bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional Cerebral Blood Flow (rCBF) in Migraine During the Interictal Period: Different rCBF Patterns in Patients With and Without Aura
Authors: Facco E , Munari M , Baratto F , Behr AU , Dal Palu A , Cesaro S , Giacomini M , Giron G
Published: March 2003

The aim of this study was to evaluate the rCBF (133Xe clearance method) in migrainous patients free from attack. Fifty patients suffering from migraine without aura (group M) and 20 suffering from migraine with aura (group MA) (age range 20-50 years) were submitted to 32 channel rCBF mapping during the interictal period. The rCBF data of patients were compared with those obtained from 60 healthy control subjects (group C) and 21 patients suffering from tension-type headache (group TH). The mean (average of all channels) rCBF values were: group M=70.5 ± 13.7ml/100g/min; group MA=56.6 ± 11.4ml/100g/min; group C=62.3 ± 8.3ml/100g/min; group TH=62.1 ± 8.4ml/100g/min (F=11.93; p<0.001). As expected, patients belonging to group TH had a normal rCBF. The mean rCBF of group M was significantly higher than that of groups C and TH, while in group MA it was significantly lower than in groups C and TH. Group M showed a diffuse hyperemia, while group MA showed rCBF values significantly lower than normal in posterior regions, according to aura. Our results suggest that: (a) the rCBF pattern in migrainous patients is different from that in both controls and TH patients, even during the interictal period; (b) patients suffering from migraine with and without aura are two distinct subpopulations with opposite rCBF deviations.
Work-Related Disability: Results From the American Migraine Study
Authors: Stewart WF , Lipton RB , Simon D
Published: March 2003

Migraine headache is a highly prevalent, often severely painful and frequently disabling disorder. The indirect costs related to disability greatly exceed the direct cost of medical care. The objective of this paper is to describe work-related disability associated with migraine headache and predictors of disability. In a two-stage survey of the US population, we estimate missed workdays and impairment at work in a sample of 1663 migraine sufferers, age 18 years and older. Lost workday equivalents (LWDE) was derived as the sum of actual missed workdays and the product of percentage effectiveness at work and days at work with the most severe headache. Overall, reported actual lost workdays and reduced effectiveness at work contributed approximately equally to total LWDE. A total of 51.1% of females and 38.1% of male migraineurs experienced six or more LWDE per year. This subgroup of migraine sufferers accounted for about 90% of the total LWDE experienced by all respondents. Among women, headache duration was the strongest predictor of LWDE followed by less significant associations with number of symptoms and pain level. Among men, only pain level was significantly associated with LWDE. Among sociodemographic factors, disability was more likely among older (40+) subjects and less likely among individuals with higher education and higher income (females only), even after adjusting for headache features. Health-care interventions may yield the greatest individual benefit (by reducing pain and disability) and the greatest societal benefit (by reducing indirect costs) if they are directed to those who account for the greatest proportion of disability.
Platelet Serotonin Pathway in Menstrual Migraine
Authors: Fioroni L. , D'Andrea G , Alecci M , Cananzi A , Facchinetti F
Published: March 2003

In order to understand the possible 5-hydroxytryptamine (5HT) anomalies in migraine, particularly in the period before the headache attack, we compared the levels of 5HT, its stable metabolite 5-hydroxyindoleacetic acid (5HIAA) and platelet monoaminoxidase (MAO) activity in patients with menstrual migraine with those of healthy female controls. In every subject, blood samples were drawn during both follicular and late luteal phases of the menstrual cycle. In controls, platelet 5HT levels remained stable, whereas 5HIAA levels and MAO activity were higher in the luteal than in the follicular phase, suggesting an increased catabolism of 5HT which occurs physiologically just before menses. In menstrual migraine 5HIAA levels and MAO activity showed similar changes with higher values in the luteal than in the follicular phase. The luteal phase values were significantly higher than those of controls. Also, and in contrast to controls, 5HT levels decreased in the luteal phase. These data suggest that 5HT availability is reduced in menstrual migraine, possibly due to an increased catabolism and/or to a reduced synthesis, and hence predisposes patients to migraine attacks.
Cyclandelate in the Prophylaxis of Migraine
Authors: Diener HC , F”h M , laccarino C , Wessely P , Isler H , Stienge H , Fischer M , Wedekind W , Taneri Z
Published: March 2003

