bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship of Yoga, Body Awareness, and Body Responsiveness to Self-Objectification and Disordered Eating
Authors: Daubenmier Jennifer J.
Published: May 2005

Study 1 tested whether yoga practice is associated with greater awareness of and responsiveness to bodily sensations, lower self-objectification, greater body satisfaction, and fewer disordered eating attitudes. Three samples of women (43 yoga, 45 aerobic, and 51 nonyoga/nonaerobic practitioners) completed questionnaire measures. As predicted, yoga practitioners reported more favorably on all measures. Body responsiveness, and, to some extent, body awareness significantly explained group differences in self-objectification, body satisfaction, and disordered eating attitudes. The mediating role of body awareness, in addition to body responsiveness, between self-objectification and disordered eating attitudes was also tested as proposed in objectification theory ( Fredrickson & Roberts, 1997 ). Body responsiveness, but not awareness, mediated the relationship between self-objectification and disordered eating attitudes. This finding was replicated in Study 2 in a sample of female undergraduate students. It is concluded that body responsiveness and, to some extent, body awareness are related to self-objectification and its consequences.
A systematic review of qualitative literature on educational interventions for evidence‐based practice
Authors: Bradley Peter , Nordheim Lena , De La Harpe Davida , Innvær Simon , Thompson Carl
Published: May 2005

This review considers individual experience of educational interventions for evidence‐based practice (EBP) and presents a two‐stage approach for synthesizing quantitative and qualitative research. To find relevant reports, a search was performed in 8 biomedical databases and 3 health education journals. In addition, relevant experts and E‐mail: discussion lists were contacted, and reference lists of reports were checked. Two reviewers quality appraised all reports according to predefined checklists. In total, seven reports (6 studies) were included. Two main frameworks were then used to synthesize the data from the included studies based on (a) predetermined research questions and (b) educational theory. The results were then compared with existing research (systematic reviews).

 The included studies were limited in number and gave limited insight. Nonetheless, some clear issues emerged. Many participants emphasized that course aims, objectives and, where relevant, precourse tasks, should be more clearly communicated, especially when courses were innovative, complex or presented in a new setting. Experiences suggested that educational uptake and the implementation of skills in practice were directly linked to the participants’ perceptions of the relevance of courses to their professional roles. A range of educational models are used to teach EBP, but no studies were found that directly compared the experiences of participants at different types of EBP courses, or described their potential strengths or weaknesses. Future studies should document educational process, outcomes and the experiences of providers and participants, and explicitly use educational theory to plan, implement and evaluate educational interventions.
Prospective randomised single blind study of epidural steroid injection comparing triamcinalone acetonide with methylprednisolone acetate
Authors: ANWAR A. , ZAIDAH I. , ROZITA R.
Published: May 2005

Aim:  This study aims to assess the effectiveness of epidural steroid injection as well as comparing two agents commonly used in these procedures, namely triamcinalone acetonide and methylprednisolone acetate.

Method:  Twenty subjects were recruited into each group receiving either agent.

Results:  Overall result showed that there were marked improvement in symptoms in both agents but there were no differences in terms of superiority from one agent to another.

Conclusion:  Epidural steroid injection is effective and both agents are equipotent.
New simple way to use the classification tree for the diagnosis of Behcet's disease
Authors: DAVATCHI Fereydoun , CHITSAZ Sam , JAMSHIDI Ahmad‐Reza , NADJI Abdol‐Hadi , CHAMS‐DAVATCHI Cheyda , SHAMS Hormoz , SHAHRAM Farhad , AKBARIAN Mahmood , GHARIBDOOST Farhad , ABDOLLAHI Bahar Sadeghi , ZIAIE Naghmeh
Published: May 2005

Background:  Behcet's Disease (BD) is a vasculitis of unknown origin. It is mainly seen around the Silk Road. The classification tree is the most sensitive and accurate criteria for the classification and diagnosis of the disease. The use of a classification tree necessitates having the diagram in hand. An arithmetic method was developed to replace the diagram by easy‐to‐remember figures.

Methods:  Each criterion was given an appropriate value: ocular lesions were given 5 points, oral aphthosis 4 points, genital aphthosis 3 points, pathergy phenomenon 2 points, and skin manifestations 1 point. Seven points or higher values were necessary to classify a patient as having Behcet's disease. The arithmetic method was tested in 5276 BD patients and in 2407 control patients.

Results:  The sensitivity of the classification tree was 97.2%, the specificity was 96.7%, and the accuracy was 97.1%. The arithmetic method gave exactly the same results.

Discussion:  The arithmetic extrapolation of the classification tree is a new and simple way for the diagnosis and the classification of Behcet's disease.
Substance use during pregnancy: risk factors and obstetric and perinatal outcomes in South Australia
Authors: KENNARE Robyn , HEARD Adrian , CHAN Annabelle
Published: May 2005

Objective: To determine the prevalence of self‐reported substance use during pregnancy in South Australia, the characteristics of substance users, their obstetric outcomes and the perinatal outcomes of their babies.

Methods: Multivariable logistic regression with STATA statistical software was undertaken using the South Australian perinatal data collection 1998–2002. An audit was conducted on every fifth case coded as substance use to identify the actual substances used.

