bluuebunny/crossref_metadata_2025 huggingface dataset:
Behavioral Response to Headache: A Comparison Between Migraine and Tension‐type Headache
Authors: Martins Isabel Pavão , Parreira Elsa
Published: March 2003

Objective.—To compare patients with migraine and tension‐type headache in their behavior during the attacks and the maneuvers used to relieve the pain.

Background.—Patients with headache often perform nonpharmacological measures to relieve the pain, but it is not known if these behaviors vary with the diagnosis, clinical features, and pathogenesis.

Methods.—One hundred consecutive patients with either migraine (n = 72 ) or tension‐type headache (n = 28) were questioned (including the use of a checklist) concerning their usual behavior during the attacks and nonpharmacological maneuvers performed to relieve the pain. The results of the two types of headache were compared.

Results.—Patients with migraine tended to perform more maneuvers than individuals with tension‐type headache (mean, 6.2 versus 3). These maneuvers included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet, and becoming immobile during the attacks. The only measure predominantly reported by patients with tension‐type headache was scalp massage. However, the benefit derived from these measures was not significantly different between the two groups (except for a significantly better response to isolation, local pressure, local cold stimulation, and symptomatic medication in migraineurs).

Conclusions.—The behavior of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed to prevent its worsening or to improve associated symptoms. These behavioral differences may be due to the different pathogenesis of the attacks or to different styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.
Sleep Disturbances After Whiplash Injury: Objective and Subjective Findings
Authors: Schlesinger Ilana , Hering‐Hanit Rachel , Dagan Yaron
Published: March 2003

Objective.—A controlled objective and subjective evaluation of sleep in a consecutive series of persons who had had a whiplash injury, shortly following the injury and 3 to 5 months later.

Methods.—In whiplash‐injured subjects and healthy controls, sleep characteristics were monitored objectively throughout the night by means of an actigraph. The following morning, participants in both groups filled out a prestructured “sleep log” that conveyed their subjective impressions as to how they had slept. The correlation between objectively measured sleep characteristics and the symptoms and physical findings, respectively, resulting from whiplash injury were also examined.

Results.—Actigraphic monitoring did not reveal a significant group difference between whiplash‐injured subjects and controls with respect to any of the sleep characteristics recorded. In self‐maintained “sleep logs,” however, the whiplash‐injured subjects reported a significantly prolonged sleep latency and significantly impaired sleep quality compared with controls (P<.001 and P<.04, respectively). In whiplash‐injured subjects, the number of arousals was positively correlated with the number of symptoms and with the number of physical signs of whiplash injury (P<.01 and P<.001, respectively). Sleep efficiency was inversely correlated with the number of injury‐related findings on physical examination (P<.009).

Conclusion.—Sleep, as monitored by actigraph in whiplash‐injured subjects, was not adversely affected by whiplash injury. The subjective impressions of the subjects, as recorded in “sleep logs,” suggest the opposite conclusion. A significant correlation exists between certain symptoms and signs of whiplash injury and abnormalities in given sleep characteristics as detected by actigraph.
Migraine and Masticatory Muscle Volume, Bite Force, and Craniofacial Morphology
Authors: Lamey P‐J. , Burnett C.A. , Fartash L. , Clifford T.J. , McGovern J.M.
Published: March 2003

The purpose of this investigation was to compare the masticatory muscle volume, bite force, and craniofacial morphology of migrainous subjects with age‐ and sex‐matched controls. Ten adult dentate migraineurs were matched with 10 dentate age‐ and sex‐matched controls. The groups consisted of nine women and one man (mean age, 43 years; range, 29 to 51 years). Volumetric analysis of the masseter and medial pterygoid muscles was performed using magnetic resonance imaging. Craniofacial morphology was analyzed from standard cephalometric radiographs using 30 angular and linear variables. Recordings of bite force were made using a strain gauge transducer. There was a significant difference in the volume of both masseter and medial pterygoid muscles between the two subject groups (P<.0001), with the muscles of the migraineurs nearly 70% larger. The migraineurs recorded significantly higher maximal bite forces (P<.0001) than did the controls. No significant differences for any craniofacial morphological measurement were demonstrated between the two groups. It was concluded that the migraineurs had larger masseter and medial pterygoid muscle volumes, and greater bite forces than the controls, which could not be explained by any change in craniofacial morphology.
Electroencephalographic Abnormalities in Aseptic Meningitis and Noninfectious Headache. A Comparative Study
Authors: Pollak Lea , Klein Colin , Schiffer Juana , Flechter Shlomo , Rabey Jose Martin
Published: March 2003

Background.—The finding of abnormalities on electroencephalogram (EEG) during the course of aseptic meningitis is often considered to be indicative of parenchymal brain involvement, even in absence of clinical signs of encephalitis.

Objective.—To investigate if patients with aseptic nonherpetic meningitis who have abnormal EEG recordings during the acute stage of the disease differ in clinical characteristics or cerebrospinal fluid findings from patients with aseptic meningitis and normal EEG recordings.

Methods.—The EEG records of 82 patients with aseptic meningitis were reviewed. A comparative group consisted of 41 age‐matched patients with severe headaches without evidence of meningeal inflammation.

