bluuebunny/crossref_metadata_2025 huggingface dataset:
A Review of the BSE Epidemic in British Cattle
Authors: Donnelly Christl A. , MaWhinney Samantha , Anderson Roy M.
Published: March 2003

ABSTRACTBovine spongiform encephalopathy (BSE) was first diagnosed in British cattle in 1986. The infectious agents of transmissible spongiform encephalopathy (TSE) diseases are believed to be infectious proteins or prions. They can remain infectious despite exposures to disinfectants, autoclaving, radiation, and ultraviolet light. TSEs affect animals as well as humans and are characterized by progressively severe psychomotor dysfunction and long incubation periods. As of August 27, 1999, 175,404 cases of BSE have been confirmed in Great Britain with 1,787 additional confirmed cases in Northern Ireland (as of August 31, 1999). Mathematical and statistical analyses of the BSE epidemic data suggest that the incidence of BSE in Great Britain and Northern Ireland will continue its rapid decline. Evidence relating to maternal and horizontal transmission of BSE is discussed. Public concern remains focused on the probable link between BSE infection in cattle and a new variant of Creutzfeldt‐Jakob Disease (vCJD) in humans, another TSE. Given the long and variable incubation periods associated with TSEs, and a possible genetic component, the eventual magnitude of this human epidemic remains uncertain.
Conceptualizing Pattern Analysis of Spectral Change Relative to Ecosystem Status
Authors: Myers Wayne L. , Patil G.P. , Taillie Charles
Published: March 2003

ABSTRACT Change is recognized as being intrinsic to ecosystems, but is also the essence of instability and the outgrowth of situations that lack sustainability. Change is arguably the most fundamental symptom for onset of abnormality in ecosystem function, and change in change cannot be detected without sufficient monitoring to determine spatial and temporal aspects of characteristic change regimes across landscapes. It must also be recognized that change can be associated with either restoration or degradation. A suite of recent developments in change detection using compressed multiband image data provides increased flexibility and practicality for systematic change detection on a regional basis. Combining such capability with conceptual extensions of spatial pattern analysis through echelons can provide a methodology for systematically monitoring spatial structure of spectral change across landscapes in order to profile characteristic broad‐scale regimes of change and to indicate trends in those regimes. Implementing these analytical scenarios with new generations of computers and remote sensors could lend a further dimension to tracking of ecosystem status over major regions.
River Ecosystem Health Down Under: Assessing Ecological Condition in Riverine Groundwater Zones in Australia
Authors: Boulton Andrew J.
Published: March 2003

ABSTRACT Below many rivers and extending laterally beneath their banks lies a zone of saturated sediments—the hyporheic zone. This region is the site of dynamic exchanges of water and materials between the groundwater below, lateral alluvial aquifers, and the river flowing above. In this centrally located ecosystem component, the actions of the microbial biofilms coating the sediments are considered to act like a biological filter, enhancing water quality during the exchange process. However, the hyporheic zones in many rivers are threatened by siltation, toxicants and increasing acidity, physical extraction for gravel, or altered groundwater inputs through pumping. Current protocols to assess river health do not explicitly consider that of the hyporheic zone, despite its central role in many rivers. This oversight is due largely to the relative infancy of the discipline of hyporheic research, limited communication to river managers by ecologists, and technical difficulties in sampling the hyporheic zone. Ecosystem health assessments in rivers with potentially important hyporheic zones could include measurements of the extent of hydrological exchange between the river and the hyporheic zone at a range of scales, the rates of some key interstitial chemical processes, and perhaps the biodiversity of hyporheic invertebrates. In Australia, the potential of some of these measurements is being investigated, especially in relation to assessing the health of “groundwater‐dependent ecosystems.”
Why Regional Coastal Monitoring for Assessment of Ecosystem Health?
Authors: Sherman Kenneth
Published: March 2003

ABSTRACT During recent years, the public and the scientific communities have signaled concern over growing degradation of ecosystem health, depleted fisheries, pollution, and habitat loss. Public concern has been registered in newspapers, electronic media, and congressional actions. Scientific concern has moved from the pages of journals to the actions of professional societies, as for example the Sustainable Biosphere Initiative of the Ecological Society of America (Lubchenco et al. 1991). Responsive actions at the national and international levels have resulted in Conventions and Protocols on Climate Change, Biodiversity, Ozone, and internationally recognized declarations for sustaining marine fisheries.
The Importance of Landscape Age in Influencing Landscape Health
Authors: Walker J. , Thompson C.H. , Reddell P. , Rapport D.J.
Published: March 2003

Ancient landscapes dominate many parts of the world and are common in Australia—do they have a future for continued agricultural production and the supply of ecological goods and services? The hypothesis is that old, weathered landscapes respond differently from young landscapes when subjected to intensive landuse. The major difference in response is that system function regresses or fails in old landscapes. The aging phenomenon is illustrated using data from a podzol chronosequence on coastal sand dunes at Cooloola, Queensland, Australia. The old systems here are shown to regress naturally from forest systems to health systems as access to nutrients decreases. Responses to landuse disturbances in old landscapes other than sand dunes, show analogous regressive trends to the dune landscapes, but the biophysical nature of the responses can vary. How can such trends in landscape health be measured to better link land capability with landuse? The concept of sustainability may not be appropriate for old landscapes and a different framework based on a health paradigm is suggested. Starting from an equilibrium perspective, we move to a conditional stability concept and then to a conditional health paradigm. Health and ill‐health are deemed to be definable within predetermined limits, that is a compliance measure, similar to the diagnostic approach in human medicine.
Ecosystem Health and Its Measurement at Landscape Scale: Toward the Next Generation of Quantitative Assessments
Authors: Patil Ganapati P. , Brooks Robert P. , Myers Wayne L. , Rapport David J. , Taillie Charles
Published: March 2003

