bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Efficacy of Calcium Antagonist Drugs in the Prophylaxis of Migraine
Authors: Solomon Glen D.
Published: June 2005

SYNOPSIS

Since 1981, numerous studies have shown the efficacy of calcium antagonist drugs in the prophylaxis of migraine. Five different agents: flunarizine, nimodipine, verapamil, nifedipine, and diltiazem, have been evaluated. This paper reviews these studies with regard to reduction in migraine frequency, percentage of patients showing improvement, percentage of patients showing 50% or greater improvement, and adverse reactions.

These studies show that these five calcium channel blockers are effective in migraine prophylaxis. Comparison of data suggest no major differences between the five agents reviewed with regard to efficacy. Furthermore, adverse reactions were divided between vascular and gastrointestinal with the “systemically active” drugs, and behavioral and muscular with the “cerebro‐specific” drugs. Lastly, most trials show a therapeutic delay of 3 to 8 weeks with the calcium channel blockers.
Ranitidine Headache
Authors: Epstein Charles M. , Klopper Jeffrey
Published: June 2005

SYNOPSIS

Five patients developed severe headaches in close association with the use of ranitidine. Two required hospitalization and three had recurrence of headaches on rechallenge. One had exacerbation of classic migraine. Headaches varied from intermittent and throbbing to steady and continuous, and onset was 12 hours to several months after beginning treatment; but all patients improved dramatically within 48 hours after ranitidine was discontinued. The great variability of ranitidine headache has important clinical and theoretical implications.
Prolactin and Migraine: Effect of L‐Dopa on Plasma Prolactin Levels in Migraineurs and Normals
Authors: Nattero G. , Corno M. , Savi L. , Isaia G.C. , Priolo C. , Mussetta M.
Published: June 2005

SYNOPSIS

Since in migraineurs a change in dopaminergic tone has been hypothesized and since in man prolactin secretionby the lactotroph cells is controlled by hypothalamic inhibitory factors (of which dopamine is the best known), wedecided to investigate plasma prolactin (PRL) response to L‐Dopa in a group of migraineurs.We tested 5 women suffering from common migraine and 5 healthy women as controls.A different behaviour of PRL secretion was observed in the two groups. In migraineurs the inhibition of PRLsecretion was less marked than in normals, with a statistically significant difference at 30 and 60 minutes.This difference might suggest a reduced responsiveness of the pituitary lactotroph cells to the action ofdopaminergic agents. The mechanisms accounting for this peculiar behaviour of PRL secretion in migraineurs arestill to be elucidated.
A Hidden Dimension in Headache Work: Applied History of Medicine
Authors: Isler Hansruedi
Published: June 2005

SYNOPSIS

Studies of forgotten non‐English and Latin texts often show that new discoveries are not quite new.Are these studies futile, or do they make sense? Some examples of missing references, found byapplied history of medicine, may provide an answer.
Transient Focal Headaches with Persistent Ipsilateral EEG Disturbances
Authors: Goldenberg E. , Arlazoroff A. , Tauber T. , Varsano D.
Published: June 2005

SYNOPSIS

Two children with severe transient focal headaches are presented. Complete relief was obtained aftercyproheptadine treatment. A characteristic feature of these cases was focal persistent irritative EEGdisturbances. All the other diagnostic examinations were normal. The possibilities of migraine alone, or ofheadache as an equivalent of epileptic fit, are discussed separately with a review of the relevant literature.Finally, the probability of an underlying autonomic epileptic phenomenon causing a classic migraineattack is raised.
Hereditary Dysrhythmic Headache
Authors: Shimomura Tokio , Nishikawa Seihou , Takahashi Kazuro
Published: June 2005

SYNOPSIS

Fifteen families including 35 patients with chronic headache showing electroencephalographic (EEG)abnormalities and dysautonomia are reported on. Nine families including 18 patients with chronicheadache, without EEG abnormalities, served as controls. In the patients with EEG abnormalities, sixpatients (17.1%) suffered from common migraine, 28 (80.0%) from muscle contraction headache and one(2.9%) from combined headache. All the patients had 6‐7Hz EEG abnormalities such as 6‐7Hz slow waves,6‐7HZ spike & wave complexes and 6‐7Hz positive spikes. Most of the patients (77.1%) manifesteddysautonomic symptoms. These symptoms were observed in only 16.7 per cent of the patients with afamily history of headache, without EEG abnormalities. In chronic headache patients, it is suggested thatthere is a group with hereditary dysrhythmic headache characterized by dysautonomia.
Psychopathology in Volunteers for Headache Research: Initial versus Later Respondents
Authors: McAnulty David P , Rappaport Neil B. , Waggoner Craig D. , Brantley Phillip J. , Barkemeyer Charles , McKenzie Sandra J.
Published: June 2005