Results.—Significantly more patients with aseptic meningitis (28%) demonstrated abnormalities on EEG than controls (12%) (P = .048). Patients with aseptic meningitis and abnormal EEG findings (n = 23) did not differ in age, duration of symptoms, clinical course, cerebrospinal fluid cell count, or protein level from those with normal EEG findings (n = 59). However, all patients with aseptic meningitis who were confused (n = 5) also revealed EEG abnormalities (P<.00012).

Patients with headache with normal EEG recordings did not differ from those with abnormal EEGs in age, sex, or duration of symptoms. Nevertheless, patients with common migraine (n = 9) showed abnormalities on EEG (P = .06) more frequently.

Conclusions.—The finding of an abnormal EEG in patients with aseptic meningitis, clear mental state and absence of focal neurological signs should not be used as proof of encephalitis. Because pathological examination is usually not performed, it remains unclear if EEG abnormalities in patients with aseptic meningitis indicate a silent parenchymal inflammation, or reflect an infectious encephalopathy.
Perceived Headache Associations in Singapore. Results of a Randomized National Survey
Authors: Ho King‐Hee , Benjamin K.C.
Published: March 2003

We attempted to discern commonly perceived associations between headache symptomatology and various clinical and social parameters based on the results of a nationwide randomized survey involving 2096 respondents. A questionnaire incorporating demographic data, headache characteristics, and management as well as basic health screening was administered by trained interviewers to those aged 12 years and older. A digital semiautomated blood pressure monitor, a Snellen chart, and urinalysis sticks were used to gather clinical information. Elevated blood pressure, poor visual acuity, and fewer hours of nightly sleep did not positively correlate with headaches of increased frequency, intensity, or duration. On the contrary, an age‐dependent negative trend was observed with regard to blood pressure and visual acuity. Individuals who performed shift work had more frequent, although not more intense or long‐lasting, headaches. Income had no effect on headache prevalence or severity. Our findings are at variance with common perceptions of headache in the region. They highlight the need for informed counseling of patients presenting to medical attention with headaches and suggest that serious intracranial disease should be excluded in atypical headaches even if perceived associations are present.
Transitional Interpersonality Thunderclap Headache
Authors: Jacome Daniel E.
Published: March 2003

Objective.—To report a patient with multiple personality disorder who experienced severe acute headaches without warnings, solely during the transition between her host personality and her pain‐prone personality.

Background.—The initial detailed description of headache in multiple personality disorder was made by Packard and Brown and published in this journal 15 years ago.

Methods.—Clinical history, neurologic examination, electroencephalogram, and brain magnetic resonance imaging.

Results.—A 54‐year‐old Holocaust survivor with an established diagnosis of multiple personality disorder had recurrent, excruciating, acute (“thunderclap”) headaches only when switching between her domineering personality and her pain‐prone personality, who suffered from chronic back pain. None of her personalities otherwise suffer from headaches. Electroencephalogram and brain magnetic resonance imaging were normal.

Conclusion.—This is an independent and current confirmation of the existence of transitional headaches in a patient with multiple personality disorder. They may occur as an isolated event during the switch process and have features of benign thunderclap headache.
Development and Validation of the Headache Needs Assessment (HANA) Survey
Authors: Cramer Joyce A. , Silberstein Stephen D. , Winner Paul
Published: March 2003

Objective.—To develop and validate a brief survey of migraine‐related quality‐of‐life issues. The Headache Needs Assessment (HANA) questionnaire was designed to assess two dimensions of the chronic impact of migraine (frequency and bothersomeness).

Methods.—Seven issues related to living with migraine were posed as ratings of frequency and bothersomeness. Validation studies were performed in a Web‐based survey, a clinical trial responsiveness population, and a retest reliability population. Headache characteristics (eg, frequency, severity, and treatment), demographic information, and the Headache Disability Inventory were used for external validation.

Results.—The HANA was completed in full by 994 adults in the Web survey, with a mean total score of 77.98 ± 40.49 (range, 7 to 175). There were no floor or ceiling effects. The HANA met the standards for validity with internal consistency reliability (Cronbach α = .92, eigenvalue for the single factor = 4.8, and test‐retest reliability = 0.77). External validity showed a high correlation between HANA and Headache Disability Inventory total scores (0.73, P<.0001), and high correlations with disease and treatment characteristics.

Conclusions.—These data demonstrate the psychometric properties of the HANA. The brief questionnaire may be a useful screening tool to evaluate the impact of migraine on individuals. The two‐dimensional approach to patient‐reported quality of life allows individuals to weight the impact of both frequency and bothersomeness of chronic migraines on multiple aspects of daily life.
Comparison of Triptan Tablet Consumption per Attack: A Prospective Study of Migraineurs in Spain
Authors: Pascual Julio , Fité Benet , López‐Gil Arturo
Published: March 2003

Objectives.—To compare patient self‐reported tablet consumption of rizatriptan 10 mg per attack (24 hours) with that of sumatriptan 50 mg, zolmitriptan 2.5 mg, and naratriptan 2.5 mg on an unselected, prescription‐based, Spanish migraine population.

