 33%. Analysis focused on: (a) description of pain intensity, quality, timing and location; (b) investigation about the role of individual and technical parameters that could influence the relative risk of pain onset during PTA; (c) comparison with other available data on pain syndromes related to the carotid artery. Intimal flapping on post-angioplasty angiograms, bradycardia during the procedure and previous history of AMI were associated with a higher risk of painful angioplasty. PTA may also serve as a tool to investigate carotid pain and may add further knowledge to the evidence available about the role of the carotid wall in the pathogenesis of facial and cranial pain.
Nostril Capsaicin Application as a Model of Trigeminal Primary Sensory Neuronal Activation
Authors: Nicolodi M
Published: March 2003

Capsaicin was applied unilaterally to the nostril mucosa of 18 episodic cluster headache sufferers in remission. Plasma and saliva levels of substance P (SP), calcitonin gene-related peptide (CGRP) and vasoactive intestinal polypeptide (VIP) were measured by radioimmunoassay. Increase of salivary SP-LI and CGRP-LI as well as of plasma CGRP-LI occurred after capsaicin stimulation. Capsaicin-induced neurochemical changes in saliva and in plasma were compared to the changes observed during cluster headache attacks measured in a separate study. The comparative changes in SP, CGRP and VIP characterizing these two conditions suggest that trigeminal capsaicin-sensitive sensory neurones are unlikely to play any fundamental role in the mechanics of cluster headache.
Endothelins: A Role in Cerebrovascular Disease?
Authors: Cardell LO , Uddman R , Edvinsson L
Published: March 2003

Vasoactive factors produced and released by the endothelium exert a powerful influence on vascular tone in the cerebral circulation. Impaired endothelium-dependent responses, such as decreased production of endothelium-derived relaxing factors, and/or release of endothelium-derived contractile factors may give rise to different pathophysiological conditions. Among the endothelium-derived contractile factors the endothelins have recently received particular attention. Endothelin-1 is the major isoform in the endothelin family, which also includes endothelin-2 and endothelin-3. Endothelin-1 is synthesized within the endothelium of cerebral vessels, whereas both endothelin-1 and endothelin-3 in addition have been identified in neurons and glia. Recent electrophysiological work has suggested a neuromodulatory role for these peptides, but at present the general interest is mainly focused on their vasoactive role. Physiological stimuli such as hypoxia, anoxia, and hemodynamic shear stress will stimulate the endothelial endothelin production. In the brain, at least two types of specific subreceptors have been cloned; ETA receptors, exclusively associated with blood vessels and ETB receptors also found on glial, epithelial, and ependymal cells. The endothelins seem so far to be the most potent vasoconstrictors yet identified. The circulating plasma levels of immunoreactive endothelin are low. Since more than 80% of the total amount released from endothelial cells seems to be secreted towards the underlying smooth muscle, endothelins have been ascribed a local vasoregulatory role. Endothelins are believed to be involved in several of our most common cerebrovascular diseases and the present review comments on their possible pathophysiological role in subarachnoid haemorrhage, cerebral ischemia, and migraine.
A Randomized Double-Blind Placebo-Controlled Crossover Study of Subcutaneous Sumatriptan in General Practice
Authors: Russell MB , Holm-Thomsen OE , Nielsen M Rishøj , Cleal A , Pilgrim AJ , Olesen J
Published: March 2003

Objective. To evaluate the therapeutic response to sumatriptan in the acute migraine attack. Material and methods. Two hundred and thirty migraineurs diagnosed by their general practitioners in accordance with their usual practice were included in the study. The patients treated two migraine attacks at home by subcutaneous injection of sumatriptan or placebo for the first attack and the alternative medication, i.e. placebo or sumatriptan, for the second attack (crossover). Following treatment, a neurology resident interviewed and examined the patients, Results. When sumatriptan was compared to placebo, significantly more of the 209 evaluable patients reported headache relief at I h (56% vs 8%, p < 0.001) and 2 h (62% vs 15%, p < 0.001) after the first injection. Resolution of nausea, photophobia, and phonophobia was significantly more common in patients on sumatriptan than in those on placebo ( p < 0.001 for all comparisons). The adverse events were usually transient and of mild or moderate severity; however, three patients withdrew due to adverse events. Ninety-five percent of patients evaluated by a neurology resident met the IHS criteria for migraine. Conclusion. In general practice, sumatriptan taken subcutaneously using an autoinjector at home was an effective and well tolerated acute treatment for migraine.
High-Dose Riboflavin as a Prophylactic Treatment of Migraine: Results of an Open Pilot Study
Authors: Schoenen J , Lenaerts M , Bastings E
Published: March 2003

