bluuebunny/crossref_metadata_2025 huggingface dataset:
The Tolosa-Hunt Syndrome—Literature Review: Seven New Cases and a Hypothesis
Authors: Hoes M. J. A. J. M. , Bruyn G. W. , Vielvoye G. J.
Published: March 2003

The Tolosa-Hunt syndrome is a superior orbital fissure and/or anterior cavernous sinus syndrome. Because the etiology is unknown, the differential diagnosis is essentially one of localization. The pathological substrate consists of a non-specific inflammation. An exhaustive literature search up to 1 January 1981 yielded altogether 214 cases. Seven personal cases are reported. A consistent pathogenesis is still lacking. Observations made in four cases led to the hypothesis that the syndrome results from dysregulation of the adaptation to stressful events, involving enhanced serotonergic activity which suppresses ACTH secretion and promotes non-specific inflammation of perivascular (venous/arterial) tissue.
Low Biological Availability of Ergotamine Tartrate After Oral Dosing in Cluster Headache
Authors: Ekbom Karl , Paalzow Lennart , Waldenlind Elisabet
Published: March 2003

An attempt was made to determine the plasma ergotamine concentrations in nine male patients with cluster headache 15–600 min after oral therapeutic doses of ergotamine tartrate (Cafergot(r)). Some of the patients were studied twice. Five patients received a constant dose of 2–4 mg daily for at least seven days. Four patients were given 1 mg five times on one day and three patients a single oral dose of 2 mg. Ergotamine was determined by means of high performance liquid chromatography with fluorescence detection-a new highly sensitive, specific method, the detection limit of which is less than 100 pg/ml for ergotamine. Ergotamine tartrate was not discovered in any of the plasma samples. In one patient ergotamine could not be detected in the cerebrospinal fluid one hour after a single oral dose of 2 mg. The oral biological availability is less than 1%, which is the maximal available fraction of unchanged ergotamine after oral administration. A clinical benefit was observed in several of our patients. These effects of the drug may be because of active metabolites being formed and/or to high affinity of ergotamine to cranial vessels.
Invasive Adenoma of the Pituitary Gland and Chronic Migrainous Neuralgia. A Rare Coincidence or a Causal Relationship?
Authors: Tfelt-Hansen P. , Paulson O. B. , Krabbe A. Æ.
Published: March 2003

After 31 years of suffering from headache attacks which in the last five years were indistinguishable from migrainous neuralgia (cluster headache), a 52-year-old man was treated for an invasive adenoma of the pituitary gland. During a two-year follow-up period he has not had one single attack of his usual headache. The case history may suggest a causal relationship between the adenoma and the headache attacks.
Aspirin Treatment of Migraine Attacks: Clinical Observations
Authors: Ross-Lee Lesley , Eadie Mervyn J. , Tyrer John H.
Published: March 2003

A retrospective study of the efficacy of soluble aspirin in migraine has been carried out. Data were available for 6l patients. These patients differed in only relatively minor ways from the remainder of the population of migraine sufferers referred to a neurological consultative practice. Soluble aspirin usually or always relieved migraine attacks in 44% of these patients, and sometimes relieved the disorder in another 25%. Adverse effects, mainly nausea and vomiting, were reported by 16% of patients only, and in some cases nausea and vomiting may have been due to migraine rather than to the drug. Response to aspirin was unrelated to factors such as the patient's age, sex and duration of migraine history, and to the severity of migraine or occurrence of nausea and vomiting during attacks. However, the presence of a migraine aura appeared to improve the chances of a response to aspirin. The aura may have permitted earlier recognition that migraine was present, and thus allowed earlier aspirin intake at a stage when it had a better chance of influencing migraine mechanisms.
Chronic Paroxysmal Hemicrania: Continued Remission of Symptoms after Discontinuation of Indomethacin
Authors: Jensen Niels Bjørn , Joensen Poul , Jensen Jørgen
Published: March 2003

Discontinuation of indomethacin in chronic paroxysmal hemicrania (CPH) usually causes relapse of symptoms within a few days. A patient with characteristic symptoms of CPH is reported. The patient had daily attacks of unilateral headache accompanied by ipsilateral lacrimation and conjunctival injection, a frequency of attacks between four and fourteen per day, and never a headache-free day. He was treated with indomethacin, and all symptoms disappeared within 24 h. After three months indomethacin was discontinued. Six months after that the patient was still symptom-free.
The Prophylactic Effect of Timolol Versus Propranolol and Placebo in Common Migraine: Beta-Blockers in Migraine
Authors: Standnes Brit
Published: March 2003

A multicentre double-blind, cross-over trial was planned to evaluate the prophylactic effect of timolol in migraine. The effectiveness of the drug was compared to propranolol and placebo. In the Norwegian part of the trial described in this paper, 18 patients completed the study. The data suggest that timolol is equivalent in effectiveness to propranolol in migraine prophylaxis. Firm conclusions should not be drawn until the results from the multicentre trial are available.
Histamine Release from Leucocytes in Migraine
Authors: Selmaj Krzysztof
Published: March 2003

