bluuebunny/crossref_metadata_2025 huggingface dataset:
Headache and Stress in a Group of Nurses and Government Administrators in Japan
Authors: Nadaoka Toshihide , Kanda Hideto , Oiji Arata , Morioka Yukiko , Kashiwakura Masaki , Totsuka Shiro
Published: March 2003

We surveyed a group of 311 nurses and 283 mid‐level government administrators in Yamagata Prefecture, Japan, to determine the prevalence and character of their headaches. We investigated the relationship of headaches to the subjects' stress, and their behaviour and coping patterns. The questionnaire we administered explored background factors, as well as the state of the respondents' mental health, life events, work motivation, support system, and interpersonal relationships.

The questionnaire was completed by 76.8% of nurses and 100% of administrators. Of these, 40.6% of nurses and 19.1% of the administrators reported recurrent headaches Furthermore, the number of headache sufferers among the women administrators was significantly higher than in the men. The nurses and the administrators who reported headache scored significantly higher than the nonheadache groups on the questions measuring symptoms of burnout, General Health Questionnaire, and learned helplessness. The group of nurses with headache had higher scores for life events, decreased work motivation. and nervous behavior than the nonheadache group; the administrators with headache scored higher for daily hassles than those of the nonheadache groups. In this study of a Japanese sample, the character of the subjects' headache and the possible inducing factors are consistent with those reported in studies of Europeans and Americans using similar testing methods. However, the high prevalence of headache among nurses and women administrators seems to be related to psychological stress, particularly work stress, which may be characteristic in Japan.
The Enhanced Ciliospinal Reflex in Asymptomatic Patients With Cluster Headache is Due to Preganglionic Sympathetic Mechanisms
Authors: Havelius Ulf , Heuck Martin , Milos Peter , Hindfelt Bengt
Published: March 2003

An amplified ciliospinal reflex response has been documented in patients with cluster headache, lacking a Horner like syndrome. The mechanism is unknown, Tentatively, it may be due to an increased release of monoamines from post‐ganglionic sympathetic nerve endings or an increased density of postsynaptic adrenergic receptors in the dilatator muscle of the iris.

The instillation of a 1% phenylephrine solution into the conjunctival sac induces mydriasis by stimulating postsynaptic adrenergic receptors in the dilatator muscle of the iris, while the instillation of a 2% tyramine solution causes mydriasis by releasing noradrenaline from the presynaptic sympathetic nerve terminals in the iris.

According to these premises, a positive correlation shouId be expected between the ciliospinal reflex response and the pupillary response to tyramine, if the enhanced ciliospinal so‐flex response was due to an increased presynaptic release of monoamines. No such correlation was found. Nor was there any positive correlation between the ciliospinal reflex response and the pupillary response to phenylephrine, contradicting an increased density of postsynaptic monoaminergic receptors in the dilatator muscle of the iris as the explanation. However, there was a significant positive correlation between the pupillary responses to phenylephrine and tyramine, ruling out any functionally caused “denervation” hypersensitivity in the dilatator muscle of the iris.

It is concluded that the amplified ciliospinal reflex response in cluster headache patients (lacking a Horner‐like syndrome) reflects compensatory pathophysiological mechanisms proximal to the third‐order sympathetic neuron.
Multicenter Prospective Evaluation of Proposed Pediatric Migraine Revisions to the HIS Criteria
Authors: Winner Paul K. , Wasiewski W. , Gladstein J. , Linder S.
Published: March 2003

Eighty‐eight children and adolescents were prospectively evaluated at eight specialty clinics comparing the diagnostic criteria of the International Headache Society (IHS) and the proposed revised (IHS‐R) classification to the clinical diagnosis. The proposed revisions to the IHS classification for pediatric migraine include: duration‐1 hour to 48 hours; Iocation‐bifrontal/bitemporal or unilateral; and symptoms‐to include photophobia or phonophobia. A comparison of the diagnostic rates of pediatric migraine with and without aura of the total sample revealed IHS (66%) versus IHS‐R (93%) and comparison of a subset of those patients less than 12 years of age (n=39) revealed IHS (49%) versus IHS‐R (87%).

Significant improvement in the diagnostic sensitivity of migraine in the pediatric population was obtained by specific modifications to the IHS criteria pertaining to duration, location, and the symptoms of photophobia and phonophobia in an ongoing multicenter prospective study. These revisions may help to form the basis for future research guidelines and for further modifications to improve the diagnostic sensitivity of pediatric migraine maintaining the IHS model.
Platelet Ionized Magnesium, Cyclic AMP, and Cyclic GMP Levels in Migraine and Tension‐Type Headache
Authors: Mishima Katsuko , Takeshima Takao , Shimomura Tokio , Okada Hiroko , Kitano Ayumi , Takahashi Kazuro , Nakashima Kenji
Published: March 2003

