bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative EEG Responses to Ischaemic Arm Stress in Migraine
Authors: Rainero I , Amanzio M , Vighetti S , Bergamasco B , Pinessi L , Benedetti F
Published: March 2003

Several studies suggest that patients with migraine respond physiologically to stress differently from controls, yet experimental data are scarce. In order to evaluate the reactivity to stress in migraine, we recorded the quantitative electroencephalogram (qEEG) during non-noxious and noxious ischaemic arm stress in two groups of healthy controls and compared the results with the effects of non-noxious ischaemic arm stress in a group of patients with migraine. In the controls, non-noxious mild stress did not produce any qEEG change but noxious stress induced a significant decrease of the alpha power. By contrast, in migraine patients the non-noxious mild stress was sufficient to induce a significant decrease of the alpha power in all brain regions. The results of our study show that migraine sufferers display a lower threshold to physical stress and confirm previous studies indicating that migraine is a disease characterized by a state of altered neuronal excitability.
Primary Yawning Headache
Authors: Jacome DE
Published: March 2003

To describe three patients with recurrent severe paroxysmal headache precipitated by yawning. Pain elicited by yawning is a well-recognized clinical phenomenon in patients with cranial neuralgia, temporomandibular joint dysfunction syndrome and Eagle syndrome. Clinical history, neurological and oral examinations, brain magnetic resonance imaging (MRI), cranial nerve electrophysiological testing and skull X-rays are reported. In all the patients pain was induced by yawning; in the third patient pain was also triggered by eructation. None had history of migraine. Facial gestures and forceful opening of the mouth did not reproduce the pain. The first patient had retroauricular pain, simvastatin-induced myopathy and subclinical axonal peripheral neuropathy; the second patient had a post-viral benign sensory neuropathy; and the third had retroauricular and facial pain and no underlying neurological illness. Cranial nerve testing and MRI of the brain were normal except for a coincidentally found pituitary adenoma on the first patient. Headache or cranial pain with yawning may occur in patients with no apparent cause (primary yawning headache). It is a chronic, benign condition that requires no specific treatment but needs to be distinguished from secondary yawning headache, of greater clinical relevance.
Sferics And Headache: A Prospective Study
Authors: Walach H , Betz H-D , Schweickhardt A
Published: March 2003

Sferics are low frequency, low intensity electromagnetic pulses radiating from distant meteorological events and other yet unknown sources. It has been hypothesized that sferics are part of the purported sensitivity to weather changes reported by headache sufferers. We tested this proposal. Patients (migraine and/or tension headache) enrolled in a randomized clinical trial gave daily headache data (intensity, frequency, duration of headache) for at least 18 weeks. Concurrently, a sferics measurement station in the vicinity of the patients recorded frequency and intensity of sferics. Usable headache data from 21 patients and the corresponding sferics series were subjected to time series analysis applying ARIMA models and then cross-correlated. We found significant and consistent cross-correlations of moderate size at lag 0 in one patient between ARIMA-filtered headache intensity and frequency ( r = 0.18) and amplitude of sferics ( r = 0.20). We conclude that in an unselected sample of headache patients some may indeed be susceptible to the low intensity type of electromagnetic radiation exemplified by sferics pulses. This phenomenon warrants further scrutiny.
No Involvement of the Calcium Channel Gene (CACNA1A) in a Family with Cluster Headache
Authors: Haan J , van Vliet JA , Kors EE , Terwindt GM , Vermeulen FLMG , van den Maagdenberg AMJM , Frants RR , Ferrari MD
Published: March 2003

It is very likely that genetic factors play a role in the pathophysiology of cluster headache (CH). As CH shares its paroxysmal character with migraine, and migraine has been described in coexistence with CH in some families, we hypothesized that both diseases might share a genetic aetiology. In this study, we tested whether the migraine CACNA1A gene on chromosome 19 is involved in CH in an extended pedigree. Haplotype analysis did not reveal an obvious disease haplotype, and SSCP analysis of all 47 exons of the CACNA1A gene did not reveal a causative mutation. CH in this family is not caused by mutations in the CACNA1A gene.
Occipital Headaches Stemming From the Lateral Atlanto-Axial (C1-2) Joint
Authors: Aprill C , Axinn MJ , Bogduk N
Published: March 2003

Studies in normal volunteers have demonstrated that the lateral atlanto-axial joints (C1-2) are capable of causing pain in the occiput, but few clinical studies have validated this source of occipital headache. The present study tested the null hypothesis that the lateral atlanto-axial joints are not a common source of occipital headache. Patients presenting with occipital pain underwent diagnostic blocks of their lateral atlanto-axial joints if they demonstrated clinical features presumptively suggestive of a C1-2 origin for their pain. Of 34 patients investigated, 21 obtained complete relief of their headache following diagnostic blocks, indicating that a C1-2 source of occipital pain is not rare. The clinical features used to select patients for blocks, however, had a positive predictive value of only 60%. Further study of headaches from C1-2 seems justified in order to establish more definitively the prevalence of this condition and how it might become better recognized in practice.
Characterization of Sumatriptan-Induced Contractions in Human Isolated Blood Vessels Using Selective 5-HT1B and 5-HT1D Receptor Antagonists and In Situ Hybridization
Authors: van den Broek RWM , Bhalla P , MaassenVanDenBrink A , de Vries R , Sharma HS , Saxena PR
Published: March 2003

