bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Pain in Human Temporal Muscle Induced by Hypertonic Saline, Potassium and Acidity
Authors: Jensen Kai , Norup Michael
Published: March 2003

The study was aimed at developing a reference model for experimental pain and tenderness in the human temporal muscle by the local injection of hypertonic saline, potassium chloride and acidic phosphate buffer, using isotonic saline as control. The design was randomized and double-blind. Twenty healthy subjects had 0.2 ml test solution injected into one temporal muscle and saline into the other. Following each injection, pain was rated on a 10-point ordinal scale and pressure-pain thresholds were measured every minute for 10 min by a pressure algometer. Hypertonic saline ( n = 11) and potassium chloride ( n = 12) induced significantly more pain than isotonic saline ( ANOVA, p < 0.0001). Compared to control injections, hypertonic saline and potassium chloride induced a significant reduction in pressure-pain threshold (ANOVA, p < 0.0001 and p < 0.05). Forty-eight percent of the injections led to the referral of pain most often to the jaws. A positive correlation between the relative occurrence of referred pain and pain intensity was observed ( p < 0.001) as was a negative correlation between the decrease in pressure-pain threshold and pain intensity ( p < 0.05).
Tension Headache and The Cervical Spine Plain X-Ray Findings
Authors: Wöber-Bingöl Çiçek , Wöber Christian , Zeiler Karl , Heimberger Karl , Baumgartner Christoph , Samec Peter , Wessely Peter
Published: March 2003

The aim of the present study was to investigate if there is any causal connection between plain X-ray findings of the cervical spine and tension headache. We evaluated the X-rays of the cervical spine of 243 patients, in 91 of which the diagnosis was “tension headache”, in 102 “headache not fulfilling the criteria of tension headache” and in 50 “spondylogenic complaints without headache”. We compared these three groups with regard to frequency and severity of radiologically assessable changes of the cervical spine and found that patients with tension headache had normal findings significantly more often and significantly less often functional or organic changes or both than patients of the other two groups. The radiologically assessable changes of the cervical spine are unlikely to have an essential role in the cause or mechanism of tension headache.
Cytochrome-P450-Dependent Hydroxylation in Cluster Headache
Authors: Tomson Torbjörn , Waldenlind Elisabet , Ekbom Karl
Published: March 2003

Two isozymes of the cytochrome-P450-dependent drug oxidizing system exhibit polymorphism. Five to 10% of a Caucasian population are deficient in debrisoquine-hydroxylase activity and about 3% in mephenytoin-hydroxylase activity (poor metabolizers). We tested the hypothesis of a possible over-representation of poor metabolizers among patients with cluster headache. The individual metabolic capacity was determined in 30 cluster headache patients after administration of a test dose of 10 mg of debrisoquine and 100 mg of mephenytoin. Two patients (6.7%) were poor metabolizers of debrisoquine and one (3.3%) a poor metabolizer of mephenytoin. This was no different from the rate of poor metabolizers, 7.1% and 3.3% respectively, in a reference panel of healthy Swedish volunteers.
Sumatriptan Injection is Superior to Placebo in The Acute Treatment of Migraine With Regard to Both Efficacy and General Well-Being
Authors: Dahlöf C , Edwards C , Toth AL
Published: March 2003

The efficacy of subcutaneous injection of sumatriptan in the acute treatment of migraine was assessed in a double-blind, randomized, placebo-controlled cross-over study of 27 migraine patients. In addition, the patients were asked to give information about their well-being and subjective symptoms by means of a self-administered standardized questionnaire. A total of 22 migraine sufferers received a subcutaneous (sc) injection of 8 mg of sumatriptan and 24 received placebo. Of these patients, 19 received both treatments and thus completed the study. The primary efficacy end-point was a reduction in headache severity from severe or moderate to mild or no headache at 30, 60, 90 and 120 min. An effective response to treatment was achieved within 30 min in 63% and within 60 min in 84% of patients when treated with 8 mg sumatriptan sc, compared with 11% for placebo ( p < 0.001). Sumatriptan also provided significant relief from nausea and photophobia as compared with placebo. The proportion of patients that needed rescue medication after 120 min was significantly lower ( p < 0.001) with active treatment when compared with placebo. Sumatriptan was well tolerated and the majority of adverse events were mild and transient. The most frequent symptoms were those of malaise/fatigue or numbness. No changes in blood pressure or ECG readings were observed during the treatment. Compared with placebo, subcutaneous 8 mg sumatriptan also caused a substantial improvement in general well-being as revealed by the Minor Symptoms Evaluation Profile-acute (MSEP-acute) questionnaire. It is concluded that subcutaneous injection of sumatriptan is an effective, rapid-acting, and well-tolerated acute treatment for migraine attacks.
A Nationwide Survey of Migraine in France: Prevalence and Clinical Features in Adults
Authors: Henry Patrick , Michel Philippe , Brochet Bruno , Dartigues Jean François , Tison Sylvie , Salamon Roger
Published: March 2003

In November 1990 a nationwide survey of migraine was conducted in France on a representative sample of residents aged 15 years and older. The diagnosis of migraine was based on the International Headache Society (IHS) classification. In a previous study, we validated a diagnostic algorithm which classifies headache sufferers as IHS migraine, “borderline” migraine, possible migraine and non-migrainous headache. The overall prevalence of migraine patients with the IHS criteria in the present study was 8.1%; another 4% were classified as “borderline” migraine, which we in fact considered as definite migraine. Age, gender and occupation were found to be risk factors for migraine. Neither frequency and duration of attacks nor length of time of disease differed with gender. Expressed intensity of attacks, however, was greater in females.
Childhood Migraine in General Practice: Clinical Features and Characteristics
Authors: Mortimer MJ , Kay J , Jaron A
Published: March 2003

