bluuebunny/crossref_metadata_2025 huggingface dataset:
Headache and Electroconvulsive Therapy
Authors: Weiner Saul J. , Ward Thomas N. , Ravaris Charles Lewis
Published: May 2005

SYNOPSIS

While headache is a documented side effect of electroconvulsive therapy (ECT), there is little information on this phenomenon. Studies of the mechanisms of ECT as a treatment for depression indicate that alterations in serotonergic neurotransmission appear to be related to its efficacy. While ECT and many of the antidepressant drugs have similar effects on serotonergic transmission, they are notably different in the changes they induce in type 2 receptors for 5‐hydroxytryptamine (5‐HT). ECT upregulates 5‐HT2, and antidepressants down regulate the receptor's expression. 5‐HT2 receptor sensitization has been associated previously with headache genesis, which may explain why ECT induces headache, and amitriptyline relieves headache.

In our study we surveyed 98 patients retrospectively about their experiences with headache prior to and following ECT. Of the 54 patients who submitted properly completed questionnaires, five reported new onset of headaches following ECT, four reported exacerbation of a previous headache problem, and two reported their headaches improved. The patients experienced changes in the character or location of pain, with a tendency to progress from tension‐type to migrainous headache. In all but two cases these developments persisted at least eight months after ECT. We discuss the possible reasons and significance of our findings.
Magnesium Content of Mononuclear Blood Cells in Migraine Patients
Authors: Gallai Virgilio , Sarchielli Paola , Morucci Piero , Abbritti Giuseppe
Published: May 2005

SYNOPSIS

Recent research has shown that magnesium levels in serum, salivary secretions and red blood cells are reduced in migraine patients with and without aura, both ictally and interictally. This suggests that lower magnesium levels can contribute to the etiopathogenetic mechanisms underlying migraine attacks. It has been suggested that mononuclear magnesium content is a reliable index of magnesium nutritional status, as it is more closely related to the total body stores than other biochemical indices. Therefore we determined mononuclear magnesium content in adult migraine patients with and without aura, in headache‐free periods and, in a number of patients, during attacks. Migraine patients with and without aura, assessed in interictal periods, had a reduced mononuclear magnesium content compared to age‐matched healthy control subjects. No significant variations were observed between ictal and interictal periods in migraine patients with aura and without aura. The lower magnesium content in mononuclear cells could indirectly indicate the reduction of brain magnesium concentration, which has recently been demonstrated in the course of migraine.
Limb Pain and Headache
Authors: Raudino Francesco
Published: May 2005

SYNOPSIS

The occurrence of limb pain in close temporal relationship with headache was sought in 245 (185 women and 60 men) patients. Eleven patients (4.4% three men and eight women) had referred pain at least once, in one or more limbs in close temporal relationship with headache. Usually the pain was located in the upper limbs, was concomitant with the headache but could precede or follow it. The severity and length varied between patients but was relatively stable in the same subject. It is possible that this symptom is more frequent than believed so far and that many patients are misdiagnosed.
Headache and Neck Pain: The Warning Symptoms of Vertebral Artery Dissection
Authors: Sturzenegger Matthias
Published: May 2005

SYNOPSIS

The clinical features of headache and neck pain in 14 patients with extracranial vertebral artery dissection proven by angiography or magnetic resonance imaging are reported. Pain was always located on the side of the dissected vertebral artery. Whereas eleven patients had head and posterior neck pain, the others had either only posterior neck pain, no change of a chronic pre‐existing headache or no pain at all. Pain started suddenly, was of sharp quality and severe intensity, different from any previously experienced headache. Following acute onset, the time course of pain was monophasic with gradual remission of a persistent headache lasting one to three weeks. A delay between onset of head or posterior neck pain and onset of neurologic dysfunction was noted in 12 patients and was less than one day and between one day and three weeks in six each. Report of this distinct type of pain, although non‐specific as an isolated symptom, should raise suspicion of an underlying vertebral artery dissection. Early confirmation of this diagnosis and subsequent anticoagulation if dissection does not extend intracranially may help prevent vertebro‐basilar ischemic deficits.
Comparison Between Venoconstrictor Effects of Sumatriptan and Ergotamine in Migraine Patients
Authors: Panconesi Alessandro , Anselmi Bruno , Curradi Carlo , Perfetto Federico , Piluso Adriano , Franchi Giancarlo
Published: May 2005

SYNOPSIS

The vasoconstrictor activity of sumatriptan and ergotamine were compared by injecting these drugs in the hand vein of migraine subjects. We used the “venotest method”, which permits the evaluation of the venoconstrictor effect of small doses of drugs, acting locally in the hand vein.

Sumatriptan injected at increasing doses in the hand vein provoked contraction only at high doses (500 μg): venoconstriction lasted 5–15 minutes and was similar in intensity and duration to that induced by 0.5‐1 μg of 5‐hydroxytryptamine (5‐HT). Likewise, ergotamine induced contraction only at a dose of 50 μg: this venoconstrictor effect was long lasting (at least I hour). Ergotamine‐induced hand vein contraction, almost completely inhibited by ketanserin, seems mediated at least in part by 5‐HT 2 receptors, like the one induced by 5‐HT and sumatriptan, already observed in a previous study.