Results: Substance use was reported by women in 707 of 89 080 confinements (0.8%). Marijuana (38.9%), methadone (29.9%), amphetamines (14.6%) and heroin (12.5%) were most commonly reported, with polydrug use among 18.8% of the women audited. Substance users were more likely than non‐users to be smokers, to have a psychiatric condition, to be single, indigenous, of lower socio‐economic status and living in the metropolitan area. The outcome models had poor predictive powers. Substance use was associated with increased risks for placental abruption (OR 2.53) and antepartum haemorrhage from other causes (OR 1.41). The exposed babies had increased risks for preterm birth (OR 2.63), small for gestational age (OR 1.79), congenital abnormalities (1.52), nursery stays longer than 7 days (OR 4.07), stillbirth (OR 2.54) and neonatal death (OR 2.92).

Conclusions: Substance use in pregnancy is associated with increased risks for antepartum haemorrhage and poor perinatal outcomes. However, only a small amount of the variance in outcomes can be explained by the substance use alone. Recent initiatives to improve identification and support of women exposed to adverse health, psychosocial and lifestyle factors will need evaluation.
Management of preterm prelabour rupture of membranes: an audit. How do the results compare with clinical practice guidelines?
Authors: GILES Michelle , GARLAND Suzanne , OATS Jeremy J. N.
Published: May 2005

Background: Preterm prelabour rupture of membranes is a common clinical event. It is associated with infection in approximately 50% of cases. Clinical practice guidelines have been developed at the Royal Women's Hospital, Melbourne, Australia for investigation and management of this condition.

Aim: To perform an audit of management of women presenting with this diagnosis and assess how inpatient management compares with the Hospital's current clinical practice guideline and how the clinical practice guideline compares with the evidence in the literature.

Methods: Retrospective audit over a 3‐month period collecting data on maternal age, gestation, microbiological results, other investigations, pharmacological treatment and outcome.

Results: All the 56 women admitted for this reason received at least one dose of antibiotic, most commonly erythromycin. More than two thirds of patients had the antibiotic changed at least once during their admission. Ten patients were prescribed intravenous antibiotics without a clear indication. Sixty‐four percent received steroids for lung maturation of the neonate and 30% received tocolysis with nifedipine. Almost two thirds of patients delivered within 7 days and there were four neonatal deaths.

Conclusion: In general management of women with premature rupture of membranes is in keeping with the current clinical practice guideline at the Royal Women's Hospital although antibiotic prescribing and management of Group B streptococcus colonisation could be improved. In addition, routine measurement of C reactive protein should cease. The current clinical practice guideline should be modified to reflect the current evidence in the literature.
Sulpiride and Paroxetine in the Treatment of Chronic Tension‐Type Headache. An Explanatory Double‐Blind Trial
Authors: Langemark Michael , Olesen Jes
Published: May 2005

SYNOPSIS

Drugs influencing monoaminergic pathways are of potential use in the treatment of pain.

A serotonin re‐uptake inhibitor, paroxetine (20‐30 mg daily), and a dopamine antagonist, sulpiride (200‐400 mg daily) were compared in a randomized, double‐blind, response‐conditional cross‐over pilot study in 50 non‐depressed patients with chronic tension‐type headache.

Headache was scored daily on a 5‐point verbal scale during 4‐weeks baseline and during 8 weeks of treatment for each drug. A 5‐point ‘Global’ assessment was obtained for each drug, In both treatment groups headache score decreased compared to baseline.

Group comparison of 24 patients first treated with paroxetine and 24 patients first treated with sulpiride showed a non‐significant trend in favor of sulpiride by 'Global' evaluation and by evaluation of the available diary records (18 paroxetine‐treated and 19 sulpiride‐treated).

Cross‐over analysis of ‘Global’ records from 20 patients treated with paroxetine followed by sulpiride and 17 patients treated in the reverse order showed better relief from sulpiride compared to paroxetine in patients having tested both drugs (P=.03). A similar difference was reflected in available headache scores (13 and 10 patients respectively; P=.03). Predominant side effects were sedation and depression, for paroxetine also nausea and head pain. None of the drugs improved headache more than one score‐point on average. A placebo controlled trial of sulpiride may be warranted.
SUNCT Syndrome: Estimation of Cerebral Blood Flow Velocity with Transcranial Doppler Ultrasonography
Authors: Shen Jie Ming , Johnsen Hans‐Jørgen
Published: May 2005

SYNOPSIS

Four patients with SUNCT syndrome (Short‐lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing) were investigated with Doppler ultra‐sonography. Blood flow velocity (V) was measured in all intracranial arteries during both normocapnia and voluntary hyperventilation in 4 patients outside attacks (2 during remission; 2 during bout, but outside attacks) and in 8 healthy individuals. Vasomotor reactivity (VMR) was calculated on the basis of the formula of percentage change in V divided by the reduction in end‐tidal PCO2 (PETCO2). Under the basal condition, the patients had a slightly, but non‐significantly higher V in the middle cerebral artery (MCA) (P>0.1) and lower V in the basilar artery (P>0.05) than controls. During hyperventilation, a significant reduction in V was observed in the anterior and posterior cerebral arteries, at a level 1.5‐2 SD above that in controls (P < 0.05), but a non‐significant difference in VMR in comparison with controls. VMCA was continuously insonated during spontaneous (n=8) and precipitated (n=4) attacks in one particular patient on different days. Prior to attack, VMCA was significantly lower on the symptomatic side than on the non‐symptomatic side (P <0.014). V MCA decreased significantly during spontaneous attacks on both sides (P < 0.01) in comparison with the pre‐attack stage, and returned to baseline before the cessation of attack. Similar findings were made during precipitated attacks. PETCO2, was rather constant throughout the entire attack study. Our data suggest that abnormal cerebral circulation may be part of the SUNCT syndrome. The vascular changes may have underlying mechanisms differing from those of the pain.
Complicated Retinal Migraine
Authors: Inan Levant E. , Uysal Hilmi , Ergün Ufuk , Yurdakul Muhlis , Karagöz Halil
Published: May 2005

