bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain Induces Decrease of Blood Flow in the Common Carotid Arteries in Cluster Headache Attacks
Authors: Hannerz Jan , Jogestrand Tomas
Published: March 2003

Eighteen cluster headache patients and five controls were studied using ultrasound duplex techniques to measure blood flow in the common carotid arteries after nitroglycerin and placebo administration. Vessel diameter and blood flow tended to be greater before nitroglycerin in patients in the cluster headache period than in patients out of period and controls. Nitroglycerin tended to increase blood flow only in patients not in the cluster period and in controls. There was a significant decrease in common carotid blood flow and increase in vascular resistance related to maximum pain in both nitroglycerin-induced and spontaneous cluster headache attacks. Blood flow did not reach the initial flow values after the attack was over. In one patient a hyperventilation attack only temporarily decreased the pain. We suggest that the decrease in blood flow and increase in vascular resistance may be due to constriction of intracranial arteries by reflex activation of sympathetic efferents, rather than to decrease of arterial CO2 tension.
SUNCT Syndrome: Forehead Sweating Pattern
Authors: Kruszewski Piotr , Zhao Jing-Ming , Shen Jie-Ming , Sjaastad Ottar
Published: March 2003

The forehead sweating function has been assessed in SUNCT syndrome-a short-lasting, unilateral, neuralgifonn headache syndrome with autonomic phenomena on the symptomatic side (conjunctival injection, lacrimation, etc.). In the three patients (of a total of six) who could be studied during paroxysms, increased evaporation was present on the symptomatic side of the forehead compared to the non-symptomatic side during attacks or to the symptomatic side between attacks. Basal sweating was generally within control limits, so long as the attack frequency was not so high as to influence the interictal level. During attacks precipitated by eating chocolate or sour apple (in the case of one of the patients), forehead sweating was also increased on the symptomatic side. The forehead sweating responses to heating and pilocarpine were without any notable or systematic asymmetries. The forehead sweating pattern in SUNCT syndrome may differ from the patterns in unilateral headaches like cluster headache, on the one hand (in which there is generally an asymmetry during heating and pilocarpine tests), and chronic paroxysmal hemicrania (CPH) and cervicogenic headache, on the other (where there is no systematic increase during attacks).
Diclofenac-K (50 and 100 mg) and Placebo in the Acute Treatment of Migraine
Authors: Dahlöf C , Björkman R
Published: March 2003

The aim of the present study was to assess the efficacy and tolerability of single oral doses of 50 mg and 100 mg of diclofenac-K compared to placebo in migraine sufferers during three attacks. The study was conducted in a double-blind, randomized, placebo-controlled, three-period, within-patient comparative trial; 72 migraine patients were treated with diclofenac-K (50 mg or 100 mg) or placebo at six centres (1 in Sweden and 5 in Finland). The primary efficacy end-point was the change in pain intensity assessed on a 100 mm Visual Analogue Scale (VAS) at 120 min after taking the study medication. We found that 50 mg and 100 mg of diclofenac-K reduced the pain intensity significantly better than placebo ( p = 0.003 and p = 0.001, respectively), without difference between the doses; 100 mg diclofenac-K was significantly better than placebo in improving phonophobia, photophobia, working ability and need for rescue medication. Diclofenac-K 50 mg or 100 mg is an effective and well-tolerated acute treatment for migraine headache and its associated symptoms. The higher dose of diclofenac-K was only marginally more effective than the lower dose.
Domperidone Plus Paracetamol in The Treatment of Migraine
Authors: MacGregor E Anne , Wilkinson Marcia , Bancroft K
Published: March 2003

This study was designed to evaluate the safety and efficacy of domperidone in combination with paracetamol in the treatment of migraine. Severity of headache, duration of migraine attack and overall efficacy of treatment were amongst the variables assessed in a randomized, double-blind, three-way cross-over comparison of 1 g paracetamol plus either domperidone 30 mg, domperidone 20 mg or placebo, taken at onset of headache. Forty-six patients attending the City of London Migraine Clinic completed the study. A significant difference was observed in the duration of the migraine attack: a median of 17.5 h with paracetamol alone was reduced to 12.0 h with the addition of domperidone 20 mg, and to 12.0 h with domperidone 30 mg. No significant adverse events were reported. A reduction in pain intensity and nausea was noted but this was not statistically significant. It was concluded that domperidone shortens the duration of a migraine attack and may help reduce headache and associated symptoms.
Comparison of Propranolol LA 80 mg and Propranolol LA 160 mg in Migraine Prophylaxis: A Placebo Controlled Study
Authors: Al-Qassab Hisham K , Findley Leslie J
Published: March 2003

Thirty patients with severe classical and common migraine participated in a double-blind placebo-con-trolled cross-over study of migraine prophylaxis with propranolol LA (long-acting) 80 mg once daily, or propranolol LA 160 mg once daily or placebo. Each treatment was given for two months. There were no significant differences between the three treatment periods in headache frequency, headache severity, nausea frequency or severity. There was a non-significant trend for reduced duration of headache with the two doses of propranolol. The possible reasons for this negative effect are discussed. The safety of propranolol and its lack of serious side effects were demonstrated.
Relief of Cluster-Tic Syndrome by the Combination of Lithium and Carbamazepine
Authors: Pascual Julio , Berciano José
Published: March 2003