Clinical doses of ergotamine (0.25 mg intramuscular) and of sumatriptan (6 mg subcutaneous) do not provoke hand vein contraction for at least I hour: this could be due to a low activity of these drugs on the 5‐HT 2 vein receptors or a technique that is unsuitable to detect the vasoconstrictor effect of drugs given by the systemic route.

The long lasting venoconstrictor effect of ergotamine may be due to a slow dissociation from receptor sites. The short vasoconstriction induced by sumatriptan could account for the recurrence of headache in many sumatriptan‐treated migraine subjects.
Adolescent Chronic Paroxysmal Hemicrania Responsive to Verapamil Monotherapy
Authors: Shabbir Nadeem , McAbee Gary
Published: May 2005

SYNOPSIS

Two teenage girls with chronic paroxysmal hemicrania demonstrated dramatic yet incomplete improvement with indomethacin. Verapamil monotherapy provided nearly complete cessation of headaches.
Continuous Chronic Tension‐Type Headache Unaffected by Two Hours of Frontalis and Trapezius Relaxation
Authors: Richman Joel L. , Haas David C.
Published: May 2005

SYNOPSIS

Fourteen patients with the continuous form of chronic tension‐type headache maintained electromyographically documented relaxation of frontalis and trapezius muscles for two consecutive hours. The headache intensity of the group did not decrease from the beginning to the end of the recording session. This result is evidence against tonic muscle tension as the mechanism of this form of headache.
Referred Headache of Rhinogenic Origin in the Absence of Sinusitis
Authors: Clerico Dean Michael , Fieldman Robert
Published: May 2005

SYNOPSIS

Nasal signs and symptoms commonly accompany cephalgia in some headache syndromes. Head pain associated with sinusitis is also fairly well‐recognized. However, referred cephalgia of rhinogenic origin, in the absence of sinonasal symptoms or disease, is poorly understood. We report a case of a patient with chronic and severe headache for whom neurological and neurosurgical evaluation failed to reveal an etiology, but who possessed an intranasal anatomical variant (without sinusitis). Her headache resolved after endoscopic nasal surgery. We discuss the mechanisms of such referred pain, and the recent technological advances that made the diagnosis and treatment of this disorder possible.
Cervical Dural Arteriovenous Malformation Presenting With Right‐Sided Occipitalgia: Before and After Successful Treatment by Embolization
Authors: Chiba Susumu , Nishioka Hitomi , Saitoh Masaki , Imai Tomihiro , Tanabe Sumiyoshi , Matsumoto Hiroyuki
Published: May 2005

SYNOPSIS

We report a 52‐year‐old man who had a 2‐year history of right‐sided occipitalgia. His pain was induced by anteroflexion of the neck. Neurologic examinations showed mild right C2 and C3 root signs. Cervical MR imaging disclosed an extra‐medullary intradural crooked shadow at the level between C2 and C3 vertebrae, which was proven by selective angiogram of the ascending cervical artery to be a dural arteriovenous malformation located in the right C3 root sleeve. Embolization by an endovascular approach resulted in angiographic and clinical cure. These findings indicate that headache due to arteriovenous malformation in upper cervical region may be surgically treatable.
Headache Characteristics Among High School and University Students
Authors: Montgomery Gary T.
Published: May 2005

SYNOPSIS

An extensive questionnaire which addressed general health, headache characteristics, antecedents to headaches, and coping strategies after one gets a headache was administered to 837 high school and university students in south Texas. Hypotheses were confirmed that (a) university students reported greater headache severity than did high school students, and (b) females reported higher frequencies of headaches and greater headache severity than did males. Our sample from south Texas reported a much lower incidence of headache than recent reports of students from other universities. Factor analysis of headache characteristics questions supported traditional headache classification. Factor analysis identified commonalities among headache antecedents and headache coping strategies. Relationships were identified between headache severity, headache antecedents and coping strategies that were consistent with previous studies.
Opioid and Sympathetic Nervous System Activity in Cluster Headache Under Verapamil or Prednisone Treatment
Authors: de Lourdes Figuerola María , Levin Gloria , Leston Jorge , Barontini Marta
Published: May 2005

SYNOPSIS

This study was undertaken to evaluate the effect of treatment with prednisone or verapamil on plasma met‐enkephalin (ME), neutrophil met‐enkephalin containing peptides (NMECP) and free and conjugated plasma catecholamines (CA) in cluster headache (CH) patients. After obtaining a basal sample, patients were randomly selected to be treated with either verapamil (n=5) or prednisone (n=5). A second blood sample was obtained 10 days after starting treatment. At this time all patients were free of symptoms. ME (0.49 ± 0.10 pmol/mL) and NMECP 135.1 ± 2.4 pmol/mg protein) levels after prednisone treatment were significantly higher (P <0.05) than in basal conditions (0.29 ± 0.08 pmol/mL and 27.14 ± 2.4 pmol/mg protein), while no differences were found in catecholamine levels. No differences in ME, NMECP or CA were found during verapamil treatment. Our results suggest that in CH the two drugs act through different mechanisms. The relief of the bout obtained with prednisone may be related to the opioid system stimulation observed in these patients.
Substance P: Correlation of CSF and Plasma Levels
Authors: Clark Jeffrey W. , deS. Senanayake Preenie , Solomon Glen D. , Gallagher Claudia
Published: May 2005