Decreased serum and intracellular levels of magnesium have been reported in patients with migraine. It has been suggested that magnesium may play an important role in the attacks and pathogenesis of headaches. We measured ionized magnesium cyclic AMP (adenosine monophosphate), and cyclic GMP (guanosine monophosphate) in platelets of patients with migraine in patients with tension‐type headache, and in healthy controls. The platelet level of ionized magnesium from patients with tension‐type headache was significantly lower than the levels from the other two groups. The platelet level of cyclic AMP from patients with migraine was higher than those from the other groups. We found no significant differences in the platelet cyclic GMP levels among the three groups. It is suggested that reduced platelet ionized magnesium in patients with tension‐type headache is related to abnormal platelet function, and that increased platelet cyclic AMP in patients with migraine is related to alteration of neurotransmitters in the platelet.
Naratriptan is Effective and Well Tolerated in the Acute Treatment of Migraine. Results of a Double‐Blind, Placebo‐Controlled, Parallel‐Group Study
Authors: Klassen Arthur , Elkind Arthur , Asgharnejad Mahnaz , Webster Chris , Laurenza Antonio ,   on behalf of the Naratriptan S2WA3001 Study Group
Published: March 2003

Objective.‐To evaluate the efficacy and tolerability of naratriptan, a novel 5‐HT1 agonist, in the acute treatment of migraine.

Design/Methods.‐Six hundred thirteen migraineurs, diagnosed according to International Headache Society criteria, treated a single migraine attack with naratriptan tablets (2.5 mg, 1 mg, 0.25 mg, or 0.1 mg) or placebo in a randomized, double‐blind, placebo‐controlled, parallel‐group study conducted at 54 United States centers. At dosing and at predetermined intervals beginning 30 minutes postdose, patients recorded migraine pain severity, clinical disability, and presence of associated migraine symptoms. Safety measures included adverse events, physical examinations, vital signs, ECGs, and clinical laboratory tests.

Results.‐Headache relief (moderate or severe pain at dosing reduced to mild or no pain) 4 hours postdose was reported in 60% of patients receiving naratriptan 2.5 mg compared with 50%, 35%, 32%, and 34% of patients receiving naratriptan 1 mg, 0.25 mg, 0.1 mg, and placebo, respectively ( P < <0.05 naratriptan 2.5 mg and 1 mg versus placebo, 1 mg versus 0.1 mg, and 2.5 mg versus 0.1 mg and 0.25 mg). Clinical disability 4 hours postdose was reported as mild or none for 70% of patients receiving naratriptan 2.5 mg compared with 63%, 47%, 48%, and 48% of patients receiving naratriptan 1 mg, 0.25 mg, 0.1 mg, or placebo, respectively ( P <0.05 naratriptan 2.5 mg and 1 mg versus placebo, 1 mg versus 0.1 mg, and 2.5 mg versus 0.1 mg and 0.25 mg). Four‐hour efficacy for absence of nausea, photophobia, and phonophobia was similar to efficacy for headache relief at each dose. The adverse event profile of each dose of naratriptan was similar to that of placebo. No clinically relevant change in any safety measure was reported.

Conclusions.‐Naratriptan is effective and well tolerated for the acute treatment of migraine. The 2.5‐mg dose appears to offer the optimum ratio of efficacy to tolerability.
Efficacy and Safety of Rizatriptan Versus Standard Care During Long‐term Treatment for Migraine
Authors: Block Gilbert A. , Goldstein Jerome , Polis Adam , Reines Scott A. , Smith Mary E. ,   Rizatriptan Multicenter Study Groups
Published: March 2003

Rizatriptan is a novel, selective 5‐HT1B/1D receptor agonist with a rapid onset of action after oral dosing for the acute treatment of migraine. We conducted a long‐term (up to 1 year), multicenter, randomized study in 1831 patients treating more than 46 000 attacks to compare the efficacy and tolerability of rizatriptan 5 mg and 10 mg to standard care medications routinely used for the acute treatment of migraine attacks. Both doses of rizatriptan were highly effective, without evidence of tachyphylaxis. Rizatriptan 10 mg was consistently superior (P<0.05), both to the 5‐mg dose and to standard care, in providing relief in 90% of attacks, with 50% pain‐free by 2 hours after dosing. The most common dose‐related adverse events were nausea, somnolence, and asthenia/fatigue. Based on this large, multicenter, long‐term trial, rizatriptan is an important new oral agent for the acute treatment of migraine.
Weekend Headache: A Possible Role of Work and Life‐style
Authors: Torelli Paola , Cologne Daniela , Manzoni Gian Camillo
Published: March 2003

The purpose of our study was to determine whether or not patients reporting weekend headache exhibit distinctive features in their work habits, family life, and leisure on workdays and on weekends as compared to other headache sufferers, and whether or not they are inclined to change their living habits at the weekend.

The study was done on an initial sample of 50 patients referred to the University of Parma Headache Centre between October 1996 and April 1997. These patients completed a specially designed questionnaire which, in addition to demographics, contained specific questions relevant to the subject matter being investigated. They were also given a diary which they had to complete for 8 consecutive weeks in order to determine the actual frequency of headache attacks over different days of the week.

The questionnaire data were only analyzed for the 38 women in the sample, because there were too few male controls for an accurate comparison with weekend headache sufferers. Among the women with weekend headache, work habits, family life, and leisure were such as to suggest a possible increase in stress and frustration on weekends, which might have made them perceive the headaches occurring on Saturdays and Sundays as more severe. No changes were found in the intake of substances such as coffee and alcohol, nor in cigarette smoking over the different days of the week. Finally, analysis of the diaries showed an increased frequency of headache attacks on weekends only among the men, which seems to corroborate the hypothesis of weekend headache as a disorder typically affecting men.
Alteration in Nature of Cluster Headache During Subcutaneous Administration of Sumatriptan
Authors: Hering‐Hanit Rachel
Published: March 2003

Objectives.– To document the relationship between the 5‐HT receptor agonist sumatriptan and a change in the nature of cluster headache in four cases. To relate the findings to the literature on the use of sumatriptan in both cluster headache and migraine.

