bluuebunny/crossref_metadata_2025 huggingface dataset:
Salivary Substance P, 5‐Hydroxytryptamine, and γ‐Aminobutyric Acid Levels in Migraine and Tension‐Type Headache
Authors: Marukawa Hiroko , Shimomura Tokio , Takahashi Kazuro
Published: March 2003

Substance P, 5‐hydroxytryptamine, and γ‐aminobutyric acid levels in saliva were measured in 55 patients with migraine during headache attacks (15 men and 40 women, average age 37.6 years), 36 patients with migraine in interictal periods (8 men and 28 women, average age 43.9 years), 48 patients with tension‐type headache during headache attacks (18 men and 30 women, average age 47.3 years), and 25 patients with tension‐type headache in interictal periods (10 men and 15 women, average age 48.6 years). Forty‐three normal healthy volunteers composed the control group (17 men and 26 women, average age 32.7 years). Substance P levels in saliva were determined using competitive enzyme‐linked immunosorbent assay, and were 26.9 ±± 45.1 pmol/mL in the patients with migraine during headache attacks, 30.0 ±± 59.7 pmol/mL in the patients with migraine in interictal periods, 243.5 ±± 1137 pmol/mL in the patients with tension‐type headache during headache attacks, 101.3 ±± 364 pmol/mL in the patients with tension‐type headache in interictal periods, and 21.2 ±± 17.4 pmol/mL in the healthy controls. 5‐hydroxytryptamine levels in saliva were determined using reversed‐phase high‐performance liquid chromatography with electrochemical detection, and were 895 ±± 1075 ng/mL in the patients with migraine during headache attacks, 758 ±± 1375 ng/mL in the patients with migraine in interictal periods, 1646 ±±1945 ng/mL in the patients with tension‐type headache during active headache periods, 1167 ±± 1495 ng/mL in the patients with tension‐type in headache‐free periods, and 450 ±± 405 ng/mL in the healthy controls. Gamma‐aminobutyric acid levels in saliva were determined using high‐performance liquid chromatography with precolumn ortho‐phthalaldehyde fluorescence detection. Gamma‐aminobutyric acid levels in saliva were 36.8 ±± 49.8 pmol/mL in the patients with migraine during headache attacks, 17.9 ±± 25.2 pmol/mL in the patient, with migraine in interictal periods, 16.0 ±± 18.3 pmol/mL in the patients with tension‐type headache during active headache periods, 14.1 ±± 6.8 pmol/mL in the patients with tension‐type headache in headache‐free periods, and 21.6 ±± 22.7 pmol/mL in the healthy controls. The salivary substance P and 5‐hydroxytryptamine levels in the patients with tension‐type headache during active headache periods were significantIy higher than those in healthy controls. In contrast, we found no significant differences between the salivary γ‐aminobutyric acid levels in the patients with tension‐type headache and healthy controls. The high levels of salivary substance P and 5‐hydroxytryptamine in tension‐type headache patients during headache periods might reflect release of substance P from the pain sensory system. Saliva could represent a fluid particularly suitable to the study of neuropeptide release under specific conditions such as migraine and tension‐type headache.
Descriptive Features and Causal Attributions of Headache in an Australian Community
Authors: Fernandez Ephrem , Sheffield Jeanie
Published: March 2003

The reported characteristics and causes of headache differ across individuals and between groups. Such differences are of interest from an epidemiological point of view. This study set out to identify the main descriptive features and causal attributions of headache within an Australian urban community. A sample of 261 subjects reporting headache volunteered to participate in the survey. Subjects completed a self‐report questionnaire for assessing demographic variables, headache parameters (intensity, duration, etc), headache medication habits, and perceived causes of one's headache (as in the UK headache survey by Blau, 1990). Results revealed that the typical headache sufferer was a middle‐aged employed individual. Migraine versus tension headache were equivalent in number, and on the average, subjects experienced moderate intensity, day‐long headaches that recurred about nine times per month. With regard to causal attributions, the prevalence of headaches due to mental stress was higher than that due to any other single stimulus (eg, noise, exercise), and alcohol was the most frequent dietary cause of headache. These findings are generally consistent with those from previous surveys, although some interesting departures emerge which may be accounted for by demographic differences in the populations studied.
Use of High Sumatriptan Dosages During Episodic Cluster Headache: Three Clinical Cases
Authors: Centonze V. , Polito B.M. , Attolini E. , Cassiano M.A. , Sabbà C. , Ricchetti G. , Bassi A. , Cavazzuti L. , Albano O.
Published: March 2003

The authors describe three patients with episodic cluster headache whose attacks were all treated with subcutaneous sumatriptan.

The patients described had a high frequency of attacks (more than two per day); therefore, far higher dosage of the drug was taken than commonly used in cluster headache. The patients did not experience any particular side effects, neither during the treatment period nor on abrupt withdrawal of the drug. Moreover, neither tachyphylaxis nor addiction were observed.