The 5-HT1B/1D receptor agonist sumatriptan is effective in aborting acute attacks of migraine and is known to cause constriction of cranial arteries as well as some peripheral blood vessels. The present study set out to investigate whether 5-HT1B and/or 5-HT1D receptors mediate contractions of the human isolated middle meningeal and temporal arteries (models for anti-migraine efficacy) and coronary artery and saphenous vein (models for side-effect potential). Concentration-response curves were made with sumatriptan (1 nM-100 μM) in blood vessels in the absence or presence of selective antagonists at 5-HT1B (SB224289) and 5-HT1D (BRL15572) receptors. SB224289 antagonized sumatriptan-induced contractions in all blood vessels, although the antagonism profile was different amongst these blood vessels. In the temporal artery, SB224289 abolished contraction to sumatriptan, whereas in the middle meningeal artery and saphenous vein sumatriptan-induced contractions were blocked in an insurmountable fashion. Moreover, SB224289 acted as a weak surmountable antagonist in the coronary artery (pKB: 6.4 ± 0.2). In contrast, BRL15572 had little or no effect on sumatriptan-induced contractions in the four blood vessels investigated. In situ hybridization revealed the expression of 5-HT1B receptor mRNA in the smooth muscle as well as endothelial cells of the blood vessels, whereas the mRNA for the 5-HT1D receptor was only very weakly expressed. These results show that the 5-HT1B receptor is primarily involved in sumatriptan-induced contractions of human cranial as well as peripheral blood vessels.
Efficacy, Safety and Tolerability of Oral Eletriptan in the Acute Treatment of Migraine: Results of A Phase Iii, Multicentre, Placebo-Controlled Study Across Three Attacks
Authors: Stark R , Dahlöf C , Haughie S , Hettiarachchi J ,   on behalf of the Eletriptan Steering Committee
Published: March 2003

The efficacy, safety and tolerability of the 5-HT1B/1D receptor agonist eletriptan (40 mg and 80 mg) in acute treatment of migraine was evaluated in a multinational, randomized, double-blind, parallel-group, placebo-controlled, three-attack study treating 1153 patients. In the initial attack, significantly more eletriptan patients reported headache relief and complete pain relief at 2 h vs. placebo (40 mg 62% and 32%, 80 mg 65% and 34%, placebo 19% and 3%; P < 0.0001). Headache relief occurred faster after eletriptan, with more patients at both doses reporting relief 30 min ( P < 0.01) and 1 h ( P < 0.0001) after treatment than after placebo. There was a significantly lower recurrence rate with eletriptan 80 mg compared with placebo ( P < 0.01). Adverse events for all treatments were generally mild or moderate and self-limiting. Eletriptan 40 mg and eletriptan 80 mg both appear to be effective and well-tolerated acute migraine treatments.
Neuropeptide Expression in the Human Trigeminal Nucleus Caudalis and in the Cervical Spinal Cord C1 and C2
Authors: Uddman R , Tajti J , Hou M , Sundler F , Edvinsson L
Published: March 2003

In migraine and other primary headaches there is a strong vascular component. Besides the trigeminovascular components some of the associated symptoms point to the involvement of brain stem regions. The central limb of the trigeminal vascular pathway is its projection to the trigeminal nucleus caudalis (TNC) and to the C1-C2 levels of the spinal cord. The aim of the present study was to demonstrate the occurrence of some neurotransmitters in these regions in man. In both the TNC and in the Rexed's laminae I and II of the dorsal horns at the C1 and C2 levels there were numerous substance P immunoreactive fibres. Fibres containing calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide (PACAP) were moderately dense in number. Fibres containing vasoactive intestinal peptide (VIP) or nitric oxide synthase (NOS) were not seen in the TNC or at the C1 and C2 levels of the spinal cord.
Open Label Trial of Coenzyme Q10 as A Migraine Preventive
Authors: Rozen TD , Oshinsky ML , Gebeline CA , Bradley KC , Young WB , Shechter AL , Silberstein SD
Published: March 2003

The objective was to assess the efficacy of coenzyme Q10 as a preventive treatment for migraine headaches. Thirty-two patients (26 women, 6 men) with a history of episodic migraine with or without aura were treated with coenzyme Q10 at a dose of 150 mg per day. Thirty-one of 32 patients completed the study; 61.3% of patients had a greater than 50% reduction in number of days with migraine headache. The average number of days with migraine during the baseline period was 7.34 and this decreased to 2.95 after 3 months of therapy, which was a statistically significant response ( P < 0.0001). Mean reduction in migraine frequency after 1 month of treatment was 13.1% and this increased to 55.3% by the end of 3 months. Mean migraine attack frequency was 4.85 during the baseline period and this decreased to 2.81 attacks by the end of the study period, which was a statistically significant response ( P < 0.001). There were no side-effects noted with coenzyme Q10. From this open label investigation coenzyme Q10 appears to be a good migraine preventive. Placebo-controlled trials are now necessary to determine the true efficacy of coenzyme Q10 in migraine prevention.
A Comparison of Disability and Psychological Factors in Migraine and Transformed Migraine
Authors: Magnusson JE , Becker WJ
Published: March 2003

