bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Oral Diclofenac in the Acute Treatment of Common Migraine Attacks: A Double-Blind Study Versus Placebo
Authors: Massiou Hélène , Serrurier Dominique , Lasserre Odile , Bousser Marie-Germaine
Published: March 2003

In a multicentre double-blind cross-over trial, oral diclofenac at a dose of 50 mg to 100 mg was compared to placebo in the acute treatment of migraine attacks. A hundred and seven patients suffering from migraine without aura were included, and 91 were analysed for efficacy; they had to treat four successive attacks-two with diclofenac and two with placebo. Diclofenac was significantly more effective than placebo ( p < 0.05) on the main judgement parameter, which was the number of attacks aborted within 2 h of drug intake, as well as on the following secondary parameters: the necessity for an escape medication and the evaluation of global efficacy. Diclofenac was well tolerated. This trial demonstrates the efficacy of diclofenac in the acute treatment of migraine attacks. It confirms the good clinical relevance of the main judgement parameter chosen, which is the one recommended by the International Headache Society, but appears to be a severe one in terms of successes.
EMG Analysis of the Late Exteroceptive Suppression Period of Temporal Muscle Activity in Episodic and Chronic Tension-Type Headaches
Authors: Wallasch Thomas-Martin , Reinecke Martin , Langohr Hans-Dieter
Published: March 2003

EMG analysis of the late exteroceptive suppression period of the temporal muscle activity is discussed as comparative methodology in the assessment of patients suffering from chronic tension-type headache and from migraineurs (1, 2). After electrical perioral trigeminal nerve stimulation during maximum voluntary jaw occlusion, early (ES1) and late (ES2) exteroceptive suppression periods can be registered above the temples using surface EMG recordings (3–6). In patients suffering from chronic tension-type headache the duration of the late suppression period is shortened ( p < 0.001) compared to migraineurs or controls. However, patients suffering from episodic tension-type headache display late suppression periods of temporal muscle activity of differing lengths.
Dihydroergokryptine Versus Dihydroergotamine in Migraine Prophylaxis: A Double-Blind Clinical Trial
Authors: Frediani Fabio , Grazzi Licia , Zanotti Annalisa , Mailland Federico , Zappacosta Boris Maurizio , Bussone Gennaro
Published: March 2003

Dihydroergokryptine has been evaluated in the prophylaxis of headache attacks in patients with migraine without aura. The study was controlled vs dihydroergotamine with a double-blind crossover design. After a 1-month run-in period, 30 patients were randomized into two groups and submitted to 4 months treatment with dihydroergokryptine 10 mg b.i.d. or dihydroergotamine (controlled release) 5 mg b.i.d. The treatment was repeated in crossover after 2 months washout. The clinical patients' evaluation was determined by monthly Pain Total Index recording, headache days/month and analgesic consumption. The patients were considered responsible when Pain Total Index decreased by 50% or more in 1 or more months of each treatment period; otherwise the patients were considered unresponsive. The response rate to dihydroergokryptine was 66% while 48% of cases were responsive to dihydroergotamine. The response rate to both treatments was 41%, while 26% did not respond to either treatment. Seven cases unresponsive to dihydroergotamine responded positively to dihydroergokryptine while two cases only, resistant to dihydroergokryptine, responded positively to dihydroergotamine. Three cases dropped out during treatment with dihydroergotamine due to gastric pain and nausea, while they did not show any side effects during dihydroergokryptine therapy. During treatment with dihydroergokryptine there was one case of skin rash which disappeared after drug withdrawal. In conclusion, dihydroergokryptine appears to be an effective drug for the prophylaxis of migraine attacks.
Short-Lasting Unilateral Neuralgiform Headache Attacks with Tearing and Conjunctival Injection: The First “Symptomatic” Case?
Authors: Bussone Gennaro , Leone Massimo , Volta Giorgio Dalla , Strada Liliana , Gasparotti Roberto , Monda Vincenzo Di
Published: March 2003

A 36-year-old man was suffering from brief, unilateral and short-lasting pain attacks always associated with marked homolateral tearing and conjunctival injection, both presenting in a cluster fashion. An arteriovenous malformation was subsequently discovered in the homolateral cerebellopontine angle. The clinical picture shares similarities with both cluster headache and trigeminal neuralgia, although it can not be accurately placed with either of these forms. Patients with similar symptoms have previously been described in detail, and on the basis of these few descriptions a new syndrome “short-lasting” unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhoea has been postulated. Assuming the validity of this syndrome as an entity, this case is in all probability its first “symptomatic” example. Careful evaluation of the varieties of cluster headache and trigeminal neuralgia, and the reporting of similar new cases as they arise are necessary to establish the nosologic boundaries of this syndrome.
Kinetics of Platelet 5-Hydroxytryptamine Uptake in Headache Patients
Authors: Hannah Patricia , Jarman Joan , Glover Vivette , Sandler M , Davies PTG , Rose F Clifford
Published: March 2003