Methods.—One hundred twenty community pharmacies recruited patients with migraine, who used their pharmacies, to fill a triptan prescription. In diaries, patients recorded baseline pain intensity and the number of triptan tablets and additional medication taken per attack. Patients treated a maximum of three attacks. Analysis of variance or the Student t test and chi‐square or Fisher exact tests were used for univariate comparisons. Hochberg corrections were used for multiple‐group comparisons. A generalized estimating equation method was used to correct for within‐subject correlation. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results.—Two hundred thirty‐one patients (84% women) treated 589 evaluable migraine attacks (sumatriptan, n = 135; naratriptan, n = 90; zolmitriptan, n = 149; rizatriptan, n = 149). Triptan tablet consumption per attack (mean ± SD) for rizatriptan (1.24 ± 0.56) was significantly lower than that of sumatriptan (1.75 ± 1.2; P  <  .05), zolmitriptan (1.61 ± 0.86; P  <  .05), or naratriptan (1.46 ± 0.62; P = .05). The average number of triptan tablets taken and additional medication use increased according to baseline pain severity. More attacks were treated with one tablet of rizatriptan (81.2%) than with one tablet of sumatriptan (51.9%), zolmitriptan (55.7%), or naratriptan (60%). The probability of using more than one triptan tablet per attack (24 hours) was more than three times greater for sumatriptan (adjusted OR = 3.71; CI, 2.05 to 6.7; P = .001) and zolmitriptan (adjusted OR = 3.32; CI, 1.82 to 6.17; P = .001), and more than two times greater for naratriptan (adjusted OR = 2.66; CI, 1.36 to 5.21; P = .004) than for rizatriptan.

Conclusions.—Rizatriptan was associated with significantly lower triptan tablet use and additional medication use per attack than the other triptans. Additional randomized studies are needed to confirm the conclusions of this study.
Migraine Is Associated With Livedo Reticularis: A Prospective Study
Authors: Tietjen Gretchen E. , Gottwald Lorie , Al‐Qasmi Mohamed M. , Gunda Padma , Khuder Sadik A.
Published: March 2003

Objective.—To investigate the relationship of livedo reticularis, an ischemic dermatopathy, and migraine, an ischemic stroke risk factor.

Background.—Livedo reticularis refers to the reddish‐blue reticular mottling of the skin resulting from narrowing of small and medium arteries at the dermis‐subcutis border. A subset of patients with livedo reticularis develop stroke in the absence of other vascular risk factors, which has been termed Sneddon syndrome. We undertook this prospective study in a non‐neurology clinic to delineate further the relationship of livedo reticularis and migraine.

Methods.—Patients in a general dermatology clinic were interviewed for vascular risk factors and history of migraine in accordance with the International Headache Society (IHS) criteria. A dermatologist, not familiar with the interview, recorded the primary dermatological diagnosis and the presence or absence of livedo reticularis on examination.

Results.—Two hundred eighty‐one consecutive patients (184 women and 97 men; average age, 52 years) were interviewed and examined. Seventy‐five (27%) had migraine (IHS codes 1.1, 1.2) and an additional 18 (6%) had atypical migraine (IHS 1.7). Livedo reticularis was noted in 46 patients (16%), with the frequency higher in women than men (42 [23%] of 184 versus 4 [4%] of 97; P < .0001). The frequency of livedo reticularis in patients with migraine was higher than in those without migraine (24 [26%] of 93 versus 22 [12%] of 188; P = .002), and higher in female than male migraineurs (23 [32%] of 72 versus 1 [5%] of 21; P = .012). In logistic regression analysis of the women, migraine was associated with livedo reticularis (odds ratio [OR], 2.3; confidence interval [CI], 1.08 to 4.71), as well as with stroke (OR, 4.0; CI, 0.87 to 18.21), coronary artery disease (OR, 3.5; CI, 1.16 to 10.33), and deep venous thrombosis (OR, 3.2; CI, 0.98 to 10.32).

Conclusions.—In women, migraine is associated with stroke, coronary artery disease, deep venous thrombosis, as well as livedo reticularis, a dermatopathy which has been pathologically linked to cerebral vasculopathy. Whether migraineurs with livedo reticularis compose a subset at higher risk of thrombosis, including stroke, deserves further investigation.
Livedo Reticularis and Migraine: A Marker for Stroke Risk?
Authors: Tietjen Gretchen E. , Al‐Qasmi Mohamed M. , Shukairy Mohammad S.
Published: March 2003

Background and Purpose.—Livedo reticularis is a dermatopathy characterized by an irregular, violaceous, netlike pattern which spares the face. Associated with a variety of conditions, it occurs consequent to pathological or physiological narrowing of small and medium arteries at the dermis‐subcutis border. Sneddon syndrome refers to the idiopathic coupling of livedo reticularis and stroke in the absence of traditional vascular risk factors. Over 50% of persons with Sneddon syndrome describe a history of headache. We undertook this study to determine the frequency of livedo reticularis in our headache clinic.

Methods.—We performed a retrospective chart review of consecutive patients attending a headache clinic over a period of 6 months. The patients had all been seen by one physician (G.E.T.) who noted the presence or absence of livedo reticularis. The charts were reviewed for age, sex, and vascular risk factors, including current use of oral contraceptives, and history of smoking, coronary artery disease, hypertension, diabetes mellitus, stroke, or arthritis.

Results.—Charts from 133 patients with headache were reviewed (24 men [18%], 109 women [82%]; mean age, 42  ±  13 years). Livedo reticularis was observed in 29 patients (22%) and in a similar proportion in men (25%) and women (21%). When we stratified the migraine population by presence or absence of livedo, we found no significant difference in age (44.5 versus 41.7 years, P  =   .16). There was a higher frequency of stroke diagnosis in the cohort with livedo reticularis (28%[8 of 29] versus 7%[7 of 104], P  =   .005), but we found no significant differences in frequency of hypertension, oral contraceptive use, diabetes mellitus, coronary artery disease, arthritis, or cigarette smoking.