The classification of patients with migraine who develop chronic daily headache is controversial, with some classifying such patients as ‘transformed migraine’. We compared patients with intermittent migraine attacks and patients with transformed migraine in terms of mean headache intensity on days with headache, depression, pain-related anxiety and headache-related disability. Patients classified clinically as also having tension-type headache were excluded. Aside from the number of days with headache per month, patients with intermittent migraine attacks and patients with transformed migraine were very similar in terms of all parameters studied. Our results support the concept that these two headache groups are closely related.
Blood Pressure Behaviour in Chronic Daily Headache
Authors: Benseñor IJM , Lotufo PA , Mion-Jr D , Martins MA
Published: March 2003

The objective was to examine the association between high blood pressure (BP) and chronic daily headache using 24-h ambulatory blood pressure monitorization (24-h ABPM). This was a cross sectional study in an out-patient clinic. Women were selected among patients referred for first evaluation, 62 with chronic daily headache and 57 without chronic daily headache. The main outcome measures were mean office systolic and diastolic blood pressure (BP), mean systolic and diastolic daytime and night-time BP and BP load, and mean systolic and diastolic nocturnal fall. Office systolic BP was 138.2 mmHg for women with chronic daily headache and 141.7 mmHg for women without headache ( P = 0.36). Office diastolic BP was 88.9 mmHg for women with headache and 92.7 mmHg for women without headache ( P = 0.17). Mean daytime and mean night-time systolic BP was, respectively, 122.2 mmHg and 108.8 mmHg for women with headache and 122.9 mmHg and 109.5 for women without headache ( P = 0.82 and P = 0.80, respectively). Mean daytime and mean night-time diastolic BP was, respectively, 78.6 mmHg and 65.4 mmHg for women with headache and 79.9 mmHg and 67.1 mmHg for the women without headache ( P = 0.80 and P = 0.45, respectively). There was no difference between the two groups regarding systolic and diastolic BP load and nocturnal systolic and diastolic fall. No significant difference in BP values was observed in women with chronic daily headache compared with women without headache using 24-h ABPM.
A Negative Trial of Sodium Valproate in Cluster Headache: Methodological Issues
Authors: Amrani M El , Massiou H , Bousser MG
Published: March 2003

We report the result of a double-blind placebo controlled study of sodium valproate (SV) (1000-2000 mg/day) in the prophylaxis of cluster headache CH. Episodic and chronic CH were defined according to the International Headache Society classification. Ninety- six patients were included, 50 in the SV group and 46 in the placebo group. After a 7-day run-in period, patients were treated for 2 weeks. The primary efficacy criterion was the percentage of patients successfully improved, i.e having an at least 50% reduction in the average number of attacks per week between the run-in period and the last week of treatment. Whatever the type of CH, there was no difference between the two groups: 50% of subjects in the SV group and 62% in the placebo group were successfully improved ( P = 0.23). This high success rate observed in the placebo group, which is likely to be due to the spontaneous remission of the episode, does not allow us to draw any valid conclusion with regard to the true efficacy of SV in the prophylaxis of CH.
A Quantification of the Placebo Response in Migraine Prophylaxis
Authors: van der Kuy P-HM , Lohman JJHM
Published: March 2003

To quantify the placebo response of prophylactic therapy in migraine, a meta-analysis of prophylactic, double-blind, placebo controlled migraine studies was performed. The total analysis included 22 studies testing 19 different products, including 2013 patients, of which 828 were treated with placebo. A reduction in migraine attacks of 50% or more (responders) was seen in 23.5% ± 8.0 (95% C.I. 18.3-28.8%) of the patients in the placebo groups and 45.5% ± 15.5 (95% C.I. 37.4-53.6%) in the active groups. A reduction in migraine attacks of 16.8% ± 12.7 (95% C.I. 10.9-22.6%) was observed in the placebo groups and 41.8% ± 11.7 (95% C.I. 36.9-46.6%) in the active groups. We propose that if the percentage of responders in an open-label prophylactic trial in migraine is above 35-40%, or if a reduction in migraine attack frequency is found of 40% or more, further studies are indicated to determine the prophylactic activity of the drug. In all studies included in this analysis, no placebo response was seen above these limits.
Rizatriptan Combined with Rofecoxib Vs. Rizatriptan for the Acute Treatment of Migraine: an Open Label Pilot Study
Authors: Krymchantowski AV , Barbosa JS
Published: March 2003