Cyclandelate inhibits calcium-induced contraction of vascular smooth muscle cells, platelet aggregation induced by thrombin, platelet-activating-factor and adenosine, and also suppresses a provoked 5HT release from platelets. This pharmacological profile suggests that cyclandelate may have a potential prophylactic effect in migraine. To test this hypothesis, a double-blind multicentre study was performed in 214 patients to investigate the efficacy and tolerability of cyclandelate compared to placebo and propranolol. After a 4-week baseline period, eligible patients (randomization 3:2:3) were treated for 12 weeks with daily doses of 1.200 mg cyclandelate ( n=81), placebo ( n=55) or 120 mg propranolol ( n=78). The number of migraine attacks (350% responders) and the migraine duration/month were compared based on the difference between baseline and the last 4 weeks of prophylactic treatment. The percentage of patients with a reduction in migraine attacks of 350% treated with cyclancelate (37.0%) or propranolol (42.3%) was not significantly superior to placebo (30.9%; P>0.025). The mean duration of migraine in hours (h) per month decreased in both active treatment groups (cyclandelate: 36.8h, p=0.046; propranolol: 34.4 h, p=0.039) compared to placebo (13.7 h) without reaching statistical significance (alpha/2=0.025). The clinical efficacy of cyclandelate and propranolol was comparable. Adverse experiences were reported by 13 patients (16.0%) treated with cyclandelate, by 5 patients (9.1%) treated with placebo and by 19 patients (24.4%) treated with propranolol. These were drug-related in 7.1% ( n=6) of patients treated with cyclandelate and in 9% ( n=7) of patients treated with propranolol. In summary, cyclandelate has a comparable efficacy to that of propranolol an established drug of first choice in the prophylaxis of migraine. Both drugs were better than placebo, but not significantly so. Both active treatments were well tolerated. ÿ box
A Sixth-Century Irish Headache Cure and Its Use in a South German Monastery
Authors: Isler H , Hasenfratz H , O'Neill T
Published: March 2003

Medieval headache treatment is largely unknown. Medieval incantations against headache enumerate bodily organs to be protected. One 8th-century Latin hymn from Lake Constance using this device is addressed to St. Aid “mechprech”, who has been identified as Aed Mac Brice, Bishop of Killare, 6th century. This Irish Saint inspired unusual legends by some rather unorthodox activities: He abducted a young girl as hostage while his inheritance was withheld, but at the same time was seen surrounded by angels. He prayed for a nun who was pregnant and made the pregnancy vanish by a miracle, and he replaced the severed heads of maids, men and horses, creating a new spring as a by-product of this operation. Already at his birth his head had hit a stone, leaving a hole in the stone which collected rainwater that cured all ailments. In our own time, such “bullaun stones” are still believed to cure headache in Ireland. According to the legends collected by Plummer and Co1man, St. Aed Mac Bricc was well known for his power to cure headaches. He relieved St. Brigid's headache when she was suffering many miles away, but his most impressive cure was in convincing a headache sufferer that the patient's headache could actually be transferred to his own head. The headache hymn or incantation is intended to repeat Aed's unique miracle.
Brain MRI in Children with Migraine
Authors: Hämäläinen ML , Autti T , Salonen O , Santavuori P
Published: March 2003

Sixteen children and adolescents, aged 5-17 years, with migraine and 24 migraine-free age-matched healthy volunteers underwent brain MR1 (1.0 T). Signal intensities of the brain, midsagittal and coronal diameters of the brainstem were quantitatively measured. General signal intensities did not differ between the groups. Compared to controls (17%), more migraine patients (50%) had high-signal foci on T2-weighted images. The diameters of the pons were greater in the migraine group ( p=0.016), although within the normal range. The diameters of the mesencephalon and the medulla oblongata did not differ between the groups, perhaps because they reach the adult size in early, childhood in contrast to the pons, which continues to grow. Childhood migraine may be associated with slightly more than average growth of the ports. As the pathophysiology of migraine is still unclear it might be worth studying with new MR methods.
Histamine Inhalation is a Specific but Insensitive Laboratory Test for Migraine
Authors: Lassen LH , Heinig JH , Oestergaard S , Olesen J
Published: March 2003

Migraine is a subjective complaint and no laboratory test has until now been of value. The aim of the present study is to evaluate whether histamine inhalation may be used as a diagnostic test for migraine. In a double blind study design, 15 migra neurs and 15 control subjects scored headache intensity and characteristics before, during, and in the subsequent 12 h after inhalation of increasing doses of histamine (0, 2, 4, 8, 16, 32 and 64 mg/ml). During the histamine inhalations, headaches increased dose-dependently in both groups Eleven of the migraineurs and eight of the healthy controls experienced headaches after the inhalations These headaches fulfilled the IHS criteria for migraine without aura in six of the migraineurs, but in none of the control subjects. Using this as a test parameter, the specificity of the test was 1, but the sensitivity was only 0.4. Our results indicate that histamine inhalation is a specific but insensitive laboratory test for migraine. Migraineurs should be informed about the risk of a migraine attack being provoked before histamine inhalation in pulmonary laboratories.
Verbal Scales in the Acute Treatment of Migraine
Authors: Massiou H , Tzourio C , EI Amrani M , Bousser MG
Published: March 2003

Verbal scales are currently used as efficacy parameters in acute migraine trials. In order to determine the correlation between headache intensity, functional disability, and relevant pain reduction, 100 patients completed a questionnaire. Our results showed that a verbal scale of headache intensity alone has different implications from one that includes pain intensity and functional ability. The reduction from a moderate to a mild headache was satisfactory to only 15% of the patients. In contrast, 77% of patients were satisfied when the headache intensity was reduced from severe to mild. These findings imply that, in assessing the efficacy of drugs used for migraine, a redaction in pain intensity from moderate to mild should not be considered as a good outcome.
Cerebrovascular Reactivity in Migraine During Headache-Free Intervals
Authors: Totaro R , Marini C , De Matteis G , Di Napoil M , Carolei A
Published: March 2003

