bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Confusional Migraine Attacks Resolved by Sleep: Lack of Significant Abnormalities in Post-Ictal Polysomnograms
Authors: Parrino Liborio , Pietrini Vladimiro , Spaggiari Maria Cristina , Terzano Mario Giovanni
Published: March 2003

We observed acute confusional migraine (ACM) attacks in two adolescents, and in both cases the episodes ended when the patients fell asleep spontaneously. Laboratory and neuroradiologic examinations were unremarkable. The post-ictal polysomnograms displayed a regular quality and duration of the physiologic components of sleep. Random posterior slow waves occurred only during the nocturnal awakenings and REM periods. The observation that sleep may resolve migraine attacks is emphasized. ACM is characterized by peculiar and relatively quickly reversible clinical manifestations and EEG abnormalities. The lack of significant abnormalities in post-ictal polysomnograms corresponds to a functional integrity of the brainstem structures involved in the global organization of sleep and may represent a useful laboratory feature in the diagnosis of ACM.
Comparison of Pharmacodynamic Effects and Plasma Levels of Oral and Rectal Ergotamine
Authors: Bülow PM , Ibraheem JJ , Paalzow G , Tfelt-Hansen P
Published: March 2003

Plasma levels and the vasoconstrictive effect of 1 mg ergotamine tartrate given as tablets or suppositories were compared. In a crossover study, eight male volunteers received tablets or suppositories containing ergotamine in a drug combination (Anervan®) and, as a control, suppositories without ergotamine. Blood sampling and measurement of toe-arm systolic gradients with a strain-gauge technique were done for up to 6 h and again after 24 h and 48 h. Only 29 of 160 blood samples contained detectable (>0.1 mg/ml) amounts of ergotamine, and kinetic comparison could not be performed. Only ergotamine-containing suppositories caused a significant ( p < 0.008) decrease in toe-arm systolic gradient which was significantly different ( p < 0.003) from the effects of ergotamine tablets and control suppositories. Rectal ergotamine is thus more biologically active, for the factor used, than oral ergotamine. We suggest that a rectal dose of 1 mg ergotamine tartrate should be tried as the initial dose in the treatment of migraine attacks.
Retropharyngeal Tendinitis
Authors: Fahlgren Holger
Published: March 2003

A rare clinical syndrome, with acute onset of severe pains localized in the back of the neck and aggravated by head movements and swallowing, has been studied in 28 patients. X-ray examinations of the cervical spine and prevertebral soft tissues in straight lateral projection of all patients in the acute phase showed significant soft-tissue swelling anterior to the vertebral bodies of C1–C4. Eighteen patients had an amorphous calcific deposit below the tuberculum anterius atlantis in or near the mid-line. The clinical symptoms were characteristic, with a benign course and freedom from complaints and regression of the radiological changes after 1–2 weeks. The diagnosis was usually made clinically and confirmed after two or more X-ray examinations of the cervical spine and the prevertebral soft tissues. The disease was in all probability caused by acute tendinitis in the longus colli musculus.
Computerized Telethermographic Assessment in Migraine, with Particular Reference to the Prodromal Phase
Authors: Giacovazzo Mario , Martelletti Paolo , Valducci Giacomo
Published: March 2003

We have studied the angular orbit and supraorbital arteries in 58 patients with classic migraine (36 females, 22 males; age (x), 43.5 years). A Dorex telethermograph apparatus, which utilizes the infrared radiations emitted by a patient, was used. The individual is placed at standard distance, and the temperature and humidity of the environment are kept constant. Three thermographic tests were performed in each patient: the first in basal condition, the other during the visual and/or sensory aura, and the last during the pain phase. The skin temperature levels decreased during the prodromal phase and increased during the migraine attack as compared with the levels obtained in basal conditions. There were significant asymmetries during the pain phase.
Contingent Negative Variation and Efficacy of Beta-Blocking Agents in Migraine
Authors: Schoenen J , Noordhout A Maertens de , Timsit-Berthier M , Timsit M
Published: March 2003

Thirty-three patients with common migraine underwent contingent negative variation (CNV) recordings before receiving prophylactic beta-blocker treatment with either metoprolol (27 patients) or propranolol (6 patients) at mean daily dosages of 110 mg and 122 mg, respectively. After 3 months the therapeutic efficacy of the beta-blocker was assessed in each patient by means of a global severity score and compared with the initial CNV recordings. The mean clinical improvement was 62%. A significant positive correlation was found between CNV amplitude before prophylaxis and the clinical response to beta-blockers: patients with higher CNV tended to respond better to therapy. Eight of 10 patients with a CNV amplitude higher than -25 V had a more than 50% reduction of the severity score—that is, a good or excellent response to the beta-blocking agent—whereas only 2 of 9 patients with an amplitude lower than -20 V had a good response.
Effects of L-5HTP with and Without Carbidopa on Plasma ß-Endorphin and Pain Perception: Possible Implications in Migraine Prophylaxis
Authors: Genazzani AR , Sandrini G , Facchinetti F , Rizzo V , Alfonsi E , Sances G , Calvani M , Nappi G
Published: March 2003