ABSTRACT The purpose of this paper is twofold: (A) to describe the challenges of reporting on changes in ecosystem health at landscape scales, and (B) to review the statistical and mathematical techniques that allow the derivation of landscape health assessments from a variety of data consisting of remote sensing imagery, demographic and socioeconomic censuses, natural resource surveys, long‐term ecological research, and other geospatial information that is site specific.

We draw upon seven innovative and integrative concepts and tools that together will provide the next generation of ecosystem health assessments at regional scales. The first is the concept of ecosystem health, which integrates across the social, natural, physical, and health sciences to provide the basis for comprehensive assessments of regional environments. The second consists of innovative stochastic techniques for representing human disturbance and ecosystem response in landscapes, and the corresponding statistical tools for analyzing them. The third constitutes representation of spatial biocomplexity in landscapes through application of echelon analysis to assessment. The fourth concerns innovative combination techniques of upper‐echelon‐based spatial scan statistic to detect, delineate, and prioritize critical study areas for evaluating and prioritizing causal factors and effects. The fifth involves the capability of comparing and prioritizing a collection of entities in light of multiple criteria, using poset mathematics of partial order with rank frequency statistics, to provide multicriterion decision support. The sixth lies in extending data mining and visualization techniques to determine associations between geospatial patterns and ecosystem degradation at landscape scales. The seventh encompasses comprehensive studies conducted on different types of regional ecosystems.

Our focus is to show how the integration of recent advances in quantitative techniques and tools will facilitate the evaluation of ecosystem health and its measurement at a variety of landscape scales. The challenge is to characterize, evaluate, and validate linkages between socioeconomic drivers, biogeochemical indicators, multiscale landscape pattern metrics, and quality of human life indicators. Initial applications of these quantitative techniques and tools have been with respect to regions in the eastern United States, including the U.S. Atlantic Slope and mid‐Atlantic region.
Clinical Practice for Ecosystem Health: The Role of Ecological Restoration
Authors: Harris J.A. , Hobbs R.J.
Published: March 2003

In this paper, we discuss the need for synergy between the emerging fields of ecosystem health and ecological restoration and examine whether anyone engaged in ecological restoration has attempted this yet, explicitly or implicitly. We provide definitions of terms used in ecosystem health and examples of ecological restoration practices in each of the major ecosystem health categories. We point to the need for effective and measurable indicators of ecosystem health. If we view the concept of ecosystem health as the diagnostic toolbox and ecological restoration as the treatment toolbox for the management of damaged ecosystems, there is clearly the potential for useful synergy. The challenge is to blend a level of generality that allows comparison among different systems with the ability to be specific enough to be helpful in particular cases.
Effectiveness of a Physical Therapy Regimen in the Treatment of Tension‐Type Headache
Authors: Hammill Jean M. , Cook Thomas M. , Rosecrance John C.
Published: March 2003

Twenty patients with diagnosis of muscle contraction headache were treated for pain relief in a physical therapy clinic once a week for six visits. The previous 3‐week period of no treatment served as a control period during which patients recorded by diary their headache frequency, duration, and intensity using a numeric pain scale. Activity level, as measured by the Sickness Impact Profile, and verbal reports of headache frequency, duration, and intensity were recorded at four points during a 1‐year period. Measurements were recorded at precontrol, pretreatment, posttreatment, and 12‐month follow‐up. Treatment included education for posture at home and work place, isotonic home exercise, massage, and stretching to the cervical spine muscles. Results indicated frequency of headaches and Sickness Impact Profile scores were significantly improved (P<0.001) over the course of treatment. These benefits were maintained after 12 months.
Use of Health Care Services in Childhood Migraine
Authors: Metsähonkala Liisa , Sillanpää Matti , Tuominen Juhani
Published: March 2003

The use of health care services in childhood migraine was studied in a representative population sample of 53 children with migraine. These children elong to a 1‐year age cohort that has been followed since birth. Migraine was diagnosed at the age of 8 to 9 years according to the International Headache Society criteria of migraine in 95 of 3580 children (2.7%). At the time of the present study, 84 of the 95 children were clinically examined at the age of 11 to 13 years. Fifty‐three of them (62.4%) still had migraine and 32 did not. Of these 53 children, 31 (51.8%) had consulted a doctor because of headache. The most important factors linked to the consultation rate were aura symptoms and maximal frequency of attacks. The children who had consulted a doctor more often had nausea and more often came from densely populated areas. They had missed school days more often because of headache than those who had not consulted a doctor.
Hospital‐Affiliated Headache Clinics in the Managed Care Era
Authors: Green Mark W. , Davis Donald W.
Published: March 2003