The spontaneous histamine release (SHR) from leucocytes in migraine patients during symptom-free periods has been investigated, and also the influence of migraine sufferer serum on histamine release (HR) from blood donor leucocytes. The leucocytes were isolated according to the Day method and histamine assay was made by the Shore spectrofluorometric method modified by Bergendorff and Uvnäs (1). SHR in the 17 female migraine patients was significantly higher (39.7% ± 13.1%) than in 8 controls (25.4% ± 4.2%). Migraine serum increased HR from blood donor leucocytes by 14.6% ± 20.2% compared with the SHR of these cells.
Cluster Headache: A Computerized Analysis of 24 h Holter ECG Recordings and Description of ECG Rhythm Disturbances
Authors: Russell David , Storstein Liv
Published: March 2003

Continuous ECG recording has been carried out for at least 24 h in 27 patients suffering from cluster headache. During the study a total of 84 attacks occurred in 25 of the 27 patients who took part. A computerized analysis of the heart rate changes accompanying attacks showed the following: (i) an increase in heart rate at the onset of attacks; the degree of this increase being dependent on the heart rate before attacks, (ii) a relative decrease in heart rate and increased variations in heart rate during attacks, (iii) a relative increase in heart rate at the end of attacks, and (iv) a relative decrease in heart rate after attacks. Five patients (18.5%) showed ECG rhythm disturbances: two frequent premature ventricular beats, one transient attacks of atrial fibrillation, one first degree atrio-ventricular block, and one patient sino-atrial block.
Cluster Headache: On the Mechanism Behind Attack-Related Sweating
Authors: Saunte Carsten , Russell David , Sjaastad Ottar
Published: March 2003

Eighteen cluster headache patients were studied using body heating or exercise tests; all but two of them were also studied with a pilocarpine test (0.1 mg/kg body wt, s.c.). Evaporimeter measurements were made on both sides of the forehead under standard conditions in a thermo room. Heat- and exercise-induced sweating was dearly less pronounced on the symptomatic side than on the non-symptomatic side of the forehead, and was significantly different compared to controls. Pilocarpine on the other hand induced a clearly more pronounced response on the symptomatic side than on the non-symptomatic side, which was also statistically significantly higher than in the control group. These findings suggest a supersensitivity of the sweat glands to pilocarpine on the symptomatic side of the forehead in most cases of cluster headache.
Chronic Paroxysmal Hemicrania. IX. On the Mechanism of Attack-Related Sweating
Authors: Saunte Carsten , Russell David , Sjaastad Ottar
Published: March 2003

In eight patients with chronic paroxysmal hemicrania (CPH), forehead sweating was measured after various provocation tests-body heating, exercise, and subcutaneous pilocarpine administration (0.1 mg/kg body weight). Evaporation was measured bilaterally on the forehead with an Evaporimeter (in g/m2/h). This was carried out in a thermo room under standardized conditions. There was no definite deficit in heat-induced or exercise-induced sweating on the symptomatic side of the forehead, contrary to findings in cluster headache. Neither did pilocarpine lead to any marked initial, temporary predominance of sweating on the symptomatic side, which has previously been found in cluster headache. In cluster headache there may be denervation supersensitivity of the sweat glands in the forehead of the symptomatic side. The present study does not therefore provide evidence for supersensitivity phenomena which could explain the homolateral forehead sweating increase seen during attacks in some CPH patients. The localized sweating increase in the forehead during attacks of CPH may possibly be a result of direct sympathetic stimulation.
Migraine: Definition and Classification
Authors: Rose F. Clifford , Capildeo Rudy
Published: March 2003

There are an enormous number of terms and classifications used in the field of headache and migraine. There is little general agreement and the situation is not helped by the introduction of new terminologies. An approach is suggested to overcome this problem based on the clinical characteristics of the patient. Until there are more definite markers of the different types of headaches, e.g. biochemical, physiological or pharmacological, this should obviate the need for yet further neurological debate.
Autonomic Disorders in Cluster Headache, With Special Reference to Salivation, Nasal Secretion and Tearing
Authors: Saunte C
Published: March 2003

Attacks of cluster headache are often associated with symptoms of an autonomic nature. A test battery allowing quantitation of salivation, nasal secretion and tearing has been employed. Fourteen patients examined under basal conditions hardly differed from a group of controls (N = 20). After stimulation with pilocarpine the patients responded like the controls. During attacks we found minimal bilateral salivation, but an increase of tearing and nasal secretion, mostly on the symptomatic side. These results correspond with those found in CPH. The finding of the minimal salivation is consistent with the notion that the headache attacks are associated with increased sympathico-tonus. The results may suggest that the complexity of the innervation pattern of the different secretory organs examined is more marked than hitherto known.
Effervescent Metoclopramide and Aspirin (Migravess) Versus Effervescent Aspirin or Placebo for Migraine Attacks: A Double-Blind Study
Authors: Tfelt-Hansen Peer , Olesen Jes
Published: March 2003