Platelet 5-hydroxytryptamine (5-HT) uptake was measured in asymptomatic headache patients attending a specialist migraine clinic, and in hospital staff who did not suffer from regular or severe headache. Current levels of anxiety and depression were assessed in all subjects using the Hospital Anxiety and Depression (HAD) scale and their possible influence on the uptake kinetics taken into account during the analysis of results. The Michaelis-Menten constant (K m) was significantly raised in common migraine and tension headache compared with controls ( p < 0.001 and p < 0.01, respectively), but not in classical migraine or cluster headache. The increase remained significant after adjusting for differences in age, sex, presence of anxiety or depression (HAD sub-scale score 3 8), drug intake during the week before testing, time elapsed since last attack and time of assay (am or pm). No differences were observed between patients and controls in the maximal rate of uptake ( Vmax) or platelet count, and previous reports of a reduction in Vmax in patients experiencing attack within 5 days prior to testing could not be confirmed. The cause and significance of an increased K m are not clear, but plasma factors acting as competitive inhibitors for the uptake site or an alteration in the configuration of the uptake site are possible explanations. If confirmed, the shared biochemical abnormality may suggest that common migraine and tension headache have a common pathogenesis.
Migraine with Aura and Photosensitive Epileptic Seizures: A Case Report
Authors: Carolis Piero de , Tinuper Paolo , Sacquegna Tommaso
Published: March 2003

An 18-year-old female presented with two seizures induced by photic stimulation. She had a positive family history for migraine and a history of febrile convulsions. Since the age of 13 she had suffered from migraine attacks with aura. A brain computerized tomography with contrast enhancement was negative and several electroencephalograms showed a photoparoxysmal response. At the age of 18 she had a partial secondary generalized seizure after photic stimulation during routine electroencephalogram. The onset of seizure was in the occipital region. Two days later, the patient presented with a typical migrainous attack with aura. Interictal apomorphine test (1.5 mg s.c.) blocked the photoparoxysmal response. According to Quesnay, dopaminergic failure of the occipital cortex may account for both epileptic and migraine features.
Pain, Tenderness, Wheal and Flare Induced by Substance-P, Bradykinin and 5-Hydroxytryptamine in Humans
Authors: Jensen Kai , Tuxen Christian , Pedersen-Bjergaard Ulrik , Jansen Inger
Published: March 2003

The algesic effect of substance-P with and without the addition of bradykinin or 5-hydroxytryptamine was studied in 13 healthy volunteers. Test substances dissolved in saline were injected into the temporal muscle and the forearm skin and the effects compared with those of saline. In the temporal muscle, none of the test substances induced more pain than saline, but substance-P with bradykinin lowered the pressure pain threshold by 18% ( p < 0.02). All test substances induced pain, wheal and flare in the forearm skin. Substance-P induced a more pronounced flare reaction than bradykinin, whereas the latter induced more pain than substance-P. This dissociation between pain and flare may indicate that C-fibres in the human skin represent more than one type of nociceptor.
The Similarities and Differences of Migraine with Aura and Migraine Without Aura: A Preliminary Study
Authors: Ranson R , Igarashi H , MacGregor EA , Wilkinson M
Published: March 2003

A preliminary study was undertaken to provide clinical evidence to support the hypothesis that: “Migraine with aura, migraine without aura and aura alone are the same condition, which differ in degree rather than pathophysiology.” At the City of London Migraine Clinic, 50 patients consecutively attending the clinic with a past or present history of migraine with aura were questioned. Of the 50 patients questioned 36 (70%) had a combination of migraine with aura, migraine without aura and/or aura alone; i.e. 70% had had more than one type of migraine attack. The duration, severity and frequency of attacks did not differ between migraine with and migraine without aura. Conclusion-the results support the hypothesis that migraine with and migraine without aura, and aura alone are not separate conditions, because: (1) most patients suffer from more than one type of migraine attack; (2) there are no significant differences in the characteristics of the migraine attacks in the different groups; (3) there are no significant differences in the characteristics of the subjects.
A Double-Blind Comparison of Granisetron and Placebo for the Treatment of Acute Migraine in The Emergency Department
Authors: Rowat Bruce MT , Merrill Charles F , Davis Alan , South Valerie
Published: March 2003

Three hundred and ninety-seven patients who presented to the emergency department were screened for a randomized, double-blind, placebo-controlled study of iv granisetron (40 μg/kg or 80 μg/kg) in acute migraine. Twenty-eight patients fulfilled the stringent eligibility criteria and completed the study. Rescue medication was required 2 h post-infusion in 8 of 10 patients receiving granisetron 40 μg/kg, 5 of 10 patients receiving granisetron 80 μg/kg, and 6 of 8 patients receiving placebo. Significant improvement (p < 0.05) in headache pain (on a visual analogue scale and categorical scale) was observed in the 80–μg/kg group. Headache pain evaluated with the Hunter headache scale indicated improvement for the sensory and affective components of headache pain in both granisetron groups. Except for more nausea at 30 min in the placebo group, no significant differences were noted between treatments. All three treatments were well tolerated. Granisetron may be effective for acute migraine headache; however, further studies with increased patient numbers are required.
Cerebrovascular Risk Factors in Migraine with Prolonged Aura and Without Aura
Authors: Pfaffenrath Volker , Kommissari Ingrid , Pöllmann Walter , Kaube Holger , Rath Michael
Published: March 2003

