bluuebunny/crossref_metadata_2025 huggingface dataset:
Post Gamma Knife Headache: A New Headache Syndrome?
Authors: Rozen Todd D. , Swanson Jerry W.
Published: March 2003

Gamma knife surgery has become an effective alternative to microsurgery in the treatment of cerebral arteriovenous malformations. In a number of patients, a de novo headache syndrome has been produced after gamma knife surgery. A case report is presented of a 62‐year‐old man who developed a migrainous type headache 15 months after gamma knife surgery. The current neurosurgical literature has very poor documentation of postsurgical headaches. A review of the literature was made to try to identify a stereotypic “post gamma knife headache,” as well as hypothesize about its mechanism of induction.
The Menstrual Cycle and Migraine: A Time‐Series Analysis of 20 Women Migraineurs
Authors: Lokken Cami , Holm Jeffrey E. , Myers Tricia Cook
Published: March 2003

This study examined the prevalence of menstrually related headache and the relationship between the menstrual cycle and stress in a group of young women migraineurs sampled from a general population. Participants (N=20) meeting International Headache Society1 criteria for migraine with or migraine without aura and not meeting criteria for menstrual migraine, provided daily headache activity, perceived stress, cognitive appraisal, and coping strategy data during two menstrual cycles. Multiple regression was used to analyze these data following a time‐series approach in which the phases of the menstrual cycle were used as predictors of variation in each participant’s headache, stress, appraisal, and coping data. Analyses revealed that fewer participants than expected showed significant relationships between their menstrual cycle and their headache activity (20%). However, for these women the amount of variation explained by the menstrual cycle was substantial. We suggest that, though some women’s migraines vary with their menstrual cycle, the number of women substantially affected may be much smaller than has been estimated in the literature. Relationships between the menstrual cycle and the stress process were also found; however, inconsistencies between this and a previous study in our laboratory 2 suggest that the nature of this relationship may vary across women migraineurs.
Twenty‐Four‐Hour Effectiveness of BMS 180048 in the Acute Treatment of Migraine Headaches
Authors: Ryan R.E. , Elkind A. , Goldstein J.
Published: March 2003

The efficacy of BMS 180048, a 5HT, agonist in the acute treatment of a migraine headache, was evaluated in 216 patients. Three doses of the study drug were compared to placebo. Patients received a single test dose in the physician’s office while being evaluated with a Holter monitor during a headache‐free day. They then treated a migraine headache with a single dose of the study drug as an outpatient. The 150 mg and 200mg doses of BMS were significantly superior to placebo on change in pain intensity at 2 hours. Patients treated with BMS 180048 had a longer duration of response than placebo‐treated patients. At the 24hour point, only 24% of the 150mg group and 25% of the 200mg group had relapsed, compared to placebo which had a 42% relapse rate. It is concluded that BMS 180048 is an effective compound for the treatment of migraine headaches with a prolonged duration of response.
The Site of Common Side Effects of Sumatriptan
Authors: Solomon Seymour , Lipton Richard B. , Newman Lawrence C.
Published: March 2003

Atypical sensations following the use of subcutaneous sumatriptan are common, but of uncertain origin. They are almost always benign, but can be mistaken for a serious adverse event by the patient. Two patients are presented with tingling or burning sensations limited to areas of heat exposure or sunburn. In these individuals, side effects are most likely generated superficially in the skin.
Chronic Intractable Headache in a Patient With Marfan's Syndrome
Authors: Fukutake T. , Sakakibara R. , Mori M. , Araki M. , Hattori T.
Published: March 2003

A 30‐year‐old woman with Marfan's syndrome had chronic intractable headaches and spontaneous intracranial hypotension. The pain was concentrated over the occipitonuchal region, had elements of both migraine and tension headache, and was often aggravated by postural change. Myelography showed multiple, large, lumbosacral arachnoid diverticula. Radioisotope cisternography revealed a halolike accumulation in the lumbosacral region and rapid uptake of isotope in the urinary bladder, indicating cerebrospinal fluid leakage. Epidural blood patching brought immediate relief from the positional headaches. We concluded that patients with Marfan's syndrome and undifferentiated chronic headaches should be radiologically evaluated for spinal meningeal defects.
Recurrent Branch Retinal Infarcts in Association With Migraine
Authors: Beversdorf David , Stommel Elijah , Allen Col n , Stevens Rosalind , Lessell Simmons
Published: March 2003

Migraine has been blamed for a variety of temporary and permanent visual complications. We describe the case of a young woman with migraine who suffered recurrent episodes of retinal infarction, one of which occurred during an attack of migraine. The infarctions resulted from occlusions of branches of the central retinal artery Extensive laboratory and radiological investigations failed to establish a nonmigrainous etiology. In some individuals, migraine may cause or promote branch retinal vaso‐occlusion and infarction.
Methylergonovine Maleate as a Cluster Headache Prophylactic: A Study and Review
Authors: Mueller Loretta , Gallagher R. Michael , Ciervo Carman A.
Published: March 2003