Previous studies have evaluated the clinical features and characteristics of migraine in selected children attending hospital clinics. There have, however, been no community studies on the prevalence and characteristics of migraine in children aged 3–11 years in British general practice. In this study, a total of 1,083 children (from 1,104 registered with a general practice) and their parents were interviewed. Possible migraine sufferers took part in an extended interview that assessed various characteristics of the patients and their attacks. The survey showed that migraine attacks started in infancy, and migrainous children were more likely to have mothers with migraine. Some clinical features were found to be age-dependent. Compared with similar hospital surveys there was a lower frequency of attacks recorded but the prevalence of aura was similar to that found in previous studies.
The Influence of Acetazolamide on Cerebral Low-Flow Regions in Migraine an Interictal 99mTc-HMPAO SPECT Study
Authors: Schlake Hans-Peter , Böttger Ingolf Gerhard , Grotemeyer Karl-Heinz , Husstedt Ingo Wilhelm , Oberwittler Christoph , Schober Otmar
Published: March 2003

Acetazolamide, a carbonic anhydrase inhibitor, has proved to be useful in the assessment of “vasodilatory capacity” in cerebrovascular disease. To obtain further information on the nature of interictal low-flow regions in migraine, we reinvestigated 20 asymptomatic patients suffering from migraine with aura ( n = 15) or without aura ( n = 5) and who had either minor ( n = 12) or marked ( n = 8) regional hypoperfusion when examined in a previous 99mTc-HMPAO SPECT investigation. These patients received acetazolamide IV prior to tracer application. In 14/20 cases regional hypoperfusion resolved. Three patients with migraine with aura had less pronounced regional hypoperfusion compared to baseline. No change in baseline hypoperfusion was detectable in three older patients. No further decreases in flow were measured. In contrast to patients with cerebrovascular ischemia, in whom acetazolamide usually enhances low-flow regions, vasodilatory capacity appears intact in most migraine patients with interictal regional hypoperfusion. Thus, the “acetazolamide test” might be useful in the differential diagnosis of migraine with aura from transient cerebrovascular ischemia.
Treatment of Migraine Attacks with Subcutaneous Sumatriptan: First Placebo-Controlled Study
Authors: Visser W Hester , Ferrari Michel D , Bayliss Evelyn M , Ludlow Susan , Pilgrim Alison J
Published: March 2003

The results of the very first large-scale placebo-controlled dose-response trial with the novel selective 5-hydroxytryptamine1-like (5HT 1-like) receptor agonist sumatriptan are presented. We studied the efficacy and tolerability of subcutaneous injections of 1 mg, 2 mg and 3 mg of sumatriptan in alleviating migraine attacks in a double-blind, placebo-controlled, parallel-group, multicentre clinical trial. Six-hundred and ninety patients were randomized and 685 received study medication. At 30 min, reduction of headache severity to mild or none (primary efficacy endpoint) was achieved in 22% (95% CI: 15-28%) of placebo-treated patients and in 39% (CI: 31-46%) of patients treated with 1 mg sumatriptan, 44% (CI: 36-51%) treated with 2 mg sumatriptan and 55% (CI: 48-63%) treated with 3 mg sumatriptan. Differences from placebo were 17% (CI: 8-27%) for 1 mg sumatriptan, 22% (CI: 13-32%) for 2 mg sumatriptan and 34% (CI: 24-44%) for 3 mg sumatriptan ( p < 0.001 for all three comparisons). Other migraine symptoms were also more effectively treated by sumatriptan than by placebo. Subsequently, an open-label 3 mg dose subcutaneous sumatriptan was given to partial or non-responders. Thirty minutes after this open dose the response rate to sumatriptan had improved to between 70 and 80%. Adverse events after sumatriptan were minor and short-lived. We conclude that subcutaneous sumatriptan is well tolerated in doses up to 3 + 3 mg and may rapidly abort migraine attacks.
Pain as the Only Manifestation of Internal Carotid Artery Dissection
Authors: Biousse Valérie , Woimant France , Amarenco Pierre , Touboul Pierre-Jean , Bousser Marie-Germaine
Published: March 2003

Internal carotid artery dissection is a major cause of ischemic stroke in the young. Pain is the leading symptom and is associated with other focal signs such as Horner's syndrome and painful tinnitus or with signs of cerebral or retinal ischemia. We report two patients with angiographically confirmed extracranial internal carotid artery dissection presenting with cephalic pain as the only manifestation. The first patient had a diffuse headache and a latero-cervical pain lasting for 12 days, reminiscent of carotidynia. The second patient experienced an exploding headache suggestive of subarachnoid hemorrhage, which was ruled out by computed tomography of the head and cerebrospinal fluid study. These patients demonstrate that recognition of carotid artery dissection as a cause of carotidynia and headache suggestive of subarachnoid hemorrhage may permit an earlier diagnosis and possibly the prevention of a stroke through the use of anticoagulation.
A Double-Blind Controlled Study of Nifedipine as An Abortive Treatment in Acute Attacks of Migraine With Aura
Authors: Hoffert Marvin J , Scholz Mary J , Kanter Roy
Published: March 2003