This paper presents a further case of cluster-tic syndrome. Cluster headache and trigeminal neuralgia have coexisted in our patient for 18 years. Carbamazepine has selectively relieved the tic douloureux, while lithium has completely controlled the cluster headache. Our case shows again that the simultaneous occurrence of cluster headache and trigeminal neuralgia seems to be more than coincidental.
The Forgotten Lumbar Puncture
Authors: Silberstein Stephen D , Corbett James J
Published: March 2003

Lumbar puncture is crucial in two distinct clinical situations in the diagnosis of the headache patient. The first is the patient who is suspected of having a symptomatic headache; the second is the patient with a chronic intractable or atypical headache disorder. This review discusses the usefulness of the lumbar puncture in the diagnosis of headache secondary to subarachnoid hemorrhage, meningitis, and intracranial hypotension and hypertension. The value of lumbar puncture in the presence of a normal CT/MRI scan is discussed.
Painful Stimulation of the Forehead Increases Photophobia in Migraine Sufferers
Authors: Drummond Peter D , Woodhouse Anne
Published: March 2003

Thresholds for visual and auditory discomfort were investigated in 51 migraine sufferers and 27 controls of similar age and sex distribution who rarely suffered from headache. Tests in migraine sufferers were carried out during the headache-free interval. Discomfort thresholds were measured before and during painful stimulation of the forehead with ice. The visual discomfort threshold was lower in migraine sufferers than in controls, and decreased further during painful stimulation of the forehead. In contrast, the auditory discomfort threshold was similar in migraine sufferers and controls, and did not decrease during painful stimulation of the forehead. These findings suggest that trigeminal discharge contributes to photophobia but not phonophobia in migraine sufferers.
Serum Interleukin-1 Beta is Increased in Cluster Headache
Authors: Martelletti Paolo , Granata Massimo , Giacovazzo Mario
Published: March 2003

We measured serum interleukin-I beta (IL-1 beta) in 24 episodic cluster headache (CH) patients and 45 normal controls using a specific ELISA method. There was an increase in IL-1 beta in all CH patients compared to controls. IL-1 beta was further increased during the ictal phase of CH compared to patients between attacks and normal individuals. Between attacks, IL-1 beta was also significantly increased compared to controls. We suggest that these results represent an activation of the immune system in CH.
The Association of Menstrual Migraine with the Premenstrual Syndrome
Authors: Facchinetti F , Neri I , Martignoni E , Fioroni L , Nappi G , Genazzani AR
Published: March 2003

To investigate the comorbidity of premenstrual syndrome (PMS) and menstrual migraine, the Menstrual Distress Questionnaire (MDQ) was prospectively administered for two consecutive menstrual cycles to 22 patients with menstrual migraine, 12 cases with migraine without aura and 15 patients with PMS. MDQ scores varied throughout the menstrual cycle in each patient group, the wider changes being shown by patients with PMS. Fourteen menstrual migraine patients and 4 migraine without aura patients achieved diagnostic criteria for PMS over two menstrual cycles. In these patients MDQ scores did not differ from PMS sufferers at any stage of the menstrual cycle. The premenstrual increase of each cluster of PMS symptoms was identical in menstrual migraine and PMS subjects with the exception of negative affect. We suggest that PMS symptoms should be taken into account in the IHS diagnostic criteria for menstrual migraine.
Magnetic Resonance Spectroscopy Studies in Migraine
Authors: Montagna P , Cortelli P , Barbiroli B
Published: March 2003

We describe the method of 31phosphorous magnetic resonance spectroscopy and review the results when it is applied to the study of brain and muscle energy metabolism in migraine subjects. Brain energy metabolism appears to be abnormal in all major subtypes of migraine when measured both during and between attacks. Impaired energy metabolism is also documented in skeletal muscle. We suggest that migraine is associated with a generalized disorder of mitochondrial oxidative phosphorylation and that this may constitute a threshold for the triggering of migraine attacks.
Lowered Circannual Urinary Melatonin Concentrations in Episodic Cluster Headache
Authors: Waldenlind E , Ekbom K , Wetterberg L , Fanciullacci M , Marabini S , Sicuteri F , Polleri A , Murialdo G , Filippi U
Published: March 2003

The circannual secretion of melatonin in 14 Swedish and 15 Italian patients suffering from episodic cluster headache was compared with 14 Swedish and 15 Italian healthy controls matched for sex and age. Overnight samples of urine were collected once a month from 8 to 14 months and kept at -20° C until analysed with RIA. The melatonin concentrations in nocturnal urine were permanently low in cluster headache and there was no consistent change of the melatonin concentration in relation to cluster periods occurring during the study. There was no definitive circannual or infraannual rhythmicity of melatonin in patients or controls. Multiple analysis of variance with repeated measurements showed a significant effect of disease ( p < 0.05), but not of time. Sex, geographical location, age, and smoking also had significant effects ( p < 0.001) on the melatonin concentrations. Lower melatonin levels in cluster headache patients than in controls may in part be related to a larger number of smokers in the patient group. The relation between tobacco use and melatonin should be further studied.
Platelet Superoxide Dismutase in Migraine and Tension-Type Headache
Authors: Shimomura T , Kowa H , Nakano T , Kitano A , Marukawa H , Urakami K , Takahashi K
Published: March 2003

