bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Flunarizine (Sibelium®) and Pizotifen (Sandomigran®) in Migraine Treatment: A Double-Blind Study
Authors: Louis P. , Spierings E. L. H.
Published: March 2003

In this double-blind, randomized multicenter study involving 75 patients, the calcium-entry blocker flunarizine (10 mg nocte) was compared with pizotifen (2-3 mg per day in three administrations). Duration of treatment was four months. The results suggest that, in the dosage used, flunarizine is at least as effective as pizotifen in both classical and common migraine as regards effect on attack frequency. Flunarizine might tend to more markedly suppress severity of the attack, though. The weight gain seen with both drugs might be slightly less with flunarizine. A practical advantage of flunarizine is its simple dosage schedule (one intake per day).
Chlormezanone in the Treatment of Migraine Attacks: A Double Blind Comparison with Diazepam and Placebo
Authors: Tfelt-Hansen Peer , Jensen Kai , Vendsborg Per , Lauritzen Martin , Olesen Jes
Published: March 2003

One hundred and fifty patients treated for an acute migraine attack all received a standard regimen consisting of metoclopramide 10 mg i.m. and—20 min later—paracetamol 1 g orally. Simultaneous trial medication was given. This consisted of placebo, diazepam 5 mg as tablets, or chlormezanone 400 mg as capsules given in a double dummy fashion. A successful treatment result was defined as a decrease of two or three steps on a four-point verbal pain report scale, and no need for further treatment. Patients with severe pain (all three treatment groups together) showed significantly better treatment results ( p < 0.001) than patients with pain of medium severity. In the group with severe pain there was no significant difference between diazepam, chlormezanone or placebo. In the group with pain of medium severity there was a significant ( p < 0.01) effect of chlormezanone, but no significant effect of diazepam. Chlormezanone may possibly be a valuable addition to antiemetic and analgesic therapy of migraine attacks.
Chronic Paroxysmal Hemicrania. VI. Precipitation of Attacks. Further Studies on the Precipitation Mechanism
Authors: Sjaastad Ottar , Russell David , Saunte Carsten , Hørven Ivar
Published: March 2003

In four of the approximately 40 cases of chronic paroxysmal hemicrania (CPH) that are known so far, attacks that are similar to the spontaneous ones may be precipitated by head movements or pressure against certain points in the neck. Head flexion was used as the precipitation procedure in a 34-year-old female who was studied several times in the course ot five years. Attacks occur within 5-40 sec, and the pain is preceded by tearing and conjunctival injection. External rubbing or external compression of the common and internal carotid arteries on the symptomatic side did not produce attacks. The combination of head flexion and external compression of the common or internal carotid arteries on the symptomatic side invariably produced an attack of usual severity and within the usual time. This investigation would seem to render unlikely the possibility of a primary vascular mediation of the signal from the neck to the ocular region. Sympathetic fibres are the likely mediators of the impulses from the neck to the ocular area.
Hangover Headache and Prostaglandins: Prophylactic Treatment with Tolfenamic Acid
Authors: Kaivola S. , Parantainen J. , Österman T. , Timonen H.
Published: March 2003

Tolfenamic acid (TA), a potent inhibitor of prostaglandin (PG) biosynthesis and action, was tested prophylactically against hangover symptoms in 30 healthy volunteers in a double–blind cross-over study. One capsule of TA (200 mg) or placebo was taken before starting to drink alcohol and another before going to bed. The hangover symptoms were evaluated in the morning. TA was found significantly better than placebo in the subjective evaluation of drug efficacy ( p<0.001) and in reducing the reported hangover symptoms in general (p < 0.01). In the TA group, significantly lower symptom scores were obtained for headache (p<0.01), and for nausea, vomiting, irritation, tremor, thirst and dryness of mouth (all p < 0.05). In a separate study with eight participants, plasma levels of PGs were followed during ingestion of alcohol with or without TA. The plasma concentrations of PGE2 and TXB2 (a metabolite of thromboxane A2) were lower in the TA group during alcohol ingestion, while PGF2a and 6-keto-PGF1a (a metabolite of prostacyclin) were unaffected. TXB2 correlated with blood alcohol levels in a U-shaped manner.
Double Blind Comparison of Mefenamic Acid and Acetaminophen (Paracetamol) in Migraine
Authors: Peatfield R. C. , Petty R. G. , Rose F. Clifford
Published: March 2003

We have assessed the role of mefenamic acid, a non-steroidal anti-inflammatory drug known to inhibit both the synthesis and actions of prostaglandins, as an analgesic in migraine by comparing it with the established analgesic paracetamol (acetaminophen) in a double-blind cross-over trial. Forty ambulant migraine patients were supplied with oral meditation for six consecutive attacks; metoclopramide 10 mg was administered in all attacks, and paracetamol 500 mg and mefenamic acid 500 mg for three attacks each. The patients recorded the intensity of the headache at the time the meditation was taken, and again after 3 hours, on a linear analogue scale. Twenty-two patients completed the trial satisfactorily. Seven had insufficient attacks and the remainder were lost to follow-up. The mean reduction in headache intensity was 36 ± 11% on mefenamic acid and 27 ± 10% (both mean ± SEM) on paracetamol. While this difference is not quite statistically significant (0.1 > P > 0.05) there still remains a 28% probability that mefenamic acid is twice as potent as an analgesic. The responses in each individual patient to the two drugs were very closely correlated (P < 0.001). Our failure to demonstrate a convincing difference between the two analgesics leads us to speculate that peripheral prostaglandin mediated pain pathways, in which paracetamol is inactive, may be less important than central pathways, which are inhibited by both drugs.
A Possible Role of the Carotid Body in the Pathogenesis of Cluster Headache
Authors: Kudrow Lee
Published: March 2003