Methylergonovine maleate (Methergine®), an ergot derivative with vasoconstrictive properties, has been cited as an effective treatment for vascular headaches. Few studies are available to support its use in headache management. An uncontrolled pilot study of 20 episodic cluster headache patients confirmed its effectiveness and tolerability as an adjunct cluster headache prophylactic. Decreased headache frequency was reported by 19 of 20 patients (95%), and 15 of 20 patients (75%) reported decreased intensity of headaches within 1 week of initiating therapy. A review of methylergonovine's pharmacokinetic, molecular, and tolerability profile clarifies its mechanisms and clinical role in headache management.
Photophobia and Phonophobia in Migraineurs Between Attacks
Authors: Main Alan , Dowson Andrew , Gross Michael
Published: March 2003

This study investigated whether migraineurs are more sensitive to light and sound while headache‐free than are: healthy people. Fifty‐two migraineurs (mean age 39 years) were selected using the International Headache Society diagnostic criteria for migraine. Forty‐eight healthy controls were matched for age, sex, and race (mean age 36 years). Visual and auditory discomfort thresholds were measured by exposing subjects to increasing light and sound until then complained of discomfort. There were significant differences; between groups in both the light discomfort threshold (P<0.90005) and the hearing discomfort threshold (P<0.0005) The thresholds for both were lower in the migraineurs.

Overall, for both groups together, there was a significant negative correlation between light discomfort threshold and age (correlation coefficient ‐0.2276, P=0.011), but not for the hearing discomfort threshold and age (P=0.275).

The results show that the migraineurs were significantly more sensitive to light and sound when headache‐free than were healthy controls. The apparent increased intolerance to light in both groups together noted with increased age, did not apply to the migraine group.
Painful Trigeminal Neuropathy: Clinical and Pharmacological Observations
Authors: Khurana Ramesh K. , Mayer Richard F.
Published: March 2003

A 74‐year‐old woman had a 5‐year history of constant burning pain and numbness of the central face of subacute onset. The central region of the face, oral cavity, and nose lacked all sensation. Corneal reflexes and the jaw jerk were absent. Blood tests, rectal biopsy, neurodiagnostic studies, and surgical exploration of the trigeminal nerve were normal. Blink reflexes were absent. Facial nerve motor latencies and EMG of the facial and masseter muscles were normal. Responses to the thermoregulatory sweat test, intradermal histamine, and simulated diving wore present. Oral administration of 500 mg dopa aggravated her pain and produced transient hypalgesia in the C2 through C5 dermatomes. Infraorbital nerve biopsy demonstrated loss of large myelinated fibers.

In conclusion: (1) Only the central region of the face is enclusively supplied by the trigeminal nerves. (2) Somato‐autonomic reflexes coupled with electrophysiological studies Iocalized the lesion to the large fibers. (3) Large fiber loss and central brain stem reorganization may explain the burning pain. (4) Dopamine may modulate trigeminal nociception.
Cerebral Blood Flow in Chronic Posttraumatic Headache
Authors: Gilkey Stephanie J. , Ramadan Nabih M. , Aurora Taruna K. , Welch KMA
Published: March 2003

Background and Purpose.‐Headache is the most common neurologic symptom following minor closed head injury. There is often a lack of objective evidence supporting an organic basis of cerebral pathology in these cases. This pilot study considers the possibility of alterations in cerebral blood flow, indicating evidence of an organic disorder in posttraumatic headache.

Methods.‐Regional cerebral blood flow studies of 35 patients with chronic posttraumatic headache (PTH) (International Headache Society criteria), identified retrospectively from our cerebral blood flow data base, were compared with those of 49 nonheadache controls and 92 migraineurs (Ad Hoc Committee criteria). Regional cerebral blood flow (initial slope index method) was measured using the xenon Xe 133 inhalation technique.

Results.‐Compared to migraineurs and controls, and after adjusting for differences (analysis of covariance) in baseline variables such as blood pressure, hematocrit, and Pco 2 , patients with PTH had: (1) significantly lower mean initial slope indices (P<0.001, P=0.002, respectively); (2) regional interhemispheric flow differences (rlFD), with higher distribution of regional asymmetrical probe pairs (rIFD≥7%: P[PTH versus control]=0.006, P[PTH versus migraine]=0.016; rIFD≥10%: P[PTH versus control]=0.011, P[PTH versus migraine]=0.003]; and (3) more hemispheric asymmetries (P[PTH versus control]=0.023, P[PTH versus migraine]=0.57). Lower mean initial slope indices and hemispheric asymmetry (mean interhemispheric flow difference ≥3.2%) predicted PTH over control (P=0.023 and 0.002, respectively). Lower mean initial slope indices predicted PTH over migraine (P=0.002).