If the brain of migraineurs is characterized between attacks by a reduction of mitochondrial phosphorylation potential, riboflavin, which has the potential of increasing mitochondrial energy efficiency, might have prophylactic effects in migraine. In this preliminary open pilot study, 49 patients suffering from migraine (45 without aura, 4 with aura) were treated with 400 mg of riboflavin as a single oral dose for at least 3 months. Twenty-three patients received in addition 75 mg of aspirin. Mean global improvement after therapy was 68.2% and there was no difference between the two groups of patients. With the exception of one patient in the riboflavin plus aspirin group who withdrew because of gastric intolerance, no drug-related side effects were reported. High-dose riboflavin could thus be an effective, low-cost prophylactic treatment of migraine devoid of short-term side effects. A placebo-controlled trial of its efficacy seems worthwhile.
Menstrual Migraine is Not Pathogenetically Related to Premenstrual Syndrome
Authors: Gupta VK
Published: March 2003

Facchinetti and colleagues present epidemiological evidence regarding comorbidity between menstrual migraine and premenstrual syndrome, and suggest that premenstural symptoms should be incorporated in the diagnostic criteria for menstrual migraine (1). The crux of the matter, however, should be the concern regarding the nature or biological significance of the common neuroendocrine link of transient and cyclic failure of endogenous opioid activity in both premenstrual syndrome and menstrual migraine patients. Is this a primary event of pathogenetic importance (which would merit inclusion in the definition) or the concomitant side effect of a carefully orchestrated adaptive mechanism?
Spontaneous and 5HT-Induced Cyclic Contractions in Superficial Temporal Arteries from Chronic and Episodic Cluster Headache Patients
Authors: Mathjan P , Brochet B , Boulan P , Henry P , Aubineau P
Published: March 2003

Superficial temporal arteries (STAs) are abnormally dilated in the painful side during cluster headache (CH) attacks. We have assessed the possible dysfunction of these arteries by comparing in vitro the reactivity of STAs removed from the painful side of CH patients during a cluster of attacks with that of STAs from patients free of CH. The responses to KC1 and norepinephrine (NE) of both types of arteries were similar. Serotonin (5HT) induced a classical dose-dependent constriction in arteries from non-CH patients, but systematically triggered rhythmic contractions in arteries from episodic CH patients. Arteries from chronic CH patients also showed spontaneous rhythmic contractions. In both cases, this activity was stopped by calcitonin gene-related peptide (CGRP) but, even in the presence of CGRP, it could be restored by low concentrations of 5HT. Thus, 5HT, unlike NA, can trigger rythmic activity in STAs of CH patients and may play a major role in CH through abnormal smooth muscle cell reactivity.
Nitroglycerin-Induced Headache is Not Dependent on Histamine Release: Support For a Direct Nociceptive Action of Nitric Oxide
Authors: Iversen HK , Olesen J
Published: March 2003

The molecular mechanisms of migraine pain have not yet been clarified. Monoamine and the peptide neurotransmitters involved in neurogenic inflammation do not cause significant head pain. Our previous studies of glyceryl trinitrate (GTN) and histamine-induced headaches have suggested that nitric oxide (NO) is the causative molecule in migraine pain. We furthermore suggest that substances capable of inducing experimental vascular headache do so via a common mediator which is NO. Finally, it is suggested that drugs exert their antimigraine activity by inhibiting NO or subsequent steps in the cascade of intracellular reactions triggered by NO. These novel observations change current views on vascular headache mechanisms and the importance of NO as an initiator of the migraine attacks dictates new approaches to the pharmacological treatment of migraine and other vascular headaches.
The Blink Reflex in Chronic Tension-Type Headache, Migraine, and Cervicogenic Headache
Authors: Sand T , Zwart JA
Published: March 2003