Background.– Studies of the efficacy and adverse effects of long‐term treatment with sumatriptan in cluster headache are limited and report conflicting findings.

Methods.– Four cases are described.

Results.– All four patients developed a marked increase in the frequency of attacks 3 to 4 weeks after initiating treatment with the drug for the first time. Three patients also developed a change in headache character, and 2 experienced prolongation of the cluster headache period. Withdrawal of the drug reduced the frequency of headaches and eliminated the newly developed type of headache.

Conclusions.– Determination of the effects of long‐term use of sumatriptan will result in more precise guidelines for the frequency and duration of treatment with this otherwise extremely beneficial drug.
A Comparative Trial of Zolmitriptan and Sumatriptan for the Acute Oral Treatment of Migraine
Authors: Gallagher R. Michael , Dennish George , Spierings Egilius L.H. , Chitra Rohini
Published: March 2003

Objective.–This randomized, double‐blind, parallel group multicenter study compared response rates and tolerability of zolmitriptan with sumatriptan in the acute treatment of migraine.

Methods.–A sample consisting of 1445 outpatients with an established diagnosis of migraine was randomized to zolmitriptan, 2.5 mg or 5 mg, or sumatriptan, 25 mg or 50 mg. Patients took 1 tablet for moderate/severe migraine and a second identical tablet, if necessary, for recurrent headache of moderate/severe intensity 4 to 24 hours after the initial dose. Up to six attacks were treated during a 6‐month period. The primary outcome measure was headache response 2 hours after the initial dose. Secondary end points included 1‐hour and 4‐hour headache response and pain relief over 24 hours.

Results.–A headache response at 2 hours was noted in 67.1% of patients taking zolmitriptan, 2.5 mg, and 64.8% of those taking zolmitriptan, 5 mg, versus 59.6% of patients taking sumatriptan, 25 mg, and 63.8% of those taking sumatriptan, 50 mg. At 2 and 4 hours, the differences between zolmitriptan, 2.5 mg, and sumatriptan, 25 mg, were statistically significant (odds ratio=1.49 and 1.67, respectively; both P<.001). Statistically significant differences between zolmitriptan, 2.5 mg, and sumatriptan, 50 mg, were seen at 2 and 4 hours post dose (odds ratio=1.21 and 1.23, respectively; both P<.05). At 1 hour post dose, the headache response rate for zolmitriptan, 2.5 mg, was numerically higher than response rates for sumatriptan, 25 mg and 50mg (odds ratio=1.16, odds ratio=1.06, though they failed to reach statistical significance; P=.061, P=.461 respectively). Differences between zolmitriptan, 5 mg, and sumatriptan, 25 mg, were statistically significant at 1, 2, and 4 hours (odds ratio=1.43, 1.46, and 1.78, respectively; all P<.001) and at 1 and 4 hours versus sumatriptan, 50 mg (odds ratio=1.28, P=.002; odds ratio=1.29, P=.012, respectively). Although not statistically significant at 2 hours, more patients responded to zolmitriptan, 5 mg, than to sumatriptan, 50 mg (odds ratio=1.16, P=.064). Patients receiving zolmitriptan, 2.5 mg or 5 mg, achieved more pain relief over 24 hours than patients receiving sumatriptan, 25 mg (odds ratio=1.47, and 1.54 respectively, both P<.001) or sumatriptan, 50 mg (odds ratio=1.17, P=.021; odds ratio=1.22, P=.005, respectively). All treatments were well tolerated.

Conclusions.–Zolmitriptan, 2.5 mg and 5 mg, was at least as effective as sumatriptan, 25 mg or 50 mg, for all parameters studied. Zolmitriptan, 2.5 mg, was significantly more effective than sumatriptan, 50 mg, in terms of headache response at 2 and 4 hours. Patients taking zolmitriptan were significantly more likely to have pain relief over 24 hours than those taking sumatriptan.
Decision Making in Migraine Patients Taking Sumatriptan: An Exploratory Study
Authors: Ivers Hans , McGrath Patrick J. , Purdy R. Allan , Hennigar Allan W. , Campbell Mary‐Ann
Published: March 2003

Until recently, much of the medical and psychological literature has examined and conceptualized the taking of medication from the viewpoint of adherence to or compliance with recommendations from health professionals. However, some authors have argued that medication taking is mostly determined by patient decision making. In order to investigate the factors and processes influencing the patient's decision to take or not take abortive therapy for migraines, 20 migraineurs (according to International Headache Society criteria) were asked, using a semistandardized interview, what factors influenced their decision to take or not take sumatriptan when they had a migraine. Qualitative analysis revealed a 2‐stage decision‐making process. First, the patient collects information from interoceptive and environmental cues (symptom monitoring) to predict whether the headache that is beginning will become a migraine. Then, if the patient decides it is a migraine, he or she weighs various factors to decide whether to take sumatriptan. These results are consistent with the current cognitive psychology literature on decision‐making processes and could lead to significant improvements in understanding the process by which patients make decisions about taking sumatriptan and, ultimately, could lead to better patient education and more effective headache control. They also open a whole new field in the empirical investigation of medication‐taking behavior.
The Migraine ACE Model: Evaluating the Impact on Time Lost and Medical Resource Use
Authors: Caro J. Jaime , Caro Graciela , Getsios Denis , Raggio Gabriel , Burrows Michael , Black Libby
Published: March 2003

Objective.–To describe the Migraine Adaptive Cost‐Effectiveness Model in the context of an analysis of a simulated population of Canadian patients with migraine.

