bluuebunny/crossref_metadata_2025 huggingface dataset:
Further Clinical Clarification of the Muscle Dysfunction in Cervical Headache
Authors: Jull G , Barrett C , Magee R , Ho P
Published: March 2003

The Headache Classification Committee of the International Headache Society listed impairments in cervical muscle function as criteria for headaches of cervical spine origin. Fifteen subjects with cervical headache and 15 controls were tested for the frequency of abnormal responses to passive stretching and abnormal muscle contraction. A new test of cranio-cervical flexion was used to assess the contraction of the deep neck flexors. Results indicated a trend towards a higher frequency of abnormal response to passive stretching of the muscles examined in the cervical headache group but only the upper trapezius proved significantly different to the control group. Deep neck flexor muscle contraction was significantly inferior in the cervical headache group. From the perspective of physical characterization of cervical headache, it appears mat response from passive stretch of muscle may not be a strong criterion for cervical headache but deep neck flexor performance may have potential to identify musculoskeletal involvement in headache. The finding may also provide positive directions for conservative treatment of cervical headache.
Motor Cortex Excitability in Patients with Migraine with Aura and Hemiplegic Migraine
Authors: Werhahn KJ , Wiseman K , Herzog J , Foörderreuther S , Dichgans M , Straube A
Published: March 2003

We studied the excitability of the motor cortex using transcranial magnetic stimulation (TMS) in 12 patients with migraine with aura (MA) and nine patients with familial hemiplegic migraine (FHM). Motor thresholds at rest, the duration of the cortical and peripheral silent period and intracortical inhibition and facilitation using paired-pulse TMS at intervals of 2 to 15 ms were measured with patients free of attacks for at least 48 h. In contrast to previous reports we could not find any significant differences between patient groups and compared to controls ( n = 17) in the parameters tested. The results suggest that there are no interictal changes of excitability of the motor cortex in migraine. This study does not support the concept of general cortical hyperexcitability in migraine secondary to a genetic predisposition or a structural alteration of inhibitory interneurones in the cortex due to repeated parenchymal insults during attacks.
Orientation Discrimination Thresholds in Migraine: A Measure of Visual Cortical Inhibition
Authors: Wilkinson F , Crotogino J
Published: March 2003

Orientation discrimination is a visual task dependent on inhibitory mechanisms in the visual cortex. In this study, orientation discrimination thresholds for bar and grating patterns were measured at two visual field locations in subjects with migraine with ( n = 20) and without aura ( n = 20) and in migraine-free control subjects ( n = 20). No statistically significant differences were found between migraine groups and the control group on either task at foveal or peripheral visual field locations. No significant correlations were found between psychophysical thresholds and age, total lifetime auras or total lifetime migraine episodes. However, a trend was seen toward slightly impaired performance on the two foveal tasks in a subgroup of subjects with the highest total lifetime aura count. Thus we have found no convincing evidence that impaired cortical inhibitory mechanisms are a predisposing characteristic in migraine, but cannot rule out the possibility that cortical inhibitory mechanisms may be adversely affected by repeated visual auras.
Intracisternal Octreotide Does Not Ameliorate Orthodromic Trigeminovascular Nociception
Authors: Kemper RHA , Jeuring M , Meijler WJ , Korf J , Ter Horst GJ
Published: March 2003

Octreotide is a long-acting somatostatin analogue that has been effectively used to treat migraine. Octreotide poorly penetrates the blood–brain barrier, but has potential central target sites in the trigeminal nucleus caudalis, which is the primary central relay station for trigeminal nociceptive information in the brain. We studied the effect of intracisternally applied octreotide in a model of trigeminovascular stimulation in the unrestrained rat using intracisternal capsaicin infusion to stimulate intracranial trigeminal nerves. Fos expression in the outer layers of the trigeminal nucleus caudalis (TNC I-II) and behavioural analysis were used to measure the effects of octreotide on capsaicin-induced trigeminovascular activation. Increases of head grooming and scratching behaviour are an indication of octreotide-induced trigeminal activation. However, octreotide did not alter the average capsaicin-induced Fos expression in the TNC I-II and capsaicin sensitive behaviours were not modified by octreotide pre-treatment. This argues against a role for central (TNC I-II) somatostatin receptors in the processing of the nociceptive trigeminovascular signals.
Pharmacodynamics of Oestrogens and Progestogens
Authors: de Lignières B , Silberstein S
Published: March 2003

The ovaries cyclically secrete estradiol and progesterone. Cyclic ovarian estradiol secretion is associated with a bone-saving and vascular protection effect. Endogenous progesterone does not modify the vasodilator effect of oestrogens. At physiological concentrations, the natural sex steroids have low antigonadotropic effects. More potent synthetic derivatives with more antigonadotropic effects were synthesized in the 1950s. After the menopause, there is no longer any need to use hormonal steroids as antigonadotropics. In addition, vascular contraindications are more common in an older population. Contraceptive steroids (particularly ethinyl estradiol) are therefore rarely used. The oestrogen that is most widely prescribed for post-menopausal replacement is a complex formulation of conjugated oestrogens of equine origin that is administered orally in a single daily dose. Improvements in hormone replacement therapy may result from the use of parenteral estradiol (providing sufficient doses are reached) and of a progestogen chemically more similar to progesterone.
Illusory Splitting as Visual Aura Symptom in Migraine
Authors: Podoll K , Robinson D
Published: March 2003