Rizatriptan is an effective and fast acting drug for the acute treatment of migraine. As with any other acute treatment for migraine, headache recurrence may occur in up to one-third of responders. Combination with non-steroidal anti-inflammatory drugs (NSAIDs) seems to reduce the incidence of headache recurrence in clinical practice. Rofecoxib is a member of a new class of NSAIDs, which selectively inhibits the COX-2 enzyme and therefore is associated with a lower risk of gastrointestinal side-effects; the drug has a long plasma half-life (17 h). This open label study compared rizatriptan with rizatriptan plus rofecoxib in the acute treatment of migraine. Fifty-six triptan naive patients from a tertiary centre (37 women and 19 men, ages 16-55 years, mean 35 years) with International Headache Society migraine were randomized into two groups. They were instructed to treat three consecutive moderate or severe attacks with either 10 mg rizatriptan (group 1: 18 women and 10 men) or with 10 mg rizatriptan plus 25 mg rofecoxib (group 2: 19 women and 9 men). The presence of headache and nausea at 1, 2 and 4 h, and of side-effects, use of rescue medication and recurrence were compared. Fifty-four patients completed the study. Group 1 treated 76 attacks and group 2 treated 81 attacks. Absence of headache at 1 h was seen in 19 attacks (25%) in group 1 and in 34 attacks (42%) in group 2 ( P = 0.082); at 2 h absence of headache was seen in 60% of group 1 attacks and in 76% of group 2 attacks ( P = 0.115). At 4 h, 75% of group 1 attacks and 88% of group 2 attacks were pain free ( P = 0.122). With regard to nausea, of those who had nausea at baseline, 31% and 49% of attacks in groups 1 and 2, respectively, were nausea free at 1 h ( P = 0.091), 75% and 79% at 2 h ( P = 0.736) and 82% and 91% ( P = 0.479) at 4 h. Recurrence, based on all attacks of those patients who achieved pain free at 4 h, was observed in 53% of group 1 and 20% of group 2 attacks ( P< 0.001). Sustained pain- free rates (for the 4-h time point) were 45.6% of group 1 and 78.9% of group 2 attacks. There were no significant differences with regard to rescue medication consumption after 4 h and side-effects in both groups. There was a non-significant trend for the combination group to have a higher response rate. The group treated with rizatriptan and rofecoxib had a lower recurrence rate than the group treated with rizatriptan. This study demonstrated that combining a fast acting triptan such as rizatriptan with rofecoxib reduced headache recurrence rates, was well tolerated and may be more effective than the use of rizatriptan alone. Double-blind, placebo-controlled studies are necessary to confirm these observations.
An Immunocytochemical Investigation of Human Trigeminal Nucleus Caudalis: Cgrp, Substance P and 5-Ht1D-Receptor Immunoreactivities Are Expressed by Trigeminal Sensory Fibres
Authors: Smith D , Hill RG , Edvinsson L , Longmore J
Published: March 2003

5-HT1D (but not 5-HT1B)-receptor immunoreactivity (i.r.) can be detected on trigeminal fibres within the spinal trigeminal tract of the human brainstem. The present study used immunohistochemical and morphometric techniques to determine the proportions of trigeminal fibres expressing substance P, CGRP or 5-HT1D-receptor immunoreactivities. Co-localization studies between 5-HT1D-receptor and substance P- or CGRP-i.r. were also performed. Brainstem material was obtained with consent (four donors) and the total number of immunoreactive fibres within the trigeminal tract was estimated using random field sampling. A greater proportion of fibres (>1 μm diameter) expressed CGRP-i.r. (80 ± 6%) compared with substance P-i.r. (46 ± 7%) or 5-HT1D-receptor-i.r. (25 ± 1%). 5-HT1D-receptor-i.r. was co-localized on some CGRP- or substance P-i.r. fibres. This suggests that 5-HT1D-receptors can regulate the release of CGRP and substance P and may be relevant to the clinical effectiveness of 5-HT1B/1D-receptor agonists in the treatment of migraine and other cranial pain syndromes.
Determinants of Tension-Type Headache in Children
Authors: Anttila P , Metsähonkala L , Aromaa M , Sourander A , Salminen J , Helenius H , Alanen P , Sillanpää M
Published: March 2003

The objective of this study was to study the prevalence, characteristics and predisposing factors of tension-type headache in children. An unselected population-based questionnaire study was carried out in 1409 Finnish schoolchildren aged 12 years. Of them, 1135 (81%) returned an acceptably completed questionnaire. The prevalence of episodic tension-type headache in children was 12% (138 of 1135). Children with episodic tension-type headache also often reported characteristics of pain typical for migraine. Children with frequent and persistent episodic tension-type headache reported stabbing and severe occipital pain, phonophobia and abdominal pain significantly more often than children with infrequent episodic tension-type headache. Neck-shoulder symptoms, symptoms of depression and oromandibular dysfunction were each independently associated with episodic tension-type headache. The father's occupation of a lower-level white-collar worker put the child at a four-fold risk for episodic tension-type headache. We conclude that episodic tension-type headache is as common as migraine in children. It can be associated with depression, oromandibular dysfunction and muscular stress. Especially children with frequent and persistent episodic tension-type headache report characteristics of pain typical for migraine.
Chronic Daily Headache in A Tertiary Care Population: Correlation Between the International Headache Society Diagnostic Criteria and Proposed Revisions of Criteria for Chronic Daily Headache
Authors: Bigal ME , Sheftell FD , Rapoport AM , Lipton RB , Tepper SJ
Published: March 2003