Conclusions.—In our headache clinic, livedo reticularis is present in more than one fifth of patients. A history of stroke is more frequent in this subset of migraineurs, raising the possibility that livedo reticularis can be used as a clinical marker to identify those migraineurs with an increased risk of stroke.
Decreased Sensitivity of 5‐HT1D Receptors in Chronic Tension‐Type Headache
Authors: Rainero I. , Valfrè W. , Savi L. , Ferrero M. , Del Rizzo P. , Limone P. , Isaia G.C. , Gianotti L. , Pollo A. , Verde R. , Benedetti F. , Pinessi L.
Published: March 2003

Objective.—To assess the sensitivity of 5‐HT1D receptors in chronic tension‐type headache using sumatriptan as a pharmacological probe.

Background.—Previous studies have suggested involvement of serotonergic systems in chronic tension‐type headache (CTTH), but relevant experimental data are limited. Sumatriptan, a 5‐HT1B/1D receptor agonist, stimulates the release of growth hormone (GH) and inhibits the release of ACTH, cortisol, and prolactin. These effects may be used to explore the function of serotonergic systems in vivo.

Methods.—We measured GH, ACTH, cortisol and prolactin (PRL) plasma concentrations in 15 patients with chronic tension‐type headache and in 18 healthy controls after subcutaneous administration of sumatriptan (6 mg) or placebo.

Results.—Placebo administration had no effect on hormone concentrations. GH and PRL secretion after sumatriptan administration was significantly (P<0.01 and <0.05) altered in CTTH patients in comparison with controls.

Conclusion.—Our results suggest that cerebral serotonergic functions mediated by 5‐HT1D receptors are altered in CTTH.
Melatonin as Adjunctive Therapy in the Prophylaxis of Cluster Headache: A Pilot Study
Authors: Pringsheim Tamara , Magnoux Eric , Dobson Colin F. , Hamel Edith , Aubé Michel
Published: March 2003

Background.—The periodicity of cluster headache suggests involvement of the suprachiasmatic nucleus of the hypothalamus, the biological clock. The secretion of melatonin, a hormone produced by the pineal gland and regulated by the suprachiasmatic nucleus, is altered in patients with cluster headache. Melatonin shifts circadian rhythms. A previous study of melatonin for primary prophylaxis of cluster headache demonstrated a 50% response rate.

Objective.—To evaluate the use of melatonin as adjunctive therapy in patients with cluster headache who have incomplete relief of their headaches on conventional therapy.

Methods.—Nine patients participated in the study, six with chronic cluster headache and three with episodic cluster headache. Patients with chronic cluster headache completed a baseline diary for 1 month, followed by 1 month of melatonin treatment, then 1 month of placebo. Patients with episodic cluster headache received placebo for 1 month, then melatonin for 1 month. Patients continued their usual prophylactic and abortive treatments during the study. Headache frequency, intensity, and use of analgesics were recorded. The primary endpoint of the study was the mean number of headaches per day, with mean daily analgesic consumption and percentage of mild, moderate, and severe headaches as secondary endpoints.

Results.—There were no significant differences between means on analysis of variance and t testing for the melatonin, placebo, and baseline months for all primary and secondary endpoints. There were no side effects reported.

Conclusions.—Patients with chronic cluster headache or patients with episodic cluster headache whose headaches are uncontrolled on conventional therapy do not appear to gain therapeutically from the addition of melatonin to their usual treatment regimens. It is perhaps the phase‐shifting properties of melatonin that mediate its effect in patients with episodic cluster headache, and it may be necessary to treat from the beginning of the cluster bout to reset the circadian pacemaker, thus producing a more positive outcome.
A Polymorphism in the Serotonin Transporter Gene Regulatory Region and Frequency of Migraine Attacks
Authors: Kotani Kazuhiko , Shimomura Tokio , Shimomura Fumiyo , Ikawa Shiro , Nanba Eiji
Published: March 2003

Background.—The serotonergic system has been thought to play an important part in the pathophysiology of migraine.

Objective.—To study an association between the polymorphism of serotonin (5‐hydroxytryptamine [5‐HT]) transporter gene‐linked polymorphic region (5‐HTTLPR) and migraine.

Method.—We compared 151 patients with migraine with 190 healthy unrelated control subjects. The 5‐HTTLPR polymorphism was detected using polymerase chain reaction. Migraine patients were interviewed regarding attack frequency in the last 6 months.

Results.—We denoted the products of the 484‐base pair (bp) fragments as the short (s) and those of 528 bp as the long (l) allele according to the previously reported manner. Migraine patients with s/s genotype were compared with those with l/s and l/l genotype. We did not find significant differences in the genotype and allele frequencies of 5‐HTTLPR between patients with migraine and control subjects. Among patients with migraine, those with s/s type had significantly more frequent attacks than those with the l/s or l/l type.

Conclusions.—This polymorphism does not appear to be involved in a genetic predisposition to the disease but may affect the frequency of attacks in patients with migraine. These findings may contribute to our understanding of factors that influence the clinical severity of migraine.
Hormone Supplementation Differently Affects Migraine in Postmenopausal Women
Authors: Facchinetti F. , Nappi R. E. , Tirelli A. , Polatti F. , Nappi G.
Published: March 2003

Objective.—To evaluate the effects of three schemes of oral hormone replacement therapy (HRT) on migraine course in postmenopausal women.