L-Tryptophan (L-TP) has been used in migraine and other pain conditions. The mechanism underlying the analgesic effect is still partly undefined. In this study the effects of subchronic administration of L-5–hydroxy-tryptophan (L-5HTP) (with and without carbidopa) on plasma ß-endorphin (ß-EP) levels and subjective pain threshold and tolerance were investigated in seven healthy volunteers. To measure also an objective indicator for pain, the nociceptive flexion reflex threshold was studied. L-5HTP treatment with and without carbidopa administration increased ß-EP levels significantly (p < 0.05). L-5HTP plus carbidopa induced an increase in ß-EP significantly (p < 0.05) higher than that after L-5HTP alone. Neither subjective pain threshold and tolerance nor RIII threshold was modified by either treatment. Our data seem to point to the existence of a complex linkage between plasma opioid levels and pain perception.
Efficacy of Nimodipine in Comparison with Pizotifen in the Prophylaxis of Migraine
Authors: Havanka-Kanniainen H , Hokkanen E , Myllylä V V
Published: March 2003

The efficacy of nimodipine in comparison with that of pizotifen was assessed in the prophylaxis of migraine in a double-blind cross-over study, in which a double-dummy technique was also utilized. The study was carried out on 43 migraine patients, of whom 15 had classic and 28 had common migraine. A 4-week run-in placebo period preceded the drug treatments, the drug treatments lasted 12 weeks, and there was a washout placebo period of 4 weeks between nimodipine and pizotifen treatments. The dosages used were 40 mg three times daily for nimodipine and 0.5 mg three times daily for pizotifen. Both nimodipine and pizotifen proved to be better than placebo, the number of migraine attacks showing a significant reduction. There was no difference between nimodipine. and pizotifen in antimigrainous efficacy, but there were fewer side effects during the nimodipine period. The results suggest that nimodipine is an effective drug for the prophylaxis of migraine, with few side effects and therapeutic efficacy equal to that of pizotifen.
Acute Confusional Migraine: Clinical and Electroencephalographic Aspects
Authors: Pietrini Vladimiro , Terzano M Giovanni , D'Andrea Giovanni , Parrino Liborio , Cananzi Antonio R , Ferro-Milone Francesco
Published: March 2003

Twelve patients with episodes of acute confusional migraine (ACM) are reported. Prolonged agitation and mental confusion characterized the headache attacks, occurring mostly among adolescents. The ictal EEG showed diffuse, slow abnormalities and a peculiar pattern known as FIRDA (frontal intermittent rhythmic delta activity). Neuroradiologic examinations and laboratory tests were unremarkable. After the acute stage, EEG gradually tended to show normalization. Apart from the noticeable similarities to the “juvenile head trauma syndrome”, the authors assume that ACM represents a peculiar clinical form among the different types of migraine associated with disorders of higher mental functions.
Whole Blood and Plasma Histamine in Common Migraine
Authors: Haimart M , Pradalier A , Launay JM , Dreux C , Dry J
Published: March 2003

Whole blood and plasma histamine levels were measured in 27 non-medicated patients with common migraine. In nine cases blood was drawn 1–2 h after the onset of a migraine attack. The whole blood histamine levels of migraineurs and controls did not differ significantly. In contrast, histamine levels were significantly increased in plasma from patients both during and between migraine attacks, as compared with controls ( p < 0.001). Finally, plasma taken from migraine patients induced a significantly greater release of histamine from control whole blood than did plasma taken from control subjects ( p < 0.01).
Prolactin in Cluster Headache: Diurnal Secretion, Response to Thyrotropin-Releasing Hormone, and Relation to Sex Steroids and Gonadotropins
Authors: Waldenlind Elisabet , Gustafsson Sven A
Published: March 2003

The diurnal rhythmicity of serum prolactin (PRL) and the PRL and thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) were studied in 31 cluster headache patients (4 chronic cases) and 14 healthy controls. Sixteen of the patients were studied both during clinical remission and headache periods. In males the nocturnal PRL peak was blunted during remissions as compared with that in cluster periods and that in control individuals. The 24-h mean PRL levels were lower during remission and cluster periods than in the controls. There were no significant differences in the PRL levels between female patients and controls. Headache attacks were often associated with increases of serum PRL levels. The PRL reponse to TRH was lower in the female patients but not in the male patients as compared with controls. The maximum testosterone levels were lower during cluster periods than during clinical remission but not when compared with controls. Serum levels of luteinizing hormone, follicle-stimulating hormone, progesterone, estradiol, T3, T4, and TSH did not differ between patients and controls. The results suggest an altered regulation of PRL secretion not only during active cluster periods but also during symptom-free intervals. The possible influence of sleep, estradiol, testosterone, medication, pain, and serotoninergic and dopaminergic mechanisms are discussed.
The Sweating Anomaly in Cluster Headache: Further Observations on the Underlying Mechanism
Authors: Sjaastad Ottar , Salvesen Rolf , Antonaci F
Published: March 2003

We describe a patient with a typical history of cluster headache for more than 18 years. During the first approximately 10 years of his disease, the pain was right-sided, and pupillometric and evaporimetric measurements indicated a sympathetic deficiency on this same side. However, for the next >6 years, his pain was consistently left-sided, although the signs of sympathetic dysfunction still were more marked on the right side. This was also true for the findings obtained during the interictal period and for the heating test performed within an attack. The implications of this interesting case are discussed. The view that two separate lines of symptom production lead to the pain and the autonomic phenomena seems to be supported by this case history. The cluster headache syndrome may also be a bilateral disorder, with only the weight of balance pointing one way or the other. Finally, the autonomic test results of this patient could reflect an autonomic “scar” in the previous headache side.
Migraine and the Lupus Anticoagulant: Case Reports and Review of the Literature
Authors: Levine Steven R , Joseph Rajiv , D'Andrea Giovanni , Welch KMA
Published: March 2003