Many headache clinics are affiliated with hospitals. These facilities were often started before the era of managed care. The new incentives and disincentives of managed care will force these programs to change their structures. Only those which document value are likely to survive.
Health‐Related Quality of Life of Chronic Headache Patients Is Predicted by the Emotional Component of Their Pain
Authors: Passchier J. , De Boo M. , Quaak H.Z.A. , Brienen J.A.
Published: March 2003

Questions to be answered by this study were: (1) what is the health‐related quality of life (HRQL) of migraine and tension headache patients who consult their general practitioner, and (2) what are the unique contributions of the perceptual and emotional components of headaches to the HRQL. The Nottingham Health Profile (NHP) was used to measure the HRQL of patients with migraine (n=27), tension headache (n=25), both migraine and tension headache (n=17), and two reference groups. Perceptual components of the pain (intensity, frequency, and duration) were measured with a headache diary, while emotional components were measured with five visual analogue scales (for tension, depression, frustration, anger and fear). The NHP dimensions of pain, sleep, energy, and social isolation revealed that each headache patient group had a lower HROI. than the healthy reference group. There were no differences in HRQL between the headache groups. Regarding the second question: it was found that the greater the patient's emotional pain, the more problems he or she had with physical mobility and social isolation. Neither the type of headache nor the headache index were related to the HRQL of the patient. We recommend to increase the research efforts concerning tension headache and to measure the emotional component of pain in clinical trials.
Idiopathic Intracranial Hypertension in a Young Child Without Visual Symptoms or Signs
Authors: Winner Paul , Bello Luis
Published: March 2003

A 7‐year‐old boy presented with a 4‐week history of daily headache. His parents reported that he was unable to attend school the week prior to presentation. Intermittent nausea without vomiting was reported, but no blurred vision, photophobia, or diplopia were described. There was no history of trauma or recent systemic illness. The physical examination showed mild neck discomfort, no papilledema, and normal cranial nerve, motor and sensory functioning. Both a CT scan of the sinuses and an MRI of the brain were normal. Although the opening pressure was elevated, the cerebrospinal fluid was also normal. In previous accounts idiopathic intracranial hypertension in children, concomitant papilledema, visual symptoms and/or palsy of the sixth cranial nerve are described. This case demonstrates that idiopathic intracranial hypertension in a young child can present as a daily headache without any visual symptoms or signs.
SUNCT Syndrome. A Clinical Review
Authors: Pareja Juan A. , Sjaastad Ottar
Published: March 2003

The clinical features of SUNCT syndrome have been reviewed in 21 patients. There were 17 men and 4 women, rendering a clear male preponderance (ratio of 4.25). The mean age at onset was around 51 years. Attacks were experienced mostly in the orbital/periorbital area and always recurred on the same side, with an erratic temporal pattern and remissions of varying lengths. Most attacks were moderate to severe in intensity and burning, electrical, or stabbing in character. The attacks were regularly accompanied by prominent, ipsilateral, conjunctival injection, tearing; and rhinorrhea or nasal obstruction. There were many precipitating mechanisms. Exclusively spontaneous attacks were described in 3 patients. The usual duration of paroxysms ranged from 10 to 60 seconds, whereas the longest duration varied from 60 to 300 seconds. The frequency of attacks during the symptomatic periods varied from less than I attack daily to more than 30 per hour. hi the majority of patients, supplementary examinations failed to show any notable abnormality. However, 2 patients were documented to have a symptomatic form of SUNCT, with a vascular malformation in the ipsilateral cerebellopontine angle. A variety of drugs and local anesthetic blockades. inclusive of tic douloureux drugs, were tried, but a persistent, convincingly beneficial effect was generally lacking SUNCT syndrome is in the differential diagnosis when encountering unilateral, orbital/periorbital headache syndromes.
Headache During Pregnancy in the Postpartum: A Prospective Study
Authors: Scharff Lisa , Marcus Dawn A. , Turk Dennis C.
Published: March 2003

The association between sex hormones and chronic headache has been the subject of a good deal of speculation. Headache is predicted to improve during pregnancy, when estrogen levels rise steadily until delivery. Retrospective studies have suggested that women with a history of migraines do tend to report decreases in headache activity with pregnancy. The purpose of this naturalistic study was to examine changes in headache that may occur during pregnancy and postpartum in women complaining of migraine, tension‐type, or combined migraine and tension‐type headaches in a prospective design. Thirty women recorded their headaches daily throughout pregnancy and up to 12 weeks postpartum. Results based on these ratings demonstrated a nonsignificant trend for headache to decrease throughout pregnancy and to increase during the birth week. Headache patterns varied slightly depending on headache diagnosis and parity. Contrary to previous retrospective study reports, migraine sufferers demonstrated an increase in headache in the third trimester. In addition, there was a tendency in multiparous women for headaches to increase in the third trimester, whereas primiparous women reported less headache activity throughout pregnancy and the postpartum.
Cerebrospinal Fluid Neuropeptides and Monoaminergic Transmitters in Patients With Trigeminal Neuralgia
Authors: Strittmatter Matthias , Grauer Markus , Isenberg Elke , Hamann Gerhard , Fischer Christian , Hoffmann Karl‐Heinz , Biaes Franz , Schimrigk Klaus
Published: March 2003

The pathogenesis of trigeminal neuralgia remains largely unknown. "Peripheral" as well as "central" causes have been suggested. To investigate the role of serotonergic, noradrenergic, dopaminergic, and peptidergic systems, we determined the concentrations of epinephrine, norepinephrine, and their breakdown product, vanillylmandelic acid, in the cerebrospinal fluid of 16 patients (55.3 ±± 8.3 years) with trigeminal neuralgia. As a marker for the dopaminergic system, we determined cerebrospinal fluid concentrations of dopamine and its metabolite, homovanillic acid. As a marker for the serotonergic system, we measured cerebrospinal fluid levels of the serotonin metabolite, 5‐hydroxyindoleacetic acid. In addition, levels of the neuropeptides, substance P and somatostatin, were determined.