Aspirin 650 mg and metoclopramide 10 mg in an effervescent preparation (Migravess(r)) were compared with effervescent aspirin 650 mg (Alka-Seltzer(r)) and placebo for common migraine attacks with a double-blind cross-over design. One hundred and eighteen patients with common migraine were entered. Eighty-five patients completed all three forms of treatment, eleven completed two, and six completed one. Medicine was taken when patients were sure they had a migraine attack and not just interval headache. After each form of treatment, they mailed a report form to the investigators. Additional medication was allowed after 2 h and was taken for 79/95 placebo treated attacks, 63/92 Migravess treated attacks, and 51/86 aspirin treated attacks (p < 0.01). Aspirin was significantly better than placebo for pain but not quite significant for nausea. Migravess(r) was significantly better than placebo for pain and for nausea. There was no significant difference between aspirin and Migravess(r) with regard to analgesic effectiveness (p = 0.33) or to antinausea effect (p = 0.18).
Chronic Paroxysmal Hemicrania: Heart Rate Changes and ECG Rhythm Disturbances. A Computerized Analysis of 24 h Ambulatory ECG Recordings
Authors: Russell David , Storstein Liv
Published: March 2003

Ambulatory ECG recordings have been carried out in five patients suffering from CPH. During the study a total of 105 attacks occurred. Contrary to findings in cluster headache, no typical pattern of heart rate change was found in association with attacks of CPH. A striking finding in all patients, however, was that there were often large and rapid variations in heart rate which could be observed “before”, “during” or “after” the attacks. One patient developed bradycardia and sino-atrial block and another bundle branch block together with episodes of atrial fibrillation in association with attacks.
Facial Temperature in Migraine, Tension-Vascular and Tension Headache
Authors: Drummond PD , Lance JW
Published: March 2003

The relationship between clinical features and changes in the extracranial circulation was studied during 209 separate attacks of headache affecting the anterior part of the head. Extracranial vascular changes were assessed thermographically and by the change in headache intensity when pressure was applied over the superficial temporal and common carotid arteries. In unilateral headaches, increased heat loss from the affected frontotemporal region was observed most frequently in attacks which were temporarily relieved by compression to the superficial temporal artery; thermographic asymmetry disappeared as the headache abated. Although such headaches were associated more frequently with migrainous features than attacks which did not respond to arterial compression, many headaches with clinical features of migraine had no vascular component detectable by thermography or vascular compression. Furthermore, the response to arterial compression was not consistent from one headache to another in the same patient. It was concluded that extracranial vascular changes recur intermittently in headache-prone patients, depending on the severity of pain and association with other features commonly regarded as migrainous. However, there was no clear demarcation point between entities diagnosed clinically as “migraine” and “tension headache”.
Vascular Compression of the C2 and C3 Roots Yet Another Cause of Chronic Intermittent Hemicrania?
Authors: Hildebrandt Jan , Jansen Jürgen
Published: March 2003

Two male patients had a history of right-sided headache attacks occurring daily and spreading from the occipital to the frontal region. The attacks were accompanied by ciliary injections on the symptomatic side, increased lacrimation and, in one case, by rhinorrhea. The pain was relieved with vasoconstricting preparations (ergotamine) and provoked with vasodilating medications (nitroglycerine). A selective conduction anaesthesia of the C2 nerve root in one case and of the C2 and C3 roots in the other, temporarily relieved the pain. At operation. vessels were found which compressed these roots. Since decompression of the nerve roots. 3 years and 1 year ago respectively, the patients have remained free of pain.
Metoprolol and Pizotifen in The Prophylactic Treatment of Classical and Common Migraine. A Double-Blind Investigation
Authors: Vilming Steinar , Standnes Brit , Hedman Christer
Published: March 2003

The prophylactic anti-migraine effect of the serotonin antagonist pizotifen and the beta1-selective beta-adrenoceptor antagonist metoprolol was compared in a double-blind cross-over study. The dosage of pizotifen was 0.5 mg t.i.d. and that of metoprolol 50 mg b.i.d. Thirty-five patients with classical or common migraine were included in the investigation. Five patients withdrew during the course of the study; four because of side effects (three on pizotifen, one on metoprolol) and one because of unassociated illness. The results show that there was no statistically significant difference in efficacy between metoprolol and pizotifen. The tolerance, especially regarding weight gain, was the major drawback with pizotifen, while metoprolol was generally well tolerated.
Classic Migraine Attack Complicated by Confusional State: EEG and CT Study
Authors: Tinuper P , Cortelli P , Sacquegna T , Lugaresi E
Published: March 2003

We report electroencephalographic and clinical observations in one attack of classic migraine, accompanied by a confusional state. The ictal EEG showed slow waves over the left hemisphere, the abnormality gradually clearing up during the four days following the attack. A brain CT scan was normal during the attack and also a few days later. A possible relationship between impairment of consciousness during the attack and left hemispheric metabolic dysfunction is discussed.
Effects on Migraine Headache of MDL 72,222, an Antagonist at Neuronal 5-HT Receptors. Double-Blind, Placebo-Controlled Study
Authors: Loisy Claude , Beorchia Sylvain , Centonze Vincenzo , Fozard John R , Schechter Paul J , Tell Guy P
Published: March 2003

MDL 72,222 (1aH, 5aH-tropan-3a-yl 3,5-dichlorobenzoate), a novel agent with antagonist activity at neuronal 5-HT receptors, was tested as an acute treatment for migraine pain under double-blind, placebo-controlled conditions. Forty-seven patients with common ( n = 29) or classical ( n = 8) migraine or mixed type with or without a psychogenic component ( n = 10) received 20–40 mg MDL 72,222 ( n = 24) or placebo ( n = 23) intravenously during the headache phase of a migraine attack. MDL 72,222 was consistently superior to placebo in rapidly alleviating the migraine pain. The treatment was remarkably well tolerated. The results are consistent with the hypothesis that the pain of migraine is related to activation of neuronal 5-HT receptors and suggest that compounds such as MDL 72,222, which block neuronal 5-HT receptors, could be useful new therapeutic agents for the management of migraine.
Muscle Nerve Sympathetic Activity In Migraine. Lack of Abnormality
Authors: Fagius Jan
Published: March 2003