Superoxide dismutase (SOD) is a radical-scavenging enzyme. We determined Cu, Zn-SOD concentrations and activities in platelets from subjects with migraine and tension-type headaches. Thirty migraine without aura (MWoA) patients, 9 migraine with aura (MWA) patients, and 53 tension-type headache patients were selected for study. Thirty healthy volunteers composed the control group. Concentrations of platelet SOD were determined using enzyme-linked immunosorbent assay techniques. The activity of platelet SOD was determined by measuring reductivity of nitroblue tetrazolium. Low concentrations of platelet SOD were found in patients with MWA and MWoA. Platelet SOD activity decreased in MWA patients but not in patients with MWoA or tension-type headaches. These findings suggest vulnerability to oxidative stress in patients with migraine. It is suggested that low platelet SOD levels may play an important role in the etiology of migraine.
Headaches from Aneurysms
Authors: Weir B
Published: March 2003

The clinical features and differential diagnosis of aneurysmal rupture of the cerebral vessels are reviewed with special emphasis on the headaches associated with this disorder.
The Epidemiology of Headache in Germany: A Nationwide Survey of A Representative Sample on The Basis of The Headache Classification of The International Headache Society
Authors: Göbel H , Petersen-Braun M , Soyka D
Published: March 2003

This study presents the first account of the prevalence of headache syndromes, defined according to the International Headache Society criteria, in a large representative sample of the German population; 5000 persons representative of the total population were selected from 30,000 households. Subjects were requested to answer a questionnaire about headache occurrence during their lifetime. The completion rate was 81.2%. Seventy-one point four percent ( n = 2902) reported a history of headache. Twenty-seven point five percent fulfilled the criteria for migraine. Thirty-eight point three percent ( n = 1557) met the criteria for tension-type headache and 5.6% ( n = 229) did not fulfil criteria for either migraine or tension-type headache. Significant correlations were found between the prevalence of the different headache syndromes and sociodemographic variables such as sex, age and place of residence. The prevalence of headache did not exhibit any significant differences between the various länder (states or regions) of Germany. When extrapolated to the total population these results reveal that 54 million people in Germany suffer from headache at least occasionally or persistently. These findings suggest that the magnitude of the neurological disorders, migraine and tension-type headache, is seriously underestimated and thus constitutes a major contemporary health problem.
Improved Description of the Migraine Aura by a Diagnostic Aura Diary
Authors: Russell MB , Iversen HK , Olesen J
Published: March 2003

We present a diagnostic aura diary for prospective recordings of migraine with aura. Three questionnaires are supplemented with sheets for drawings and plottings of visual and sensory auras. Twenty patients recorded 54 attacks of migraine with aura and 2 attacks of migraine aura without headache. The visual and sensory aura were usually gradually progressive, reaching maximum development in 15 and 25 min (median) respectively and had a total duration of 20 and 55 min (median) respectively. Approximately 13% of the attacks had acute onset of visual aura associated with other features more typical of migraine. The visual and sensory auras always preceded typical migraine headache, and headache occurring before aura symptoms was always of the tension type, The migraine headache was milder than in attacks of migraine without aura and often did not have migraine characteristics. In attacks with unilateral head pain, headache and aura symptoms were contralateral in 90% and ipsilateral in 10%.
Leukocyte Subsets and Cortisol Serum Levels in Patients With Migraine Without Aura and Chronic Tension-Type Headache
Authors: Leone M , Biffi M , Leoni F , Bussone G
Published: March 2003

Leukocyte subsets, serum cortisol and immunoglobulin production were investigated in a group of 12 migraine without aura patients, 12 chronic tension-type headache patients and compared with findings in 12 healthy controls. Chronic tension-type headache patients had statistically significant increased levels of B-lymphocytes (CD19 + cells) ( p < 0.05), while migraine sufferers had a similarly significant decrease in CD8 + T-lymphocytes ( p < 0.05). Migraine patients also had an increased percentage of B-lymphocytes although this failed to reach statistical significance. Immunoglobulin production and cortisol serum levels did not differ in the two headache groups. We conclude that the observed abnormalities in tension-type headache and migraine are unlikely to be a consequence of pain or of hypothalamic-pituitary-adrenal axis dysfunction.
Exteroceptive Suppression of Temporalis Muscle Activity During Migraine Attack and Migraine Interval Before and After Treatment with Sumatriptan
Authors: Göbel H , Krapat S , Dworschak M , Heuss D , Ensink FBM , Soyka D
Published: March 2003