SYNOPSIS

Objective: To determine the correlation between cerebrospinal fluid and plasma concentrations of substance P.Patients: 37 patients undergoing lumbar puncture for various diagnostic purposes. Measurements: Samples of cerebrospinal fluid and blood were obtained at the same visit. Substance P was measured by radioimmunoassay technique. At least 4 separate measurements were conducted on each sample to insure accuracy. Results: The mean plasma SP level was 1.195 (± 1.1). The mean cerebrospinal fluid substance P level was 1.075 (± .07). There was a statistically significant positive correlation between substance P level in the plasma and cerebrospinal fluid. The Pearson correlation coefficient was 0.656 (P<.0001) and the Spearman correlationcoefficient was 0.698 (P<.0001). Conclusions: Plasma substance P levels closely correlate with cerebrospinal fluid substance P levels. This will simplify the measurement of substance P in the evaluation of therapeutic agents for headache.
A Prospective Study of Juvenile Migraine With Aura
Authors: Lanzi G. , Balottin U. , Borgatti R.
Published: May 2005

SYNOPSIS

We studied a group of young migraine with aura patients with whom it was possible to reconstruct the course and the characteristics of the disturbances preceding or accompanying the onset of the headache.

The 47 subjects, 31 female and 16 male, were diagnosed (IHS classification) as Migraine with typical aura (n=40), Familial hemiplegic migraine (n=1l), Basilar migraine (n=6), and Migraine with prolonged aura (n=5).

Visual (43 cases) and sensory disturbances (20 cases) were the most commonly described symptoms; a motor deficit was reported in 10 out of 47 cases. Other disturbances such as vertigo attacks, aphasia, spatial disorientation, loss of consciousness or a decreased level of consciousness with the appearance of automatic movements, were much rarer.

In our cases the visual disturbances were not isolated but were accompanied by other symptoms in 29 cases, and in 5 of the 18 cases in which there were only visual symptoms, the disturbances presented in succession; a "march" of the sensory and motor disturbance was found in 66% and 68% of cases, respectively.

The data from our cases in which the disturbance seems most frequently to originate in the occipital areas (visual disorders) and then to spread to the temporo‐parietal regions in part confirms that there is a posterior to anterior dynamic in the cerebral areas involved.
Migraine as a Sequela to Chronic Low Back Pain
Authors: Duckro Paul N. , Schultz Karl T. , Chibnall John T.
Published: May 2005

SYNOPSIS

The occurrence of headache as a sequela of low back pain was examined in a sample of chronic pain patients. All patients had low back pain without history of head, neck, or upper back injury or headache onset simultaneous with the low back pain, Consistent with prior research, headache was found to be a common concomitant of back pain. In many patients, headache was found to have begun or exacerbated markedly after onset of low back pain. Prevalence of migraine in female patients was significantly higher than the population prevalence for females in the United States; this was not true for male patients. Potential mechanisms for explaining the high prevalence of migraine following low back pain are discussed, including increased muscle tension, psychosocial factors, and analgesic overuse.
Prolonged Impaired Consciousness in Basilar Artery Migraine
Authors: Muellbacher W. , Mamoli B.
Published: May 2005

SYNOPSIS

Basilar artery migraine is a distinctive disorder characterized by recurrent occipital headache with typical migrainous phenomena in conjunction with a variety of symptoms referable to a transient dysfunction of the brainstem, the cerebellum and the occipital lobes. Impairment of consciousness is a common feature but is usually too brief to be captured by electroencephalography. Here we report an unusual case of basilar artery migraine with prolonged attacks of impaired consciousness lasting more than two Weeks, thus allowing electroencephalographic follow‐up. In the acute stage, EEG showed marked generalized slow wave delta activity. After the attack, both the electroencephalographic and clinical findings subsided within the following weeks.
Measuring the Functional Status and Well‐Being of Patients with Migraine Headache
Authors: Osterhaus Jane T. , Townsend Raymond J. , Gandek Barbara , Ware John E.
Published: May 2005

SYNOPSIS

Objective: Compare adult migraineurs' health related quality of life to adults in the general U.S. population reporting no chronic conditions, and to samples of patients with other chronic conditions. Methods: Subjects (n=845) were surveyed 2–6 months after participation in a placebo‐controlled clinical trial and asked to complete a questionnaire including the SF‐36 Health Survey, a migraine severity measurement scale and demographics. Results were adjusted for severity of illness and comorbidities. Scores were compared with responses to the same survey by the U.S. sample and by patients with other chronic conditions. Results: Response rate was 67%. After adjustment for comorbid conditions, SF‐36 scale scores were significantly (P 0.001 ) lower in migraineurs, relative to age and sex‐adjusted norms for the U.S. sample with no chronic conditions. Some health dimensions were more affected by migraine than other chronic conditions, while other dimensions were less affected by migraine. Measures of bodily pain, role disability due to physical health and social functioning discriminated best between migraineurs, the U.S. sample, and patients with other chronic conditions. Patients reporting moderate, severe and very severe migraines scored significantly (P £ 0.001 ) lower on five of the eight SF‐36 scales than the U.S. sample. Conclusions: Migraine has a unique, significant quality of life burden.
Illness Beliefs and Alexithymia in Headache Patients
Authors: Wise Thomas N. , Mann Lee S. , Jani Niru , Jani Sushma
Published: May 2005