Microelectrode recordings of muscle nerve sympathetic activity (MSA) in the peroneal nerve were performed in eight patients with common migraine, when they were free of headache and during a spontaneously occurring attack of migraine. During the migraine headache all subjects remained on the same level of MSA as in the control situation and the responses to manoeuvres (slow deep breathing, the Valsalva manoeuvre, sustained hand grip, immersion of one hand into ice water) showed no qualitative or quantitative change. Assessment of vagal influence on the heart showed no change from control situation to attack of migraine. The study provides direct evidence against the existence of any abnormality of MSA during ongoing migraine headache and does not support the assumption that migraine is a generalized vasomotor disorder. No conclusions about possible dysfunction in other parts of the sympathetic nervous system can be drawn.
Changes in Headache After Treatment of Mandibular Dysfunction
Authors: Forssell Heli , Kirveskari Pentti , Kangasniemi Pentti
Published: March 2003

To analyse the effect of treatment of mandibular dysfunction on headache, 35 patients with migraine, 20 patients with combination headache and 36 patients with muscle contraction headache were studied in a clinical double-blind trial. Patients in the treatment group received occlusal adjustment and those in the placebo group mock occlusal adjustment. After eight months and four months, respectively, the neurologist evaluated the treatment outcome. The frequency of headache was reduced in 79% and the intensity in 53% of patients suffering from muscle contraction headache or combination headache in whom the adjustment of the dental occlusion had been successfully accomplished. The difference from the placebo group was statistically significant. The decrease in headache frequency as calculated from the headache diaries correlated with the decrease in the index of clinical signs of mandibular dysfunction.
A Placebo-Controlled, Double-Blind, Cross-Over Trial of Flunarizine in Common Migraine
Authors: Sørensen Per Soelberg , Hansen Klaus , Olesen Jes
Published: March 2003

After four weeks of medication-free baseline observation, 29 patients with common migraine randomly received flunarizine (10 mg daily) or placebo for a 16-week period. After four weeks wash-out they crossed treatments for another 16 weeks; 27 patients completed the trial. Compared with placebo, flunarizine significantly reduced the frequency of migraine attacks and the derived headache indices, but the duration and severity of single attacks remained unchanged (Mann-Whitney U-test). The effect of flunarizine increased during the 16-week treatment period and during the last four weeks the number of migraine attacks was reduced to 50% compared to the wash-out period. The only side-effect of flunarizine was mild daytime sedation in three patients. It is concluded that flunarizine is a valuable new prophylactic agent for common migraine.
A New Formulation of Aspirin: Bioavailability and Analgesic Efficacy in Migraine Attacks
Authors: Brandon Roslyn A , Eadie Mervyn J , Curran Adrian CW , Nolan Peter C , Presneill Jeffrey J , Patterson Marc C
Published: March 2003

Plasma aspirin and salicylate concentrations were followed after 600 mg of a new palatable glycinated preparation of aspirin was given to six healthy male volunteers in an attempt to investigate whether pre-gastric absorption of aspirin could occur. In each subject the drug was administered by three different routes, viz. (i) swallowed with water, (ii) dissolved sublingually and retained in the mouth, and (iii) allowed to disperse on the tongue, and then swallowed without water intake. Using the latter route of administration and the same aspirin formulation, plasma aspirin and salicylate concentrations were also followed in 10 patients during acute migraine attacks. These results were compared with those from another 10 migraineurs given 600 mg of soluble aspirin swallowed with water during attacks. Aspirin and salicylate pharmacokinetic parameters ( Cmax, tmax, t1/2, Kabs and AUC) in the normal volunteers were not significantly different ( p > 0.05) whether glycinated aspirin was swallowed with water or swallowed without water after dispersion in the mouth. However, negligible aspirin was absorbed when the glycinated preparation was retained in the mouth. In migraine patients, there was no significant difference ( p > 0.05) between the bioavailabilities of soluble aspirin swallowed with water (AUC = 5.7 ± 2.3 mg h/1) and glycinated aspirin swallowed without water (AUC = 4.4 ± 1.6 mg h/l). There also was no significant difference ( p > 0.05) when the time courses of pain relief were compared, both treatments being associated with a significant ( p < 0.01) analgesic effect. The glycinated aspirin was thus bioequivalent to swallowed aspirin but has no advantages for migraineurs over soluble aspirin if water is readily available for self-administration.
Segregation Analysis of Migraine in 128 Families
Authors: Devoto Marcella , Lozito Antonio , Staffa Guido , D'Alessandro Roberto , Sacquegna Tommaso , Romeo Giovanni
Published: March 2003