Patients with migraine with aura treated each of six acute attacks with either nifedipine or vehicle administered in double-blind, randomized form. Two modes of administration were studied. Both increased the intensity of headaches compared to vehicle. We conclude that nifedipine is not useful as an abortive treatment of migraine with aura.
Exteroceptive Suppression of Temporalis Muscle Activity: Perspectives in Headache and Pain Research
Authors: Göbel Hartmut , Dworschak Mathias , Wallasch Thomas-Martin
Published: March 2003

The paper describes possible future applications of the exteroceptive suppression (ES) of temporalis muscle activity in headache and pain research. ES is examined as a method for investigating the pathophysiology of pain mechanisms, for assisting clinical diagnosis, and for evaluating therapeutic effects. ES is one of the newest methods in headache research which permits an objective analysis of head pain as well as pain mechanisms and accordingly has an important future in headache research.
Contingent Negative Variation-Findings and Perspectives in Migraine
Authors: Kropp Peter , Gerber Wolf-Dieter
Published: March 2003

Contingent negative variation (CNV) is a negative cerebral potential which is related to attention and arousal. CNV occurs during an experimental situation in which stimuli and responses are serially organized. Between attacks migraine patients have on average higher negative amplitudes compared to healthy controls or patients with tension-type headache. Successful treatment with beta-blocking agents decreases CNV amplitudes. In spite of encouraging findings in neurological disorders, CNV is not widely used. In this review some possible reasons for this are pointed out.
Is Increased Amplitude of Contingent Negative Variation in Migraine Due to Cortical Hyperactivity or to Reduced Habituation?
Authors: Kropp Peter , Gerber Wolf-Dieter
Published: March 2003

The aim of this study was to compare the habituation kinetics of contingent negative variation (CNV) between 12 migraineurs without aura and matched healthy controls. CNV was studied with a 3 sec interval between the warning stimulus (WS) and the imperative stimulus (IS). The data from (a) the total interval (WS-IS), (b) early component, and (c) late component were analyzed. During successive trials the habituation kinetics were determined using regression analysis. On CNV averaged over 32 trials, migraine patients had a significantly higher negativity in the total interval compared to controls. When sequential blocks of four trials were analyzed, the most significant finding in migraineurs was lack of habituation of the early CNV component. The present study indicates that a delayed habituation, rather than a general increased cortical activity, is responsible for the CNV abnormalities in migraine without aura. We suggest that migraineurs between attacks not only have a cortical hyperexcitability, but also a lack of cortical inhibition causing delayed habituation.
Topographic EEG Mapping in Childhood Headaches
Authors: Pothmann Raymund
Published: March 2003

The clinical distinction between migraine without aura and tension headache is more difficult in young children than it is in adults. The objective of this study was to examine the usefulness of topographic EEG mapping, as one method among other diagnostic techniques, for establishing a diagnosis. The clinical diagnosis of tension headache and migraine in children between 6 and 15 years of age was established according to criteria of the International Headache Society classification. Children with migraine and tension headache were examined during and between attacks. EEG mapping showed lateralized parietal diminution of alpha-power more frequently during an attack of migraine than during tension headache, which regressed between attacks. Compared to other methods, such as visual evoked potentials, EEG mapping may have the advantage of helping to diagnose each single headache, which could be useful in patients with combined headaches.
Neuroexcitatory Amino Acid Levels in Plasma and Cerebrospinal Fluid During Migraine Attacks
Authors: Martínez Francisco , Castillo José , Rodríguez José Ramón , Leira Rogelio , Noya Manuel
Published: March 2003

A current hypothesis for migraine suggests that neuroexcitatory amino acids may participate in the triggering of attacks. To investigate this possibility we measured glutamic and aspartic acid level in plasma and cerebrospinal fluid (CSF) of patients with common and classic migraine during attacks, making comparisons with controls suffering from stress. Plasma levels of amino acids in migraine patients were lower than in controls. CSF concentrations of glutamic acid were higher in migraineurs than in controls. Our results suggest an excess of neuroexcitatory amino acids in the CNS of migraine patients during attacks, possibly favoring a state of neuronal hyperexcitability.
Red Blood Cell Magnesium Levels in Migraine Patients
Authors: Gallai Virgilio , Sarchielli Paola , Morucci Piero , Abbritti Giuseppe
Published: March 2003

In the last few years, it has been suggested that magnesium plays a central role in establishing a threshold for migraine attacks and in intervening with the pathogenetic mechanisms involved in their onset. Accordingly, we determined red blood cell magnesium levels in adult migraine patients with and without aura interictally and in some of them also ictally. In comparison with normal subjects, migraineurs with and without aura had significantly lower red blood cell magnesium levels in the interictal period. Ictal red blood cell magnesium levels did not differ from the interictal values. Low red blood cell magnesium levels could be a peripheral expression of the reduced brain magnesium concentration observed in migraine patients.
A Double-Blind Placebo-Controlled Trial of Intranasal Capsaicin for Cluster Headache
Authors: Marks David R , Rapoport Alan , Padla Dennis , Weeks Randall , Rosum Robert , Sheftell Fred , Arrowsmith Frances
Published: March 2003

It has been suggested that treatment of cluster headache (CH) patients with topical capsaicin may desensitize sensory neurons by depleting the nerve terminals of substance P. We attempted to determine whether capsaicin is effective in aborting CH attacks. Patients in acute cluster were randomized to receive either capsaicin or placebo in the ipsilateral nostril for 7 days. Patients recorded the severity of each headache for 15 days. Headaches on days 8–15 of the study were significantly less severe in the capsaicin group vs the placebo group. There was also a significant decrease in headache severity in the capsaicin group on days 8–15 compared to days 1–7, but not in the placebo group. Episodic CH patients appeared to benefit more than chronic CH patients. These results indicate that intranasal capsaicin may provide a new therapeutic option for the treatment of this disease.
Raeder's Syndrome. A Case With an Unusual Localization
Authors: Pimentel José , Martins Isabel Pavão
Published: March 2003