Alterations of intracranial vessel tone have been implicated in the pathophysiology of migraine. The cerebrovascular reactivity was measured by means of transcranial Doppler in 60 migraine patients with ( n = 30) or without aura ( n = 30) during the headache-free interval and in 30 healthy controls. The vasomotor response was evaluated during hypercapnia induced by inhalation of a mixture of CO2 5% and O2 95% and during hypocapnia obtained after voluntary hyperventilation. To improve the power of the study in detecting possible abnormalities of cerebrovascular reactivity, two different measures were performed at 1 week intervals in migraine patients and controls. Reactivity index values during CO2 inhalation were significantly different ( p=0.01) among the three groups during the first and second measurements; in particular, lower values were found in patients suffering from migraine without aura with respect to controls ( p<0.05, Scheffe's test). Values of reactivity index obtained following induction of hypocapnia did not differ between migraine patients and controls (all p values >0.05). Our data suggest a reduced vasodilatory response to hypercapnia of cerebral arterioles in patients suffering from migraine without aura with respect to controls that might be related to baseline arteriolar vasodilation.
Prevalence of Sleep Disorders in Childhood and Adolescence with Headache
Authors: Bruni O , Fabrizi P , Ottaviano S , Cortesi F , Giannotti F , Guidetti V
Published: March 2003

Although a relationship between headache and sleep disturbances has been reported in adults, only few data have been available in children. Accordingly, we performed a survey to determine the prevalence of sleep disturbances in children with migraine and tension-type headache. A questionnaire of history and clinical data and of sleep disturbances was given to parents of 283 headache subjects (164 with migraine and 119 with tension-type headache). Results were compared to a normative group comparable for age and sex of 893 normal healthy subjects. Migraine subjects showed a higher prevalence of sleep disturbances during infancy as well as 3-month colic. In both headache groups, more parents had sleep disturbances and there was a higher occurrence of co-sleeping and napping. A high frequency of sleep disturbances involving sleep quality, night awakening, nocturnal symptoms and daytime sleepiness was reported in headache children. No statistical differences were found in the prevalence of sleep disturbances between migraine and tension-type headache. However, the migraine group tended to have “disturbed sleep” more often with increased prevalence of nocturnal symptoms such as sleep breathing disorders and parasomnias. Our results give further support to an association between sleep and migraine that may have a common intrinsic origin.
Intravital Microscope Studies on the Effects of Neurokinin Agonists and Calcitonin Gene-Related Peptide on Dural Vessel Diameter in the Anaesthetized Rat
Authors: Williamson DJ , Hargreaves RJ , Hill RG , Shepheard SL
Published: March 2003

This study describes a novel intravital microscope technique for direct measurement of dural blood vessel diameter through a closed cranial window in anaesthetized rats. This technique avoids removal of the skull which can lead to problems o altered vessel reactivity and brain swelling that are encountered with open cranial window techniques. Substance P and calcitonin gene-related (CGRP) evoked increases in dura vessel diameter, which were abolished by the NK1 receptor antagonist, RP67580 and the CGRP receptor antagonist, human-CGRP(8–31) respectively. Neurokinin A produced increases in dural vessel diameter which were unaffected by the NK2 receptor antagonist SR 48968 but were blocked by RP67580, suggesting that neurokinin A can act through NK1 receptors to produce dural vasodilation in rats. The NK3 receptor agonist, senktide, had no effects on dural vessel diameter. All drugs were administered intravenously. In humans, vasodilation within the meningeal vasculature has been implicated in the pathogenesis of migraine, the present experiments indicate that substance P or neurokinin A (both acting through NK1 receptors) or CGRP may be responsible.
Regional Cerebral Blood Flow and Oxygen Metabolism during Migraine with and Without Aura
Authors: Andersson JLR , Muhr C , Lilja A , Valind S , Lundberg PO , Långström B
Published: March 2003

Eleven cases of migraine with and without aura were investigated with positron emission tomography (PET). Regional cerebral blood flow (rCBF), oxygen metabolism (rCMRO2) and oxygen extraction (rOER) were measured during baseline ( n = 11), aura ( n = 6), headache ( n = 10) and after treatment with sumatriptan ( n = 4). Data were analysed using and ROI-based approach from 26 different anatomically defined regions, and also an exploratory approach whereby all subjects were normalized to a stereotactic brain atlas; t-maps were constructed by depicting significant changes between states. The exploratory approach revealed a region corresponding to the primary visual cortex with significant reductions in rCBF (23.1%) and rCMRO2 (22.5%), but no change in rOER during the headache phase compared to baseline. These data suggest that cerebral ischemia was not the primary cause of the attacks in these cases.
Peripheral Vascular Effects and Pharmacokinetics of the Antimigraine Compound, Zolmitriptan, in Combination with Oral Ergotamine in Healthy Volunteers
Authors: Dixon RM , Meire HB , Evans DH , Watt H , On N , Posner J , Rolan PE
Published: March 2003