SYNOPSIS

The present study examined psychopathology in 64 volunteers for an on‐going headache research project.Subjects (19 to 58 years old) who responded immediately to newspaper articles requesting volunteersdiffered in levels of psychopathology from those who responded later. It was further noted that thedifferences observed occurred on those MMPI scales found to discriminate among headache diagnosticgroups (Scales 2, 7, and 8). Recommendations for future research are made in light of these findings.
Migraine Warnings
Authors: Amery Willem K. , Waelkens Jan , Vandenbergh Vic
Published: June 2005

SYNOPSIS

The early prodromal phase of a migraine attack, poorly documented yet conceivably relevant to the pathogenesisof the attack, was studied in 149 patients, mainly female, with classic or common migraine who were aware ofthese prodromal phenomena. On a questionnaire a variety of prodromes, nearly all well reproduceable, werereported. Day‐before and day‐of‐attack symptoms were noticed by 79% and 88% of the patients, respectively. Inthe other 12–21% signs were mainly observed by the partner. Some prodromes invoked the “cause orconsequence?” question as to certain trigger factors. Others bore rather striking similarities to the classic aura, sothat evolutive symptoms seemed to merge with the early part of the migraine attack. The incidence, or at least theawareness of prodromes was correlated with the occurrence of some factors aggravating the headache and withpost‐attack symptoms, was higher in women, in patients with long‐standing disease and frequent attacks, inpatients who had other types of headaches as well, and in classic migraine sufferers.
Visual Evoked Potentials in Cluster Headache: Central Structures Involvement
Authors: Boiardi A. , Carenini L. , Frediani F. , Porta E. , Sinatra M.G. , Bussone G.
Published: June 2005

SYNOPSISThe typical lateralization of pain and autonomic dysfunction in Cluster Headache has prompted severalresearches, seeking a pathogenetic interpretation of this syndrome, considering this peculiar clinical aspect.In this study, we evaluated VEPs responses in 20 CH subjects, 10 with right‐sided pain and 10 with left‐sided pain,comparing them with 20 VEPs responses in normal subjects. VEPs morphologies and latencies did not differ fromnormal controls. On the other hand, P100 amplitudes are significantly lower than controls, on the pain side only.This asymmetry of the response is constant and exceeds normal variation. These data suggest a centralinvolvement in CH pathogenesis. The possible mechanisms of this involvement are discussed.
Emergency Treatment of Intractable Migraine
Authors: Gallagher R. Michael
Published: June 2005

SYNOPSIS

The treatment of refractory or prolonged migraine is a difficult problem for the physician and patient. Treatment varieswith physician and location, but widely accepted is therapy with an injectable analgesic in combination with asedative/antimetic and/or ergotamine.Since prolonged migraine headache is said to be associated with cranial vascular inflammation, the addition ofcorticosteroids to treatment may enhance relief. An analysis was conducted of 162 patients who were treated with andwithout steroids for intractable migraine headache in the emergency department of a large community hospital.Patients were divided into three groups. Group I consisted of 73 patients treated with meperidine and promethazine;Group II, 32 patients treated with dihydroergotamine and meperidine; Group III, 57 patients treated with meperidine,promethazine and dexamethasone. All patients were telephoned 24 hours after treatment to determine the degree ofheadache relief. Twenty‐one patients (29%) from Group I; 12 patients (37%) from Group II; and 41 patients (72%) fromGroup III reported marked relief.From this limited study, it appears that the inclusion of dexamethasone in the treatment of intractable migraineheadache is of benefit.
Flunarizine versus Pizotifen: A Double‐Blind Study in the Prophylaxis of Migraine
Authors: Rascol A. , Montastruc J.L. , Rascol O.
Published: June 2005