The concentration of norepinephrine (P<0.01) and its metabolite, vanillylmandelic acid, (P<0.05) were significantly decreased in our patients. The level of the dopamine metabolite, homovanillic acid, was also significantly reduced (P<0.01). Also significantly decreased was 5‐hydroxyindoleacetic acid (P<0.01). Substance P was significantly elevated (P<0.05). Somatostatin was significantly decreased (P<0.05).

We hypothesize that the sum of complex neurochemical changes plays a role in the pathogenesis of trigeminal neuralgia. The elevated substance P could support the concept of a neurogenic inflammation in the trigeminovascular system, whereas changes in the monoaminergic transmitters and their metabolites seem to reflect a more central dysfunction possibly due to a longer duration of the disease and an accompanying depression.
Botulinum Toxin Injection for Cervicogenic Headache
Authors: Hobson Douglas E. , Gladish Daniel F.
Published: March 2003

We report a 28‐year‐old woman with a 5‐year history of cervicogenic headache following a whiplash injury, Her unilateral neck pain, if aggravated by exertion, would create a predictable sequence of events leading to a hemicephalgia. She proved medically refractory to usual therapies, but had a striking response to a single botulinum toxin injection in her symptomatic rapezius muscle. Repeated injections every 3 months have been required to maintain this benefit. The implications of this observation are discussed.
Trigeminal Neuralgia. Clinical Manifestations of First Division Involvement
Authors: Sjaastad Ottar , Pareja J.A. , Zukerman E. , Jansen J. , Kruszewski P.
Published: March 2003

A series of 19 patients with what originally had been diagnosed as a first division (V1) trigeminal neuralgia was collected. The inclusion criteria were severe, rather short‐lasting pain attacks within the V1 area, combined with trigger mechanisms. There were 10 women and 9 men, and the mean age of onset was 57.8 years. Fifteen of 16 with adequate information on attack duration had paroxysms of a “few seconds'“ duration or less, whereas 10 patients had paroxysms lasting ≥2 seconds. In an exceptional case, only “more long‐lasting” attacks (greater than 30 seconds’ duration) were experienced.

In regard to autonomic phenomena, lacrimation was most frequently present (in a total of 8 patients; 3 rather regularly, 5 more irregularly). The combination of lacrimation, conjunctival injection, and rhinorrhea was present in only 2 (of 19), and in neither of them in a major way. Typically, autonomic phenomena occurred during the later stages of disease and during particularly severe and long‐lasting attacks. Seven of 14 with adequate information also had nocturnal attacks. Initially, a more or less complete carbamazepine effect was reported by 10 of 13 patients. Precipitation mechanisms were the same as with second and third division tic, but were mainly located within the V1 area, particularly initially.

A comparison with SUNCT syndrome has been made. SUNCT is a predominantly male disorder, with only exceptional attacks of ≥10 seconds' duration, and generally with attacks of 15 seconds or longer. Autonomic symptoms and signs are more pronounced than in V1 tic. Carbamazepine generally provides minor, if any, benefit in SUNCT. The present work strongly indicates that the two disorders are essentially different.
Sumatriptan Relieves Migrainelike Headaches Associated With Carbon Monoxide Exposure
Authors: Lipton Richard B. , Mazer Cynthia , Newman Lawrence C. , Solomon Seymour
Published: March 2003

We report a 58‐year‐old woman with long‐standing migraine who developed a pattern of weekend headaches which occurred only while staying at her Connecticut vacation home The headaches promptly responded to sumatriptan. Investigation revealed a high carbon monoxide level in her home due to a defective furnace. Replacing the furnace eliminated the headaches. This case highlights the importance of searching for secondary causes of headache even in patients responsive to sumatriptan. It also suggests that carbon monoxide may trigger headaches mediated by trigeminovascular inflammation.
Recurrent ‘Migrainelike’ Episodes in Patients With HIV Disease
Authors: Rinaldi Rita , Manfredi Roberto , Azzimondi Giuseppe , Rodorigo Giuseppina , Tonon Caterina , De Rosa Vincenzo , Mastroianni Antonio , Coronado Olga V. , Legnani Cristina , Chiodo Francesco , D'Alessandro Roberto
Published: March 2003

Recurrent transient neurological deficits have been described in human immunodeficiency virus (HIV)‐infected subjects, but their frequency, pathogenesis, and outcome are still unsettled.

We describe 10 HIV‐infected patients with transient neurological deficits (0.8% of all patients followed in ourdepartment during the last decade). All patients were in the advanced stage of immunological disease. None of theclinical or special investigations performed outside of the attacks indicated an underlying structural lesion of the centralnervous system. In 80% of these patients, anticardiolipin antibodies were present. The final outcome was unrelated tothese transient neurological deficits which, per se, had a benign course.