Conclusions.‐Patients with PTH have reduced regional cerebral blood flow, and regional and hemispheric asymmetries. These cerebral hemodynamic alterations support an organic basis to chronic posttraumatic headache.
Quantitative Assessment of the Tension‐Type Headache and Migraine Severity Continuum
Authors: Schade Auke J.
Published: March 2003

Two quantitative measures for Waters'1 tension‐type head ache and migraine severity continuum are proposed. To ensure face validity, symptoms and precipitants of this disorder were compiled from the literature as a basis for the Auckland Migraine and Headache Inventory. This inventory was completed by 84 participants (mean age ± SD, 26.0 ± 9.7 years; range, 18 to 59 years) who complied with the criteria of the International Headache Society, for migraine of tension‐type headache. The migraine headache index and the number of precipitants were derived from the Auckland Migraine and Headache Inventory. These scores yielded significant internal reliability ( r s =.77 and .84), test‐retest reliability ( r s =.86 and .74), and concurrent validity ( r s =.57) coefficients. The data, therefore, support the notion that the migraine headache index and the number of precipitants are reliable and valid indices of tension‐type headache and migraine severity, suitable for participant selection and assessment of treatment. This study offers support for Waters'1 suggestion that tension‐type headache and migraine are extremes of a severity continuum.
Chronic Paroxysmal Hemicrania Presenting as Otalgia With a Sensation of External Acoustic Meatus Obstruction: Two Cases and a Pathophysiologic Hypothesis
Authors: Boes Christopher J. , Swanson Jerry W. , Dodick David W.
Published: March 2003

Objective.—To describe two cases of chronic paroxysmal hemicrania manifested by otalgia with a sensation of external acoustic meatus obstruction and to suggest that the trigeminal‐autonomic reflex is a mechanism for the sensation of ear blockage.

Background.—Maximum pain in chronic paroxysmal hemicrania is most often in the ocular, temporal, maxillary, and frontal regions. It is less often located in the nuchal, occipital, and retro‐orbital areas. Review of the literature on chronic paroxysmal hemicrania found no reports of pain primarily localized to the ear and associated with a sensation of external acoustic meatus obstruction.

Methods.—The history, physical examination, imaging studies, and successful treatment plan in two patients with otalgia and ear fullness and a subsequent diagnosis of chronic paroxysmal hemicrania are summarized.

Results.—The first patient was a 42‐year‐old woman with a 10‐year history of unilateral, severe, paroxysmal otalgia occurring five times a day with a duration of 2 to 60 minutes. During an attack, the ear became erythematous and the external acoustic meatus felt obstructed. There were no other associated autonomic signs. The second patient was a 49‐year‐old woman with a 3‐year history of unilateral, severe, paroxysmal otalgia occurring 4 to 15 times a day with a duration of 3 to 10 minutes. During an attack, her ear felt obstructed, and she noted ipsilateral eyelid edema and ptosis. Both patients quickly became pain‐free after taking indomethacin and required its continued use to prevent headache recurrence.

Conclusions.—Chronic paroxysmal hemicrania may be manifested by otalgia with a sensation of external ear obstruction. When the otalgia is paroxysmal, unilateral, severe, frequent, and associated with autonomic signs, one should consider the diagnosis of chronic paroxysmal hemicrania, especially because of the prompt response to indomethacin. The most important feature to consider when making the diagnosis of chronic paroxysmal hemicrania is the frequent periodicity of discrete, brief attacks of unilateral cephalgia separated by pain‐free intervals. It is hypothesized that the sensation of ear obstruction in these patients is due to swelling of the external acoustic meatus mediated through increased blood flow by the trigeminal‐autonomic reflex.
Primary Headaches in HIV‐Infected Patients
Authors: Mirsattari Seyed M. , Power Christopher , Nath Avindra
Published: March 2003

Headache in patients with human immunodeficiency virus (HIV) infection may indicate life‐threatening illnesses such as opportunistic infections or neoplasms. Alternatively, such patients may develop benign self‐limiting headaches. Hence, defining the various types of headache in these patients is essential for proper management. This study describes the clinical characteristics of primary headaches occurring in a group of HIV‐infected patients. Of 115 patients seen from 1990 to 1996, 44 (38%) had headaches. Primary headaches were present in 29 (66%) patients and secondary causes were identified in 15 (34%). Among those with primary headaches, migraine occurred in 22 (76%), tension‐type headache in 4 (14%), and cluster headache in 3 (10%) patients. Half of those with migraine (n=ll), 1 patient with tension‐type headache, and 1 patient with cluster headache developed chronic daily headaches which were severe and refractory to conventional headache or antiretroviral therapy. We conclude that primary headaches in patients with HIV infection are: (1) the commonest type of headache; (2) may present for the first time in individuals with severe immunosuppression; (3) usually bear no relationship to antiretroviral drug therapy; (4) polypharmacy, depression, anxiety, and insomnia are commonly associated comorbidities; (5) frequently do not respond to conventional management and carry a poor prognosis; and (6) do not require neuroradiological and/or cerebrospinal fluid evaluations.
Selective Serotonin Reuptake Inhibitors for Migraine Prophylaxis
Authors: Landy Stephen , McGinnis Judy , Curlin Dana , Laizure S. Casey
Published: March 2003

The objective of this study was to assess the efficacy of sertraline in migraine prophylaxis. Other selective serotonin reuptake inhibitors have been studied for migraine prophylaxis, but this is the first report with sertraline. Twenty‐seven subjects were enrolled and baseline assessment of migraine frequency and severity were measured over a 4‐week period. Subjects were then randomized to receive placebo or sertraline in a double‐blind fashion with headache frequency and severity measured over an 8‐week period. Subjects completed a daily diary reporting the occurrence, severity, and degree of impairment associated with migraine.