We describe a patient with a Raeder's paratrigeminal neuralgia consisting of left-sided frontal and orbital pain, Homer syndrome (including anhydrosis of the forehead), and sensory loss in the territory of the first division of the trigeminal nerve. The involvement of the ophthalmic nerve is not consistent with the usual localization of this syndrome to the pericarotid sympathetic plexus. Oculosympathetic and sympathetic fibers supplying the sweat glands of the forehead join the ophthalmic nerve in the cavernous plexus localized in the cavernous sinus. Therefore, this seems to be the most likely site of the lesion when the ophthalmic nerve is involved.
The Genetics of Migraine Without Aura and Migraine With Aura
Authors: Russell Michael Bjørn , Olesen Jes
Published: March 2003

Studies of twins, spouses and familial aggregation strongly suggest that migraine without aura (MO) and migraine with aura (MA) are genetically determined. The mode of inheritance is most likely multifactorial in both MO and MA. However, autosomal dominant inheritance with reduced penetrance cannot be excluded in either MO or MA. At present the only evidence for genetic heterogeneity of MA is familial hemiplegic migraine with slowly progressive ataxia. This phenomenon can also be explained by linkage of different genes. All existing studies have been characterized by one or more of the following methodologic shortcomings: selection of probands from clinic populations, information obtained by questionnaire, family history obtained through probands, insufficient description of the attacks, lack of distinction between MO and MA. Useful strategies for future studies of migraine genetics are discussed.
The Trigemino-Pupillary Response in Cluster Headache
Authors: Micieli Giuseppe , Tassorelli Cristina , Ruiz Luigi , Sandrini Giorgio , Nappi Giuseppe
Published: March 2003

Central impairment of the integrative neural systems controlling vegetative function and pain perception has been demonstrated in cluster headache (CH). Recently, we described the human pupillary response (trigeminal reflex) to quantified (painless and painful) corneal stimulation with a combined neurophysiological and pharmacological technique. In this study, the trigeminal reflex was evaluated in 26 subjects with episodic cluster headache. During the active phase of the disease, on the side of the pain we observed reduced mydriasis to electrical stimuli with an intensity equal to the corneal reflex threshold, and on both sides to stimuli with intensity that equalled the pain threshold. No difference was found when amplitude of the miotic phase was compared in the different groups. These suggest disordered pupillary activation in response to pain, probably sympathetic in origin, which is bilateral, detectable also during the remission phase and which cannot be explained simply by the antidromic release of pain-related peptides.
Sumatriptan Relaxes Isolated Porcine Ophthalmic Artery, But Inhibits VIP-Induced Relaxation
Authors: Vincent Maurice B , White Linda R , Bakken Inger Johanne , Sjaastad Ottar
Published: March 2003

Sumatriptan, a 5-hydroxytryptamine (5HT)1-like receptor agonist, is a new antimigraine drug which is also effective in cluster headache (CH), a disorder with marked ocular circulatory abnormalities. Sumatriptan could putatively exert a therapeutic effect in this vascular bed. The present study is an attempt to assess sumatriptan's vasoactivity in isolated porcine ophthalmic artery (POA) and to verify whether it has similar activity to 5HT, and whether it interferes with the vasodilation induced by calcitonin gene-related peptide (CGRP) and vasoactive intestinal peptide (VIP). In contrast to 5HT, sumatriptan induced only slight contraction in POA at high concentrations. However, in some artery segments pre-contracted with PGF22a, sumatriptan induced a slight and short-lasting but marked relaxation. In addition, relaxations induced by VIP were inhibited significantly by sumatriptan, whereas CGRP effects were not influenced by the drug. Such reactions suggest that sumatriptan's effect in CH is probably unrelated to direct ocular arterial vasoconstriction.
Amplifying Effect of Sumatriptan on Noradrenaline Venoconstriction in Migraine Patients
Authors: Panconesi Alessandro , Franchi Giancarlo , Anselmi Bruno , Curradi Carlo , Tarquini Brunetto
Published: March 2003

The venoconstrictive activity of sumatriptan and its interaction with noradrenaline (NA)- and 5-hydroxy-tryptamine (5HT) venoconstriction was studied in vivo in the hand vein of migraineurs. Sumatriptan, injected at increasing doses into the vein, caused local venoconstriction after a 500 mg dose, comparable to that induced by 0.5–1 mg of 5HT. This venoconstriction was completely inhibited by low doses of ketanserin (5 mg). Subcutaneous sumatriptan (6 mg) provoked a minor increase in vein tone, lasting less than 30 min. Non-venoconstrictive doses of sumatriptan (10–100 mg), injected in the hand vein, produced an amplification of NA-venoconstriction but not of 5HT-induced venoconstriction. A similar increased effect was displayed by subcutaneous sumatriptan (6 mg) for at least 1 h. Sumatriptan appears to cause peripheral venoconstriction only at high doses locally applied (in the hand vein), by acting on 5HT2 receptors. Clinical subcutaneous doses (6 mg) do not show significant venoconstrictive effects. The amplifying effect on NA venoconstriction, also caused by 5HT, ergotamine and dihydroergotamine in human cranial arteries, may be important in explaining the therapeutic action of sumatriptan in migraine attacks.
Headache and Cortisol Responses to M-Chlorophenylpiperazine are Highly Correlated
Authors: Gordon Marc L , Lipton Richard B , Brown Serena-Lynn , Nakraseive Christina , Russell Marjorie , Pollack Simcha Z , Korn Martin L , Merriam Arnold , Solomon Seymour , Praag Herman M van
Published: March 2003

