bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and Significance of Muscle Tenderness During Common Migraine Attacks
Authors: Tfelt‐Hansen P. , Lous I. , Olesen J.
Published: August 2005

SYNOPSIS

To analyse from which extracranial tissues the pain of common migraine arises, 50 patients with typical common migraine were studied during the attack. Systematic recording of pain in 18 regions of the head and neck was followed by systematic palpation of 26 cranial and neck muscles and tendon insertions. All 50 patients were tender, and tenderness corresponded to pain in all but 2 cases. The most frequent sites of tenderness were: sternocleidomastoid, anterior temporal, neck and shoulder muscles, the coronoid process and occipital insertions. Referred pain was found in 73% of patients. Major pathways were sternocleidomastoid to temporofrontal area or occiput, occiput to vertex or temporofrontal area, neck to vertex or brow. The most tender spots were infiltrated with lidocaine 1.5% or saline double blindly. Results were judged clinically and by visual analog scales. 2648 patients were symptom free after 70 minutes which is significantly better than with medical treatment (p<0.01). There was no difference between lidocaine and saline. The study demonstrates that pericranial muscles and tendon insertions are important for common migraine pain.
Complement Studies in Migraine
Authors: Behan Wilhelmina M.H. , Behan P.O. , Durward W.F.
Published: August 2005

SYNOPSIS

The cause of migraine is unknown but there is circumstantial evidence to suggest that immune mechanisms may be involved in its pathogenesis: several workers have noted an increased incidence of allergy in patients with the disease and the migraine which accompanies the ingestion of specific foods has also been explained on an allergic basis. In a recently reported study investigators detected evidence of activation of the serum complement system during migraine headache, with significant reductions in complement factors C4 and C5, and the appearance of C3 breakdown products.

We therefore studied 40 patients, who included 10 subjects in the acute and quiescent phase of the disease. We measured complement components CIq, C4, C3, C7 and Factor B, together with the conversion products of C3 and Factor B. CH 50 units were also estimated and anti complementary activity was assayed. No abnormalities were detected in any of the patients either in an attack or during a remission. Thus, our results do not confirm that complement activation plays a role in migraine headache.
Recurrent Painless Oculomotor Palsy in Children. A Variant of Ophthalmopegic Migraine?
Authors: Durkan Gerald P. , Troost B. Todd , Slamovits Thomas L. , Spoor Thomas C. , Kennerdell John S.
Published: August 2005

SYNOPSIS

We report two children with isolated recurrent painless oculomotor palsy in whom neurodiagnostic investigations were normal. The tests included Edrophonium hydrochloride (Tensilon) testing and arteriography in one child. Single attacks were observed from onset to resolution in both children. A diagnosis of painless ophthalmoplegic migraine was suspected. Because permanent deficits in ocular motility are apt to occur following repeated attacks of ophthalmoplegic migraine, one child was placed on prophylactic therapy with propranalol. She later developed periodic headache with nausea despite treatment.
Migraine and Tension Headache: Is There a Physiological Difference?
Authors: Anderson Cathy D. , Franks Ronald D.
Published: August 2005

SYNOPSIS

The purpose of this study was to conduct a controlled comparison of tension and migraine headache under several experimental conditions.

Ten subjects from each of the following diagnostic groups ‐ tension headache, migraine headache, and healthy controls ‐ were observed under conditions of unstructured relaxation, mild stress, and recovery from stress. Forearm and forehead muscle potential, peripheral temperature, electrodermal response, heart rate, and systolic and diastolic blood pressure were monitored during these sessions. In addition, ratings of pain were obtained, and booklets II and III of the Edwards Personality Inventory were completed by each subject. The hypotheses that tension headache is associated with increased frontalis muscle tension and that migraine headache is associated with increased vasomotor activity were not supported with respect to resting levels, response to physical or psychological stress, or in relationship to pain. Personality differences between the three groups were observed. Migraine subjects appeared to be more perfectionistic and success‐oriented than the other groups: and tension headache subjects, more anxious and insecure. It was suggested that although personality differences indicate the existence of two distinct disorders, physiological variables that were believed to be basic to the pathophysiology of these headaches (e.g. frontalis EMG in tension headache) do not distinguish these two types of headache.
Use of a Computerized Data Base in a Headache Clinic
Authors: Bana D.S. , Leviton A. , Slack W.V. , Geer D.E. , Graham J.R.
Published: August 2005

SYNOPSIS

We have designed and are using an interactive computer‐based headache interview in which patients sit in front of a terminal and answer questions posed by the computer. Data entered are summarized and printed for use by the patient's physician. Preliminary data obtained by the computer interview can be used to generate and test hypotheses. We compared patient‐entered data to physicians' diagnoses for 26 patients with the diagnosis of common migraine and 20 with the diagnosis of muscle contraction headache. Contrary to common beliefs, we found that almost equal numbers in each group acknowledged (1) visual changes before some headaches, (2) headaches precipitated by alcohol, and (3) headaches that coincided with change in the weather. Furthermore, patients seemed more likely to acknowledge more than one kind of headache to the computer than to the physician.
Bilateral Cephalic Blood Volume Pulse Recordings in a Migraineur and a Non‐migraineur
Authors: McCaffrey Robert J. , Isaac Walter
Published: August 2005