The role of cerebrovascular risk factors such as mitral valve prolapse, platelet aggregation, platelet activation and cardiac arrythmias in migraine was investigated in a total of 44 migraineurs (32 migraineurs without aura and 12 with prolonged aura) and 32 controls. Comparing the total of migraineurs and the two subgroups with controls, mitral valve prolapse, a raised thromboxane B2 level, at least one platelet aggregation dysfunction or an abnormality in 24-h ECG was statistically seen no more often than in the control group. Neither did combinations of the variables occur more frequently. Altogether, this study showed no increased coincidence of migraine with prolonged aura and migraine without aura with the above parameters. The absence of cardiac and haematological abnormalities in migraine with prolonged aura focuses attention on the control of the cortical microcirculation.
Migraine and Antiphospholipid Antibodies
Authors: Tietjen Gretchen E
Published: March 2003

Migraine and antiphospholipid antibodies. Cephalalgia 1992:12:69–74. Antiphospholipid antibodies have been detected in patients with transient neurologic symptoms including migraine aura. The role of these antibodies in the pathogenesis of migraine is not fully understood. The available data suggest an association between the migraine-like phenomena and antiphospholipid antibodies, but not between migraine headache and antiphospholipid antibodies. To elucidate the actual role of antiphospholipid antibodies in migraine, prospective, controlled studies are needed.
Cluster Headache: Phospholipid Metabolism in Polymorphonuclear Cells
Authors: White Linda R , Stovner Lars Jacob , Vincent Maurice B , Løbben Ole Petter , Fragoso Yara D , Bjerve Kristian S , Sjaastad Ottar
Published: March 2003

Our group has previously reported significant changes in the incorporation of precursors into glycerophos-pholipids, particularly phosphatidylserine, in polymorphonuclear cells obtained from the peripheral blood of cluster headache patients, when compared with controls. The potential of these results led to further work using both the previous methodology and a modified isolation technique to obtain polymorphonuclear cells in as pure a state as possible. Neither the new results obtained using the original technique, nor the results with high purity polymorphonuclear cells from controls and cluster headache patients, confirm the marked changes in precursor uptake into glycerophospholipids originally reported.
Subcortical Cerebral Blood Flow and Metabolic Changes Elicited by Cortical Spreading Depression in Rat
Authors: Mraovitch Sima , Calando Yolande , Goadsby Peter J , Seylaz Jacques
Published: March 2003

Changes in cerebral cortical perfusion (CBFLDF), local cerebral blood flow (ICBF) and local cerebral glucose utilization (ICGU) elicited by unilateral cortical spreading depression (SD) were monitored and measured in separate groups of rats anesthetized with a-chloralose. CBFLDF was recorded with laser Doppler flowmetry, while ICBF and ICGU were measured by the quantitative autoradiographic [14C]iodoantipyrine and [14C]-2-deoxyglucose methods, respectively. SD elicited a wave of hyperemia after a latency of 2 to 3 min followed by an oligemic phase. Ninety minutes following the onset of SD cortical (frontal, parietal and occipital) ICBF and ICGU were essentially the same as on the contralateral side and in sham-treated rats. However, alteration in the ICBF and ICGU in upper and lower brainstem persisted. The present results demonstrate, for the first time, that long-lasting cerebrovascular and metabolic alterations take place within the subcortical regions following SD. These regions provide an attractive site to integrate observations in man concerning spreading depression and the aura of migraine with the other features of the syndrome.
Cytochrome P-450-Dependent Hydroxylation in Migraine
Authors: Dahlöf Carl , Alm Christina , Bertling Ingegerd , Barret Lena
Published: March 2003

The hypothesis was tested that an acute oxidation deficiency related to potential dietary trigger factors plays a role in the migraine attack. Migraine sufferers (14F and 4M), fulfilling the criteria for migraine with and without aura according to the classification of the International Headache Society, were coadministered oral mephenytoin (100 mg) and debrisoquine (10 mg) during the initial phase of a typical migraine attack. This was repeated during a period without migraine. The hydroxylation of mephenytoin and debrisoquine hydroxylation did not differ during and without the migraine attack. We conclude that hydroxylation, via cytochrome P-450 (2D6, 2C8 and 9), is not reduced during the migraine attack. The results do not support the hypothesis that oxidation deficiency is involved in the pathophysiology of migraine.
From Serotonin Receptor Classification to the Antimigraine Drug Sumatriptan
Authors: Saxena Pramod R , Ferrari Michel D
Published: March 2003

