bluuebunny/crossref_metadata_2025 huggingface dataset:
Classic Migraine: Effective Prophylaxis with Metoprolol
Authors: Kangasniemi P , Andersen AR , Andersson PG , Gilhus NE , Hedman C , Hultgren M , Vilming S , Olesen J
Published: March 2003

Metoprolol slow-release tablets (Durules®), 200 mg, given once daily in the morning were compared with placebo in the prophylaxis of classic migraine. The trial comprised eight Scandinavian neurologic centres and was designed as a double-blind cross-over study with 4 weeks' run-in, four weeks washout, and 8 weeks of either treatment. Seventy-seven patients with two to eight migraine attacks per month were entered in the trial, and 73 completed it. A total of 1119 attacks with aura symptoms and 374 without were recorded. Metoprolol was significantly better than placebo with regard to the total frequency of attacks (1.8 versus 2.5 attacks/4 weeks), mean duration of attacks (6.0 versus 8.0 h/attack), mean global rating, and consumption of analgesics per attack: Similar differences could be shown for attacks with aura symptoms alone, except for the duration of attacks. Metoprolol is the first drug for which a prophylactic effect in classic migraine has been convincingly demonstrated.
Pupillary Sympathetic Hypofunction and Asymmetry in Muscle Contraction Headache and Migraine
Authors: Takeshima Takao , Takao Yoshiki , Takahashi Kazuro
Published: March 2003

Pupillary autonomic dysfunction and right-left differences were investigated in muscle contraction headache (MCH) and migraine, by means of biocular infrared video pupillography (biocular Iriscorder). The study was performed on 36 patients with MCH or migraine and on 23 healthy controls. The pupillary area before light stimuli and maximum dilatation velocity of pupils, in MCH patients and migraineurs, showed significant differences from those of controls. Pupillary asymmetry was observed in both headache categories. The behavior of MCH pupils to light stimuli under dark conditions was rather similar to that of migraine pupils. Both pupillary sympathetic hypofunction and subtle anisocoria were present not only in patients with migraine but also in those with MCH.
Pathoanatomic Studies in a Case of Tolosa-Hunt Syndrome
Authors: Hannerz Jan
Published: March 2003

In an earlier study patients with symptoms of orbital venous vasculitis-that is, cases of characteristic orbital pain and pathologic orbital phlebograms-were found to have increased signs of cerebral atrophy compared with age-matched controls. One such patient with nine incidents of Tolosa-Hunt syndrome and advanced cerebral atrophy is reported, and his medical history and pathoanatomic studies are reported in detail. The cause of the atrophy was multiple small infarctions, which are suggested to be due to vasculitis. Other findings in this case support the hypothesis that the Tolosa-Hunt syndrome may be only one manifestation of a generalized vasculitis.
Hepatic Cytochrome P450–Mediated Oxidation Function in Migraine
Authors: Amery WK , Davies PTG , Caers LI , Heykants J , Steiner TJ , Woestenborghs R , Rose F Clifford
Published: March 2003

Hepatic cytochrome P450-dependent oxidation is deficient in 5% to 10% of the Caucasian population. A similar percentage seems to suffer from migraine. The hypothesis was tested that an oxidation deficiency possibly relevant to potential dietary triggers plays a role in the pathogenesis of migraine. In 37 migraine sufferers and 26 controls age- and sex-matched to 26 of these patients, debrisoquine hydroxylation following an oral dose of 10 mg was employed as a marker of oxidation status, determined by calculating the metabolic ratio (MR): urinary debrisoquine/urinary 4–hydroxydebrisoquine. MR was similarly distributed in migraineurs and controls. Three subjects in each group were poor metabolizers (MR ± 30, versus normal range, 0.1–12). MR in patients did not depend on type of migraine (common versus classic), attack frequency, the presence of trigger factors, smoking or a history of adverse reactions or sensitivity to medicines.
Dysfunction of the Sympathetic Nervous System in Cluster Headache
Authors: Drummond Peter D
Published: March 2003

Ocular sympathetic function was studied in 13 cluster headache patients during and between attacks and several weeks or months after attacks had subsided. The pupillary response to tyramine eyedrops and facial sweating and flushing in response to body heating and to the taste of chilies were also investigated during remission. Pupillary dilatation lag on the symptomatic side persisted between bouts and correlated significantly with loss of thermo-regulatory sweating in the lower part of the forehead. In six patients in remission, pupillary dilatation in response to tyramine eyedrops was impaired on the symptomatic side, whereas five patients showed no sign of ocular sympathetic deficit. These findings indicate that incomplete sympathetic deficit persisted on the symptomatic side in a subgroup of cluster headache patients during remission. In most of this subgroup the pattern of sympathetic deficit was consistent with impaired function of postganglionic cervical sympathetic fibres.
Subdural Hematoma Presenting as Headache in Systemic Lupus Erythematosus
Authors: Bovim Gunnar , Jørstad Størker , Schrader Harald
Published: March 2003

Systemic lupus erythematosus (SLE) affects the nervous system in 75% of cases (1). A female with several neurological manifestations in the case history presented with severe headache, psychiatric disturbances, and increasing paraparesis. She was found to have bilateral subdural hematomas, and after evacuation her neuropsychiatric symptoms, including headache, disappeared. It is speculated that the reported low incidence of subdural hematomas in SLE may be more apparent than real. On the basis of our case, we recommend repeated neuroradiological investigations to uncover this important, treatable and otherwise potentially fatal cause of headache.
Cisternographic Pattern of Spontaneous Liquoral Hypotension
Authors: Molins A , Alvárez J , Sumalla J , Titus F , Codina A
Published: March 2003