The serotonin receptor agonist m-chlorophenylpiperazine (m-CPP) stimulates the release of cortisol and prolactin, and induces migraine-like headaches. We have studied the neuroendocrine and headache responses to m-CPP in 8 subjects with migraine and I0 normal subjects. Each subject underwent two challenge tests, one with 0.25 mg/kg PO of m-CPP and the other with placebo, administered in a double-blind crossover format. Serial measurements of serum cortisol, prolactin, and m-CPP levels were made at 30-min intervals for 210 min following ingestion of the medication. The incidence and severity of headache was assessed by a structured telephone interview after each test. We confirmed that m-CPP stimulates the release of cortisol and prolactin, and may induce headache, in both migraine subjects and normal controls. The cortisol response as well as ratings of headache severity and duration directly correlated with plasma levels of m-CPP. There were highly significant associations between the cortisol response and both headache severity and duration, independent of m-CPP plasma levels. We did not find statistically significant differences between the migraine and normal subjects in terms of their neuroendocrine or headache responses to m-CPP.
5HT in Migraine Patients with Medication-Induced Headache
Authors: Hering R , Glover V , Pattichis K , Catarci T , Steiner TJ
Published: March 2003

Whole blood 5HT levels were measured in seven female migraine sufferers with chronic daily headache due to medication abuse, before and after abrupt medication withdrawal. A statistically significant increase in 5HT levels, from mean 4.89 mmol/1 to mean 6.59 mmol/I ( p < 0.05, Wilcoxon signed rank test), as well as a significant improvement in the number of headache-free days ( p < 0.05, Wilcoxon signed rank test), occurred after 4 weeks of withdrawal. We conclude from this pilot study that 5HT may be important in the physiopathogenesis of chronic daily headache. Alternatively, reduced 5HT may be the result of chronic daily headache or else an epiphenomenon.
Beta-Endorphin Levels are Reduced in Peripheral Blood Mononuclear Cells of Cluster Headache Patients
Authors: Leone M , Sacerdote P , D'Amico D , Panerai AE , Bussone G
Published: March 2003

Opioid system hypofunction has been postulated in cluster headache (CH) on the basis of reduced opioid levels found in the cerebrospinal fluid (CSF). In this study beta-endorphin levels were monitored in the peripheral blood mononuclear cells of 65 episodic CH patients (32 in remission and 33 in cluster period) and 50 healthy controls. Beta-endorphin levels were significantly lower than controls in CH patients experiencing both phases of the illness (ANOVA, p < 0.0001). The persistence of this abnormality during pain-free remission suggests a primary alteration in the regulation of beta-endorphin in peripheral blood mononuclear cells. We speculate that these findings reflect reduced CNS levels of beta-endorphin in CH.
Migraine Angiitis Precipitated by Sex Headache and Leading to Watershed Infarction
Authors: Jackson Matthew , Lennox Graham , Jaspan Timothy , Jefferson David
Published: March 2003

Vasospasm is a rare cause of cerebrovascular disease except following subarachnoid haemorrhage. We describe a woman who developed an explosive-type sex headache, followed by a series of severe migrainous headaches associated with fully reversible segmental cerebral arterial narrowing and dilatation, resulting in widespread infarction in cerebral arterial border zones. This led to transient loss of consciousness and multiple focal cortical deficits including blindness. She had a past history of migraine and a family history of both migraine and sex headaches. Similar cases have been reported in the literature under a variety of rubrics. We suggest that this newly recognized clinico-radiological syndrome is a migraine variant.
A Differential Response to Treatment With Divalproex Sodium in Patients With Intractable Headache
Authors: Rothrock JF , Kelly NM , Brody ML , Golbeck A
Published: March 2003

We consecutively recruited 75 patients with intractable headache syndromes, divided them into three groups (frequent migraine = FM, transformed migraine = TM, and tension type headache = TT) based on their headache symptoms and treated all 75 with divalproex sodium. Thirty-six patients (48%) reported a 350% reduction in headache frequency. We noted significantly different treatment response rates in the three patient groups, with FM patients reporting the highest rate of improvement (11/18 = 61%), TM patients an intermediate rate (22/43 = 51%), and TT patients the lowest response rate (3/14 = 21%), These data suggest that prophylactic therapy with divalproex may be effective in selected patients with intractable headache syndromes and that identification of clinically distinct headache subtypes may assist in predicting response to treatment.
Head Pain in Non-Traumatic Carotid Artery Dissection: A Series of 65 Patients
Authors: Biousse V , D'Anglejan-Chatillon J , Massiou H , Bousser M-G
Published: March 2003