An hypothesis regarding the possible role of the carotid body in the pathogenesis of cluster headache is presented. It states: 1. The pathways concerned with cyclic cluster periods may begin centrally involving specific areas in the hypothalamus. The major influence of this physiological change is proposed to be an inhibition of the sympathetic and disinhibition of parasympathetic supplies to the carotid body. The result, whether due to increased vasomotor tonus or interruption of intrinsic sympathetic stimulation, is suggested to cause diminished peripheral chemoreceptor activity. 2. The pathway concerned with onset of spontaneous or induced attacks begins, as proposed, with oxygen desaturation-which, upon reaching threshold levels may induce a hyperactive chemoreceptor response, and stimulate through afferent pathways the nuclei of the 7th and 10th cranial nerves and respiratory centers, via the nucleus solitarius. 3. The consequence of this excitation may involve the third suggested pathway resulting in stimulation of peripheral secretory and other receptors innervated by the cranial nerves.
Headache and Epilepsy: Two Autonomous Entities?
Authors: Savoldi Faustino , Tartara Amelia , Manni Raffaele , Maurelli Maurizia
Published: March 2003

The relationship between headache and epilepsy remains unresolved. We studied 3,600 patients affected by primary headache and 36 epileptic patients with a present or past history of headache. In the first group, no family history of epilepsy nor epileptiform EEG patterns were found. In the second group, there was no chronological relationship between epileptic seizure and headache attack in more than half of the patients; when found (46.1%) the relationship was neither precise nor specific. Taken as a whole, these data suggest the autonomous nature of epilepsy and headache.
“Hemicrania Continua”: Another Headache Absolutely Responsive to Indomethacin
Authors: Sjaastad Ottar , Spierings Egilius LH
Published: March 2003

Two cases suffering from a headache apparently at variance with well recognized headaches are described. It is characterized by a steady, non-paroxysmal, probably severe to moderately severe hemicrania localized anteriorly or anteroposteriorly and is not associated with nausea. Indomethacin exerts an absolute, persistent and clearly dose-dependent effect on this headache, which differs from unilateral headache syndromes such as cluster headache and cervicogenic headache in its temporal pattern and indomethacin response. It differs from chronic paroxysmal hemicrania in its temporal pattern and in the lack of accompanying symptoms.
Metoprolol and Propranolol in The Prophylactic Treatment of Classical and Common Migraine. A Double-Blind Study
Authors: Kangasniemi P , Hedman C
Published: March 2003

In a double-blind, cross-over study the effect and tolerance of the non-selective beta-blocker propranolol in a dosage of 80 mg twice daily was compared to that of the beta1-selective beta-blocker metoprolol 200 mg once daily in Durules(r) (a controlled-release formulation). The attack frequency, migraine days, severity score, consumption of acute medication and subjective evaluation were the main parameters used for evaluation. Thirty-six patients with classical or common migraine were included. Thirty-three completed the investigation. It is concluded from the results that there are no differences in efficacy between metoprolol and propranolol regarding the studied parameters. Both drugs reduced the migraine symptoms compared to the run-in period and were generally well tolerated.
CSF β-EP in Headache and Depression
Authors: Nappi Giuseppe , Facchinetti Fabio , Martignoni Emilia , Petraglia Felice , Bono Giorgio , Genazzani Andrea R
Published: March 2003

Cerebrospinal fluid (CSF) levels of b-endorphin ( b-EP) were measured in 9 migraineurs with interparoxysmal headache (MIH), in 13 patients with major depression in an active phase (5 suffered from MIH), and in 16 age-matched controls. b-EP was measured by specific RIA after gel-chromatography. While b-EP levels of depressed patients (58.5 ± 21.0 fmol/ml, M ± SD) were similar to those of controls (65.8 ± 26.6), those of migraineurs (15.0 ± 11.1) were significantly reduced ( p < 0.01). In depressed patients also suffering from MIH, b-EP concentrations (22.8 ± 7.2, p < 0.05) were half those reported in depressed patients without pain problems. The reduced CSF b-EP levels in patients whose headache and depression coexist support the notion that this neuropeptide is concerned with chronic pain, independently of the affective state.
Pain Characteristics of Painful Ophthalmoplegia (The Tolosa-Hunt Syndrome)
Authors: Hannerz Jan
Published: March 2003

Pain characteristics of the Tolosa-Hunt syndrome were abstracted from the observations of five patients with repeated incidents of painful ophthalmoplegia. The pain was experienced either as pressure behind the ophthalmoplegic eye or as boring pain in one orbital region, fluctuating in intensity, sometimes worsening to knife stab-like pain in the eye. The unilateral pain did not shift side during a solitary incident of painful ophthalmoplegia and was never completely absent. The pain was increased when the eyes were strained, when cold wind blew against the face, and when a change in the weather took place. It was accompanied by a feeling of swelling in the affected region, but not by nausea nor vomiting. Conventional headache drugs provided little relief. All cases experienced tenderness when pressure was applied to the ipsilateral supraorbital foramen. The pain was suggested to be related to an increased load on the impaired venous blood flow in the region of the superior orbital fissure.
Headaches and Stress in Schoolchildren: An Epidemiological Study
Authors: Passchier J , Orlebeke JF
Published: March 2003