SYNOPSISThe calcium entry blocker flunarizine was compared with an antiserotonin agent, pizotifen, in the prophylaxis ofmigraine. Thirty‐five patients were treated under double‐blind conditions for four months. The number of migraineattacks gradually declined in both groups with an eventual mean reduction of 65% and 45% in the flunarizine andpizotifen groups respectively. The efficacy of the former drug developed somewhat faster but no statisticallysignificant differences between the groups were found. Weight gain was the main side effect in both groups. Otherside effects were rare.It is concluded that flunarizine is a useful alternative for the prophylactic treatment of migraine.
Amelioration of Ophthalmoplegic Migraine by Prednisone: A Case Report
Authors: Smith Charles D. , Reeves Alexander G.
Published: June 2005

SYNOPSIS

A 42‐year‐old patient with a 40‐year history of paroxysmal headache associated with recurrent rightabducens palsy was treated with prednisone for three days following headache onset. Initiation ofprednisone within four hours of headache onset resulted in decreased severity and duration of theheadache and prevention or marked amelioration of the ophthalmoparesis. Therapy delayed beyondeighteen hours had a much less dramatic effect.
Thomas Willis', Two Chapters on Headache of 1672: A First Attempt to Apply the “New Science” to this Topic
Authors: Isler Hansruedi
Published: June 2005

SYNOPSISM

To most physicians, Thomas Willis (1621–1675) is only known for the Circle of Willis, but he achievedmuch more: he was one of the three great clinicians of 17th‐century England, and the founder of modernbrain anatomy and clinical neurology. He coined the word “neurology,” discovered reflex action, and wrotethe first textbook of clinical neurology. He made use of an imaginary neurophysiological framework whichenabled him to anticipate numerous discoveries of the 19th century.The first two chapters of the clinical part of his textbook deal with headache. Wolff's hypothesis,“complete migraine,rdquo; the slow spreading of focal symptoms, the cerebral origin of vomiting, and clusterperiodicity are found to be anticipated, at least in part. The combination of hypothetical pathophysiologyand arbitrary nosology is quite suggestive of the present situation, although the system is different.The review is based on the original Latin text of 1672.
Dexamethasone Suppression Test in Cluster Headache
Authors: Devoize Jean‐Louis , Rigal François , Eschalier Alain , Zarifian E. , Tournilhac Michel
Published: June 2005

SYNOPSIS

The dexamethasone suppression test was performed on eleven patients with cluster headache. Interest in such investigation of the hypothalamo‐pituitary‐adrenal axis in cluster headache arose from both a certain analogy with manic‐depressive disorders and recent data on abnormal patterns of cortisol secretion in cluster headache. Investigation results were normal in all patients, showing that the hypothalamo‐pituitary‐adrenal dysfunction reported in depressions is not a biological feature of cluster headache.
Calcitonin and Migraine
Authors: Patti Francesco , Scapagnini Umberto , Nicoletti Francesco , Prato Agata , Millia Claudio , Clementi Giuseppe
Published: June 2005

SYNOPSIS

A group of 30 patients (12 M ‐ 18 F) suffering from migraine underwent salmon calcitonin therapy for a period of one month. All patients were treated at first for 30 days with vehicle administration in a daily i.m. injection, as a control. Calcitonin effectiveness was evaluated in terms of changes in frequency, intensity and duration of the migraine attacks. The results show a significant difference between the observation period (vehicle only) and treatment phase, with improvement during the calcitonin treatment.
Bilateral Sympathetic Dysfunction in Post‐Traumatic Headaches
Authors: Khurana Ramesh K. , Nirankari Varinder S.
Published: June 2005

SYNOPSIS

Two patients developed generalized throbbing headaches, tenderness of the anterior neck and unilateral ptosis following whiplash injury. They were systematically evaluated for involvement of the central nervous system, carotid arteries, vagi and cervical sympathetic nerves. Biochemical study of pupils revealed bilateral postganglionic Horner's syndrome. Thermal‐induced facial sweating showed supraorbital anhidrosis. Follow‐up 18 to 54 months after injury demonstrated partial improvement in pupillary functions and headaches but persistent supraorbital anhidrosis. Pertinent literature on sympathetic dysfunction and post‐traumatic headaches is reviewed, and the reasons and implications for sympathetic involvement in hyperextension‐hyperflexion injury are discussed.
Basilar Artery Migraine: EEG and Evoked Potential Patterns During Acute Stage
Authors: Ganji S.
Published: June 2005