In order to assess the prevalence and characteristics of cephalic pain in internal carotid artery (ICA) dissection, and to compare clinical and angiographic features of patients with painful and non-painful dissections, we observed 65 patients with angiographically diagnosed extracranial ICA dissection from 1972 to 1990. Forty-eight patients (74%) complained of a cephalic pain which was inaugural in 38 (58.5%). It was homolateral to the dissection in 79% of cases and lasted from 1 h to 30 days, with a median of 5 days. Signs of cerebral or retinal ischemia were observed in 79% of patients, often delayed and occurring up to 29 days after the onset of pain. A painful Horner's syndrome was present in 31% of patients, and was the only manifestation of dissection in 16%. The clinical presentation of the dissections and angiographic findings were similar in patients with and without pain except for a past history of migraine which was more frequent in patients with painful dissections. Cephalic pain is frequent and often inaugural in carotid dissection. Its recognition is important for early diagnosis and treatment.
Headache in Acute Cerebrovascular Disease: A Prospective Clinical Study in 240 Patients
Authors: Arboix A , Massons J , Oliveres M , Arribas MP , Titus F
Published: March 2003

To evaluate the clinical features of headache in stroke, a prospective study was carried out in 240 consecutive patients with acute stroke who had intact expressive function. Headache occurred in 38%: 32% of 195 patients with ischemic stroke and 64.5% of 45 patients with hemorrhagic stroke ( p < 0.0001). Headache patients were younger (mean age 62 ± 15 vs 67 ± 11.5 years) than non-headache patients ( p < 0.01). A history of previous vascular or tension-type headache was found in 40.5% of the headache group, but in only 23.5% of the non-headache group ( p < 0.01). In ischemic stroke, headache was observed in 41% of thrombotic infarcts, in 39% of cardioembolic infarcts, in 23% of lacunar infarcts and in 26% of TIA. Headache was significantly more common in thrombotic than lacunar infarcts ( p < 0.05). In hemorrhagic stroke, headache was observed in all subarachnoid hemorrhages and in 58% of intraparenchymal hemorrhages. In ischemic stroke, the mean duration of the headache was 25 ± 28 h and in hemorrhagic stroke 64.5 ± 36.5 h ( p < 0.00001). In ischemic stroke the headache was focal in 74% and mild or moderate in intensity in 74%. In hemorrhagic stroke, it was diffuse in 52% and the pain intensity was incapacitating in 70%. Headache was more common in vertebrobasilar stroke (59%), in comparison with carotid stroke (26%) or stroke of unclear vascular topography (33%) ( p < 0.00001). Fifty-six and a half percent of patients with cortical stroke had headaches, as opposed to only 26.5% of patients with subcortical stroke ( p < 0.005). Ten percent of the patients presented with sentinel headache.
Absence of Vasoactive Peptide Release from Brain to Cerebral Circulation During Onset of Migraine With Aura
Authors: Friberg L , Olesen J , Olsen T Skyhøi , Karle A , Ekman R , Fahrenkrug J
Published: March 2003

In eight patients carotid angiography was required for evaluation of transient neurological attacks. Cerebral blood flow results, angiography and clinical observations subsequently suggested the diagnosis of migraine. We measured plasma concentrations of substance P(SP), neuropeptide Y (NPY), calcitonin gene-related peptide (CGRP) and vasoactive intestinal peptide (VIP) in repeated blood samples obtained from the carotid artery and the internal jugular vein in conjunction with cerebral angiography followed by 4 to 6 repeated recordings of regional cerebral blood flow (rCBF) with the intracarotid Xenon-133 injection technique. This technique is known to induce attacks of migraine with aura in many sufferers. Four patients developed aura symptoms. In three this was succeeded by throbbing headache, Typical, migraine-related, focal hypoperfusion occurred in conjunction with the aura symptoms. The remaining four patients had no symptoms or rCBF changes. There were no systematic or statistically significant changes over time in arterial-venous plasma concentrations or in the release rates of any of the peptides. All migraineurs had an overall elevated mean CGRP value compared to control values from the literature. The overall plasma levels of the potent vasoconstrictor NPY were higher ( p < 0.10) in the group that developed symptoms and rCBF changes (136 pmol/l) than in the non-symptomatic group (97 pmol/l). The difference in NPY levels could perhaps be associated with the focal rCBF decrease seen in the attack group.
Handedness and Headache
Authors: Messinger HB , Messinger MI , Kudrow L , Kudrow LV
Published: March 2003

A California handedness study involved 199 male and 74 female cluster headache sufferers as well as 477 migraineurs. Earlier reported data indicated that cluster headache patients had a left-handedness prevalence of over 15%. With the current data the prevalence in males was 11.0% and in females, 8.2%. The corresponding migraine figures were 11.8% and 8.1%. The cluster and migraine headache groups did not differ significantly from each other or from the expected 10% frequency of left-handedness in either sex.
Use and Abuse of Analgesics in Tension-Type Headache
Authors: Schnider P , Aull S , Feucht M , Mraz M , Travniczek A , Zeiler K , Wessely P
Published: March 2003

Eighty patients suffering from tension-type headache for an average of 21 years were asked to report on all drugs they had ever taken (type, dosage, duration of intake, efficacy) or were taking currently. The patients had consumed on average 6.3 different drugs. The cumulative doses of derivatives of para-aminophenol, pyrazolone, and salicylic acid in some cases reached a maximum of several kilograms. Most drugs were classified by the patients as “moderately effective”. The rating “very effective” was assigned primarily to barbiturates; however, barbiturates are no longer used as components of compound analgesic drugs in Austria. At the time of investigation, patients consumed 2.5 (mean) different drugs, primarily as compound preparations. Seventeen patients (21%) showed signs of possible analgesics- or ergotamine-induced headache and were therefore advised to undergo withdrawal therapy. Our results show that patients with tension-type headache are at considerable risk of becoming drug-dependent and of acquiring analgesics-induced headache.
Combined Oral Lysine Acetylsalicylate and Metoclopramide in the Acute Treatment of Migraine: A Multicentre Double-Blind Placebo-Controlled Study
Authors: Chabriat H , Joire JE , Danchot J , Grippon P , Bousser MG
Published: March 2003