SYNOPSIS

Research regarding psychological factors in head pain have generally focused upon personality traits and psychopathology. The role of illness beliefs offers another method of elucidating perceptions, attitudes and convictions towards a somatic complaint. One hundred patients, evaluated for head pain at a neurology clinic, were administered the Illness Behavior Questionnaire (IBQ) to delineate illness beliefs; the Illness Effects Questionnaire (IEQ) to quantify the disruptive aspects of head pain; and the Toronto Alexithymia Scale (TAS) to assess the subjects propensity to somatize as well as the ability to identify and report emotions. The data found no difference between subjects diagnosed with migraine syndrome and those with tension head pain in the IBQ dimensions, the TAS or in reported levels of anxiety or depression. However, chronicity of symptoms was associated with increased irritability. The clinical implications of the findings suggest that patients with head pain are psychologically distressed but often possess alexithymic characteristics that make insightful associations difficult.
Abortive Migraine Therapy in the Office with Dexamethasone and Prochlorperazine
Authors: Saadah Hanna A.
Published: May 2005

SYNOPSIS

Corticosteroids are commonly used in the abortive therapy of status migrainosus. However, this practice is based more on clinical experience than on published data. At my office, over a period of two years, 108 patients (156 migraine episodes) were treated with intravenous dexamethasone. Most of these patients had prolonged migraines that had resisted other forms of abortive therapy. The first 22 patients (32 migraine episodes) were given 10 mg of dexamethasone over 5 minutes, the next 39 patients (55 migraine episodes) were given 20 mg over 10 minutes, and the last 47 patients (69 migraine episodes) were given 3.5 mg of prochlorperazine over 5 minutes followed by 20 mg of dexamethasone over 10 minutes. Adverse effects were minor and patients with episodic migraines responded more favorably than those with intractable migraines. In the episodic migraine groups, response rates ranged from 80–89%, relapse rates from 29–35%, and remission rates from 57–83%. After the intravenous injections, repetitive oral abortive therapy was often required to treat relapses and secure remission. Adding 3.5 mg of pro‐chlorperazine to 20 mg of intravenous dexamethasone significantly shortened the response time.
Inheritance of Cluster Headache and its Possible Link to Migraine
Authors: M.D. Kudrow Lee , M.D. Kudrow David B.
Published: May 2005

SYNOPSIS

We evaluated the possibility that cluster headache may be a transmitted disorder, influenced by migraine genetics. In the first part of a two part study, 24 female cluster headache probands having at least one first degree relative with cluster headache were evaluated for familial histories of cluster and migraine headache. Headache histories of most parents, sib‐lings and children were satisfactorily documented by either direct interview or by information provided by knowledgeable relatives. In approximately a third of relatives, the headache history could not be properly ascertained. The second part of the study evaluated occurrence rates of cluster and migraine headaches among first degree relatives of 200 female and 100 male cluster headache patients, and the proportion of affected relatives. These data were compared to those of 200 women and 100 men with migraine headache; family history data were, for the most part, provided by headache patients.

Twenty‐four of two hundred cluster headache women (12%) had at least one first degree relative with cluster headache. Three generations of cluster headache were found in 7/ 24 kindreds (29.17%). Parental cluster headache was found in 19 of the 24 probands (79.17%); in 14/19 (73.68%), transmission was from father to proband. Fifty percent of cluster pro‐bands also had migraine headaches, and almost 50% had a family history of migraine. Similarly, of the larger population of 300 cluster patients, approximately 45% had a positive family history of migraine. Of 1652 relatives of all cluster patients, 3.45% had cluster headache (thirteen times the expected frequency of cluster headache in the general population) and 17.55% had migraine headaches.

The combined occurrence rate of cluster and migraine headaches among mothers or fathers of cluster patients differed little from the parents of migraine patients (X2 = 3.16, P <.10; X2 = 0.28, P < 0.70, respectively). Migraine was significantly more common, however, among some relatives of migraineurs compared to combined frequencies of migraine and cluster headache among relatives of cluster patients. Finally, the migraine population of Goodell et al.28 was compared to our cluster headache population for occurrence of either headache type among children where neither, one or both parents had headaches. The results for our cluster population was 36.33%, 48.07% and 71.43%, respectively; this distribution was not significantly different from the migraine group of Goodell et al. (28.6%, 44.2% and 69.2%),28 and conformed to a Mendelian pattern of transmission (X2 = 37.55, P < 0.001).

Results of this study provided evidence suggesting a genetic basis for cluster headache. Equally compellingwere findings suggesting a genetic link between migraine and cluster headaches. The authors have speculatedthat migraine and cluster headache may be the same disorder, genotypically, but expression of the latter mayinvolve a more complex process requiring, as yet unknown, extrinsic or intrinsic influences.
Serotonin (5‐HT) and Migraine
Authors: Silberstei Stephen D.
Published: May 2005