Lupus anticoagulants (LA) are antiphospholipid serum immunoglobulins generally associated with autoimmune conditions, especially systemic lupus erythematosus (SLE). They have recently been linked to thrombotic events, including stroke. A possible association of migraine with LA is now forwarded with the presentation of two cases and a literature review. Our two patients, both in their forties, had migrainous phenomena without SLE or thrombotic events. Eight other cases were found in the literature, suggesting more than a chance association. Relevance to migraine pathophysiology is discussed and may come from the ability of the LA to alter prostaglandins and platelet activity and to interact with neuronal phospholipids. Further, larger studies are needed to support this association.
Personality Inventory for Children and Childhood Migraine: A Case-Controlled Study
Authors: Guidetti Vincenzo , Fornara Roberto , Ottaviano Salvatore , Petrilli Alessandro , Seri Stefano , Cortesi Flavia
Published: March 2003

The personality inventory for children (PIC), which is similar in structure to the MMPI and hence free from subjective interpretation, is applicable to children from 6 to 16 years of age. We used it in 40 children with common migraine aged 8 to 14 years and in 40 controls comparable in age, sex, and socioeconomic status. Although the migraine subjects did not emerge as globally different from the controls, they presented significantly higher scores on the Somatic concern, Depression, and Anxiety scales, irrespective of sex. These results underline the value of PIC in the diagnostic assessment of childhood migraine.
Cluster Headache Pathogenesis: A Pupillometric Study
Authors: Salvesen R , Bogucki A , Wysocka-Bakowska MM , Antonaci F , Fredriksen TA , Sjaastad O
Published: March 2003

Thirty-two cluster headache patients and healthy controls (n = 16-20 for the various tests) were examined by means of a Whitaker pupillometer during pain-free intervals. Eye drops of the sympathomimetic agents tyramine, hydroxyamphetamine, and phenylephrine were instilled into the conjuctival sacs on separate occasions, and pupillary diameters recorded at standard time intervals. The mydriatic responses of the two pupils were compared. A moderate, but statistically significant, basal relative miosis was found on the pain side in cluster headache. The symptomatic-side pupils were less responsive than their counterparts when stimulated with tyramine and hydroxyamphetamine, the difference being statistically significant for the OH-amphetamine test. With the phenylephrine test, however, the mydriasis on the symptomatic side significantly exceeded that of the contralateral pupil. This pattern of reactions does not quite correspond to those of “ordinary” Horner‘s syndrome (1st, 2nd, and 3rd neuron lesion). There are, however, gross similarities with the recently reported pattern in central sympathetic neuron dysfunction. In cluster headache there is probably a “Homer-like picture” rather than a proper Horner's syndrome.
Catecholamine Response to Light in Migraine
Authors: Stoica Emilian , Enulescu Olimpia
Published: March 2003

The effect of the shift from a low to a high luminosity of the environment on the urinary excretion of norepinephrine (NE) and epinephrine (E) was studied in migraineurs (26 cases) and controls (25 cases). In the latter the shift from a low to high light exposure increased NE excretion; in contrast, in migraineurs exposure to high luminosity resulted in a depression of NE excretion and an augmentation of E excretion. The possible participation of E discharge produced by photostimulation or by other stimuli in the pathogenesis of migraine attack is discussed.
Cervicogenic Headache: Results of Computer-Based Measurements of Cervical Spine Mobility in 15 Patients
Authors: Pfaffenrath V , Dandekar R , Mayer ETh , Hermann G , Pöllmann W
Published: March 2003

Head and neck pain are often attributed to impaired mobility of the cervical spine. No established methods exist to examine such an impaired mobility objectively in patients with cervicogenic headache. Therefore, functional roentgenograms of the cervical spine in maximum ventral and dorsal flexion were analyzed in 15 patients with cervicogenic headache and in 18 controls. Qualitative radiologic evaluation showed no significant differences in either group. A computer-based technique to assess the mobility of the cervical spine demonstrated a statistically pronounced hypomobility of the craniocervical joints C0/C2 and an impaired overall mobility of the upper cervical spine (C0-C5) in the cervicogenic headache group. The most evident hypomotility was found in segment C0/C1. Interesting was, furthermore. a probably compensatory hypermotility in segment C6/C7. These findings did not correlate with the results of the qualitative radiologic evaluation.
EMG in Common Migraine: Changes in Absolute and Proportional EMG Levels During Real-Life Stress
Authors: Goudswaard Plona , Passchier Jan , Orlebeke Jacobus F
Published: March 2003

The absolute and proportional EMG levels of the frontal, temporal, and corrugator muscles of 37 migraine patients and 37 matched controls were recorded during three experimental sessions: adaptation and real-life and experimental stress, both of long duration. Migraine patients did not show significantly different absolute EMG levels but had higher proportional EMG levels of the corrugator muscle than controls in each session. Migraine patients did not have different facial muscle responses to stress, and the two experimental groups reacted similarly to real-life and experimental stress. No relation was found between muscle activity and reported headache within 24 h after real-life stress. Increased EMG activity due to stress does not seem to be a significant cause of headache in common migraine as defined in this study, but rather a response to pain. Migraine patients with headache during stress showed lower muscle tension than patients without headache.
Placebo-Controlled Double-Blind Trial of Pirprofen and an Ergotamine Tartrate Compound in Migraine Attacks
Authors: Kinnunen Esko , Erkinjuntti Timo , Färkkilä Markus , Palomäki Heikki , Porras Jukka , Teirmaa Heikki , Freudenthal Ylva , Andersson Peter
Published: March 2003