The headache index, a composite measure of migraine frequency and severity, scores did not significantly improve between assessments at baseline (20.8 ± 14.88), 8 weeks (17.6 ± 12.27), and 12 weeks (16.7 ± 6.38) in the treatment group (n=6) (P=0.956). This finding is compared to other studies with the serotonin selective reuptake inhibitors, fluoxetine, fluvoxamine, and paroxetine. The authors believe that the selective serotonin reuptake inhibitors are not as effective as conventional migraine prophylaxis medications such as β‐blockers, tricyclic antidepressants, or divalproex sodium, but that in patients with comorbid depression who have failed conventional therapy selective serotonin reuptake inhibitors may be effective.
Fasting Headache, Weight Loss, and Dehydration
Authors: Mosek Amnon , Korczyn Amos D.
Published: March 2003

Recently, we showed that fasting is a strong headache precipitator unrelated to coffee, tea, or smoking withdrawal or to oversleeping. In the current study, we evaluated the role of dehydration as a possible precipitator of fasting headache. The effects of a 25‐hour fast of the Jewish Yom Kippur (Day of Atonement) were studied in women who participated in our previous Yom Kippur study. We asked the subjects to weigh themselves at the beginning and at the end of the Yom Kippur fast, assuming that the weight loss would largely reflect dehydration. In all but 1 of the 56 participants, the fast resulted in weight loss but only 28 (50%) reported headache. The average weight loss was 1.4 ± 0.8 kg in those who developed headache and 1.2 ± 0.5 kg in those who did not. This small difference was not statistically significant. We conclude that dehydration, as reflected by acute weight loss, is an unlikely cause of headache during a single day of fasting. The mechanism of fasting headache remains unclear.
Hyperthyroidism Mimicking Increased Intracranial Pressure
Authors: Herwig Uwe , Sturzenegger Matthias
Published: March 2003

We report a 32‐year‐old woman presenting with progressive symptoms of increased intracranial pressure and slight enlargement of the ventricles on CT scan. The underlying cause was hyperthyroidism due to Graves' disease. With treatment to correct the hyperthyroid state, all symptoms rapidly disappeared. The rare onset of hyperthyroidism with symptoms indicating intracranial hypertension, and the possible pathophysiologic mechanisms are discussed.
Pharmacokinetics of Rizatriptan Tablets During and Between Migraine Attacks
Authors: Cutler Neal R. , Jhee Stanford S. , Majumdar Anup K. , McLaughlin Debra , Brucker Mary Jo , Carides Alexandra D. , Kramer Mark S. , Matzura‐Wolfe Deborah , Reines Scott A. , Goldberg Michael R.
Published: March 2003

Gastric stasis during migraine attacks results in delayed absorption of several orally administered antimigraine agents. This study, as part of a larger trial, was conducted to examine the pharmacokinetics of rizatriptan tablets during and between migraine attacks. Participating patients met IHS criteria for migraine with or without aura, and suffered between one and eight migraines per month for the previous 6 months. In part 1 of the study, 21 patients were randomized to receive a single 5‐mg tablet of rizatriptan or placebo in the migraine‐free state. In part 2, the same patients were treated during migraine with rizatriptan 5‐mg tablets (n=18) or placebo (n=3). Blood samples were obtained before dosing and 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, and 12 hours after dosing. The plasma concentration profile (ie, AUC(0‐∞), Cmax, Tmax) of rizatriptan 5‐mg tablets administered during and between migraine attacks were comparable. The median Tmax for rizatriptan between and during attacks was 1 hour, indicating rapid absorption even during a migraine attack. Rizatriptan 5 mg was well tolerated and 67% of the patients experienced headache relief 2 hours postdose.
Chronic Inflammatory Demyelinating Polyneuropathy Presenting With Headache and Papilledema
Authors: Morrison Karen E. , Davies Paul T.G.
Published: March 2003

Chronic inflammatory demyelinating polyneuropathy is a disorder typified clinically by motor and sensory neuropathy of at least 2 months' duration and pathologically by multifocal inflammatory demyelination. Its usual presentation is with features reflecting the polyneuropathy, namely limb weakness with hyporeflexia or areflexia and sensory symptoms of glove and stocking distribution.

In this report, we detail the course of a 53‐year‐old man who presented to our neurological service with a severe headache in association with papilledema. The initial diagnosis considered was of possible primary intracranial pathology. Two months later, he developed limb weakness and sensory symptoms typical of chronic inflammatory demyelinating polyneuropathy. His headache, papilledema, and limb symptoms responded to oral corticosteroid therapy, the standard treatment for this type of neuropathy. We hypothesize that his headache and papilledema were due to the elevated cerebrospinal fluid protein level as a result of the polyneuropathy. To our knowledge, this is the first report of headache being a prominent and early symptom of this disorder.
Late‐Life (Migrainous) Scintillating Zigzags Without Headache: One Person's 27‐Year Experience
Authors: Fisher C. Miller
Published: March 2003

Background.—Episodes of typical scintillating zigzags similar to the visual aura of migraine may occur without headache, especially after the age of 50. There is no record of one individual's long‐term experience.