We describe five cases of headache due to spontaneous liquoral hypotension, the syndrome comprising sudden, intense and oppressive orthostatic holocranial headache. The headache improved in the recumbent position and was accompanied by nausea and sometimes vomiting. There was no history of lumbar puncture or previous trauma. CSF tension was low or negative. The CSF showed a raised protein content and increased red and white cell counts. CT scan was normal or showed a slit ventricular system. Improvement was complete three to eight weeks from onset. The treatment consisted of bed rest and oral and parenteral fluid replacement. An isotope cisternography carried out in all patients while the headache was present showed a cisternographic pattern characterized by a combination of premature elimination and failure to detect the isotope at the cerebral convexity. Scan images did not show CSF leakage at any site. This stereotyped reaction pattern suggests that CSF hyperabsorption is the most likely pathophysiological mechanism of this entity.
Flunarizine (10 and 20 mg) i.v. Versus Placebo in the Treatment of Acute Migraine Attacks: A Multi-Centre Double-Blind Study
Authors: Pfaffenrath Volker , Oestreich Wolfgang , Haase Wolfgang
Published: March 2003

In a multi-centre, randomized double-blind study, the effect and tolerance of 10 and 20 mg flunarizine i.v. versus placebo was tested on 102 migraineurs with acute migraine attacks with and/or without aura. Thirty-seven patients received 10 mg flunarizine, 32 received 20 mg and 33 received placebo. The groups were comparable. Response to treatment was defined as pain reduction of at least 50% within 60 min on a visual analogue scale after i.v. drug administration. This effect was noted on 59.4% with 20 mg flunarizine, on 24.3% with 10 mg flunarizine and on 30.3% with placebo. The tolerance of flunarizine i.v. was similar to placebo. Blood pressure and pulse rate were not affected by flunarizine. All in all, 20 mg flunarizine i.v. appeared to be a suitable alternative for treatment of acute migraine attacks.
Cerebral Mapping in Subjects Suffering from Migraine With Aura
Authors: Facchetti Dante , Marsile Claudia , Faggi Luigi , Donati Edoardo , Kokodoko Agostino , Poloni Marco
Published: March 2003

Cerebral mapping of the spontaneous electroencephalographic activity was performed in 31 subjects suffering from migraine with aura and the results were compared with those of a matched control group. All the patients were examined during the interictal period. While traditional visual interpretation of EEG records was negative in all but five cases (16.1%) spectral analysis showed an asymmetry in alpha total power over the posterior regions in 13 cases (41.9%) and an asymmetry in alpha band peak frequency in 17 (54.8%). By means of cerebral mapping and statistical significance probability mapping we were able to demonstrate a significant increase in alpha total power in 13 cases (41.9%) and a regional increase in delta and theta total power in 20 cases (64.5%). In comparison with the control group, the migraine patients showed a widespread increase in slow activity (theta and delta) mostly over the temporal regions.
Functional Radiographic Examination of the Cervical Spine in Patients with Post-Traumatic Headache
Authors: Jensen Ole Kudsk , Justesen Tummas , Nielsen Frank Farsø , Brixen Kim
Published: March 2003

The segmental extension-flexion motion of the cervical spine and the overall C1–C7 motion were measured on functional X-rays in 19 patients with post-traumatic headache and 19 age-and sex-matched controls. The extension-flexion C1–C7 motion was reduced in patients with post-traumatic headache due to reduced motion in three segments: C2–C3, C5–C6 ( p < 0.05), and C6–C7 ( p < 0.01). In both groups a negative correlation between the C1–C7 motion and age was found, but the regression coefficients were different. Only in the control group could a negative correlation between segmental motion and age be demonstrated. In the patients with post-traumatic headache a statistically significant negative correlation between the log(pain index) and the age-corrected C1–C7 motion was found ( p < 0.04). On the segmental level a negative correlation between the log (pain index) and the age-corrected C1–C2 and C5–C6 motion could be demonstrated ( p < 0.05). Regarding C6–C7 there was a tendency to negative correlation. Furthermore, a negative correlation between the frequency of associated symptoms (dizziness, visual disturbances and ear symptoms) and the age-corrected C5–C6 motion was found. Consequently the decrement of motion primarily affected C2–C3, C5–C6, and C6–C7, whereas the analysis of correlation with pain index indicated C1–C2 and C5–C6 (C6–C7) as the most important segments involved.
Anticardiolipin Antibodies in Migraine
Authors: Hering Rachel , Couturier Emile GM , Steiner TJ , Asherson Ronald A , Rose F Clifford
Published: March 2003