Sixty-one patients, 16 with classic and 45 with common migraine, were treated during three subsequent attacks with pirprofen, a new inhibitor of prostaglandin synthesis; an ergotamine tartrate compound; or placebo, in a randomized, double-blind multicentre study. Pain relief after a single dose and reduction of the attack intensity occurred most often with pirprofen in patients who needed more than one dose. Among them, however, the duration of attack was shortest with ergotamine. Working ability was well preserved with pirprofen, especially among patients with common migraine, and this treatment was ranked highest by the patients. However, no statistically significant differences were found between pirprofen and ergotamine. No serious side effects were observed with pirprofen. This study establishes the usefulness of pirprofen in the treatment of acute migraine.
Pupil Responsiveness in Cluster Headache: A Dynamic TV Pupillometric Evaluation
Authors: Micieli Giuseppe , Magri Marco , Sandrini Giorgio , Tassorelli Cristina , Nappi Giuseppe
Published: March 2003

In this study the variations in pupil diameter induced by different stimuli (dark-light adaptation, light reflex, electric stimulation of the sural nerve) were investigated in episodic (in the active or remission phases) and in chronic cluster headache (CH) patients. Pupil size monitoring was performed with a monocular, infrared TV pupillometer, and sural nerve stimuli were applied after the pain threshold had been measured as the flexion reflex threshold of the biceps femoris muscle (RIII reflex). The results were compared with those obtained in patients with “peripheral” (third neuron) Horner's syndrome and in healthy sex- and age-matched controls. On the symptomatic side we found an impairment of pupil response to light flashes and nociceptive stimuli; similar findings were sometimes evident on the pain-free side, too. These results substantiate previous observations that in cluster headache a dysfunction of the integrative central nervous system pathways also exists intercritically and mostly bilaterally, involving both autonomic regulation and pain perception mechanisms.
Cervicogenic Headache: The Forehead Sweating Pattern
Authors: Fredriksen Torbjørn A
Published: March 2003

Forehead sweating in 11 patients with cervicogenic headache was tested with the Evaporimeter. All were studied during heating experiments, 2 patients during exercise, and 10 patients after pilocarpine stimulation. Five patients were studied during spontaneous attacks. The evaporation during spontaneous attacks was symmetrical. This was also the case after heating, exercise, and pilocarpine stimulation. These findings differ clearly from the situation in cluster headache. These observations indicate that cervicogenic headache and cluster headache differ fundamentally with regard to autonomic involvement.
A Survey of Headache in Parkinson's Disease
Authors: Lorentz Ivan T
Published: March 2003

There are few reports on the prevalence of headache in Parkinson's disease (PD). In the present study, 223 chronic PD sufferers and 291 controls are surveyed by a headache questionnaire. There is no significant difference in the total prevalence of headache in sex and age-matched patients and controls. However, male patients with PD have a higher prevalence of moderate to severe migraine than the control population.
Opioid Control of the Hypothalamus-Pituitary-Adrenal Axis Cyclically Fails in Menstrual Migraine
Authors: Facchinetti Fabio , Martignoni Emilia , Fioroni Loridine , Sances Grazia , Genazzani Andrea R
Published: March 2003

To assess the biological correlates of the precipitation of migraine attacks in the perimenstrual period, plasma b-endorphin (b-EP) and cortisol responses to naloxone (8 mg iv) and corticotropin releasing hormone (100 μg iv) were evaluated in both the follicular phase and the premenstrual period in 7 patients suffering from menstrual migraine and in 7 healthy, asymptomatic control volunteers. In the controls, naloxone evoked a significant release of both b-EP (F = 5.86, p < 0.002) and cortisol (F = 4.43, p < 0.008), independently of the menstrual cycle phase (F = 0.31 and 1.04, for b-EP and cortisol, respectively). Menstrual migraine patients, on the other hand, showed a significant hormone response only in the follicular phase, not in the premenstrual period. Corticotropin releasing hormone significantly increased b-EP and cortisol in both the controls and the menstrual migraine patients, independently of the menstrual cycle phase. In both the naloxone and corticotropin releasing hormone testings, the basal b-EP levels measured in the premenstrual period were lower than those observed in the follicular phase ( p < 0.02). These data demonstrate a cyclical, premenstrual dysfunction of the hypothalamic control exerted by opioids on the hypothalamus-pituitary-adrenal axis. Impairment of this fundamental adaptive mechanism (involved in stress responses and in pain control) could establish a causal relationship between menstrual-related migraine attacks and premenstrual opioid hyposensitivity.
Long-Acting Propranolol in the Prophylaxis of Migraine: A Comparative Study of Two Doses
Authors: Carroll JD , Reidy M , Savundra PA , Cleave N , McAinsh J
Published: March 2003