We compared the early (ESI) and late (ES2) exteroceptive suppression (ES) periods of temporalis muscle activity in 18 migraine patients during both the migraine interval and migraine attack and investigated the effect of sumatriptan and placebo on ES parameters. The measurements were performed in a balanced sequence at four different times on each patient, twice during the migraine interval and once in each of two migraine attacks. First ES1 and ES2 were measured (stimulus intensity 20 mA, stimulus duration 0.2 ms, stimulation frequency 2 Hz, averaging of 10 responses), then the medication was given on a double-blind basis with an autoinjector using either 6 mg sumatriptan or a placebo solution. Thirty minutes after application the measurements were repeated. No significant differences were found in early and late exteroceptive suppression latencies and durations between baseline measurements. Treatment did not affect the latencies of ESI and ES2. While sumatriptan caused a significant increase in ES1 duration (p £ 0.05) both during the migraine interval and during the migraine attack, placebo showed no significant effect on ES1 duration. Treatment with sumatriptan during the migraine attack was accompanied by a significant increase in the duration of ES2 (p £ 0.05), but no significant changes in the durations of the late suppression periods were observed under any other conditions. The results do not support the assumption that under the experimental conditions chosen migraine attacks are accompanied by a paroxysmal change in the brain-stem mechanisms involved in the modulation of the ES parameters. Since sumatriptan during the migraine interval selectively lengthens ES1 but not ES2, it can be assumed that the substance has a primary effect on brain-stem mechanisms in migraine patients that cannot be explained in terms of secondary pain-induced mechanisms.
Magnetic Resonance Imaging in Retropharyngeal Tendinitis
Authors: Ekbom K , Tothall J , Annell K , Träff J
Published: March 2003

Seven consecutive patients with acute retropharyngeal tendinitis underwent plain X-ray and magnetic resonance imaging (MRI) of the cervical spine. All seven had marked soft tissue swelling anterior to C1 and C2 on plain X-ray, and soft tissue calcification at this level was present in five of them. On MRI, there was markedly increased signal intensity on T2-weighted images in the acute phase and intermediate signal intensity on T1-weighted images, anterior to the level of C1 and C2, often extending as far down as C6. These changes correlated well with the soft tissue swelling seen on conventional X-ray of the cervical spine. The maximum mid-sagittal thickness of the soft tissues was significantly greater in the tendinitis patients ( p < 0.001) than in 12 control subjects free of symptoms from the pharynx or the cervical spine. Treatment with non-steroidal anti-inflammatory drugs rapidly alleviated symptoms, and at follow-up MRI showed regression or complete restitution of the changes. In conclusion, MRI can visualize the edematous changes in the longus colli muscle and adds useful diagnostic information in suspected cases of acute retropharyngeal tendinitis.
Isolated Headache as the Presenting Clinical Manifestation of Intracranial Tumors: A Prospective Study
Authors: Vázquez-Barquero A , Ibáñez FJ , Herrera S , Izquierdo JM , Berciano J , Pascual J
Published: March 2003

We prospectively studied over two years the incidence of headache as the initial and isolated clinical manifestation of adult patients suffering from intracranial tumors ( n = 183). Fifteen patients (8%) exhibited headache as their first and isolated clinical manifestation. Age, sex, neoplasm localization, or pathological diagnosis did not correlate with the presence of headache. Posterior fossa location and hydrocephalus, though not reaching statistical significance, were more frequent in patients who presented with headache as the first symptom. At the moment of diagnosis, 59 (31%) of the patients admitted to headache, though only I out of the 15 patients starting as headache still had this symptom as the only manifestation. From our experience in adults, isolated headache for longer than 10 weeks will only exceptionally be secondary to an intracranial neoplasm.
Vascular Malformation of the Cerebellopontine Angle Associated with “SUNCT” Syndrome
Authors: Morales F , Mostacero E , Marta J , Sanchez S
Published: March 2003

A 70-year-old man complained of two distinct types of unilateral headache during the past fifteen years. When the illness began, the pain was intermittent and short-lasting. In successive years, the crises appeared in clusters and lasted weeks to months. At present, the pain occurs daily, and is located on the right side, from the forehead supraorbitally to the temporal region. Some attacks last 30 sec and are accompanied by tearing, conjunctival injection, rhinorrhea and a subjective need to micturate. Other headaches last 1/2-1 h and are occasionally accompanied by local ipsilateral dysautonomic symptoms. Attacks of pain are provoked by movements of the trunk and neck. A vascular malformation in the right cerebellopontine angle was demonstrated on cranial CT and MRI, and by angiography.
Oral Sumatriptan: Effect of a Second Dose, and Incidence and Treatment of Headache Recurrences
Authors: Ferrari MD , James MH , Bates D , Pilgrim A , Ashford E , Anderson BA , Nappi G
Published: March 2003

Oral sumatriptan in a dose of 100 mg aborts about 60% of migraine attacks within 2 h, but the headache may recur within 24 h. We investigated: (i) the incidence of headache recurrence after oral sumatriptan, (ii) whether a second tablet of sumatriptan at 2 h increases initial efficacy and/or (iii) prevents headache recurrence and (iv) whether a further tablet of sumatriptan treats headache recurrence. In a randomized, parallel-group clinical trial, 1246 patients treated one to three migraine attacks (with or without aura) with 100 mg oral sumatriptan. Two hours later they all took a double-blind randomized second tablet of sumatriptan (group I) or placebo (group II). Patients who initially improved, but then experienced headache recurrence took a further double-blind randomized tablet of sumatriptan or placebo. Proportions of patients who improved from moderate/severe headache to mild/none were similar in groups I and II at 2 h (55 vs 56%) and 4 h (80 vs 77%). Incidences of headache recurrence (moderate/severe-any grade of headache) and median times to headache recurrence were also similar: 22–32% at 16 h in group I and 25–33% at 16.5 h in group II. Sumatriptan was superior to placebo in treating headache recurrence: 74 vs 49% ( p = 0.017) in group I and 70 vs 30% ( p = 0.0001) in group II. Thus, one-fourth of patients experience headache recurrence at about 16 h after successful treatment of a migraine attack with 100 mg oral sumatriptan. A second tablet of sumatriptan at 2 h does not increase initial efficacy and neither prevents nor delays headache recurrence. A further tablet of sumatriptan is, however, highly effective in treating headache recurrence. All dose regimens were well tolerated.
The Insulin Tolerance Test and Ovine Corticotrophin-Releasing-Hormone Test in Episodic Cluster Headache II: Comparison With Low Back Pain Patients
Authors: Leone M , Maltempo C , Gritti A , Bussone G
Published: March 2003