The International Headache Society (IHS) has been criticized for its approach to classification of chronic daily headache (CDH); Silberstein and Lipton criteria provide an alternative to this approach. The aim of this study is to apply the alternative diagnostic approaches to a sample of CDH patients consulting in specialty care. Our sample consisted of 638 patients with CDH. Patients were classified according to both classification systems. Patients were predominantly female (65.0%), with ages ranging from 11 to 88 years. According to the Silberstein and Lipton classification, we found eight different diagnoses. The most common diagnosis was chronic migraine (87.4%), followed by new daily persistent headache (10.8%). Just six patients had chronic tension- type headache (CTTH). Applying the IHS criteria we found 14 different diagnoses. Migraine was found in 576 (90.2%) patients. CTTH occurred in 621 (97.3%), with only 10 (1.57%) having this as the sole diagnosis. We conclude that both systems allow for the classification of most patients with CDH when daily headache diaries are available. The main difference is that the IHS classification is cumbersome and requires multiple diagnoses. The Silberstein and Lipton system is easier to apply, and more parsimonious. These findings support revision of the IHS classification system to include chronic migraine.
Cervicogenic Headache: Lack of Influence of Pregnancy
Authors: Sjaastad O , Fredriksen TA
Published: March 2003

The influence of pregnancy upon the head pain of cervicogenic headache (CEH) has been studied in 14 patients (number of pregnancies 25). Migraine was used as control group ( n = 49; number of pregnancies 116). CEH was diagnosed according to The Cervicogenic Headache International Study Group guidelines. Migraine was diagnosed according to International Headache Society (IHS) guidelines; a further requirement was that at least eight of nine solitary IHS diagnostic requirements of migraine were present. In 79%—or more—of CEH patients, attacks seemed to appear just as usual during pregnancy; in one patient, attacks stopped completely, and in two there may have been a minor reduction of attacks. A significantly lower number of migraine patients (up to 18%) were more or less uninfluenced by pregnancy (CEH vs. migraine P < 0.0001, X2 test). The lack of response to pregnancy may be a sort of biological marker in CEH. It may also help in clinically distinguishing CEH from migraine when CEH starts early in life, i.e. prior to pregnancies.
Greater Occipital Nerve Blockade for Cluster Headache
Authors: Peres MFP , Stiles MA , Siow HC , Rozen TD , Young WB , Silberstein SD
Published: March 2003

Cluster headache is perhaps the most painful of the primary headache disorders. Its treatment includes acute, transitional, and preventive therapy. Despite the availability of many treatments, cluster headache patients can still be difficult to treat. We treated 14 cluster headache patients with greater occipital nerve block as transitional therapy (treatment initiated at the same time as preventive therapy). The mean number of headache-free days was 13.1+23.6. Four patients (28.5%) had a good response, five (35.7%) a moderate, and five (35.7%) no response. The greater occipital nerve block was well tolerated with no adverse events. Headache intensity, frequency and duration were significantly decreased comparing the week before with the week after the nerve block ( P< 0.003, P = 0.003, P< 0.005, respectively). Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache.
Efficacy and Safety of Acetaminophen and Naproxen in the Treatment of Tension-Type Headache. A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Prior MJ , Cooper KM , May LG , Bowen DL
Published: March 2003

The objective of this study was to evaluate and compare the efficacy and safety of single doses of acetaminophen (paracetamol) 1000 mg and naproxen 375 mg vs. placebo over a six-hour period in the treatment of tension-type headache. The treatments were compared in a randomized, double-blind, multicentre, placebo-controlled study. Efficacy was evaluated using four standard analgesic summary endpoints (the sum of pain intensity differences from baseline, the maximum pain intensity from baseline, the sum of the pain relief scores, and the maximum pain relief score). Both acetaminophen 1000 mg and naproxen 375 mg were significantly superior to placebo ( P ≤ 0.009 and P ≤ 0.021, respectively) but not significantly different from each other ( P ≥ 0.498) for these four endpoints. For example, the mean sum of pain intensity differences from baseline was 9.14 ± 0.34 for acetaminophen 1000 mg and 8.81 ± 0.35 for naproxen 375 mg compared with 7.42 ± 0.34 for placebo. Other efficacy endpoints (percentage of responders (pain reduced to none) at two hours, onset of meaningful relief, time to use of rescue medication and subject's overall impression of study medication) showed similar trends. A significantly larger mean pain intensity difference from baseline was observed for acetaminophen 1000 mg (1.13) than for naproxen 375 mg (0.95) ( P = 0.036) at one hour after treatment. There was no significant difference among the treatment groups in the incidence of adverse events ( P = 0.730). In summary, the results of this well-controlled, double-blind study demonstrate that over-the-counter acetaminophen 1000 mg and prescription naproxen 375 mg are effective and well tolerated in the treatment of tough (moderate-to-severe) tension-type headache.
Naratriptan in the Preventive Treatment of Cluster Headache
Authors: Mulder LJMM , Spierings ELH
Published: March 2003

We describe the preventive use of naratriptan, mostly as add-on to high-dose verapamil treatment, in nine patients with cluster headache. The addition of the naratriptan further improved the headaches in seven of the nine patients.
Hyperbaric Oxygen Treatment of Active Cluster Headache: A Double-Blind Placebo-Controlled Cross-Over Study
Authors: Remahl AIM Nilsson , Ansjön R , Lind F , Waldenlind E
Published: March 2003