Members of the new class of antimigraine compounds, 5HT1B/1D agonists, as well as ergotamine, may cause vasoconstriction through stimulation of 5HT receptors on peripheral vessels. The cardiovascular effects of 20 mg oral zolmitriptan (Zomig, formerly 311C90), 2 mg oral ergotamine and the combination were assessed in a randomized double-blind, placebo-corirolled crossover study in 12 healthy subjects. Pharmacodynamic measures included oscillometric blood pressure, systolic blood pressure at the toe and arm using a strain gauge technique, stroke volume and cardiac output using bioimpedance cardiography, high-resolution ultrasound to measure brachial arterial diameter and a novel Doppler method to measure blood flow velocity. Both drugs produced small degrees of peripheral vasoconstriction, including increases in diastolic blood pressure and blood flow velocity and decreases in arterial diameter and toe-arm systolic pressure gradient. These effects were generally additive with the combination but of no clinical importance. There were no significant changes in cardiac output, stroke volume heart rate or ECG. Zolmitriptan, at eight times the likely therapeutic dose, was generally well tolerated both alone and in combination with ergotamine. Ergotamine had no clinically important effects on zolmitriptan pharmacokinetics. Ergotamine, migraine, peripheral vasculature, pharmacokinetics, zolmitriptan
Outcome of Early School-Age Migraine
Authors: Metsähonkala L , Sillanpää M , Tuominen J
Published: March 2003

We studied the outcome of migraine from early school-age to prepuberty in a group of 84 children. The children belonged to a population-based, unselected follow-up sample of a 1-year age cohort. At the age of 8 to 9 years, 95 (2.7%) children of this age cohort had migraine according to a postal questionnaire. At age 11 to 12 years, 84 of them were traced and interviewed face-to-face. Only four (4.8%) of these children no longer had headache. Fifty-three (63.1%) children had migraine. Seventeen (20.2%) had migraine-type headache which did not completely fulfil the International Headache Society criteria for migraine, seven (8.3%) children had episodic tension-type headache and three (3.6%) had other headache. Among the children who had migraine at age 11 to 12, boys had significantly more frequent migraine attacks than girls (mean 2.7/month versus 1.8/month; p=0.016). They also used more drugs and were more frequently absent from school because of headache than girls, but these differences were not significant. Problems in the relationships between parents seemed to be another factor associated with frequent migraine.
Simultaneous Recording of Pattern Reversal Electroretinograms and Visual Evoked Potentials in Migraine
Authors: Shibata K , Osawa M , Iwata M
Published: March 2003

We recorded full-field pattern seversal electroretinograms (PERGs) and visual evoked potentials (PVEPs) simultaneously in 15 migraine with aura, 14 migraine without aura patients during the interictal period, and in 23 sex- and age-matched normal subjects. All subjects had normal visual fields. The visual aura in all patients was hemianopsia or fortification spectra. Neither migraine group showed significant differences from normal in latency and amplitude of PERGs. In migraine with aura, the amplitudes of PVEPs in classic migraine at the mid-occipital electrode were significantly ( p<0.01) higher than normal. PVEP amplitudes were significantly ( p<0.01) high or on the contralateral side of the aura than the ipsilateral side in both visual aura and normal subjects, but there was no significant difference in latency. This high amplitude and asymmetry of PVEPs may contribute to defective inhibition between interhemispheric visual occipital areas or striate and peristriate areas.
The Reproducibility of Cephalic Pain Pressure Thresholds in Control Subjects and Headache Patients
Authors: Sand T , Zwart JA , Helde G , Bovim G
Published: March 2003

Pain pressure thresholds (PPT) were measured at 13 cephalic points bilaterally in 30 headache patients (10 with tension-type headache, 10 with migraine and 10 with cervicogenic headache) and 10 control subjects on three different days. During the sessions, the subjects reported their pain intensity on the right and left sides of the head on a visual analogue scale (VAS). The variability between days was estimated as a coefficient of repeatability (CR=2 standard deviations of intraindividual differences). The mean CR across all 13 locations was larger in headache patients (2.0 kg/cm2) than in controls (1.68 kg/cm2). Variability (CR) was larger in headache patients as compared to control subjects for 11 of the 13 points (p=0.02). Reliability was better in controls (intraclass correlation coefficients (ICC) ranging from 0.55 to 0.85) than in headache patients (ICC ranging from 0.43 to 0.78). A moderate negative association between PPT and pain intensity was demonstrated. The intraindividual PPT difference (PPT on the most painful occasions-PPT on the least painful occasions) was negative at 12 of 13 cephalic points (p=0.003, across-location mean difference: -0.20 kg/cm2). The PPT differed significantly from one day to the next. A part of this variation was presumably related to the circumstances around the procedure; thresholds were lower when the subjects came directly to algometry without any preceding medical examination at all 13 points (p=0.0002). These results have implications for the planning of future algometer studies. The sample size that is required in studies of headache patients is greater than that in studies of healthy subjects, especially when patients suffer from pain during the PPT session. Particular attention should be paid to circumstances (e.g. preceding medical investigations) around the algometry procedure in order to reduce variability.
Frequency of Severe Attacks in Migraine Sufferers of the Gazel Cohort
Authors: Michel P , Dubroca B , Dartigues JF , El Hasnaoui A , Henry
Published: March 2003