Present Material.—This paper is a personal account of all 41 episodes of scintillating zigzags that occurred between the ages of 59 and 85. Observations were made on several aspects of the visual event itself—evolution, pattern, scotoma, coloration, duration, lateralization, etc. The chronological distribution of spells, circumstances of occurrence, time of day, the season, etc were noted. The study was observational in nature. Documentation of this experience could be of value clinically and scientifically.

Results.—The spells occurred irregularly, unrelated to season, time of day, activity at onset, diet, and temperamental state. The characteristic appearance was a flickering zigzag line that began centrally and migrated to the periphery. The display, which was stereotyped, was achromatic. The average duration was 15 minutes. Both visual fields were equally involved, never at the same time. The details of the scintillating zigzag line are actually complex and an account of the observations of others and of the author is included here.
Dramatic Headache Relief After Sumatriptan in a Patient With a Pituitary Macroadenoma
Authors: Shah AK. , Freij W.
Published: March 2003

We are reporting an interesting case of pituitary macroadenoma. The patient presented with sudden, bifrontal, pulsating headache; photophobia; and an abducens nerve palsy, due to extension of the tumor into the cavernous sinus region. The headache resolved completely after a subcutaneous injection of sumatriptan.
Psychiatric Comorbidity Is Related to Headache Induced By Chronic Substance Use in Migraineurs
Authors: Radat Francoise , Sakh Dina , Lutz Gina , Amrani Mohamed El , Ferreri Maurice , Bousser Marie‐Germaine
Published: March 2003

Headache centers have to deal with patients suffering from headache induced by chronic substance use which is a well‐recognized complication of migraine treatment. The objective of this study was to compare psychiatric comorbidity between migraineurs with and without chronic substance use: 34 migrainous inpatients with chronic substance use were compared with 34 sex‐matched noncomplicated migraineurs in a case‐control study. The results showed a significantly higher prevalence of major depressive disorder, panic disorder, and social phobia in the patients with a history of chronic substance use. Consistently, anxious and depressive dimensions were significantly higher in these patients. Therefore, psychiatric morbidity may be linked to chronic substance use in migraineurs. This stresses the importance of psychiatric assessment and the need for appropriate treatment in such patients.
Diagnosis of Migraine in Children Attending a Pediatric Headache Clinic
Authors: de Grauw Ton J. , Hershey Andrew D. , Powers Scott W. , Bentti Anna‐Liisa
Published: March 2003

The International Headache Society (IHS) criteria for migraine are not sufficient to diagnose migraine in children. Specifically, the duration and localization of the headache are different in children and adults with migraine. This study compared the formal IHS criteria with pediatric‐amended IHS criteria and IHS criteria with the duration factor removed in children younger than 18 years. In addition, the older criteria by Vahlquist and by Prensky and Sommer were also compared. Finally, clinical diagnosis of migraine was compared with IHS criteria with the duration factor removed.

The study showed that many children with a shorter duration headache have migraine and also that a number of children with a very long duration of headaches still fit the diagnosis of migraine. Unilateral headache is quite uncommon. The majority of children with migraine complained of bilateral headaches.

It is concluded that the IHS criteria for pediatric migraine should be revised. We suggest making the duration factor a minor criteria for migraine in children or to exclude headaches lasting longer than 72 hours only in children younger than 15 years.
Naratriptan in the Prophylaxis of Transformed Migraine
Authors: Sheftell Fred D. , Rapoport Alan M. , Coddon David R.
Published: March 2003

We report three patients with transformed migraine, previously refractory to a wide variety of traditional preventive pharmacologic and nonpharmacologic interventions. Naratriptan 2.5 mg given each morning, with a second tablet allowed for breakthrough headache, at least 4 hours later, demonstrated a remarkable reduction in frequency and intensity of daily headache. In addition, a subjective improvement in quality of life and restoration of functioning including a decrease in missed workdays was noted. All three patients had previously experienced good responses to sumatriptan or zolmitriptan, but were limited in frequency of use by the authors. The patients were not experiencing rebound phenomena at the onset of treatment with naratriptan. Clinical responses were noted within 3 to 7 days of initiation of treatment. Traditional risk factor analysis and screening were performed. Naratriptan was extremely well tolerated, with no cardiovascular adverse events reported or observed. Possible mechanisms of action are discussed.
Cluster Headache. Premonitory Symptoms
Authors: Raimondi Elsa
Published: March 2003

The emergence of symptoms which may precede by days the onset of a series of painful attacks of cluster headache is not often reported in the medical literature. In this report, four patients who described these premonitory symptoms are presented. The importance of premonitory symptoms is emphasized, for they provide a means to institute an early prophylactic therapy and the possibility of clarifying the physiopathology of this primary headache.
Influence of Colors on Habituation of Visual Evoked Potentials in Patients With Migraine With Aura and in Healthy Volunteers
Authors: Áfra J. , Mascia A. , Genicot R. , Albert A. , Schoenen J.
Published: March 2003

Objective.– To investigate whether colored glasses influence the habituation of visual evoked potentials.