Sixteen patients, 12 with episodic and four with chronic cluster headache (CH) according to the International Headache Society criteria (1), participated in the study. They were randomly selected to start with one out of two different hyperbaric treatments in a double-blind, placebo-controlled, cross-over study design. Both gases were administered by mask inside a multiplace hyperbaric chamber for 70 min at 250 kPa (2.5 ATA) in two sessions 24 h apart. Active treatment was 100% oxygen (HBO treatment), while placebo treatment was 10% oxygen in nitrogen (hyperbaric normoxic placebo = sham treatment) corresponding to breathing air at sea level. All patients were decompressed on air. The patients documented the number of headache attacks and their degree of severity according to a modified VAS scale (level 0-4, where level 0 = no headache and level 4 = very severe headache). A headache index (HI = sum of (number of attacks times degree of severity)) was calculated for the run-in week prior to and the week after each separate treatment. A treatment was regarded as effective if it reduced the HI by > 50%. Blood samples were taken from the external jugular vein before and during hyperbaric treatment (after 30 and 70 min), 1 day and 1 week after each treatment for analyses of calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) and in a few patients also endotheline and nitrate. No difference between HBO and sham treatment on the HI or the prophylactic effect was observed in our study. However, 83% of the episodic CH patients and 25% of the chronic ones responded to either of the two treatments with at least 50% reduction of HI or remission for shorter or longer periods. This response rate exceeds an expected high placebo response due to the study procedure. Two episodic CH patients still experienced remission on follow-up 1 year after sham treatment. Five patients reported mild or moderate CH attacks during the sham treatment, and none during the HBO treatment. Changes in neuropeptides, endotheline and nitrate levels did not differ systematically when comparing the two different hyperbaric treatments or with respect to responders and non-responders. We conclude that two HBO sessions were not more effective than two sham treatments in reducing the HI and interrupting the CH period when given in a well-established cluster period or in chronic CH. The hyperbaric condition itself seems effective in reducing the HI, at least in patients with episodic CH, although a powerful placebo response can not be ruled out.
The Paroxysmal Hemicrania-Tic Syndrome
Authors: Boes CJ , Matharu MS , Goadsby PJ
Published: March 2003

Two cases of paroxysmal hemicrania (PH) associated with trigeminal neuralgia are reviewed. The paroxysmal hemicrania component in one patient was episodic, while it was chronic in the other. Each headache type responded completely to separate treatment, highlighting the importance of recognizing this association. We review the six other cases of chronic paroxysmal hemicrania-tic (CPH-tic) reported, and suggest that the term paroxysmal hemicrania-tic syndrome (PH-tic) be used to describe this association.
Central 5-Ht Receptor Hypersensitivity in Migraine Without Aura
Authors: Cassidy EM , Tomkins E , Dinan T , Hardiman O , O'Keane V
Published: March 2003

Serotonin has long been implicated as a key neurotransmitter in migraine. There is a dearth of research specifically examining 5-HT1A receptor sensitivity in migraine despite the importance of this receptor in regulating central serotonergic tone. In this study we examined the hypothesis that migraine without aura is associated with hypersensitivity of central 5-HT1A receptors, using a 5-HT1A neuroendocrine challenge drug and comparing serum prolactin responses between a test group with migraine and a matched group of healthy controls.

Twelve female subjects fulfilling International Headache Society (IHS) criteria for migraine without aura were evaluated. Following an overnight fast, subjects presented for testing at 9am. An intravenous canula was inserted and serum prolactin was assessed at baseline and every 30 min for 3 h following a single dose of 30 mg oral buspirone, a 5-HT1A-receptor agonist. Subjects were assessed during the first 5 days of the menstrual cycle. No subjects were taking psychotropic medication or migraine prophylactic treatment. Patients with current or previous psychiatric disorder, daily headache or analgesic overuse were excluded. 16 healthy female volunteers matched for age and menstrual status were also evaluated and served as controls.

There was no difference in baseline prolactin between groups. There was a significant rise in prolactin following buspirone in both groups. Subjects with migraine had a significantly increased prolactin response to buspirone (delta max) compared to controls ( P < 0.001).

This study supports the hypothesis that migraine without aura is associated with a relative hypersensitivity of central 5-HT1A receptors. This is of relevance given the role of the 5-HT1A receptor in controlling raphe 5-HT tone and in the possible association between migraine and anxiety and depression.
Urinary Nitric Oxide Metabolites and Lipid Peroxidation By-Products in Migraine
Authors: Ciancarelli I , Tozzi-Ciancarelli MG , Massimo C Di , Marini C , Carolei A
Published: March 2003