The concept of severe migraine was raised to define migraineurs most in need of care and for use in clinical practice. We aimed to measure the frequency of severe attacks in a working sample of 276 migraine sufferers using a diary over a 3-month period. Migraine sufferers recorded each attack's clinical features, the degree of their disability, their use of drugs and the effectiveness of the drugs. Since the definition of severe attack is not standardized, we studied the impact of different definitions on the frequency. The frequency of severe attacks was 0.9% and appeared to be very sensitive to the definitions, ranging between 0.4 and 13%. In France, the extrapolated number of severe attacks is nearly one million out of a total of 115 million. In the migraineurs who had had at least one severe attack, the individual variability of intensity, duration or disability was very high, so the proportion of severe attacks in a given sufferer was low—between 15% and 50%. We conclude that the global concept of severe migraine is not relevant and should be split into two componentssevere attack and severe migraine sufferer. The goals are different, too. Regarding treatment, for example, the severe attack concept is more valid for acute treatment strategies, whereas the severe migraine sufferer concept should be preferred to determine the need for prophylactic treatment. Since much work is being done nowadays to define a rate treatment strategies, definition of the criteria of severe attack and validation of a measurement tool should be a priority.
Reliability of an Illness Severity Measure for Headache in A Population Sample of Migraine Sufferers
Authors: Stewart WF , Lipton RB , Simon D , Von Korff M , Liberman J
Published: March 2003

Objectives: To examine the reliability and related measurement properties of an illness severity measure for headache derived from responses to a 16-item self-administered questionnaire, the Headache Impact Questionnaire (HImQ), and to determine if there is support for combining measures of pain and disability into a single scaled measure of severity.

Methods: A population-based sample of migraine headache sufferers completed the HImQ twice, an average of 38 days apart. The HImQ included questions about number of headaches in the last 3 months, headache duration, last headache, pain intensity (two questions), need for bedrest (two questions), disability in specific domains of activity (seven questions about interference with ability to work, do household chores, and engage in non-work activity), and symptoms (two questions).

Results: Test-retest correlations of individual questions ranged from 0.65 to 0.93. In principal components analysis, a single factor with significant loading emerged. One measure of pain intensity (average pain score from 0 to 10) and items related to disability (i.e., missed days due to headache, and reduced effectiveness because of headache) in defined activity domains (work for pay, housework, nonwork activities) had the greatest weights on this single factor, supporting prior work on combining measures of pain and disability into a single scale. The HImQ score was derived as the sum of average pain intensity and total lost time in each of the three domains of activity, expressed as lost days. The latter was derived as the sum of actual missed days in each activity domain and reduced effectiveness day equivalents in each activity with a headache. The test-retest correlation was 0.77 for all eligible subjects and 0.85 when one influential outlier was removed. Cronbach's alpha was 0.83.

Conclusions: The HImQ score, based on eight items, is a highly reliable and internally consistent measure of headache severity.
An Interregional Comparative Study of Headache Clinic Populations
Authors: Mendizabal JE , Rothrock JF
Published: March 2003

We present a comparative study between headache clinic populations from 2 inherently different regions of the United States. Using standardized methods, 1 of us (JFR) prospectively evaluated 578 new patients attending the headache clinic at the University of California in San Diego. In a similar manner, we subsequently evaluated 115 new patients presenting to the headache clinic at the University of South Alabama in Mobile, Alabama. We found few differences between the 2 populations. These differences more likely reflect regional variations in healthcare delivery or methodologic artifact than intrinsic dissimilarities.
Oculosympathetic Alterations in Migraine Patients
Authors: De Marinis M , Assenza S , Carletto F
Published: March 2003

Oculosympathetic function was studied in 20 headache-free migraine patients and in 20 controls. Pupillary investigation was performed under basal conditions, and after instillation of tyramine (2%) and phenylephrine (1%) eyedrops. Each test was performed twice shortly after a spontaneous attack and then repeated after 7 and 15 days. In the patients, the normal mydriatic response induced by tyramine was significantly ( p< 0.001) reduced and phenylephrine instillation caused a significant ( p< 0.01) pupillary dilatation in both the assessments performed shortly after the attack. These abnormal responses were bilateral in all patients and slightly anisocoric in some. They were significantly ( p< 0.001) more pronounced in the patients who had pain and pronounced vascular features. The reduced oculosympathetic response to tyramine, as well as the hypersensitivity to phenylephrine, was less evident 7 days after the attack and absent after 15 days. A transient and bilateral post-ganglionic oculosympathetic hypofunction, with adrenoceptor hypersensitivity, was found to be temporally related to the migraine attack, regardless of the side or predominant side of pain.
Medication Patterns of Recurrent Headache Sufferers: A Community Study
Authors: Forward SP , McGrath PJ , MacKinnon D , Brown TL , Swann J , Currie EL
Published: March 2003

This community-based telephone survey determined medication patterns of 274 frequent headache sufferers who reported 12 or more headaches a year. Headaches were classified using the International Headache Society's (IHS) criteria. Participants reported on 465 types of headaches: 129 tension headaches, 158 migraine headaches, 8 chronic tension headaches, and 148 headaches which were unclassifiable using IHS criteria. Females ( n=133) reported an average of 1.9 types of headache and males ( n=141) reported 1.5 headache types. Fifty-six percent of respondents used acetaminophen for tension-type and 60% used acetaminophen for migraine. One percent used prescription medication for tension headache and 12% used prescriptions for migraine. The perceived effectiveness of over-the-counter medication was approximately 7 on a scale of 0–10 for tension headaches and 6 for migraine. Both tension-headache and migraine-headache sufferers waited about 1 h before taking any medication. Tension-headache sufferers waited until the headache was above 5 on a 0 to 10 scale (4.6 for migraine). It is possible that more aggressive use of medication might improve headache management.
Endothelin in Migraine Patients
Authors: Kallela M , Färkkilä M , Saijonmaa O , Fyhrquist F
Published: March 2003