A randomized double-blind, cross-over study using treatment periods of 12 weeks with a 2-week washout, comparing two long-acting formulations of propranolol (`Inderal’*(1) LA 160 mg daily and Half-‘Inderal’ LA 80 mg daily) was performed after a placebo run-in of 4 weeks on 51 patients. The study indicated that both long-acting formulations were significantly better than placebo in reducing the frequency of migraine attacks ( p < 0.01). After 12 weeks there was a significantly lower ( p = 0.03) frequency of migraine attacks in patients on the higher dose formulation than in those on the lower dose formulation. There was no significant difference in the frequency of side effects produced by the two formulations.
Muscle Tenderness in Tension Headache Treated with Acupuncture or Physiotherapy
Authors: Carlsson Jane , Fahlcrantz Astrid , Augustinsson Lars-Erik
Published: March 2003

Sixty-two female patients with chronic tension headache were randomized into two treatment groups-acupuncture and physiotherapy. The intensity of headache, muscle tenderness and neck mobility was assessed before and after treatment. Thirty healthy women were used for comparison. Before treatment it was found that muscle tenderness was increased and neck rotation was reduced in the patient group compared with controls. There was a significant correlation between the intensity of headache and muscle tenderness. After treatment, the intensity of headache and muscle tenderness were reduced in both treatment groups. The headache was more improved in the physiotherapy group, and there was a marked reduction in the intake of analgesics. The tenderness was reduced in all muscles tested in the physiotherapy group but only in some of the muscles after acupuncture. The limitation of neck rotation was not influenced by either treatment.
Sleep Deprivation Headache
Authors: Blau JN
Published: March 2003

Headaches due to insufficient or interrupted sleep are generally labelled “tension headaches” of psychogenic origin. In 25 healthy subjects, variable amounts of sleep loss (1–3 h for 1–3 nights) caused headaches lasting from 1 h to all day. The headache was most frequently a dull ache, a heaviness or a pressure sensation felt in the forehead and/or at the vertex. Simple analgesics, purchaseable without a doctor's prescription, completely or markedly reduced the head pain in 20–60 min. Headaches due to insufficient sleep differ from tension headaches in their site, duration and response to analgesics. Assuming that pain implies a regional dysfunction, headaches caused by sleep loss provide support for the notion that sleep has a restorative function in the brain.
Sex Steroids and Cluster Headache: Hypotheses
Authors: Polleri A
Published: March 2003

The pathophysiological significance of the changes in gonadal function observed in cluster headache is far from clear. Some features of the disease, such as the sex predominance, the lateralization of symptoms and the character of pain itself may be connected to some biological effects of gonadal steroids.
Occupational Stress in Migraine is Weekend Headache a Myth or Reality?
Authors: Morrison DP
Published: March 2003

To determine whether or not the frequency of migraine attacks increased at weekends in employed patients and if so, whether or not this was related to the type of migraine, 35 female patients prospectively recorded the presence or absence of migraine attacks daily over a six-week period. They were also asked to estimate the frequency with which emotional factors predisposed to their migraine attacks and to provide details of their occupation. A diagnosis of common (migraine without aura) or classical migraine (migraine with aura) was made according to both the criteria of the Ad Hoc Committee on the Classification of Headache and those of the International Headache Society. Eleven percent and 6% of patients, respectively, felt that emotional factors “usually” or “always” predisposed to migraine attacks. There was no significant increase in the frequency of migraine attacks at weekends in either the total group or in the employed patients. Similarly, the type of migraine made no difference to the results. There was therefore no evidence for a delayed onset of migraine at weekends related to the weekday stress of employment.
Lack of Antinociceptive Activity of Sumatriptan in Rodents
Authors: Skingle Malcolm , Birch Phillip J , Leighton Glynnis E , Humphrey Patrick PA
Published: March 2003

The present study attempts to determine whether the novel anti-migraine drug sumatriptan has antinociceptive activity in rodents. Sumatriptan had little or no antinociceptive activity against a range of noxious stimuli and we therefore conclude that it is unlikely that the beneficial effects of the drug in treating migraine are due to a non-specific analgesic action.
Propranolol in Acute Migraine: A Controlled Study
Authors: Fuller GN , Guiloff RJ
Published: March 2003

Propranolol is an established agent in migraine prophylaxis. Uncontrolled studies have suggested an action in the acute attack. We present the first double-blind placebo controlled study of propranolol in 27 unselected patients with common (migraine without aura) and classical (migraine with aura) migraine. There were 23 pairs of headaches in the 14 patients who completed the study. No difference was found, when the data were analysed by headache pair or by patient, in severity duration and subjective assessment of efficacy between those treated in an attack with propranolol 40 mg and placebo.
Responders and Non-Responders to Metoprolol, Propranolol and Nifedipine Treatment in Migraine Prophylaxis: A Dose-Range Study Based on Time-Series Analysis
Authors: Gerber WD , Diener HC , Scholz E , Niederberger U
Published: March 2003