We discuss the possible etiopathogenetic mechanisms of such episodes and suggest that they may be “migrainelike”events, possibly related to transient functional circulatory abnormalities secondary to an immunologicalantiphospholipid antibody‐dependent mechanism.
Sumatriptan and Cerebral Blood Flow Velocity Changes During Migraine Attacks
Authors: Totaro Rocco , De Matteis Giorgio , Marini Carmine , Baldassarre Massimo , Carolei Antonio
Published: March 2003

Transcranial Doppler studies on the effects of sumatriptan on cerebral hemodynamics have shown conflicting results. We evaluated blood flow velocity changes in 21 patients suffering from migraine with (n = 4) or without aura (n = 17) during a spontaneous attack, before and after treatment with sumatriptan. Flow velocity in the internal and external carotid, middle cerebral, and basilar arteries was measured by means of transcranial Doppler. During the attack, measurements were taken before subcutaneous sumatriptan injection, then after 30 minutes, 2 hours, and 24 hours. An additional measurement was taken 1 week later, in a headache‐free state. We found a significant reduction of flow velocity during the attack in the middle cerebral artery on both sides (P < 0.05). After sumatriptan administration, flow velocity increased in the internal carotid artery on both sides (P < 0.05) and in the middle cerebral artery on the headache side (P = 0.0001), but not in the external carotid and basilar arteries (P > 0.05). Flow velocity changes may reflect the vasodilation present at the onset of the migraine attack followed by vasoconstriction in the internal carotid and middle cerebral arteries after sumatriptan treatment. Since vasoconstriction occurs in responders and nonresponders to treatment, it is unlikely to be the primary mechanism by which sumatriptan relieves headache.
Sphenopalatine Ganglion Block for Treatment of Sinus Arrest in Postherpetic Neuralgia
Authors: Saberski Lloyd , Ahmad Mahmood , Wiske Prescott
Published: March 2003

A 64‐year‐old woman presented with bradycardia from sinus pauses during exacerbations of postherpetic trigeminal distribution neuralgia. She had underlying systemic lupus erythematosus. Sphenopalatine ganglion blockade was employed to treat her pain. The episodes of bradycardia resolved with successful alleviation of pain. This report emphasizes that a sphenopalatine ganglion blockade can be employed in the treatment and prevention of sinus arrest associated with postherpetic trigeminal distribution neuralgia.
Status Migrainosus: An Unusual Presentation of a Brain Abscess
Authors: Bruera Osvaldo Carlos , de Lourdes Figuerola Maria , Gandolfo Claudia , Saggese Javier , Giglio Jorge Alberto
Published: March 2003

Status migrainosus and brain abscess are uncommon complications of migraine and infectious diseases, respectively. We describe a woman with a history of migraine with aura but without any history of a pyogenic infectious process, who suffered status migrainosus as the sole manifestation of a brain abscess.
Chronic Daily Headache. How Should it Be Included in the IHS Classification?
Authors: Nappi Giuseppe , Granella Franco , Sandrini Giorgio , Manzoni Gian Camillo
Published: March 2003

A number of patients attending specialty headache centers complain of very frequent, almost continuous or continuous headaches, which are usually grouped together under the term chronic daily headache, a category which does not appear in the International Headache Society (IHS) classification. On the basis of the IHS criteria, these patients can only be classified as having a chronic tension‐type headache with the possible addition of migraine, if migrainous attacks are superimposed on the “background” headache. However, several studies have demonstrated that most patients with chronic daily headache originally suffered from migraine and that their migraine has transformed, in the course of time, into a chronic headache picture in which isolated migraine attacks may or may not persist. Despite some differences in the personal opinions of authors involved in the care of patients with chronic daily headache, some views seem to be generally accepted: (1) the great majority of chronic daily headaches are transformations of an original episodic migraine and cannot be included in the chronic tension‐type headache category, (2) the current IHS classification does not allow many patients presenting with chronic daily headache to be classified correctly, (3) an important nosological category (transformed migraine) has emerged from all the studies on this subject, (4) it is impossible to diagnose transformed migraine merely by “photographing” the picture of single attacks. Although some theoretical problems remain unresolved, it seems to us that the next revision of the IHS classification can no longer ignore the existence of chronic daily headache.
α‐Dihydroergocryptine in the Prophylaxis of Migraine: A Multicenter Double‐Blind Study Versus Flunarizine
Authors: Bussone G. , Cerbo R. , Martucci N. , Micieli G. , Zanferrari C. , Grazzi L. , Fabbrini G. , Cavallini A. , Granella F. , Ambrosoli L. , Mailland F. , Poli A. , Manzoni G.
Published: March 2003