Methods.—Thirty‐eight patients presenting for clinical evaluation of menopausal status and suffering from migraine were enrolled. The observational period lasted 7 months, during which women filled in a daily diary with the clinical features of headache attacks and analgesic use. We evaluated climacteric symptoms, anxiety and depression. After a 1‐month run‐in period, women were assigned to one of three regimens of HRT: estradiol hemihydrate 1 mg/day plus norethisterone 0.5 mg/day for 28 days, in a continuous combined scheme; oral conjugated estrogens 0.625 mg/day for 28 days plus medroxyprogesterone acetate 10 mg/day in the last 14 days, in a sequential continuous scheme; and estradiol valerate 2 mg/day for 21 days plus cyproterone acetate 1 mg/day from day 12 to 21 in a sequential cyclical scheme. Follow‐up evaluations were performed at 3 and 6 months.

Results.—During the run‐in period, the three subgroups of patients were similar as far as the features of migraine are concerned. Overall, a progressive increase in attack frequency (from 2.2  ±  1.0 to 3.8  ±  1.3, P<.001), days with headache (from 3.4  ±  1.3 to 4.9  ±  1.9, P<.001), and analgesic consumption (from 3.4  ±  1.3 to 5.6  ±  2.2, P<.001) was observed after 6 months. Duration of attacks decreased (from 18.1  ±  7.4 to 13.6  ±  4.2 hours, P  =  .005), whereas severity worsened (from 1.9  ±  0.2 to 2.1  ±  0.2, P<.001). The increase in number of days with headache and number of analgesics used was smaller in the group receiving the continuous combined regimen than in the other two groups.

Conclusion.—Although HRT typically will lead to some worsening of headache syndrome, estradiol hemihydrate plus norethisterone given in a combined continuous scheme was the regimen best tolerated by our patients.
Migraine and Psychiatric Comorbidity: From Theory and Hypotheses to Clinical Application
Authors: Sheftell Fred D. , Atlas Susan J.
Published: March 2003

Objective.—To review psychiatric issues that accompany migraine and means of addressing these issues.

Background.—Psychiatric factors and migraine may interact in three general ways, etiologically, psychophysiologically or biobehaviorally, and comorbidly (the two disorders coexist), which is the present focus. There are several possible mechanisms of comorbidity. The relation between two disorders may be a result of chance. One disorder can cause another disorder: Diabetes can cause diabetic neuropathy. There might be shared environmental risks: Head trauma can cause both posttraumatic epilepsy and posttraumatic headache. And there may be environmental or genetic risk factors that produce a brain state giving rise to both conditions, that is, there may be some common biology underlying both conditions. This last mechanism seems to be the most likely one underlying comorbidity of migraine and psychiatric disorders. We introduce a possible role for classical paradigms of learned helplessness in regard to psychiatric comorbid depressive and anxiety disorders and migraine.

Results.—There appears to be an association between migraine and affective disorders, particularly depression and anxiety. There are a number of formal tools for recognizing depression, but clinical evaluation should not be overlooked. Once diagnosed, depression and anxiety should be treated, both to improve the success of migraine treatment and to improve the patient's quality of life. Patients with recurring headaches are much more likely to overuse and misuse, rather than abuse, pain medications. It is important to be alert for signs that the patient may be misusing medication. Behavioral approaches can surround and support pharmacological therapy.

Conclusions.—Migraine is often comorbid with psychiatric disorders, particularly depression and anxiety. The relationship is likely based on shared mechanisms and successful treatment is possible.
Headache and Other Types of Chronic Pain
Authors: Marcus Dawn A.
Published: March 2003

Objective.—To compare pain severity, disability, psychological distress, and quality of life between patients with headache and nonheadache treatment‐seeking chronic pain patients.

Methods.—Six hundred forty‐three patients seeking treatment at a university pain clinic were divided into 3 categories based on primary pain complaint and the presence of focal or diffuse pain complaints: headache, nonheadache focal (pain involving <50% of the body), and nonheadache diffuse (pain involving ≥50% of the body). Patients completed questionnaires to identify pain severity, disability, depression, anxiety, and quality of life.

Results.—Patients with headache differed from nonheadache patients for all evaluated parameters. Average pain severity on a 0 to 10 point severity scale was 5.55 for headache, 6.93 for nonheadache focal, and 8.05 for nonheadache diffuse. Pain occurred an additional 1.51 to 1.71 days per week for patients without headache. Compared to patients with headache, patients without headache reported greater frequency of reduced daily activities and complete disability related to pain. In addition, patients without headache and with diffuse pain reported more depression (78.2% vs. 45.8%) and anxiety (70.0% vs. 39.1%) than patients with headache. Quality of life measures were significantly reduced in patients with either nonheadache focal or diffuse conditions compared to patients with headache.

Conclusions.—Even when considering patients with focal rather than diffuse chronic pain complaints, patients with headache are dissimilar from other patients with chronic pain. Pain severity, frequency, disability, psychological distress, and quality of life are significantly more prominent or impaired in patients with chronic pain without headache compared to patients with headache.
Transcranial Doppler in Migraine Attacks Before and After Treatment With Oral Zolmitriptan or Sumatriptan
Authors: Thomaides Thomas , Karagounakis Demetrios , Spantideas Anastasios , Katelanis Stavros
Published: March 2003

Background.—Intracranial blood flow velocity (BFV) changes in migraine have been studied fairly extensively. Although a number of investigations have been performed in migraineurs with nitroglycerin‐induced attacks, there has been no reported transcranial study involving such attack treated with zolmitriptan or sumatriptan.