Antiphospholipid antibodies have occasionally been observed in small series of migraine patients, possibly signalling an immunological pathogenesis in a subgroup. We have measured anticardiolipin antibody levels in a series of 94 migraine patients (35 patients having migraine with aura, 59 without aura), during acute attacks and between attacks. Platelet counts were normal and VDRL was negative in all patients. A low positive anticardiolipin antibody level was found in only one patient, which was negative six months later. There appears to be no association between the presence of anticardiolipin antibodies and migraine. Antiphospholipid antibodies are unlikely to have a material pathogenetic role. Statistically, the incidence of significantly raised anticardiolipin antibody levels in this group of patients does not exceed 4% at a 95% probability level.
Exteroceptive Suppression of the Masseter, Temporalis and Trapezius Muscles Produced by Mental Nerve Stimulation in Patients with Chronic Headaches
Authors: Nakashima Kenji , Takahashi Kazuro
Published: March 2003

Exteroceptive suppression of the masseter, temporalis and trapezius muscles, produced by mental nerve stimulation, was studied in 46 patients with chronic headaches. The background contracting electromyographic activity prior to stimulation showed no difference between normal subjects and patients with any type of headache. In patients with chronic tension-type headache associated with a disorder of the pericranial muscles, the duration and degree of exteroceptive suppression were lower when compared with normal subjects. A low degree of exteroceptive suppression was observed also in patients suffering from migraine without aura, although exteroceptive suppression in patients suffering from migraine with aura and cluster headache was the same as that in normal subjects. A low degree of exteroceptive suppression may play a role not only in chronic tension-type headache associated with a disorder of the pericranial muscles, but also in migraine without aura.
Propranolol in the Treatment of Acute Migraine Attacks
Authors: Banerjee Mala , Findley Leslie
Published: March 2003

The efficacy of the beta-adrenoceptor antagonist propranolol in the acute treatment of patients in attacks of either classical (migraine with aura) or common migraine (migraine without aura) headache was assessed in a double-blind placebo-controlled crossover trial with fixed doses. The trial was carried out on 25 patients. The treatment period was set at eight weeks, with the provision of shortening or lengthening it if necessary with a maximum period of seventeen weeks. A minimum of three migraine attacks were treated during each treatment period. Patients were assessed according to: the mean duration and mean severity per treatment period of migraine attacks. The secondary efficacy assessment was made on the basis of the percentage of attacks requiring escape medication per treatment period. The study, based on the t-distribution statistical model with a confidence level of 95%, showed that propranolol had no significant effect in aborting acute attacks of migraine when compared with placebo.
Migraine Postdromes: Symptoms After Attacks
Authors: Blau JN
Published: March 2003

To determine the nature and duration of symptoms after the headache phase of migraine, 40 migraineurs (11 with and 29 without an aura) were given a questionnaire to complete on the day after a migraine attack. The most common symptoms that remained were physical and mental tiredness, subdued or depressed mood, impaired concentration, reduced physical activities and yawning; weak or clumsy limbs, head tenderness, neck ache or stiffness, impaired sight and altered fluid balance were less frequent. The number of symptoms ranged from 2 to 11 (average 6) per patient lasting for a mean of 18 h, usually the whole of the next day. Symptoms after the main migraine attack can help to diagnose migraine particularly when there is no aura before the onset of headache. Eliciting postdromes aids patient-doctor rapport and confidence. The range of symptoms lends support to the notion that the whole of the brain is involved in the aftermath of migraine attacks.
MMPI Personality Profiles in Patients With Primary Headache Syndromes
Authors: Pfaffenrath Volker , Hummelsberger Josef , Pöllmann Walter , Kaube Holger , Rath Michael
Published: March 2003

The role of psychological factors in the course of primary headache syndromes is still controversial. Using the Minnesota Multiphasic Personality Inventory (MMPI) we investigated the personality profiles of 434 headache patients (160 migraineurs, 95 with tension type headache, 30 with cluster headache and 149 with combination headache) in accordance with the IHS criteria. In the first three MMPI scales (hypochondria, depression, hysteria) there was a slight increase in T mean values to over 60, but still in the range of two standard deviations of the normal population. There were no statistically significant differences between the four headache groups and between patients with and without analgesic abuse. It was impossible to distinguish headache groups on the basis of their personality profiles by means of reclassification with discriminant analysis. In a cluster analysis, patients with cluster headache showed the highest number (20%) of abnormalities, but also the highest percentage (13%) of completely normal results. Our findings- a cross section analysis of personality profiles-contradict many other MMPI-based studies.
Migraine in Patients With History of Centro-Temporal Epilepsy in Childhood: A Hm-PAO SPECT Study
Authors: Septien L , Pelletier JL , Brunotte F , Giroud M , Dumas R
Published: March 2003

The authors report the results of a retrospective controlled study on the incidence of migraine in centro-temporal epilepsy compared to absence epilepsy, partial epilepsy and a group of patients with cranial trauma without epilepsy. The following observations from this series of 129 patients were made. Migraine was present in 63% of the patients with centro-temporal epilepsy (rolandic epilepsy), in 33% with absence epilepsy, in 7% with partial epilepsy and in 9% of the cranial trauma group. These results suggest that the association of centro-temporal epilepsy and migraine is non-fortuitous and also to a lesser degree in absence epilepsy. The role of neurotransmitters in this association is discussed. No decrease in cerebral blood flow was observed in 12 patients with rolandic epilepsy on a Hm-PAO SPECT study.
Evaluation of Pericranial Myofascial Nociception by Pressure Algometry. Reproducibility and Factors of Variation
Authors: Petersen Karin Lottrup , Brennum Jannick , Olesen Jes
Published: March 2003