This multicentre, double-blind, randomized, placebo-controlled, parallel study was designed to evaluate the efficacy of combined oral lysine acetylsalicylate and metoclopramide (LAS-MCP) in the acute treatment of migraine attacks. A total of 266 patients, 18–65 years old, with two to six attacks of migraine with or without aura (IHS criteria) per month were included. The patients had to treat two migraine attacks with LAS-MCP (1620 mg lysine acetylsalicylate-the equivalent of 900 mg aspirin- combined with 10 mg metoclopramide) or placebo. The main outcome measure was headache relief (reduction in headache severity from grade 3 or 2-severe or moderate-to grade 1 or 0-mild or none) 2 h after treatment. LAS-MCP was superior to placebo for headache relief (56% vs 28%) and for the following secondary outcome measures: complete headache relief (18% vs 7%; p < 0.001), nausea (28% vs 44%; p < 0.001), vomiting (3% vs 11%; p = 0.001), use of rescue medication (47% vs 68%; p < 0.001), global efficacy judged as good or excellent (32% vs 14%; p < 0.001). The tolerability was considered as good in 94% of treated attacks in both groups. Combined oral lysine acetylsalicylate and metoclopramide is an effective and well-tolerated acute treatment of migraine attacks.
Personality Characteristics Before and After Treatment of Different Head Pain Syndromes
Authors: Mongini F , Ibertis F , Ferla E
Published: March 2003

In order to examine whether, in patients with different types of headache and craniofacial pain, MMPI and STAI scores are significantly different before and after treatment, 114 patients with tension-type headache (n = 34), atypical facial pain (n = 20), temporomandibular joint dysfunction (n = 36), migrainene (n = 16), cluster headache (n = 4), chronic paroxysmal hemicrania (n = 2), trigeminal neuralgia (n = 2) were examined. A pain index was calculated (0–10) which quantified pattern, duration and frequency of pain. The Italian MMPI (356 item abbreviated version) and the STAI tests were administered before and after treatment. A paired t-test was used to assess pre- and post-treatment differences, and multiple regression analysis was employed to examine whether such differences correlated with the improvement in the pain index. In the total group after treatment, there was a significant reduction of certain MMPI scores (Hs, D, Hy, Pa, Pt, Sc, Si) and of STAI 1 and 2 scores. Separate analysis confirmed this among women but not among men. No relation was found between MMPI and STAI changes and the degree of improvement as assessed through the pain index. Clinical improvement leads to normalization of MMPI profiles and STAI scores in women. The psychometric data before treatment were not predictive for treatment outcome.
If Migraine Prophylaxis Does Not Work, Think About Compliance
Authors: Steiner TJ , Catarci T , Hering R , Whirmarsh T , Couturier EGM
Published: March 2003

Data are presented on nine patients with migraine by IHS criteria, recruited from those presenting to the clinic for treatment and needing prophylaxis. Pizotifen 0.5 mg tds was prescribed for 8 weeks and dispensed in special containers with an electronic event recorder concealed in the lid. This responded to the pressure change with each opening of the container and recorded it in real time. The information was later downloaded to a PC for analysis. At trial end, two patients had been lost to follow-up, one had not started the treatment at all, two had dropped out because of alleged side effects (drowsiness), and four patients had completed the study. For these, the quantity of tablets used as a percentage of that prescribed (i.e., compliance assessed on the basis of returned-tablet count) ranged from 62.6% to 91.9%; the percentage of days in which three doses had been taken ranged from only 15.8% to 79%; the percentage of doses taken on schedule (8 h ± 25% after the previous dose) ranged from 21.1% to 47.3%. It is possible that all evaluations of efficacy and tolerance of migraine prophylactics reported so far have been unsoundly based.
Dietary Migraine: Recent Progress in the Red (And White) Wine Story
Authors: Sandler M , Li N-Y , Jarrett N , Glover V
Published: March 2003

The concept of dietary migraine as a clinical entity remains controversial. We review here such objective evidence that has been put forward for its existence. Red wine, in particular, is commonly alleged to initiate attacks in susceptible individuals. We discuss how some of its recently described pharmacological properties might trigger off the sequence of events leading to migrainous headache.
Increased Cerebrovascular pCO2 Reactivity in Migraine with Aura- a Transcranial Doppler Study During Hyperventilation
Authors: Thomsen LL , Iversen HK , Olesen J
Published: March 2003

Cerebrovascular reactivity during hypocapnia was tested in 20 migraineurs (8 with aura, 12 without aura) and 30 sexand age-matched healthy subjects, and during nitroglycerin-induced headache in 12 healthy subjects. Before and during hyperventilation, mean blood-flow velocity (Vmean) in the middle cerebral artery was measured with transcranial Doppler. In each subject a pCO2 reactivity index (RI) was calculated as DVmean/baseline Vmean)/ DpCO2. Interictally, patients with migraine with aura showed higher RI ( p < 0.05 ANOVA and multiple range test) than controls, whereas migraineurs without aura did not differ from healthy subjects. Ictal and interictal RIs were similar in 9 patients suffering from migraine without aura. No side-to-side differences were detected in RI. During nitroglycerin-induced headache, the RIs were no different from those recorded during migraine attacks and in non-nitroglycerin-provoked healthy controls (p < 0.05, ANOVA and multiple range test). The exaggerated response in migraine with aura might predispose for the characteristic changes in rCBF seen during attacks.
Migraine to the Year 2000
Authors: Sandler M
Published: March 2003