The aim of the present study was to ascertain, on the basis of single case statistics and time-series analysis, responder and non-responder rates for metoprolol, propranolol and nifedipine in migraine prophylaxis. In addition, an attempt was made to identify the dose relationship for the various drugs on headache parameters. In a double-blind dose-finding study, 58 patients were treated in five consecutive dosage steps each lasting 1-3 months. All patients kept a headache diary before, during and after treatment. Serum drug levels were also determined. The data were assessed by time-series analysis, as well as by multiple regression and analysis of variance. A significant improvement was noted in 54.4% of patients with migraine during treatment with metoprolol. The study did not confirm the high success rates in migraine prophylaxis of nifedipine and propranolol quoted in the literature. Administration of nifedipine led to an increase in migraine attacks in 71% of the patients. Nifedipine was of no value in the prophylaxis of migraine. Only 32% of patients showed a reduction in frequency of migraine attacks during administration of propranolol. The analysis of variance failed to show any significant difference between the responder rates for metoprolol and propranolol. Higher doses of propranolol and metoprolol were more effective. Multiple regression analysis explained a considerable part of variance for propranolol (but not for metoprolol) as a result of reduced intake of ergotamine preparations and analgesics. It can therefore be concluded that part of the prophylactic effect of propranolol is attributable to a reduction in the use of migraine medication.
Differential Emotional Precipitation of Migraine and Tension-Type Headache Attacks
Authors: Donias Stamatis H , Peioglou-Harmoussi Sotiria , Georgiadis George , Manos Nicholas
Published: March 2003

The frequency of precipitation of headache attacks by individual emotional states as well as the awareness of vulnerability to particular emotional precipitants were investigated in 90 consecutive patients with tension-type headache and 50 consecutive migraine subjects at an Outpatient Headache Clinic. There was differential emotional precipitation in tension-type headache and migraine, with patients with tension-type headache reacting more selectively to negative emotional arousal (anger, anxiety) and reporting a graded frequency of attack precipitation by individual emotional states. Migraine subjects reported a more uniform distribution of attacks among different emotional precipitants. The two groups also showed a differential awareness of vulnerability to individual emotional precipitants. A cognitive process screening the emotional precipitants of tension-type headache and migraine attacks is proposed, based on different cognitive schemata functioning either over-effectively or defectively. The significance of cognitive mediation of the precipitation of attacks is further emphasized for a comprehensive management of both tension-type headache and migraine.
Headache as a Warning Symptom of Impending Aneurysmal Subarachnoid Haemorrhage
Authors: Østergaard John R
Published: March 2003

About half of the aneurysm patients admitted to neurosurgical departments experience warning symptoms in the form of minor bleeding episodes days or even several months before a major haemorrhage occurs. Headache is the most common symptom of this warning leak, occurring in 9 out of 10 patients. The onset of headache is sudden and is unusual in severity and location, being unlike any headache the patient has otherwise experienced. It is frequently accompanied by transient nausea, vomiting, visual disturbances or meningism. Medical advice may be sought by the patient but all too often the diagnostic importance of a warning headache is missed. It is misinterpreted as attacks of migraine, tension headache, the flu, sinuitis, or a “sprained neck”, A more vigilant attention to the presence of a warning headache probably offers the greatest opportunity for altering the otherwise serious natural history of aneurysmal sub-arachnoid haemorrhage. If a warning headache is suspected, lumbar puncture is the examination of choice, once CT scanning has ruled out an intracranial mass lesion.
Plasma Interleukin-1, Tumour Necrosis Factor and Hypothalamic-Pituitary-Adrenal Axis Responses During Migraine Attacks
Authors: Hilten JJ van , Ferrari MD , Meer JWM Van der , Gijsman HJ , Looij BJ
Published: March 2003

To evaluate systemic cytokine and hypothalamic-pituitary-adrenal axis responses in migraine, we measured plasma levels of tumour necrosis factor, interleukin-1, adrenocorticotropic hormone, and cortisol, as well as body temperature during and between attacks in 20 migraine patients. We found no evidence of systemic rise of cytokines during migraine attacks. Plasma cortisol and adrenocorticotropic hormone responses were similar to those found to experimentally-induced pain in normal subjects, i.e. elevated cortisol and unchanged adrenocorticotropic hormone levels. Unexpectedly, body temperature tended to be lower during attacks.
The Insulin Tolerance Test and the Ovine Corticotrophin-Releasing Hormone Test in Episodic Cluster Headache
Authors: Leone Massimo , Zappacosta Boris M , Valentini Sergio , Colangelo Anna M , Bussone Gennaro
Published: March 2003

Clinical observations indicate a central nervous system, probably hypothalamic, involvement in cluster headache pathogenesis. In order to investigate the supposed hypothalamic involvement in cluster headache, we followed the hypothalamic-pituitary-adrenal axis and autonomic responses to the insulin tolerance test and the ovine corticotrophin-releasing hormone test in episodic cluster headache patients, both during remission and during the cluster period. The study revealed increased basal cortisol levels in all cluster patients. A blunted cortisol response to ovine corticotrophin-releasing hormone, in spite of a normal ACTH surge, was subsequently found in both illness phases. These findings suggest hypo-thalamic-pituitary-adrenal axis hyperactivity in both cluster phases. Furthermore, reduced ACTH and cortisol responses after insulin challenge were also observed in both remission and cluster period patients; a reduced norepinephrine surge was seen only in the cluster period. Taken together, these results suggest a hypothalamic involvement in the altered neuroendocrinological and autonomic responses found in our patients.
Meningeal Enhancement and Low CSF Pressure Headache. An MRI Study
Authors: Sable Steven G , Ramadan Nabih M
Published: March 2003

A 34-year-old woman developed severe and incapacitating positional headaches two weeks following a minor head trauma. Lumbar punctures demonstrated unmeasurable or very low CSF pressures. Gado-linium-enhanced cranial MRI showed diffuse enhancement of thickened meninges, suggesting inflammation. One year later, MRI was normal.
Cyclooxygenase Inhibitors Modify the Relaxant Effect of Vasoactive Intestinal Polypeptide and Substance P in Isolated Porcine Ophthalmic Artery
Authors: Vincent Maurice B
Published: March 2003