Background.– We have previously shown that during pattern‐reversal stimulations lasting 2 minutes the amplitude of the visual evoked potential increases in migraine with and without aura between attacks, whereas it decreases in healthy volunteers. Red light was found to increase visually evoked EEG fast activity only in children with migraine with aura. Wearing rose‐tinted glasses for 4 months decreased attack frequency in parallel with a reduction of the visually evoked EEG fast activity.

Methods.– We compared the change in amplitude of the visual evoked potential using five different tinted glasses in 12 patients with migraine with aura and in 10 healthy volunteers. During continuous stimulation at 3.1 Hz, five blocks of 50 responses were sequentially averaged using red, yellow, green, blue, and grey glasses and without glasses in a random order and analyzed in terms of latencies and N1‐P1 amplitudes. Amplitude changes were calculated for each block by comparison with the first block in every condition and analyzed statistically using Zerbe's method.

Results.– In healthy volunteers, the visual evoked potential amplitude increased with red glasses compared to without glasses (P=.05) or with green glasses (P=.03). In patients with migraine with aura, no significant difference was detected using colored glasses. Our findings in healthy volunteers are in line with earlier reports of increased excitability of the human visual cortex when exposed to red light. The lack of such a pattern in patients with migraine with aura suggests that the visual cortex is interictally hypoexcitable rather than hyperexcitable, which is consistent with studies of transcranial magnetic stimulation.
Rizatriptan Tablet Versus Wafer: Patient Preference
Authors: Adelman James U. , Mannix Lisa K. , Von Seggern Randal L.
Published: March 2003

After taking both conventional oral rizatriptan tablets and oral disintegrating rizatriptan tablets in the treatment of migraine with or without aura, patients were permitted to select their formulation preference. All adult patients who had requested continuation of rizatriptan during a 6‐month period were included in the study. Of the 367 patients studied, 188 selected the oral disintegrating tablet, while 179 preferred the conventional tablet. Although individual patients had strong preferences for one preparation over the other, no group preference was found.
Treatment of Chronic Daily Posttraumatic Headache With Divalproex Sodium
Authors: Packard Russell C.
Published: March 2003

Objective.—To determine the effectiveness of divalproex sodium in the treatment of chronic daily posttraumatic headaches.

Background.—Divalproex sodium has been found to be useful for the treatment of migraine and chronic daily headache. No studies have been done to evaluate effectiveness in posttraumatic headache.

Methods.—A retrospective review was done of 100 patients treated with divalproex for chronic daily posttraumatic headache of 2 months or longer.

Results.—Sixty percent of patients with chronic posttraumatic headache had mild to moderate improvement in their headaches after at least 1 month of divalproex sodium. Forty percent either showed no response (26%) or discontinued treatment because of side effects (14%). Fifty‐eight percent of patients showing improvement had a change in headache pattern from daily to episodic.

Conclusions.—Divalproex sodium appears to be safe and effective for treatment of patients with persistent, chronic daily posttraumatic headaches.
Sumatriptan for Headache Caused by Head and Neck Cancer
Authors: Manfredi Paolo L. , Shenoy Sachin , Payne Richard
Published: March 2003

The use of sumatriptan for the treatment of migraine and cluster headache is well established. Sumatriptan has also been reported to be effective for the treatment of postdural puncture headache, postictal headache, and headache related to intravenous immunoglobulin infusion. We report two patients with headache caused by locally invasive head and neck cancer relieved by oral sumatriptan.
Assessing the Impact of Migraine on Health‐Related Quality of Life: An Additional Use of the Quality of Well‐being Scale–Self‐administered
Authors: Sieber William J. , David Kristin M. , Adams Jim E. , Kaplan Robert M. , Ganiats Theodore G.
Published: March 2003

Objectives.—To compare the interviewer‐administered Quality of Well‐being Scale (QWB) with a self‐administered form (QWB‐SA) for patients with migraine, and to compare the health status of migraineurs to other medical populations.

Background.—With the increasing need to document the cost‐effectiveness of treatment for migraine, limitations with both the Medical Outcomes Study Short Form‐36 items and the QWB have been an impediment to research using cost‐effectiveness as an outcome. Demonstrating the sensitivity of an alternative instrument which addresses these limitations would facilitate cost‐effectiveness analyses on treatments for migraine.

Methods.—Eighty‐nine adults (87% women) known to suffer from migraine were asked to complete both the interviewer‐administered QWB and the self‐administered version (QWB‐SA) on three occasions. The first occasion was on a day when no migraine was experienced in the previous 7 days. The second and third assessments were completed within 48 hours of the onset of a migraine.

Results.—While both the QWB and the QWB‐SA successfully distinguished migraine from nonmigraine days, more migraines were reported on the QWB‐SA. Overall, both instruments showed similar patterns of patient dysfunction during a migraine attack. Each component of the QWB‐SA successfully distinguished migraine from nonmigraine days, and the QWB‐SA showed a linear sensitivity to pain intensity and disability during a migraine episode. Both instruments are able to detect a migraine's effect on multiple domains of quality of life. Study participants scored significantly lower on the QWB‐SA during a migraine episode than several comparison medical populations.