Although migraine is inextricably bound up with 5-hydroxytryptamine and its many receptors, its precise mechanisms continue to elude us and there is still no clear evidence supporting either a vascular or neurogenic hypothesis unequivocally. What appears to distinguish migraine sufferers from normal subjects may be a greater genetic sensitivity to a wide variety of triggering agents-even including nitric oxide and the migraine aura, as well as those more usually recognized. Attention is drawn to a possible role for neurotrophins, such as the hyperalgesia-provoking nerve growth factor (NGF) in particular, as well as basic fibroblast growth factor (bFGF) and brain-derived neurotrophic factor (BDNF).
Platelet Models and Their Possible Usefulness in the Study of Migraine Pathogenesis
Authors: D'Andrea G , Cananzi AR , Perini F , Hasselmark L
Published: March 2003

Platelets may be linked to migraine. On the one hand they are activated during the migraine attack and thus may participate in the pathogenesis of the disorder (the nature of this activation is still unknown). In order to understand this platelet anomaly, we discuss the data available in the literature. In particular, we review recent in vitro studies of a-granules and dense bodies secretion, and aggregation induced by collagen and PAF. On the other hand, platelets share many metabolic characteristics with serotonergic neurons and endothelial cells. Accordingly, platelets have been used to investigate the possible role of serotonin turnover and nitric oxide function in migraine. In both cases, the data obtained have shown peculiar abnormalities that may explain pathogenetic and clinical aspects of primary headache.
Assessment of Peripheral Vascular Effects of Antimigraine Drugs in Humans
Authors: Es NM van , Bruning TA , Camps J , Chang PC , Blauw GJ , Ferrari MD , Saxena PR , Zwieten PA van
Published: March 2003

The vascular beds of the forearm and finger can be used to study the peripheral effects of antimigraine drugs under normal and pathologic circumstances. We have investigated the novel antimigraine drug sumatriptan, a selective agonist for 5HT1 receptors. Its antimigraine effect may be attributed, at least in part, to constriction of cranial arteriovenous anastomoses (AVAs). In assessing the peripheral vascular effects of sumatriptan we used a forearm and finger blood flow model. Forearm blood flow (FBF) is mainly determined by resistance vessels, whereas finger blood flow (FiBF) mainly involves skin vessels, which contain many AVAs. Changes in FBF and FiBF can be assessed using venous occlusion plethysmography. Changes in AVA flow are determined by measuring the patency of the vascular beds of the forearm and hand to well-defined radiolabeled microspheres, which are injected into the brachial artery. We report the effects of sumatriptan on FBF, FiBF and AVA flow when administered into the brachial artery of healthy volunteers, and discuss the peripheral vascular effects of therapeutic doses of sumatriptan when given subcutaneously in migraine patients during and between attacks.
Changes of Neuroendocrine Axes in Patients with Menstrual Migraine
Authors: Fioroni L , Martignoni E , Facchinetti F
Published: March 2003

Menstrual migraine (MM) is a menstrually related disorder (MRD) characterized by several symptoms in common with premenstrual syndrome (PMS). It has been hypothesized that in both MM and PMS hormonal cyclicity could change the balance of neurotransmitters and neuromodulators like monoamine and opioid. In this article we analyze all the data collected by our group on the central opioid tonus and the adrenergic and serotonergic systems in patients affected by menstrual migraine.
In Vivo Neuroreceptor Imaging by SPECT in Migraine
Authors: Friberg L
Published: March 2003

In vivo imaging of neuroreceptor ligand binding in the human brain is a young discipline. In migraine patients only few studies on dopamine D2 receptor binding have been reported. Many potentially useful radiolabeled receptor ligands for SPECT investigations in humans are currently being treated in animal models. There are no reports on development of radiolabeled, specific 5HT1D receptor ligands, which would be of considerable interest in studies of migraine patients. The radiochemistry of receptor ligand development for SPECT is complex and expensive. However, once a suitable radiolabeled ligand has been developed, e.g. labeled with I–123 with a fairly long decay ratio, it can be made widely accessible to nuclear medical units. SPECT might even prove to be as powerful a tool as PET for quantification of neuroreceptor binding profiles. Quantification, though, is not a trivial problem and there is still a need for development of kinetic models that can be applied in the clinical setting, particularly for studies of acute conditions like a migraine attack.
Health-Related Quality of Life Under Six Months' Treatment of Migraine-An Open Clinic-Based Longitudinal Study
Authors: Dahlöf CGH
Published: March 2003

Health-related quality of life (HQL) assessment in the clinical setting have distinguished subjective perceptions (e.g. well-being), signs/symptoms of the disease, and functional capacity as three major components. The impact of short-term treatment for migraine attacks on these variables was evaluated in an open prospective 6-month study at the Gothenburg Migraine Clinic. Socio-economic factors, subjective symptoms, and general well-being/quality of life were evaluated by self-administered questionnaires in 99 patients with migraine with or without aura in accordance with the classification of the International Headache Society. Short-term treatment comprising conventional therapy or subcutaneous sumatriptan reduced number of days per month with migraine and absenteeism from work, migraine-associated symptoms, but did not significantly improve general well-being between attacks. Future assessment of the patients' HQL in accordance with this approach would enable us to consider all the advantages and disadvantages of current therapies of particular interest in the field of migraine.