SYNOPSIS

Serotonin, or 5‐hydroxytryptamine [5‐HT], is a biogenic amine implicated in controlling feeding behavior, thermoregulation, sexual behavior, and sleep. 5‐HT receptors recognize at least three types of molecular structures: G protein coupled receptors, ligand gated ion channels, and transporters. It is now believed that there are at least seven different families of receptors, many of which have subtypes. The nervous system can be compared to a group of well‐modulated neural networks functioning in parallel. The serotonergic system may modulate these networks rather than actually mediate individual responses. Circumstantial evidence suggests a link between 5‐HT and migraine. Platelet HT decreases during an attack, and in some cases increased levels of metabolites are found. Many antimigraine drugs interact with 5‐HT and its receptors.
Effect of Biofeedback‐Assisted Relaxation on Migraine Headache and Changes in Cerebral Blood Flow Velocity in the Middle Cerebral Artery
Authors: McGrady Angele , Wauquie Albert , McNei Apryl , Gerar Gary
Published: May 2005

SYNOPSIS

Twenty‐three patients with diagnosed migraine headaches were randomly assigned to a biofeedback‐assisted relaxation therapy group or to a group who relaxed on their own. The biofeedback trained group decreased pain and medication more than the self relax group. Cerebral blood flow velocity was measured in the middle cerebral artery with transcranial doppler (TCD). The trained group significantly reduced systolic and mean cerebral blood flow velocity on the side with the highest velocity.
Factors Influencing Treatment‐Seeking Behavior In Problem Headache Sufferers
Authors: Rokick Lori A. , Holroy Kenneth A.
Published: May 2005

SYNOPSIS

Subject samples used in research on recurrent headache disorders typically are composed of individuals who are seeking or receiving treatment. To the extent such subjects are unrepresentative of the larger population of recurrent headache sufferers, the external validity of findings may be jeopardized. We examined young recurrent (tension‐type or migraine) headache sufferers and compared individuals who had sought treatment (N=81) and individuals who had not sought treatment (N=109) for their headache problem. Subjects who did not experience headaches (N=129) served as a comparison group. Recurrent headache sufferers who had sought treatment reported more frequent headaches and experienced problem headaches for a longer period of time than recurrent headache sufferers who had not sought treatment for their headaches. However, the two treatment‐seeking groups did not differ on measures of psychological symptoms, coping strategies, or beliefs about their headache disorder. Irrespective of whether they had sought treatment or not sought treatment for their headache problems, recurrent headache sufferers reported higher levels of depression and physical symptoms than comparison subjects. These results provide no support for the hypothesis that psychological symptoms or neuroticism are associated with treatment‐seeking behavior in recurrent headache sufferers.
Headache in Brain Tumor: A Cross‐Sectional Study
Authors: Suwanwela Nijasri , Phanthumchinda Kammant , Kaoropthum Surachai
Published: May 2005

SYNOPSIS

Headache is one of the cardinal features of intracranial neoplasm. However, there is little published information on the prevalence and clinical profiles of headache in patients with brain tumor. This cross‐sectional study recruited 171 cases of brain tumor. The average age was 39 years (range from 4 to 75 years). The female to male ratio was 1.2:1. The prevalence of headache was 71%. The duration of headache ranged from 3 days to 10 years with an average of 15.7 months. Most prominent headache profiles in this series were intermittent, nocturnal and early morning headache as well as headache upon arising. Most of the patients had mild to moderately severe headache. Headache is more common with tumors below the tentorium cerebelli. It is more prevalent in primary and intracerebral tumor than in metastatic and extracerebral tumor. Headache has lateralizing value, especially in patients with supratentorial lesions who have no obvious increased intracranial pressure.
Application of Metoclopramide Specificity in Migraine Attacks Therapy
Authors: Schwarzberg Moshe N.
Published: May 2005

SYNOPSIS

The 5‐HT3 antagonism property of metoclopramide, acting on receptors presumably located in the trigeminovascular system, is the theoretical basis of its remarkable success, as a single intravenous agent, in the treatment of migraine attacks. The specific anti‐migraine activity of oral metoclopramide is, most probably, applicable only when its plasma level is equivalent to 10 mg injected intravenously. The clinical effective dose of ergotamine, beginning from the minimal dose of 1 mg, correlates well with its affinity for 5‐HT18 and 5‐HT1D receptors, and the rank order of clinical potency of ergotamine is superior to sumatriptan. The presumed synergic power of drugs that interact with both 5‐HT1 and 5‐HT3 receptors is examined, in order to formulate a highly potent, low headache recurrence, oral combination.
Ketorolac (Toradol ®) Induced Lithium Toxicity
Authors: Lyer Vasudeva
Published: May 2005

SYNOPSIS

A case of lithium neurotoxicity in a patient with cluster headache, resulting from coadministration of ketorolac is reported. While lithium interaction with many other NSAIDs is well‐known, ketorolac has not been incriminated.
MRI Angiography of a Patient Before and During Alcohol‐Induced Cluster Headache
Authors: Somerville Brian
Published: May 2005

SYNOPSIS

A 25‐year‐old man, subject to bouts of left supraorbital cluster headache on an annual basis over the previous 8 years, volunteered for MRI angiography during an active period. Studies were conducted before and during a typical cluster headache attack induced by alcohol. MRI angiography failed to show dilatation of the ophthalmic artery on either the symptomatic side, or the non‐symptomatic side during headache, nor was there observed any dilatation of the anterior cerebral arteries on either side.
Inter‐Observer Agreement in the Diagnosis of Childhood Headache
Authors: Wolstein Jörg R. , Seshia Shashi S. , Haese Philip , Adams Coleen , Booth Frances A. , Reggin James D.
Published: May 2005