Illusory splitting was illustrated as a visual migraine aura symptom in six of 562 Migraine Art pictures. In this type of illusion, objects or persons appear to be split, along fracture lines of varying form and orientation, into two or more parts that may be displaced and separated from each other. The illusion is strongly associated with the presence of elementary geometric hallucinations. Phenomenological similarities and differences of illusory splitting to the visual perceptual disturbances of fragmentation and mosaic illusion are discussed.
Effects of Subcutaneous Sumatriptan on Plasma Growth Hormone Concentrations in Migraine Patients
Authors: Pinessi L , Rainero I , Savi L , Valfrè W , Limone P , Calvelli P , Del Rizzo P , Gianotti L , Taliano M , Ghigo E , Arvat E
Published: March 2003

The purpose of this study was to assess the sensitivity of 5-HT1D receptors in migraine using sumatriptan as a pharmacological probe. The drug stimulates the release of growth hormone (GH) and this effect may be used to explore the function of cerebral serotonergic systems in vivo. We administered sumatriptan and placebo to 15 migraineurs and to 10 controls. Blood samples were collected -15, 0, 15, 30, 45, 60 and 90 min after injection. Placebo had no effect on hormone concentrations. Sumatriptan induced a significant ( P < 0.01) increase in GH concentrations both in migraine patients and healthy controls. The GH increase was not significantly different in the two groups. Our results suggest that cerebral serotonergic functions mediated by 5-HT1D receptors are not altered in migraine. Sumatriptan overuse could lead to adverse effects mediated by its neuroendocrine activity.
The Influence of Ergotamine Abuse on Psychological and Cognitive Functioning
Authors: Roon KI , Bakker D , van Poelgeest MIE , van Buchem MA , Ferrari MD , Middelkoop HAM
Published: March 2003

Migraine patients abusing ergotamine often have chronic daily headaches associated with tiredness, sleep and memory disturbances, and reduced general well‐being. We quantified psychological and cognitive functioning in 12 migraine patients with and 12 without ergotamine abuse (≥ 5 days/week for ≥ 6 months) and 12 healthy controls. Psychological functioning assessed by Symptom Checklist‐90 (SCL‐90) and Profile Of Mood State (POMS), was impaired in ergotamine abusers compared to healthy controls. Cognitive functioning divided into four domains: attention (critical flicker frequency analysis and mental control subscale of the Wechsler Memory Scale (WMS), speed of information processing (reaction time tasks and lexical decision tasks), memory (four subscales of the WMS) and cognitive flexibility (trailmaking test and WMS digits backwards), was impaired in ergotamine abusers in speed of information processing and cognitive flexibility. These differences disappeared after correction for total SCL‐90 scores. In conclusion, ergotamine abuse is associated with high psychological distress but not with structural impaired cognitive functioning.
Memory Disturbances in Migraine With and Without Aura: A Strategy Problem?
Authors: Le Pira F , Zappalà G , Giuffrida S , Lo Bartolo ML , Reggio E , Morana R , Lanaia F
Published: March 2003

Cognitive defects in migraine have been reported by several authors. These findings however, are controversial. In this study we carried out an investigation on 14 patients with migraine with aura and 16 with migraine without aura according to the International Headache Society criteria. They were submitted to a comprehensive battery of neuropsychological tests. The patients were compared with a control group not significantly different as to age, sex and education. Migraine subjects showed impaired neuropsychological performances only on some cognitive tests. Both groups of patients did worse than the control group on visuo‐spatial memory tasks, while only migraineurs without aura showed significantly impaired verbal memory performances. The memory defects, both on visuo‐spatial and on verbal cognitive tasks, could depend on an impaired recall mechanism. These memory difficulties seem related to strategically and organizationally defective aspects of learning.
Repetitive Cortical Spreading Depression in a Gyrencephalic Feline Brain: Inhibition by the Novel Benzoylamino-Benzopyran SB-220453
Authors: Smith MI , Read SJ , Chan WN , Thompson M , Hunter AJ , Upton N , Parsons AA
Published: March 2003

Transient cortical depolarization is implicated in the pathology of migraine. SB-220453 is a potent anti-convulsant which inhibits neurogenic inflammation and cortical spreading depression (SD)-evoked nitric oxide release via a novel but unknown mechanism. This study further investigates the effects of SB-220453 on generation and propagation of repetitive SD in the anaesthetized cat. Vehicle or SB-220453 1, 3 or 10 mg/kg was administered intraperitoneally 90 min prior to induction of SD in the suprasylvian gyrus (SG). Changes in d.c. potential were recorded in the SG and the adjacent marginal gyrus (MG). In vehicle-treated animals ( n = 7), a brief exposure (6 min) to KCl induced a median (25–75% range) number of five (four to six) and three (two to four) depolarizations over a duration of 55 min (32–59 min) and 51 min (34–58 min) in the SG and MG, respectively. SB-220453 produced dose-related inhibition of the number of events and period of repetitive SD activity. SB-220453 also reduced SD-induced repetitive pial vasodilatation but had no effect on resting haemodynamics. However, when SD events were observed in the presence of SB-220453, it had no effect on metabolic coupling. These results show that SB-220453 produces marked inhibition of repetitive SD in the anaesthetized cat. SB-220453 may therefore have therapeutic potential in treatment of SD-like activity in migraine.
Visual Contrast Processing in Migraine
Authors: Shepherd Aj
Published: March 2003