Hypothalamic involvement has been invoked to explain the periodicity of the cluster periods and rhythmicity of the pain attacks in cluster headache. To explore this hypothesis the ovine corticotrophin-releasing hormone (o-CRH) and the insulin tolerance test were administered to a group of episodic cluster headache sufferers during both cluster period and remission. A group of low back pain patients and healthy subjects comprised the control populations. For the o-CRH test, 7 healthy subjects, 7 low back pain patients, 6 cluster headache patients in remission, and 12 in cluster period were studied. Five healthy subjects, 7 low back pain patients, 6 cluster headache patients in remission, and 9 in cluster period were administered the insulin tolerance test. Significantly increased basal cortisol levels were found in cluster headache patients in both illness phases ( p < 0.0001), but not in low back pain patients. Significantly reduced cortisol response to the o-CRH test was observed in cluster headache patients in both phases compared to healthy controls ( p < 0.02.). A blunted ACTH and cortisol response ( p < 0.0001 and p < 0.003 respectively) to the insulin tolerance test was present in cluster headache patients in both phases of the illness compared to healthy subjects and low back pain patients. On the contrary, the ACTH surge after insulin induced hypoglycemia was significantly increased in the low back pain patient group ( p = 0.02). These results suggest that the altered hypothalamic-pituitary-adrenal axis responsiveness in cluster headache patients is not a consequence of the pain, and point to a central, probably hypothalamic derangement in this pathology.
Immunocyte Enumeration in Duodenal Biopsies of Migraine Without Aura Patients With or Without Food-Induced Migraine
Authors: Pradalier A , Maur P De Saint , Lamy F , Launay JM
Published: March 2003

The possibility of an IgE-mediated allergic mechanism in food-induced migraine remains controversial. Twenty consecutive migraine patients, 11 with food-induced migraine, 9 without, were investigated for determination and counting of immunocyte populations (IgA, IgM, IgE, IgG containing cells) by biopsies at duodenum 2 level. Conventional histology and plasmocyte populations were not significantly different between the two groups of migraine patients. This study does not support the existence of an IgE-mediated allergic mechanism in food-induced migraine.
Benign Paroxysmal Vertigo of Childhood: A Long-Term Follow-Up
Authors: Lanzi G , Balottin U , Fazzi E , Tagliasacchi M , Manfrin M , Mira E
Published: March 2003

We examined clinical aspects of Benign Paroxysmal Vertigo (BPV) in infancy and its most frequent differential diagnosis, in particular analogies and differences with forms of “migrainous vertigo” (MV) of later onset. During a long-term follow-up of 7 cases of BPV, diagnosed according to the Basser criteria, 5 of 7 BPV cases spontaneously resolved and 6 of 7 patients later developed migraine and other migraine-related symptoms. This course differs from that described for MV only in the age of onset of headache and in the chronological relationship with vertigo. The authors suggest that BPV can be interpreted as a migraine precursor and MV as a migraine equivalent.
Elongated Styloid Process and Eagle's Syndrome
Authors: Montalbetti L , Ferrandi D , Pergami P , Savoldi F
Published: March 2003

A controversial entity, Eagle's syndrome, is reviewed. After an anatomical description of the maxillo-vertebro-pharyngeal region we summarize the causative, diagnostic and therapeutic aspects of the syndrome. Two different conditions are often reported as Eagle's syndrome: one characterized by dysphagia and unilateral pharyngeal pain radiating to the ear and worsened by swallowing; the other characterized by pain in the head and neck region due to compression of the neurovascular structure by an elongated styloid process. The latter also includes typical cranial neuralgias (such as glossopharyngeal neuralgia) and carotidynia. We believe that the term “Eagle's syndrome” is legitimate only in the first case and in those “atypical” painful head and neck conditions related to an elongated styloid process and relieved by styloidectomy. We believe Eagle's syndrome deserves consideration in the International Headache Classification.
The Nitric Oxide Hypothesis of Migraine and Other Vascular Headaches
Authors: Olesen J , Thomsen LL , Lassen LH , Olesen IJ
Published: March 2003

The molecular mechanisms of migraine pain remain to be determined. Our studies of glyceryl trinitrate (GTN)-induced and histamine-induced headaches have led us to propose that nitric oxide (NO) may be the causative molecule in migraine pain. We also propose that substances capable of inducing experimental vascular headache do so with NO as the common mediator. Finally, we suggest that drugs with antimigraine activity inhibit NO and the cascade of intracellular reactions triggered by NO. We believe these observations provide new insight into the mechanisms of vascular headache. The importance of NO as a potential initiator of the migraine attack indicates new directions for the pharmacological treatment of migraine and other vascular headaches.
Migraine, Tension Headache and Left-Handedness
Authors: Hering R
Published: March 2003