Background.–The high prevalence of migraine and its substantial impact on patients' ability to function normally present a significant economic burden to society. In light of the recent availability of improved pharmaceutical treatments, a model was developed to assess their economic impact.

Methods.–The Migraine Adaptive Cost‐Effectiveness Model incorporates the costs of time lost from both work and nonwork activities, as well as medical resource and medication use. Using Monte Carlo techniques, the model simulates the experience of a population of patients with migraine over the course of 1 year. As an example, analyses of a Canadian population were carried out using data from a multinational trial, surveys, national statistics, and the available literature.

Results.–Using customary therapy, mean productivity losses (amounting to 84 hours of paid work time, 48 hours of unpaid work time, and 113 hours of leisure time lost) were estimated to cost $1949 (in 1997 Canadian dollars) per patient, with medical expenditures adding an average of $280 to the cost of illness.

Conclusions.–With customary treatment patterns, the costs of migraine associated with reduced functional capacity are substantial. The migraine model represents a flexible tool for the economic evaluation of different migraine treatments in various populations.
Sumatriptan in Patients With Postdural Puncture Headache
Authors: Connelly Neil Roy , Parker Robert K. , Rahimi Armin , Gibson Charles S.
Published: March 2003

Objective.–To determine the efficacy of sumatriptan in the management of patients presenting for an epidural blood patch for the management of postdural puncture headache.

Background.–Postdural puncture headache can be quite severe, requiring invasive therapy (ie, epidural blood patch). Sumatriptan has been used successfully in patients with postdural puncture headache, however, its use has not been investigated in a controlled fashion.

Methods.–Ten patients with postdural puncture headache presenting for an epidural blood patch were given either saline or sumatriptan subcutaneously. The severity of the headache was evaluated at baseline and 1 hour following injection. If the headache remained severe, an epidural blood patch was performed.

Results.–Only one patient in each group received relief from the injection.

Conclusions.–We do not recommend sumatriptan in patients who have exhausted conservative management of postdural puncture headache.
Migraine‐Associated Seizure: A Case of Reversible MRI Abnormalities and Persistent Nondominant Hemisphere Syndrome
Authors: Friedenberg Scott , Dodick David W.
Published: March 2003

The complex relationship between migraine and epilepsy is highlighted by the occurrence of a seizure during a migraine attack without aura. This phenomenon, referred to as migralepsy, suggests an inherent overlap in the underlying pathophysiology of these events. We report the case of a patient who had a generalized seizure, persistent nondominant hemisphere syndrome, and reversible magnetic resonance imaging abnormalities during a prolonged migraine attack without aura.
Use of Intravenous Valproate Sodium in Status Migraine
Authors: Norton John
Published: March 2003

Patients with migraines have typically been given one group of medications for abortive treatment and another for preventative. In the acute situation when the patient has severe nausea it is difficult to administer medications. Intravenous medications would avoid this problem but are limited to the opiates and dihydroergotamine. The following cases demonstrate the acute treatment of migraine with intravenous valproic acid (Depacon). The oral form of valproic acid has been used as a prophylactic agent, but the intravenous form may provide an alternative for abortive care as well. The ease of administration and lack of side effects are also important considerations. Double‐blind studies will help clarify the situation.
Immunological Aspects in Migraine: Increase of IL‐10 Plasma Levels During Attack
Authors: Munno I. , Marinaro M. , Bassi A. , Cassiano M.A. , Causarano V. , Centonze V.
Published: March 2003

In the present study, 23 patients with migraine without aura were monitored during a migraine attack. Plasma levels of interleukin (IL)‐4, IL‐5, IL‐10, and interferon‐γ were measured by enzyme‐linked immunosorbent assay techniques. Interestingly, we observed low to undetectable IL‐5 and IL‐4 levels, whereas high IL‐10 levels were seen in 52.2% of the patients. Interferon‐γ plasma levels were undetectable in all patients. After treatment with sumatriptan, 10 patients showed a subsequent decrease in IL‐10 and an increase in both IL‐4 and IL‐5 plasma levels. Although these findings are derived from a limited number of patients, the apparent return to the IL‐4 and IL‐5 cytokine profile observed during the interictal period leads us to speculate that a preferential enhancement of TH2‐type cytokine production may contribute to the pathogenesis of migraine.
Sumatriptan Can Alleviate Headaches Due to Carotid Artery Dissection
Authors: Leira Enrique C. , Cruz‐Flores Salvador , Leacock Rodney O. , Abdulrauf Saleem I.
Published: March 2003

Cluster headaches can be mimicked by a spontaneous carotid artery dissection. We report a 45‐year‐old man with a spontaneous carotid artery dissection whose unilateral headache responded to sumatriptan. An oral dose of 50 mg of sumatriptan relieved 90% of the pain after 2 hours. A second dose the next day achieved similar results within 4 hours. The diagnosis of dissection was made later by magnetic resonance angiogram and conventional angiography. This case illustrates that a positive response to a triptan can not be used to distinguish the first attack of cluster headache from a carotid artery dissection.
Evaluation of the Impact of Migraine and Episodic Tension‐type Headache on the Quality of Life and Performance of a University Student Population
Authors: Bigal Marcelo Eduardo , Bigal Janaína Maciel , Betti Michelle , Bordini Carlos Alberto , Speciali José Geraldo
Published: March 2003

Objective.—To determine the prevalence of migraine and episodic tension‐type headache (ETTH) among university students as well as its impact on academic performance and quality of life.