After the synthetic serotonin 5-hydroxytryptamine (5-HT) became available in the early 1950s, attempts were soon under way to study the nature of 5-HT receptors. Using the guinea-pig isolated ileum, Gaddum and Picarelli (1957) suggested that 5-HT-induced contractions were mediated by a morphine-sensitive “M” receptor located on the parasympathetic ganglion and a dibenzyline-sensitive “D” receptor located on the smooth muscle. Though this classification was used during the next three decades, it was realized that some effects of serotonin, for example vasoconstriction within the carotid vascular bed, were not mediated by either “M” or “D” receptors. When radioligand binding studies led to the identification of 5-HT1 and 5-HT2 “receptors” in the rat brain membranes, it became increasingly apparent that the two receptor classifications were not identical. Thus, a new framework for serotonin receptor nomenclature and classification was proposed: 5-HT 1 -like (5-HT 1), 5-HT 2 (formerly “D”) and 5-HT 3 (formerly “M”) receptors. At the present time, several subtypes of 5-HT 1 receptors as well as a 5-HT 4 receptor are also recognized. As the serotonin receptor classification was emerging to indicate that carotid vasoconstriction by serotonin is mediated by a subtype of 5-HT 1 receptors, on the migraine front it was being suggested that the disease is associated with vasodilatation within the cranial extracerebral circulation and deranged serotonin metabolism and that certain antimigraine drugs caused a selective carotid vasoconstriction, probably via serotonin receptors. Therefore, Humphrey and colleagues conceived that synthesis of serotonin derivatives may lead to a compound that would elicit highly selective carotid vasoconstriction and abort migraine attacks. Indeed, via the synthesis of 5-carboxamidotryptamine and AH25086, sumatriptan was designed. The drug acts as an agonist at the vasoconstrictor 5-HT 1 receptor subtype and has proved highly effective in the therapy of migraine attacks.
Immunological Alterations in Cluster Headache During Remission and Cluster Period. Comparison with Low Back Pain Patients
Authors: Bussone G , Salmaggi A , Leone M , Valentini S , Dufour A , Nespolo A
Published: March 2003

Cluster headache is a disorder of unknown origin. Some studies have focused their attention on neuroendocrine derangement, others on immunity. To probe central alterations in cluster headache (CH), immune parameters were investigated in cluster headache patients in comparison to low back pain patients and healthy controls. Increases in peripheral blood monocytes found in remission cluster headache patients may be attributable to chronic central nervous system (hypothalamic?) noradrenergic dysfunction or altered b-endorphin. Alterations in NK+, CD3+ and CD4+ levels found in cluster period cluster headache and low back pain patients are probably pain or stress-related.
Sumatriptan in Chronic Cluster Headache: Results of Continuous Treatment for Eleven Months
Authors: Ekbom Karl , Waldenlind Elisabet , Cole Jayne , Pilgrim Alison , Kirkham Andrew
Published: March 2003

A 32-year-old man received a total of 480 injections of subcutaneous sumatriptan 6 mg for the treatment of acute attacks of chronic cluster headache over an eleven-month period. Over 90% of the attacks resolved within 10 min of treatment (average 6.8 ± 3.4). As a comparison, the average duration of 61 attacks occurring over the same period, but not treated with sumatriptan, was 56.1 ± 20.8 min. This difference was highly significant. There was no clinical evidence of tachyphylaxis, and there were no adverse effects. This is the first report of a long-term treatment of cluster headache with sumatriptan. It is concluded that sumatriptan in this case was an effective and well-tolerated treatment for cluster headache.
Headache and Chiari type I Malformation: Occurrence in Female Monozygotic Twins and First-Degree Relatives
Authors: Stovner Lars Jacob
Published: March 2003

The Chiari type I malformation has recently been reported in three generations of a family, including female monozygotic twins. Headache was the main symptom in several family members. Various headache patterns consistent with migraine without aura, cough headache, tension headache and hypoliquorrhoeic headache were present, and different patterns might coexist in the same patient. In the twins and their mother, who all had a headache consistent with migraine without aura, there were atypical features such as occipital pain location, lack of side-shift of the pain, lack of ergotamine effect and precipitation of attacks by Valsalva-like manoeuvres. The headache was significantly relieved by operation in the one twin with major herniation and the most marked headache. We suggest that in these patients the migraine-like headache mimics true migraine but that there is a causal relationship between the different headache types reported and the malformation.
Ipsilateral Cluster Headache and Chronic Paroxysmal Hemicrania: Two Case Reports
Authors: Tehindrazanarivelo Alain Djacoba , Visy Jean Marc , Bousser Marie-Germaine
Published: March 2003

We report two patients with ipsilateral attacks of cluster headache and chronic paroxysmal hemicrania. The first patient, a 33-year-old man, started having attacks of chronic cluster headache at the age of 27. At 33, they were replaced by typical attacks of ipsilateral chronic paroxysmal hemicrania which showed a dramatic improvement with indomethacin 150 mg daily. After two days of complete remission, cluster headache attacks reappeared and persisted until verapamil, 360 mg a day, was added to indomethacin. The second patient, a 45-year-old man, first developed attacks of episodic cluster headache at the age of 35. At 44, he experienced ipsilateral typical attacks of chronic paroxysmal hemicrania, and two months later attacks of cluster headache. Under verapamil 240 mg daily, attacks of cluster headache disappeared, but those of chronic paroxysmal hemicrania increased in frequency until indomethacin 150 mg daily was added. These observations suggest a close relationship but not a similarity between cluster headache and chronic paroxysmal hemicrania, and show the practical therapeutic interest of maintaining this distinction. Cluster headache, chronic paroxysmal hemicrania, indomethacin, verapamil
Exteroceptive Suppression of Temporalis Muscle Activity: Methodological and Physiological Aspects
Authors: Schoenen Jean
Published: March 2003