SYNOPSIS

Bilateral blood volume pulse response recordings from the fronto‐temporal artery were obtained from a migraineur during a headache state, in a headache free state, and for several days following one headache in order to assess for general vasomotor disregulation. Recordings were also obtained at various times prior to the onset of several independent headaches. The results indicated marked variability for both within session recordings and between session recordings for the migraineur. The recordings from the non‐migraineur, who was matched to the migraineur on several relevant factors, indicated greater consistency of the blood volume pulse both within and between sessions than was observed with the migraineur. The findings lend support to previous research which indicates that the vasomotor response system of migraineurs may be in a chronic state of disregulation relative to the vasomotor response system of non‐migraineurs.
Perception of Stimulus Intensity by Migraine and Non‐migraine Subjects
Authors: Klein Sandra H.
Published: August 2005

SYNOPSIS

Migraineurs and non‐migraineurs performed a weight judgment task designed to measure stimulus intensity modulation style. The study revealed that migraineurs were more likely than non‐migraineurs to increase their estimate of a weight's heaviness following stimulation with a similar weight. This tendency to increase the perceived intensity of stimuli may be one factor underlying the reported vaso constriction of migraineurs to low or moderate intensity stimuli that elicit vaso dilation in non‐migraineurs. Questionnaire data is also described showing that migraineurs have a generalized preference for activities involving less intense levels of stimulation than those preferred by non‐migraineurs. Implications of these findings for understanding the complex etiology of migraine are discussed.
Biofeedback, Brief Psychotherapy and Tension Headache
Authors: Bell Noa Wieselberg , Abramowitz Stephen I. , Folkins Carlyle H. , Spensley James , Hutchinson Grant L.
Published: August 2005

SYNOPSIS

The present study was performed to compare the effectiveness of broadly‐based biofeedback and brief eclectic psychotherapy in alleviating tension headache. Twenty‐four patients diagnosed as suffering from this disorder were randomly assigned to one of four conditions: biofeedback, brief psychotherapy, biofeedback plus brief psychotherapy and waiting‐list control. Results indicated the equivalent effectiveness of the three active treatments in ameliorating various behavioral and psychophysiological aspects of tension headache. Contrary to expectation, broad‐gauged biofeedback produced more psychological gains than brief eclectic psychotherapy, The behavioral and psychophysiological findings are discussed in terms of a shared symptom‐removal focus, whereas the unexpected psychological findings are considered in light of headache patients' characteristic resistance to the psychological explanations of their illness afforded by psychotherapy.
Physiological Self‐control and the Biofeedback Treatment of Headache
Authors: Haber Joel D. , Thompson J. Kevin , Raczynski James M. , Sikora Thomas L.
Published: August 2005

SYNOPSIS

The present paper reviews the utilization of self‐management procedures (self‐control, discrimination, and self‐maintenance) in the biofeedback treatment of headache. A wide variety of methodological shortcomings were evident. Few studies either included adequate self‐control designs or demonstrated that subjects acquired self‐control of the targeted response. Discrimination training was reported in only one study. Self‐maintenance procedures were widely used, but were not based on the prior acquisition of self‐control by subjects. Suggestions for the assessment and training of self‐management strategies are presented. Future research should report the relationship between self‐control, discrimination, and self‐maintenance in regard to treatment outcome. It is concluded that a determination of the efficacy of biofeedback for headache must await further clarification of these issues.
Naloxone Effectiveness on Spontaneous and Induced Perceptive Disorders in Migraine
Authors: Sicuteri Federigo , Boccuni Maria , Fanciullacci Marcello , Gatto Gaetano
Published: August 2005

SYNOPSIS

Scotoma is the most frequent perceptive disturbance in migraine. Other visual, auditory, smelling and own body image distortions frequently occur, but they are seldom reported by patients unless specifically requested. The basic mechanism of these perceptive disorders as well as of pain is still unknown. Pentazocine, an agonist of s opiate receptors (mainly subserving the nervous structures involved in perceptive disturbances) provokes visual and own body image distortions in most migraine patients. In addition, naloxone (a specific opiate antagonist) prevents or reverts the perceptive disorders induced by pentazocine. Naloxone injected at the onset of the spontaneous scotoma interrupts the visual phenomena in most of classic migraineurs. When scotomata is interrupted by naloxone, even the headache intensity is usually reduced and the pain duration is shortened. In common migraine, naloxone administered after the onset of headache is ineffective on pain and extra‐pain phenomena.
Validity of the Headache Diary for Children
Authors: Richardson Gwendolen M. , McGrath Patrick J. , Cunningham S. June , Humphreys Peter
Published: August 2005

SYNOPSIS

This study was designed to measure the validity of two variations of a self‐report pain intensity scale. Sixteen children aged 9‐17, suffering from migraine headaches and one parent of each child recorded headache intensity daily at fixed intervals for four weeks in headache diaries. Half of the children used a pain intensity scale with behavioral descriptors of pain severity accompanied by numbers zero to five; the remainder used a scale that was identical except for the addition of subjective pain descriptors. Validity was determined by assessing the degree of inter‐rater concordance between the child's rating of intensity of head pain and the parent's independent rating of the same phenomenon. Concordance values, determined by weighted kappa, ranged from slight to almost perfect and all but one were significant, r<.05, providing evidence for the validity of this scale. Percentage agreement and weighted percentage agreement were also calculated and indicated high levels of concordance. Inclusion of subjective descriptors did not significantly affect ratings.
Atenolol for Migraine Prophylaxis
Authors: Forssman Bengt , Lindblad Carl Johan , Zbomikova Vera
Published: August 2005

SYNOPSIS

The preventive effect of atenolol on migraine attacks was compared to placebo in a double‐blind cross‐over study. 24 patients with classic and/or common migraine entered the 36‐week study; four subsequently dropped out. The effect of atenolol was significantly better than that of placebo. The number of headache attacks was reduced in 15 of 20 patients (r<0.05) and the values for integrated headache diminished in 19 of 20 patients (r<0.001).