SYNOPSIS

Electroencephalographic and evoked potential studies were done during the ictal phase of migraine in a 22‐year‐old woman with basilar artery migraine. Prominent posterior slowing was seen in the EEG pattern during the symptomatic period. Clinical improvement coincided with the reversal of abnormality in the EEG tracing. The findings from the multimodality evoked potentials were within normal limits.
Duration of Postural Headache After Lumbar Puncture: Effect of Needle Size
Authors: Kovanen Jussi , Sulkava Raimo
Published: June 2005

SYNOPSIS

The effect of needle size on postural headache after diagnostic lumbar puncture was studied in 300 patients at the Outpatient Department of Neurology, University of Helsinki. In three groups of 100 patients a needle size of 0.9mm (20 gauge), 0.7mm (22 gauge) and 0.6mm (23 gauge) were used, respectively. The total number of days with incapacitating postural headache in the groups diminished significantly with the decreasing needle size from 282 through 181 to 76 days. An analysis of CT scans performed in 95 patients showed that the incidence of post‐lumbar puncture headache significantly decreased with brain atrophy seen on CT independently of the needle size. The results suggest that the thinnest needle (0.6mm) usable without special techniques should be chosen for diagnostic lumbar punctures at outpatient departments.
Sublingual Flunarizine: a New Effective Management of the Migraine Attack. A Comparison versus Ergotamine
Authors: Bonuso Salvatore , Stasio Emanuela Di , Marano Enrico , Sorge Fulvio , Leo Alfonso
Published: June 2005

SYNOPSIS

Flunarizine was found to be effective in the acute treatment of isosorbide dinitrate induced migraine attacks, when given in a dosage of 10 mg sublingually.

The present study consists of two parts: in the first preliminary investigation, 7 out of 8 migraine patients who developed a typical migraine attack after isosorbide dinitrate were relieved of pain within about 10 minutes. On the basis of this result a second, randomized controlled open trial was performed, in which the acute efficacy of flunarizine was compared with ergotamine tartrate, 0.25 mg i.m., on 40 migraine patients. Flunarizine was found as effective as ergotamine (75% positive responses in the flunarizine group, 70% in the ergotamine group). The mean latency of the flunarizine effect was significantly lower than that of the ergotamine ( r < 0.001, Student's t test). Moreover sublingual flunarizine was found to be virtually devoid of side effects.
Glucose and Diet in the Fasting Migraineur
Authors: Marsters J.B. , Mortimer M.J. , Hay K.M.
Published: June 2005

SYNOPSIS

In migraine, are there different metabolic responses to glucose ingestion, and if so, do the patients have different detectable characteristics which may be of use to determine their treatment?

Thirty two volunteer migraineurs, for whom fasting was a known precipitant, were challenged with a glucose meal after an overnight fast. Symptoms and glucose levels were recorded at intervals over three hours. Examination of the changes in symptoms, elicited two groups with opposite responses, which were also significantly different with respect to circulating glucose levels. Furthermore, sub‐groups defined by dietary precipitants as expressed by the migraineur, were also found to be significantly different in both of these parameters.

A treatment plan, for this type of migraine attack, based on the the dietary factors which may provoke its evolution and the response to glucose, is discussed.
Post‐Traumatic Headache Patients II: Special Problems, Perceptions, and Service Needs
Authors: Barnat Michael R.
Published: June 2005

SYNOPSIS

Much of the research literature on the psychology of chronic headache focuses on the obsessionalism and/or general neuroticism of the sufferers. More recently, some work has shifted the focus to other aspects of the clinical picture, e.g., what, in the aggregate, headache patients want out of treatment, and how they view treatment and their own disorders.

As an extension of this recent line of inquiry, the present study was designed to provide data on post‐traumatic headache patients, their “special problems, perceptions and service needs.” The respondents, described in a previous report: “Post‐traumatic headache patients I: Demographics, injuries, headache and health status,” were new and return patients in a headache treatment center. In the course of a twelve month period, the opinions of one hundred seventeen patients were sampled.