To test the existence of inherited liability to migraine, formal segregation analysis of family data collected from 128 patients has been performed. Patients were subdivided into three groups in accordance with the presence or absence of migraine in their parents. The results obtained in each group were then compared with those expected on the basis of two different modes of simple Mendelian inheritance, namely autosomal dominant and autosomal recessive transmission. Our data show that neither of the two hypotheses can be accepted. thus suggesting the existence of a possible genetic heterogeneity of liability to migraine.
Urinary 5–HIAA in Migraine: Evidence of Lowered Excretion in Young Adult Females
Authors: Bousser Marie-Germaine , Elghozi Jean-Luc , Laude Dominique , Soisson Thierry
Published: March 2003

Urinary 5–hydroxyindoleacetic acid (5–HIAA) and homovanillic acid (HVA) were determined in 44 young adult migraine patients (35 women, 9 men) between attacks and in 33 healthy controls (23 women, 10 men). HVA excretion was equivalent in all groups. 5–HIAA was unaltered in men but was significantly decreased in female migraine patients when compared with their sex-matched controls (-31%, p < 0.01). No relationship was found between 5–HIAA excretion and the various characteristics of migraine, such as the time that had elapsed since the last attack and the presence or absence of oral contraception. The relatively marked decrease in 5–HIAA excretion in female migraine patients can hardly be accounted for by a reduction in either neuronal or platelet serotonin metabolism alone. A reduction in the intestinal contribution to urinary 5–HIAA might be the crucial factor.
Calcium Deficiency and Supraorbital Headache: A Clinical Study of Adult Subjects
Authors: Janiri Luigi , Gallo Giuseppe , Nicoletti Walter
Published: March 2003

The present study was aimed at investigating the relationship between “chronic constitutional tetany” (spasmophilia) and headache. Several adult patients presenting with neuromuscular hyperexcitability, anxiety, dysautonomia, and oculofrontal headache were subjected to a series of ion and hormone blood tests, and the results were compared with those in control subjects. Calcium and parathyroid hormone levels were significantly decreased, and phosphorus and beta-endorphin-like immunoreactivity were significantly increased. A subgroup of the patients had all four abnormalities. In most cases the family history was positive for headache. Sleep disturbances and personal histories of periodic syndrome in infancy were recorded. It is concluded that a correlation may exist between the symptoms assessed and an impairment of some ion and hormone levels. There are several traits in common with “common migraine”, and our patients may form a subgroup of that group. A possible linkage between headache/tetany and the periodic and hyperventilation syndromes is discussed. The increased beta-endorphin-like immunoreactivity is putatively a reactive phenomenon.
Effect of a Carbohydrate-Rich Diet, Low in Protein-Tryptophan, in Classic and Common Migraine
Authors: Hasselmark Lena , Malmgren Rigmor , Hannerz Jan
Published: March 2003

Because serotonin, released from platelets, has been suggested to initiate migraine, a decreased platelet serotonin content, attained by a reduced intake of serotonin and the serotonin precursor tryptophan, might be beneficial. In the brain, however, increased serotonin levels, achieved by a high carbohydrate intake, are probably favourable. Seven migraine patients (four with classic, three with common migraine) were placed on a carbohydrate-rich diet, low in protein-tryptophan. Three of the four classic migraineurs, but none of the common migraineurs, noted improvement in their migraine. Platelet serotonin uptake was within the normal range both before and at the end of the diet period. The apparent positive effect in the classic migraineurs could be due to a reduced intake of migraine-precipitating foods and/or increased brain serotonin levels.
Psychophysiologic Response Patterns in Migraine Before and After Temperature Biofeedback: Prediction of Treatment Outcome
Authors: Ellertsen Bjørn , Nordby Helge , Hammerborg Dag , Thorlacius Sigurdur
Published: March 2003

Psychophysiologic response patterns were studied in female migraine patients during headache-free periods (n = 16) and in controls (n = 8). Cardiovascular variables studied were heart rate (HR) and temporal artery pulse wave amplitudes (PWA). Phasic responses to 80-dB, 1000-Hz tones, each lasting 2 sec and sounded at irregular intervals, were studied within a habituation laboratory design. In addition, electromyographic (EMG) levels from the frontal muscles and hand temperature were measured. HR responses were less pronounced and PWA reduction more pronounced in migraine patients than in controls. There were no differences between migraine patients and controls in habituation pattern. Migraine patients showed lower hand temperature and higher EMG levels than controls. Migraine patients were treated with eight temperature biofeedback sessions and were evaluated clinically and psychophysiologically during and 2 months after treatment. Clinical follow-up evaluation was done 2 years after treatment. An average reduction in headache frequency of 66% was reported. A relationship between HR and PWA response pattern before treatment and treatment outcome was found. Migraine patients reporting most pronounced clinical improvement showed a “normalization” of the PWA response pattern after treatment.
“Hemicrania Continua”: The First Bilateral Case?
Authors: Pasquier Florence , Leys Didier , Petit Henri
Published: March 2003

The patient reported had had a continuous headache involving the whole skull for 7 years. Many drugs had failed to relieve the pain, but with indomethacin the headache completely disappeared within 3 days. Nine months later the treatment was discontinued without any relapse. This variety of headache, not previously reported, was quite similar to the “hemicrania continua” except for its localization.
Chronic Paroxysmal Hemicrania in a South African Black: A Case Report
Authors: Joubert Jacques , Powell D , Djikowski J
Published: March 2003