In recent years studies of the suppression of EMG activity in temporalis muscle induced by stimulation in the trigeminal territory have opened new perspectives in headache research. The various methods that have been used in different laboratories are reviewed and some of the physiological modulations of temporalis exteroceptive suppression are described. Among different methods of recording, averaging 10 full-wave rectified EMG responses produces results with acceptable variability and discomfort. In order to obtain maximal responses the intensity of the stimulation should reach at least 20 mA. To avoid habituation of the second temporalis exteroceptive suppression period (ES2), the stimulation frequency has to be at O.1 Hz or below. The level of voluntary contraction is not a critical variable as long as it reaches 50% of maximum. Some physiological variations of temporalis suppression are well documented. In females, ES2 is shorter during menstruation than at mid-cycle and correlated with the estradiol/progesterone ratio in plasma. Conditioning temporalis ES2, by a preceding peripheral stimulus markedly reduces its duration, which is partly reversible by naloxone. Various pharmacological agents are able to modify temporalis ES2: its duration is increased by 5-HT1 antagonists, but decreased by 5-HT uptake blockers; contradictory results have been obtained with acetylsalicylic acid. These results suggest that inhibitory brain-stem interneurons mediating temporalis ES2 are inhibited by serotonergic afferents, probably from the raphe magnus nucleus, and that the latter receives an excitatory input from the periaqueductal gray matter and other limbic structures, in part via opioid receptors.
Contingent Negative Variation: Methods and Potential Interest in Headache
Authors: Schoenen Jean , Timsit-Berthier M
Published: March 2003

Contingent negative variation (CNV) is an event-related slow cerebral potential which has been found abnormal in migraine. Its methodology is described. Contrary to other neurophysiological techniques, CNV needs special equipment and expertise. On average, CNV amplitude is increased and its habituation is lacking in migraine without aura between attacks, but not in migraine with aura. The sensitivity of CNV as a diagnostic tool is low, but its specificity is high. CNV amplitude normalizes after treatment with beta-blockers. The CNV abnormalities in migraine might be due to hyperreactivity of central catecholaminergic pathways.
Topographic EEG Mapping Methods
Authors: Klotz Jürgen Michael
Published: March 2003

After almost 40 years of research on EEG computer analysis, present clinical applications of this method remain limited. At the present time, EEG mapping is suited primarily for research. Despite the pitfalls of an uncritical application of EEG mapping, progress in clinical research made possible by EEG mapping techniques has been considerable. Some problems of data acquisition, display and statistical analysis are discussed in this paper. For headache research examination of the activated EEG, especially with photic stimulation, has greater diagnostic importance than mapping under resting conditions.
Second Cervical Root Neurofibroma and Ipsilateral Migraine Headache
Authors: Goldhammer Leo
Published: March 2003

This is a case history of a 38–year-old woman with a dumbbell-shaped C2 neurofibroma associated with right-sided classic migraine headaches (migraine with aura) and cervical trigeminal signs on the affected side. Surgical removal of the tumor was followed by resolution of the migraine headaches and persistence of the signs of cervicotrigeminal involvement.
Effect of Biofeedback Treatment on Sympathetic Function in Common Migraine and Tension-Type Headache
Authors: Grazzi Licia , Bussone Gennaro
Published: March 2003

Behavioral therapies such as biofeedback are commonly used to treat migraine and tension headache. Controlling sympathetic activity is effective for controlling the pain in both disturbances. A group of 26 common migraine patients and a group of 14 tension headache patients were treated by electromyographic biofeedback (EMG-BFB); blood samples were collected during the treatment (1st session; pre and post 10th session) and plasma catecholamines and cortisol measured to determine basal levels and changes induced by the behavioral therapy. The clinical efficacy of BFB treatment for tension headache and common migraine was confirmed. The basal values of the plasma stress indices were significantly different between the two groups, but did not change during treatment. The lack of correlation between the clinical improvement and the biological indices monitored indicates the need for further studies with standardized protocols in order to probe the mechanism of action of these effective behavioral therapies.
Headache Resembling Tension-Type Headache as the Single Manifestation of Lyme Neuroborreliosis
Authors: Brinck Thomas , Hansen Klaus , Olesen Jes
Published: March 2003

We present two patients with monosymptomatic headache resembling chronic tension-type headache as the first manifestation of Lyme neuroborreliosis. The headache developed over a few days in both cases and lasted for three months in the first case and for two and a half years in the second case before the diagnosis of Lyme neuroborreliosis was made. Neuroimaging and many laboratory investigations did not lead to the diagnosis, which was only established after lumbar puncture. The CSF in both cases showed high protein, lymphocytic pleocytosis and Borrelia burgdorferi-specific intrathecal antibody synthesis. The headache disappeared completely after treatment with penicillin G. In patients suffering from daily headaches which have developed subacutely, Lyme neuroborreliosis should be considered even in the absence of signs of meningeal irritation. A lumbar puncture should be performed more often than is presently customary and the CSF should be examined for pleocytosis as well as Borrelia burgdorferi-specific intrathecal antibody synthesis.
Sumatriptan for the Treatment of Migraine Attacks-A Review of Controlled Clinical Trials
Authors: Tfelt-Hansen Peer
Published: March 2003