The present report describes the following areas: patients' perceptions of their general progress toward recovery, sources of health care information relevant to their condition, patients' adequacy of communication about their condition, service needs, concurrent sources of care, areas of functional improvement, present life adjustment, and anticipations of the future.
A Wellness Program in the Treatment of Headache
Authors: Simons Alan , Solbach Patricia , Sargent Joseph , Malone Leslie
Published: June 2005

SYNOPSIS

The development of a wellness program for the treatment of headache at the Headache Center of theMenninger Foundation progressed through a series of steps based on research and clinical experience. Initialfeedback from participants suggested that some positive changes were started because of the program butthat the program did not help maintain such changes.Wellness is defined and is described in its possible applications to the treatment of headache. Traditionalbarriers to the clinical employment of such applications are also described. A survey of the literature exploresthose barriers and possible reasons why such barriers need no longer interfere with employing a wellnessprogram in supplementing existing treatment.Recommendations are given based on the survey of literature and clinical experience.
Tension Headaches: Relation Between MMPI Paranoïa Score and Pain and Between MMPI Hypochondriasis Score and Frontalis EMG
Authors: Collet L. , Cottraux J. , Juenet C.
Published: June 2005

SYNOPSIS

The relation between MMPI, frontal EMG and pain is examined in 25 subjects with tension headaches. Our results point to an association between high levels of weekly pain and high paranoïa scores (p < .01) but fail to confirm previous reports on the correlation of pain with hypochondriasis, depression and hysteria. This finding is discussed in terms of a reciprocal pain/personality relation. The results also show that the only correlation to be found for frontal EMG is that with hypochondriasis MMPI scores (p < .01).
Autonomic Dysfunction in Adult Migraineurs
Authors: Havanka‐Kanniainen H. , Tolonen U. , Myllylä V.V.
Published: June 2005

SYNOPSIS

The autonomic nervous system (ANS) functions of 60 migraine patients, aged from 23 to 50 years, wereinvestigated during headache‐free intervals by utilizing a number of cardiovascular reflexes as indices.Thirty‐five healthy subjects of similar age served as a control group. The pulse rate (R‐R‐interval) variationwas recorded in normal and deep breathing, in the Valsalva manoeuvre, and in an orthostatic test (a tilttable was used); and the blood pressure reactions were recorded in an orthostatic test and in an isometricwork (hand grip) test.There were significant differences in the results between migraine patients and control subjects in theR‐R‐interval variation ratio, both in normal and deep breathing tests and in the Valsalva manoeuvre. Thedifferences between migraine patients and controls in pulse rate variation in orthostatic test and in bloodpressure reactions in isometric work test were highly significant (p < 0.001 ). There were no statisticallysignificant differences in cardiovascular reflex responses of various subgroups of migraine patients(common‐classic, frequent‐infrequent attacks, normal‐abnormal EEGs). These results suggest mildparasympathetic hypo function, but more definite sympathetic hypofunction (Valsalva manoeuvre,orthostatic test and isometric work test) in adult migraine patients during headache‐free intervals.
The Non‐epileptiform Basilar Artery Migraine
Authors: Jacome Daniel E. , Risko Marlyn
Published: June 2005

SYNOPSIS

Five patients with basilar artery migraine (BAM) are described. One, while exhibiting electroencephalographic(EEG) interictal discharges and photo‐paroxysmal responses entirely suppressed by carbamazepine orvalproate, had no improvement of her attacks. Subsequent therapy with propanolol did improve the attacksdespite persistence of EEG abnormalities. A second patient had paroxysmal abnormalities and improved withisometheptene mucate. Three other patients had normal ictal and interictal EEGs, including after activationprocedures. A population of patients with basilar artery migraine exists with normal EEG recordings or withparoxysmal activity independent from that of migraine; these patients may respond to drugs other thananticonvulsants.
Pattern‐Shift Visual Evoked Responses and EEG in Migraine
Authors: Polich John , Ehlers Cindy L. , Dalessio Donald J.
Published: June 2005

SYNOPSIS

Visual evoked responses (VERs) and spectral analysis of background EEG were obtained from 20migraine patients and their age‐matched controls. Full‐ and half‐field reversing checkerboardstimulus presentations elicited no substantial differences between the subject groups for any of themajor component (N75, P100, N145) latencies or amplitudes. No VER differences were found forpatient subcategories based on side of headache, symptom history, or age. However, migrainepatients demonstrated slight but significantly higher mean frequency in their background EEG in the4–8 Hz frequencies in leads C 3 ‐P 3 and C 4 ‐P 4 , and a lower mean frequency in the 8–12 Hz band inleads F 3 ‐C 3 and F 4 ‐C 3 relative to controls. The results are discussed and compared to previousstudies of visual evoked potentials and EEG in migraine patients.
Leukotriene B4 Generation by Polymorphonuclear Leukocytes: Possible Involvement in the Pathogenesis of Headache
Authors: Selmaj K. , De Belleroche J. , Das I. , Rose F. Clifford
Published: June 2005