Pressure pain detection threshold and pressure pain tolerance threshold were measured in the temples and on the fingers in 40 healthy volunteers, equally distributed as to sex and handedness. Lower pressure pain thresholds were found over the temporal muscle than in a neighbouring temporal location without interposed myofascial tissue ( p < 0.001), indicating that nociception from myofascial tissue contributes to the pressure pain threshold. Pressure pain tolerance was more reproducible within the individual subject but differed more between subjects than pressure pain detection. Pressure pain thresholds were higher on the fingers than in the temples ( p < 10-5) and, in general, thresholds were higher in males than in females ( p = 0.02 – 0.09). Finally, pressure pain thresholds were lateralized in dextrals but not in sinistrals. The information that can be obtained from pressure pain detection and tolerance thresholds is discussed and examination of both threshold types is recommended in future studies.
Cutaneous Sensory Stimulation Leading to Facial Flushing and Release of Calcitonin Gene-Related Peptide
Authors: Goadsby Peter J , Edvinsson Lars , Ekman Rolf
Published: March 2003

A patient is described with a 17-year history of intractable left-sided facial pain. The pain occurred daily in 5 sec spasms to a maximum of one every 2–3 min and was restricted to the left upper face. It was associated with rhinorrhoea on the left and often with ipsilateral facial flushing. Conventional therapy, including carbamazepine, baclofen and three posterior fossa explorations, had not provided lasting relief. Local facial stimulation by tapping a painful trigger point led to both pain and flushing of the face ipsilaterally. During this flushing, blood was collected and assayed using sensitive radioimmunoassays for several neuropeptides (neuropeptide Y, substance P, vasoactive intestinal polypeptide and calcitonin gene-related peptide). A marked (119%) increase in calcitonin gene-related peptide was noted in the external jugular vein blood ipsilaterally during the flushing with no change in the other peptides measured. To quantitate the effect of calcitonin gene-related peptide on human extracranial vessels, standard pharmacological procedures were used to examine the potency of the peptide as a vasodilator of human facial artery. The 1C50 of calcitonin gene-related peptide for the prostaglandin F2a -precontracted human facial artery was 10-9 mol/1. The relevance of these observations to the clinical problem of migraine is considered.
A Double-Blind Study of Ibuprofen Versus Placebo in the Treatment of Acute Migraine Attacks
Authors: Kloster Reidar , Nestvold Knut , Vilming Steinar T
Published: March 2003

The efficacy of ibuprofen, a non-steroidal anti-inflammatory drug, was assessed in the acute treatment of migraine. Twenty-five patients completed a double-blind placebo-controlled multicrossover trial. The initial dose of ibuprofen was 1200 mg. Six migraine attacks were randomly treated in each patient, three with ibuprofen and three with placebo. The results indicated a statistically significant reduction in the duration of the migraine attacks and also a statistically significant reduction in the severity of headache and nausea in the ibuprofen-treated attacks. The use of additional medication was significantly reduced in the ibuprofen-treated attacks (25.6% vs 57.5%), No serious side effects were reported. Ibuprofen is valuable in the treatment of acute migraine attacks.
Cluster Headache: Alterations in Heart Rate, Blood Pressure and Orthostatic Responses During Spontaneous Attacks
Authors: Kruszewski Piotr , Bordini Carlos , Brubakk Alf O , Sjaastad Ottar
Published: March 2003

Changes in heart rate and blood pressure (BP) have been monitored beat-to-beat in a cluster headache patient with and without attacks using a non-invasive Doppler servo method. Two attacks were monitored and during one of them a tilt test was carried out. The variability of heart rate and BP was greater during the attack than during the interparoxysmal period. A marked bradycardia occurred during attacks. Systolic BP increased slightly. There was no heart rate increase after tilting during the attack, whereas this was present invariably during tests carried out interparoxysmally. BP changes during “attack tilt” were difficult to evaluate because of large variation. This may be the first observation of a baroreflex arc dysfunction during a cluster headache attack.
Sumatriptan is a Potent Vasoconstrictor of Human Dural Arteries Via a 5-HT1-Like Receptor
Authors: Jansen Inger , Edvinsson Lars , Mortensen Anders , Olesen Jes
Published: March 2003

The action of sumatriptan, putatively a selective 5-HT 1D or 5-HT 1 -like receptor agonist which is effective in the treatment of migraine, has been studied on fresh human dural (middle meningeal) arteries. In low concentrations (10-8 -10-7 M) it was found to be a significantly stronger vasoconstrictor of dural arteries compared to cerebral and temporal arteries. However, its potency was less than that of 5-HT. The sumatriptan-induced vasoconstriction was antagonized by methiothepin (10-9 -10-8 M), but not by ketanserin (10-7 M). The observations suggest that the sumatriptan-induced contraction of the dural artery is mediated via activation of 5-HT 1D or 5-HT 1 -like receptors, whereas it does not appear to activate the 5-HT 2 receptors.
Effect of Sodium Valproate on The Secretion of Prolactin, Cortisol and Growth Hormone in Migraine Patients
Authors: Hering Rachel , Gilad Irit , Laron Z , Kuritzky A
Published: March 2003

A single oral dose of 500 mg sodium valproate had no effect on prolactin, growth hormone and cortisol secretion in 10 migraine patients when compared with five healthy controls and four migraine patients receiving placebo. Basal values of prolactin (PRL), cortisol and growth hormone (GH) were within the normal range, though PRL basal levels were lower in three patients (21.5%) in the migraine group.
Transcranial Doppler Ultrasonic Features in Episodic Tension-Type Headache
Authors: Wallasch Thomas-Martin
Published: March 2003