Some migraine sufferers report certain visual patterns can reliably trigger a migraine attack, such as high contrast striped patterns or flickering lights. Differences between people with and without migraine on tasks that involve these patterns have been attributed to abnormal cortical processing in migraine, although the locus and extent of the abnormality remains unclear, as is any relationship between impairment on various visual tasks. In this study 58 migraine sufferers and 61 control subjects participated in three visual tasks involving striped patterns. One assessed pattern sensitivity with high contrast patterns, the second detection thresholds for low contrast patterns and the third supra-threshold contrast scaling. With each measure, the performance of migraine sufferers as a group differed to the performance of non-migraine control subjects. There were no significant differences between the migraine subgroups when classified according to the presence or absence of aura. Cross-correlating the results from the three tasks, however, revealed consistent associations: impaired or extreme responses on one task were associated with impaired or extreme responses on the others. There were no overall effects due to migraine duration, the frequency of migraine attacks or the time since the last attack. These results are discussed in the context of visually induced migraine, proposed causes of abnormal cortical function in migraine and the prospects for developing clinically useful tests of visual function.
Two New SUNCT Cases Responsive to Lamotrigine
Authors: Leone M , Rigamonti A , Usai S , D'amico D , Grazzi L , Bussone G
Published: March 2003

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare and debilitating headache form generally unresponsive to treatment. Following a recent report of a SUNCT patient who responded to lamotrigine, we tried this drug in two new SUNCT patients, reported here. In both cases prophylaxis was successful, suggesting lamotrigine might be the first effective treatment for this rare and debilitating headache syndrome.
A Prospective Study of Migraine With Aura Attacks in a Headache Clinic Population
Authors: Cologno D , Torelli P , Cademartiri C , Manzoni Gc
Published: March 2003

In order to investigate the prevalence of migraine with aura (MA) attacks according to the criteria set by the International Headache Society (IHS) for diagnosis down to the three-digit level of classification, and to determine the recurrence and possible variability of MA attacks over time, we conducted a 6–15-month-long prospective study on 64 MA patients (42 women and 22 men) consecutively referred for the first time to the University of Parma Headache Centre. At the end of the follow-up period, diagnosis was the same as at the first visit for 80.0% of patients, while it was changed for 20.0%. Throughout the duration of the study, the average number of attacks for each patient was 5.3 ± 6.2 (range 0–30). Attacks of migraine with typical aura were the most frequent (69.1% of patients), but migraine aura without headache (29.1%) and migraine with prolonged aura (20.0%) were also common; by contrast, basilar migraine and migraine with acute onset aura were reported only by one patient in either case. Migraine aura without headache was statistically significantly more frequent in males than in females. Our study results suggest that in most cases the frequency of recurrent MA attacks is relatively low and provide interesting indications about the prevalence of the different MA subtypes listed in the IHS classification, albeit in a headache clinic population.
Evidence-Based Migraine Therapy: Learning Needs and Knowledge Assessment
Authors: Purdy RA
Published: March 2003

One of the primary goals of continuing medical education (CME) is to enhance the learners' performance, and a major goal of evidence-based medicine (EBM) is to improve knowledge of current best care. This paper overviews the use of a Learning Needs and Knowledge Assessment tool to highlight the potential learning needs and knowledge of neurologists and to focus the issues, interest and interactions of neurologists in a workshop on EBM migraine therapy. Virtually all neurologists felt they used evidence-based medicine in their daily practice. Surprisingly, 50% of neurologists agreed that they were uncertain which triptan to use. The great majority of neurologists felt that the triptans were not all equally efficacious. Our survey identified significant knowledge gaps among neurologists regarding how to appraise the validity of evidence from a randomized clinical trial, and with regard to what are the most clinically useful measures of benefit in clinical trials.
Hypofunctionality of Gi Proteins as Aetiopathogenic Mechanism for Migraine and Cluster Headache
Authors: Galeotti N , Ghelardini C , Zoppi M , Del Bene E , Raimondi L , Beneforti E , Bartolini A
Published: March 2003

The involvement of Gi proteins in the modulation of pain perception has been widely established, and mutations in G-proteins have already been identified as the aetiopathological cause of human diseases. The aim of the present study was to determine whether a deficiency or a hypofunctionality of the Gi proteins occurred in primary headache. The functionality and the level of expression of Gi proteins were investigated in lymphocytes from migraine without aura, migraine with aura and cluster headache sufferers. A reduced capability to inhibit forskolin-stimulated adenylyl cyclase activity in headache patients was observed. Migraine patients also showed basal adenosine cAMP levels about four times higher than controls. The reduced activity of Gi proteins seems not to be related to a reduction of protein levels since no significant reduction of the Giα subunits was observed. These results indicate Gi protein hypofunctionality as an aetiopathogenic mechanism in migraine and cluster headache.
Lack of Pharmacokinetic Interaction Between the Antimigraine Compound, Almotriptan, and Propranolol in Healthy Volunteers
Authors: Fleishaker JC , Sisson TA , Carel BJ , Azie NE
Published: March 2003