Endothelins (ETs) are the most potent vasoconstrictors known, and may be the mediators of the vasoconstrictive phase in migraine attacks. We studied 31 previously selected migraine patients with (9) and without (22) aura ictally and interictally to determine their plasma ET-1 values. The mean interictal and ictal values were 5.3 pg/ml (SD 1.8) and 6.4 pg/ml (SD 3.9), respectively. The ictal values were markedly elevated at the beginning of the migraine attack (<2 h) and declined to interictal or even lower level later (4 to 6 h) in the course of an attack. The local vasoconstriction at the beginning of a migraine attack might be ET-mediated secondarily to serotonin activation.
Efficacy and Adverse Events of Subcutaneous, Oral, and Intranasal Sumatriptan Used for Migraine Treatment: A Systematic Review Based on Number Needed To Treat
Authors: Tfelt-Hansen P
Published: March 2003

Objectives: To evaluate the efficacy, speed of onset, and adverse events of 6 mg subcutaneous, 100 mg oral, and 20 mg intranasal sumatriptan in the treatment of migraine attacks.

Design: Systematic review of placebo-controlled randomized clinical trials.

Data sources: Thirty trials up to April 1997 retrieved from a systematic literature search (Medline, review papers, handsearching of journals, congress proceedings, manufacturer's database); no restriction on language.

Outcome parameters: Numbers needed to treat (NNT) were calculated for relief of headache and for adverse events (when data were available). Therapeutic gain was used to evaluate speed of onset of action.

Results: Subcutaneous sumatriptan was more efficacious, combined number needed to treat 2.0 at 1 h, than oral (3.0 at 2 h) and intranasal sumatriptan (3.1 at 2 h). For adverse events, the NNT was 3.0 for subcutaneous and 8.3 for oral sumatriptan. Only limited data on adverse events for intranasal sumatriptan were available. Therapeutic gain analysis during the first 2 h showed that subcutaneous sumatriptan was the fastest-acting form of administration.

Conclusions: Subcutaneous sumatriptan in a dose of 6 mg is significantly more efficacious than 100 mg of oral sumatriptan, but causes more adverse events than oral sumatriptan. Subcutaneous sumatriptan is the form with the quickest onset of action. Intranasal sumatriptan has the same efficacy as oral sumatriptan and a quicker onset of action than the oral form, but with a limited therapeutic effect for the first 30 min after administration.
Epidemiology of Tension-Type Headache in Santiago, Chile: A Prevalence Study
Authors: Lavados PM , Tenhamm E
Published: March 2003

Objective: To describe the importance of tension-type headache (TTH) in Santiago, Chile, by analyzing its prevalence, clinical features, and impact by age, gender, and socioeconomic status, using widely accepted international diagnostic criteria.

Methods: In 1993, a representative sample of 1540 adults (older than 14) of the province of Santiago were interviewed using a standard questionnaire. A total of 1385 (89.9% response rate) subjects responded to the survey. Initially, a designated member of each household responded to the questionnaire. Subsequently, each household member with headache was asked to respond to questions about the severity, frequency, location, duration, associated symptoms, and impact in work and social activities of their most frequent headaches. TTH diagnoses were determined in accordance with the International Headache Society criteria of 1988.

Results: Total prevalence was found to be 26.9% (95% CI: 24.6–29.3%); 35.2% in females (95% CI: 31.7–38.8%) and 18.1% in males (95% CI: 15.2–21.3%). The prevalence of episodic TTH was 24.3% (95% CI: 22.1–26.7%) and of chronic TTH 2.6% (95% CI: 1.8–3.6%). Overall, and by subtype, prevalence was significantly higher in females (ratio 1:9). There was no significant variation in prevalence by socioeconomic or age group except in chronic TTH, in which there was an increase with age.

Conclusions: TTH is a prevalent condition in a sample of adults of Santiago, similar to that reported in previous studies using similar methodologies. Overall, TTH represents 72.3% of all recurrent headaches.
Contingent Negative Variation in Patients with Chronic Daily Headache
Authors: Siniatchkin M , Gerber W-D , Kropp P , Vein A
Published: March 2003

The aim of this study was the investigation of amplitude and habituation of contingent negative variation (CNV) in migraine and chronic daily headache (CDH) patients in order to describe possible neurophysiological features responsible for the clinical transformation and worsening of the headache. Fifteen females suffering from migraine without aura and 15 females diagnosed with CDH evolved from migraine without aura with interparoxysmal chronic tension-type headache (transformed migraine), underwent CNV recording. Fifteen healthy females matched for age served as controls. CNV was obtained from C3 and C4 using the standard reaction time paradigm and 3 sec ISI. The amplitudes and habituation of total CNV, early and late components, and of post-imperative negative variation (PINV) were calculated. The migraine patients were characterized by significantly more pronounced negativity of the early component and total CNV, compared to CDH sufferers and controls. CDH patients demonstrated significantly reduced negativity of the late component and pronounced PINV compared to the other groups. The early component of CNV did not habituate in migraine or CDH patients. However, the impaired habituation in CDH was related to significantly lower amplitudes. These results support the diagnostic and scientific value of habituation in migraine research and therapy. Late components of CNV and PINV can be considered as predictive variables for transformation of migraine. The results are discussed in terms of the relationship between late CNV, PINV, environment control abilities and susceptibility for development of depression.
The Syndrome of Spontaneous Intracranial Hypotension
Authors: O'Carroll CP , Brant-Zawadzki M
Published: March 2003