The authors point out both the efficacy of sumatriptan, confirmed in all the treated attacks, and its safety even at higher dosages than recommended.
Cluster Headache is an Inherited Disorder in Some Families
Authors: Russell Michael Bjørn , Andersson Poul Gertz , Iselius Lennert
Published: March 2003

We investigated the familial occurrence of cluster headache in 370 probands with cluster headache, diagnosed according to the operational diagnostic criteria of the International Headache Society. Seven probands belonged to three families. A positive family history of cluster headache was found in 7% (25 of 366) of the families. Compared with the general population, the first‐ and second‐degree relatives of the 370 probands with cluster headache had a 14‐ and 2‐fold increased risk of having cluster headache, after standardization for sex and age. This increased familial risk strongly suggests that cluster headache has a genetic cause. The patterns of segregation were assessed by complex segregation analysis performed with the computer program, POINTER. The segregation analysis suggests that cluster headache has an autosomal dominant gene with a penetrance of 0.30 to 0.34 in males and 0.17 to 0.21 in females. The gene is present in 3% to 4% of males and 7% to 10% of females with cluster headache.
Psychosocial Factors and Prediction of Headaches in College Adults
Authors: Labbé Elise E. , Murphy Lisa , O'Brien Carol
Published: March 2003

The current study evaluated psychosocial variables that may contribute to the experience of headache in college adults. One hundred ninety‐nine participants, 103 women and 96 men, completed head pain logs for 4 weeks after completing measures assessing psychosocial variables. Multiple regression analyses indicated that level of emotional functioning, perception of stress, and gender were predictive of future headache frequency, intensity, and duration. Family history and health habits did not predict headache activity. These findings are consistent with research investigating psychosocial variables and headache activity.
Ketoprofen Versus Paracetamol in the Treatment of Acute Migraine
Authors: Karabetsos Alexandros , Karachalios George , Bourlinou Paraskevoula , Reppa Asimina , Koutri Rozeta , Fotiadou Androniki
Published: March 2003

The efficacy and safety of ketoprofen and paracetamol were compared for the treatment of acute migraine in a randomized, double‐blind study of 64 patients. Thirty‐four patients received ketoprofen 100 mg intramuscularly, and 30 patients received paracetamol 500 mg intramuscularly. Partial or complete relief of pain and other symptoms was achieved 15 to 20 minutes after administration in the ketoprofen group and within 35 minutes in the paracetamol group. Complete relief of pain was achieved within 30 to 40 minutes after ketoprofen in 28 patients (82.5%) compared to 5 patients (17.5%) in the paracetamol group. Six of the patients treated with ketoprofen needed a second dose for complete relief of pain during the 4‐hour follow‐up period. Side effects were rare and minimal. Our findings suggest that ketoprofen produced statistically significant benefit in the treatment of acute migraine.
Loss of Productivity and Quality of Life in Migraine Sufferers Among French Workers: Results From the GAZEL Cohort
Authors: Michel P. , Dartigues J.F. , Lindoulsi A. , Henry P.
Published: March 2003

To assess the burden of migraine, we compared the productivity and the perceived health of 991 migraine sufferers (IHS criteria), 1004 other‐headache sufferers, and 1757 nonheadache sufferers randomly chosen among volunteers from employees of the French national gas and electricity company. The extent of absenteeism was collected independently from the study subjects during a 4‐year period. Performance at work was self‐assessed at the end of the followup. The study subjects also completed the Short‐Form 36 Health Survey Questionnaire (SF36) and the Spielberger anxiety scale. The number of workdays lost due to migraine was not statistically different between the migraine and control groups, after adjustment for age, sex, and number of health impairments other than headaches. Performance was found to be greatly reduced in migraineurs. The quality of life was poorer and the anxiety level was higher in the migraine group than in the nonheadache group. There was no difference between migraineurs and other‐headache sufferers for any variable. The lack of difference in absenteeism between migraineurs and nonheadache subjects calls into question prior research based on self‐report. Moreover, it also calls into question the economic impact of migraine due to its indirect costs found in previous studies without e control group. We found that the burden of migraine may be considered mainly in terms of reduced quality of life.
Analgesic Drug Taking: Beliefs and Behavior Among Headache Patients
Authors: Ferrari Anna , Stefani Marina , Sternieri Sabina , Bertolotti Marco , Sternieri Emilio
Published: March 2003

Objective. —To explore beliefs and behavior with respect to analgesic drug taking in headache patients. To compare episodic headache to chronic headache sufferers.

Methods. —A consecutive series of 280 headache patients, newly admitted to the Headache Center of the University of Modena, all referred by their general practitioner, were asked to fill out a brief questionnaire, specially compiled for this survey. The questionnaire invited patients to indicate how they themselves thought they should best cope with their headache, and how they actually did so in practice.

Results. —The majority of our patients had a positive attitude towards over‐the‐counter analgesics, which they believed to be more adequate than prescription drugs for acute treatment of their headache. They handled analgesics very carefully, believing it correct to take the drug only when the pain became unbearable, if it was not possible for them to stop work. Chronic headache patients tended to consume more prescription drugs than episodic headache sufferers. Furthermore, the majority of chronic sufferers, as opposed to episodic sufferers, took the analgesic even when not at work.