Background.—Headache is a very common symptom in clinical practice. The reduced capacities due to migraine can be profound, and more studies are needed to evaluate, in particular, school performance. Few studies have been conducted to evaluate the impact of tension‐type headache on work productivity, quality of life, and the impact of headache on school performance.

Methods.—A total of 1022 students were interviewed. Two questionnaires were utilized, a standard one that permitted a diagnosis of migraine or ETTH according to the criteria of the International Headache Society and a second one consisting of a battery of tests on quality of life.

Results.—A total of 256 students (25%) had migraine and 336 (32.9%) reported ETTH. When in pain, migraineurs demonstrated a 62.7% decrease in productivity while studying, compared with a 24.4% decrease in those with ETTH. Fifty percent of migraineurs tried to study despite the pain, compared with 53.2% of those with ETTH. With respect to all other items tested, there was a significantly higher impairment in the presence of migraine than in the presence of ETTH and in the presence of the latter compared with a control situation.

Conclusions.—The present study confirms the profound impact of headache on the performance of university students, with this impact much more evident among migraineurs but also important among students with ETTH.
Hypnic Headache: Report of Two Cases
Authors: Vieira‐Dias Marta , Esperança Paula
Published: March 2003

Hypnic headache constitutes one rare type of primary short‐lasting headache related to sleep.

The authors describe two cases of hypnic headache that had a very good response to lithium carbonate. Although these two cases do not fulfill the proposed criteria for hypnic headache, as the pain was not bilateral, and, in case 2, it had a longer duration than previously described, we believe that the very good response to lithium carbonate favors this diagnosis.

We believe that it is important to consider a diagnosis of hypnic headache because of the remarkable response to lithium carbonate shown by some patients with this condition.
Successful Use of Propranolol in Migraine Associated With Electroconvulsive Therapy
Authors: Hawken Emily R. , Delva Nicholas J. , Lawson J. Stuart
Published: March 2003

To date, there have been no reports on the use of propranolol in electroconvulsive therapy (ECT)‐induced migraine; we describe a 32‐year‐old woman who was successfully treated with propranolol for this condition. Over a course of ECT, the patient developed increasingly severe migraine which was refractory to treatment with acetaminophen, codeine, and naproxen. Sumatriptan did not relieve the headache and aggravated the nausea. Successful migraine relief was achieved with a combination of propranolol and naproxen, administered before and after ECT. Propranolol reduced blood pressure and decreased the heart rate, measured before and immediately after ECT. Propranolol, possibly in combination with naproxen, may be useful in both acute and prophylactic treatment of post‐ECT migraine.
Migraine Prevention and Errors in Living: Dr. Graham's Lessons for Patients and Physicians
Authors: Spierings Egilius L.H.
Published: March 2003

John R. Graham, MD (1909‐1990), the “father of headache management,” left us and our patients with migraine with valuable advice … advice based on extensive experience in headache management which, at the time of his retirement, spanned more than half a century.
Characteristics of Headache Associated With Acute Carbon Monoxide Poisoning
Authors: Hampson Neil B. , Hampson Lindsay A.
Published: March 2003

Objective.—To evaluate systematically the characteristics of headache due to acute exposure to carbon monoxide.

Background.—Headache is the most commonly reported symptom in acute carbon monoxide poisoning. While it is often described as throbbing and diffuse, a systematic characterization of carbon monoxide‐associated headache has never been published.

Methods.—Patients referred for hyperbaric oxygen treatment of acute carbon monoxide poisoning were asked whether headache was part of their symptom complex. When present, specific details about the nature of the headache were collected from 100 consecutive patients through use of a standardized questionnaire.

Results.—Information on carbon monoxide‐associated headache was collected from 34 female and 66 male patients with a mean carboxyhemoglobin level of 21.3%± 9.3%. The most common location for pain was frontal (66%), although more than one location was involved in 58% of patients. Nature of the pain at any time during its course was dull in 72% of patients and sharp in 36%. Headache was throbbing in 41%, continuous in 74%, and intermittent in 16% of those evaluated. Peak intensity of pain did not correlate with the carboxyhemoglobin level. Headache improved prior to hyperbaric oxygen treatment in 72%, resolving entirely in 21%. Of those with residual headache, pain improved with hyperbaric oxygen in 97%, resolving entirely in 44%.