The authors report four cases of headache and other symptomatology related to the syndrome of intracranial hypotension. They were seen in a routine clinical practice over the past 3 years. The clinical features, magnetic resonance imaging (MRI) findings, and follow-up of these patients are described. Review of the prior literature on the topic is also included. All four patients presented with orthostatic headache syndrome. Three of the four demonstrated diffuse leptomeningeal thickening and enhancement on MRI studies. One subsequently developed a subdural effusion. One patient demonstrated downward displacement of the posterior fossa initially, which resolved on follow-up MRI scanning. Possible pathophysiologies of the syndrome are discussed.
Glossopharyngeal Neuralgia Referred From A Pontine Lesion
Authors: McCarron MO , Bone I
Published: March 2003

Paroxysmal pain in the form of glossopharyngeal neuralgia is less frequent and less well understood than that of trigeminal neuralgia. Diagnostic confusion can arise especially when both conditions occur in the one patient. We report a patient with a 20-year history of left-sided glossopharyngeal neuralgia with trigger zones in both the trigeminal and glossopharyngeal dermatomal distributions. Magnetic resonance imaging revealed a single T2-weighted hyperintense signal in the left pons with no other abnormality. It is postulated that ephaptic transmission between central pain fibers and the trigeminal or glossopharyngeal fibers, which both enter the spinal trigeminal tract, resulted, respectively, in conventional and “referred” glossopharyngeal neuralgia.
Comorbidity of Headache and Depressive Disorders
Authors: Mitsikostas DD , Thomas AM
Published: March 2003

The goal of the present study was to investigate the clinical profile of patients with primary headache syndromes who also suffer from mood disorders. Four-hundred-and-seventy headache outpatients (170M, 300F) and 150 age- and sex-matched healthy subjects were screened using a specific questionnaire that included the Hamilton rating scales for anxiety and depression. The average scores of the Hamilton rating scales for anxiety and depression were significantly higher in headache sufferers (17.4 and 14.2, respectively) than in healthy people (6.8 and 5.7, respectively). The frequency of headache attacks, the history of headaches, and gender (women more than men) were correlated with the score of the Hamilton rating scale for both anxiety and depression. Sixteen headache patients (3.4%) achieved the DSM-IV criteria for major depression or dysthymia versus one among headache-free subjects (0.6%; OR 5.2). Patients suffering from drug-overuse and migraine with aura showed the higher odds ratios (35 and 17, respectively). These results suggest that those headache patients with long history and high frequency of headaches, or patients suffering from migraine with aura and drug-overuse might benefit from psychiatric evaluation.
Characteristics and Prevalence of Transient Visual Disturbances Indicative of Migraine Visual Aura
Authors: Mattsson P , Lundberg PO
Published: March 2003

The objective of this study was to estimate the prevalence of and to compare the characteristics of transient visual disturbances (TVDs) of possible migraine origin in a clinical and a general population. Data were obtained in interviews from 100 consecutive female migraine patients (17-69 years) and 245 women (40-75 years) from the general population. The lifetime prevalences were 37% and 13%, respectively. We did not detect any differences in characteristics of TVDs between patients and women in the general population. A gradual onset of five or more minutes was stated by as few as 45% and 46%, respectively. The typical headache phase in conjunction with a TVD had more migrainous features in patients. We conclude from our data that the TVDs in this study, which do not fulfill the IHS criteria for migraine with aura, more likely represent poorly described or abortive migraine phenomena, rather than phenomena of other origin.
Efficacy and Safety of Rizatriptan Wafer for the Acute Treatment of Migraine
Authors: Ahrens SP , Farmer MV , Williams DL , Willoughby E , Jiang K , Block GA , Visser WH
Published: March 2003

Rizatriptan is a potent, highly selective 5HT1B/1D agonist with rapid onset of action for acute treatment of migraine. Rizatriptan wafer1 is a novel, freeze-dried dosage formulation of rizatriptan which rapidly disintegrates on the tongue, is swallowed with saliva, and may be taken without liquids. The efficacy and tolerability of rizatriptan wafer were examined in a placebo-controlled, double-blind, outpatient study in 555 migraineurs. The primary efficacy endpoint was pain relief at 2 h. From 30 min onwards, significantly more patients experienced pain relief and became pain-free after rizatriptan 10-mg wafer compared to placebo. At 2 h, the percentage of patients with pain relief was significantly higher after rizatriptan 10-mg wafer (74%), 5-mg wafer (59%) compared with placebo (28%). Rizatriptan 10-mg wafer was superior to rizatriptan 5-mg wafer on pain relief at 1.5 and 2 h ( p<0.05). Significantly more patients were pain-free at 2 h after rizatriptan 10-mg wafer (42%), 5-mg wafer (35%) compared with placebo (10%). Both doses of rizatriptan wafer were well tolerated. Rizatriptan wafer is a convenient, highly effective new formulation for acute treatment of migraine.
Cenesthetic Pain Sensations Illustrated by an Artist Suffering From Migraine with Typical Aura
Authors: Podoll K , Bollig G , Vogtmann T , Pothmann R , Robinson D
Published: March 2003