Intake of ergotamine products was significantly lower in all patients using such drugs, while the consumption of common analgesics did not differ between the trial periods. No serious side effects were noted.
Clinical Value of a Dopaminergic Agonist Administration in Migraine Patients
Authors: Geraud G. , Guell A. , Courtade M. , Dupui Ph. , Bes A.
Published: August 2005

SYNOPSIS

The migraine subject exhibits a dopaminergic vascular hypersensitivity on the brain level (CBF increase) as well as on the peripheral level (BP decrease). A dopaminergic agonist, piribedil, was administered by intravenous infusion (0,1 mg/kg over 30 minutes) to 150 patients known to suffer from migraine or other kinds of headache. 94% of migraine patients developed nausea or vomiting and 69% a decrease of BP, severe enough to discontinue the infusion. In non migraine headaches, the piribedil infusion had no effects in 61% of patients and provoked a decrease of BP in 16% of cases only. The piribedil test could be used to distinguish genuine migraine from other cephalalgia in patients prone to headache.
Weightlifters Headache
Authors: Paulson George W.
Published: August 2005

SYNOPSIS

Five young men developed sudden severe headache and neck pain while weightlifting. They had no evidence of pheochromocytoma, emotional turmoil, neurological or radiological abnormality. Pull or tear of ligaments is suggested as one possible cause, with rest and cautious neglect as a logical therapeutic approach.
The Involvement of Trigeminal Substance P Neurons in Cluster Headache. An Hypothesis
Authors: Hardebo Jan Erik
Published: August 2005

SYNOPSIS

Substance P (SP) neurons, with bipolar axons from the cell body, in sensory ganglia, exhibit unique properties in that impulses may travel either orthodromically or antidromically in the various ramifications of the axons, and that the transmitter may be released both in the central and peripheral ends of the neuron. Thus, these nerves are not only sensory, carrying nociceptive impulses from the periphery, but also motor with ability to dilate blood vessels, constrict smooth muscle cells and cause protein extravasation, glandular secretion, release from mast cells and excitation of autonomic ganglion cells. Within the individual neuron several local reflex arches ‐ axon reflexes ‐ are established in this way.

An hypothesis is forwarded about the pathophysiology of cluster headache, against the background of recent morphological and functional evidence for SP neurons in the ipsilateral trigeminal nerve and its connections to various cranial structures including the sphenopalatine (pterygopalatine) ganglion and internal carotid perivascular nerve plexus. Activation of SP fibers in the ophthalmic and maxillary divisions may give rise to practically all symptoms of an attack of cluster headache. This provides a rational explanation for the beneficial effect on both pain and vegetative symptoms achieved by blockade of the Gasserian or sphenopalatine ganglia in this disease. A temporary arrest of central inhibitory serotonergic impulses presynaptically on the SP neurons in the caudal trigeminal nucleus is, with our present knowledge, a likely explanation for such an activation, even if it may not be the only factor. A comparison is made with the present opinion on activation of parasympathetic and blockade of sympathetic nerves to explain the various symptoms of a cluster attack.
The Meningeal Representation in the Trigeminal Ganglion An Experimental Study in the Cat
Authors: Steiger Hans Jakob , Meakin Charles J.
Published: August 2005

SYNOPSIS

The somatotopic representation of the cranial dura mater and the major cerebral arteries in the semilunar ganglion of the cat has been studied experimentally. Neuroanatomical tracer substance was applied to various dural sites as well as to the internal carotid and middle cerebral artery and labeled cells were subsequently identified in the trigeminal ganglion. Cells in the first trigeminal division were found to innervate the medial aspect of the anterior cranial fossa, the tentorium cerebelli and the intracranial carotid and the middle cerebral artery. Neurons associated with the orbital roof were located predominantly in the dorsal and intermediate layers of the second division while the dura of the middle fossa was represented mainly in the dorsal strata of the third division. Labeled cells were smaller than the average ganglion cell.
Metabolic Abnormality in Cluster Headache
Authors: de Belleroche J. , Rose F. Clifford , Das I. , Cook G.E.
Published: August 2005

SYNOPSIS

Cluster headache has a number of distinct features in the periodicity and frequency of headache and associated phenomena such as, ipsilateral rhinorrhoea and lacrimation. In some cases, however, it may be difficult to confirm diagnosis and apply the appropriate treatment. Lithium is beneficial in cluster headache but would exacerbate migraine. Hence there is a need for diagnostic methods for migraine or migraine subtypes and cluster headache. We have found that one readily measured parameter, erythrocyte choline, is significantly depressed in cluster headache patients both during and between attacks and this may therefore offer an aid to diagnosis. Further analysis of the pathways giving rise to this abnormality may give insight to the aetiology of cluster headache, as discussed below.
Clinical and Hemodynamic Effects During Treatment of Vascular Headaches with Verapamil
Authors: Meyer John Stirling , Dowell Richard , Mathew Ninan , Hardenberg Jeffrey
Published: August 2005