This study was designed to assess the pharmacokinetics of almotriptan, a 5-HT1B/1D agonist, when administered in the presence and absence of propranolol. Healthy male ( n = 10) and female ( n = 2) volunteers received (i) 80 mg propranolol twice daily for 7 days and 12.5 mg almotriptan on day 7, and (ii) 12.5 mg almotriptan on day 7, according to a two-way crossover design. Plasma and urinary almotriptan concentrations were measured by high performance liquid chromatography (HPLC) methods. Treatment effects on pharmacokinetic parameters were assessed by analysis of variance (anova). Statistically significant differences between treatments in area under the curve (AUC), clearance, and half-life were observed ( P < 0.03), but these differences were < 7%. Ninety percent confidence interval analysis of log-transformed pharmacokinetic parameters showed that the treatments were equivalent. Adverse events were mild to moderate in intensity, and no treatment effects on vital signs were observed. The results show that propranolol has no effect on the pharmacokinetics of almotriptan. Concomitant administration of the two drugs is well tolerated.
Investigations into Migraine Pathogenesis: Time Course for Effects of m-CPP, BW723C86 or Glyceryl Trinitrate on Appearance of Fos-Like Immunoreactivity in Rat Trigeminal Nucleus Caudalis (TNC)
Authors: Martin RS , Martin GR
Published: March 2003

Clinical and preclinical studies suggest that 5-HT and nitric oxide (NO) mobilization within the trigeminovascular system is fundamental to the initiation of migraine attacks., e.g. m-chlorophenylpiperazine (m-CPP) and glyceryl trinitrate (GTN) induce headache in humans. 5-HT2B receptors are known to mediate NO-dependent vasorelaxation in peripheral blood vessels, raising the possibility that this receptor is implicated in the pathogenesis of the disease. Therefore, we measured the effects of 5-HT2B agonists (m-CPP or BW723C86) or GTN on trigeminal nerves by quantifying Fos expression in the rat TNC. m-CPP (0.1 mg/kg, i.v.) induced time-dependent elevations in Fos-LI in the rat TNC 2 h and 8 h after injection. In contrast, neither intravenous GTN (0.5 μg/kg per min, infused 20 min) nor BW723C86 (0.1 mg/kg, i.v.) increased Fos-LI at 2 h or 8 h after administration. These data are not consistent with the involvement of the 5-HT2B/2C receptors or NO in trigeminovascular activation, and by inference migraine, and suggest the contribution of some other unidentified pathway.
The Vågå Study; Epidemiology of Headache I: The Prevalence of Ultrashort Paroxysms
Authors: Sjaastad O , Pettersen H , Bakketeig L S
Published: March 2003

In a large-scale study of headache epidemiology in Vågå, Norway, 1838 adult parishioners(18–65 years of age) were examined, and this represents 88.6% of the target group. Jabs and jolts syndrome/idiopathic stabbing headache (ISH) was verified in 35.2% of the questioned parishioners. This prevalence is much higher than previously observed ones. There were clearly more females than males, the female/male ratio being 1.49, as compared to a ratio of 1.06 in the study cohort ( P-value: < 0.0001, χ2 test). The ratio, 1.49, also differs clearly from a previously observed one: 6.6 ( P-value = 0.0003, Fisher's exact test). Control studies included blinded re-check of 100 work-ups, with complete concurrence (kappa-value of 1.00 and blinded re-check of 41 individuals (kapp value of 0.841). Jabs and jolts/ISH are frequent and almost the sole shortlasting (generally < 3 s duration) cephalic paroxysms.
Platelet 3H Ketanserin Binding in Migraine
Authors: Shukla R , Khanna VK , Pradeep S , Husain M , Tandon R , Nag D , Dikshit M , Srimal RC , Seth PK
Published: March 2003

Platelet 3H ketanserin binding was studied in 33 patients of migraine and 30 healthy controls. The binding characteristics: equilibrium dissociation constant (Kd) and maximal number of binding sites (Bmax) determined by Scatchard analysis revealed a significant decrease in Kd and no change in Bmax in migraine cases. No correlation was observed between the Kd and Bmax with the clinical features of migraine. The findings of the present study show that there is a decreased affinity of platelet 5-HT2 receptors in migraine.
An Open Preference Study with Sumatriptan 50 mg and Zolmitriptan 2.5 mg in 100 Migraine Patients
Authors: Pascual J , Muñoz R , Leira R
Published: March 2003

Understanding factors influencing patients' preference will improve guidance to make rational choices in expanded symptomatic migraine treatment. The objective of this open-label, cross-over study was to explore patients' preferences for sumatriptan 50 mg vs. zolmitriptan 2.5 mg tablets, focusing on factors influencing this preference. One hundred consecutive migraine patients attending our clinics were asked to treat three attacks with each medication and then fill out a preference questionnaire. Ninety-four migraineurs completed the trial and 42 (44%, 95% CI 34–58%) reported that they preferred zolmitriptan 2.5 mg over sumatriptan 50 mg tablets and 27 (29%, 20–38%) preferred sumatriptan 50 mg. The remaining 25 (27%, 18–36%) did not show any preference. For the initial treatment of the attacks, there were more patients needing just one tablet of zolmitriptan 2.5 mg compared with sumatriptan 50 mg (67 vs. 39%). The reasons for preference among those 69 patients who had shown preference for either of the two triptans were: a faster onset of action (speed of onset) (73%), a longer duration of the effects (39%), fewer adverse events (35%) and lower price (13%). Only one-quarter of the studied migraine population thought that sumatriptan 50 mg and zolmitriptan 2.5 mg were equivalent, which suggests that most migraine patients differentiate between triptans. A faster onset of action (speed of onset) was the most important reason for preference.
The Prevalence of Migraine in Patients with Bipolar and Unipolar Affective Disorders
Authors: Fasmer OB
Published: March 2003