Conclusions. —The use of over‐the‐counter drugs is considered the best way to treat acute headache even by subjects suffering from severe idiopathic headache and seeking professional care in specialized clinics. Prescribed analgesics are underused by patients with serious episodic headache, which is precisely the group for which they are principally intended.
Alpha1‐Adrenergic Blockers: Do They Have a Place in the Prophylaxis of Migraine?
Authors: Vatz Kenneth A.
Published: March 2003

On the basis of the author’s personal experience with migraine, and occasional reports in the literature suggesting that alpha1‐adrenergic blocking drugs may have a beneficial effect in the prophylaxis of migraine, 10 patients with migraine in a general neurology practice were placed on either terazosin or doxazosin. A decrease in migraine frequency or severity or both was seen in all but I patient, but 5 patients discontinued the drug due to side effects. No serious adverse reactions were reported. This anecdotal experience with the alpha 1 ‐adrenergic blockers warrants a controlled, double‐blind study of this class of drugs for the prophylaxis of migraine.
Continuous Intravenous Dihydroergotamine in the Treatment of Intractable Headache
Authors: Ford Robert G. , Ford Kay T.
Published: March 2003

We reviewed data on 171 patients with refractory headache treated by continuous intravenous dihydroergotamine mesylate (IV DHE 45 ÒÒ ) and repetitive IV DHE and compared the efficacy of continuous IV DHE to repetitive IV DHE. One hundred (58.5%) patients had refractory chronic daily headache. Seventy‐one (42%) had drug rebound headache. One hundred thirty‐eight (81%) had refractory migraine without aura, and 28 (16%) had migraine with aura. Treatment consisted of either continuous IV DHE by infusion pump or repetitive IV DHE and withdrawal of excessively used analgesics, analgesic narcotics, ergotamines, or benzodiazepines. Eighty‐nine (92.5%) patients treated with continuous IV DHE became headache‐free; the majority, 62 (64.5%), within 3 days. Sixty‐five (86.5%) patients treated by repetitive IV DHE became headache‐free, 50 (66.5%) within three days. The average hospital stay for both treatment groups was 4 days. Twelve (12.5%) of the continuous group and 12 (16%) of the repetitive group were headache‐free within 24 hours. The average length of time to become headache‐free was similar for the two groups, 3.06 days for continuous IV DHE and 2.94 days for repetitive IV DHE. The most common side effect was nausea, followed by diarrhea, vomiting, and leg cramps.

We conclude that DHE can be accurately and easily administered by continuous IV infusion pump, and that continuous IV DHE is a safe and efficacious mode of treatment producing results similar to repetitive IV DHE.
Psychophysical Precedents of Migraine in Relation to the Time of Onset of the Headache: The Migraine Time Line
Authors: Spierings Egilius L.H. , Sorbi Marjolijn , Maassen Gerard H. , Honkoop Peter C.
Published: March 2003

We conducted a prospective study of 19 female migraine patients who kept a diary four times per day at 8 AM, I PM, 6 PM, and 11 PM for 10 consecutive weeks. In the diary, the patients recorded the occurrence as well as the features and associated symptoms of their headaches. They also rated five mood states: alertness, tension, irritability, depression, and fatigue, as well as the quality of sleep and the incidence and stressfulness of daily hassles as measurements of stress. They quantified the variables through the use of 100‐mm visual analog scales.

In the diaries, we identified 68 migraine headaches of which 23 developed during the night, 19 during the morning, 16 during the afternoon, and 10 during the evening. The headaches which developed during the evening or night were preceded by an increased incidence of daily hassles during the afternoon. The headaches which developed during the morning or afternoon were preceded by increased tension the previous days.

The day before the headaches which developed during the morning, the incidence of daily hassles was increased during the morning, afternoon, and evening. The increased tension at I PM was followed by increased fatigue at 6 PM, which was still present at 8 AM of the morning during which the headaches developed. The day before the headaches which developed during the afternoon, the increased tension at 6 PM was followed by increased alertness at 11 PM. The next morning, the stressfulness of daily hassles was increased at 8 AM, followed by increased tension and irritability at 1 PM.

We conclude that there are three different sequences of events with regard to the psychophysical precedents of migraine, depending on the time of onset of the headache: the migraine time line.
Headache Diary in the Diagnosis of Childhood Migraine
Authors: Metsähonkala Liisa , Sillanpää Matti , Tuominen Juhani
Published: March 2003

The usefulness of a headache diary in the diagnosis of migraine and in the clarification of migraine symptoms was studied in 145 children. These children belong to a 1year age cohort of 5356 children that has been followed since birth. The children were enrolled in the present study according to their headache status in a questionnaire study at the age of 8 to 9 years, at which time 50 children had migraine, 43 had nonmigrainous headache, and 52 did not have recurrent headache. Information on their present headache status was collected with a face‐to‐face interview at the age of 11 to 13 years and from a headache diary after the interview. The children kept the diary for 2 to 7 months. Altogether, 72 children had migraine according to the International Headache Society criteria for migraine, either in the interview or in the diary. Eight children were diagnosed only according to the diary (11.1%). Thirty‐three children had both migraine attacks and nonmigrainous headache episodes according to the diary, even though they were able to report only one type of headache episode in the interview. The duration of headache episodes was underestimated in the interview, compared to the diary in the children with migraine. Many children recognized new aura symptoms, associated symptoms, and characteristics of pain when they started to pay attention to these when filling in the diary during the follow‐up period. The headache diary is useful in clarifying the features of headache attacks and in the diagnosis of headache types in children.
Clinical and Demographic Characteristics of Migraine in Urban Children
Authors: Lee Lai H. , Olness Karen N.
Published: March 2003

Objective.‐To establish the frequency, symptoms, duration, and treatment methods of childhood migraine in an urban area.

Design.‐Self‐administered questionnaire survey. The questionnaire was designed according to criteria suggested by the International Headache Society (IHS).