Sumatriptan, a 5HT1-like receptor agonist, is a completely new treatment principle for migraine. In an extensive international programme of controlled clinical trials, sumatriptan, 6 mg subcutaneously and 100 mg orally, was superior to placebo in reducing headache and associated symptoms. The response rate for subcutaneous sumatriptan (70–84% after 1 h and 81–87% after 2 h) was higher than for oral sumatriptan (50–67% after 2 h). Additional doses did not increase efficacy. Oral sumatriptan was superior to Cafergot (2 mg ergotamine plus 200 mg caffeine) and somewhat better than aspirin (900 mg) plus metoclopramide (10 mg). Recurrence of migraine occurred in approximately 40% of attacks. Side effects were generally mild and short-lived in the controlled clinical trials. However, in clinical practice sumatriptan has subsequently caused rare cases of heart ischemia and sumatriptan is contraindicated in patients with a history of ischemic heart disease.
Severe Diffuse Intracranial Vasospasm as a Cause of Extensive Migrainous Cerebral Infarction
Authors: Sanin Luis C , Mathew Ninan T
Published: March 2003

We report on a 47-year-old white female with a long history of recurrent episodes of migraine with aura, who progressed to develop a continuous intractable headache during the course of which cortical blindness and quadriparesis occurred due to extensive and bilateral hemispheric cerebral infarction. Severe diffuse intracranial major arterial vasospasm was demonstrated by arteriogram. All studies were negative for CNS vasculitis, including cerebral biopsy. The arterial spasm reversed itself, but the patient did not improve. Smoking was the only additional risk factor. Vasospasm is an important cause to be considered in migrainous infarctions. The use of vasoconstrictor agents such as DHE in patients with migraine with prolonged aura has to be carefully re-evaluated.
Dopamine D2–Receptor Imaging With 123I-Iodobenzamide SPECT in Migraine Patients Abusing Ergotamine: Does Ergotamine Cross The Blood Brain Barrier?
Authors: Verhoeff Nicolaas PLG , Visser W Hester , Ferrari Michel D , Saxena Pramod R , Royen Eric A van
Published: March 2003

Two migraine patients were studied by in vivo SPECT using the dopamine D2–receptor specific radioligand 123I-3–iodo-6–methoxybenzamide (123I-IBZM) during ergotamine abuse and after withdrawal. Results were compared with 15 healthy controls. Striatum/cerebellum and striatum/occipital cortex ratios of count rate density were calculated as a semiquantitative measurement for striatal dopamine D2–receptor binding potential. No differences were found in striatal uptake of 123I-IBZM between healthy controls and the patients when on or off ergotamine. Preliminary evidence suggests that ergotamine may not occupy striatal dopamine D2–receptors to a large extent and thus may not cross the blood brain barrier in large quantities.
Increased Platelet Serotonin Content and Hypersecretion from Dense and A-Granules In Vitro In Tension-Type Headache
Authors: D'Andrea Giovanni , Hasselmark Lena , Alecci Michela , Perini Francesco , Welch KMA
Published: March 2003

We investigated platelet aggregation and secretion from dense and a-granules in vitro in 28 tension-type headache (TH) patients and 26 healthy controls. We also measured basal platelet serotonin levels, Platelet aggregation was normal in TH, but the secretion of serotonin and platelet factor 4 (PF4) was significantly increased in response to 0.5 and 2.0 mg/ml collagen and to 1.0 mmol/l PAF. The basal platelet serotonin levels were also higher in patients than in controls. The mechanisms of platelet hypersecretion remain to be determined, but the increased secretion of serotonin is probably in part related to the increased basal levels. The increased platelet serotonin in TH patients may reflect an enhanced serotonin turnover.
Occipital Neuralgia Treated by Intradural Dorsal Nerve Root Sectioning
Authors: Horowitz Michael Bruce , Yonas Howard
Published: March 2003

The term occipital neuralgia was first used in 1821 to describe a characteristic pain in the region innervated by the greater occipital nerve. Since that time numerous authors have failed to reach a consensus concerning the presentation, cause, and treatment of this entity. Review of these previous works reveals that the term occipital neuralgia encompasses a collection of signs and symptoms which develop secondary to a variety of different disease processes. We have treated nine patients suffering from severe occipital pain with associated C2 hypesthesia, unilateral retro-orbital pain, and occipital or C2 tubercle trigger points by intradurally sectioning the C1-C4 dorsal rootlets (C4 if shoulder pain existed). All patients had been treated previously with various modalities without success. This paper discusses the results obtained in these patients.
Testing Models for Genetic Determination in Migraine
Authors: Mochi M , Sangiorgi S , Cortelli P , Carelli V , Scapoli C , Crisci M , Monari L , Pierangeli G , Montagna P
Published: March 2003

We collected two clinically matched samples of patients, one sample affected by migraine with aura the other by migraine without aura, to investigate the genetic determination of these conditions. A maternal and X-linked transmission for both these diseases was considered unlikely after pedigree analysis. Classical segregation analysis indicated a likely autosomal recessive kind of transmission for both. Reduced penetrance and the h2 values, however, imply the presence of additional genetic and/or environmental factors controlling the phenotypic expression of migraine.
Effect of Peppermint and Eucalyptus Oil Preparations on Neurophysiological and Experimental Algesimetric Headache Parameters
Authors: Göbel H , Schmidt G , Soyka D
Published: March 2003