SYNOPSIS

An open trial of long‐term prophylactic therapy with Verapamil (240 mg/day) was completed in 44 patients with different types of chronic headache including: classic migraine (N = 15), common migraine (N = 11 ), cluster headache (N = 14), and muscle contraction headache (N = 4). Results were compared with similar trials utilizing Nifedipine and Nimodipine. Cerebral blood flow was measured before and after treatment. All three drugs block Ca 2+ entry into vascular smooth muscle and were effective in prophylactic treatment of migraine and cluster headaches but not in muscle contraction headaches. Treatment with Verapamil for 2‐3 weeks abolished or attenuated migraine prodromes, decreased headache frequency in cluster and classic migraine, but were less effective in common migraine. Cerebrovascular resistance was significantly reduced by Verapamil, confirming its vasodilator effects. Side effects were less common with Verapamil than with Nifedipine and included postural hypotension, constipation and skin rash. Decreased efficacy after long‐term treatment with Verapamil responded to dose increases. Experience in this laboratory with Nimodipine, Verapamil and Nifedipine indicates that all are effective in prophylactic treatment of vascular headache in that order of preference.
Psychiatric Consultation in a Headache Unit
Authors: Khouri‐Haddad S. Eker
Published: August 2005

SYNOPSIS

Two hundred twenty nine psychiatric consultations of patients with headache were reviewed. A search was made for the presence of stress or conflict, preceding and maintaining the headache. The major finding was the patients' inability to cope with stress or conflict threatening their self‐esteem. Anxiety level was raised when issues of inadequacy, insecurity and helplessness surfaced. In predisposed individuals, defenses against or repressed responses to loss of self‐esteem were manifested by anger, anxiety, depression and headache.
Headache of Nasal Spur Origin: an Easily Diagnosed and Surgically Correctable Cause of Facial Pain
Authors: Gerbe Ronald W. , Fry Terry L. , Fischer Newton D.
Published: August 2005

SYNOPSIS

Intranasal spur pathology is presented as an easily diagnosed and readily correctable cause of facial pain within the confines of proper diagnostic evaluation and thorough elimination of other more serious causes of facial pain and headache.
Some Benefits of High Frontalis Tension in Tension Headache Sufferers
Authors: Moran Carmen C. , Cleary Patrick J.
Published: August 2005

SYNOPSIS

Although the relationship between EMG levels and tension headache remains unclear, elevated frontalis EMG levels in tension headache sufferers are usually assumed to be part of the debilitating experience of headache. Elevated tension levels are seldom considered in an activation‐type framework. Consequently, headache patients are encouraged to relax in almost all situations. Two experiments were performed to examine whether tension headache sufferers showed any benefits from elevated tension levels during periods demanding a sustained level of cognitive efficiency. Headache subjects were compared with non‐headache subjects during discrimination and reaction time task performance across three levels of frontalis tension. Both groups' performance improved under increasing tension conditions relative to the low tension condition. In both experiments improvement was noted as a reduction in the most extreme scores, reflecting possible “mental blocks“. In Experiment 2 median reactions times were also affected. In Experiment I the variation in reaction time scores across the tension levels was greater in the headache group than the non‐headache group. Even when the optimal level of tension varied across task difficulty levels, low frontalis tension was never the optimal condition. It was concluded that tension headache prone individuals being treated by relaxation or biofeedback techniques need to be informed about the increased tendency towards slower responding under conditions of frontalis relaxation.
Decreased Thromboxane Production in Migraine Patients During Headache‐Free Period
Authors: Keinänen‐Kiukaanniemi S. , Kääpä P. , Saukkonen A.‐L. , Viinikka L. , Ylikorkala O.
Published: August 2005

SYNOPSIS

To study the role of the proaggregatory, vasoconstrictory thromboxane A 2 (TxA 2 ) in migraine, the plasma levels of Thromboxane B 2 (TxB 2 ), the stabile metabolite of TxA 2 , were measured from 14 adults and 8 children with migraine during the attack‐free interval. In addition, the platelets' capacity to generate TxB 2 during spontaneous clotting was studied. The plasma TxB 2 concentrations were lowered in the adult migraine patients. Also the platelets' capacity to produce TxB 2 was reduced in migraine children and in adults with classic migraine. The decreased platelet TxA 2 synthesis in the attack‐free period of migraine patients may reflect a deficient pool of platelet arachidonic acid, the precursor of TxA 2 , perhaps as a result of increased consumption during migraine attacks.
Cytosolic Ionized Calcium Homeostasis in Platelets: An Abnormal Sensitivity to PAF‐Activation in Migraine
Authors: Joseph Rajiv , Welch K.M.A. , Grunfeld S. , Oster S.B. , D'Andrea G.
Published: August 2005

SYNOPSIS

Platelet cytosolic ionized calcium ([Cai2+]) was measured in aequorin‐loaded gel‐filtered platelets in the basel state and following stimulation with thrombin, collagen and platelet‐activating factor (PAF). 25 healthy controls, 20 interval migraine subjects and 26 acute ischemic stroke patients were studied. Compared to controls, the basal [Cai2+] was increased in migraineurs (p = 0.05) and after stimulation with PAF (p<0.03); thrombin‐ and collagen‐induced changes were similar to control. Compared to controls, basal [Cai2+] was increased in stroke patients (p<0.002); the increase in [Cai2+] after stimulation with thrombin (p<0.05), collagen (p<0.02) and PAF (p< 0.05) was also greater in stroke. Compared to migraineurs, [Cai2+] was further increased in stroke after stimulation with thrombin (p<0.002) and collagen (p<0.02); PAF‐induced changes were similar in stroke and migraine.