Participants.‐In 1994, with the help of school officials in 41 elementary and middle schools in the Greater Cleveland Area, 18000 questionnaires were distributed to the parents of schoolchildren who ranged in age from 5 to 13 years.

Results.‐Of the total 2572 respondents, 222 children (8.6%) met the IHS criteria for migraine. Male to female ratio was 1:1.2 (99:120), 65.8% had a positive family history of migraine, 30.6% had onset of migraine at 4 to 5 years of age, and 54.1% reported having an aura (71% of these were visual aura). The headaches were mostly pulsating, poorly localized, lasted about 2 to 12 hours, and were aggravated by motion, noise, and bright light. The associated symptoms were nausea, vomiting, photophobia, and phonophobia. During the attack, 43% of the migraineurs had to stay in bed, and 27% were unable to attend school. Only 19.8% of the migraineurs were diagnosed to have migraine by their physicians, and most of these had not received treatment.

Conclusion.‐This study in an urban area indicates that childhood migraine is a common, often underdiagnosed disorder that causes significant suffering for children and their families.
Pericranial Muscle Tenderness and Exteroceptive Suppression of Temporalis Muscle Activity: A Blind Study of Chronic Tension‐Type Headache
Authors: Lipchik Gay L. , Holroyd Kenneth A. , Talbot France , Greer Michelle
Published: March 2003

The aim of the present study was to examine the ability of pericranial muscle tenderness and the second exteroceptive suppression period to distinguish chronic tension‐type headache sufferers, migraine sufferers, and controls in a young adult population utilizing a blind design. The second exteroceptive suppression periods were assessed using the methodology recommended by the European Headache Federation and were scored with an automatec computer software program designed in our laboratory to provide reliable, standardized, and precise quantification of exteroceptive suppression periods and eliminate any influence of experimenter bias that may occur with manual scoring.

Our sample consisted of 45 subjects diagnosed according to IHS criteria: 25 with chronic tension‐type headache and 20 with migraine without aura. Twenty‐three headache‐free controls were recruited. Consistent with our previous findings, abnormalities in pericranial muscle‐tenderness, but not in the second exteroceptive suppression period distinguished chronic tension‐type headache sufferers from controls. The chronic tension headache sufferers exhibited the highest pericranial muscle tenderness and the control group exhibited the lowest tenderness (p<.001). Pericranial muscle tenderness was quite successful in distinguishing recurrent headache sufferers from controls, but failed to distinguish chronic tension‐type headache sufferers from migraineurs. Our findings raise the possibility that pericranial muscle tenderness is present early in the development of chronic tension‐type headache and migraine without aura, and thus might contribute to the etiology of headache disorders. Our findings also indicate that a shortened second exteroceptive suppression period is not a reliable marker for chronic tension‐type headache in young adults.
Headache Caused by a Sphenoid Mucocele but Presenting as an Ergotamine‐Induced Headache
Authors: Bauer Birgit , Evers Stefan , Lindörfer Hans W. , Schuierer Gerhard , Henningsen Henning , Husstedt Ingo‐W.
Published: March 2003

In a 65‐year‐old woman, symptomatic headache caused by a mucocele of the sphenoid sinus led to ergotamine abuse and subsequent ergotamine‐induced headache. Since there were no neurological symptoms initially and the patient previously suffered from migraine, the mucocele was not recognized. Only after unsuccessful drug withdrawal therapy and an MRI, was the correct diagnosis made. Surgical removal of the mucocele led to complete relief of headache within 3 weeks. We conclude that ergotamine‐induced headache can develop on the basis of symptomatic headache. In spite of the effectiveness of ergotamine tartrate, an MRI should be performed if focal neurological symptoms occur.
Migrainous Syndrome With CSF Pleocytosis. SPECT Findings
Authors: Rodriguez A.B. Caminero , Pareja J.A. , Arpa J. , Vivancos F. , Palomo F. , Coya J.
Published: March 2003

Brain single photon emission computed tomography (SPECT) findings are described in four adult patients with the transient syndrome of headache with neurological deficits and cerebrospinal fluid (CSF) pleocytosis. Focal deficits consisted of right‐sided hemisensory changes with or without motor dysphasia or dysarthric speech (n=4) and confusional episodes (n=1). All patients had a CSF pleocytosis (with a mean of 309 cells/mm 3 on the first spinal tap; range 75 to 590) and an elevated total protein (mean 130.5 mg/dL; range 70 to 193). The EEG showed excessive focal slowing (n=2). A technetium Tc 99m hexamethyl propylenamine oxime (HMPAO) brain SPECT was performed during a symptom‐free period, within 8 and 25 days after the onset of symptoms (n=4). Three patients showed a decreased tracer uptake in the anterior left hemisphere, topographically consistent with the neurological deficits and EEG slowing. One patient showed no abnormalities. These findings indicate either focally impaired neuronal metabolism or hypoperfusion in regional cerebral blood flow, which could bear some relationship with the clinical features. The possibility that SPECT abnormalities may represent an epiphenomenon was also considered.
Acrophase Amplitude of Ambulatory Blood Pressure Decreases in Migraineurs
Authors: Takeshima Takao , Mishima Katsuko , Tabata Masako , Burioka Naoto , Nakashima Kenji
Published: March 2003