A 35-year-old black man with a 4-year continuous history of multiple paroxysms of unilateral temporal and ocular pain is reported. Multiple (that is, 15–20) attacks occurred in 24 h. There were no symptom-free periods. Mild exophthalmos, marked sweating, nasal congestion, and lacrimation were present on the affected side. There was no response to ergot preparations, steroids, or lithium but dramatic and sustained relief with indomethacin.
Orbital Phlebography in Patients with Cluster Headache
Authors: Hannerz Jan , Ericson Kaj , Bergstrand Gustaf
Published: March 2003

Thirteen patients with cluster headache in an active stage were investigated with orbital phlebography. About 60% of the patients showed pathologic changes on the phlebograms, such as changes in the appearance of the superior ophthalmic vein. Five patients had pathologic changes on both sides and three patients on one side only. All patients with unilateral pathologic findings on orbital phlebography had the attacks on the same side. The phlebographic findings in these patients with cluster headache were very similar to those of patients with the Tolosa-Hunt syndrome. There is also some similarity in the symptoms in the two disorders. It has previously been suggested that the Tolosa-Hunt syndrome is caused by venous vasculitis, and the present findings to some extent support the idea that cluster headache may have the same etiology.
Cluster Headache in Women: Clinical Findings and Relationship with Reproductive Life
Authors: Manzoni Gian Camillo , Micieli Giuseppe , Granella Franco , Martignoni Emilia , Farina Stefano , Nappi Giuseppe
Published: March 2003

Cluster headache (CH) occurs rarely among women; for this reason only a limited number of studies have been reported on the characteristics of the disease in the female population. In this study, 82 females (age range, 14–72 years) with episodic (69 cases) or chronic (13 cases) CH were investigated. The clinical features of headache and the physiologic events related to reproductive life were compared with those of various control groups. We did not find any remarkable differences in clinical features between men and women. Unlike other forms of primary headache, the course of CH does not seem to be modified by menstruation, pregnancy, or puerperium. Finally, our data seem to confirm a hypofertility trend, mostly after onset of CH, which had previously been noticed by other authors.
Neuropsychologic Symptoms in the Migraine Syndrome
Authors: Ardila Alfredo , Sanchez Erick
Published: March 2003

Twenty patients with complex neuropsychologic symptoms associated with classic migraine were selected from a group of 200 patients with vascular headache. Twenty types of symptoms were found and grouped into six categories (language, visual symptoms, cognitive-dysmnesic symptoms, olfactory-gustatory hallucinations, automatisms, and somatosensory symptoms). Some of the symptoms found have apparently not been reported previously. The importance of the analysis of this complex neuropsychologic set of symptoms and of the possible consequences of complicated, frequent vascular headache is emphasized.
Cluster Headache-Like Headaches: A Symptomatic Feature?: A Report of Three Patients with Intracranial Pathologic Findings
Authors: Greve Esther , Mai Jesper
Published: March 2003

This report concerns three patients with cluster headache-like headaches associated with intracranial pathologic findings. The question whether the occurrence of cluster headache-like headaches may be a symptomatic feature is still not solved. In two of the three presented cases the cluster headache-like headaches disappeared when the intracranial abnormalities were treated.
Retropharyngeal Tendinitis: Three Probable Cases with an Unusually Low Epicentre
Authors: Fahlgren Holger
Published: March 2003

Retropharyngeal tendinitis is a rare but underdiagnosed disorder. The clinical picture is characterized by increasingly severe pain in the upper neck occurring within 1 or 2 days and with pain aggravated by swallowing and head movements. Acute-phase roentgenograms show substantial soft-tissue swelling anterior to the vertebral bodies, C1 to C4, often accompanied by amorphous calciferous deposition below the anterior tubercle of the atlas. The course is benign, the patient being asymptomatic after 1 or 2 weeks. I briefly describe three cases which were characterized by severe pain in the mid-cervical spine and radiologic findings of soft-tissue swelling anterior to the vertebral bodies, C2-C6. These cases were probably due to acute tendinitis of the longus colli muscle, although located at a lower level than in previously reported cases of retropharyngeal tendinitis.
Cluster Headache: Further Observations on the Dissociation of Pain and Autonomic Findings
Authors: Sjaastad O , Antonaci F , Fragoso YD
Published: March 2003

A 51-year-old male cluster headache patient had during five bouts in the course of 11 years always had the headache attacks on the left side. Autonomic abnormalities were, however, present on the right side. Pupillometrically, there was thus a Horner-like syndrome on the right (non-symptomatic) side, with miosis and a relatively more marked dilatation of that eye subsequent to topical application of a directly working sympathomimetic agent (phen-ylephrine) than after an indirectly working one (hydroxyamphetamine), whereas this was not the case on the symptomatic side. The findings on evaporimetry were not as clear-cut as the pupillometric findings; however, even facial sweating was consistent with a pathologic condition on the right (non-symptomatic) side. A primary dichotomy of pain and autonomic signs (that is, not due to change of side of pain localization) thus seems to be present in this case.
Combined Low-Dose Acetylsalicylic Acid and Dihydroergotamine in Migraine Prophylaxis: A Double-Blind, Placebo-Controlled Crossover Study
Authors: Bousser Marie Germaine , Chick Jacques , Fuseau Eliane , Soisson Thierry , Thevenet Robert
Published: March 2003