Conclusions.—The QWB and the QWB‐SA appear to have sensitivity to migraine severity, and the ability to quantitate an effect in multiple quality‐of‐life domains. Both measures can be used to calculate quality‐adjusted life‐years, thus facilitating cost‐effectiveness and health policy work in this important clinical area.
Evaluating HIV‐Infected Patients With Headache: Who Needs Computed Tomography?
Authors: Gifford Allen L. , Hecht Frederick M.
Published: March 2003

Objective.—To empirically test a clinical prediction rule for evaluating HIV‐infected patients complaining of headache and to identify those at low risk for intracranial mass lesion who do not need immediate computed tomography of the head.

Design.—Two retrospective clinical cohorts of HIV‐infected patients clinically evaluated for headache.

Methods.—To describe the headache clinical outcomes, medical records were abstracted from all HIV‐infected patients evaluated for headache with computed tomography of the head at two urban hospitals. Patients were categorized as low, intermediate, or high risk based on clinical criteria (focal neurological signs, altered mental status, history of seizure) and immune status (CD4 lymphocytes≤200/μL). Records were abstracted from a second unselected cohort of HIV‐infected outpatients with headache who were all treated and followed in primary care (N=101).

Results.—Of 101 unselected HIV‐infected outpatients followed in primary care after headache, 1% (95% confidence interval [CI], 0% to 6%) had a treatable intracranial lesion. Of 364 HIV‐infected patients with headache sent for evaluation with computed tomography of the head, the rate of any abnormality was zero in the low‐risk group (95% CI, 0% to 10%; n=35); 9% in the intermediate‐risk group (95% CI, 2% to 16%; n=242); and 21% in the high‐risk group (95% CI, 12% to 29%; n=87).

Conclusion.—Most HIV‐infected patients with headache may be treated with analgesics and followed up clinically. Those without focal neurological signs, altered mental status, seizure, or decreased CD4 lymphocytes are unlikely to have intracranial mass lesions.
Tension‐type Headache and Stressful Events: The Role of Selective Memory in the Reporting of Stressors
Authors: Wittrock David A. , Foraker Shannon L.
Published: March 2003

This study examined evidence for the role of selective memory for stressful events in women with headache. Previous studies have reported that on retrospective measures of stress, those with tension‐type headache report more stressful events and rate the events as more stressful than did headache‐free controls. However, when ratings are made concurrently, participants with headache and controls did not differ in their ratings of equivalent stressors presented in the laboratory. One theory for why differences are found in stress ratings made retrospectively, but not concurrently, is that selective memory biases recollection of past events in patients with headache. This study compared self‐report ratings of stressful events and their perceived impact made either concurrently or retrospectively to determine if selective memory might explain the discrepancies found in earlier studies. Participants included 20 patients with tension‐type headache and 22 headache‐free controls. Participants were compared on hourly, daily, and weekly measures of stressors and their perceived impact via hourly and nightly visual analog scale ratings, the Daily Stress Inventory, and the Weekly Stress Inventory. If support was to be offered to the hypothesis that selective memory biases the retrospective memory of patients with headache, then an interaction between group assignment (ie, headache versus control group) and time of rating would be expected. No such interaction occurred. Results from the study suggest that all participants have a tendency to overestimate stress on retrospective measures, but that patients with headache do not do so at a significantly different rate than do headache‐free controls. The alternative hypothesis that patients with headache tend to appraise everyday events as more stressful is supported.
Valproic Acid Is Effective in Migraine Prophylaxis at Low Serum Levels: A Prospective Open‐Label Study
Authors: Kinze Stephan , Clauss Michael , Reuter Uwe , Wolf Tilo , Dreier Jens Peter , Einhäupl Karl Max , Arnold Guy
Published: March 2003

Objective.—We evaluated the efficacy of prophylactic valproic acid treatment (6 months) on the frequency of migraine attacks and the number of migraine headache days with respect to serum levels.

Background.—Valproic acid, a GABAergic drug, has been shown to be effective for migraine prophylaxis. Results from several dose‐ and serum level‐adjusted studies have recommended valproic acid doses within a range of 500 to 1500 mg per day for migraine prophylaxis.

Design and Methods.—In this prospective open‐label study, 52 patients received valproic acid doses of 300 to 1200 mg per day; 45 patients were treated per protocol. Valproic acid serum levels increased linearly in relation to the valproic acid dose and were between 21 and 107 μg/mL at the end of the treatment period. Patients were divided into two groups: those with valproic acid serum levels less than 50 μg/mL (group 1) and those with serum levels greater than 50 μg/mL (group 2).

Results.—The frequency of migraine attacks was significantly reduced in group 1 from 3.5 ± 0.9 to 2.0 ± 0.9 attacks per month. Migraine headache days also decreased (6.4 ± 3.5 to 4.6 ± 2.9 days per month). In the high serum level group, a reduction of migraine attacks from 3.5 ± 0.9 to 2.8 ± 1.0 attacks per month and only a slight decrease in headache days (6.4 ± 3.5 to 6.1 ± 2.4 days per month) was observed. The outcome of group 1 (low serum level) was significantly better than that of group 2 with respect to both parameters (P<.05). Side effects were generally mild and temporary.