The Geschwind-Behan hypothesis, that migraine is more common among left-handed patients, was tested in 320 migraine sufferers. The frequency of left-handedness was also assessed in 68 tension headache patients and compared to that in 140 healthy controls. No significant differences were observed. This study failed to support the association between migraine, tension headache and left-handedness using the IHS classification of headache.
Pressure-Controlled Palpation: A New Technique Which Increases the Reliability of Manual Palpation
Authors: Bendtsen L , Jensen R , Jensen NK , Olesen J
Published: March 2003

The objective of the present study was to investigate whether the reliability of tenderness evaluation can be increased by using a new technique called “pressure-controlled palpation” (pcp). The technique has been made possible by a newly invented piece of equipment called a palpometer, with which a pressure-sensitive plastic film attached to the index finger records the pressure exerted. In 15 patients with chronic tension-type headache and in 15 healthy volunteers, 2 investigators studied myofascial tenderness using conventional palpation and pressure-controlled palpation. Tenderness was scored on a 4–point scale in each of the examined pericranial regions. The sum of tenderness scores recorded by two observers using conventional palpation differed significantly ( p = 0.0003), while results did not differ between observers using pressure-controlled palpation ( p = 0.89). During palpation with seven different pressure intensities a positive and linear relation between pressure and pain intensity was found ( p = 0.00006). Pain intensity reported by the subjects correlated highly with tenderness scored by the observer (rs = 0.95, p < 0.0001). These results demonstrate for the first time that tenderness scores can be compared between observers if palpation pressure is controlled. Pressure-controlled palpation represents a major improvement on current palpation techniques and should be standard in future research on myofascial pain disorders.
Syncope and Seizure-Like Activity Secondary to Acute Herpes Zoster Infection of the Trigeminal Nerve
Authors: Bonamico L , Celnik P
Published: March 2003

Syncope may occur with glossopharyngeal neuralgia. We describe a patient with acute herpetic infection of the first branch of the trigeminal nerve associated with episodes of shooting pain, cardiac arrest and tonic-clonic movements. Resemblances with the so-called “cardiovascular” form of glossopharyngeal neuralgia, as well as putative mechanisms of the syncope, are discussed.
Diagnosis of Headache in Childhood and Adolescence: A Study in 437 Patients
Authors: Wöber-Bingöl C , Wöber C , Karwautz A , Vesely C , Wagner-Ennsgraber C , Amminger GP , Zebenholzer K , Geldner J , Baischer W , Schuch B
Published: March 2003

We investigated whether the criteria for idiopathic headache published by the International Headache Society (IHS) are useful in childhood and adolescence and compared the diagnoses according to this classification with those of Vahlquist. We used a semi-structured questionnaire to examine a total of 437 children and adolescents referred consecutively to a headache outpatient clinic. Twenty-eight of 437 patients were excluded because of symptomatic or unclassifiable headache. Of 409 patients with idiopathic headache, 70.4% had definite migraine or tension-type headache (IHS 1.1, 1.2, 2.1, 2.2), 20.5% had a migrainous disorder (IHS 1.7) and 9.1% had headache of the tension-type not fulfilling the criteria (IHS 2.3). In the differential diagnosis of migraine and tension-type headache the intensity of pain, aggravation of headache by physical activity, nausea and vomiting were the most important features. The quality of pain, photo- and phonophobia were less helpful and location least important. The duration of migraine attacks was less than 2 h in 19.0% of the migraine patients. In general, the diagnostic criteria of migraine were highly specific but less sensitive, and those of tension-type headache highly sensitive but less specific. The agreement between IHS criteria and those of Vahlquist was marked (kappa = 0.57). We conclude that the IHS criteria are useful for classifying headache in children and adolescents referred to a headache outpatient clinic. A forthcoming modification of the IHS criteria should consider a reduction of the minimum duration of migraine attacks from 2 h to I h and should try to increase the sensitivity of the criteria for migraine and the specificity of the criteria for tension-type headache.
Paroxysmal Vertigo as a Migraine Equivalent in Children: A Population-Based Study
Authors: Abu-Arafeh I , Russell G
Published: March 2003

We studied the prevalence, causes and clinical features of paroxysmal vertigo (PV) in the well-defined childhood population of the City of Aberdeen. We applied a screening questionnaire to 2165 children (10% random sample of all children 5–15 years of age) attending schools in Aberdeen. Children with a history of at least three episodes of vertigo over the past year due to unknown causes were invited for clinical interview and examination. Children with PV were compared with a group of children with migraine, and with a group of asymptomatic children matched for age and sex. Forty-five children fulfilled the diagnostic criteria for PV (prevalence rate 2.6%, 95% CI 1.9–3.4). They were noted to have clinical features in common with children with migraine, including trigger and relieving factors, associated gastrointestinal and sensory symptoms, vasomotor changes, and a similar pattern of associated recurrent disorders (such as headache, abdominal pain and cyclical vomiting), atopic diseases and travel sickness. Also, they had a twofold increase in the prevalence of migraine (24%) compared with the general childhood population (10.6%). The overlap in the clinical features of PV and migraine suggests that the two conditions are related and that it is reasonable to continue to regard PV as a migraine equivalent.
Epidemiology of Headache
Authors: Rasmussen BK
Published: March 2003