Headache parameters, personality variables and stress factors were assessed in a sample of about 2,300 school pupils between 10 and 17 years of age in Amsterdam. More than 15% of the subjects reported headaches occurring weekly. Fear of failure and school problems, but not achievement motivation, had significant positive correlations with headache complaints after correction for differences in sex and age. Menarche and social class had little bearing in relation to the headache variables. From all reported causes of headache, stress was mentioned most frequently in both elementary and secondary schools.
Experimental Toothclenching in Common Migraine
Authors: Jensen Kai , Bülow Per , Hansen Hanne
Published: March 2003

The effect of 30 min voluntary toothclenching was studied in 48 patients with common migraine, randomized in two groups. Group 1 performed low-level tension at 5% and group 2, high-level tension at 30% the individual maximum, as judged by surface EMG from the temporal muscle. Pericranial muscle tenderness was evaluated by manual palpation and a four-point verbal scale. Headache, nausea, and soreness of the chewing muscles were scored on visual analogue scales. Although surface EMG, soreness, blood pressure, heart rate and difficulty in completing the toothclenching session all showed that group 2 patients were subjected to significantly higher levels of muscle tension than group 1 patients, headache developed equally often in both groups (63%). Headache was even more pronounced in group 1 (n.s.). Five patients in group 1 and none in group 2 developed an attack of migraine during the following 24 h. Pericranial muscle tenderness was unaffected by the experimental procedure. There was no significant correlation between headache intensity and pericranial muscle tenderness. Muscle ischemia, muscle “fatigue”, and strain on muscle insertions are thus unlikely to cause attacks of common migraine.
Flunarizine-Pizotifen Single-Dose Double-Blind Cross-Over Trial in Migraine Prophylaxis
Authors: Cerbo Rosanna , Casacchia Massimo , Formisano Rita , Feliciani Massimo , Cusimano Giuliana , Buzzi Maria Gabriella , Agnoli Alessandro
Published: March 2003

The results of a double-blind cross-over clinical trial involving 27 patients with classical or common migraine are described to compare the prophylactic effect of the calcium entry-blocker flunarizine with that of pizotifen. Duration of the treatment was two months, with an evening single-dose administration of both drugs. For most parameters, there was no definite difference between flunarizine and pizotifen in migraine prophylaxis. It has been demonstrated previously that pizotifen is an effective drug in migraine prophylaxis, and these results suggest that flunarizine is effective, too. Weight gain as a side effect was less frequent and less severe with flunarizine than with pizotifen; other side effects showed the same incidence with both drugs.
Changes in the Dopaminergic Control of Prolactin Secretion and in Ovarian Steroids in Migraine
Authors: Murialdo Giovanni , Martignoni Emilia , Maria Andrea De , Bonura Maria Luisa , Sances Grazia , Bono Giorgio , Polleri Alessandro
Published: March 2003

Prolactin (PRL) responses to dopamine (DA) blockers and to direct and indirect DA agonists have been studied in 23 healthy women, 17 women with catamenial migraine and 17 with non-catamenial migraine in both their follicular and luteal phases. PRL responses to the DA blockers were greater in the follicular phase of both migraine groups than in controls. The inhibitory effect of nomifensine on PRL secretion was dampened in the follicular phase of both migraine groups. These findings demonstrate an increased PRL reserve in migraine and suggest the existence of a dopaminergic supersensitivity of the lactotrophic postsynaptic DA receptors. The impaired inhibitory effect of nomifensine on PRL secretion hints at a decrease of the presynaptic DA content in tuberoinfundibular DA neurons. In migrainous women 17-β-oestradiol levels are higher in both ovarian phases, whereas progesterone concentrations and the progesterone to oestradiol ratio are lower than in healthy subjects in the luteal phase. These data suggest the existence of a change in the oestrogen-dependent modulation of pituitary DA receptors.
Chronic Paroxysmal Hemicrania: X. On the Autonomic Involvement
Authors: Sjaastad Ottar , Aasly Jan , Fredriksen Torbjørn , Bakowska Maria M Wysocka
Published: March 2003

In four patients with chronic paroxysmal hemicrania, two of whom could precipitate attacks mechanically, various autonomic function tests were carried out in connection with attacks. Not all features could be studied in all patients, Forehead sweating and temperature were measured. Sweating, tearing, and nasal secretion were studied after systemic atropine administration, which reduced attack-related sweating, tearing, and nasal secretion markedly. Intra-ocular pressure was measured before and after the topical administration of an alpha-receptor blocking agent, thymoxamine. After topical thymoxamine no definite intra-ocular pressure increase occurred during precipitated attacks. In attacks precipitated by head movements, forehead sweating occurred seconds (up to 30 sec) before the pain. This study indicates that at least in some CPH cases, forehead sweating is not caused by the pain. Nor is the pain secondary to increase in intra-ocular pressure. The thymoxamine experiments seem to indicate that alpha-receptors in some way may be connected with the intra-ocular pressure increase during attack.
Nimodipine in the Treatment of Headache in Chronic Cerebral Ischemia
Authors: Hadjiev Dimiter , Velcheva Irena , Ivanova Lilia
Published: March 2003