SYNOPSIS

Retinal migraine is not uncommon, but permanent sequelae are rare. We describe the case of a 23‐year‐old woman who had suffered from retinal migraine for five years. After a typical migraine attack a left nasal quadranopsia persisted. Fluorescein angiography showed a branch retinal arterial occlusion. Other causes were ruled out by appropriate laboratory techniques. Her visual field defect has persisted for eleven months.
Interdisciplinary Outpatient Group Treatment of Intractable Headache
Authors: Scharff Lisa , Marcus Dawn A.
Published: May 2005

SYNOPSIS

Approximately 10% of adults suffer from severe or disabling headaches. For many patients, headaches are reduced with traditional medical, physical, or psychological therapies. However, a significant minority continue to report debilitating headaches despite the use of these conventional therapies. An integrated, interdisciplinary approach combining these three individual components in a group treatment setting was offered to patients who had failed previous therapy. The interdisciplinary treatment resulted in over 70% of patients experiencing a 50% or better reduction in headaches at follow‐up of an average of 5.8 months. Overall, there was an average reduction in medication use at follow‐up of 71%. The treated group reported significantly greater reduction in headache activity and medication consumption compared to a group that was referred to but did not receive group treatment. The results suggest that an interdisciplinary outpatient group treatment may provide a cost‐effective end time‐efficient treatment option for patients with a variety of recurring headaches, even if they have failed conventional therapies that use medical, physical, and psychological treatments individually.
Migraine and the Neck
Authors: Blau J.N. , MacGregor E.A.
Published: May 2005

SYNOPSIS

Fifty patients with migraine were asked about the occurrence of neck symptoms during different phases of their attacks, and if they felt the neck could act as a precipitant. Of the 32 reporting neck pain or stiffness, 10 noted symptoms during the premonitory phase, 30 during the headache phase, and 10 postdromally. In 7 cases the pain radiated into the shoulder and in 1 case into the lumbar region. These findings indicate extracerebral involvement of the migraine process and an overlap between the trigeminal and cervical distribution.
Migraine Headaches: Coping Efficacy of Guided Imagery Training
Authors: Ilacqua Giorgio E.
Published: May 2005

SYNOPSIS

This study compares the effectiveness of guided imagery, (psychosynthetic approach), and biofeedback in the treatment of migraine headache. Specifically, the volunteer's subjective perception of the efficacy of the treatments is assessed.

The subjects were 40 male and female volunteers presenting with migraine headache diagnosis at Sunnybrook Health Sciences Centre in Toronto, Canada. Subjects were randomly assigned to one of the three treatment conditions or to a control group. All subjects attended six sessions of training. Measures were completed pre‐ and post‐treatment.

The results did not reveal significant reduction in migraine activity in any of the treatment groups. There were no differences among the groups regarding the intake of medication. Nevertheless the implementation of guided imagery training resulted in subjective reports of improved capacity to cope with the pain and in subjective reports of a reduced perception of the pain itself, although objective measures did not indicate an appreciable change in migraine activity.

Findings from the present study do not support either feedback or guided imagery training as more effective in counteracting migraines although subjective reports do favor guided imagery as having a positive influence on the perception of migraine pain.

These findings are discussed from the perspective of empowering the sufferers by providing them with a more active role in dealing with the migraine triggering physiology, abandoning the "learned helplessness" typical of chronic pain syndromes.

The issue of cost effectiveness is raised and it supports the use of guided imagery versus biofeedback training given the lack of theoretical agreement in the current literature.
Headache Recurrence in Pregnant Women with Migraine
Authors: Chen T‐C. , Leviton A.
Published: May 2005

SYNOPSIS

The goal of this study was to evaluate to what extent pregnancy influences headache recurrence in women with · diagnosis of migraine at, or before, their first prenatal visit. Data from the large, prospective Collaborative Perinatal Project of 55,000 pregnancies were reviewed. Less than 2% of women in the sample of first study pregnancies were considered to have migraine at their initial prenatal visit (n=508). Of the 484 women with a complete data set, 17% experienced complete cessation of headache throughout pregnancy and another 62% experienced two or fewer headaches in the third trimester. These observations lead to the conclusion that many migraineurs (79% in this sample) experience improvement in headache recurrence during pregnancy. Only 21% experienced no improvement at all. No demographic or obstetrical factor was associated with headache improvement.
Use of Dihydroergotamine in Patients with Postconcussion Syndrome
Authors: McBeath Juanita G. , Nanda Anil
Published: May 2005