The greater concentration of basal cytosolic ionized Ca2+ in platelets of migraine sufferers was associated with a normal response to activation by thrombin and collagen suggesting the presence of platelet hyporesponsiveness to activation by these agents in migraine sufferers. Unlike ischemic stroke patients where there is a nonspecific increase in response to platelet stimulating agents, the platelets of migraine sufferers appear to be specifically sensitive to activation by PAF suggesting that altered sensitivity to this phospholipid may be a characteristic unique to migraine sufferers.
Headache Patients As They See Themselves
Authors: Bane Dhirendra S. , Graham John R. , Spierings Egilius L.H.
Published: August 2005

SYNOPSIS

The purpose of this study is to demonstrate a simple technique for gaining information about the headache patient as a person. Eighty four headache patients while admitted to the hospital as in‐patients, over the past 8 years, were asked simply “to write about themselves”. The autobiographies which they eagerly supplied were amazingly frank and helpful in revealing details of their lives and feelings of a sort considered relevant to the management of the patient with headache.
Differential Changes in Receptor‐Mediated Transduction in Migraine and Cluster Headache: Studies on Polymorphonuclear Leucocytes
Authors: de Belleroche Jackie , Morris Richard , Davies P. T. G. , Rose F. Clifford
Published: August 2005

SYNOPSIS

The distinctive clinical features of these conditions are borne out pharmacologically where drugs used with beneficial effects in one condition may exacerbate the other. This led us to investigate whether separate interacting/antagonistic receptor‐mediated transduction systems may be affected in these conditions. Previous work in our laboratory indicated that the prostacyclin stimulation of adenylate cyclase in lymphocytes was significantly reduced in cluster headache but unaffected in migraine. Hence in this study, we investigated the polyphosphoinositide system which upon receptor activation gives rise to two second messengers, inositol trisphosphate and diacylglycerol. The chemotactic factor stimulation of inositol phosphate production in polymorphonuclear leucocytes (PMNs) was used as the assay system. The maximum response was obtained at approximately 0.1μM chemotactic factor (EC50=13nM for control subjects). Female migraineurs (9 non‐smokers) were compared with a matched group of controls and found to have a significantly reduced PMN response to chemotactic factor stimulation (42% of control at 0.1 μM) while male cluster headache patients (7 smokers) showed a response slightly greater than a matched group of controls (male smokers). Interestingly, cluster headache patients undergoing lithium treatment showed a significantly reduced response (39% of the control response at 0.1 μM chemotactic factor). This indicates that lithium may have its beneficial effect in cluster headache by suppressing an overactive polyphosphoinositide system while being of little benefit in migraine where a substantial depression is already evident. Appropriate targetting of drugs to these transduction systems may offer a useful basis for treatment.
Hemiplegic Migraine in Pregnancy
Authors: Mandel Steven
Published: August 2005

SYNOPSIS

Hemiplegic migraine during pregnancy is a ram occurrence, and recovery is usually spontaneous and complete. The presence of motor and sensory deficits with migraine should prompt the obstetrician to investigate for more serious neurological conditions.

The literature contains few case reports of hemiplegic migraine during pregnancy. This paper discusses two case histories.
Impaired Cardiovascular Reflexes in Cluster Headache and Migraine Patients: Evidence for an Autonomic Dysfunction
Authors: Boiardi A. , Munari L. , Milanesi I. , Paggetta C. , Lamperti E. , Bussone G.
Published: August 2005

SYNOPSIS

To investigate autonomic nervous system involvement in cluster headache (CH) and migraine, we compared the cardiovascular reflex responses of common migraine and CH subjects to a group of controls. A battery of 5 well‐codified autonomic tests was applied: (1) deep breathing test (DB); (2) lying to standing test (LS); (3) Valsalva manoeuvre (VAL); (4) postural hypotension test (PH); (5) blood pressure response to sustained handgrip (SHG). Our data confirm an autonomic dysfunction in CH, mainly affecting the parasympathetic system. Evidence for an impairment of sympathetic cardiovascular reflex regulation was obtained in the common migraine group.
Are There Objective Criteria to Follow Up Migrainous Patients? A Prospective Study with Thermography and Evoked Potentials
Authors: Volta G. Dalla , Anzola G. P.
Published: August 2005

SYNOPSIS

Eight patients with common migraine (CM), 9 with classic migraine (CLM), 5 with cluster headache (CH), and 10 with muscle contraction headache (MCH) were evaluated, before and after treatment, using electronic thermography of face (T.T.) and visual evoked potentials (V.E.R).

In the 10 MCH's the T.T. and V.E.P. findings were comparable to those obtained from ten control subjects.

In the three remaining groups we obtained the following results: Before therapy eighteen out of the 22 vascular headache patients showed a positive “cold patch” in the external carotid territory, ipsilateral to the prevailing side of pain. After six months on therapy the “cold patch” had disappeared or was attenuated in all the patients, who concomitantly had clinical improvement.

Ten out of the 22 patients (all CH's, 5 out of 9 CLM, no CM) presented in the baseline condition an asymmetry in V.E.P.s (hemifield stimulation). After six months the asymmetry persisted in only 4 patients.