Conclusions.—The headache accompanying acute carbon monoxide poisoning is extremely variable in nature. “Classic” throbbing, diffuse headaches were rarely described by patients. There are no patterns which can be considered characteristic to aid in the diagnosis of carbon monoxide‐induced headache. Similarly, no trait was identified which might allow elimination of carbon monoxide poisoning from the differential diagnosis of headache.
Diffusion‐Weighted Magnetic Resonance Imaging During the Aura of Pseudomigraine With Temporary Neurologic Symptoms and Lymphocytic Pleocytosis
Authors: Gekeler Florian , Holtmannspötter Markus , Straube Andreas , Klopstock Thomas
Published: March 2003

A typical feature of pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis (PMP) is the long duration of aura symptoms. To determine if these prolonged auras cause early ischemic parenchymal changes, we performed diffusion‐weighted magnetic resonance imaging during the aura of a patient with PMP and found no reduction of water diffusion.
Disappearance of Migraine Attacks During Long‐Lasting Postdural Puncture Headache: A Case Report
Authors: Oomura Masahiro , Yamawaki Takemori , Miyashita Kotaro , Yamagami Hiroshi , Naritomi Hiroaki
Published: March 2003

We report a patient with a history of frequent migraine attacks who developed postdural puncture headache that persisted for 3 months. His migraine attacks ceased during the period of his postdural puncture headache, but resumed 3 days after disappearance of that headache. This case suggests an interrelationship between the mechanisms of postdural puncture headache and migraine.
The Burden of Illness Associated With Headache Disorders Among Young Adults in a Representative Cohort Study
Authors: Waldie Karen E. , Poulton Richie , Dcp
Published: March 2003

This study investigated the functional impairment (work and social functioning and general health status) associated with migraine and tension‐type headache (TTH) among young adult members of the Dunedin Multidisciplinary Health and Development Study. Using criteria based on the International Headache Society classificatory system, the 1‐year prevalence for migraine headache was 7.4%, TTH was 11.1%, and combined headache (coexisting migraine and TTH) was 4.3%. All comparisons were against a health control group (headache free) and a diagnostic control group (individuals without headache currently using medication for asthma). Although those suffering from migraine and combined headache had the most severe impairment in work‐ and social‐related activities, those with TTH reported significantly poorer social and mental health functioning and poorer emotional and physical functioning while performing everyday roles than did headache‐free controls. Study members with combined headache had the poorest self‐reported health, with significantly lower ratings on physical, vitality, and mental health measures than asthmatics currently using medication. The pervasive impairment reported across multiple life domains among young headache sufferers illustrates the significant burden of illness associated with headache disorders.
Upper and Lower Cluster Headache: Clinical and Pathogenetic Observations in 608 Patients
Authors: Cademartiri Carola , Torelli Paola , Cologno Daniela , Manzoni Gian Camillo
Published: March 2003

Objective, Background, and Methods.—Ever since it was proposed by Ekbom and Kugelberg back in 1968 on the basis of the different location of head pain during attacks, the differentiation of cluster headache into an upper syndrome (US) and a lower syndrome (LS) has been regarded as a purely academic distinction. To evaluate whether this differentiation is indeed well founded and to understand its possible significance in the light of current pathogenetic knowledge, we rigorously applied Ekbom and Kugelberg's classification criteria to a sample of 608 patients with cluster headache (CH; 440 men and 168 women), including 483 with episodic CH, 69 with chronic CH, and 56 with CH periodicity undetermined.

Results.—Of these patients, 278 could be classified as US sufferers and 330 as LS sufferers. Our data analysis showed statistically significant clinical differences between the two syndromes: pain location was more common in the ocular, temporal, and nuchal regions among LS sufferers; in addition, patients with LS reported not only a higher rate of autonomic symptoms, but also a higher predominance of nasal congestion, ptosis, and forehead and facial sweating among these symptoms.

Conclusions.—Based on current anatomofunctional knowledge and on the most recent pathogenetic findings, we believe that changes in hypothalamic activity posteroinferiorly may lead to activation of the caudal part of the spinal trigeminal nucleus by way of the hypothalamus, midbrain, and trigeminal nerve fibers and consequently to activation of the trigeminovascular system with a different location in the two syndromes. More specifically, there seems to be a larger and more extensive involvement of the subnucleus caudalis in LS compared with US, where only its ventrocaudal portions are likely to be affected.
Lifetime Prevalence and Characteristics of Recurrent Primary Headaches in a Population‐Based Sample of Swedish Twins
Authors: Svensson Dan A. , Ekbom Karl , Larsson Bo , Waldenlind Elisabet
Published: March 2003

Objective.—To examine the lifetime prevalence and other characteristics of recurrent primary headaches in twins.

Background.—The twin model may provide insights into the role of genetic and environmental influences in headache disorders. However, assumptions as to whether twins are representative of the general population, and whether monozygotic and dizygotic twins are similar have rarely been addressed.

Methods.—The study population consisted of a random sample of 17‐ to 82‐year‐old twins from the Swedish Twin Registry (n = 1329). Structured interviews on the telephone by lay personnel and the International Headache Society criteria were used for assessment and diagnosis of recurrent primary headaches. Prevalence data of the general population for migraine and tension‐type headache was obtained from various published reports.