SYNOPSIS

We prospectively assessed inter‐observer agreement in the diagnosis of recurrent headaches in children. Clinical letters containing information on 40 children with headaches (age 4.3 to 17.8 years, median 10.4 years) were given to four Pediatric Neurologists. One or more headache types could be checked off on a data sheet that listed the main types recognized by the International Headache Society and an additional one, “combined migraine and tension‐type headache”. There were six combinational pairs of neurologists. The six pairs yielded 240 sets of diagnoses. Percentage agreement ranged from 45% to 78%, Kappa values from 0.20 to 0.59, and weighted Kappa from 0.19 to 0.52 within the six pairs. Agreement was 76% when both neurologists in a pair assigned single headache types and 4% when one or both neurologists diagnosed multiple types. The International Headache Society suggests that patients may have multiple types of headache and recommends that all types be classified. We suggest that the option of diagnosing more than one headache type from data in clinical letters may reduce inter‐observer agreement.
Is Temporomandibular Dysfunction a Cranial Dystonia? An Electrophysiological Study
Authors: Raudino Francesco
Published: May 2005

SYNOPSIS

In 26 patients suffering from temporomandibular dysfunction (TMD) the silent period (ES), which consists of an early (ES1) and a late (ES2) inhibition which interrupts the voluntary electromyographic activity after an electrical stimulus, was recorded from the masseter muscles. Several different patterns were identified: in 8 patients (group I) the ES was normal; in I patient (group II) the ES was entirely absent; in 11 patients (group III) only the ES2 was absent and in 6 patients (group IV) ES1 and ES2 were combined. Such results can be explained by hypothesizing several functional states: normal excitability in group I, absolute (group II) or relative (group III) inexcitability and hyperexcitability in group IV. A central origin of TMD can be related either to a “dysregulation” of circuits located in the brainstem which give rise to the ES or to the centers, probably located in the basal ganglia, which control the circuits of the brainstem.
A Comparative Study of Amitriptyline and Fluvoxamine in Migraine Prophylaxis
Authors: Bánk Jozsef
Published: May 2005

SYNOPSIS

Current treatment of migraine either abortive or prophylactic is often unsatisfactory. Prophylactic treatment of severe migraine may reduce attack frequency, and current therapy centers on beta‐blockers, serotonin (5‐HT) reuptake blockers and 5‐HT 2 receptor antagonists. The author compared the efficacy and safety of amitriptyline and fluvoxamine among migraine patients (24F, 8M vs. 23F, 9M) in a double blind study. The efficacy of amitriptyline has already been established by earlier clinical studies. The other investigated drug, fluvoxamine, has a more selective 5‐HT reuptake blocking property than amitriptyline. In this study, amitriptyline significantly reduced the number of headache attacks, but it caused severe drowsiness in many migraineurs. The fluvoxamine also favorably influenced on the number of headache attacks and caused only slight side effects. These findings suggest, that fluvoxamine may be an alternative drug in migraine prophylaxis, however, further studies should be performed with more subjects.
Neurophysiological Studies in Chronic Paroxysmal Hemicrania and Hemicrania Continua
Authors: Antonaci Fabio , Sandrini Giorgio , Danilov Andrei , Sand Trond
Published: May 2005

SYNOPSIS

To explore the possible involvement of the pain control system, pain pressure threshold (PPT), nociceptive flexion reflex (RIll), blink and corneal reflexes have been studied for pain perception assessment in 12 patients with chronic paroxysmal hemicrania (CPH) and 12 patients with hemicrania continua (HC). PPT was found to be reduced in HC and CPH when separately compared to controls. In addition, a significant reduction of subjective pain perception (Tp) which was most marked on the symptomatic side, has been demonstrated after sural nerve stimulation in CPH. The RIll reflex threshold on the symptomatic side was significantly reduced when patients were compared to controls, No major differences between CPH and HC as regards blink reflex latencies were found; nor was any such difference observed when comparing the two headache groups to controls. The corneal reflex thresholds were found significantly reduced bilaterally in CPH, irrespective of whether the treatment was given or not.
Tension‐Type Headaches
Authors: Silberstein Stephen D.
Published: May 2005

Tension‐type headache is the term designated by the International Headache Society to describe what was previously called tension headache, muscle contraction headache, psychomyogenic headache, stress headache, ordinary headache, and psychogenic headache. The International Headache Society defines tension‐type headache more precisely, distinguishes between the episodic and the chronic varieties, and divides them into two groups, those associated with a disorder of the pericranial muscles and those not associated with this type of disorder. Most clinic‐based studies of tension‐type headache suffer from selection bias, as they include patients with more severe headaches, patients with concomitant migraine, and patients with chronic daily headache. Traditionally, episodic tension‐type headache and migraine have been considered distinct disorders, and the International Headache Society continues the separation, Some believe that both migraine and tension‐type headache are recurring benign headaches. Chronic tension‐type headache used to be called chronic daily headache, but they are not identical, Chronic tension‐type headache must be distinguished from chronic daily headache even though the International Headache Society has not done this. Chronic daily headache is a syndrome consisting of a group of disorders and can be subclassified into primary and secondary types, The primary chronic daily headache disorders include transformed migraine, chronic tension‐type headache, new daily persistent headache, and hemicrania continua. Secondary causes of chronic daily headache include post‐traumatic headache, cervical spine disorders, and headache associated with vascular disorders and nonvascular intracranial disorders. Patients with frequent headaches are prone to overuse analgesics, ergotamine, or both. Most patients with chronic daily headache overuse symptomatic medication. Treatment is most difficult for patients with chronic daily headache. These patients often have physical and emotional dependency, low frustration tolerance, a sleep disturbance, and depression. Stopping overused medication is crucial. Detoxification is difficult and frequently requires hospitalization and aggressive headache management.
Migraine Diagnosis and Clinical Symptomatology
Authors: Solomon Seymour
Published: May 2005