R1 and R2 blink reflex latencies were investigated blind in 10 patients with cervicogenic headache, 11 patients with chronic tension-type headache, 11 patients with migraine, and 9 headache-free controls. There were no R1 or R2 latency differences between the four groups. The latency of R1 increased significantly with headache duration in tension-type headache patients. Shorter R1 latencies were found on the symptomatic side than on the non-symptomatic side in cervicogenic headache patients. The results suggest that a state of hyperactivity may be present in the ipsilateral trigeminal nucleus in cervicogenic headache. Hypoactivity, however, may develop over time in tension-type headache.
Internal Ophthalmoplegia Associated with Migraine Attacks
Authors: Leone M , Grazzi L , Moschiano F , Bussone G
Published: March 2003

The case of a young woman presenting with repeated headache episodes associated with right eye midriasis is described. CT scan, MR of the brain and selective cerebral angiography were unremarkable. Tyramine eyedrop response suggested parasympathetic hypofunction on the affected side. The diagnosis of ophthalmoplegic migraine is proposed.
5HT2 Receptors in Cerebral Cortex of Migraineurs Studied Using PET and 18F-Fluorosetoperone
Authors: Chabriat H , Tehindrazanarivelo A , Vera P , Samson Y , Pappata S , Boullais N , Bousser MG
Published: March 2003

Since the brain 5HT2 receptors might be implicated in migraine pathogenesis, we have used positron emission tomography and 18F-fluorosetoperone, a 5HT2 specific radioligand, to investigate in vivo the cortical 5HT2 receptors in migraine subjects. Nine migraineurs who had either migraine with and without aura ( n = 5) or only migraine without aura ( n = 4) were studied between attacks. Twelve unmedicated healthy subjects of similar mean age were used as controls. Brain radioactivity was measured after 18F-setoperone IV injection for 90 min. A decrease of the regional specific distribution volumes (SDV) of the ligand was observed both in migraineurs and in controls. The age adjusted group means of SDV did not differ between patients and controls for the whole and for the right or left frontal, temporal, parietal and occipital cortex. These results suggest that cortical 5HT2 receptors may be unaltered between attacks in migraine sufferers.
Cerebral Blood Flow Velocities are Reduced During Attacks of Unilateral Migraine Without Aura
Authors: Thomsen LL , Iversen HK , Olesen J
Published: March 2003

It has been disputed whether or not large intracranial arteries are dilated during migraine attacks. In order to answer this question the present transcranial Doppler study focused on side-to-side differences of middle cerebral artery blood velocity during unilateral attacks of migraine without aura in 25 patients. Blood velocity in the middle cerebral artery was lower on the headache side (59 cm/s) than on the non-headache side (65 cm/s) during the migraine attack. No such difference was found outside of attack (65 cm/s both sides). The difference (headache side minus non-headache side) was on average -6.1 cm/s during attack compared to -0.4 cm/s outside of attack ( p = 0.01). Assuming that rCBF is unchanged during attacks of migraine without aura, our results suggest a 9% increase in middle cerebral artery lumen (cross-sectional area) on the affected side during unilateral attacks of migraine without aura. The findings, however, do not necessarily mean that arterial dilatation is the only or even the most significant cause of pain.
Contingent Negative Variation During Migraine Attack and Interval: Evidence for Normalization of Slow Cortical Potentials During the Attack
Authors: Kropp P , Gerber W-D
Published: March 2003

The contingent negative variation (CNV) amplitudes of 16 subjects with migraine without aura were studied during pain-free intervals and during attacks and the results were compared with those of 22 healthy subjects. In 32 trials the CNV amplitudes were calculated for (a) “total interval”, (b) “early CNV component”, (c) “late CNV component”, and (d) habituation. There was a significantly higher total CNV amplitude in migraine subjects during pain-free intervals compared to that of the healthy subjects and migraine patients during an attack. Healthy subjects as well as subjects studied during the attack showed a significant habituation whereas migraine subjects studied during pain-free intervals did not. This suggests that the higher CNV amplitude in migraine patients studied between pain-free attacks may be due in part to impaired habituation.
Non-Invasive Trigeminal Evoked Potentials: Normative Aging Data
Authors: Polich J , Dalessio DJ , Aung M , DeYarman M
Published: March 2003