The evidence supports a valid temporal relationship between the clinical improvement and the modification in T.T. and V.E.P.s findings in CLM and CH. In CM there is a relationship between clinical course and T.T. but not V.E.P.s.
Idiopathic Headaches: A Neuropsychological and Computerized Electromyographic Study
Authors: Formisano R. , Buzzi M. G. , Cerbo R. , Frascarelli M. , Meco G. , Sabatini U. , Rocchi L. , Agnoli A.
Published: August 2005

SYNOPSIS

Considerable disagreement is found in the literature regarding the correlations between the degree of the electromyographically recorded tension of the head and cervical muscles, and muscle contraction headache.

31 patients were admitted to the study and divided into 3 groups according to the diagnostic criteria of Ad Hoc Committee: vascular headache, muscle tension and mixed headache, in addition to 5 control subjects. The EMG recording was carried out with superficial electrodes on neck muscles during rest conditions (base EMG), under stress conditions (stress EMG), and finally during isometric contraction against resistance (max EMG).

The exclusion from the study of patients with clinical characteristics definable as “psychogenic” headaches made it possible to obtain a homogeneous sample of patients with the diagnosis of muscle tension headache.

Higher values of muscle tension in the group of patients suffering from muscle tension headache as compared to other groups of patients and to control subjects were found.
Childhood Muscle Contraction Headache: Current Issues in Assessment and Treatment
Authors: Labbé Elise E.
Published: August 2005

SYNOPSIS

Most of the psychological and medical literature on childhood headache focuses on migraine headache. Very little research exists on the assessment and treatment of muscle‐contraction (MCH) in children. The present paper reviews current ideas on what constitutes a MCH in children, pathophysiology, prevalence, and assessment and treatment approaches. The medical and psychological literature indicates childhood MCH is similar to adult MCH. MCH is believed to be caused by psychological or stress‐related factors; however, only a few studies have addressed this issue with children. Questions remain as to what psychological factors to assess, and the best approach with children. Difficulties exist in obtaining reliable accounts of stressful events as well as headache symptoms. Pain diaries or questionnaires completed during the head pain may prove useful. Several studies have evaluated the use of EMG biofeedback and/or relaxation training with children MCH sufferers. Results are encouraging but methodological shortcomings prohibit firm conclusions. It is concluded that further research with childhood MCH is warranted in order to obtain a more complete medical and psychological understanding. Furthermore, this information is useful in differential diagnosis and for effective intervention in a chronic pain condition.
Canine Hypophysectomy Using a Ventral Paramedian Approach
Authors: Axlund Todd W. , Behrend Ellen N. , Sorjonen Don C. , Simpson Stephen T. , Kemppainen Robert J.
Published: August 2005

Objective—To evaluate the degree of pituitary exposure, completeness of hypophysectomy, and perioperative morbidity associated with an alternative paramedian surgical approach and excisional technique for the canine pituitary gland.

Study Design—Experimental imaging, surgical, and endocrinologic study.

Animal Population—Nine healthy, purpose‐bred Beagle dogs.

Methods—Surgical landmarks for the pituitary were determined by computed tomography (CT), and then using a ventral paramedian approach medial to the rami of the mandible, the pituitary was exposed and removed en bloc by manipulation and ultrasonic aspiration. Efficacy of the procedure was evaluated using endocrinologic and pathologic observation.

Results—CT images allowed the precise location of surgical landmarks for hypophysectomy. Statistically significant decreases in secretion of all measured pituitary hormones except adrenocorticotropic hormone (ACTH) occurred after hypophysectomy. Despite the absence of gross evidence of residual pituitary tissue, immunohistochemical staining revealed residual pituitary cells in the sella turcica of most dogs.

Conclusion—CT imaging and a paramedian approach facilitated surgical access to the pituitary gland by a transoral technique; however, use of an ultrasonic aspirator removed all visible pituitary glands but left cellular remnants capable of ACTH secretion in the sella turcica.

Clinical Relevance—Although this technique did not result in complete hypophysectomy, clinical use in dogs with pituitary‐dependent hyperadrenocorticism is warranted because the goal is not complete hypophysectomy but removal of a pituitary tumor.
Early Detection and Treatment of Screw Loosening in Triple Pelvic Osteotomy
Authors: Bogoni Paolo , Rovesti Gian Luca
Published: August 2005

Objective—To detect early screw loosening in triple pelvic osteotomy (TPO) and to evaluate the efficacy of retightening using fluoroscopic guidance and minimally invasive surgery to maintain acetabular alignment and achieve bone healing.

Study Design—Prospective clinical study.

Sample Population—Sixteen dogs that had TPO.

Methods—Dogs (16) had TPO (21) by using pre‐angled plates secured with 3.5 and 4.0 mm screws, with ischiatic or iliac cerclage, for osteosynthesis. In all but 1 TPO at least 1 screw was inserted into the sacral body (43 screws). The mean radiographic screw length inserted in the sacrum was 10.2 mm, and the mean percent sacral engagement was 22%. Dogs were examined clinically and radiographically immediately postoperatively, and at 10, 30, 60, and 90 days to evaluate screw position. Loose screws were retightened through stab incisions using fluoroscopy to locate the screw.

Results—TPO was performed without operative complications. At 10 days, 12 TPOs (57%; 11 dogs) had loose screws primarily located in the cranial aspect of the plate. This represented 20% (25) of the inserted screws. In 5 dogs, screw loosening resulted in medial rotation of the acetabular segment. All loose screws were retightened; 3 screws loosened again in 2 dogs and were detected at 60 days. However, the osteotomies healed with the planned acetabular rotation without further intervention. Screw tightening corrected the acetabular segment displacement. Screws correctly seated at 10 days did not subsequently loosen. Clinical and radiographic outcome was judged excellent in all dogs.