Ambulatory blood pressure was recorded and analyzed in 13 migraineurs during headache‐free periods and in 11 healthy subjects. Systolic blood pressure, mean blood pressure, diastolic blood pressure, pulse pressure, and pulse rate were recorded for 48 hours (three times every hour from 6 AM to mid night, once an hour at night). Circadian variation of blood pressure was analyzed using single cosinor analysis and group mean cosinor analysis methods. Single cosinor analysis identified significant circadian rhythm of systolic blood pressure in 10 of 11 control subjects (90.9%) and 5 of 13 migraineurs (38.5%. P<0.02 versus controls, Fisher’s exact test). Incidences of significant circadian rhythm of mean blood pressure and diastolic blood pressure were 100% and 100% in controls, 48.2% and 53.8% in the migraineurs (P<0.01, P<0.02 versus controls). Incidences of significant rhythm of pulse pressure were 36.3% in controls and 38.5% in the migraine group (difference was not significant). Group mean cosinor analysis identified significant circadian rhythm in both the migraine group and the controls. The MESOR (midline estimating statistic of rhythm) values of systolic, mean, and diastolic blood pressures showed no significant differences between the migraine group and the controls. Acrophase amplitudes of systolic, mean, and diastolic blood pressures were 4.2, 5.2, and 5.9 mm Hg in the migraine group, respectively; and 7.2, 7.3, and 7.5 mm Hg in the controls, respectively. These amplitudes of systolic, mean, and diastolic blood pressures in the migraine group were significantly smaller than those in the controls. These data suggest that some migraineurs lose or alter their circadian blood pressure rhythm. Evaluating migraineurs as a group, significant circadian rhythm of blood pressure can be identified and oscillation amplitudes of blood pressures are decreased. The present results suggest that migraineurs may be subject to dysfunction of the circadian rhythm generator and the autonomic nervous system. Possible involvement of serotonergic projections from the raphe to the suprachiasmatic nuclei of the hypothalamus in migraine is discussed.
Hemicrania Continua With Onset at an Early Age
Authors: Fragoso Yara D. , Machado Paulo Christian
Published: March 2003

The authors describe the case of an adolescent who had suffered from unilateral continuous headache since she was 8 years old. Treatment with indomethacin 50 mg/day promptly relieved the pain which had affected her for the previous 9 years. To the best of our knowledge, this is the earliest onset of hemicrania continua reported.
Potential Neurogenic and Vascular Roles of Nitric Oxide in Migraine Headache and Aura
Authors: Myers Daniel E.
Published: March 2003

It has long been known that nitrate and nitrite medications consistently cause significant headache as a side effect. Classical research has shown that cerebral vasodilation accompanies the use of these medications. More modern studies suggest that these vasodilators exert their action on blood vessels via nitric oxide and its second messenger, cyclic guanosine monophosphate. This paper reviews research studies and theoretical articles which address the concept that nitric oxide plays a major role in the vasodilation associated with the headache phase of migraine with aura. A brief discussion of nitric oxide biochemistry and pharmacology follows.

In addition, there is a review of evidence examining the possible contributions of nitric oxide to the neurogenic and vascular events associated with spreading cortical depression, an animal model of migraine aura. The paradoxical hypotheses that nitric oxide may contribute to both the propagation of spreading cortical depression and its limitation are presented. Finally, a rationale for the experimental use of nitric oxide agonists and antagonists in the abortion of migraine aura is introduced.
Epidemiology of Chronic Daily Headache in the General Population
Authors: Castillo Jesús , Muñoz Pedro , Guitera Victoria , Pascual Julio
Published: March 2003

Background and Objectives.—Although chronic daily headache, mainly transformed migraine, is an important reason for consultation in headache clinics, its actual prevalence is unknown. This study analyzes the prevalence of the different types of chronic daily headache in an unselected population.

Methods.—A questionnaire exploring headache frequency was distributed to 2252 unselected subjects. Those having headache 10 or more days per month were given a headache diary and were seen by a neurologist who classified their headaches. The varieties of chronic daily headache were classified according to the second revision of IHS criteria proposed by Silberstein et al published in Neurology 1996;47:871.

Results.—The questionnaire was returned by 1883 subjects (83.5%). One hundred thirty‐five admitted to headache 10 or more days per month. Chronic daily headache criteria were fulfilled by 89 individuals (4.7%). Eighty were women. Forty‐two (47.2% of subjects with chronic daily headache and 2.2% of all subjects) had chronic tension‐type headache. Analgesic overuse was found in 8 (17%). Transformed migraine was diagnosed in 45 (50.6% of subjects with chronic daily headache and 2.4% of all subjects). Fourteen (31.1%) individuals with this form of chronic daily headache overused ergots or analgesics. The remaining 2 cases in this series met the criteria of new daily persistent headache. No one was diagnosed as having hemicrania continua.

Conclusions.—Almost 5% of the general population (9% of women) suffers from chronic daily headache, the proportion of chronic tension‐type headache and transformed migraine being quite similar. Less than one third overuse analgesics. The prevalence of chronic daily headache subtypes shown here differs from data obtained from headache clinics, emphasizing that caution is needed in extrapolating data from specialized units to the general population.
The Headache in American Medical Practice in the 19th Century: A Historical Overview
Authors: McTavish Jan R.
Published: March 2003

An examination of American medical literature reveals that in the 19th century, headache was seen as an important diagnostic sign, and served to demonstrate medicine’s concern with explanations, rather than its therapeutic effectiveness. Headache treatment was therefore directed at causes rather than at its chief symptom: painkilling was regarded as empirical, quackish, and sectarian. Even when nonnarcotic analgesic drugs, such as phenacetin and aspirin, were introduced towards the end of the century, physicians tended not to use them for headache.
The Occipital Cortex Is Hyperexcitable in Migraine: Experimental Evidence
Authors: Aurora SK. , Cao Y. , Bowyer SM. , Welch K.M.A.
Published: March 2003

Objectives.—Threshold for generation of magnetophosphenes has been reported to be lower in migraine. We compared the threshold for eliciting phosphenes by transcranial magnetic stimulation and the ability to visually trigger headache in a select group of individuals with migraine with and without aura to normal controls.