SYNOPSIS

The experience with 34 patients who came to the Shreveport Headache Clinic for treatment of postconcussion headache is reviewed. All had been suffering from postconcussion (posttraumatic) syndrome for periods ranging from one day to more than three years, and all displayed, in addition to headache, at least three other symptoms characteristic of the syndrome, eg, memory problems, impaired concentration, sleep problems, dizziness, and anxiety. After initial evaluation at the clinic, the patients were admitted to Willis Knighton Medical Center and treated with repetitive administration of intravenous dihydroergotamine (DHE) and metoclopramide. A good to excellent overall response to DHE therapy was achieved by 88% (29) of the patients. The percentages and numbers of patients obtaining good to excellent relief of selected key symptoms were: 85% (28) ‐ headache, 91% (30) ‐ memory problems, 94% (31) ‐ sleep problems, and 88% (29) ‐ dizziness. DHE was well‐tolerated, and no serious or unexpected adverse reactions were reported. The most frequently reported adverse reactions were mild nausea and brief worsening of headache.
1044 Women with Migraine: The Effect of Environmental Stimuli
Authors: Hay K. Michael , Mortimer Marek J , Barker David C. , Debney Lorna M. , Good Peter A
Published: May 2005

SYNOPSIS

This study initiated by a self‐help migraine group investigated disability caused by visual environmental stimuli, e.g. glare, flicker, pattern and color. One thousand forty‐four women with migraine completed the self‐report questionnaire on visual environmental stimuli reported in earlier studies to precipitate or aggravate migraine. One hundred twenty‐one female controls were obtained from general practice and hospital out‐patients. The responses of the classical, common and non‐migraine groups were compared. Women with classical migraine expressed greater disability than those with common migraine or controls both in respect of number of visual sensitivities reported (P < 0.0001 ) and severity of consequences of such stimuli (P < 0.0001). This study indicated differences between classical and common migraine outside of the attack phase apart from aura. Reported range of sensitivities for the migraineurs peaked between the ages of 46–60 years. A high level of unrealized disability caused by visual environmental stimuli was thus identified in hitherto unexplored self‐help groups.
Acute Headache of Recent Onset and Subarachnoid Hemorrhage: A Prospective Study
Authors: Lledo A. , Calandre L. , Martinez‐Menendez B. , Perez‐Sempere A. , Portera‐Sanchez A.
Published: May 2005

SYNOPSIS

Twenty‐seven patients with acute severe headache of recent onset were prospectively recruited in the Emergency Room. Mean duration of headache was 61 hours. CT scan disclosed subarachnoid bleeding in 4 patients and spinal tap revealed subarachnoid hemorrhage (SAH) in 5 patients with normal CT scan. In most SAH cases pain was bilateral, very intense and involving the occipital region. Four of these patients had doubtful or no nuchal rigidity and in one, pain improved while in the Emergency Room.

In every case with an intense acute severe headache of recent onset CT scan and (if normal) a lumbar puncture are warranted to help rule out a SAH.
Recurrence of Cluster Headache After Carotid Thrombendarterectomy
Authors: Björne Annika , Hindfelt Bengt , Havelius Ulf
Published: May 2005

SYNOPSIS

The pathophysiology of cluster headache is largely unknown. One important contributing factor may be an abnormal intracranial‐extracranial hemodynamic state. A male patient suffered from chronic left‐sided cluster headache for about 15 years. After the institution of lithium therapy the symptoms abated. He was completely free from cluster headache for more than 20 years, until the first postoperative day after a thrombo‐endarterectomy for symptomatic 70% carotid stenosis.

This case report indicates the importance of abrupt carotid hemodynamic changes along with dysfunction of the cephalic sympathetic nervous system in the initiation of cluster headache.
Persistent Post‐DuraI‐Puncture Headache Treated With Epidural Infusion of Dextran
Authors: Aldrete J. Antonio
Published: May 2005

SYNOPSIS

A retrospective review was done on medical records of 13 patients with persistent post‐dural‐puncture headaches after one or more epidural blood patches. Headache occurred in nine patients with post‐laminectomy syndrome after “wet taps” while performing epidural blocks. In two patients post‐dural‐puncture headache appeared after long term implanted intrathecal catheters were removed. In two other cases headache developed after spinal anesthesia. Treatment included bed rest, intravenous hydration and at least one epidural blood patch; three patients were given 60 milliliters of epidural saline, without success. Eight epidural catheters were inserted through the lumbar access and five through the caudal approach. Initially, a bolus of 20 milliliters of dextran‐40 was given followed by an infusion of 3 mL/hr, until 12 hours after the head pain and any other related symptoms subsided. In all patients the headache disappeared within 20 hours after initiating therapy (9.55 mean hours, SD ± 0.79). In five patients headache ceased in less than five hours. Nausea and photo‐phobia subsided earlier. Patients with post‐dural‐puncture headache resistant to other treatments, including at least one epidural blood patch, were successfully treated by a bolus followed by continuous epidural infusion of dextran‐40.
An Update on the Epidemiology of Migraine
Authors: Lipton Richard B. , Silberstein Stephen D. , Stewart Walter F.
Published: May 2005