A mild electric shock applied to the lower lip was used to elicit reliable evoked potentials from the trigeminal nerve in 50 normal adults who ranged in age from 20 to 69 years. The waveforms were morphologically similar to those observed with invasive procedures. No substantial effects for subject age, side of stimulation, or recording electrode were obtained for any of the individual trigeminal evoked potential amplitudes or latencies. Female subjects tended to have somewhat larger amplitudes and shorter latencies than male subjects. The results suggest that non-invasive procedures produce reliable evoked potential measures of trigeminal nerve function for patients of all ages.
Cluster Headache Attacks Treated for Up Three Months with Subcutaneous Sumatriptan (6 mg)
Authors: Ekbom K , Krabbe A , Micelli G , Prusinski A , Cole JA , Pilgrim AJ , Noronha D
Published: March 2003

In the first three months of a 24–month open study to assess the safety and efficacy of subcutaneous sumatriptan 6 mg in the long-term acute treatment of cluster headache, 138 patients treated a maximum of two attacks daily each with a single 6 mg injection. A total of 6353 attacks were treated. Adverse events, reported in 28% of sumatriptan-treated attacks, were qualitatively similar to those seen in migraine long-term trials. Their incidence did not increase with frequent use of sumatriptan. There were no clinically significant treatment effects on vital signs, ECG recordings or laboratory parameters. Headache relief (a reduction from very severe, severe or moderate pain to mild or no pain) at 15 min was obtained for a median of 96% of attacks treated. There was no indication of tachyphylaxis, decrease in the speed of response, or increased frequency of attacks with long-term treatment. This study demonstrated that, in long-term use, subcutaneous sumatriptan 6 mg is a well-tolerated and effective acute treatment for cluster headache.
Migraine and Stroke in Childhood and Adolescence
Authors: Wöber-Bingöl Ç , Wöber C , Karwautz A , Brandtner M Feucht S , Scheidinger H
Published: March 2003

Over 3 years we evaluated two patients, an adolescent and a child, with migraine-like headache and ischemic stroke. Based on our clinical observations and on liter: review of migraine and stroke in the pediatric age group, we believe that the criteria of migrainous infarction outlined by the International Headache Society (IHS) could be occasionally too restrictive Therefore, we suggest subclassifying migrainous infarction into: (i) “definite”, referring to the patient: ischemic stroke fulfills all the IHS criteria, (ii) “possible”, referring to ischemic strokes which I 1 some, but not all, criteria. This subclassification of migrainous infarction may be relevant in cal practice and in human research studies.
The Neuroendocrine Challenge Paradigm in Headache Research
Authors: Gordon ML , Lipton RB , Brown S-L , Praag HM van
Published: March 2003

The neuroendocrine challenge paradigm provides a “window” on central neurotransmitter function in vivo. This strategy is based on the premise that the sensitivity of certain central receptors can be inferred from the magnitude of the hormonal response to specific pharmacologic probes. For example, the serotonin (5HT) receptor agonist m-chlorophenylpiperazine (m-CPP) stimulates the release of cortisol and prolactin and induces migraine-like headaches. We have previously reported that the headache and cortisol responses to m-CPP are highly correlated, which may implicate a disturbance in central serotonergic neurotransmission in the pathogenesis of migraine. As pharmacologic probes with greater specificity for 5HT receptor subtypes become available, we may be able to elucidate these mechanisms with greater precision. The neuroendocrine challenge methodology is also applicable to the study of other neurotransmitter systems and other headache disorders.
Magnetic Resonance Spectroscopy in Migraine
Authors: Montagna P
Published: March 2003

31-phosphorus Magnetic Resonance Spectroscopy (MRS) is a technique developed for the non-invasive study of energy metabolism in living subjects. It determines the concentrations of high and low energy phosphates in resting and activated conditions, and of intracellular pH. 31P-MRS has been applied to the study of migraine, both during and in between attacks. Intracellular brain pH remains unchanged during the migraine attack, suggesting that ischemia does not play a relevant role in the origin of the neuro-logical signs. During and in-between attacks, migraineurs display abnormalities in energy metabolism of brain and muscle, consisting of reduced levels of phosphocreatine, reduced cellular-free energy and increased rate of ATP biosynthesis. We suggest that these abnormalities in energy metabolism predispose migraineurs to develop an attack under conditions of increased brain energy demand.