In a pilot study we used transcranial Doppler ultrasound (TCD) to measure cerebral blood flow velocities in 21 headache-free episodic tension-type headache sufferers and in the same number of age- and sex-matched control subjects. We found increased blood flow velocities in the anterior, middle and posterior cerebral arteries and a decreased pulsality index in the middle and posterior cerebral arteries in tension-type headache sufferers compared to controls. Vascular bruits were significantly more frequent in the basal cerebral arteries of the patients compared to controls. There were no significant asymmetries of blood flow velocities in corresponding arteries. The findings suggest a multifactorial pathogenesis in episodic tension type headache including vascular abnormalities.
The Optimal Length of Headache Recording in Juvenile Migraine Patients
Authors: Osterhaus SOL , Passchier J
Published: March 2003

The representativeness of headache recording periods of one, two, three, four and five weeks for juvenile migraine was examined in 41 juvenile patients (suffering from migraine attacks at least twice a month). At pre-treatment and at follow-up, on average a three-week recording period was found to be adequate. On the basis of these findings a longer data-collection period is recommended for juvenile migraineurs than for adult migraine patients at follow-up.
How Many Different Headaches Do You Have?
Authors: Laughey William F , MacGregor E Anne , Wilkinson Marcia IP
Published: March 2003

Patients with migraine attending a specialist clinic often have more than one type of headache. One hundred and two patients attending the City of London Migraine Clinic for the first time were asked: 'What type(s) of headache do you think you have?” A separate diagnosis was made by the doctor, who was blinded to the self-diagnosis. On clinic diagnosis, 27 (26.5%) patients were found to have migraine plus an additional non-migraine headache. When compared with the self-diagnosis, 15 (56%) of these had correctly self-diagnosed two types of headache. Many migraineurs can distinguish migraine from non-migraine headaches when they have both.
Cortical Spreading Depression Does Not Result in the Release of Calcitonin Gene-Related Peptide into the External Jugular Vein of the Cat: Relevance to Human Migraine
Authors: Piper Richard D , Edvinsson Lars , Ekman Rolf , Lambert Geoffrey A
Published: March 2003

There is circumstantial evidence that cortical spreading depression (SD) may account for the scotoma and the “spreading cortical oligemia” seen during migraine with aura. It has been shown that calcitonin gene-related peptide (CGRP) is increased in blood taken from the external jugular vein (EJV) in humans during migraine and after stimulation of the trigeminal ganglion. To test the hypothesis that cortical SD may elevate the concentration of this vasoactive peptide in the EJV during migraine, we have measured its concentration in the external jugular vein of cats during cortical SD. This study demonstrates that SD has no effect on the concentration of CGRP either during the passage of a wave of spreading depression across the cortex or, 60 min later, during the period of post-SD cortical oligemia.
The Safety of Sumatriptan in Asthmatic Migraineurs
Authors: Lloyd DK , Pilgrim AJ
Published: March 2003

A recent report has questioned the safety of sumatriptan in asthmatic migraineurs. To investigate this, we have reviewed the sumatriptan clinical trial safety database of over 75 completed trials. Within the clinical trial database, 375 asthmatic patients were identified who treated 1214 migraine attacks with sumatriptan. The incidence and nature of adverse events in the asthmatic patient subgroup who received sumatriptan was similar to that in the complete clinical trial population. Six reports of asthma were recorded as adverse events, but only one case was classified by the investigator as related to treatment. There is no clinical or pharmacological evidence to suggest that the safety profile of sumatriptan is altered in asthmatic patients compared to other migraine sufferers.
Intracranial Hypertension and Migraine
Authors: Ramadan Nabih M
Published: March 2003

We describe the case report of a migraineur who developed daily postural headache due to benign intracranial hypertension. The CSF pressure was elevated despite the lack of papilledema on clinical examination. This case emphasizes that intracranial hypertension without papilledema must be in the differential diagnosis of the so-called “migraine transformation” headache. Accordingly, CSF analysis, including CSF pressure measurement, should be part of the diagnostic evaluation of “migraine transformation” headache.
Hypothalamic Modulation of Nociception and Reproduction in Cluster Headache. I. Therapeutic Trials of Leuprolide
Authors: Nicolodi Maria , Sicuteri Federigo , Poggioni Marco
Published: March 2003

A slow-release gonadotropin-releasing hormone (Gn-RH) analogue was administered to 30 males suffering from chronic cluster headache (CH) in a placebo-controlled study with the aim of enhancing neurotransmission in the pain-suppressing systems of the hypothalamus through a feedback action involving neuroendocrine functions too. A significant improvement in the severity of the pain occurred together with the expected lowering of the libido and serum levels of testosterone and luteinizing hormone. We postulate that the benefit of the Gn-RH analogue relates to an impairment of neuronal modulation in cluster headache.
Hypothalamic Modulation of Nociception and Reproduction in Cluster Headache. II. Testosterone-Induced Increase of Sexual Activity in Males with Cluster Headache
Authors: Nicolodi Maria , Sicuteri Federigo , Poggioni Marco
Published: March 2003