There is a well-known association between migraine and affective disorders, but the information is sparse concerning the prevalence of migraine in subgroups of the affective disorders. The present study was undertaken to investigate the prevalence of migraine in unipolar depressive, bipolar I and bipolar II disorders. Patients with major affective disorders ( n = 62), consecutively admitted to an open psychiatric ward, were examined with a semi-structured interview based on DSM-IV diagnostic criteria, combined with separate criteria for affective temperaments. Diagnosis of unipolar and bipolar I disorders followed the DSM-IV criteria, while bipolar II disorder encompassed patients with either discrete hypomanic episodes or a cyclothymic temperament. Migraine was diagnosed according to IHS-criteria. Symptoms of migraine were found to be common in these patients, both in those with unipolar depression (46% prevalence of migraine) and in those with bipolar disorders (44% prevalence). Among the bipolar patients there was, however, a striking difference between the two diagnostic subgroups, with a prevalence of 77% in the bipolar II group compared with 14% in the bipolar I group ( P = 0.001). These results support the contention that bipolar I and II are biologically separate disorders and point to the possibility of using the association of bipolar II disorder with migraine to study both the pathophysiology and the genetics of this affective disorder.
Prevalence and Clinical Features of Migraine in A Population of Visually Impaired Subjects in Curitiba, Brazil
Authors: Kowacs PA , Piovesan EJ , Lange MC , Werneck LC , Tatsui CE , Ribas LC , Scapucin L , Marques LEA , Moreira ATR
Published: March 2003

To investigate the relevance of lacking or diminished visual input on the expression of migraine, we evaluated its prevalence and clinical features in a population of visually impaired subjects. Between September 1999 and April 2000, 203 visually impaired subjects with a headache inventory were surveyed. Those with headache were assessed according to IHS criteria for the presence of migraine. Migraineurs had their symptoms further detailed through an interview and a headache diary. Of the 104 subjects reporting headaches during the last 6 months, 29 had migraine (14.2%). The prevalence of migraine was not influenced by whether the visual impairment was complete or partial. Mean frequency of migraine attacks was 2.7/month. Most subjects (96%) reported severe and/or moderate attacks. Nausea, vomiting, aggravation by activity and phonophobia were reported by 62%, 37.9%, 86.2% and 96.6% of the subjects, respectively. Visual impairment does not seem to influence prevalence of migraine or its clinical features.
The Hemicrania Continua Diagnosis
Authors: Pareja JA , Antonaci F , Vincent M
Published: March 2003

More than 16 years after the first description of hemicrania continua (HC), its aetiology and pathogenesis remain obscure. Clinically, HC is considered a syndrome with two pivotal characteristics: (i) strictly unilateral (moderate, fluctuating, relatively long-lasting) headache; and (ii) absolute response to indomethacin. HC is further characterized by some ancillary, but mostly ‘negative’, features such as: (iii) relative paucity of accompaniments; and (iv) lack of precipitating factors. The female preponderance is also remarkable, although not diagnostic in the solitary case. Finally, a non-specific, but remarkable feature is the temporal pattern. HC may present as a remitting or chronic (continuous) headache. In HC, unilaterality and absolute response to indomethacin are considered crucial diagnostically. Existing controversy, such as regarding atypical features, particularly the so-called ‘HC resistant to indomethacin’, is discussed. The nature of hemicrania with negative indomethacin response remains most unclear; it may not belong to the HC cycle at all. Accordingly, we propose that the typical clinical picture of HC, including an absolute response to indomethacin, be termed Hemicrania continua vera. More or less analogous, but indomethacin-resistant, clinical pictures can provisionally be termed Hemicrania generis incerti (of undetermined nature), provided other diagnostic possibilities have been ruled out. The differential diagnosis of HC vs. other unilateral headaches is commented on. Previous attempts at classification of HC into the group chronic daily headache (CDH) are discussed. The only acceptable ‘link’ of HC with the other headaches classified as CDH is the temporal pattern (which is a non-specific feature). HC is probably pathophysiologically different from the others disorders classified under CDH. Conversely, HC and chronic paroxysmal hemicrania share many common features, including the absolute response to indomethacin. HC should probably be included in the IHS group 3.
Chronic Daily Headache in Taipei, Taiwan: Prevalence, Follow-Up and Outcome Predictors
Authors: Lu S-R , Fuh J-L , Chen W-T , Juang K-D , Wang S-J
Published: March 2003

We conducted a two-stage population-based headache survey among subjects aged ≥15 in Taipei, Taiwan. Subjects with chronic daily headache (CDH) in the past year were identified, interviewed and followed-up. CDH was defined as a headache frequency > 15 days/month, with a duration > 4 h/day. Of the 3377 participants, 108 (3.2%) fulfilled the criteria for CDH, with a higher prevalence in women (4.3%) than men (1.9%). TM was the most common subtype (55%), followed by CTTH (44%). Thirty-four per cent of the CDH subjects overused analgesics. At the 2-year follow-up, 35% of the CDH subjects still had CDH. The significant predictors for persistent CDH at follow-up included: older age (≥ 40 years) (RR = 2.4), CDH onset after 32 years (RR = 1.8), CDH duration ≥6 years (RR = 2.0), medication overuse (RR = 1.8), and ‘daily’ headache (RR = 2.1). We found that CDH is not uncommon in the community and its prevalence is similar among different populations. Older subjects and those with medication overuse may have a more protracted course of illness.
Melatonin in the Preventive Treatment of Chronic Cluster Headache
Authors: Peres MFP , Rozen TD
Published: March 2003