Conclusion—Loose screws in TPO plates can be identified by 10 days postoperatively and retightened using fluoroscopic guidance to achieve acetabular realignment and healing without need for further surgery.

Clinical Relevance—Postoperative radiographic evaluation of screw position at 10 days after TPO is recommended to detect loose screws. Retightening loose screws should be considered as an alternative to TPO revision or confinement, especially in immature dogs.
Proximal Tibial Intraarticular Ostectomy for Treatment of Canine Cranial Cruciate Ligament Injury
Authors: Jerram Richard M. , Walker Alex M. , Warman Chris G. A.
Published: August 2005

Objective—To report a technique for surgical alteration of the slope of the tibial plateau by a proximal tibial intraarticular ostectomy (PTIO) after injury to the canine cranial cruciate ligament (CCL) and to determine the outcome.

Study Design—Prospective clinical study.

Animals—Dogs (n=52) with CCL injury in 60 stifle joints.

Methods—CCL injury was treated by lateral stifle arthrotomy, removal of CCL remnants, and appropriate meniscal surgery. PTIO was performed to remove a wedge of bone from the proximal aspect of the tibia. The ostectomy site was reduced and stabilized using a bone plate and screws applied to the medial surface of the tibia as well as a craniocaudal positional screw. Dogs were evaluated at 6 weeks, 6, and 12 months by complication assessment, lameness scores, stifle range of motion (ROM), thigh circumference, radiographic assessment, degenerative joint disease (DJD) scores, and surgeon and owner evaluation of function.

Results—Lameness scores improved by 6 and 12 months in all but 1 dog. Thigh circumference and DJD were increased at 6 and 12 months. Complications occurred in 20% of dogs with all but 1 occurring perioperatively or within 6 weeks; most common were injury to the long digital extensor tendon (4 dogs) and plate failure (3); 2 other dogs required surgery to treat complications. Most owners (98%) reported that lameness had improved by 12 months; 90% were extremely or very satisfied with the procedure and 90% would have the same procedure performed on another dog.

Conclusion—PTIO to level the tibial plateau provided a satisfactory clinical outcome in dogs >20 kg with CCL injury and the complication rate was similar to tibial plateau levelling osteotomy (TPLO). Stifle osteoarthritis continued to progress radiographically.

Clinical Relevance—PTIO represents an alternative to TPLO that does not require specialized surgical equipment.
Modification of the Superficial Cervical Axial Pattern Skin Flap for Oral Reconstruction
Authors: Dundas James M. , Fowler J. David , Shmon Cindy L. , Clapson J. Brian
Published: August 2005

Objective—To describe an extended pedicle flap based on the superficial cervical artery (SCA) for closure of oral defects in dogs.

Study Design—Anatomic study; in vivo experimental study.

Animals—Canine cadavers (13) and 3 dogs.

Methods—The prescapular branch of the SCA was cannulated and perfused with a lead oxide gelatin mixture. The area perfused by 1 SCA was examined as was the rostral extent of the flap. Staged implantation was performed to evaluate flap performance in vivo. In stage 1, the flap was prepared for implantation into the oral cavity. In stage 2, the flap was fully developed to include the 1°, 2°, and partial 3° angiosome of 1 SCA pedicle. The flap was transposed by a bridging incision and a parapharyngeal tunnel into the oral cavity. The flap was used to reconstruct a partial‐thickness defect created in the palate.

Results—The territory of the contralateral SCA was captured in all cadavers. The full flap reached the level of the canine teeth in all cadavers. In live dogs, necrosis was not observed after implantation into partial‐thickness defects and dehiscence was minimal. Loss of pliability secondary to de‐epithelialization and staging resulted in a limitation of rostral reach of the flap.

Conclusions—Whereas the flaps did not reach as far rostrally as anticipated, they survived well in the harsh oral environment. The flap may be modified to reconstruct full‐thickness palatal defects.

Clinical Relevance—The extended SCA pattern flap may be adapted for closure of oral defects.
Tolerance of Cutaneous or Mucosal Flaps Placed into a Radiation Therapy Field in Dogs
Authors: Séguin Bernard , Mcdonald Dawn E. , Kent Michael S. , Walsh Peter J. , Théon Alain P.
Published: August 2005

Objective— To determine the clinical outcome and factors affecting cutaneous or mucosal flaps in dogs treated with radiation therapy (RT).

Study Design— Longitudinal clinical study

Animals— Twenty‐six client‐owned dogs

Methods— Dogs entered in the study had a flapping procedure and RT as part of their treatment. The sequence of flapping and RT included: (1) planned preoperative RT, (2) postoperative RT, and (3) flapping as a salvage procedure for management of complications or local tumor recurrence after RT. Flap complications were defined as necrosis, local infection, dehiscence, and ulceration. The risk and severity of flap complication were analyzed independently.

Results— Twenty (77%) dogs had a complication; 6 dogs required an additional flapping procedure; and 4 dogs had an unresolved complication. Flapping procedures performed to correct a complication, or failure of RT, had a significantly greater risk for complication; however, postoperative RT decreased the severity of complication. A dose per fraction of 4 Gy compared with 3 Gy was prognostic for increased severity of complications, whereas the head and neck location was prognostic for decreased severity of complication.