Short-lasting chronic testosterone administration did not change the course of cluster headache in seven chronic sufferers, whereas it enhanced sexual excitement in comparison with male control subjects who received the same treatment. We postulate that the sexual excitement induced in cluster headache sufferers by chronic treatment with testosterone relates to an impairment of neuronal modulation in this disorder.
Cellular Adaptation in Migraineurs with Chronic Daily Headache
Authors: Hering Rachel , Gardiner Ion , Catarci Teresa , Whitmarsh Thomas , Steiner Timothy , Belleroche Jacqueline de
Published: March 2003

Ergotamine and analgesic misuse are now recognized as causes of chronic daily headache and the condition responds well to drug withdrawal with reduced headache frequency. In this study, we have investigated whether medication misuse is associated with an alteration in membrane transduction which is sensitive to drug withdrawal. This was carried out by assay of the thrombin-stimulated generation of inositol phosphates in platelets from 12 migraine patients with chronic daily headache and analgesic misuse, 7 migraine patients with chronic daily headache and ergotamine misuse and 7 control subjects. After drug withdrawal, a significant decrease in headache frequency was seen at one month in both patient groups. Withdrawal of analgesics produced a significant decrease in thrombin-stimulated inositol phosphate production at one month; this was further decreased a month later with a reduction in Bmax of 60% and no significant change in KD. A similar pattern was obtained in ergot misuse patients, with the KD value decreasing by 56% one month after drug withdrawal. These results provide evidence of an adaptation in transduction with misuse of analgesics and ergotamine which correlates with headache frequency.
Cervicogenic Headache: Electronystagmography, Perception of Verticality and Posturography In Patients Before and After C2-Blockade
Authors: Dieterich Marianne , Pöllmann Walter , Pfaffenrath Volker
Published: March 2003

Fourteen patients with cervicogenic headache (9F, 5M) with a mean age of 42.8 (29–58) years were examined, before and within two hours after unilateral anaesthetic C2-blockades, clinically as well as by means of electronystagmography, subjective visual vertical test and posturography. After C2-blockade, patients exhibited a slight gait deviation to the injected side without eye movement disorder, dysmetria or ataxia. Although in two of nine patients there was a small influence on lateral body sway on posturography, no specific pattern of abnormalities in eye-head-body coordination could be found before or after C2-blockades. Thus, there is no clinical evidence for a significant reproducible influence of the second cervical root on oculomotor or cerebellar function in cervicogenic headache. These findings confirm earlier data in animal experiments.
What Some Patients Can Eat During Migraine Attacks: Therapeutic and Conceptual Implications
Authors: Blau JN
Published: March 2003

Although nausea and vomiting are diagnostic migraine symptoms, most patients can take tablets by mouth and a few say they can eat some food. This study was conducted to determine the proportion who could eat or drink, what was consumable and with what effect. One-hundred-and-nine migraineurs were asked what they could eat or drink at the beginning or height of their attacks; 59 could not take any food by mouth, but 50 could eat during the headache phase of their migraine attacks. Four ate normally, 5 took smaller amounts of their normal dietary intake, and 3 took lighter meals. Dry, carbohydrate foods were consumable by the remaining 38: a few had specific cravings, most stated the precise variety which, when eaten, reduced nausea, headache, other symptoms or length of attacks. Patients should therefore be encouraged to eat what they can tolerate, with their tablets taken as early as possible after the onset of attacks. Simultaneous nausea, tolerance or even craving for specific foods occur in other conditions, particularly high altitude headaches which share other features of migraine attacks. The observations in this paper support the notion that migraine is a central neuronal metabolic disturbance.
1-Deprenyl Test in Migraine: Neuroendocrinological Aspects
Authors: Calabresi P , Silvestrini M , Stratta F , Cupini LM , Argiro G , Atzei GP , Bernardi G
Published: March 2003

We evaluated the effect of 1-deprenyl, a drug that increases the availability of endogenous dopamine, on the plasma levels of prolactin and growth hormone in 10 female patients with migraine and in 10 control subjects matched for age and menstrual phase. The patients showed a significant decrease in prolactin levels at 30, 60 and 120 min after the oral administration of 5 mg of 1-deprenyl when compared with the values obtained in controls ( p < 0.001). The effects of 1-deprenyl on growth hormone plasma levels were not significantly different between patients and controls. These data suggest that 1-deprenyl inhibits prolactin release in migraine patients, but not in control subjects. This differential sensitivity could be explained by dopamine receptor supersensitivity in migraine patients.
Mechanisms of Increased Sensitivity to Noise and Light in Migraine Headache
Authors: Woodhouse Anne , Drummond Peter D
Published: March 2003

To determine whether phonophobia is a manifestation of loudness recruitment, the hearing and auditory discomfort thresholds to an 8000 Hz tone were measured during the headache-free interval and again during an attack of migraine in 16 migraine sufferers. The visual discomfort threshold was also determined. For comparison, measures were taken in 10 non-headache controls of similar age and sex distribution. Auditory and visual discomfort thresholds decreased substantially during attacks of migraine. Increases (three subjects) or decreases (three subjects) in hearing threshold during attacks of migraine were significantly greater than the variation recorded in control subjects from Session I to Session 2. The findings do not support the view that phonophobia in migraine is a manifestation of loudness recruitment, although cochlear disturbances might mediate hearing loss in some cases. Disruption of central sensory processing mechanisms during migraine could increase sensitivity to quiet sounds, and contribute to phono- and photophobia.
Dopamine D2 Receptor Blockade and Antimigraine Action of Flunarizine
Authors: Wöber C , Brücke T , Wöber-Bingöl C , Asenbaum S , Wessely P , Podreka I
Published: March 2003