SYNOPSIS

Epidemiologic studies provide estimates of the scope and distribution of the public health problems posed by migraine. These studies have been facilitated by the development of the International Headache Society criteria for migraine, which have now been used in separate prevalence studies in several countries. In this article, we review some of the methodological challenges in studying migraine epidemiology, report recent results from studies using IHS criteria, and suggest directions for future research.
Diagnosing Recurring Headaches: IHS Criteria and Beyond
Authors: Marcus Dawn A. , Nash Justin M. , Turk Dennis C.
Published: May 2005

SYNOPSIS

Current classification systems for diagnosing recurring headaches utilize sets of specific criteria. To determine the usefulness of these criteria in the practical application of diagnosing headache patients, 698 headache specialists were asked to review four case vignettes of headache patients and assign a diagnosis. They also ranked International Headache Society (IHS) criteria along with other features commonly used in the diagnosis of headaches in order of importance. There was no difference in ranked importance for the specific criteria posed by the IHS compared with commonly used criteria not included within the IHS system. A large majority of the respondents combined IHS features with other associated features not used in the IHS system as the basis of diagnostic assignment. These results raise a question about the acceptance and utilization of the IHS system as a basis for diagnoses. They also suggest that there is a need to educate health care providers about the appropriate use of the current IHS criteria to increase reliability of headache diagnosis.
A Population‐Based Survey of the Social and Personal Impact of Headache
Authors: Kryst S. , Scherl E.
Published: May 2005

SYNOPSIS

To explore the social and personal impact of headache, we contributed questions on serious headache to a population‐based telephone survey on health in Kentucky. A total of 647 persons aged 20 and older was assessed for serious headache. Migraine without aura was distinguished from non‐migraine headache using a modification of the 1988 IHS criteria. The 12‐month period prevalence for all serious headaches was 13.4%; for migraine, it was 8.5%. Demographically, there was a higher proportion of headache sufferers in the low income bracket (<$10,000/year) and a higher proportion of women reporting migraines. Of those with serious headaches, 73.6% stated that headaches adversely affected their lifestyle in at least one way. Migraineurs reported significantly more interference in family relations, work attendance, and work efficiency than non‐migraineurs. Women said their family relationships and work productivity were impacted significantly more often than men. Of those reporting disability, 46.8% said they take only non‐prescription medications. We conclude there is a significant number of serious headache sufferers in Kentucky who experience social as well as vocational impairment as a result of their illness. Further research is recommended to evaluate the extent of interpersonal and personal disability and to identify barriers to adequate health care for headache sufferers.
Chronic Tension‐Type Headache: An Investigation of the Appraisal Process
Authors: Kearney Jeffrey M. , Holm Jeffrey E. , Kearney Maria L.
Published: May 2005

SYNOPSIS

The few existing studies that have explicitly examined appraisal of stress in tension‐type headache sufferers have found that these individuals perceive events in a more negative manner than headache‐free controls. However, can it necessarily be assumed that they perceive events in a less accurate manner than headache‐free controls? To answer this question, sixty chronic tension‐type headache sufferers and 60 controls engaged in a 40‐trial contingency learning task in which they had to estimate the amount of control they could exert. Results provide little support for the notion that the cognitive appraisal of tension‐type headache sufferers is more accurate than that of headache‐free individuals. However, differences were found in perceived control when behavioral involvement was considered. This result is discussed in terms of learned helplessness theory.
Headache and Depression: Confounding Effects of Transdiagnostic Symptoms
Authors: Hol Jeffrey E. , Penzie Donald B. , Holroy Kenneth A. , Brow Timothy A.
Published: May 2005

SYNOPSIS

A link between headache and depression has been noted in the literature for over 30 years. To date, however, studies investigating this relationship have ignored the potential impact transdiagnostic symptoms (i.e., symptoms indicative of both depression and headache) may have on correlations between measures of depression and measures of headache activity. The present study examined this issue using the Beck Depression Inventory in a large sample of recurrent headache sufferers who had presented for treatment at one of two university‐based clinics. Factor analysis identified two distinct, albeit correlated, factors reflecting cognitive/affective symptoms and somatic symptoms. Correlational analyses found consistent relationships between the somatic symptom factor and measures of headache activity, but not between the cognitive/affective factor and headache activity. We suggest that the BDI items comprising the somatic factor identified in this study may not be appropriate indicators of depression in recurrent headache samples.
Tension Headache: Botulinum Toxin Paralysis of Temporal Muscles
Authors: Zwart John‐Anker , Bovim Gunnar , Sand Trond , Sjaastad Ottar
Published: May 2005

SYNOPSIS

The pathogenetic mechanism of tension headache (TH) is still unknown. The role of pericranial muscle tension in TH is also enigmatic. To evaluate this factor in chronic TH, pericranial muscles were paralysed in 6 chronic TH patients, using botulinum toxin. All patients fulfilled the IHS criteria of chronic TH associated with involvement of the pericranial muscles, but not the current criteria for cervicogenic headache. The patients were followed‐up regularly with evaluation of the paralysis, changes in pain intensity, and pressure pain threshold measurements. We primarily only injected the temporal muscle on the one side, using the other side as a control. Contralateral muscles were in some cases injected at a later stage. In our study, we did not find any significant reduction in pain intensity, as measured by the visual analogue scale, nor any changes in pressure pain threshold, as measured by an algometer. On the basis of our observations, we conclude that muscle tension in these muscles possibly plays a minor role in the genesis of chronic TH. In our study, however, we have only treated a limited number of patients, and only one pericranial muscle has been injected systematically. Further studies of various neck/posterior head muscles ought to be performed in order to further evaluate a possible effect of tension in the pericranial musculature in producing this type of pain.
Double‐Blind Trial of Fluoxetine: Chronic Daily Headache and Migraine
Authors: Saper Joel R. , Silberstein Stephen D. , Lake Alvin E. , Winters Marjorie E.
Published: May 2005