The effects of peppermint oil and eucalyptus oil preparations on neurophysiological, psychological and experimental algesimetric parameters were investigated in 32 healthy subjects in a double-blind, placebo-controlled, randomized cross-over design. Four different test preparations were applied to large areas of the forehead and temples using a small sponge and their effect was evaluated by comparing baseline and treatment measure. The combination of peppermint oil, eucalyptus oil and ethanol increased cognitive performance and had a muscle-relaxing and mentally relaxing effect, but had little influence on pain sensitivity. A significant analgesic effect with a reduction in sensitivity to headache was produced by a combination of peppermint oil and ethanol. The essential plant oil preparations often used in empiric medicine can thus be shown by laboratory tests to exert significant effects on mechanisms associated with the pathophysiology of headache.
Assessment of International Headache Society Diagnostic Criteria: A Reliability Study
Authors: Leone M , Filippini G , D'Amico D , Farinotti M , Bussone G
Published: March 2003

In 1988 the International Headache Society (IHS) introduced new diagnostic criteria for headaches and craniofacial pain. Since headaches can be diagnosed solely on the basis of information provided by the patient, it is essential that the criteria are reproducible and consistent. phenomena to a form designed to reflect the IHS criteria. Interobserver concordance (kappa statistics) in the application of the diagnostic hemicrania; kappa = 0.88 for migraine; kappa = 0.75 for tension-type headache; (ii) “almost perfect” to “substantial” for the second digit migraine without aura; kappa = 0.71 for chronic tension-type headache; kappa = 0.66 for cluster headache-like disorder not fulfilling the eria. These results show that the IHS diagnostic criteria are satisfactorily applicable to high quality medical records abstracted by experienced.
Octreotide Dependency and Headache: A Case Report
Authors: May A , Lederbogen S , Diener HC
Published: March 2003

We report on headache induced by a somatostatin octapeptide analog (octreotide) used for the treatment of acromegaly, This “rebound” headache has severe tension-type characteristics and occurs every 6–8 h. It resolves dramatically within minutes with octreotide administration. This is the first report of headache developing under treatment with octreotide.
Thresholds for Detection of a Target Against a Background Grating Suggest Visual Dysfunction in Migraine With Aura But Not Migraine Without Aura
Authors: Chronicle EP , Wilkins AJ , Coleston DM
Published: March 2003

Square-wave gratings with particular spatial characteristics in visual illusions. Patients with migraine are particularly susceptible to these illusions and report disc. it. Their discomfort tends to be greater when the gratings are illuminated by red light, a tendency 1 known by controls. Gratings that induce illusions have been found to impair the recognition of opt superimposed targets in headache-free control subjects. We measured the impairment of target detection under illuminants of various chromaticities in migraineurs with and without aura and in mat controls. Migraineurs with aura had significantly higher thresholds for target detection than either migraineurs without aura or controls; in addition, the effect of chromaticity was slightly more pronounced in both migraine groups than in the control group. These findings are consistent with a recent suggestion that migraine with aura might give rise to subclinical damage to the primary visual cortex
The Effects of Aspirin on the CNV in Healthy Individuals
Authors: Vein A , Voznesenskaya T , Danilov A
Published: March 2003

The effects of aspirin on the contingent negative variation (CNV) of 16 healthy, right-handed volunteers were studied in accordance with a placebo-controlled double-blind crossover design. Early and late CNV factors were measured. Aspirin caused a statistically significant decrease of the early wave and an increase of mean amplitude of the late wave. A central action of aspirin, affecting noradrenergic and dopaminergic structures, may be responsible for the CNV changes.
Platelet and Plasma Levels of Glutamate and Glutamine in Migraine With and Without Aura
Authors: Cananzi AR , D'Andrea G , Perini F , Zamberlan F , Welch KMA
Published: March 2003

We evaluated plasma and platelet glutamate and glutamine levels in migraine with and without aura during headache-free periods and compared the results with those of normal controls. The plasma and platelet levels of glutamine in migraine with and without aura were normal. Migraine without aura patients had higher glutamate levels in plasma, and normal platelet levels. In migraine with aura patients, glutamate levels were high in platelets, but not in plasma. This suggests different profiles of excitatory amino acid metabolism in migraine with and without aura.
Convergence of Afferents from Superior Sagittal Sinus and Tooth Pulp on Cells in the Thalamus of The Cat
Authors: Angus-Leppan H , Olausson B , Boers P , Lambert GA
Published: March 2003

We have previously shown convergence of craniovascular and tooth pulp afferents in the cervical spinal cord of cats. This study looked for similar convergence in the thalamus. Fifty-four thalamic cells with input from tooth pulp, superior sagittal sinus, or both, were identified. Twenty-nine cells with tooth pulp and superior sagittal sinus input were located in the ventrobasal complex or the intralaminar nuclei. Most of these 29 cells were also excited by cooling the contralateral tooth pulp, and 21 had receptive fields on the contralateral face or forelimb. Twenty cells excited by stimulation of superior sagittal sinus, and not tooth pulp, were found in several nuclei. The 5 cells excited by stimulation of tooth pulp, but not sagittal sinus, were restricted to the ventrobasal complex. The data confirm convergence from sagittal sinus, tooth pulp, and skin in the thalamus of anaesthetized cats.
Genetic Markers: Association Study in Migraine
Authors: Pardo J , Carracedo A , Munoz I , Castillo J , Lema M , Noya M
Published: March 2003