This thesis is based on nine previously published papers. It represents the first prevalence study of specific headache entities in a representative general population, where the diagnoses are based on a structured interview and examination by a physician using internationally accepted operational diagnostic criteria. The study population was a random sample of 1000 men and women aged 25-64. The participation rate was 76%. The prevalences of the different forms of headache are assessed and the study provides descriptive data concerning symptomatology, precipitating factors, impact of female hormones, use of medical services and work consequences of the headache disorders and describes various factors associated with the disorders. Only half of migraineurs and one-sixth of subjects with tension-type headache consulted their general practitioner because of headache and even less consulted a specialist. These consultation rates reflect the selection of cases that may bias studies in clinic populations. The study supports the notion that migraine and tension-type headache are separate clinical entities and that migraine without aura and migraine with aura are distinct subforms of migraine. Migraine and tension-type headache are sex- and age-dependent disorders with female preponderance and lower prevalence in older age groups. The female preponderance may be explained by clinical factors related to female hormones. There is no clear evidence of any association between sociodemographic variables and migraine or tension-type headache. Tension-type headache is related to a series of psychosocial variables while migraine is not. The results suggest that migraine is primarily a constitutional disorder and tension-type headache a more complex phenomenon influenced by several psychosocial factors. The limitations of cross-sectional data in pointing out risk factors with sufficient certainty are stressed. Longitudinal follow-up studies are the most important challenge in future epidemiological headache research.
Neurogenic Model of Migraine
Authors: Buzzi MG , Bonamini M , Moskowitz MA
Published: March 2003

Activation of peripheral trigeminal fibers induces neurogenic inflammation in rat dura mater, as well as vascular and mast cell changes. These changes parallel an increase of vasodilating and permeability promoting peptides in venous effluent of the cephalic circulation. The experimental model of electrical trigeminal ganglion stimulation or systemic capsaicin administration has proven effective in detecting cellular activation in brainstem trigeminal nuclei. Animal experimental models of trigeminovascular activation and the effects of antimigraine drugs on functional and morphological consequences of such activation provide the background for further models and for developing pharmacological strategies in this field.
Is Positron Emission Tomography a Useful Tool for Studying Migraine?
Authors: Sadzot B , Maquet P , Franck G
Published: March 2003

Despite the high prevalence of migraine in the population, the pathophysiology of this condition remains poorly understood. Vascular changes have been postulated. With positron emission tomography and various radiotracers, it is possible to have a non-invasive access to a number of parameters of interest in migraine research. These are presented and discussed in this article. PET has great potential for answering some basic questions concerning the physiological or biochemical changes that can occur during and between migraine attacks. Few studies have been published, however, probably because of (i) limitations inherent to the technique and (ii) problems in study design.
Increased Cerebral Blood Flow Velocity Induced by Cold Pressor Test in Migraine: A Possible Basis for Pathogenesis?
Authors: Micieli G , Tassorelli C , Bosone D , Cavallini A , Bellantonio P , Rossi F , Nappi G
Published: March 2003

Noradrenergic nuclei of the locus coeruleus are believed to be involved in migraine pathogenesis. We recently demonstrated a typical intracerebral vasoconstriction after prolonged (5 min) exposure to cold pressor test (CPT), likely related to a central noradrenergic mechanism modulated at the locus coeruleus level and eliminated by pretreatment with clonidine. In the present study, we used transcranial Doppler ultrasonography to monitor blood flow velocity (BFV) changes to CPT in the middle cerebral artery (MCA) of migraine with (MA, n = 12) and without (MO, n = 15) aura subjects. CPT induced a significant increase in BFV and a concomitant decrease in the pulsatility index (PI), a pattern which is the opposite of the results obtained with controls. The results were comparable when controls were pretreated with clonidine. The MO patients produced an intermediate pattern between the MA and control subjects. A possible altered modulatory effect of opioids and/or serotonin on noradrenergic nuclei of the brainstem is the possible cause of the observed inverse response in migraine, suggesting intracerebral vasomotor instability in these patients.
“Menstrual” Migraine: Towards a Definition
Authors: MacGregor EA
Published: March 2003

“Menstrual” migraine, a term misused by both patients and doctors, lacks precise definition. This dissertation critically reviews papers on the subject and examines the problem from a clinical perspective. A definition is proposed that the term “menstrual” migraine should be restricted to attacks exclusively starting on or between day l ± 2 days of the menstrual cycle; the woman should be free from attacks at all other times of the cycle. This definition, unlike many used previously, links to a specific mechanism; the timing is consistent with oestrogen withdrawal. If this is correct, “oestrogen withdrawal” migraine may be a better term. Future studies, necessary to support or refute these proposals, are suggested.
Reactions of the Middle Meningeal Artery of the Cat to Neural and Humoral Stimulation
Authors: Michalicek J , Gordon V , Lambert G
Published: March 2003