SYNOPSIS

This study is the first double‐blind placebo‐controlled trial of fluoxetine for chronic daily headache (CDH) and migraine. After a one month single‐blind baseline on placebo, subjects with CDH (n=64) and migraine (n=58) were randomly assigned to a three month trial of fluoxetine (20 mg) or an identical placebo. Fluoxetine and placebo were increased to 40 mg in the second month, depending on patient response. Patients kept daily headache records, and completed 100 mm visual analogue scales (VAS) of headache and mood each month.

For the group of CDH patients on fluoxetine, overall headache status (VAS) after three months compared to the end of the single‐blind placebo baseline improved a mean of 50% vs. 11% for those receiving the double‐blind placebo ( P =.029), with 47% vs. 23% improving at least 50% ( P =.097, n.s.). Fluoxetine patients showed significant improvement in monthly mood ratings compared to placebo (.001 by the end of the study), and modest but significant improvement in daily records of headache frequency ( P =.019) but not pain severity. Significant mood improvements preceded improvement in headache, reaching significance by the end of the second month on fluoxetine ( P =.013), while headache improvement emerged only during the third month ( P =.001). Double‐blind investigator judgement identified more headache improvement in fluoxetine than placebo recipients (40% vs. 22%, P =.032).

Fluoxetine was not effective on any measure for migraine, with the exception of modest mood improvement at the end of the third month ( P =.043). Adverse effects were more frequent but not more severe for fluoxetine, including sleep disturbance (28% vs. 8%, P =.008), tremors (20% vs. 5%, P =.025), and minor stomach pain (13% vs. 0%, P =.008).

Fluoxetine appears moderately effective for CDH but not migraine, with a generally tolerable side effect profile. The influence on headache may be linked to its effect on mood. In general, study subjects were not clinically depressed. Future research might focus on subjects with comorbid depression and headache.
Chronic Paroxysmal Hemicrania in a Child
Authors: Gladstein J. , Holden E.W. , Peralta L.
Published: May 2005

SYNOPSIS

Chronic paroxysmal hemicrania (CPH) is a relatively new condition first described in 1973. Since its first description, over 80 cases have been reported worldwide. Very few cases have been reported in children. We report the presentation of an 8‐year‐old boy to illustrate the problems in diagnosis and treatment of this rare disease in childhood.
Side‐Locked Unilaterality and Pain Localization in Long‐Lasting Headaches: Migraine, Tension‐Type Headache, and Cervicogenic Headache
Authors: D'Amico Domenico , Leone Massimo , Bussone Gennaro
Published: May 2005

SYNOPSIS

Side‐locked unilaterality and specific localization of pain are not as well‐defined clinical characteristics in long‐lasting headaches (duration more than 4 hours) as they are in short‐lasting forms. We examined side‐locked unilaterality and pain distribution at onset and at peak headache in 74 patients with different forms of long‐lasting headache: migraine and tension‐type headache (IHS) and cervicogenic headache (according to Sjaastad et al). Side‐locked unilaterality of pain was found in all forms, but to differing extents‐20.8% in migraine, 12.5% in tension‐type headache, while it was a mandatory criterion for cervicogenic headache. The pain tended to localize anteriorly, particularly at onset, in migraine; was more diffuse in tension‐type headache; and always began in the occipitonuchal region in cervicogenic headache. Our results may contribute to a better clinical definition of long‐lasting headaches.
Plasma Monoamines in Tension‐Type Headache
Authors: Castillo J. , Martínez F. , Leira R , Lema M. , Noya M.
Published: May 2005

SYNOPSIS

Clinical and pharmacological data suggest a derangement of central monoaminergic systems in tension‐type headache. Biochemical evidence has been rarely recognized. These findings may relate with pathophysiological mechanisms of headache or with underlying depression. We measured platelet‐rich plasma serotonin and plasma catecholamines (norepinephrine, epinephrine, and dopamine) in 30 patients with tension‐type headache and in 20 healthy controls, using High‐Pressure Liquid Chromatography. We studied differences between groups and the relation between biochemical parameters and clinical indices evaluating duration and severity of headache and depression. Platelet serotonin levels in tension headache patients were higher than in controls ( P <0.001). Plasma catecholamine levels were lower in patients than in controls ( P <O.001 for epinephrine and dopamine, and P <0.05 for norepinephrine). There was a positive correlation between dopamine levels and duration of history of headache (r=0.55, P <0.05). A negative correlation between epinephrine levels and severity of headache was observed (r=‐51, P <0.01). No correlations were found between monoamine levels and severity of depression. Our results add to the evidence of alterations of monoaminergic central systems in tension‐type headache patients. These alterations seem to be independent from the underlying depression and related to the pathophysiologic mechanisms of headache.
Paroxetine in the Treatment of Chronic Daily Headache
Authors: Foster Carol A. , Bafaloukos Jacklyn
Published: May 2005