The aim of this study was to evaluate the influence of nimodipine on non-migrainous vascular headache in patients with chronic cerebral ischemia. Eighty-six patients were examined in a double-blind trial for 16 weeks (12 weeks of nimodipine or placebo, followed by a 4-week placebo period). Fifty-six patients were studied in an open trial for 12 months. In the total material of the double-blind study there was no difference as far as improvement of headache was concerned when comparing the patients treated with nimodipine with those receiving placebo. However, in a group of 38 patients with a higher degree of headache intensity, selected in accordance with the Sandoz Clinical Assessment Geriatric scale, a statistically significant difference was found in favor of nimodipine. The results obtained in the long-term open trial seem to confirm the effect of nimodipine on headache. The underlying mechanisms of the beneficial effect of the drug have been discussed.
Pupillary Functional Asymmetry in Patients With Muscle Contraction Headache
Authors: Shimomura Tokio , Takahashi Kazuro
Published: March 2003

Twenty-five patients with ‘muscle contraction headache’ (MCH) underwent tyramine papillary tests, and 15 of them also underwent physiologic pupillary tests and cold pressor tests. Twenty healthy controls underwent tyramine pupillary tests, physiologic pupillary tests, and cold pressor tests. In the tyramine papillary tests and the physiologic papillary tests, the controls showed a symmetric mydriasis. In contrast, MCH patients showed asymmetric mydriasis after tyramine instillation and in the physiologic pupillary tests. In the cold pressor tests MCH patients reacted in the same manner as the controls. It is suggested that MCH patients have pupillary sympathetic imbalance. The role of this imbalance in the pathogenesis of MCH remains uncertain.
Cluster Headache in The Republic Of San Marino
Authors: D'Alessandro Roberto , Gamberini Gloria , Benassi Giulia , Morganti Giovanni , Cortelli Pietro , Lugaresi Elio
Published: March 2003

The prevalence of cluster headache (CH) in the Republic of San Marino (21,792 inhabitants; 10,893 men and 10,899 women) was studied, reviewing the past 15 years' medical records of neurological, ophthalmological, and otorhinolaryngological services. Further cases were searched for by means of a letter sent to each inhabitant. Control of the case collection method was performed on a random sample of 1314 inhabitants over 7 years, interviewed for possible past or present cluster headache. We found 15 cases of CH (14 men, 1 woman), for an estimated prevalence ratio of 69 cases per 100,000 population. No previous reports have been published on the prevalence of CH in the general population.
Effects of L-5HTP With and Without Carbidopa on Plasma β-Endorphin and Pain Perception: Possible Implications in Migraine Prophylaxis
Authors: Genazzani AR , Sandrini G , Facchinetti F , Rizzo V , Alfonsi E , Sances G , Calvani M , Nappi G
Published: March 2003

L-Tryptophan (L-TP) has been used in migraine and other pain conditions. The mechanism underlying the analgesic effect is still partly undefined. In this study the effects of subchronic administration of L-5-hydroxytryptophan (L-5HTP) (with and without carbidopa) on plasma β-endorphin (b-EP) levels and subjective pain threshold and tolerance were investigated in seven healthy volunteers. To measure also an objective indicator of pain, the nociceptive flexion reflex threshold was studied. L-5HTP treatment with and without carbidopa administration increased b-EP levels significantly ( p < 0.05). L-5HTP plus carbidopa induced an increase in b-EP significantly ( p < 0.05) greater than that induced by L-5HTP alone. Neither the subjective pain threshold and tolerance nor the RIII threshold was modified by either treatment. Our data seem to point to the existence of a complex linkage between plasma opioid levels and pain perception.
Responsiveness of the Visual System in Childhood Migraine Studied by Means of VEPs
Authors: Brinciotti Mario , Guidetti Vincenzo , Matricardi Maria , Cortesi Flavia
Published: March 2003

We have tried to ascertain whether the increased visual evoked potential (VEP) amplitude found in adult migraineurs is present also in children with migraine. We investigated 43 children, 26 male and 17 female, with a mean age of 11.4 years, 24 with common and 19 with classic migraine, and compared them with a control group of 20 children, 11 male and 9 female, with a mean age of 9.7 years. Flash and pattern reversal VEPs were recorded in both groups, and the study was carried out in the pain-free interval between attacks. The children with migraine showed a significant ( p < 0.01) increase in VEP amplitude on flash stimulation but not on pattern reversal. There were no differences between classic and common migraine. The abnormal responsiveness of the visual system seems to be related to variations in light intensity rather than to spatial contrasts.
Abdominal Migraine: A Childhood Syndrome Defined
Authors: Symon David NK , Russell George
Published: March 2003

It has long been recognized that some cases of recurrent abdominal pain in children are related to migraine, but the diagnostic criteria for abdominal migraine have not been defined. We have identified a group of children with recurrent abdominal pain who had a family history of migraine—in over half the cases in a first-degree relative—and who obtained marked relief from their symptoms from specific anti-migraine therapy. These children had a well-defined syndrome comprising episodes of midline abdominal pain of sufficient severity to interfere with normal activities and lasting for prolonged periods, frequently accompanied by pallor, headache, anorexia, nausea, and vomiting. It is proposed that these children have “abdominal migraine”.
Drug Abuse in Chronic Headache: A Clinico-Epidemiologic Study
Authors: Granella Franco , Farina Stefano , Malferrari Giovanni , Manzoni Gian Camillo
Published: March 2003