Methods.—With ultrasound, we studied the BFV and pulsatility index (PI) changes in the middle cerebral artery in 45 symptom free, otherwise healthy, unmedicated patients with migraine without aura, and in 15 age‐ and sex‐matched controls before nitroglycerin, at the time of maximum head pain induced by nitroglycerin and every 30 minutes for 2 hours after zolmitriptan (15 subjects) or sumatriptan (15 subjects) administration. Headache was rated on a 4‐point scale.

Results.—During headache attacks, BFV decreased significantly (36.7±3.3, 38.4±3.4, and 37.4±4 cm/sec, respectively, in the zolmitriptan, sumatriptan, and nontreated migraine groups, but not in the controls who were migraine free (P  <  .01). These abnormalities disappeared 1 hour after zolmitriptan or sumatriptan administration (49.7±3.7 and 48.9±3.9cm/sec, respectively). There were no significant changes in PI.

Conclusion.—Our data indicate that nitroglycerin‐induced headache in individuals with migraine without aura is associated with BFV changes that are reversed by administration of an oral triptan.
Ibotenate Injections into the Pre‐ and Parasubiculum Provide Partial Protection against Kainate‐Induced Epileptic Damage in Layer III of Rat Entorhinal Cortex
Authors: Eid Tore , Du Fu , Schwarcz Robert
Published: March 2003

Summary:  Purpose: A loss of neurons in layer III of the entorhinal cortex (EC) is often observed in patients with temporal lobe epilepsy and in animal models of the disorder. We hypothesized that the susceptibility of layer III of the EC to prolonged seizure activity might be mediated by excitatory afferents originating in the presubiculum.

Methods: Experiments were designed to ablate the presubiculum unilaterally by focal ibotenate injections and to evaluate the effect of this deafferentation on the vulnerability of EC layer III neurons to the chemoconvulsant kainate (injected systemically 5 days later).

Results: After treatment with kainate, 11 of the 15 rats preinjected with ibotenate showed clear‐cut, partial neuroprotection in layer III of the EC ipsilateral to the ibotenate lesion. Serial reconstruction of the ibotenate‐induced primary lesion revealed that entorhinal neurons were protected only in animals that had lesions in the pre‐ and parasubiculum, especially in the deep layers (IV–VI).

Conclusions: The deep layers of the pre‐ and parasubiculum appear to control the seizure‐induced damage of EC layer III. This phenomenon may be of relevance for epileptogenesis and for the pathogenesis of temporal lobe epilepsy.
Economic Burden of Epilepsy in India
Authors: Thomas S. V. , Sarma P. S. , Alexander M. , Pandit L. , Shekhar L. , Trivedi C. , Vengamma B.
Published: March 2003

Summary:  Purpose: The economic burden due to epilepsy is not adequately examined in developing countries. Cost estimates are very important in health care planning and delivery of services. We have estimated the direct and some of the indirect costs of epilepsy in India.

Methods: Epilepsy centers attached to University hospitals in six states of India participated in this study. Data on clinical characteristics, utilization of medical services, and costs were collected in a standardized format.

Results: There were 285 patients (mean age, 22.6 + 12.5 years) drawn from six centers in this study. The annual cost of epilepsy per patient was INR 13,755 (USD, 344). The direct cost was INR 3,725 (USD, 93), and the indirect cost was INR 10,031 (USD, 251). Direct cost included medical consultations (INR 329), laboratory services (INR 271), hospitalization charges (INR 316), and cost of travel to clinics (INR 659). The indirect cost included the cost of lost productivity due to seizures, its complications, or attendance to clinics. There are ∼5 million people with epilepsy in India. The economic burden due to epilepsy to the nation is to the tune of INR 68.75 billion (USD, 1.7 billion).

Conclusions: The annual economic burden of epilepsy in India is 88.2% of GNP per capita and 0.5% of the GNP.
Epileptic Seizures after Treatment with Thiocolchicoside
Authors: De Riu Pier Luigi , Rosati Giulio , Sotgiu Stefano , Sechi GianPietro
Published: March 2003

Summary:  Purpose: To report the occurrence of epileptic seizures in humans, closely related to the use of the centrally acting muscle relaxant thiocolchicoside.

Methods: Description of three case histories.

Results: Two patients, affected with complex‐partial seizures, sometimes secondarily generalized, receiving antiepileptic therapy, were seizure free for 7 and 9 years, respectively. They had the reappearance of tonic–clonic seizures few days after the continued use of thiocolchicoside, at a cumulative dose of the drug of 52 mg and 76 mg, respectively. The third patient was brain damaged and without a history of seizures. He had a sudden, convulsive seizure a few minutes after 4 mg intramuscular thiocolchicoside.