Methods.—Transcranial magnetic stimulation was performed using the Cadwell MES‐10 stimulator. A circular coil, 9.5 cm in diameter, was applied to the occipital scalp (7 cm above the inion). Stimulator intensity was increased in 10% increments until subjects reported visual phenomena or 100% intensity was reached. Stimulator intensity was then fine‐tuned to determine the threshold at which phosphenes were seen. In the same subjects, visual stimulation was given in 3.0 T MRI and if a headache occurred the response was recorded.

Results.—Fifteen subjects with migraine were compared to 8 controls. A significant proportion of the migraineurs (86.7%) developed phosphenes compared to the controls (25%) (P=.006). The probability of triggering a headache was also higher in the migraineurs (53%); no headache was triggered in the controls (P=.019). A significant correlation was found between the threshold for phosphenes on transcranial magnetic stimulation and visually triggered headache (P=.002). When only migraine was considered, there was again a significant trend (P=.O84).

Conclusions.—There is a difference in threshold for excitability of occipital cortex in migraineurs and controls.The hyperexcitable visual cortex in migraine is predisposed to visually triggered headache.
Baclofen in Cluster Headache
Authors: Hering‐Hanit R. , Gadoth N.
Published: March 2003

Cluster headache is a rare, severe, clinically well‐characterized disorder that occurs in both episodic and chronic forms. The painful short‐lived attacks occur unilaterally and are associated with signs and symptoms of autonomic involvement. They are difficult to treat, and reported prophylactic therapies include ergotamine, steroids, methysergide, lithium carbonate, verapamil, valproate, capsaicin, leuprolide, clonidine, methylergonovine maleate, and melatonin.

Baclofen, an antispastic agent, has been shown to have an antinociceptive action. Its efficacy in the treatment of neuralgias, central pain following spinal lesions or painful strokes, migraine, and medication misuse chronic daily headache suggested that it may prevent cluster headache attacks. Nine cluster headache patients received baclofen, 15 to 30 mg, in three divided doses. Within a week, six of nine patients reported the cessation of attacks. One was substantially better and became attack free by the end of the following week. In the remaining two patients, the attacks worsened and corticosteroids were prescribed. In this pilot study, baclofen seemed to be effective and well tolerated for the prevention of cluster headache.
Genetic and Environmental Factors Associated With Migraine in Schoolchildren
Authors: Bener A. , Uduman S.A. , Qassimi E.M.A. , Khalaily G. , Sztriha L. , Kilpelainen H. , Obineche E.
Published: March 2003

Objective.–The aim of this study was to find the prevalence of migraine and headache in schoolchildren in the United Arab Emirates and to determine the genetic and environmental factors associated with these conditions.

Methods.–A cross‐sectional population study was performed from October 1995 to June 1996. Subjects were selected by a multistage stratified sampling procedure. Data were collected by screening questionnaires followed by clinical interviews. Twelve primary schools and 1400 schoolchildren of United Arab Emirates nationality resident in the Al Ain City, Dubai, and Sharjah emirates were recruited for this study. A total of 1159 (82.7%) schoolchildren gave their consent to the study.

Results.–The estimated prevalence rates for headache and migraine were 36.9% and 13.7%, respectively. The prevalence of headache is increased with age, the highest prevalence being in 13‐year‐old children (17.5%). Of the 159 children who fulfilled the diagnostic criteria for migraine, 76 were boys whose mean age (± SD) was 10.3 years ± 2.8 years, and 83 were girls (mean age 9.9 ± 2.5 years). Of the children who had migraine, 20 (12.6%) had migraine without aura, and 13 (8.2%) had migraine with aura. The most common migraine symptoms in schoolchildren had been aggravated by physical activity (47.2%) and a positive family history of migraine (46.5%). The most common illnesses were infectious illnesses (41.5%). There was a strong relationship between migraine and the timing of examinations (46.5%). The most common environmental exposure for migraine was found to be playing on a computer (45.9%), followed by loud noise (41.5%), and a hot climate (37.1%). In familial occurrence of headache among immediate relatives, the most frequently affected relative was the mother (17.6%).

Conclusion.–Headache and migraine are common in childhood and may be influenced by social, familial, environmental, and psychological factors.
Solubilized Ibuprofen: Evaluation of Onset, Relief, and Safety of a Novel Formulation in the Treatment of Episodic Tension‐type Headache
Authors: Packman Barry , Packman Elias , Doyle Geraldine , Cooper Stephen , Ashraf Elizabeth , Koronkiewicz Karen , Jayawardena Shyamalie
Published: March 2003

Objective.—To evaluate the relative efficacy of a new solubilized formulation of ibuprofen compared with acetaminophen caplets.