Among the patients referred to the Headache Centre in Parma between 1979 and 1984, 95 (5%) were found to be drug abusers, having taken analgesics every day for at least a year. They had had chronic headache for at least 12 months: migraine with interparoxysmal headache in 83.1% and chronic tension headache in 16.9%. Almost all patients were combination-analgesics abusers, and only about a quarter of them were taking ergotamine. The largest single factor favouring the transformation of episodic headache into a chronic one was the drug abuse. The patients studied during 1984 were subjected to detoxification with 6 months' follow-up study. Our investigation suggests that all instant-relief drugs can sustain and possibly initiate a chronic headache.
Psychophysiologic Response Patterns in Tension Headache: Effects of Tricyclic Antidepressants
Authors: Ellertsen Bjørn , Nordby Helge , Sjaastad Ottar
Published: March 2003

Tension headache (TH) and control subjects ( n = 22, 11 in each group) were evaluated within a habituation experimental design, in which psychophysiologic responses to auditory stimulation were measured. Auditory stimuli were 20 80-dB, 1000-Hz tones, each lasting 2 sec and sounded at irregular intervals. Subjects were evaluated twice, with a 6-month interval. At the time of the first session TH subjects were being treated with tricyclic antidepressant, yielding a positive clinical effect. Medication was withdrawn 3 weeks before the second session. Phasic responses in heart rate and temporal artery pulse amplitudes and averaged EMG levels from the frontal muscles were measured. Significantly lower heart rate reactivity and significantly less pronounced left temporal artery pulse amplitude responses were found in non-medicated TH subjects than in controls. TH patients showed a pulse amplitude increase in response to stimulation, whereas control subjects showed a decrease. The pulse amplitude response pattern was normalized in medicated TH patients. EMG levels were similar in TH patients and controls when patients were receiving medication, whereas TH patients showed significantly higher frontal EMG levels than control when medication had been withdrawn.
Flunarizine and Migraine in Childhood: An Evaluation of Endocrine Function
Authors: Guidetti Vincenzo , Ottaviano Salvatore , Fiorentino Domenico , Fornara Roberto , Moscato Davide
Published: March 2003

Flunarizine was tested for prophylactic efficacy and for side effects in 10- to 13-year-old patients with severe migraine (> 2 attacks per month). The 13 preadolescents received a single 5-mg dose at night for 2 months. The attack frequency decreased significantly, and the effect was maintained over time. The endocrine status, investigated before and after treatment, showed no significant interference with pituitary, beta-pancreatic, or gonadal function.
Thyroid-Stimulating Hormone and Prolactin Responses to Thyrotropin-Releasing Hormone in Common Migraine
Authors: Murialdo Giovanni , Masturzo Paola , Filippi Ugo , De Palma Diego , Balbi Daniela , Polleri Alessandro , Ferrari Maria Luisa , Farinini Daniele , Albano Claudio
Published: March 2003

Intravenous administration of 50 μg or 200 μg thyrotropin-releasing hormone (TRH) to men with common migraine elicited blunted prolactin (PRL) responses, when compared with healthy controls. The thyroid-stimulating hormone (TSH) response was enhanced after 50 μg TRH in the migraineurs, but not after 200 μg. The physiologic TSH dose-response relationship was abolished in migraine sufferers. The data may be interpreted in the light of dopaminergic and noradrenergic supersensitivity, for PRL and TSH, respectively. The TSH response in migraine differs from the one that occurs in depression.
Flunarizine in Prophylaxis of Childhood Migraine: A Double-Blind, Placebo-Controlled, Crossover Study
Authors: Sorge Fulvio , Simone Roberto De , Marano Enrico , Nolano Maria , Orefice Giuseppe , Carrieri Pietro
Published: March 2003

An 8-month, double-blind, placebo-controlled, crossover trial of flunarizine in the prophylaxis of migraine has been performed in 70 children. After 4 weeks of medication-free base-line observation, 35 children (group A) received flunarizine (5 mg/day) and 35 (group B) received placebo over a 12-week period. After a 4-week washout they crossed treatments for another 12 weeks. Sixty-three patients completed the trial. In both groups flunarizine significantly reduced the frequency and average duration of headache attacks. In group A efficacy was maintained after placebo crossover for the last 4 months of the study. Five subjects in group B stopped placebo because of ineffectiveness; two children in group A discontinued flunarizine treatment, one because of excessive daytime sedation and the other because therapy was ineffective. The main side effects were daytime sedation and weight gain. It is concluded that flunarizine is an effective drug for the treatment of childhood migraine. In a study of this length no serious side effects were discovered.
Substance P in the Human Iris: Possible Involvement in Echothiophate-Induced Miosis in Cluster Headache
Authors: Fanciullacci Marcello , Pietrini Umberto , Geppetti Pierangelo , Nicolodi Maria , Curradi Carlo , Sicuteri Federigo
Published: March 2003

Substance P-like immunoreactivity (SP-LI) was measured by radioimmunoassay in iris, choroid, and retina obtained from men after death. Although present in different amounts, SP-LI, eluting as authentic SP or SP sulfoxide in the high-performance liquid chromatography system, was found in the three ocular structures. The retina contained higher concentrations of SP-LI than the iris and choroid. The possible functional involvement of iris SP was studied in 22 episodic cluster headache (CH) patients by using the anticholinesterase agent echothiophate iodide (EI), which also induces an atropine-resistant miosis, putatively due to release of SP from trigeminal sensory neurons. In CH patients EI eye drops instilled into both eyes provoked a prolonged miosis with a more marked response in the pupil of the symptomatic eye. It is proposed that the hyperfunction of SP-containing neurons may coexist with the previously documented sympathetic hypofunction in the innervation of the symptomatic pupil of CH.
Plasma Vasopressin Levels in Induced Migraine Attacks
Authors: Peatfield RC , Hampton KK , Grant PJ
Published: March 2003