The physiology and pharmacology of the middle meningeal artery was investigated in cats in order to determine whether this artery was subject to normal neural and humoral control mechanisms. Carotid and middle meningeal arterial blood flows and resistances were measured in 16 cats anaesthetized with chloralose. The cervical sympathetic nerves were stimulated electrically. Stimulation of the cervical sympathetic nerves pre-ganglionically reduced blood flow in the middle meningeal artery by producing vasoconstriction in its resistance bed. The vasoconstriction was mediated via catecholamine-containing nerves, as it was abolished by prior intravenous administration of bretylium. Intravenous injections of noradrenaline or adrenaline also produced vasoconstriction in the middle meningeal arterial bed. 5-Hydroxytryptamine (5HT), on the other hand, produced a dilatation in the middle meningeal artery. We conclude that neurally or humorally released catecholamines can provide a plausible mechanism for vasoconstriction in the middle meningeal artery. The dilator effect of 5HT contrasts with the constrictor effect of the 5HT1-like receptor agonist sumatriptan and suggests a complex 5HT receptor pharmacology for the artery.
Pattern Reversal Visual Evoked Potentials in Children With Migraine or Tension-Type Headache
Authors: Rossi LN , Pastorino GC , Bellettini G , Chioci A , Mariani E , Cortinovis I
Published: March 2003

Pattern reversal visual evoked potentials were recorded in 71 children with different types of migraine (e.g. migraine with aura, migraine without aura) or tension-type headache and in 19 controls (mean age of both groups 9 years). P100 latencies were comparable in all three groups.
Pilot Study of MK-462 in Migraine
Authors: Cutler NR , Claghorn J , Sramek JJ , Block G , Parebianco D , Cheng H , Olah TV , Reines SA
Published: March 2003

MK-462 is a potent, selective 5HT1D receptor agonist which may be useful in treating acute migraine. We conducted a double-blind placebo-controlled inpatient study to assess the preliminary efficacy and safety of oral doses of MK-462 20 mg ( n = 8) and 40 mg ( n =36) vs placebo ( n =21), administered to 65 male and post-menopausal female migraine patients aged 22–51 with moderate or severe migraine headache. Headache severity and functional disability were measured at 0.5, 1, 1.5, and 2 h post-dose. The 20 mg dose was well tolerated and 4/8 patients obtained relief in headache severity at the 2 h time point. The 40 mg dose was well tolerated and was significantly ( p <0.05) superior to placebo at the 1.5 and 2 h time points (with 27/36 or 75% obtaining relief at 2 h compared to 7/21 or 33% for placebo). Adverse events occurred in 50% of patients on 20 mg MK-462, 72% of those on 40 mg MK-462, and in 52% of placebo-treated subjects. The most common adverse events associated with MK-462 were drowsiness (20 mg 12%; 40 mg 44%; placebo 24%), dry mouth (10 mg 36%; placebo 19%), and lightheadedness/dizziness (40 mg 17%; placebo 10%). Based on these preliminary results, MK-462 appears worthy of continued study for the treatment of acute migraine.
The Family History of Migraine. Direct Versus Indirect Information
Authors: Russell MB , Fenger K , Olesen J
Published: March 2003

Migraine assessed by proband report was evaluated in a family study of migraine. A clinical interview of spouses and first-degree relatives by a physician was used as an index of validity. The operational diagnostic criteria of the International Headache Society were used. Of the 378 probands from the general population, 126 had migraine without aura, 127 had migraine with aura, 17 had both migraine without aura and migraine with aura and 108 had never had migraine. Spouses ( n = 229) and first-degree relatives ( n = 1109) were included in the analyses. Sensitivity, specificity, predictive values and chance-corrected agreement rate for the diagnosis of migraine were 49%, 93%, 81% (PVpos), 77% (PVneg) and 0.47, respectively. The corresponding values for migraine without aura were 58%, 87%, 63% (PVpos), 84% (PVneg) and 0.46 respectively, while the values for migraine with aura were 52%, 88%, 61%, (PVpos), 83%, (PVneg) and 0.42, respectively. Migraine assessed by proband report is not satisfactory for diagnosing migraine in relatives, since the number of affected relatives is highly underestimated. Our results emphasize the necessity of a clinical interview of the relatives in family studies of migraine.
A Quality of Life Instrument for Adolescents with Chronic Headache
Authors: Langeveld JH , Koot HM , Loonen MCb , Hazebroek-Kampschreur AAJM , Passchier J
Published: March 2003

We developed a generic Quality of Life (QL) measurement scale for adolescents between 12 and 18 years of age, primarily for use on youngsters with chronic headaches or migraine. The Quality of Life Headache in Youth (QLH-Y) is a 71 item (69 multiple choice items and two visual analogue scales) QL measurement scale. It assesses an individual's QL in six QL subdomains. Study 1 ( n = 223) was aimed at item selection and scale construction. Thirteen subscales were developed to cover the four QL subdomains Psychological Functioning, Functional Status, Physical Status and Social Functioning. The QL subdomains satisfaction with life in General and Satisfaction with Health were covered by two visual analogue scales. Internal consistency of nearly all the subscales was satisfactory. Study 2 ( n = 159) was conducted to evaluate the validity and stability of the QLH-Y. Indications for parent-youth agreement, construct validity and sensitivity for headache and migraine were obtained. Stability coefficients were between 0.47 and 0.72 for the 1-week interval and between 0.31 and 0.60 for the 6-month interval. Nearly all of the QLH-Y subscales appeared to be more sensitive to differences between subjects with headaches and headache-free subjects, while the QL subdomain Functional Status was most sensitive for subjects who had suffered from a recent headache.