Enhanced endothelium nitric oxide (NO) and superoxide anion release may cause migraine through related cerebral blood flow changes. Thirty subjects suffering from migraine with and without aura and 20 healthy controls were investigated. Urine samples collected for 24 h during and after the migraine attack, and during the headache-free period, were assayed for urinary NO stable metabolites (NOx) and thiobarbituric acid reactive substances (TBARS). During the headache-free period urinary NOx and TBARS levels were higher in migraine sufferers than in controls (NOx 0.77 ± 0.14 vs. 0.28 ± 0.15 mmol/mmol creatinine, P < 0.05; TBARS 0.40 ± 0.19 vs. 0.26 ± 0.13 μmol/mol creatinine, P < 0.05). Also, NOx excretion was higher during the headache-free period than during or after the migraine attack ( P < 0.05). Urinary TBARS were increased during the attack with respect to the headache-free period ( P < 0.05). No differences were observed in the same parameters between sufferers of migraine with and without aura. Urinary NOx and TBARS might be promising as markers of their systemic levels to evaluate the increased vulnerability to oxidative stress in migraine sufferers.
Trigemino-Cervical Reflex in Patients with Headache
Authors: Milanov I , Bogdanova D
Published: March 2003

Neurophysiological studies have shown abnormal activity of some brainstem nuclei in headache patients. The trigemino-cervical reflex is an anti-nociceptive reflex that gives an opportunity for evaluation of the brainstem interneurone activity. It has not been previously examined in headache patients. We studied 15 patients with predominantly unilateral chronic tension-type headache, 15 patients with migraine without aura and 32 healthy subjects. The trigemino-cervical reflex was recorded bilaterally from the resting sterno-cleidomastoid muscle using surface electromyographic recordings. In all headache patients the trigemino-cervical reflex on the painful side was with shortened latency compared with the non-painful side and with healthy persons. The results suggest decreased activity of the brainstem inhibitory interneurones. We suggest that although the pathophysiological mechanisms of tension-type headache and migraine are different, they share common mechanisms of abnormal pain control.
Epidemiology of Headache in an English District
Authors: Boardman HF , Thomas E , Croft PR , Millson DS
Published: March 2003

Headache prevalence, characteristics and impact in adults were measured using a cross-sectional general population survey in North Staffordshire, UK. A postal survey was mailed out to 4885 adults (aged ≥ 18 years) with an adjusted response rate of 56% ( n = 2662). Of respondents 93% reported headache ever and 70% in the last 3 months. Women and younger people reported higher headache prevalences. Of those reporting headache in the last 3 months, 23% experienced headache at least weekly and 16% experienced severe headache pain. Headaches affected work, home or social activities in 43% of sufferers and 20% reported at least moderate headache-related disability. Higher levels of disability were associated with higher levels of pain, 61% with severe disability reporting severe pain compared with 13% who had mild or moderate disability. In the total adult population sample headache affected more than two-thirds in the last 3 months and 14% of all adults reported headache-related disability of at least moderate level, which translates to a large burden in the general population.
Aspirin in Episodic Tension-Type Headache: Placebo-Controlled Dose-Ranging Comparison with Paracetamol
Authors: Steiner TJ , Lange R , Voelker M
Published: March 2003

Most people with episodic tension-type headache (TTH) treat themselves with over-the-counter analgesics. In the absence of clear evidence of dose-related efficacy of the two most commonly used analgesics, aspirin (acetylsalicylic acid) and paracetamol (acetaminophen), this study compared two doses of each with placebo. In a double-blind, double-dummy, randomized parallel-groups comparative trial, 638 consenting subjects aged 16-65 years with episodic TTH (but not migraine) by IHS criteria were recruited from the UK general population by advertisement. They treated one episode of moderate or severe TTH with a single dose of 500 or 1000 mg aspirin, 500 or 1000 mg paracetamol or placebo. The primary objective was to compare aspirin 1000 mg with placebo, and the primary end-point was subjective pain relief (total or worthwhile) 2 h after treatment ('response'). Additionally, pain intensity on a 100-mm visual analogue scale and functional impairment were monitored regularly for 4 h and at 24 h, although rescue medication was allowed after 2 h. The analysis was of the intention-to-treat population of 542 who took treatment (all providing outcome data). Treatment groups were matched at baseline. Aspirin 1000 mg (75.7% response rate; P = 0.0009) and to a lesser extent aspirin 500 mg (70.3%; P = 0.011) and paracetamol 1000 mg (71.2%; P = 0.007), but not paracetamol 500 mg (63.8%; P = 0.104), were statistically more effective than placebo despite a high placebo-response rate (54.5%). Outcome was not affected by headache intensity at baseline. Secondary end-points including functional recovery (by median times of 4.0-13.5 h) were consistent with these findings, although a minority of subjects recorded long-duration functional impairment (37-54 h). Adverse events reported by 13.4-18.9% of subjects were mild or moderate, and transient. No safety concerns arose.
Hypnic Headache Syndrome: Association of the Attacks with Rem Sleep
Authors: Pinessi L , Rainero I , Cicolin A , Zibetti M , Gentile S , Mutani R
Published: March 2003

We describe the polysomnographic data of two patients with nocturnal headache attacks fulfilling the clinical criteria for hypnic headache syndrome. Two overnight polysomnographic studies were performed in each patient. Four nocturnal headache attacks were captured, all emerging from the REM phase of sleep. Our findings suggest a close relationship between the REM phase of sleep and the appearance of hypnic headache attacks.
Extracephalic Jabs/Idiopathic Stabs. VÅGÅ Study of Headache Epidemiology
Authors: Sjaastad O , Pettersen H , Bakketeig LS
Published: March 2003