Migraine is a very common phenomenon. Eighteen percent of women in this country and 6% of men have migraine. The old classification for headaches and diagnostic criteria were published in 1962, more than a quarter of a century ago. In 1988, the International Headache Society published a new classification and diagnostic criteria for all headache disorders, cranial neuralgias, and facial pain. The International Headache Society classification divides migraine, as it had been divided in the past, into two major categories: migraine without aura (formerly called common migraine) and migraine with aura (formerly called classical migraine). These criteria are rather complex and simpler criteria are proposed for clinical practice. The typical patient with migraine is a woman whose headaches began in adolescence or young adult life. There usually is a family history of migraine. Migraine is almost always more than just a headache. Virtually anything in the external environment and many things in the internal milieu may provoke migraine in a susceptible individual. There are many potential manifestations of the aura of migraine, but 90% are visual phenomena. Migraine in children is a little different than in adults. When the onset is below the age of puberty, the ratio of females to males is equal, but after puberty there is a striking predominance of women over men in a ratio of 3:1. Whenever the history of migraine is not typical or if something unexpected is found on examination, imaging studies are warranted.
Increased 11‐dehydrothromboxane B 2 in Migraine: Platelet Hyperfunction in Patients with Migraine during Headache‐free Period
Authors: Kitano Ayumi , Shimomura Tokio , Takeshima Takao , Takahashi Kazuro
Published: May 2005

SYNOPSIS

Several disturbances in platelet function have been reported in migraine and tension‐type headache (TH). The plasma 11‐dehydrothromboxane B 2 (11‐dTXB 2 ) is free from artifactual increase during blood sampling, and it can be a reliable indicator of thromboxane A 2 (TXA 2 ) production in vivo. TXA 2 is a very potent proaggregatory and vasoconstrictory metabolite formed in the platelets. We investigated plasma 11‐dTXB 2 and 5‐hydroxytryptamine (5‐HT) levels in patients with migraine during headache‐free periods and in patients with chronic TH. The mean value of plasma 11 ‐dTXB 2 levels in migrainous patients was significantly higher than those in TH patients and healthy controls. The mean value of plasma 5‐HT levels in TH patients was significantly lower than those in migrainous patients and healthy controls. There was no correlation between plasma 11‐dTXB 2 levels and plasma 5‐HT levels in any group. The results suggest the existence of continuous platelet activation in migrainous patients.
Headache in Sturge‐Weber Syndrome
Authors: Klapper Jack
Published: May 2005

SYNOPSIS

Based on reports of headache in arteriovenous malformations and epilepsy, one would predict that the prevalence of migraine headache in the Sturge‐Weber syndrome would be higher than in the general population.

A questionnaire designed to determine the prevalence and type of headache by IHS criteria was sent to the 500 members of the Sturge‐Weber Foundation.

The average age of the patients in this sample (71 patients) was 15 years. The sex ratio was approximately one to one. Headache meeting IHS criteria for migraine occurred in 28% (equally among males and females) compared to 17% in females and 5% in males in the general population, Neurologic deficits occurred in 58% during migraine, The prevalence of migraine in children under the age of 10 (31%) was higher than that reported in the general population (5%) and the age of onset was younger. The mechanism of migraine headache in Sturge‐Weber syndrome may be similar to that found in epilepsy and vascular malformations.
Low Flow Dural Arteriovenous Shunt: Another Cause of “Sinister” Tolosa‐Hunt Syndrome
Authors: Brazis Paul W. , Capobianco David J. , Chang Fenn‐Lei F. , McLeish William M. , Earnest Franklin
Published: May 2005

SYNOPSIS

A 73‐year‐old man developed acute, painful, ophthalmoplegia. The pain improved with oral steroids and a diagnosis of Tolosa‐Hunt syndrome was made. Review of his angiogram revealed a low flow dural arteriovenous shunt that drained posteriorly. Dural arteriovenous shunts may thus be another cause of “sinister” Tolosa‐Hunt syndrome.
Video Assessment of Yawning Induced by Sublingual Apomorphine in Migraine
Authors: Del Bene Enrico , Poggioni Marco , De Tommasi Francesco
Published: May 2005

SYNOPSIS

A double‐blind, placebo‐controlled study was carried out in 14 migraineous outpatients and 8 control subjects to assess yawning response to 0.25 mg of sublingual apomorphine, a dopamine receptor agonist, by means of an audiovisual technique. Apomorphine induced a significantly higher number of yawns than placebo in both groups of subjects, but the effect was significantly greater in migraine sufferers than in controls. The result seems to confirm the previous reported hyper‐responsiveness to pharmacological dopaminergic stimulation in migraine sufferers. Moreover, the audiovisual technique seems to be an appropriate tool to study yawning response in man.
Pet Ownership and Prophylaxis of Headache and Chronic Pain
Authors: Hirsch Alan R. , Whitman Bradley W.
Published: May 2005