Vasopressin (aVP) at low concentrations functions as an antidiuretic hormone and has vasoconstrictive effects. To investigate the possible role of aVP in the pathogenesis of migraine, six patients with a history of induced migraine were given 100 g chocolate, and blood samples for plasma aVP were taken before ingestion and every hour for 4 h. In one patient who presented with severe headache and nausea the base-line plasma aVP concentration was 15.2 pg/ml; it fell to 3.2 pg/ml at 2 h before rising to 10 pg/ml at 3 h and 4 h as the symptoms worsened. In the five patients with moderate or no headache plasma aVP concentrations remained in the normal range (<3 pg/ml) throughout. The results suggest that aVP does not have a role in the aetiology of migraine. The possibility exists that during severe attacks of nausea there is release of aVP, which may be responsible for the facial pallor, antidiuresis, and coagulation abnormalities occasionally observed in migraine.
Cervicogenic Headache: Pupillometric Findings
Authors: Fredriksen TA , Wysocka-Bakowska MM , Bogucki A , Antonaci F
Published: March 2003

Eleven female patients with cervicogenic headache (mean age, 43 years; range, 25–59 years) have been examined with the pupillometer. The pupillary diameter was examined in the basal state (that is, the status before pharmacologic stimulation) and after topically administered tyramine (2%), phenylephrine (1%), and hydroxyamphetamine (1%). A total of 51 tests were performed, 35 in the asymptomatic period and 16 during pain attacks. In a control group consisting of 26 age-matched women a total of 39 tests were carried out. Before pharmacologic stimulation (that is, in the “basal state”) the pupils were smaller in the asymptomatic (pain-free) period than during pain attacks in the patients and also as compared with that of control individuals. The anisocoria (the difference in pupillary size in the same individual) observed was not significantly different between the patient group and control individuals either in the basal state (before pharmacologic stimulation) or after pharmacologic stimulation. The mydriasis resulting from the instillation of the three sympathicomimetic drugs was symmetrical in both controls and patients both during and between the pain attacks. This finding is in clear contrast to what is found in cluster headache, in which there is a “Horner-like” syndrome on the symptomatic side. These two headaches thus seem to differ essentially with regard to this variable.
Arachidonic Acid Metabolism in Polymorphonuclear Cells in Headaches: A Methodologic Study
Authors: Fragoso Yara Dadalti , Seim Arnfinn , Stovner Lars Jacob , Mack Merete , Bjerve Kristian S , Sjaastad Ottar
Published: March 2003

Prostaglandins and leukotrienes have been implicated in the pathogenesis of various types of headache, mainly because some, but not all, cyclo-oxygenase inhibitors are effective in their treatment. We have therefore investigated whether a pathologically changed turnover of arachidonic acid (AA)-containing phospholipids can be seen in headache patients, using isolated polymorphonuclear cells (PMNs) from healthy controls and patients with chronic paroxysmal hemicrania (CPH) and cluster headache. PMNs from healthy controls incorporated 55% of the added (1-14C)AA into total lipids, and 0.5% ± 0.14% of this radioactivity was found in the phosphatidylserine (PS) fraction. PMNs from a cluster headache and a CPH patient showed 300% and 900% increase in PS labeling from AA, respectively. No other phospholipids showed any difference between controls and patients. The results are discussed in connection with membrane signal transduction via the PS-dependent protein kinase C.
Somatosensory-Evoked Potential Study in Headache Patients
Authors: Firenze Caterina , Gatto Frances Del , Mazzotta Giovanni , Gallai Virgilio
Published: March 2003

Somatosensory-evoked potentials (SEPs) after median nerve stimulation were studied in 34 patients with common migraine, in 30 patients with muscle-contraction headache, and in 10 cluster headache patients. The SEPs were registered before and after histamine administration. Latency values in common migraineurs showed no variation when compared with those in controls. Although not statistically significant, the N1-P2 amplitude was increased in 14 (41.1%) of these patients after histamine stimulation. No changes were observed in muscle-contraction headache patients either with or without histamine administration. In all cluster headache patients, the N1-P2 amplitude decreased after histamine stimulation. These results are discussed in the light of current hypotheses concerning the pathophysiologic mechanisms of headache.
Flunarizine in Migraine Prophylaxis: Efficacy and Tolerability of 5 mg and 10 mg Dose Levels
Authors: Centonze Vincenzo , Magrone Domenica , Vino Marcello , Caporaletti Paola , Attolini Ettore , Campanale Giancleto , Albano Ottavio
Published: March 2003

The use of flunarizine, a drug which has proven its efficacy in migraine, is often associated with important side effects. The aim of this paper has been to check their incidence at different dose levels (5 mg vs 10 mg). Our data confirm the occurrence of important side effects (in particular weight gain); on the other hand, they emphasize the dose-dependency of the side effects.
Sensory Neuropeptides (Substance P, Calcitonin Gene-Related Peptide) and Vasoactive Intestinal Polypeptide in Human Saliva: Their Pattern in Migraine and Cluster Headache
Authors: Nicolodi Maria , Bianco Elena Del
Published: March 2003