Results.—A total of 372 subjects (29%) had ever had recurrent headaches. In total, 241 recurrent headache sufferers fulfilled the criteria for migraine or tension‐type headache, and the lifetime prevalence was 7.1% for migraine without aura, 1.4% for migraine always with aura, 1.9% for migraine occasionally with aura, 9.4% for episodic tension‐type headache, and 1.3% for chronic tension‐type headache. The lifetime prevalence of all migraine and all tension‐type headache, including another 84 subjects fulfilling all but one of the criteria for migraine or tension‐type headache, was 13.8% and 13.5%, respectively. The corresponding prevalence risk for women was 2.4 (95% confidence interval [CI] 1.7, 3.4) and 1.5 (95% CI 1.1, 2.1), respectively. Zygosity was not a significant predictor for migraine. In tension‐type headache, the prevalence risk for dizygotic twins and unlike‐sexed twins as compared with monozygotic twins was 1.9 (95% CI: 1.2, 3.1) and 1.8 (95% CI: 1.1, 2.9), respectively.

Conclusion.—There is no twin‐singleton or monozygotic‐dizygotic difference for the risk of migraine. In tension‐type headache, twins seem to have a lower risk than singletons, and this is especially true for monozygotic twins.
Volume and Nature of Telephone Calls in a Specialty Headache Practice
Authors: Loder Elizabeth , Geweke Lynne
Published: March 2003

Background.—No information exists regarding the contribution of patient‐related telephone calls to the burden of headache practice.

Objective.—To identify the nature and volume of patient‐related telephone calls to a specialty headache practice over a 1‐month period.

Design and Methods.—The characteristics of all patient‐related calls to a single headache practitioner occurring during July 2001 were documented. Information was obtained on the caller, reason for call, length of call, timing and day of call, stated importance of call, patient's principal headache diagnosis, and principal comorbid psychiatric disorder, if any.

Results.—One hundred sixty‐five outpatient headache‐related calls were received in July 2001, 3.17 for every hour of headache clinic scheduled. A total of 65% of all calls was generated by just 36% of callers. Of the 32 patients who placed more than one call during the study period, 50% had chronic daily headache, 53% had a personality disorder, and 38% had both. Twenty‐seven percent of all calls were placed by someone other than the patient, 58% involved requests for medication refills, and 17% reported a new symptom or medication side effect. Over half of all calls were placed on Mondays and Tuesdays. Relatively few occurred outside work hours; 18% of calls characterized as “emergency” and 36% of calls characterized as urgent involved requests for controlled substances. Most of these calls were placed by patients with personality disorders. None of the 11 calls characterized as emergency calls was judged so by the physician; only 19% of the urgent calls were judged so by the physician.

Conclusions.—Telephone calls contribute substantially to the burden of caring for patients in a specialty headache practice. Patients with chronic daily headache and personality disorders contribute disproportionately to this telephone burden. Efforts to identify such patients at presentation and educate them regarding appropriate telephone use seem to be warranted.
Prevalence of Head Trauma in Patients With Difficult Headache: The North Norway Headache Study
Authors: Bekkelund Svein Ivar , Salvesen Rolf
Published: March 2003

Objective.—To test whether chronic headache (>3 days/week) is more prevalent than episodic headache (<3 days/week) in patients with a previous history of significant head trauma.

Method.—We included 903 consecutive patients referred to a specialist center for headache during a period of 2 years. As the main parameter, we selected self‐reported history of previous significant head trauma defined as loss of consciousness or hospitalization due to head trauma.

Results.—One hundred eighty‐nine out of 903 patients with difficult headache referred to a neurologist had a previous history of head trauma (21%). We identified 297 patients with headache 3 days or more per week (33%). Of these patients with chronic headache, 68 (23%) reported previous significant head trauma compared with 121/714 (17%) in other patients with headache (P  =  .18). Shorter length of education was associated with chronic headache; however, age, sex, or specific headache syndromes such as migraine or tension headache were not related to chronicity.

Conclusion.—Although the incidence of previous head trauma was prevalent in this highly selected group of patients with headache, such a history was not a predictor of chronicity.
Soluble Interleukin‐2 Receptors Increase During the Active Periods in Cluster Headache
Authors: Empl M. , Förderreuther S , Schwarz M , Müller N , Straube A
Published: March 2003

Objective.—To investigate whether cytokines are altered during the active period of cluster headache.

Background.—Patients with cluster headache show activation of the hypothalamus in PET studies and via endocrinologic parameters. Data also suggest an inflammatory process occurs in cluster headache. A connection between the presumed inflammatory cause, an immunological activation, and the hypothalamus could be generated by certain cytokines.

Design and Methods.—ELISA was used to determine the serum levels of soluble interleukin‐2 receptors, interleukin‐1, interleukin‐6, and 2 soluble interleukin‐6 receptors (sIL‐6R and soluble gp130) in 18 patients with cluster headache (6 women and 12 men) during the cluster period and in 17 healthy controls who were headache‐free (3 women and 14 men).

Results.—Patients with cluster headache had significantly increased soluble interleukin‐2 receptors (413.6±223 U/mL vs. 290.0±112 U/mL; P < .05) compared with controls. Serum levels of interleukin‐1 (0.29±0.30 pg/mL vs. 0.13±0.13 pg/mL, n.s.), interleukin‐6 (0.87±0.6 pg/mL vs. 0.91±0.7 pg/ml; n.s.), soluble interleukin‐6 receptors (33,131±8,349 pg/mL vs. 35,063±7,606 pg/mL; n.s.), or soluble gp130 (289±59 pg/mL vs. 283±20 pg/mL; n.s.) did not differ between the 2 groups, although patients with cluster tended to have higher interleukin‐1 values.