The absolute indomethacin effect in some unilateral headaches may, at least partially, be cyclooxygenase inhibition-independent. Aspirin and indomethacin, for example, may inhibit the neurogenically induced plasma extravasation in rat dura mater. Given the putative involvement of trigeminal neuropeptides in the pathophysiology of these conditions, the influence of cyclooxygenase inhibitors (indomethacin, acetylsalicylic acid (ASA) and naproxen) has been studied upon substance P, calcitonin gene-related peptide and vasoactive intestinal peptide (VIP)-induced vasodilatation in PGF2a precontracted porcine ophthalmic arteries in vitro. None of the cyclooxygenase inhibitors significantly altered the effects of calcitonin gene-related peptide. The 10-10 mol/1 VIP-induced relaxation was inhibited significantly by all three cyclooxygenase inhibitors. Substance P-induced relaxation (from 10-10 to 10-8 mol/l) was enhanced by ASA and inhibited both by naproxen and, to a lesser extent, by indomethacin. The results suggest mainly that VIP-induced relaxations, particularly at lower concentrations, may be inhibited by all three cyclooxygenase inhibitors, and that naproxen, to a greater extent than aspirin or indomethacin, showed a tendency to inhibit vasodilatation induced by all peptides.
Blood Flow Velocities in the Vertebrobasilar System During Migraine Attacks a Transcranial Doppler Study
Authors: Zwetsloot CP , Caekebeke JFV , Jansen JC , Odink J , Ferrari MD
Published: March 2003

In this study, blood flow velocity in the basilar artery and both vertebral and middle cerebral arteries was measured with a transcranial Doppler device in 23 migraineurs during and outside a migraine attack. The aim of the study was to compare blood flow velocities during and outside an attack and to examine vascular reactivity to voluntary hyperventilation during both conditions. No differences in blood flow velocity were found. Although blood pressure was increased and end-expiratory CO2 decreased during the attack, this exerted no influence on blood flow velocity. Neither was a difference in vascular reactivity to voluntary hyperventilation detected between the two conditions. These findings support the notion of functional integrity of the examined large arteries during migraine attacks without aura.
Recurrent Tolosa-Hunt Syndrome
Authors: Hannerz Jan
Published: March 2003

Twenty consecutive patients with recurrent Tolosa-Hunt syndrome were studied. One had a parent who suffered from recurrent Tolosa-Hunt syndrome. Thirty-three percent of the patients had also recurrent periods of weeks to months of unilateral periorbital pain without ophthalmoplegia. One patient had cluster headache before the Tolosa-Hunt syndrome started. Some patients had involvement of cranial nerves outside the cavernous sinus region during Tolosa-Hunt syndrome and also between episodes. The same systemic symptoms, i.e. back pain, cold feet, arthralgia, gut problems, varices, vertigo, chronic fatigue, thrombophlebitis, memory deficiency and signs of inflammation in serum, occurred in Tolosa-Hunt syndrome as earlier found in patients with orbital venous vasculitis. Seventy-three percent of the patients had pathologic orbital phlebograms. All patients treated with steroids reacted promptly; four who developed chronic pain syndromes were treated satisfactorily with azathioprine.
Symptomatic Chronic Paroxysmal Hemicrania
Authors: Vijayan N
Published: March 2003

A patient with chronic paroxysmal hemicrania (CPH) associated with a gangliocytoma growing from within the sella turcica is reported. This tumor displaced the floor of the third ventricle and surrounded the internal carotid artery on the same side as the headache. Partial removal of the tumor followed by radiation resulted in amelioration of headache. The anatomical location of the tumor and its possible relationship to the pathogenesis of CPH is discussed.
Activation of the Trigeminovascular System by Mechanical Distension of the Superior Sagittal Sinus in The Cat
Authors: Kaube Holger , Hoskin Karen L , Goadsby Peter J
Published: March 2003

Distension of dural sinuses in man produces migraine-like pain. In eight a-chloralose anaesthetized cats mechanical distension of the superior sagittal sinus with a small intraluminal device was used to activate single units in the dorsolateral C2 spinal cord. Units in this region have been shown to respond to electrical stimulation of the superior sagittal sinus in the cat model. Linked responses to mechanical dilatation could only be obtained with very rapid stretching stimuli or high amplitudes of distension of the vessel. Lower thresholds for transduction of distension in the vessel wall may depend on transferral to the dura or biochemical or neural pre-sensitization of the superior sagittal sinus. These data are consistent with the view that migraine is not primarily a vascular disorder but requires at least humoral or neural facilitation.
Accompanying Symptoms of Cluster Attacks: Their Relevance to the Diagnostic Criteria
Authors: Nappi Giuseppe , Micieli Giuseppe , Cavallini Anna , Zanferrari Carla , Sandrini Giorgio , Manzoni Gian Camillo
Published: March 2003