Substance P, calcitonin gene-related peptide and vasoactive intestinal polypeptide-like immunoreactivities have been evaluated in the saliva of 15 subjects suffering from migraine without aura and 16 control subjects. All three peptides were also measured in the symptomatic/non-symptomatic side saliva sampled from 10 cluster headache sufferers during the cluster period, 5 cluster headache sufferers out of the cluster period, as well as in the right and left side saliva of 18 control subjects. The most interesting result gives a clear difference in common migraine and cluster headache salivary vasoactive intestinal polypeptide-like immunoreactivity contents. In fact, these are enhanced during cluster headache attack and decreased during migraine attack when compared with the interictal period vasoactive intestinal polypeptide-like immunoreactivity levels. Another remarkable finding concerns the significant increase of substance P-like immunoreactivity and calcitonin gene-related peptide-like immunoreactivity levels, from basal values, in the saliva sampled during both migraine and cluster headache attacks. Control subjects showed a calcitonin gene-related peptide-like immunoreactivity and substance P-like immunoreactivity salivary contents significantly higher than migraine sufferers' saliva sampled in basal conditions. Conversely, calcitonin gene-related peptide-like immunoreactivities levels in controls were lower than in cluster headache sufferers' saliva obtained during intervals. Finally, during cluster headache attacks the enhancement of substance P-like immunoreactivity and vasoactive intestinal polypeptide-like immunoreactivity salivary contents interest the non-symptomatic side, whereas the symptomatic side salivary substance P-like immunoreactivity and vasoactive intestinal poly-peptide-like immunoreactivity contents remain unchanged. These findings do not allow any final conclusion. However, this biochemical evaluation indicates relevant changes of the salivary neuropeptides in diseases, such as migraine and cluster headache, in which pain transmission is surely involved.
Studies on Nitroglycerin and Histamine Provoked Cluster Headache Attacks
Authors: Bogucki Andrzej
Published: March 2003

Attacks of cluster headache provoked by the administration of nitroglycerin (1 mg sublingually) or histamine (0.01 mg/kg subcutaneously) were studied. The constant latency time in individual patients during nitroglycerin and histamine provocation suggested that the same mechanism is involved in both methods of headache induction. Repeated nitroglycerin provocation revealed its tendency to lengthen duration of the refractory period at the end of the bout, when the attacks were less frequent. The “cross studies” on spontaneous and nitroglycerin provoked attacks indicated that the underlying mechanism of both is at least partially the same.
Coagulation Factors in Orbital Venous Vasculitis
Authors: Hannerz Jan , Blombäck Margareta
Published: March 2003

Orbital venous vasculitis has earlier been shown to be associated with spontaneous ecchymoses. With the reservation that platelet function was not investigated and fibrinolysis only partly, this study of the coagulation factors of eight patients with orbital venous vasculitis showed normal findings, suggesting immunologic etiology rather than coagulation deficiency as the cause of the spontaneous ecchymoses.
Migraine Treatment With Nicardipine
Authors: Leandri Massimo , Rigardo Sergio , Schizzi Rodolfo , Parodi Carlo Italo
Published: March 2003

A novel calcium entry blocker, nicardipine, has been tested using a dosage of 20 mg twice a day against placebo on 30 patients suffering from migraine without aura, according to a double-blind, cross-over design; overall duration of the study was four months (two with nicardipine and two with placebo). Migraine parameters such as monthly frequency, mean intensity and mean duration of attacks were monitored. Two indexes were also calculated: index A (monthly frequency x mean intensity) and index B (monthly frequency x mean intensity x mean duration). All the parameters considered and the two indexes showed a marked and significant improvement after nicardipine treatment in comparison to both placebo and pre-study scores. Detailed analysis of the cross-over results showed that improvement obtained with nicardipine lasted some time after the drug was discontinued. Nicardipine did not alter the blood and attention tests performed and caused few side effects.
Oculomotor Disturbances in Patients with Tension Headache Treated with Acupuncture or Physiotherapy
Authors: Carlsson Jane , Rosenhall Ulf
Published: March 2003

Forty-eight female patients with chronic tension headache were randomized into two treatment groups-acupuncture and physiotherapy. The patients were examined using oculomotor tests. Intensity of the headache and tenderness of the trapezius muscles were assessed in accordance with graded scales. The mean velocity gain for smooth pursuit eye movements improved for all target velocities both in the physiotherapy group and in the acupuncture group. The latency was reduced for all three gaze angles in the physiotherapy group while no improvement occurred in the acupuncture group. There was a reduction of headache intensity in both groups while tenderness of the trapezius muscles was reduced in the physiotherapy group but unchanged in the acupuncture group. A significant correlation was found between average of the mean velocity gain and tenderness of the trapezius muscles.
Hemicrania Continua. The First Spanish Case: A Case Report
Authors: Pareja Juan A , Palomo Tomás , Gorriti Miguel A , Pareja Julia , Espejo José , Morón Baldomero , Trigo Maximino
Published: March 2003