SYNOPSIS

Forty‐eight patients with chronic daily headache, unresponsive to several combinations of pharmacological treatments, were selected for an open‐label study using paroxetine. Patients were given 10 mg to 50 mg of paroxetine for a period of 3 to 9 months. Ninety‐two percent of the patients improved significantly, based on the patients' percent of the reduction in number of headache days per month. The common side effects were fatigue, insomnia, and urogenital disturbances. The possible mechanism of action of paroxetine in the treatment of chronic daily headache is discussed. Paroxetine appears to be effective in the treatment of chronic daily headache; however, double blind studies are needed to confirm these preliminary findings.
Clinical and Angiographic Features of Thunderclap Headache
Authors: Slivka Andrew , Philbrook Bryan
Published: May 2005

Thunderclap headache is an acute high intensity headache similar to that seen in the setting of ruptured saccular aneurysm. We report four patients without subarachnoid hemorrhage who presented with thunderclap headache. Three patients had transient neurologic signs or symptoms. Cerebral angiography revealed diffuse segmental intracerebral arterial vasoconstriction which was reversible in the one patient in whom angiography was repeated. The headaches resolved spontaneously in all cases and after 1 week did not recur. These cases highlight the specific clinical and angiographic features and the self‐limited course of patients with thunderclap headache and suggest that thunderclap headache may represent a unique headache category. On the basis of these cases and others reported in the literature, we propose diagnostic criteria for thunderclap headache.
Serum and Red Blood Cell Magnesium Levels in Juvenile Migraine Patients
Authors: Soriani S. , Arnaldi C. , De Carlo L. , Arcudi D. , Mazzotta D. , Battistella P.A. , Sartori S. , Abbasciano V.
Published: May 2005

Recently an important role for magnesium in establishing the threshold for migraine attacks has become evident. Accordingly, we measured serum and red blood cell magnesium levels in juvenile migraine patients with and without aura interictally. In comparison with normal subjects, migraineurs had significantly lower serum and red blood cell magnesium levels.
Transnasal Butorphanol in the Treatment of Acute Migraine
Authors: Hoffert Marvin Jay , Couch James R. , Diamond Seymour , Elkind Arthur H. , Goldstein Jerome , Kohlerman Nicholas J. , Saper Joel R. , Solomon Seymour
Published: May 2005

We studied transnasal butorphanol (Stadol NS·) for pain relief during acute migraine in a multicenter, randomized, double‐blind, placebo controlled trial using ambulatory patients at 10 geographically diverse headache centers. Patients were volunteer adults diagnosed with migraine with or without aura by International Headache Society criteria. One hundred fifty‐seven patients completed the study. We treated the pain of one headache in each patient with either transnasal butorphanol (n=107) or transnasal placebo (n=50). Pain relief, pain intensity, nausea, vomiting, and effect on function were measured periodically. Adverse experiences were documented. Global assessments were made at follow‐up. With butorphanol, migraine pain was reduced from moderate, severe, or incapacitating to slight or absent for 35 patients (33%) within 30 minutes, for 50 patients (47%) within 1 hour, and for 76 (71%) within 6 hours, compared to 2 (4%) 8 (16%) and 15 (30%) respectively for placebo. Side effects were prominent, though confounded by the migraine. The most common side effects, compared to placebo, were dizziness (58% vs 4%), nausea and/or vomiting (38% vs 18%), and drowsiness (29% vs 0%). We conclude that transnasal butorphanol is a useful analgesic for the pain of acute migraine. Its prominent side effects and low self reinforcement rate may limit its usefulness in some patients, while increasing its appropriateness for others.
Migraine and Concomitant Symptoms Among 8167 Adult Twin Pairs
Authors: Honkasalo M‐L. , Kaprio J. , Winter T. , Heikkilä K. , Sillanpää M. , Koskenvuo M.
Published: May 2005

We studied the inheritance of migraine and concomitant symptoms among 2690 monozygotic (1524 female and 1166 male) pairs and 5497 dizygotic (2951 female and 2546 male) twin pairs. Our material consists of a population‐based questionnaire study among Finnish twins in 1981. The definition of migraine is based on a questionnaire method.

Concordance was assessed using probandwise concordance rates and tetrachoric correlations for monozygotic (MZ) and dizygotic (DZ) twin pairs. For estimating the contribution of genetic factors to the susceptibility of migraine, a polygenic multifactorial model was used. Structural equation models were applied for estimating variance components and to compare different genetic models.

Nearly one‐half (40% to 50%) of the liability to migraine is attributable to genetic factors. In all structural analyses, the model with both additive genetic and unshared environmental component had the best goodness‐of‐fit value. The genetic component varied between 34% to 51% in different migraine types. There were no remarkable differences between sexes except in the effects due to dominance, where the proportion was 26% for men and 14% for women. Concomitant symptoms among subjects within pairs concordant for headache had genetic effects varying from 56% (subjects with unilaterality) and 56% (subjects with visual symptoms) to 45% (persons with nausea and vomiting). The two threshold model of headache points to the continuum model of headache, and the thresholds represent different levels of severity of the pain.