This multicenter, double‐blind, clinical study was designed to compare the efficacy and safety of α‐dihydroergocryptine and flunarizine in the prophylaxis of migraine without aura. One hundred thirty‐five patients fulfilling the diagnostic criteria of the International Headache Society were enrolled at five neurologic centers. The study design included a 1‐month pretreatment phase with placebo; a 6‐month, double‐blind, double‐dummy treatment phase with α‐dihydroergocryptine (10 mg twice daily) or flunarizine (5 mg once daily); a further 3‐month follow‐up phase without treatment. Efficacy was assessed using the patient's diary. Laboratory tests, vital signs, and adverse events were monitored. Analysis of covariance for repeated measures was performed on the intent‐to‐treat sample. Both treatments led to a significant reduction in the frequency of migraine, days with headache, and use of relief medication. Overall, 51% of those treated with α‐dihydroergocryptine and 49% of those treated with flunarizine were responders (50% or greater reduction in attack frequency), the average percentage of reduction being 64% with α‐dihydroergocryptine and 51% with flunarizine. There was no significant difference between the two groups in terms of incidence of adverse events; dizziness and weight gain were the most frequent observed adverse events with α‐dihydroergocryptine and flunarizine, respectively. Based on the overall improvement in migraine parameters, α‐dihydroergocryptine can be recommended for use in migraine prophylaxis.
Use of Percutaneous Electrical Nerve Stimulation (PENS) for Treating ECT‐Induced Headaches
Authors: Ghoname El‐sayed A. , Craig William F. , White Paul F.
Published: March 2003

Five patients who experienced migrainelike attacks associated with electroconvulsive therapy (ECT) were treated using a novel nonpharmacologic therapy known as percutaneous electrical nerve stimulation (PENS). In this sham‐controlled preliminary evaluation, PENS therapy proved to be a useful alternative to opioid analgesics for the acute treatment and/or prevention of ECT‐induced headache.
MMPI Changes Associated With Therapeutic Intervention: A Migraine Control Study
Authors: Fan Arthur Yin , Gu Ren‐Juan , Zhou An‐Nan
Published: March 2003

The investigation of personality traits of migraineurs with the Minnesota Multiphasic Personality Inventory (MMPI) is important research, but so far has led to diverse conclusions. This study aimed to investigate the influences of treatment intervention on the personality of migraineurs. Twenty‐three Chinese patients (5 men, 18 women) with migraine (2 with aura, 21 without aura) were given the Chinese edition of the MMPI, before and after treatment, and were compared with 30 nonheadache healthy control subjects (6 men, 24 women). Statistical analyses were made among the three groups. The results revealed that patients in the pretreatment group with migraine had significantly higher scores on subtests of neuroticism (hypochondriasis, depression, hysteria) and schizophrenia. After treatment, the scores on subtests of hysteria, psychasthenia, and schizophrenia were remarkably lower (P<.05); the MMPI profile of the posttreatment group was within the reference range, but the scores of the neurotic scales were still higher than those of the healthy control group (P<.01). These results suggest that after treatment, disturbances in thinking, sentiment, and behavior were eliminated, and anxiety symptoms remarkably reduced, but some “migraine personality” characteristics remained and could influence the long‐term results of treatment to some extent. It is suggested that management of migraine should include psychological intervention.
Valproate Prophylaxis for Migraine Induced by Selective Serotonin Reuptake Inhibitors
Authors: Delva Nicholas J. , Horgan Salinda A. , Hawken Emily R.
Published: March 2003

We report the successful use of valproate in a 44‐year‐old woman with migraine induced by selective serotonin reuptake inhibitors. Valproate should be considered for those patients who develop serious migraine for the first time, or worsening of previous migraine, after the initiation of treatment with selective serotonin reuptake inhibitors and for whom continued treatment with this class of drugs is important.
Limb‐Threatening Ischemia Due to Ergotamine: Case Report With Angiographic Evidence
Authors: Salvesen Rolf , Prytz Jan Fredrik
Published: March 2003

A 29‐year‐old woman presented with severe leg pain that had lasted for several weeks. During that period, she had taken painkillers in order to achieve sleep. In the week before she was admitted to hospital, she had noticed numbness and a cold feeling below her knees. There were no arterial pulsations below her groin, the skin of her legs being cold and pale. She had a history of chronic daily headache and had ingested Cafergot compound corresponding to ergotamine 2 to 3 mg daily for the previous 2 or 3 months. Angiography demonstrated severe narrowing of both superficial femoral arteries for a distance of about 5 to 6 cm and a subtotal stenosis of the right popliteal artery. After discontinuation of ergotamine, the patient's symptoms gradually disappeared within a few days. Angiography was repeated 2 days after the first examination and demonstrated regression of the spasms in the femoral arteries and reestablished flow in the distal vessels. Ergotamine tartrate can induce life‐threatening ischemia of an extremity. Discontinuation of ergotamine is usually sufficient to reverse the ischemia, however, intravenous infusion of sodium nitroprusside may occasionally be necessary to avoid limb amputation.
Daily Migraine With Aura: A New Migraine Variant
Authors: Merims D. , Kuritzky A.
Published: March 2003

The frequency of migraine attacks is not used as a diagnostic criterion, however, it is a very important factor in the evaluation of migraine severity and its treatment. Several studies report the frequency of migraine attacks using the International Headache Society criteria. No investigator, however, has reported daily migraine attacks.

In the current report, we present five patients whose headaches transformed from episodic migraine to daily migraine with aura. To the best of our knowledge, this is the first description of this variant of migraine. The symptoms in all the patients described comply strictly with the International Headache Society criteria for the diagnosis of migraine with typical aura.