The case of a patient suffering from strictly unilateral continuous headache, absolutely responsive to indomethacin is reported. This is the first Hemicrania continua case to be documented in Spain. The tyramine test resulted in anisocoria with the smaller pupil on the symptomatic side. A second tyramine test after one week on 75 mg indomethacin per day failed to produce anisocoria. Treatment was reduced to 25 mg indomethacin per day, and this dose was sufficient to control the headache completely.
Neuromagnetic Fields in Migraine: Preliminary Findings
Authors: Barkley Gregory L , Tepley Norman , Simkins Robert , Moran John , Welch KMA
Published: March 2003

Neuromagnetic signals consistent with spreading cortical depression have been observed in 9 of 12 migraine patients studied, but not in normal controls (out of 8 studied) or in patients with non-migrainous headache (4 studied). These signals consist of large amplitude, usually biphasic waveforms presumably arising from the onset or offset of spreading cortical depression in a sulcus, and prolonged attenuation of magnetic amplitudes, associated with suppressed neuronal activity. Techniques are described which recognize various kinds of artefacts and which distinguish changes in state of arousal of the patient from the presumed spreading cortical depression signals.
Cluster Headache: Ultrastructural Evidence for Mast Cell Degranulation and Interaction with Nerve Fibres in the Human Temporal Artery
Authors: Dimitriadou V , Henry P , Brochet B , Mathiau P , Aubineau P
Published: March 2003

It has been suggested that histamine plays an important role in the pathogenesis of cluster headache. In addition, both neurogenic and vascular components have been described during cluster headache attacks without an obvious anatomical link between them. Our ultrastructural observations of human temporal arteries from cluster headache patients and their comparison to those from a control group strongly suggest that mast cells may be this link. Mast cells in both groups show a very close apposition with nerve fibres, suggesting a functional interaction between them. Moreover, in the cluster headache group exclusively, adventitial mast cells show profound morphological modifications suggesting progressive degranulation. These data strongly suggest that mast cells could be directly or indirectly involved in the pathophysiology of cluster headaches.
Increase in Plasma Methionine-Enkephalin Levels During the Pain Attack in Episodic Cluster Headache
Authors: Figuerola Maria de Lourdes , Vindrola Osvaldo , Barontini Maria Beatriz , Leston Jorge Alberto
Published: March 2003

Since high levels of endogenous opioids (endorphins, enkephalins) were found in brain areas classically related to nociception, their peripheral levels in humans were studied in different pain syndromes yielding contradictory results. This study was undertaken to assess changes in plasma methionine-enkephalin (met-enkephalin) levels in patients with episodic cluster headache associated with the pain period. Twenty-nine patients, 24 in the cluster period (6 of them during an attack) and 3 in the remission period were studied. Two other patients were subjected to a longitudinal follow-up. Plasma met-enkephalin levels were determined by radioimmunoassay (RIA) with specific antibody. Plasma peptide concentration (pmol/ml) was higher ( p < 0.001) in patients during the pain attack (3.97 ± 1.18) than in controls (0.25 ± 0.03). When measured 4 and 48 h after the pain attack lower levels were found (0.46 ± 0.06) which decreased to control values after 24 h. These results may suggest involvement of peripheral enkephalins in pain modulation in patients with episodic cluster headache.
Abnormal Perceptual Experiences in Migraine
Authors: Morrison Diana P
Published: March 2003

The prevalence of abnormal perceptual experiences as symptoms of migraine attacks was determined in a consecutive series of 46 new female referrals to a migraine clinic. All patients met the diagnostic criteria of the International Headache Society for migraine with aura or migraine without aura and had no other serious physical illness. Seven patients (15%) reported abnormal perceptions (olfactory and/or gustatory hallucinations and distortions of body image) as part of most migraine attacks. A statistically significant association was found between these abnormal perceptual experiences and complaints of mood change, particularly increased depression and irritability, as part of most migraine attacks. It is suggested that spreading depression of cortical electrical activity may be responsible for the manifestations of temporal lobe and limbic system dysfunction.
The Headache Profile of Idiopathic Intracranial Hypertension
Authors: Wall Michael
Published: March 2003

The headache profile of idiopathic intracranial hypertension (IIH, pseudotumour cerebri) has not previously been prospectively studied. We administered a questionnaire to 63 cases at the time of diagnosis. Fifty-eight of the cases had headache and 93% of those with headache reported it to be their most severe ever. Patients characteristically noted a pulsatile headache of gradually increasing intensity that had awakened them. Daily headache occurred in 74% of those reporting headache. Pain in a nerve root distribution or retro-ocular pain with eye movement, uncommon with other headache disorders, help to differentiate this headache syndrome.
Transcranial Doppler Sonography in Familial Hemiplegic Migraine
Authors: Pierelli Francesco , Pauri Flavia , Cupini Letizia Maria , Fiermonte Giancarlo , Rizzo Paolo Andrea
Published: March 2003

A patient affected by familial hemiplegic migraine underwent Transcranial Doppler Sonography twice: the first during a spontaneous attack with right hemiparesis and aphasia, the second during a headache-free period. During the attack the following haemodynamic changes were seen: (a) bilateral increase in the middle cerebral artery and anterior cerebral artery blood flow velocities (this increase was more pronounced on the left side), (b) decreased systo-diastolic ratio and pulsatility index on the right side, (c) increased systo-diastolic ratio and pulsatility index on the left side. Our results indicate that during the attack in this familial hemiplegic migraine patient a diffuse vasoconstriction of the basal cerebral arteries developed. Moreover, Transcranial Doppler Sonography data suggest that a prolonged vasoconstriction of the peripheral arterioles could play a role in determining the neurological symptoms in this syndrome.