We studied in vivo the influence of flunarizine on dopamine D2 receptors and investigated whether dopamine D2 receptor blockade is involved in its antimigraine action. Eleven migraine patients, treated with flunarizine, 10 mg per day, underwent single photon emission computer tomography (SPECT) using [123I] labeled iodobenzamide, a ligand with high affinity and high specificity for D2 receptors. There was a reduction of the dopamine D2 receptor binding potential in all patients compared to age-matched controls. The efficacy of flunarizine in migraine prophylaxis failed to correlate with the degree of the dopamine D2 receptor blockade. The antimigraine action of flunarizine may not involve antidopaminergic mechanisms.
Function of the Peripheral Serotoninergic Pathways in Migraine: A Proposal for An Experimental Model
Authors: Martelletti P , Stirparo G , Rinaldi C , Fusco BM
Published: March 2003

We propose a model for assessing the function of 5HT receptors in migraine by evaluating their expression on monocytes by means of double-labeling fluorocytometry (CD14–positive cells FITC-labeled). This model demonstrates that during headache induced in, migraine without aura sufferers given isosorbide dinitrate followed by sumatriptan treatment 5HT expression on monocytes progressively increases. This increase may be due to the activation of 5HT turnover and to the increased availability of 5HT displaced by sumatriptan from 'cerebrovascular receptors during head pain.
EEG Features in Juvenile Migraine: Topographic Analysis of Spontaneous and Visual Evoked Brain Electrical Activity: A Comparison with Adult Migraine
Authors: Genco S , Tommaso M de , Prudenzano AMP , Savarese M , Puca FM
Published: March 2003

Topographic analysis of spontaneous and steady-state visual evoked brain electrical activity was carried out between attacks in 82 migraine patients (40 youths and 42 adults). In adult migraine with aura a significant increase of delta rhythm percentage power was observed compared with migraine without aura and age-matched controls. Children suffering from migraine both with aura and without aura had an increased theta rhythm compared to normal controls. The presence of alpha interhemispheric asymmetry discriminated between migraine with aura and without aura, just as in adults. An increased amplitude of the SVEP F1 component with a tendency to the spread of visual reactivity was observed in juvenile migraine with and without aura; this pattern was not dissimilar from the one previously observed in adult migraine with and without aura. Abnormal photic driving in migraine is independent of age and type of migraine.
Cervical Musculoskeletal Dysfunction in Post-Concussional Headache
Authors: Treleaven J , Jull G , Atkinson L
Published: March 2003

Persistent headache is a common symptom following a minor head injury or concussion, possibly related to simultaneous injury of structures of the cervical spine. This study measured aspects of cervical musculoskeletal function in a group of patients (12) with post-concussional headache (PCH) and in a normal control group. The PCH group was distinguished from the control group by the presence of painful upper cervical segmental joint dysfunction, less endurance in the neck flexor muscles and a higher incidence of moderately tight neck musculature. Active range of cervical motion and postural attitude were not significantly different between groups. As upper cervical joint dysfunction is a feature of cervicogenic causes of headache, the results of this study support the inclusion of a precise physical examination of the cervical region in differential diagnosis of patients suffering persistent headache following concussion.
Migraine, Polycythemia and Chronic Mountain Sickness
Authors: Arregui A , León-Velarde F , Cabrera J , Paredes S , Vizcarra D , Umeres H
Published: March 2003

In the epidemiological study among 379 adult men with permanent residence at 4300 meters (14,200 feet), we found 32.2% with migraine (mostly migraine with aura), 15.2% with tension-type headache (episodic more than chronic), and 7.2% with other headaches. The frequency of migraine increased with age from 30.1% in the 20–29 year age group to 36.8% in the 50–59 year group. Episodic tension-type headaches also showed this trend. We found an age-specific increase in the frequency of high hemoglobin (Hb > 213 g/l), low oxygen saturation (O2 saturation <81.5%), and high chronic mountain sickness scores. Male migraineurs and those with more than two headaches per month had the highest hemoglobin levels and chronic mountain sickness scores when compared with high altitude men without headaches.
White Matter MRI Hyperintensities in a Hundred and Twenty-Nine Consecutive Migraine Patients
Authors: Pavese N , Canapicchi R , Nuti A , Bibbiani F , Lucetti C , Collavoli P , Bonuccelli U
Published: March 2003

The most frequently reported abnormal MRI finding in migraine is the presence of high signal white matter foci (WMF) on long TR images. Recently, WMF have been distinguished in periventricular WMF (PVF), when contiguous to ventricles, and deep WMF (DF), when far from these. DF, but not PVF, appear positively correlated with cerebrovascular risk factors and are called leukoaraiosis. In this study the MRI examination was performed in 129 consecutive migraine patients (83 of them had migraine without aura and 46 migraine with aura). In 19.3% of the migraineurs studied we observed WMF on T2 weighted images strictly localized in the deep white matter (DF). No PVF were observed. These findings were independent of the type of migraine and did not correlate with age, sex, disease duration, or frequency of attacks. The presence in a subgroup of migraineurs of leukoaraiosis (DF), for which a vascular genesis has been hypothesized, suggests that migraine could represent, a cerebrovascular risk factor in these patients.
Bilateral Asymmetry of Cerebral Blood Velocity in Cluster Headache
Authors: Micieli G , Bosone D , Cavallini A , Rossi F , Pompeo F , Tassorelli C , Nappi G
Published: March 2003