SYNOPSIS

The belief that having household pets promotes good health is ubiquitous among Americans. Recent studies support this belief where certain medical conditions are concerned. To investigate the advantages of pet ownership in the prophylaxis of headache and other chronic pain conditions, we queried 62 patients suffering from such diseases about whether they owned pets and whether children and other adults shared their households. We similarly queried a control group of 38 patients with various conditions not involving headache or chronic pain. We found that statistically, the experimental group and the control group were not significantly different in their household compositions. In fact, those with headaches and chronic pain, on average, owned slightly more pets and had slightly more children and other adults sharing their households than did those without headache or chronic pain conditions. Thus, contrary to our expectations, pet ownership apparently conferred no analgesic benefits, nor did the presence of children or of other adults in the household confer any benefit to headache and other chronic pain sufferers.
Sumatriptan in Acute Migraine Using a Novel Cartridge System Self‐Injector
Authors: Gross M.L.P. , Kay J. , Turner A.M. , Hallett K. , Cleal A.L. , Hassani H. ,   the United Kingdom Study Group
Published: May 2005

SYNOPSIS

This double‐blind. randomized, placebo‐controlled, parallel‐group, multicenter study assessed the efficacy, acceptability, safety, and tolerability of subcutaneous sumatriptan 6 mg administered using a novel cartridge system self‐injector for the acute treatment of migraine.

Eighty‐six patients treated one migraine attack at home with sumatriptan or placebo. A second identical injection was available after 1 hour for inadequate relief or if the headache recurred. Rescue medication was available I hour later. The primary end point was headache relief (improvement in headache from moderate or severe to mild or no pain) within 60 minutes of the first injection. Secondary end points included the acceptability of the self‐injector, requirement for and efficacy of a second dose, relief of nonheadache symptoms, use of rescue medication, and adverse events.

Significantly more patients taking sumatriptan than placebo reported headache relief I hour after the first injection (88% vs 11%, P <0.001). The device was well accepted by patients; about 90% found it easy to use and wanted to take further medication using it. Significantly fewer patients taking sumatriptan than placebo required a second injection (33% vs 92%, P <0.001) or rescue medication after the second injection (35% vs 67% P <0.05). Significantly more patients taking sumatriptan than placebo reported headache relief after the second injection (83% vs 32%, P <0.01), and resolution of non‐headache migraine symptoms (54% vs 23%, P <0.01). Sumatriptan was generally well tolerated.

Subcutaneous sumatriptan 6 mg self‐administered using the novel self‐injector is an effective, well accepted, and well tolerated acute treatment of migraine.
The Effect of Verapamil Calcium Antagonist on Autonomic Imbalance in Migraine: Evaluation by Spectral Analysis of Beat‐to‐Beat Heart Rate Fluctuations
Authors: Zigelman Michal , Appel Shlomo , Davidovitch Simha , Kuritzky Arieh , Zahavi Izhar , Akselrod Solange
Published: May 2005

SYNOPSIS

Abnormalities in autonomic control have been documented in migraine even during the headache‐free interval. It has long been recognized that spectral analysis of heart rate (HR) fluctuations can reflect the autonomic function, especially the sympathetic to parasympathetic balance. This technique is the basis for a quantitative approach to the investigation of migraine applied in the present study.

A 24‐hour Holter ECG recording was performed for each subject in a group of five migraine patients during the inter‐headache period. In addition, shorter 5‐minute‐long recordings of blood flow (BF) and blood pressure (BP) were made in these patients in both supine and standing positions. Short, 256‐second subtraces were taken every 30 minutes along the 24‐hour ECG signal and were submitted, as well as the BF and BP traces, to A/D conversion and computation of the power spectrum of fluctuations in HR, BF, and BP. Spectral analysis of fluctuations in these hemodynamic parameters was performed in the migraine patients before and during the treatment with verapamil and compared to that of a healthy control group. This procedure enabled us to assess the autonomic function, the sympathetic vs parasympathetic balance, and their response to a change in position, before and during calcium blockade.

A characteristic autonomic abnormality is revealed in the group of untreated migraine patients in supine position: enhanced low frequency (LF) fluctuations reflecting increased sympathetic sensitivity during the inter‐headache phase. An exaggerated sympathetic response is measured in the migraine patients during the transition from supine to standing position with a concomitant nonsignificant decrease in parasympathetic response. Under the influence of verapamil, the enhancement in low frequency fluctuations is reversed as well as the exaggerated sympathetic response to standing.
Treatment of Childhood Headache with Dihydroergotamine Mesylate
Authors: Linder Steven L.
Published: May 2005

SYNOPSIS

This study was undertaken to determine whether pediatric patients with migraine without aura who have failed standard outpatient regimens including intravenous dihydroergotamine mesylate (DHE) in conjunction with oral metoclopramide would respond to an inpatient treatment protocol of intravenous DHE and oral metoclopramide. Thirty patients were evaluated in this study which was an open label, retrospective review of treatment. Independent of the duration of the refractory migraine, 80% of the patients responded to the protocol with only minimal side effect. The dose of DHE mesylate ranged from 0.1 to 0.5 mg. The dose of DHE is lower than is typically utilized in standard adult protocols. The patients received an average of five doses of DHE.