The efficacy of the combination of dihydroergotamine (10 mg) with acetylsalicylic acid (80 mg) (DHE + ASA) in the prophylaxis of migraine was studied in a double-blind, placebo-controlled crossover trial (8 weeks twice). Of 45 patients who entered the study, 38 completed it. The number of attacks was significantly ( p = 0.003) reduced during active treatment (11.5 ± 6.2) compared with placebo (16.6 ± 9.9). The mean duration, the mean severity, and the mean score for symptomatic acute medication of attacks did not differ significantly. The overall assessment made by the patients themselves was in favor of DHE + ASA ( p = 0.001). These results indicate a moderately beneficial effect of the dihydroergotamine/low-dose acetylsalicylic acid combination in migraine prophylaxis.
Cluster Headache: Combined Assessment with Pupillometry and Evaporimetry
Authors: Salvesen R , Sand T , Sjaastad O
Published: March 2003

Twenty-nine patients with cluster headache have been examined with the pupillometer and the evaporimeter. Pupils were dilated by sympathicomimetic drugs instilled into the conjunctival sacs, and responses of the two sides were compared. Forehead sweating was stimulated by body heating and by pilocarpine injection, and sweat evaporation on the two sides was compared. Most patients demonstrated the known patterns of hyposecretion on heating, of pilocarpine supersensitivity, and of deficient pupillary dilatation on OH-amphetamine stimulation on the symptomatic side and a supersensitivity of this pupil to phenylephrine. There were deviations from the rule for all methods of testing. Sixteen patients demonstrated a typical supersensitivity response of the pupil and of the sweat glands on the symptomatic side. Six patients had no such response, and seven patients had a discrepancy between the pupillary and the sweat gland response to stimulation, supersensitivity being present in one system only. There was a high degree of concordance between the results of the various methods of examination.
Lactation Headache — A New Form of Headache?
Authors: Askmark Håkan , Lundberg Per Olov
Published: March 2003

The case of a 26-year-old woman suffering from brief attacks of headache occurring on every occasion of nursing is described. Pulse rate and blood pressure are normal during the attacks and serum prolactin responds normally to nursing. Plasma vasopressin increases before each headache attack. Propranolol does not prevent the headache, which disappears only after lactation has ceased. Possible pathophysiological mechanisms related to suckling are discussed.
Lumbar Iohexol Myelography and Diagnostic Lumbar Puncture. Headache and Associated Side Effects in Relation to Neurological Signs and Diagnosis, Previous Mental Symptoms and Pain History
Authors: Sand T , Stovner LJ , Myhr G , Sjaastad O
Published: March 2003

Various possible risk factors for postlumbar puncture (and postiohexol-myelographic) headache and associated side effects were analysed. Headache and nausea occurred significantly more often in patients without clinical findings than in those with findings. We found significantly different incidences of severe headache and nausea between diagnostic subgroups after a lumbar puncture. The greatest headache incidence was found in patients without a definite neurological diagnosis, while nausea occurred most frequently in patients with various painful disorders. Following iohexol myelography, nausea occurred most often in patients who had a history of previous mental symptoms and in patients with a history of previous headache disorders. Mental symptoms were more frequently reported in patients who also had experienced mental symptoms previously. The relationship between side effects and negative clinical findings was stronger than the relationship between side effects and previous mental symptoms.
An Open Study Comparing Manual Therapy with the Use of Cold Packs in the Treatment of Post-Traumatic Headache
Authors: Jensen OK , Nielsen FF , Vosmar L
Published: March 2003

One year after head trauma, 23 patients with post-traumatic headache entered a prospective clinical controlled trial to find out if specific manual therapy on the neck could reduce the headache. The study was completed by 19 patients (83%). Ten patients were treated twice with manual therapy and nine patients were treated twice with cold packs on the neck. The pain index was calculated blindly. Two weeks after the last treatment the mean pain index was significantly reduced to 43% in the group treated with manual therapy compared with the pretreatment level. At follow-up five weeks later, the pain index was still lower in this group compared with the group treated with cold packs, but this difference was not statistically significant. The pain index for all 19 patients was significantly correlated to the use of analgesics as well as to the frequency of associated symptoms (number of days per week with dizziness, visual disturbances and ear symptoms). It is concluded that the type of manual therapy used in this study seems to have a specific effect in reducing post-traumatic headache. The result supports the hypothesis of a cervical mechanism causing post-traumatic headache and suggests that post-traumatic dizziness, visual disturbances and ear symptoms could be part of a cervical syndrome.
The Influence of Sex and Pre-Traumatic Headache on the Incidence and Severity of Headache After Head Injury
Authors: Jensen Ole Kudsk , Nielsen Frank Farsø
Published: March 2003

Pre- and post-traumatic headache of 168 individuals aged 18–60 years was registered 9–12 months after a head trauma. Headache before the trauma was reported by 39.9%, women being in the majority. After the trauma 64.3% were suffering from headache. Post-traumatic headache was reported by 64 patients (38.1%), of whom 22 patients experienced an increase of already existing headache and 42 patients complained of new headache. Patients suffering from headache before the trauma were not more at risk of having post-traumatic headache than patients who did not suffer from headache before the trauma. Patients who experienced an increase of already-existing pre-traumatic headache used more analgesics than patients first suffering from headache after the trauma. Post-traumatic headache was reported by more women than men ( p < 0.02), the corresponding relative risk being 1.6. Both the use of analgesics and the frequency of headache showed a significant increase for patients with post-traumatic headache when compared with a “control group” of 41 patients with unchanged headache and when compared with all patients with headache before the trauma. There was no significant difference in the location of pain between the groups analysed.
Headache and Family History
Authors: Messinger Harley B , Spierings Egilius LH , Vincent Arnaud JP , Lebbink John
Published: March 2003