Cluster headache is a stereotypic headache disorder marked by short-lasting bouts of severe unilateral head pain and associated autonomic symptoms. Almost pathognomonic of this condition are nocturnal attacks that usually occur during the first random eye movement sleep phase of the evening. Melatonin levels have been found to be decreased in cluster headache patients. A lack of melatonin secretion may predispose the cluster sufferer to nocturnal and, possibly, daytime attacks. Leone et al. demonstrated that melatonin could rapidly alleviate cluster attacks, but only in episodic cluster patients. We report two chronic cluster headache patients who had both daytime and nocturnal attacks that were alleviated with melatonin.
Relationship Between Sleep Apnoea Syndrome, Snoring and Headaches
Authors: Neau J-P , Paquereau J , Bailbe M , Meurice J-C , Ingrand P , Gil R
Published: March 2003

There is still a controversy regarding the relationship between sleep apnoea syndrome and headaches, especially morning headaches. Our objectives were: (i) to compare the prevalence and the clinical data of headaches in sleep apnoea syndrome (SAS) and control (snorers) groups defined by polysomnographic recording; (ii) to analyse the clinical improvement of headaches with appropriate treatment; and (iii) to correlate headaches with mood disorders, and nocturnal respiratory and architectural sleep parameters in order to understand the underlying pathophysiological mechanisms. This is a prospective study of 324 consecutive patients referred to our sleep centre for snoring. Of these, 312 patients who underwent sleep polysomnography were finally included. Patients and controls were interviewed about their medical past, headache history and clinical characteristics, their daytime sleepiness (Epworth's sleepiness scale) and their mood disorders (Zerssen's scale). Follow-up of patients with headaches (SAS and control groups), treated or not, was also assessed. According to our definition of SAS, patients were dissociated in SAS ( n = 164) and snorers ( n = 148). Fifty-three SAS patients had headaches, of whom 58.5% (n = 30) suffered from morning headaches. However, there was no statistical difference between the two groups concerning the prevalence and the clinical characteristics of headaches. In addition, headaches and morning headaches were not correlated with nocturnal respiratory and architectural sleep parameters, nor with excessive daytime sleepiness, but were strongly correlated with mood disorders. In 36 SAS patients, headaches improved under treatment, but this was not statistically different from what was found among untreated snorers. Headaches and morning headaches are common in patients with SAS but may be considered as a non-specific symptom. The underlying mechanisms are not fully elucidated but depression could play an important role. Despite this absence of specificity, the treatment of SAS, especially nasal continuous positive airway pressure, leads to an improvement in headaches in several cases.
Objective Assessment of Autonomic Signs During Triggered First Division Trigeminal Neuralgia
Authors: Pareja JA , Barón M , Gili P , Yangüela J , Caminero AB , Dobato JL , Barriga FJ , Vela L , Sánchez-del-Río M
Published: March 2003

A total of 26 episodes of V-1 trigeminal neuralgia attacks have been recorded in two female patients. Autonomic phenomena were assessed according to a semiquantitative scale. Attacks lasted 17 ± 5 s. Mild lacrimation without conjunctival hyperaemia, rhinorrhea or ptosis was observed, even in relatively long lasting episodes. This is in clear contradiction with SUNCT (shortlasting, unilateral, neuralgiform headache with conjunctival injection, tearing and rhinorrhea) attacks that are always dramatically accompanied by both lacrimation and conjunctival injection of the symptomatic side from the very onset of symptoms. Carbamazepine provided complete and sustained relief of symptoms in both patients. Herein we will show differential autonomic features of V-1 trigeminal neuralgia vs. SUNCT that will both aid the clinician to distinguish both syndromes and stress that both entities are nosologicaly different.
Changes in Headache Prevalence Between Pre-School and Pre-Pubertal Ages
Authors: Virtanen R , Aromaa M , Rautava P , Metsähonkala L , Anttila P , Helenius H , Sillanpää M
Published: March 2003

The prevalence rates of headache in first-born children were determined at the ages of 6 and 12 years in over 1000 families. A headache questionnaire was mailed to 1132 families when the children were 6 years old, and to 1126 families when the children were 12 years old. Seven hundred and ninety-eight families responded to both questionnaires. The prevalence of headache before the 6 months preceding the questionnaire ('previous headache') was 19% when the children were 6 years of age and 31% when the children were 12 years of age. The corresponding prevalences of headache during the 6 months immediately proceeding the questionnaire ('present headache') were 16% and 19%. Variation in occurrence of headache was high during follow-up years. Maternal frequent headache (≥1/month) was significantly associated with the increase in prevalence of present headache in boys between the ages of 6 and 12 years. Frequent headache in mothers, fathers and siblings, and the occurrence of chronic illness, were also significantly associated with headache in the 12-year-old children.
Study of an Adenosine A1 Receptor Agonist on Trigeminally Evoked Dural Blood Vessel Dilation in the Anaesthetized Rat
Authors: Honey AC , Bland-Ward PA , Connor HE , Feniuk W , Humphrey PPA
Published: March 2003