Conclusions: Our case histories indicate that thiocolchicoside has a powerful epileptogenic activity. This drug should be avoided in patients with epilepsy or acute brain injury and possible disruption of the blood–brain barrier.
Ictal Perfusion Changes During Occipital Lobe Seizures in Infancy: Report of Two Serial Ictal Observations
Authors: Hollo Andras , Kaminska Anna , Véra Pierre , Cieuta Cecile , Ville Dorothée , Bulteau Christine , Dulac Olivier , Chiron Catherine
Published: March 2003

Summary: Serial‐ictal single‐photon‐emission computed tomography (SPECT) examinations are presented in two infants (ages 1 and 2 years), with early ictal and ictal in one, and ictal and late ictal images in the other. Both had pharmacoresistant occipital epilepsy, due to focal cortical dysplasia. In the first case, size of ictal hyperperfusion increased in the course of the seizure from early ictal to ictal state. A concomitant ictal hypoperfusion was observed around the hyperperfused area. In the second patient, there was a dramatic difference between ictal and late ictal images. In the late ictal state, the previous occipital ictal hyperperfusion and extraoccipital ictal hypoperfusion disappeared, together with homolateral posterotemporal and contralateral occipital hyperperfusion, corresponding to seizure propagation. Ictal extratemporal blood‐flow changes are therefore highly dynamic, particularly in very young children.
Unusual Imaging Findings in Progressive Myoclonus Epilepsy
Authors: Marrie R. A. , Shoubridge E. A. , Antel J. P. , Arnold D. L. , Chen J. , Andermann E. , Andermann F.
Published: March 2003

Summary: We describe a patient with progressive myoclonus epilepsy (PME), white matter hyperintensities in the corpus callosum, cerebral hemispheres, and left cerebral peduncle on magnetic resonance imaging (MRI), and positive oligoclonal bands. A phosphorus magnetic resonance spectrum was compatible with mitochondrial dysfunction. Abnormal white matter signals are not a feature of the known PME syndromes, although they occur in Leber's hereditary optic neuropathy (LHON). These abnormalities oriented the diagnosis toward mitochondrial disease.
Caloric Restriction Inhibits Seizure Susceptibility in Epileptic EL Mice by Reducing Blood Glucose
Authors: Greene Amanda E. , Todorova Mariana T. , McGowan Richard , Seyfried Thomas N.
Published: March 2003

Summary:  Purpose: Caloric restriction (CR) involves underfeeding and has long been recognized as a dietary therapy that improves health and increases longevity. In contrast to severe fasting or starvation, CR reduces total food intake without causing nutritional deficiencies. Although fasting has been recognized as an effective antiseizure therapy since the time of the ancient Greeks, the mechanism by which fasting inhibits seizures remains obscure. The influence of CR on seizure susceptibility was investigated at both juvenile (30 days) and adult (70 days) ages in the EL mouse, a genetic model of multifactorial idiopathic epilepsy.

Methods: The juvenile EL mice were separated into two groups and fed standard lab chow either ad libitum (control, n = 18) or with a 15% CR diet (treated, n = 17). The adult EL mice were separated into three groups; control (n = 15), 15% CR (n = 6), and 30% CR (n = 3). Body weights, seizure susceptibility, and the levels of blood glucose and ketones (β‐hydroxybutyrate) were measured over a 10‐week treatment period. Simple linear regression and multiple logistic regression were used to analyze the relations among seizures, glucose, and ketones.

Results: CR delayed the onset and reduced the incidence of seizures at both juvenile and adult ages and was devoid of adverse side effects. Furthermore, mild CR (15%) had a greater antiepileptogenic effect than the well‐established high‐fat ketogenic diet in the juvenile mice. The CR‐induced changes in blood glucose levels were predictive of both blood ketone levels and seizure susceptibility.

Conclusions: We propose that CR may reduce seizure susceptibility in EL mice by reducing brain glycolytic energy. Our preclinical findings suggest that CR may be an effective antiseizure dietary therapy for human seizure disorders.
Benign Partial Epilepsies of Adolescence: A Report of 37 New Cases
Authors: Capovilla G. , Gambardella A. , Romeo A. , Beccaria F. , Montagnini A. , Labate A. , Viri M. , Sgrò V. , Veggiotti P.
Published: March 2003

Summary:  Purpose: To delineate the electroclinical features of patients with partial seizures in adolescence with a benign outcome.

Methods: Patients were recruited in five different Italian epilepsy centers. Patients were selected among those with partial seizures between ages 11 and 17 years. We excluded benign childhood epilepsies, those with neurologic or mental deficits, and those with neuroradiologically documented lesions. We also excluded patients with less than 3 years' follow‐up or who were still receiving antiepileptic therapy.

Results: There were 37 (22 male, 15 female) patients. Seizures started at the mean age of 14.5 years (range, 11–16.11). Two main electroclinical patterns emerged: 16 of 37 patients had somatomotor seizures frequently associated with focal theta discharges involving the centroparietal regions. Ten of 37 patients showed versive seizures and interictal spiking involving the posterior regions. A third group had clinical characteristics resembling the cases described by Loiseau. All had a favorable outcome.

Conclusions: This relevant multicenter study further confirms the existence of benign partial epilepsies with onset during adolescence.
Quality of Life Self‐Assessment as a Function of Lateralization of Lesion in Candidates for Epilepsy Surgery
Authors: Andelman Fani , Fried Itzhak , Neufeld Miriam Y.
Published: March 2003

Summary:  Purpose: This prospective study aimed to investigate the relationship(s) of the laterality of the epileptogenic lesion to personality factors, emotional processing, and the subjective experience of quality‐of‐life (QOL) self‐assessment in candidates for epilepsy surgery.