Ultrashort cephalic paroxysms are well known. In the parish of Vågå, Norway, 35.2% of the 18-65-year-old subjects ( n = 1779) were recently found to have such jabs. In the present work, a search has been made for extracephalic ‘jabs’. A questionnaire was in its entirety administered by the same investigator (O.S.) in a ‘semistructured’ way. Facial jabs were present in three women, and in one of them the pain spread to the head. Four subjects had jabs occurring at random throughout the body, also including the cephalic area. Pure nuchal jabs were present in 12 subjects, 10 of whom were males. This sex preponderance difference differs significantly from that in jabs in general (with 40.2% males). The characteristics of the extracephalic jabs, i.e. the duration and temporal pattern, do not seem to differentiate them essentially from jabs in general. The subjects were not asked specific questions regarding extracranial jabs. Most of the affected individuals gave information spontaneously about their jabs. For these reasons, this study is not a proper prevalence study. It does show, however, that extracranial jabs exist, and it gives some indications as to their frequency.
Caring for people with learning disability: a survey of general practitioners' attitudes in Southampton and South‐west Hampshire
Authors: Stein Ken
Published: March 2003

The aim of the present paper was to examine general practitioners' (GPs') beliefs about: the demands made on the primary care team by people with learning disability; their confidence in meeting health care needs and perceived training requirements; attitudes towards specialist or generic health service provision, and current contact with specialist teams; and attitudes towards screening in people with learning disability. A postal questionnaire was sent to a randomly selected partner from 95% of the practices in the Southampton and South‐west Hampshire Health District. Forty‐eight (75%) GPs responded and few were undecided about the demands placed on primary care teams, but beliefs were mixed. Most GPs were confident in dealing with the medical care needs of people with learning disability and the majority felt that training courses would not be worthwhile, except to learn more about specialist services where contact was very low and a ‘link worker’ scheme had had little apparent impact. Most respondents agreed that GPs should meet the medical needs of people with learning disability as part of general medical services and approximately half had a positive attitude towards providing regular health checks. Respondents were cautious about offering cervical cancer screening to women with learning disability. A small minority suggested that they would take no action to follow up a non‐attendance for mammography. As a heterogeneous population, it is not surprising that GPs' attitudes vary widely. Further research is required to establish the nature and scale of demands made on primary health care teams, and to evaluate systematic means of addressing health care needs of people with learning disability.
Interviewing witnesses with learning disabilities for legal purposes
Authors: Milne Rebecca , Bull Ray
Published: March 2003

The present paper gives an overview of the research literature examining how best to obtain the maximum quality and quantity of information from people with learning disabilities (LDs) in a non‐biasing manner. First, the authors outline the research concerning the memory performance of people with LDs and then they go on to describe the specific strategies which have been recommended for use with this group. The relative merits of different types of questions are examined. It is argued that the main difficulty in interviewing people with LDs concerns errors of omission and that research should find ways to enhance recall, especially since detail is the currency of both the criminal and civil justice systems. One such method that has been found to gain greater recall is the cognitive interview. The paper finishes by briefly describing this technique and its efficacy for use with vulnerable groups.
Motivating learning disabled offenders with alcohol‐related problems: a pilot study
Authors: Mendel Elizabeth , Hipkins Jane
Published: March 2003

The present study aimed to apply motivational interviewing techniques in assisting clients with learning disabilities through the Stages of Change (Prochaska & Diclemente 1986). Motivational interviewing and the stages of change model have been effectively applied to alcohol problems. However, this approach has not been applied to people with learning disabilities. Particularly within a forensic service, there is a need to develop group treatments for people with alcohol‐related offences as current alcohol education programmes do not necessarily lead to changes in attitudes and behaviour. This involved interactive teaching methods adapted for people with mild learning disabilities. The group met for 1 h over three sessions and staff training was provided. A variety of measures (pre and post group) demonstrated increases in clients' motivation, self‐efficacy and determination to change their drinking behaviour. Recommendations were made to develop the group further.
Using music to develop peer interaction: an examination of the response of two subjects with a learning disability
Authors: Hooper Jeff
Published: March 2003

The paper examines the response of two subjects who attended a programme of music activity therapy in which the music activities encouraged peer interaction. Music activity therapy was compared with a control condition (i.e. ball and target games). Both treatment conditions increased the level of positive interaction. The absence of negative interaction was also significant. The results affirmed the value of nonverbal interventions in encouraging interaction, and offered insights into the relationship between the two subjects.
Discussing the menopause with women with learning disabilities
Authors: McCarthy Michelle , Millard Lorraine
Published: March 2003

Traditionally, little attention has been paid to the menopause as it affects women with learning disabilities. Consequently, older women with learning disabilities have rarely been adequately prepared for, or supported through, what for most women is a significant ‘change of life’. None of the existing literature focuses on the women's perspectives, but rather, looks at menopause from a medical angle, in particular focusing on the timing of onset. The research study described in the present paper is an attempt to gain some insights into the ways in which women with learning disabilities perceive the menopause. The main informants were women with learning disabilities themselves, but also general practitioners, staff in learning disability services and parents who still cared for their middle‐aged daughters at home. The research project also involved the non‐disabled researchers working alongside two groups of women with learning disabilities, who acted as advisors and consultants to the project, and who were paid for their time.