Methods.—This double‐blind, randomized, parallel group study evaluated 154 subjects taking a single dose of solubilized ibuprofen, 400 mg; acetaminophen, 1000 mg; or placebo for the relief of episodic tension‐type headache. Time to relief was measured using a stopwatch, and overall efficacy was measured using traditional categorical pain and relief scales.

Results.—Ibuprofen capsules (liquigel), 400 mg, were significantly faster than both acetaminophen, 1000 mg, and placebo for all time‐to‐relief measures. Ibuprofen liquigel had a median time to first perceptible pain relief of 39 minutes compared with 47 minutes for acetaminophen and 113 minutes for placebo. For median time to meaningful relief, ibuprofen liquigel had a time of 39 minutes compared with 53 minutes for acetaminophen and more than 180 minutes for placebo (P.02 for both measures). In addition, ibuprofen liquigels demonstrated significantly superior overall analgesic efficacy compared with acetaminophen, 1000 mg, for the relief of episodic tension‐type headache. Both active treatments had a side effect profile similar to placebo.

Conclusions.—Although several other studies have demonstrated the overall analgesic superiority of ibuprofen to acetaminophen, this study demonstrated that the liquigel formulation also provides a clinically relevant advantage for time to analgesic effects.
Venlafaxine Extended Release (XR) for the Prophylaxis of Migraine and Tension‐type Headache: A Retrospective Study in a Clinical Setting
Authors: Adelman Leon C. , Adelman James U. , Von Seggern Randal , Mannix Lisa K.
Published: March 2003

Objective.—To assess the efficacy of extended‐release venlafaxine in the prophylaxis of migraine and chronic tension‐type headache.

Background.—Venlafaxine, a structurally novel antidepressant, is a selective serotonin‐norepinephrine reuptake inhibitor. This study is the first to test the effects of extended‐release venlafaxine on headaches.

Methods.—Patients were evaluated on a retrospective basis. Fifty‐six patients with chronic tension‐type headache and 114 patients with migraine were prescribed extended‐release venlafaxine. Nearly all the study subjects had been resistant to several previous preventive medications. Patients took venlafaxine for an average of 6 months with a median dose of 150 mg (range, 37.5 to 300 mg).

Results.—The mean frequency of headaches in the group with chronic tension‐type headache fell from 24.0 to 15.2 per month (P < .0001). The group with migraine showed a reduction from 16.1 to 11.1 headaches per month (P < .0001). The medicine was well tolerated.

Conclusions.—This trial indicates that extended‐release venlafaxine has potential in headache prophylaxis based on its efficacy and safety profile. We recommend a double‐blind, placebo‐controlled study to further assess the role of extended‐release venlafaxine in headache prevention.
Modified‐Release Formulation of Tizanidine in Chronic Tension‐type Headache
Authors: Murros K. , Kataja M. , Hedman C. , Havanka H. , Säkö E. , Färkkilä M. , Peltola J. , Keränen T.
Published: March 2003

The efficacy of the modified‐release formulation of tizanidine (Sirdalud) was compared with placebo in a randomized, double‐blind, parallel‐group study of 138 women and 47 men, aged 18 to 79 years, with a history of chronic tension‐type headache (IHS categories 2.2 and 2.3). The treatment period was 6 weeks preceded by a 2‐week prerandomization period. The patients were randomly assigned to receive 6‐mg Sirdalud, 12‐mg Sirdalud MR, or placebo. The study medication was taken once per day, orally in the evening. Efficacy was measured by visual analog scale, the number of headache‐free days, the daily duration of headache, and the use of paracetamol. The primary end point was the severity of daily headache derived from visual analog scale scores covering the last 2 treatment weeks. One hundred sixty patients (56 in the 6‐mg group, 49 in the 12‐mg group, and 55 in the placebo group) completed the study. The severity of the headache decreased similarly in the treatment groups and the placebo group. The visual analog scale values decreased from the prerandomization values by 53% in the 6‐mg group, 48% in the 12‐mg group, and 52% in the placebo group. The modified‐release formulation of tizanidine in doses up to 12 mg taken in the evening is not superior to placebo in the treatment of chronic tension‐type headache. The placebo effect was unexpectedly strong in the present study, supporting the view that psychophysiological mechanisms are of considerable importance in sustaining chronic tension‐type headache.
Postpartum Cerebral Angiopathy in a Patient With Chronic Migraine With Aura
Authors: Modi Mala , Modi Girish
Published: March 2003

A 25‐year‐old woman with a history of chronic severe migraine with aura presented in an apoplectic state 1 week after the delivery of her third child. She developed a severe headache and within hours lapsed into a coma. A CT scan of the brain showed cerebral edema and an occipital hemorrhage. A four‐vessel angiogram showed diffuse arterial narrowing of all the intracranial vessels with segmental narrowing of the suprasellar portion of the internal carotid arteries bilaterally. She had no risk factors for stroke or vasculitis. Her pregnancy and delivery were uneventful with no preeclampsia or eclampsia. Apart from ergometrine at the time of the delivery, no vasoconstrictor drugs were used.

She recovered spontaneously. Serial CT scans of the brain demonstrated resolution of the edema and hemorrhage with the development of cortical and watershed infarcts. A repeat cerebral angiogram was normal. She was, therefore, diagnosed as having suffered from postpartum cerebral angiopathy, a form of reversible cerebral vasoconstriction, called the Call or Call‐Fleming syndrome.