Methods: Patients who were candidates for epilepsy surgery were studied. Eighteen of them (aged 19–61 years) had localization‐related epilepsy in the right temporal lobe (RTLE), 18 (aged 21–50 years) had localization‐related epilepsy in the left temporal lobe (LTLE), and 20 were demographically matched normal subjects. The Spielberger Trait/State Anxiety questionnaire and the QOLIE‐31 questionnaire for self‐assessment of quality of life were used. One‐way analysis of variance, Pearson correlations, and linear regression analyses were performed on group and anxiety levels and QOLIE variables.

Results: LTLE patients systematically showed higher levels of anxiety and lower self‐estimates of the quality of their lives when compared with RTLE patients. All anxiety measures were highly correlated with Total QOL in LTLE (p < 0.05) but not in RTLE patients; however, different parameters of QOL showed different relationships with measures of anxiety. Results of multiple regression analyses suggested that the level of anxiety was relatively stable and less affected by QOL factors in LTLE as compared with RTLE patients (p = 0.03).

Conclusions: A high level of anxiety shown by LTLE patients may represent a personality trait and cause a response bias in overreporting of negative symptoms and a decreased self‐assessment of QOL. It may also present a presurgical risk factor, particularly for patients with LTLE lesions. Appropriate patient counseling is advised.
Contrasting Effects of Zonisamide and Acetazolamide on Amygdaloid Kindling in Rats
Authors: Hamada Koichi , Song Hong‐Ki , Ishida Shiro , Yagi Kazuichi , Seino Masakazu
Published: March 2003

Summary:  Purpose: Zonisamide (ZNS) and acetazolamide (AZM) are two antiepileptic drugs (AEDs) that differ in clinical efficacy. To elucidate the mechanisms of action of these compounds, we investigated their therapeutic and prophylactic effects in rats by using a kindling model of partial epilepsy.

Methods: Electrodes were implanted into the left amygdala of adult male Wistar rats. The animals were stimulated at the afterdischarge threshold until five stage 5 seizures were induced. The generalized seizure threshold was then determined. Therapeutic effects were examined in rats manifesting successive convulsions with near‐threshold stimulation. To test prophylactic effects, drugs were administered intraperitoneally before daily kindling stimulation until the animal had a stage 5 seizure or reached day 18.

Results: ZNS (10–40 mg/kg; n = 6) suppressed kindled seizures in a dose‐dependent manner. Repeated administration for 7 days produced tolerance to anticonvulsive effects. AZM (25–200 mg/kg; n = 7) showed limited therapeutic effect, alleviating only the clonic convulsion in stage 5 seizures and reducing afterdischarge duration. Secondary generalization was not significantly suppressed during repeated treatment (50–200 mg/kg; n = 6). ZNS, 25 or 40 mg/kg (n = 8), significantly retarded seizure development; 15.0 or 17.0 daily stimulations were required to produce a stage 5 seizure. AZM, 50–200 mg/kg (n = 6), also retarded seizure development, with 14.0–14.8 stimulations required.

Conclusions: ZNS exhibited modest therapeutic and prophylactic effects, whereas AZM showed mainly prophylactic effects. Hypotheses are presented that may explain the mechanisms of action of these drugs.
Antiepileptogenesis and Seizure Prevention Trials with Antiepileptic Drugs: Meta‐Analysis of Controlled Trials
Authors: Temkin Nancy R.
Published: March 2003

Summary:  Purpose: To synthesize evidence concerning the effect of antiepileptic drugs (AEDs) for seizure prevention and to contrast their effectiveness for provoked versus unprovoked seizures.

Methods: Medline, Embase, and The Cochrane Clinical Trials Register were the primary sources of trials, but all trials found were included. Minimal requirements: seizure‐prevention outcome given as fraction of cases; AED or control assigned by random or quasi‐random mechanism. Single abstracter. Aggregate relative risk and heterogeneity evaluated using Mantel–Haenszel analyses; random effects model used if heterogeneity was significant.

Results: Forty‐seven trials evaluated seven drugs or combinations for preventing seizures associated with fever, alcohol, malaria, perinatal asphyxia, contrast media, tumors, craniotomy, and traumatic brain injury. Effective: Phenobarbital for recurrence of febrile seizures [relative risk (RR), 0.51; 95% confidence interval (CI), 0.32–0.82) and cerebral malaria (RR, 0.36; CI, 0.23–0.56). Diazepam for contrast media–associated seizures (RR, 0.10; CI, 0.01–0.79). Phenytoin for provoked seizures after craniotomy or traumatic brain injury (craniotomy: RR, 0.42; CI, 0.25–0.71; TBI: RR, 0.33; CI, 0.19–0.59). Carbamazepine for provoked seizures after traumatic brain injury (RR, 0.39; CI, 0.17–0.92). Lorazepam for alcohol‐related seizures (RR, 0.12; CI, 0.04–0.40). More than 25% reduction ruled out valproate for unprovoked seizures after traumatic brain injury (RR, 1.28; CI, 0.76–2.16), and carbamazepine for unprovoked seizures after craniotomy (RR, 1.30; CI, 0.75–2.25).

Conclusions: Effective or promising results predominate for provoked (acute, symptomatic) seizures. For unprovoked (epileptic) seizures, no drug has been shown to be effective, and some have had a clinically important effect ruled out.