In addition to attacks with the well-known pulsating characteristics of migrainous headache, migraine patients may experience a variety of peculiar pain sensations which are phenomenologically similar to the spontaneous sensations occurring in patients with thalamic disturbances and to the cenesthesias described as basic symptoms in functional psychoses. A 36-year-old artist with a history of migraine with typical aura provided impressive illustrations of cenesthetic pain sensations experienced during his migraine attacks, including sensations of pressure and sensations of pulling. It is suggested that cenesthetic pain sensations represent aura symptoms of migraine indicative of focal cerebral dysfunction, probably in the thalamic region. The occurrence of cenesthetic pain sensations as a migraine symptom supports the notion of an organic etiology of cenesthesias, as postulated in Huber's concept of basic symptoms of functional psychoses.
Great Pains: Famous People with Headaches
Authors: Jones JM
Published: March 2003

Have headaches influenced the course of history? It is very difficult to prove, but there is no doubt that head pains have affected some of the most influential people in history. This review explores how headaches have affected some of the world's most famous people.
Effect of Cortical Spreading Depression on Activity of Trigeminovascular Sensory Neurons
Authors: Lambert GA , Michalicek J , Storer RJ , Zagami AS
Published: March 2003

The effect of cortical spreading depression, a proposed initiating event for migraine pain, on cortical blood flow (laser Doppler method) and on the spontaneous firing rate and stimulus-evoked responses of trigemino-cervical neurons with craniovascular input was studied in 17 neurons in 8 cats anesthetized with chloralose. Cortical spreading depression, induced via cortical pinprick injury, produced an initial wave of cortical hyperemia (243 ± 57% of control) and a later and smaller phase of oligemia (96 ± 4% of control). Neither the basal discharge rate (6.7 ± 1.7 sec-1) nor the evoked responses to electrical stimulation of the superior sagittal sinus (4.1 ± 0.8 discharges per stimulus) of upper cervical spinal cord neurons was altered over periods of up to 2 h following one, two, or three waves of spreading cortical depression. We conclude that a small number of episodes of cortical spreading depression is not capable of activating C2 cervical spinal cord craniovascular sensory neurons in the cat.
Migraine Polypharmacy and the Tolerability of Sumatriptan: A Large-Scale, Prospective Study
Authors: Putnam GP , O'Quinn S , Bolden-Watson CP , Davis RL , Gutterman DL , Fox AW
Published: March 2003

Polypharmacy (the prescription of more than one therapy for a single patient) and subcutaneous (s.c.) sumatriptan tolerability were prospectively studied in 12,339 migraineurs, each followed for up to 1 year. Inclusion/exclusion criteria were minimal and mirrored United States Imitrex® labeling. Drug usage and compliance monitoring were automatically interfaced with prescription refill. Concomitant drugs were used by 79% of patients, with analgesics, antidepressants, and sedatives used most commonly. No adverse interactions between sumatriptan and neurological drugs were found, possibly reflecting relative inability of the former to cross the blood-brain barrier. No difference in cardiovascular adverse events was associated with oral contraceptive use, which was more common than expected. No other drug class influenced adverse event probability, although sample sizes for these comparisons was sometimes <400 patients. This study confirms the prevalence of polypharmacy in migraine, identifies the drugs used, and concludes that, on a population basis, the tolerability of s.c. sumatriptan, when used according to labeled instructions, is unaffected by these concomitant drugs.
Headache in Schizophrenic Patients: A Controlled Study
Authors: Kuritzky A , Mazeh D , Levi A
Published: March 2003

Various studies have indicated that chronic schizophrenic patients share a lower rate of headaches than the normal population. A questionnaire concerning the symptomatology of headache was administered to 108 schizophrenic patients in the chronic stage and to 100 normal subjects. The questions dealt with type, location, frequency, severity, and duration of headache, as well as with its accompanying phenomena. Both groups shared a high distribution of headache reports, and generally no significant differences were observed in the various parameters. It was found that schizophrenic patients tend to refrain from complaining about their headache, although they are capable of its precise description. No correlation was found between the type of headache and type of schizophrenia.
Migraine Associated with Panic Attacks
Authors: Ossipova W , Kolosova OA , Vein AM
Published: March 2003

Migraine headache and panic disorder are two conditions that have a number of underlying physiological and psychological abnormalities in common. The temporal relationship between the occurrence of migraine headache and panic attacks could be different, however. According to our observations, some migraine subjects develop panic attacks with the typical symptoms (palpitation, dyspnea, anxiety/fear, shiver, sweating, polyuria) on the “peak” of their attacks. This variant of migraine without aura was conditionally defined as “panic migraine”. Here we describe two patients suffering from migraine without aura in whom migraine was associated with the typical panic attack. It is suggested that a pronounced autonomic dysregulation along with marked psychological abnormalities could be responsible for the constellation of migraine and panic symptoms during one episode. Taking into account the previously obtained results, it is concluded that compared to “pure” migraine, “migraine associated with panic attacks” is characterized by a severe course, marked autonomic and emotional disturbances during pain-free intervals, seriously impaired quality of life, and requires a specific therapeutic approach.