The purpose of this study was to use intravital microscopy to determine the effect of a selective adenosine A1 receptor agonist, GR79236 (1, 3 and 10 μg/kg i.v.), on neurogenic dural blood vessel dilation in anaesthetized rats. Vasodilation was evoked either by electrical stimulation of perivascular trigeminal nerves or by intravenous CGRP. GR79236 (1-10 μg/kg i.v.) caused a dose-dependent inhibition of neurogenic vasodilation, but had no significant effect on dural vasodilation caused by CGRP. GR79236 (1-3 μg/kg i.v.) had no effect on basal dural vessel diameter, but caused transient dose-dependant bradycardia and hypotension. Bradycardia was more prolonged following 10 μg/kg i.v. GR79236. Pre-treatment with the adenosine A1 receptor antagonist DPCPX (1 μg/kg i.v.) prevented the inhibitory effect of GR79236 (10 μg/kg i.v.) on neurogenic vasodilation as well as GR79236-induced bradycardia and hypotension. These data suggest that the inhibition of neurogenic vasodilation by GR79236 is mediated via the activation of prejunctional adenosine A1 receptors. Provided the systemic cardiovascular effects could be limited, such a mechanism may offer a novel approach to migraine therapy.
Cognitive Disturbances and Regional Cerebral Blood Flow Abnormalities in Migraine Patients: Their Relationship with the Clinical Manifestations of the Illness
Authors: Calandre EP , Bembibre J , Arnedo ML , Becerra D
Published: March 2003

The purpose of the present study was to evaluate neuropsychological performance and regional cerebral blood flow in migraine patients, and to investigate whether possible abnormalities in any of these fields could be related to the chronicity of the disease. The sample included 60 patients and 30 healthy control subjects; all of them were subjected to a complete neuropsychological assessment, including emotional variables. In addition an interictal 99Tc-HMPAO SPECT was performed in 56 patients and 15 controls. Disturbances in memory, attention and visuomotor speed processing were observed among migraineurs experiencing higher frequency of attacks and in those with a long history of migraine. Anxiety levels were higher in patients than in controls and were positively correlated with attack frequency, but not with cognitive test scores. Brain perfusion abnormalities, mostly hypoperfusion areas, were found in the 43% of patients; poorer performance in two tests, measuring verbal and visual memory, respectively, was found in these patients.
Topiramate: A Case Series Study in Migraine Prophylaxis
Authors: Young WB , Hopkins MM , Shechter AL , Silberstein SD
Published: March 2003

We reviewed the electronic records of 74 migraine patients treated with topiramate for more than 6 weeks. Twenty-four patients had episodic migraine and 50 had chronic (transformed) migraine. Most (81%) started treatment at 25 mg per day and reached a dose of 100 mg twice a day (mean dose on the last follow-up visit was 208 mg). The mean headache frequency decreased from 20.6 days to 13.6 days per month ( P < 0.0001) for all headaches (9.9-5.1 ( P < 0.0001) and 25.7-17.7 ( P < 0.001) for episodic migraine and chronic migraine, respectively). The percentage of patients whose headache frequency was reduced by ≥ 50% was 44.6% for all patients; 58.3 for episodic migraine and 38.0 for chronic migraine. For all patients mean headache severity (10-point scale) was reduced from 6.2 to 4.8 ( P < 0.0001). Patients on monotherapy (20%) and polytherapy (80%) had similar reductions in headache frequency. Adverse events were usually mild to moderate and were seen in 58.1% (paresthesias in 25%, cognitive difficulties 14.9%). Mean weight loss was 3.1 ± 4 kg (3.8% of total body weight).
Exteroceptive Suppression Patterns of Masseter and Temporalis Muscles in Central and Peripheral Headache Disorders
Authors: Tataroglu C , Kanik A , Sahin G , özge A , Yalçinkaya D , Idiman F
Published: March 2003

The objective of this study was to compare the exteroceptive suppression patterns of masseter and temporalis muscles in patients with primary and secondary headache disorders originating from peripheral joint dysfunction. We accomplished the temporalis and masseter exteroceptive suppression in 28 patients with migraine, 25 patients with chronic tension-type headache (CTH), 22 patients with temporomandibular joint (TMJ) dysfunction and 18 healthy controls. The onset latencies and duration of the first suppression period (S1) was not significantly different between the patients and controls. The duration of the second suppression period (S2) was shorter in patients with CTH, migraine (analysed during attack) and TMJ dysfunction than those obtained from controls. A distinctive finding was significantly prolonged onset latency in patients with TMJ over those obtained from patients with CTH and migraine. We concluded that the onset latency of the S2 period is a useful parameter in the differential diagnosis of primary and peripheral headache disorders.
Treatment of Headache with Botulinum Toxin A—a Review According To Evidence-Based Medicine Criteria
Authors: Evers S , Rahmann A , Vollmer-Haase J , Husstedt I-W
Published: March 2003