Eleven genetic markers were typed in 112 unrelated patients with migraine (50 with aura, 62 without aura) and compared with a random sample of healthy individuals. No significant differences were found for the ABO and Rh systems, acid phosphatase 1, phosphoglucomutase 1, adenosine deaminase, haptoglobin, transferrin, alpha-1–antitrypsin, and D1S80. Strong associations between the group of patients with migraine and group-specific component GC 1F-1F and esterase-D ESD 2–2 phenotypes were observed. These associations raise the possibility that a molecular genetic factor for migraine may exist in or near the Group Component (chromosome 4) and Esterase D (chromosome 13) loci, and represent a first comprehensive step in the eventual localization and isolation of the migraine genes.
Neuropeptides in the Cerebral Circulation: Relevance to Headache
Authors: Edvinsson L , Goadsby PJ
Published: March 2003

The article briefly describes the innervation of the human cerebral circulation by nerve fibers containing neuropeptide Y (NPY), vasoactive intestinal peptide (VIP), substance P (SP), and calcitonin gent-related peptide (CGRP). The neuropeptides in human cerebral arteries were characterized by radioimmunoassay in combination with HPLC. These neuropeptides mediate contraction (NPY) and dilatation (VIP, SP, CGRP). In conjunction with spontaneous attacks of migraine or cluster headache, release of CGRP is seen. With the associated symptoms of nasal congestion and rhinorrhea, VIP is released. Successful treatment may abort the peptide release in parallel with disappearance of headache.
Experimental Headache in Humans
Authors: Iversen HK
Published: March 2003

The need for valid human experimental models of headache is obvious. Several compounds have been proposed as headache-inducing agents, but only the nitroglycerin (NTG) model has been validated. In healthy subjects, intravenous infusions of the nitric oxide (NO) donor NTG induce a dose-dependent headache and dilatation of the temporal, radial and middle cerebral artery. NTG-induced headache, although less intense, resembles migraine in pain characteristics, but the accompanying symptoms are rarely present. Cephalic large arteries are dilated during migraine headache as well as during NTG headache. N-acetylcysteine enhances the formation of NO and potentiates NTG-induced headache, whereas mepyramine, a H1-antagonist capable of blocking histamine-induced headache, has no effect. Thus, the headache is dependent on NO or other steps in the NO cascade. The model is useful for pharmacological interventions and sumatriptan reduced the NTG-induced headache. The NTG model may be a valuable tool in the development of future migraine drugs.
Cross-Correlation Between Stress, Pain, Physical Activity, and Temporalis Muscl EMG in Tension-Type Headache
Authors: Clark GT , Sakai S , Merrill R , Flack VF , McCreary C
Published: March 2003

Thirty-six tension-type headache subjects and 36 non-headache matched controls recorded their temporalis muscle electromyographic (EMG) activity and their pain intensity, stress and physical activity levels in a daily diary. Measurements were performed every 30 min for 6 days (EMG 3 days only). A time-lagged cross-correlational analysis between pain, stress, physical activity, and EMG shows that the highest correlation coefficient values occurred between pain and stress at the same ( r = 0.33) and at the two preceding 0.5 h time points ( r = 0.21 and r = 0.26) in the headache group. Virtually no correlation was found between pain, stress, or physical activity with EMG for either group. These data show that temporalis muscle activity levels were not related to the rise and fall of the subjects' pain or stress levels. Conversely, elevated stress appeared to be highly related to pain; it occurs as both an antecedent and simultaneous event with elevated headache pain.
Freud and Migraine: The Beginning of a Psychodynamically Oriented View of Headache a Hundred Years Ago
Authors: Karwautz A , Wöber-Bingöl C , Wöber C
Published: March 2003

Sigmund Freud, the famous Viennese founder of psychoanalysis, suffered from recurrent episodes of severe headache. Autobiographic and biographic data make it evident that he had migraine. Freud's theoretical approaches to pain in general and to migraine in particular are discussed. Initially, Freud's theories on the etiopathogenesis of pain and migraine focused on neurophysiological hypotheses which are of historical interest. They were replaced by psychodynamic hypotheses which are still important for our current understanding of pain and headache. These psychodynamic pain theories are reviewed and their importance for headache research is discussed.
Idiopathic Stabbing Headache (Jabs and Jolts Syndrome)
Authors: Pareja JA , Ruiz J , de Isla C , Al-Sabbah H , Espejo J
Published: March 2003

The clinical features of idiopathic stabbing headache (“jabs and jolts syndrome”) were studied in 38 patients who were diagnosed throughout a 1-year period. Mean age at the onset of symptoms was 47.1 years ± 14.5 (SD), and a clear female preponderance was demonstrated (female/male ratio=6.6), Painful attacks were ultrashort, i.e. virtually all attacks in more than two thirds of cases lasted only one second. The frequency of attacks varied immensely, ranging from 1 attach per year to 50 attacks daily. The pain paroxysms usually occurred with an irregular or sporadic temporal pattern. The localization of painful attacks was reported frequently as unifocal, usually in the orbital area, but also multifocal patterns were observed, the attacks frequently changing location from one area to the next. The majority of attacks occurred spontaneously, and accompanying phenomena were reported only rarely. Indomethacin treatment (75 mg daily) seemed to have a complete or partial effect in most patients treated as such ( n = 17).