Conclusions.—Because elevated soluble interleukin‐2 receptors indicate T cell activation, our findings suggest immune activation during cluster headache. Because interleukin‐2 can activate the hypothalamus and stimulate the release of Corticotropin‐releasing Factor (CRF), interleukin‐2 could link a putative immunological cause of cluster headache with the observed hypothalamic activation. Systemic changes of interleukin‐1 or the interleukin‐6 system do not seem to play a role in cluster headache, as no alterations of serum levels were observed. Even so, unchanged serum levels do not exclude limited local production.
Clinical Efficacy of Frovatriptan: Placebo‐Controlled Studies
Authors: Ryan R. , Géraud G. , Goldstein J. , Cady R. , Keywood C.
Published: March 2003

Objective.—To confirm the clinical efficacy of frovatriptan 2.5 mg.

Background.—Frovatriptan is a new 5‐hydroxytryptamine (5‐HT)1B/1D receptor agonist being developed for the acute treatment of migraine with or without aura. Results from preclinical and clinical pharmacology studies showed frovatriptan to be a potent 5‐HT1B receptor agonist with a long terminal elimination half‐life (26 hours) and a broad therapeutic index.

Design.—Three randomized, placebo‐controlled, double‐blind, parallel‐group trials, in a total of 2676 patients, were performed to confirm the clinical efficacy of frovatriptan 2.5 mg for the acute treatment of migraine.

Results.—In all three studies, headache response 2 hours after frovatriptan dosing was significantly greater than that seen with placebo (P.001) with approximately a two‐fold measure of effect over placebo for headache response at 2 and 4 hours postdosing. Time to headache response occurred within 1.5 hours in a substantial proportion of patients. The incidence of 24‐hour headache recurrence with frovatriptan was low (10% to 25%). Frovatriptan therapy also was associated with a high degree of patient satisfaction.

Conclusions.—Frovatriptan represents a consistently effective acute treatment for migraine and accompanying symptoms.
Distinguishing Subtypes of Temporal Lobe Epilepsy with Background Hippocampal Activity
Authors: Zaveri Hitten P. , Duckrow Robert B. , De Lanerolle Nihal C. , Spencer Susan S.
Published: March 2003

Summary:  Purpose: Two subtypes of temporal lobe epilepsy (TLE) can be defined through clinical observations and analysis of hippocampal tissue resected during surgical procedures for intractable TLE: (a) mesial temporal sclerosis (MTS), which is characterized by extensive changes to the hippocampus and good surgical outcome; and (b) paradoxical temporal lobe epilepsy (PTLE), which is characterized by minimal cell loss and comparatively poorer surgical outcome. Patients in both subtypes have seizures that appear to begin in the medial temporal lobe, but documented differences in substrate and outcome between these subtypes has defined a need to distinguish MTS and PTLE patients before surgery. This report describes a retrospective study to investigate the feasibility of doing so during intracranial monitoring.

Methods: Background EEG epochs, 5 min in duration, were recorded from the anterior hippocampus in 14 (10 MTS and four PTLE) patients with consistent localization of seizure onset to medial temporal structures. The power spectral density (PSD) of the EEG epochs was calculated by a Fourier spectral estimator, and the total signal power and power of the delta, theta, alpha, beta, and gamma frequency bands were submitted to group‐to‐group comparison.

Results: Spectral peaks were observed in the delta band in all PSD estimates and in the theta band in nine of 14 (seven MTS, two PTLE) estimates. The MTS and PTLE subtypes could be distinguished by the total signal power and delta band power. These power measurements were greater in the PTLE subtype.

Conclusions: Both delta and theta spectral components are present in hippocampal background EEGs recorded from patients with TLE. The results indicate that group differences exist in spectral measures of background hippocampal signals recorded from MTS and PTLE subtypes. This suggests both that substrate differences in cellular composition and connectivity are reflected in hippocampal background EEGs and that spectral measurements of these signals may hold promise for tests to identify the group membership of individual patients.
Low Concentration of DL‐2‐Amino‐5‐phosphonovalerate Induces Epileptiform Activity in Guinea Pig Hippocampal Slices
Authors: Gorji Ali , Speckmann Erwin‐Josef
Published: March 2003

Summary:   Purpose: The specific mechanisms by which low concentrations of cyclosporine induce seizures and low concentrations of phencyclidine provoke behavioral excitation remain to be elucidated. Both compounds block N‐methyl‐d‐aspartate (NMDA) receptors. The aim of this study was to determine if low concentrations of the NMDA‐receptor blockers increase the seizure susceptibility.

Methods: Guinea pig hippocampal slices were exposed to artificial cerebrospinal fluid containing the NMDA blocker dl‐2‐amino‐5‐phosphono‐valerate (APV; 0.1–10 μM). Extracellular field potentials were recorded from CA1 and CA3 regions.

Results: Low concentrations of APV induced epileptiform burst discharges (0.1–0.25 μM), whereas higher doses failed to decrease the seizure threshold (1–10 μM).

Conclusions: The results indicate that the excitatory effect of low concentrations NMDA blockers may play a role in the neurotoxicity of aforementioned substances.