An interesting additional observation concerns the beneficial effect of phenytoin, a drug that has not proved to be effective in migraine but showed some efficacy in our patients.
l‐5‐Hydroxytryptophan in the Prophylaxis of Chronic Tension‐type Headache: A Double‐Blind, Randomized, Placebo‐Controlled Study
Authors: Ribeiro Carlos A. Fontes , For The Portuguese Headache Society
Published: March 2003

A parallel, randomized, double‐blind trial is reported, in which 78 patients with chronic tension‐type headaches were treated with l‐5‐hydroxytryptophan (5‐HTP) (
n = 43) or placebo (
n = 35) for 8 weeks, after a washout period of 2 weeks and with a follow‐up period of a further 2 weeks. Five patients dropped out (1 with placebo and 4 with 5‐HTP), 1 was excluded due to noncompliance, and in 7 treatment was suspended due to adverse events (3 with placebo and 4 with 5‐HTP), yielding a final number for evaluation of 65 patients. In comparison with the group treated with placebo, there was no statistically significant change in the number of days with headache or in headache intensity in the group treated with 5‐HTP, 300 mg per day; however, there was a significant decrease in the consumption of analgesics. During the 2 weeks after treatment, there was a significant decrease in the number of days with headache. Subjective opinion during this latter period was also favorable to 5‐HTP.
Sudden Worsening of Cluster Headache: A Signal of Aneurysmal Thrombosis and Enlargement
Authors: McBeath Juanita G. , Nanda Anil
Published: March 2003

We report a 55‐year‐old man presenting with symptoms of cluster headache, including throbbing pain behind the left eye, tearing, and rhinorrhea. Magnetic resonance imaging and magnetic resonance angiography revealed no abnormalities. Two days of intravenous dihydroergotamine resolved his pain. His headaches were somewhat relieved with a treatment regimen of 100 mg of imipramine each night, 40 mg of propranolol twice a day, 250 mg of divalproex three times a day, and dihydroergotamine nasal spray for breakthrough headaches. Two months later, the severity of his pain increased dramatically. Repeat imaging revealed a large thrombosed left posterior communicating artery aneurysm. Following obliterative surgery, his headaches are infrequent and mild and resemble tension headaches. Dramatic changes in headache characteristics can be an indicator of aneurysmal enlargement and thrombosis. This case illustrates the importance of repeat imaging when a patient's headache significantly worsens.
Headache Caused by a Spinal Cord Stimulator in the Upper Cervical Spine
Authors: Ward Thomas N. , Levin Morris
Published: March 2003

We report persistent headaches developing in a patient subsequent to the placement of a spinal cord stimulator in the upper cervical spine. These persistent headaches responded to dihydroergotamine and sumatriptan. Headaches ceased upon repositioning of the stimulator lower in the cervical spine. We postulate an effect of the device on the trigeminovascular system via the nucleus caudalis trigeminalis and/or spinal trigeminal tract.
Effects of Medication Use on Health State in Postictal Migraineurs
Authors: Mulder E.J.C.M. , Passchier J. , Linssen W.H.J.P. , De Geus E.J.C.
Published: March 2003

We investigated whether headache‐free patients with migraine report a lower health state compared with healthy controls, and whether health state is differently affected during the postattack period after using sumatriptan versus habitual nonvasoactive medication. Mood, health state, and personality questionnaires were administered once during an interictal period and twice within 30 hours after different migraine attacks treated with sumatriptan or habitual nonvasoactive medication. Twenty migraineurs without aura, 10 migraineurs with aura, and 30 matched and headache‐free controls participated in this study. During an interictal period, patients with migraine reported more problems regarding social activities and pain compared with healthy controls. During the postictal period, mood (fatigue and emotional state) was negatively affected by an attack that was treated with habitual medication, whereas health state (physical pain, social activities, current pain) was similar to the migraine‐free period. Sumatriptan treatment had beneficial effects on aspects of health state and mood during the postictal period.
Idiopathic Intracranial Hypertension and Hemophilia A
Authors: Jacome Daniel E.
Published: March 2003

Objective.—A patient with hemophilia A and long‐standing recurrent symptoms of idiopathic intracranial hypertension is described. During his relapses, he experienced headache, and attention and language disturbance, but no visual symptoms.

Background.—Hemophilia A is a rare inherited coagulation disorder secondary to factor VIII deficiency. Idiopathic intracranial hypertension has been reported in association with prothrombotic conditions and iron deficiency anemia, but not in patients with hemophilia A. Recurrent or chronic headache is not a typical symptom of hemophilia, but headache is a presenting sign of intracranial bleed in persons with hemophilia.

Methods.—Medical history review, clinical neurologic examination, brain magnetic resonance imaging, computed head tomography, and electroencephalogram were performed.

Results.—Neurologic examination revealed bilateral papilledema during relapses of idiopathic intracranial hypertension. Multiple lumbar punctures preceded by the intravenous administration of factor VIII early in the course of the illness confirmed the presence of elevated cerebrospinal fluid pressures and absence of subarachnoid blood. He had no complications from lumbar punctures. Initial electroencephalograms showed background slowing but later normalized. Magnetic resonance imaging of the brain and computerized tomography of the head were normal. Relapses of idiopathic intracranial hypertension were eventually controlled with the administration of acetazolamide.