The relationship between migraine and postpartum angiopathy in the development of reversible cerebral vasoconstriction is discussed.
Botulinum Toxin Type A and EMG: A Key to the Understanding of Chronic Tension‐type Headaches?
Authors: Rollnik Jens D. , Karst Matthias , Fink Matthias , Dengler Reinhard
Published: March 2003

Background.—The pathogenesis of chronic tension‐type headache remains unclear, and the role of muscle tension is especially controversial. Botulinum toxin type A, a potent inhibitor of muscle tone, has been used to treat chronic tension‐type headache.

Objective.—To determine whether clinical response to treatment of chronic tension‐type headache with Botox A parallels changes in resting muscle activity recorded through serial electromyography (EMG).

Methods.—We randomly assigned eight patients with chronic tension‐type headache to pericranial injection of 500 MU Botox A versus placebo (isotonic saline).

Results.—At 6 and 12 weeks following treatment, there were no significant differences in clinical outcome between the placebo and the Botox A groups. This occurred despite EMG evidence of a reduction in resting muscle activity in the Botox A‐treated patients.

Conclusion.—These results support the hypothesis that peripheral mechanisms such as increased muscle tone play, at most, a minor role in the pathophysiology of chronic tension‐type headache.
Chronic Daily Headache: Identification of Factors Associated With Induction and Transformation
Authors: Bigal Marcelo E. , Sheftell Fred D. , Rapoport Alan M. , Tepper Stewart J. , Lipton Richard B.
Published: March 2003

Background.—Chronic daily headache (CDH) is one of the more frequently encountered headache syndromes at major tertiary care centers. The analysis of factors related to the transformation from episodic to chronic migraine (CM) and to the de novo development of new daily persistent headache (NDPH) remain poorly understood.

Objectives.—To identify somatic factors and lifestyle factors associated with the development of CM and NDPH.

Methods.—We used a randomized case‐control design to study the following groups: 1) CM with analgesic overuse (ARH), n = 399; 2) CM without analgesic overuse, n = 158; and 3) NDPH, n = 69. These groups were compared with two control groups: 1) episodic migraine, n = 100; and 2) chronic posttraumatic headache (CPTH); n = 65. Associated medical conditions were assessed. We investigated the case groups for any association with somatic or behavioral factors. Data were analyzed by the two‐sided Fischer's exact test, with the odds ratio being calculated considering a 95% confidence interval using the approximation of Woolf.

Results.—When the active groups were compared with the episodic migraine group, the following associations were found: 1) ARH: hypertension and daily consumption of caffeine; 2) CM: allergies, asthma, hypothyroidism, hypertension, and daily consumption of caffeine; and 3) NDPH: allergies, asthma, hypothyroidism, and consumption of alcohol more than three times per week. The following associations were found when comparing the active groups with CPTH: 1) ARH: asthma and hypertension; 2) CM: allergies, asthma, hypothyroidism, hypertension, and daily consumption of caffeine; and 3) NDPH: allergies, asthma, hypothyroidism, and consumption of alcohol more than three times per week.

Conclusions.—Several strong correlations were obtained between patients with specific types of CDH and certain somatic conditions or behaviors; some have not been previously described. Transformation of previously episodic headache or development of a NDPH thus may be related to certain medical conditions and behaviors beyond the frequently incriminated precipitant analgesic overuse. As similar results were obtained when CPTH was used as a control, the correlation is more complex than simple comorbidity.
Results of Surgery in Patients with Refractory Extratemporal Epilepsy with Normal or Nonlocalizing Magnetic Resonance Findings Investigated with Subdural Grids
Authors: Cukiert Arthur , Buratini Jose A. , Machado Elcio , Sousa Alcione , Vieira Joaquim O. , Argentoni Meire , Forster Cassio , Baldauf Cristine
Published: March 2003

Summary:  Purpose: To study the efficacy of extensive coverage of the brain surface with subdural grids in defining extratemporal cortical areas amenable for resection in patients with refractory extratemporal epilepy (R‐ExTE) and normal or nonlocalizing magnetic resonance imaging (MRI) scans.

Methods: Sixteen patients with R‐ExTE were studied. Eleven patients had simple partial, eight had complex partial, and three had supplementary motor area seizures. Seizure frequency ranged from three per month to daily episodes. Interictal EEG showed large focal spiking areas in 11 patients, secondary bilateral synchrony in four, and was normal in one patient. Surface ictal recordings were nonlocalizing in six patients, and in 10, they disclosed large ictal focal spiking areas. MRI was normal in 10 patients, and in six patients, focal nonlocalizing potentially epileptogenic lesions were found. All patients were given an extensive coverage of the cortical convexity with subdural electrodes through large unilateral (n = 13) or bilateral (n = 3) craniotomies. Bipolar cortical stimulation was carried out through the implanted electrodes.

Results: Interictal invasive recording findings showed widespread spiking areas in 13 patients and secondary bilateral synchrony in three. Ictal invasive recordings showed focal seizure onset in all patients. There were six frontal, two parietal, one temporooccipital, four rolandic, and three posterior quadrant resections. Thirteen patients had been rendered seizure free after surgery, and three had 90% of seizure‐frequency reduction. Pathologic findings included gliosis (n = 10), cortical dysplasia (n = 5), or no abnormalities (n = 1). Six patients had transient postoperative neurologic morbidity.

Conclusions: Extensive subdural electrodes coverage seems to be an effective way to investigate patients with R‐ExTE and normal or nonlocalizing MRI findings.