SYNOPSIS

Leukotriene B4 (LTB4) levels in plasma and its generation in vitro from isolated polymorphonuclearleukocytes (PMN) were measured in migraine and cluster headache patients during and between painattacks. The LTB4plasma levels in cluster headache patients during an attack were significantly higherthan in patients between attacks. There was a positive correlation between the time of sampling from thebeginning of attack and the LTB4level. The LTB4 plasma levels in migraine patients during and betweenattacks did not differ significantly from control levels. The results suggest that LTB4appears rapidly in thecirculation at the beginning of a cluster attack and thereafter declines in amount. LTB4release from PMNwas induced by stimulation with the calcium ionophore A23187. The release of LTB4was significantlyhigher in migraine patients during attacks on stimulation with a submaximal dose of A23187 0.5 μM. LTB4 release induced by A23187 in migraine patients during symptom‐free intervals and cluster headachepatients did not differ from healthy controls. LTB4 release was not affected by 5HT and NA inconcentrations up to 10‐4M. The results suggest that LTB4is more easily generated in migraine patientsduring attacks. These studies on isolated cells provide a suitable model for the investigation of themetabolism of lipoxygenase derivates in headache patients.
Familial Hemiplegic Migraine: A New Case
Authors: Bergouignan Francois‐Xavier , Ferrer Xavier , Julien Jean
Published: June 2005

SYNOPSIS

The definition of familial hemiplegic migraine is still unsettled. We report the case of a young man who has had hemiplegic migraine attacks for ten years. CT of the brain was abnormal with a low density in the temporal lobe, suggesting infarction and probably having no relation to the attacks. There was a clear family history of hemiplegic migraine, possibly with the same type of attack. Ergotamine tartrate seemed to be effective in preventing headache. This case challenges the current clinical definition of familial hemiplegic migraine, in that while the attack pattern was hereditary, the hemiplegia occurred as an aura rather than accompanying and outlasting the headache.
The Time Relationships of Migraine and Cluster Headache When Occurring in the Same Patient
Authors: Solomon Seymour , Cappa Karen Guglielmo
Published: June 2005

SYNOPSIS

Of 1,688 patients with migraine or cluster headache, 16 (one percent) had a history of both. In 14 of the 16 patients, migraine occurred first and was either replaced by cluster headache (7 patients) or continued during the years of cluster headache (7 patients). In one patient, migraine and cluster headache began at the same time and in one patient, cluster headache preceded migraine. A review of the literature reveals a similar sequence of migraine almost always preceding cluster headache when the two occur in the same patient.

The relationships between migraine and cluster headache are discussed. In rare instances, cluster headache appears to evolve from migraine.
Idiopathic Headaches: Relationship to Life Events
Authors: Nattero G. , Lorenzo C. De , Biale L. , Torrie E. , Ancona M.
Published: June 2005

SYNOPSIS

228 patients were interviewed using Paykel's list. The aim of this study was to detect possible differences among vascular, tension and tension‐vascular headaches with special attention to stressing events preceding the onset of headache.

The statistical analysis of the results showed significant differences among the groups studied for the weight of life events in the 10 years prior to the onset of headache. Minor differences emerged for the year immediately prior to the headache onset. Particular differences were also observed in the distribution of life events with the aid of qualitative analysis.

Worthy of notice is the fact that the migraineurs tested resuIted to be less damaged by stress than the other patients.
Basilar Artery Migraine After Uncomplicated Whiplash Injuries
Authors: Jacome Daniel E.
Published: June 2005

SYNOPSIS

Four female patients with basilar artery migraine (BAM) developing after isolated whiplash neck injuries, uncomplicated by spinal fractures, luxations or by intracranial lesions, are described. BAM constitutes a subtype of posttraumatic migraine headaches, occurring in the absence of direct head trauma, and moderately and variably ameliorated with common anti‐migraine medications and physical therapy directed to the injured neck.
Defect of Serotonin Binding to Mononuclear Cells from Episodic Cluster Headache Patients
Authors: Martelletti P. , Alteri E. , Pesce A. , Rinaldi‐Garaci C. , Giacovazzo M.
Published: June 2005