Conclusions.—Due to the lack of additional benefit from higher valproic acid doses (more than 600 mg per day), we recommend daily valproic acid doses of 500 to 600 mg with a target serum level less than 50 μg/mL for the prophylactic treatment of migraine.
Prevalence of Migraine in Croatia: A Population‐Based Survey
Authors: Zivadinov Robert , Willheim Ksenija , Jurjevic Ante , Sepic‐Grahovac Dubravka , Bucuk Mira , Zorzon Marino
Published: March 2003

Objectives.—The aim of the present study was to estimate the prevalence of migraine among Croatian adults. This is the first epidemiological study of migraine in Croatia in which the operational diagnostic criteria of the International Headache Society have been applied.

Methods.—The study population consisted of all residents (aged 15 to 65 years) of Bakar, County of The Coast and Gorski Kotar, Croatia. A population‐based survey was undertaken using a “face‐to‐face, door‐to‐door” interview method. The participation rate was 73.3%. All participants were screened for headache history according to the International Headache Society criteria. Headache screen positive responders (65.7%) were interviewed by trained medical students with a structured detailed interview focused on migraine.

Results.—A total of 720 lifetime migraineurs were identified. The lifetime prevalence of migraine was 22.9% (95% confidence interval, 20.9 to 25.1) in women, 14.8% (95% confidence interval, 13.1 to 16.8) in men, and 19% (95% confidence interval, 17.6 to 20.5) in both sexes. The highest lifetime prevalence of migraine was in women in the age group 40 to 49 years (38.1%). Among 636 active migraineurs, 399 (62.7%) were women and 237 (37.3%) were men; 55.8% had migraine without aura, 35.2% migraine with aura, and 6.9% migraine both with and without aura. The 1‐year prevalence of migraine, migraine without aura, migraine with aura, and migraine both with and without aura in women was 18%, 11.3%, 8.6%, and 2.2%, respectively. In men, the 1‐year prevalence of migraine, migraine without aura, migraine with aura, and migraine both with and without aura was 12.3%, 7.3%, 3%, and 0.7%, respectively.

Conclusions.—The prevalence of migraine in this Croatian population showed rates quite similar to those reported in neighboring countries, such as Italy and France. Further studies are needed to estimate the prevalence rates of migraine in the total Croatian population.
Olanzapine as an Abortive Agent for Cluster Headache
Authors: Rozen Todd D.
Published: March 2003

Objective.—To evaluate olanzapine as a cluster headache abortive agent in an open‐label trial.

Background.—Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs.

Methods.—Olanzapine was given as an abortive agent to five patients with cluster headache in an open‐label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5‐mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose.

Results.—Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache‐free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness.

Conclusions.—Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache.
Persistent Migrainous Visual Phenomena Might Be Responsive to Lamotrigine
Authors: Chen Wei‐Ta , Fuh Jong‐Ling , Lu Shiang‐Ru , Wang Shuu‐Jiun
Published: March 2003

Two patients with migraine reported having experienced persistent auralike visual phenomena for months to years. All laboratory investigations were normal except for occipital hypoperfusion on the brain single photon emission computed tomography. After lamotrigine treatment for 2 weeks, they both had a resolution of the visual symptoms. Persistent migrainous visual phenomena are potentially benign and probably a status of spontaneous aura.
Information About Migraine Disability Influences Physicians' Perceptions of Illness Severity and Treatment Needs
Authors: Holmes William F. , MacGregor E. Anne , Sawyer James P.C. , Lipton Richard B.
Published: March 2003

Objective.—To assess physician‐patient communication about headache‐related disability and to evaluate the influence of information about disability on physicians' perceptions of illness severity and the treatment needs of migraineurs.

Background.—Evidence suggests that migraine is suboptimally treated in clinical practice, partly due to poor communication between physicians and their patients.

Methods.—One hundred five neurologists and primary care physicians with an interest in headache participated in two interactive surveys, one in North America (n=42) and one in Europe (n=63). Each survey focused on the evaluation of four videotaped migraine cases. The first case was evaluated twice, initially after a typical symptom history that centered on diagnosis and then following a fuller history of migraine disability. Additional questions assessed the extent of the collection of migraine disability information in clinical practice.

Results.—Physicians reported that they recorded symptoms relating to diagnosis (eg, pain location/intensity, associated symptoms) rather than information on headache‐related disability. Only about one third of patients volunteered disability information. When made available to them, physicians rated information on disability as one of the most important factors in assessing treatment needs. In particular, when physicians knew the patient's disability history: (1) the proportion of physicians who rated the patient's illness as “severe” increased by 128% in North America, 27% in Europe; (2) the proportion of physicians who recommended immediate treatment increased by 63% in North America, 37% in Europe; and (3) the proportion of patients recommended for a follow‐up visit increased by 15% in North America, 18% in Europe.

Conclusions.—Physicians and patients often fail to discuss headache‐related disability during consultation. This information has a powerful influence on physicians' perceptions of illness severity, treatment choice, and the need for follow‐up. Tools to improve communication about headache‐related disability, such as the Migraine Disability Assessment questionnaire, may favorably improve migraine management.