In this study, 69 episodic cluster headache (CH) patients (40 in the active phase, 29 in remission period) underwent a complete TCD examination in order to verify the relationship between cerebral blood velocities (CBVs) and the clinical profile of the disease. Fifteen patients were examined during both phases, while 7 were monitored during a spontaneous attack. Sixty-three healthy sex and age-matched controls were also studied. We measured widespread, asymmetric CBV activation during the active phase, bilaterally in the anterior circulation and also in the posterior circulation. A relative reduction of CBV on the anterior cerebral artery pain side, also during remission, suggests a relationship between local vasodilation and the autonomic symptoms ipsilateral to pain during CH attacks.
Intractable Headache: Aseptic Meningitis and Sphenoidal Sinusitis
Authors: Silberstein SD
Published: March 2003

Sphenoid sinusitis, an uncommon cause of headache, is associated with significant morbidity. A 30-year-old man presented with a progressive intractable headache and aseptic meningitis. Failure to recognize sphenoid disease on brain CT delayed diagnosis; treatment with IV antibiotics resolved the disorder.
Migrainous Phenomenon Precipitated by Lumbar Puncture Headache
Authors: Drislane FW
Published: March 2003

This case report describes a patient without personal or family history of migraine or other recurrent headaches who developed a typical lumbar puncture headache leading to a characteristic migrainous visual field deficit. There was no history of analgesic or other medication use or other precipitant, and neither symptom recurred in years of follow-up. The sequence of symptoms suggests that mechanical distortion or irritation of cranial pain-sensitive structures can precede and precipitate the migrainous cortical dysfunction.
Non-Synaptic Diffusion Neurotransmission: A Novel Concept for Future Migraine Research
Authors: Bach-y-Rita P
Published: March 2003

The concept of non-synaptic diffusion neurotransmission (NDN) is reviewed. Evidence is presented that monoamine neurotransmission is largely by NDN. The role of NDN in pain and sleep is described and its relevance to migraine research is discussed.
Cortical Spreading Depression Reduces Dural Blood Flow a Possible Mechanism for Migraine Pain?
Authors: Lambert GA , Michalicek J
Published: March 2003

These experiments were designed to investigate a possible mechanism linking the phenomenon of cortical spreading depression with activation of the trigeminal sensory system in migraine. Blood flow in the cortex and middle meningeal artery was measured in cats before and during propagation of a wave of cortical spreading depression, initiated by cortical pin-prick, This caused a transient propagated increase in cortical blood flow. Cortical spreading depression was accompanied by a decrease in blood flow in the middle meningeal artery, sometimes to very low levels. The results suggest that the pain of migraine could arise from dural ischemia induced by cortical spreading depression.
The International Headache Society (IHS) Headache Classification as Applied to a Headache Clinic Population
Authors: Sanin LC , Mathew NT , Bellmeyer LR , Ali S
Published: March 2003

Four hundred patients attending a headache clinic were classified using the IHS criteria. The majority required more than two, often three or four, diagnoses. Even though migraine was the most common diagnosis, only 1/4 of those with a migraine diagnosis had it as the only diagnosis. Seventy-five percent of migraine patients had coexistent chronic tension-type headache (CTTH), drug-induced headache or both. Ninety-six percent of patients diagnosed as having migraine with aura also suffered from migraine without aura. More than 1/3 of patients (37.7%) attending the clinic suffered from chronic daily headache (CDH) (chronic cluster headache excluded), which is not included as a separate entity in the IHS classification. Pure CTTH formed only a small minority of CDH, whereas 86.6% of CDH had migraine as one of the diagnoses. Drug-induced headache was a prominent second or third diagnosis. The advantages and disadvantages of multiple verses single diagnosis in CDH and the need to recognize the natural history of headache disorders in the classification are discussed.
Headache Classification and The Bible: Was St Paul's Thorn In The Flesh Migraine?
Authors: Göbel H , Isler H , Hasenfratz H-P
Published: March 2003

The conversion of Saul to Paul was a major event in the history of Western culture. Compared with its impact, any medical comments may seem redundant, but they have kept their place in the literature for many centuries. The flashing light that caused Saul to fall is often explained as solar retinopathy or keratitis, a seizure, or even a hysterical fit. These interpretations propose either a trivial injury or disease that would interfere with mental health. Neither version is quite compatible with the dramatic dimension of the event and with Paul's later achievements and sufferings. In later years, Paul became a great manager, preacher and writer who was able to carry on under any kind of duress, though not without very painful reactions. He was suffering from bouts of unilateral headache, and also from a chronic eye condition which gave great trouble to his followers but did not cause lasting damage; the descriptions fulfil the criteria for migraine without aura of the 1988 Headache Classification. If the flashing light that caused Paul to fall down is interpreted as a visual migraine aura, with the additional symptoms of “not seeing” or photophobia and anorexia, it fails into place with his later history of migraine.