The aim of this review is to evaluate the studies available from reference systems and published congress contributions on the prophylactic treatment of idiopathic and cervicogenic headache with botulinum toxin A, and to classify these studies according to evidence-based medicine (EBM) criteria. The studies were analysed with respect to the study design, the number of patients enrolled, the efficacy parameters, and the significance of results. We used the following classification of EBM. I: randomized, controlled study with sufficient number of patients; II: well-designed, controlled study (or randomized, controlled study with insufficient number of patients, no exact diagnosis, missing data of botulinum toxin A dose); III: well-designed, descriptive study; IV: case reports, opinions of experts. For tension-type headache, two studies were found with negative evidence of I with respect to the primary endpoint. There are about as many positive as negative studies with evidence of II or III. For the therapy of migraine, one study with both negative and positive evidence of I, one in part positive study of II, and three positive studies classified as III are available. Two studies on cervicogenic headache with evidence of II and III are contradictory. In addition, we found several positive case reports. For patients with cluster headache, there are positive and negative case reports. We found one positive case report for the treatment of chronic paroxysmal hemicrania. As a result of this analysis, we consider no sufficient positive evidence for a general treatment of idiopathic and cervicogenic headaches with botulinum toxin A to date. Further studies are needed for a definite evaluation of subgroups with benefit from such treatment.
Sum of Pain Intensity Differences (Spid) in Migraine Trials. A Comment Based on Four Rizatriptan Trials
Authors: Tfelt-Hansen P , McCarroll K , Lines C
Published: March 2003

Sum of Pain Intensity Difference (SPID) is an outcome measure that summarizes treatment response over a clinically relevant period. SPID is widely reported in clinical trials of analgesics but has been little used in migraine trials. We compared SPID over 2 h with the standard migraine outcome measures of pain-free at 2 h and headache relief at 2 h using data from four published clinical trials of rizatriptan in migraine patients. In assessing treatment response (rizatriptan and sumatriptan versus placebo, rizatriptan versus sumatriptan, within-treatment dose effects), SPID usually yielded similar results to the more easily understood pain-free measure.
3D Kinematic Analysis and Clinical Evaluation of Neck Movements in Patients with Whiplash Injury
Authors: Antonaci F , Bulgheroni M , Ghirmai S , Lanfranchi S , Toffola E Dalla , Sandrini G , Nappi G
Published: March 2003

In recent decades whiplash injuries, being a major reason for compensation claims, have become increasingly important in forensic medicine. In view of this, a reliable diagnostic method of assessing cervical range of motion (ROM) is needed. The aim of the present study was to evaluate neck function with a 3D kinematic method compared with clinical evaluation in whiplash injury. Seventy consecutive patients (M/F = 18/52) with a history of whiplash injury (WH) and 46 healthy volunteers (M/F = 24/22), mean age, respectively 33 ± 9 and 28 ± 6 years (mean ± SD) entered the study. Patients suffered from neck pain and/or unilateral headache. A computerized kinematic analysis of the ROM (Elite system) using passive markers and two infrared TV cameras was used. Clinical evaluation of active ROM was also performed both in patients and in 61 controls (M/F = 23/38; mean age 47 ± 18 years). Thirty out of 70 patients were tested at the time of their first consultation (T0) and 6 months later (T6), and 12 were also followed up after a year (T12). All neck movements, except extension, were significantly reduced in WH subjects compared with controls, in particular lateral bending. Comparing ROM at T0, T6 and T12, no significant differences were found. A global index of motion (GIM), obtained by calculating the sum of ROM in absolute value for all the movements acquired, was significantly reduced in WH compared with control subjects. The interobserver reliability of the clinical evaluation was globally acceptable. On the basis of the clinical evaluation, a significantly reduced ROM was found in all movements in WH subjects compared with an age-matched population. Computing the number of impaired cervical movements (ICMs), a significantly higher number was observed in WH patients than in controls, showing a decreasing trend at T6 and T12, with a significant improvement at T6 vs. T0. The computerized study of neck ROM may constitute a useful tool in the evaluation of WH at baseline and follow-up.
Low Socio-Economic Status is Associated with Increased Risk of Frequent Headache: A Prospective Study of 22718 Adults in Norway
Authors: Hagen K , Vatten L , Stovner LJ , Zwart J-A , Krokstad S , Bovim G
Published: March 2003

Prevalence studies exploring the relation between socio-economic status (SES) and headache have shown conflicting results. This is the first prospective study analysing the relation between SES and risk of headache. A total of 22 685 adults not likely to suffer from headache were classified by SES at baseline in 1984-1986, and responded to a headache questionnaire in a follow-up 11 years later (1995-1997). SES at baseline was defined by educational level, occupation, and income. The risk of frequent headache and chronic headache (> 6, and ≥ 15 days/month, respectively) at follow-up was estimated in relation to SES. When defining SES by educational level or type of occupation, low status was associated with increased risk of frequent and chronic headache at follow-up. The risk of frequent and chronic headache decreased with increasing individual income, but only among men. We conclude that individuals with low SES had higher risk of frequent and chronic headache than people with high SES.
Spontaneous Carotid Artery Dissection with Cluster-Like Headache
Authors: Mainardi F , Maggioni F , Dainese F , Amistà P , Zanchin G
Published: March 2003

A case of carotid artery dissection in a 41-year-old-woman is described whose main symptom was cluster-like pain. The case is interesting for its atypical presentation with only two other like cases in the literature, and the site of dissection, localized in the intrapetrous curvature of the carotid artery. The case highlights the need for active co-operation between clinician and neuroradiologist during neuroimaging assessment which must be focused on the clinical evaluation of the individual patient so as to avoid error, particularly in atypical cases.