Our results emphasize a multifactorial and higher than previously reported genetic pattern in the etiology of migraine. Also unshared environmental factors play an important role.
Headache and Cysticercosis in Ecuador, South America
Authors: Cruz M. E. , Cruz I , Preux P.‐M. , Schantz P. , Dumas M.
Published: May 2005

Intractable headaches have been described as the presenting complaint of many patients with T. solium neurocysticercosis. We conducted a house‐to‐house neuroepidemiological survey of 2,723 residents of an Andean community, known to be endemic for this infection. Migraine headaches were confirmed in 187 cases (68.7 per thousand), and tension headaches were diagnosed in 77 cases (28.3 per thousand). Fifty‐seven migraine sufferers accepted computed tomography examination, and in 19 it revealed neurocysticercosis. In 11 out of 52 migraineurs who had their blood drawn, electron immunotransfer blot testing (EITB) was positive for anticysticercal antibodies. In a computer‐generated random sample of this community, 109 headache‐free individuals were examined by CT, and 87 had EITB. Of the 109 subjects examined by CT, 14 were positive for cysticercosis. Of the 87 individuals tested by EITB, 7 were positive. A statistically significant difference between the symptom‐free general population and the migraine patients was obtained for both CT (odds ratio 3.39, P<0.005) and EITB (odds ratio 3.07, P<0.05) diagnosis of neurocysticercosis. Neurocysticercosis appears to be a significant risk factor for the presentation of migraine‐type headaches in areas endemic for T. solium infection.
Postoperative Headache in Acoustic Neuroma
Authors: Vijayan N.
Published: May 2005

Recently, it has become obvious that disabling postoperative headache is a major problem with acoustic neuroma surgery. A questionnaire was used to retrospectively evaluate the incidence, clinical features, prognosis and possible therapeutic measures of this particular form of headache. Forty‐two percent (42%) of patients had some headache prior to surgery but this was not a major complaint. After surgery, 75% of patients experienced headache. Only 24% had complete relief of headache. A very gradual improvement of the pain occurred in 32%. Pathogenesis remains unclear, but clinical characteristics of the headache suggest a combination of tension‐type, neuralgic and vascular components. Postoperative pain occurs mostly around the surgical site suggesting that this type of headache is the result of surgical trauma. A prospective long‐term study is needed to delineate this condition further. Some therapeutic suggestions are offered.
Quantification of Headache Disability: A Diagnostic‐Based Approach
Authors: Micieli Giuseppe , Frediani Fabio , Cavallini Anna , Rossi Francesco , Bussone Gennaro , Merli Silvio , Nappi Giuseppe
Published: May 2005

The quantification of the social and economic handicaps caused by headache is a complex problem, especially given the great variability of headache patients' clinical pictures. In the present study, 400 patients, consecutively admitted to Headache Centers in Pavia and Milan, were interviewed on the relationship between headache and their work and social activities, in order to evaluate their socioeconomic handicap due to headache. The analysis of the data primarily focused on attack‐type headaches (migraine, cluster headache, and episodic tension‐type headache) and chronic or daily headaches (chronic tension‐type headache and migraine combined with tension‐type headache). These latter types were often characterized by the daily use or abuse of analgesics.

The overall profile which emerged from the study reveals relatively low levels of handicap or disability in work and social activities. These low levels can be mainly attributed to timely, and at times excessive, use of analgesics.
The Frontotemporal Region Plays a Role in the Genesis of Migraine Without Aura
Authors: Bonuso Salvatore , Marano Enrico , Di Stasio Emanuela , Sorge Fulvio , Tetto Antonio , Testa Nunzio
Published: May 2005

We have compared the migraine‐inducing effect of nitroglycerin ointment applied to the frontotemporal region of the head, which is innervated by the ophthalmic and maxillary divisions of the trigeminal nerve, with that of nitroglycerin applied to the chin (innervated by the mandibular division), the posterolateral region of the neck (innervated by the second and third cervical roots), the lateral surface of the proximal third of the forearm (innervated by the sixth cervical root), and the medial surface of the upper‐arm region (second dorsal root). One hundred patients suffering from migraine without aura were randomly divided into five equal groups. Each group received an application of 5 mg nitroglycerin in 2% ointment on a preselected body area for 2 hours. Frontotemporal nitroglycerin induced a significantly greater number of early onset migraine attacks with respect to the arm and forearm regions. In all cases, nitroglycerin applied to the frontotemporal region resulted in subsequent migraine, whereas there was a significant number of negative trials with nitroglycerin applied to the neck, arm, and forearm vs the frontotemporal area. It, therefore, appears that the trigeminal nerve endings in the affected frontotemporal region are particularly sensitive to the migraine‐inducing effect of the nitrate. This suggests a peripheral neurogenic hypothesis of migraine genesis.
Hemicrania Continua: Remitting Stage Evolved From the Chronic Form
Authors: Pareja Juan A.
Published: May 2005

It is known that in hemicrania continua the chronic stage may be preceded by a remitting stage. In the present communication, the reverse sequence has been demonstrated, ie, a transition from the chronic to the remitting stage. The headache was characterized by a chronic pattern from the beginning until the commencement of indomethacin treatment, which provided long‐lasting relief. Withdrawal of the drug resulted in reappearance of headaches with the same clinical features but in a remitting fashion. Resumption of indomethacin treatment had a dramatic effect on the remitting headaches. Such a temporal evolution of symptoms is consistent with the prevailing view that in a patient with hemicrania continua, there may be two temporal patterns.