In two headache questionnaire surveys we inquired about the occurrence of headache in the mothers, fathers, siblings and children of the respondents. In total, 633 people completed valid questionnaires, 260 in the first survey and 373 in the second. The hypothesis was that familial headache occurrence would be positively associated with headache frequency. In each survey, the regression of headache frequency on the number of parents having headache was highly significant. Neither sex nor the sibling and children variables were significant predictors. In the cross-tabulations of the parental occurrence of headache with headache frequency we saw a dear “break-point” between the “no headache” and the headache frequency categories studied. For the final analyses the dichotomy “headache/no headache” was related in fourfold tables to headache occurrence in the father and the mother separately, and to the number of headache parents. The positive associations were not simply due to the large number of migraine cases since they remained after removing the migraineurs.
Cervical Spinal Cord Neurons Receiving Sensory Input from the Cranial Vasculature
Authors: Lambert Geoffrey Andrew , Zagami Alessandro Stefano , Bogduk Nikolai , Lance James Waldo
Published: March 2003

The superior sagittal sinus, middle meningeal artery or superficial temporal artery was stimulated electrically in anaesthetized cats. Field potential recordings were used to locate areas of maximum responses in the upper cervical cord, which were then further examined for responsive single units. Short latency units responded to stimulation of the superior sagittal sinus with a mean latency of 11.9 ms. Some units also responded at longer latencies in the 200–250 ms range. Spontaneous discharge rates of some units in a dorsolateral area of the cervical cord were accelerated by iontophoretic application of glutamic or homocysteic acid to these same units. Evoked action potentials were commonly multiphasic. Dorsolateral area units commonly received convergent input from two vessels and often had receptive fields on the face and limbs. Spontaneously active cells which respond to electrical stimulation were accelerated by the local application of bradykinin to the sinus and responses of dorsolateral area units could be reversibly blocked by local application of lignocaine to the sinus. It was concluded that the dorsolateral area is a relay area for the perception of pain from cranial vessels.
Exteroceptive Silent Period of Temporalis Muscle in Menstrual Headaches
Authors: Schoenen Jean , Bottin Dominique , Sulon José , Gaspard Ulysse , Lambotte René
Published: March 2003

The second exteroceptive silent period (ES2) of temporalis muscle was recorded on days 1 and 15 of the menstrual cycle in 17 women, 9 of whom suffered regularly from tension-type headaches during menstruation. Mean duration of temporalis ES2 was significantly shorter on day I of the cycle than on day 15. This difference was due to a marked menstrual reduction of ES2 in the headache subgroup. A positive correlation was found between ES2 durations and oestradiol/progesterone ratios. We hypothesize that the variations of ES2 during the ovarian cycle result from the modulatory effects of oestrogens on descending aminergic pathways that control excitability of inhibitory brainstem interneurons mediating exteroceptive suppression of jaw-closing motoneurons.
Chocolate is a Migraine-Provoking Agent
Authors: Gibb CM , Davies PTG , Glover V , Steiner TJ , Rose F Clifford , Sandler M
Published: March 2003

Patients with migraine who believed that chocolate could provoke their attacks were challenged with either chocolate or a closely matching placebo. In a double-blind parallel group study, chocolate ingestion was followed by a typical migraine episode in 5 out of 12 patients, while none of the 8 patients challenged with placebo had an attack ( p = 0.051). The median time to the onset of the attack was 22 h. This brief study provides some objective evidence that chocolate is able to provoke a migraine attack in certain patients who believe themselves sensitive to it.
Blood Magnesium Levels in Migraine
Authors: Schoenen Jean , Sianard-Gainko Jeannette , Lenaerts Marc
Published: March 2003

Serum and erythrocyte magnesium levels were screened between attacks in patients with migraine without aura ( n = 38) and with aura ( n = 6), and for comparison in a group of patients suffering from chronic tension-type headache ( n = 25) as well as a group of neurological, non-headache patients ( n = 19). Serum magnesium levels were not significantly different between the four groups of patients. In contrast, magnesium in erythrocytes was on average significantly reduced in patients with migraine without aura compared to the other groups. It is hypothesized that this reduction might be due to an abnormal regulation of intracellular magnesium possibly reflecting at the periphery changes observed in the brain of migraineurs (8).
Episodic Cluster Headache and Narcolepsy: A Case Report
Authors: Alberca R , Botebol G , Boza F , Navarro A
Published: March 2003

A patient who first presented with episodic cluster headache later developed narcolepsy. In spite of REM sleep alterations associated with narcolepsy, the frequency and distribution of pain attacks did not change when narcolepsy occurred and were similar to those seen in cases of episodic cluster without narcolepsy. The lack of influence of narcolepsy on the pattern of cluster pains questions the role of REM sleep states in triggering pain in episodic cluster.