Conclusion.—Idiopathic intracranial hypertension may develop in patients with hemophilia A in the absence of visual symptoms. Therapeutic and diagnostic lumbar punctures were safe to perform on this patient, following the administration of factor VIII.
Migraine Diagnosis and Treatment: Results From the American Migraine Study II
Authors: Lipton Richard B. , Diamond Seymour , Reed Michael , Diamond Merle L. , Stewart Walter F.
Published: March 2003

Objective.—A population‐based survey was conducted in 1999 to describe the patterns of migraine diagnosis and medication use in a representative sample of the US population and to compare results with a methodologically identical study conducted 10 years earlier.

Methods.—A survey mailed to a panel of 20 000 US households identified 3577 individuals with severe headache meeting a case definition for migraine based on the International Headache Society (IHS) criteria. Those with severe headache answered questions regarding physician diagnosis and use of medications for headache as well as headache‐related disability.

Results.—A physician diagnosis of migraine was reported by 48% of survey participants who met IHS criteria for migraine in 1999, compared with 38% in 1989. A total of 41% of IHS‐defined migraineurs used prescription drugs for headaches in 1999, compared with 37% in 1989. The proportion of IHS‐defined migraineurs using only over‐the‐counter medications to treat their headaches was 57% in 1999, compared with 59% in 1989. In 1999, 37% of diagnosed and 21% of undiagnosed migraineurs reported 1 to 2 days of activity restriction per episode (P<.001); 38% of diagnosed and 24% of undiagnosed migraineurs missed at least 1 day of work or school in the previous 3 months (P<.001); 57% of diagnosed and 45% of undiagnosed migraineurs experienced at least a 50% reduction in work/school productivity (P<.001).

Conclusions.— Diagnosis of migraine has increased over the past decade. Nonetheless, approximately half of migraineurs remain undiagnosed, and the increased rates of diagnosis of migraine have been accompanied by only a modest increase in the proportion using prescription medicines. Migraine continues to cause significant disability whether or not there has been a physician diagnosis. Given the availability of effective treatments, public health initiatives to improve patterns of care are warranted.
Trigeminal Neuralgia and Cerebellopontine‐Angle Lipoma in a Child
Authors: Raieli Vincenzo , Eliseo Gianluca , Manfrè Luigi , Pandolfi Eleonora , Romano Marcello , Eliseo Mario
Published: March 2003

Trigeminal neuralgia and cerebellopontine‐angle lipomas are very rare in children. We describe the history and findings of an 8‐year‐old boy with right trigeminal neuralgia and a lipoma detected by magnetic resonance imaging at the level of the root‐entry zone of the right seventh cranial nerve. We propose a possible mechanism of infiltration of the trigeminal rootlets by the lipoma.
Headache Characteristics and Race in Singapore: Results of a Randomized National Survey
Authors: Ho King‐Hee , Ong Benjamin K.C.
Published: March 2003

This study presents the first account of the racial differences in headache prevalence and characteristics in the Singapore population. A questionnaire was administered to 2096 individuals from a randomized sample of 1400 households to test the hypothesis that race was independently correlated with headache diagnosis and morbidity. The overall lifetime prevalence of headaches in the study population was 82.7%; this did not vary between racial groups. The modal age of headache onset in all races was in the second decade and was similar in all races. Multivariate analysis showed that headache morbidity was independent of age, sex, income level, marital status, shift duties, and educational level, and correlated only with race and a positive family history of severe headache. Non‐Chinese were more likely to suffer from severe headaches than Chinese, were more likely to seek medical attention, and were more likely to require medical leave for their symptoms. Non‐Chinese had more migrainous headaches than Chinese, although characteristics of headache both groups experienced that were unrelated to severity differed only in a few aspects. We conclude that racial factors account for differences in headache classification, perception of headache severity and health‐seeking behavior.
How Does Almotriptan Compare With Other Triptans? A Review of Data From Placebo‐Controlled Clinical Trials
Authors: Dahlöf Carl G.H. , Dodick David , Dowson Andrew J. , Pascual Julio
Published: March 2003

Almotriptan, the new selective 5‐HT1B/1D agonist, has a higher oral bioavailability than any other triptan, with more than two thirds of the administered dose absorbed within the first hour both inside and outside of a migraine attack. Gender or the presence of food in the stomach does not affect its pharmacokinetic profile, and the compound has no clinically relevant interactions with other drugs.

Among the available triptans, response rates at 2 hours range from 50% to 80%, with 20% to 50% of patients pain‐free. Almotriptan 12.5 mg provides similar efficacy, with significant advantage over placebo at 30 minutes and a reliable consistency (75% in two of three attacks). Headache typically recurs in 25% to 45% of patients with most triptans. The recurrence rate with almotriptan 12.5 mg, 18% to 27%, is among the lowest reported.

The tolerability of almotriptan 12.5 mg is close to that of placebo with a low incidence of central nervous system side effects and chest symptoms.

In conclusion, almotriptan's consistent pharmacokinetics and good efficacy, in combination with excellent tolerability, make it an attractive choice in the acute treatment of migraine attacks.
Hemiplegic Cluster
Authors: Siow Hua Chiang , Young William B. , Peres Mario F. P. , Rozen Todd D. , Silberstein Stephen D.
Published: March 2003

We report four cases of a new variant of cluster headache associated with hemiparesis. Clinical similarities with hemiplegic migraine suggest that hemiplegic cluster, too, may be a channelopathy. One of our patients had a family history suggestive of an autosomal dominant inheritance.