Conclusions— Although morbidity was substantial, cutaneous or mucosal flaps were used successfully in an RT field in 85% of the dogs. Flaps that were part of the planned therapy as opposed to those used to correct a complication or failure of RT had a better clinical outcome.

Clinical Relevance— Cutaneous or mucosal flaps can be part of the treatment of dogs with tumor when adjuvant or neoadjuvant RT is to be used.
Evaluation of 2 Cement Techniques for Augmentation of Stripped 1.5 mm Screw Sites in the Distal Metaphysis of Feline Radii
Authors: Griffon Dominique J. , Stoller Alex , Schaeffer David J. , Seddighi Mohamed R. , Johnson Ann L. , Kurath Peter
Published: August 2005

Objective—To evaluate the effect of 2 cement augmentation techniques on pullout strength of 1.5 mm screws placed in stripped 1.5 mm screw sites in the distal metaphysis of feline radii.

Study Design—Experimental study.

Sample Population—Feline radii (21 pairs).

Methods—Treatment groups (n=4) were allocated according to a Latin square design to 4 sites in each pair of radii. Positive and negative controls were a 1.5 mm screw and a screw of the same diameter in a previously stripped screw hole, respectively. Treatment groups were a 1.5 mm screw implanted in a previously stripped screw hole after injection of polymethylmethacrylate (PMMA) or a bioresorbable calcium phosphate cement (CPC, Norian®skeletal repair system (SRS)). The ultimate pullout strength was compared between groups.

Results—The mean (±SEM) pullout strength of screws augmented with either bone cement was less than that of the positive control group and greater than that of the negative control. Injection of CPC or PMMA before screw implantation increased the pullout strength of the negative control by 86.8±22.9% and 104.1±32.1%, respectively. Holding power of the positive control screws differed from these 2 groups, and was 274.8±39.17% higher than that of the negative control.

Conclusion—Injection of CPC or PMMA increases but does not restore the holding power of stripped 1.5 mm diameter screws.

Clinical Relevance—The use of CPC (Norian®SRS) augmentation of stripped 1.5 mm diameter screws warrants clinical investigation as it combines biomechanical results similar to PMMA with osteoconduction and resorbability.
Localization of Cathepsin K and Tartrate‐Resistant Acid Phosphatase in Synovium and Cranial Cruciate Ligament in Dogs with Cruciate Disease
Authors: Muir Peter , Schamberger Gwenn M. , Manley Paul A. , Hao Zhengling
Published: August 2005

Objective— To localize cathepsin K and tartrate‐resistant acid phosphatase (TRAP) in synovium and cranial cruciate ligament (CCL) of dogs with cruciate disease.

Animals— Dogs (n=15) with cruciate disease and ruptured CCL, and 12 dogs with intact CCL.

Methods— Synovium and CCL were examined histologically and cells containing cathepsin K or TRAP were identified immunohistochemically and histochemically, respectively.

Results— Increased cellular localization of cathepsin K and TRAP was detected in synovium and ruptured CCL in dogs with cruciate disease, when compared with tissues from dogs with intact CCL. Inflammation of synovium with TRAP+ macrophage‐like cells was seen in 73% of dogs with CCL disease, but was not seen in dogs with intact CCL. The presence of cathepsin K and TRAP protein in synovium and CCL tissues was significantly correlated in dogs with CCL rupture.

Conclusion— Inflammation of the epiligament of ruptured CCL with cathepsin K+ and TRAP+ macrophage‐like cells forms part of a similar, more generalized chronic inflammatory change within the periarticular tissues of the stifle of a large proportion of dogs with CCL rupture.

Clinical Relevance— Production of matrix‐degrading enzymes by the synovium may induce progressive pathologic rupture of the CCL. Therefore, these collagenolytic pathways may offer a novel target for medical therapy of joint inflammation in canine patients with cruciate disease.
Laser Vocal Cordectomy Fails to Effectively Reduce Respiratory Noise in Horses with Laryngeal Hemiplegia
Authors: Brown Jennifer A. , Derksen Frederik J. , Stick John A. , Hartmann William M. , Robinson N. Edward
Published: August 2005

Objective—To report the effect of unilateral laser vocal cordectomy on respiratory noise and airway function in horses with experimentally induced laryngeal hemiplegia (LH).

Study Design—Experimental study.

Animals—Six Standardbred horses without upper airway abnormities at rest or during high‐speed treadmill exercise.

Methods—Respiratory sounds and inspiratory trans‐upper airway pressure (PUi) were measured before (baseline) and 14 days after induction of LH by left recurrent laryngeal neurectomy, and again 30, 60, 90, and 120 days after endoscopically assisted laser cordectomy of the left vocal cord. Data were collected with the horses exercising on a treadmill at a speed producing maximum heart rate (HRmax).

Results—In horses exercising at HRmax, induction of LH caused a significant increase in PUi, sound level (SL), and the sound intensity of formant 2 (F2) and 3 (F3). The sound intensity of formant 1 (F1) was unaffected by induction of LH. Laser vocal cordectomy had no effect on SL, or on the sound intensity of F1and F3. At 30, 60, 90, and 120 days after surgery, PUiand the sound intensity of F2were significantly reduced, but these variables remained significantly different from baseline values.

Conclusions—Unilateral laser vocal cordectomy did not effectively improve upper airway noise in horses with LH. The procedure decreased upper airway obstruction to the same degree as bilateral ventriculocordectomy.

Clinical Relevance—Currently, laser vocal cordectomy cannot be recommended for the treatment of upper airway noise in horses with LH.