Two-hundred-and-fifty-one consecutive cluster headache (CH) patients referred to the Pavia and Parma Headache Centers were evaluated in order to verify the presence and recurrence of one or more autonomic symptoms. Data obtained show that in 2.8% of patients cluster attacks were not accompanied by localized autonomic symptoms, thus confirming the report of Ekbom. We observed a high prevalence of photophobia, nausea and vomiting. The IHS diagnostic criteria for CH may need to be modified. The high frequency of “general” autonomic symptoms seems to suggest a component of “central” drive in the physiopathology of cluster headache.
Reduction of Calcitonin Gene-Related Peptide in Jugular Blood Following Electrical Stimulation of Rat Greater Occipital Nerve
Authors: Vincent Maurice B , Ekman Rolf , Edvinsson Lars , Sand Trond , Sjaastad Ottar
Published: March 2003

Although it is known that pain in the forehead may be induced by neck abnormalities, the actual neck-head connections responsible for development of pain in trigeminal areas are poorly understood. Vasoactive neuropeptides released from sensory fibres, such as substance P (SP) and calcitonin gene-related peptide (CGRP), have been considered as important elements in headache pathophysiology. The levels of CGRP-like immunoreactivity (LI) were measured bilaterally in the jugular blood (52 rats) and intraocular aspirates (66 rats) following electrical stimulation of the left greater occipital nerve, and in the jugular blood of 13 control animals. One-third of the stimulated rats had varying combinations of conjunctival injection, tearing, diminished eye aperture and miosis or mydriasis on the stimulated side. The other two-thirds exhibited no ocular signs. Significantly lower levels of CGRP-LI were present in the jugular blood on the stimulated side in comparison with control rats. There was comparatively lower CGRP-LI on the non-stimulated side as well, but to a lesser extent. Significant differences between the stimulated and the non-stimulated side were present, particularly in the tearing/diminished eye cleft group. It is proposed that stimulation of the rat GON inhibits the trigeminal system (reduction of CGRP-LI) and possibly activates parasympathetic fibres (ocular changes).
Vasoreactivity of the Intracranial Internal Carotid Artery
Authors: Hardebo Jan Erik
Published: March 2003

The vasoreactivity of the intracranial segment of the internal carotid artery to transmitters, present in the perivascular sympathetic, parasympathetic and sensory nerves, as well as to other vasoactive agents of relevance for headache, was tested in man and monkey. The total arterial segment from both species is equipped with contractile receptors for noradrenaline, serotonin, prostaglandin F2a, ergotamine and sumatriptan. Further, the total arterial segment dilated upon exposure to calcitonin gene-related peptide in both species. Other vascoactive transmitters, acetylcholine, substance P and neurokinin A, caused only weak dilatation, restricted to the proximal extracavernous segment in the monkey. The findings are discussed in relation to the pathogenesis and treatment of cluster headache.
Exteroceptive Suppression of Temporalis Muscle Activity: Findings in Headache
Authors: Wallasch Thomas-Martin , Göbel Hartmut
Published: March 2003

Exteroceptive suppression of temporalis muscle activity was proposed by Schoenen and co-workers in 1987 as a tool in headache diagnosis and research. Their finding of a decreased or abolished second silent period (ES2) in chronic tension-type headache sufferers has been confirmed by several independent laboratories during the last five years. Temporalis silent periods have also been studied in various other types of headaches. Their modulation by neuropsychological factors and pharmacological agents has also been investigated as well as their retest reliability. The pathophysiological concept of muscle contraction in tension-type headache has been challenged by studies using temporalis silent periods. The exterocepfive suppression of temporalis muscle activity points unequivocally towards a central pathogenetic mechanism, although it remains unclear whether the abnormalities of temporalis ES2 represent the primary dysfunction or a secondary phenomenon in chronic tension-type headache.
Contingent Negative Variation in Childhood Migraine
Authors: Besken Evelyn , Pothmann Raymund , Sartory Gudrun
Published: March 2003

Adult migraineurs without aura have an increased amplitude of the Contingent Negative Variation (CNV) between attacks. Given the potential diagnostic importance of this finding and the difficulties associated with diagnosing migraine in childhood it seemed important to assess CNV in children suffering from this disorder. Ninety-seven children aged between 8 and 14 years were recruited. Forty-two suffered from migraine, 34 from tension-type headache. Twenty-one healthy controls were also studied. CNV was recorded from Fz, Cz and Pz referenced to linked earlobes during 20 trials consisting of two tones of moderate intensity with an interstimulus interval (ISI) of 4 sec and an intertrial interval (ITI) of 10 to 14 sec. The second tone of each trial required a button press. EOG was recorded from the left eye. The 10 CNV responses with the least EOG artefact were selected and averaged. Children with migraine had a highly significantly more negative mean CNV amplitude at all three electrode sites than children with tension-type headache and also a more pronounced Post-Imperative-Negative-Variation (PINV). Migrainous children differed from controls only at Cz (ISI). There was also a highly significant increase of mean CNV amplitude and PINV at all three electrode sites in the control group compared to the tension headache group.
Computerized EEG Topography in Childhood Migraine Between and During Attacks
Authors: Seri S , Cerquiglini A , Guidetti V
Published: March 2003

Topographic EEG mapping was performed in 58 migrainous children (mean age: 12.9 years; 39 without, 19 with aura) between attacks. Ten children were also recorded during an attack with visual aura. Between attacks there were no significant differences between migraineurs and age-matched controls. During visual aura a decrease in occipital alpha power contralateral to the affected hemifield was found in all patients. This was followed by a bilateral frontal increase in delta power, and, during the headache, by an increased delta activity in posterior-temporal and occipital electrode sites. The possible brain mechanisms underlying these EEG changes are discussed.