SYNOPSIS

Methysergide is the drug of choice for the prophylaxis of the crises in Episodic Cluster Headache (ECH). Thissubstance is a partial antagonist of both serotonin and histamine. Nevertheless, the classical anti‐histamine drugsdo not have any therapeutic effect in this disease. The etiological role of serotonin has never been taken intoconsideration, because the plasma levels of this mediator have never been found increased. This is not surprising,since serotonin is rapidly degraded in the circulation or immediately bound by circulating platelets. Therefore, apossible role of serotonin cannot be excluded. Serotonin is capable of modulating in vitro the motility of humanmonocytes. Our previous studies showed an increase in the number of circulating monocytes in ECH. Therefore,we examined the in vitro interactions between circulating cells from ECH patients and serotonin.21 ECH patients were studied, in and out of the crisis period. 5 adults were used as normal controls. Circulatingmononuclear cells were tested for their ability to specifically bind 5‐HT, using ( 3 H) labeled 5‐HT.Normal human mononuclear cells bind serotonin in a saturable and specific fashion, and most of this binding isthrough a high affinity site (Kd = 100nM). Conversely, cells from ECH patients lack this high affinity binding siteand only display binding through the low affinity site. The lack of this high affinity binding can be demonstrated inthe patients during the crisis as well as out of it.A possible explanation for the loss of this high affinity binding site could be that the cells of the patients havebeen previously exposed in vivo to high concentrations of serotonin, probably generated during the crisis period.
Scalp Tenderness and Sensitivity to Pain in Migraine and Tension Headache
Authors: Drummond Peter D. , Drummond Peter D.
Published: June 2005

SYNOPSIS

Pressure‐pain threshold was assessed in the forehead, temples, occiput and neck of 102 patients with migraine or tension headache, and in 35 nonheadache control subjects of similar age and sex distribution. Pain sensitivity to the application of a weighted blade to the fingers was also assessed. Tenderness was greater in patients than in controls, particularly at the site of migraine or tension headache, and to a lesser extent in other areas of the scalp. Scalp tenderness persisted for several days after headache had subsided. The threshold for pain in the fingers was greater during headache than during the headache‐free interval but did not differ from pain threshold in control subjects. Pain in the fingers increased more rapidly in patients with episodically‐recurring tension headaches than in other patient categories or control subjects. These findings demonstrate that scalp tenderness is not due to a general increase in sensitivity to pain during migraine. In contrast, diffuse disruption of central pain modulating systems may be involved in the pathophysiology of episodically‐recurring tension headaches.
Benign Recurrent Transient Monocular Blindness: A Possible Variant of Acephalgic Migraine
Authors: Tomsak Robert L. , Jergens Paul B.
Published: June 2005

SYNOPSIS

Twenty‐four patients with benign recurrent transient monocular blindness of possible migrainous etiology are presented. The visual loss was predominantly one‐sided and stereotyped in character. Postural change or exercise was a provocative factor in half the cases. Other neurologic symptoms were not present and only one patient developed permanent visual loss during an attack. Evaluation by CT scanning, angiography, echocardiography, and ophthalmodynamometry, when performed, was uniformly normal.
Timolol Maleate, A Beta Blocker, In the Treatment of Common Migraine Headache
Authors: Gallagher R. Michael , Stagliano Robert A. , Sporazza Carl
Published: June 2005

SYNOPSIS

Timolol maleate, a beta blocker, has been shown to reduce the frequency of common migraine headache in clinical trials. An analysis of 116 patients treated prophylactically for common migraine with timolol maleate 10–30 mg. per day was conducted. There were 35 males and 81 females ranging in age from 19 to 61 years; they experienced 3 to 8 headaches per month. After 6 months 11 patients (9%) showed > 75% improvement, 47 patients (41%) showed 50–74% improvement, 31 patients (27%) showed 25–49% improvement, 23 patients (20%) showed <25% improvement, and 4 patients (3%) discontinued because of side effects. This limited study suggests that timolol maleate may be of benefit in the treatment of some migraine patients.
Geomagnetic Activity and the Severity of the Migraine Attack
Authors: Kuritzky A. , Zoldan Y. , Hering R. , Stoupel E.
Published: June 2005

SYNOPSIS

Thirty patients suffering from either classical or common migraine recorded the dates of their headaches and their severity. A total of 486 attacks in fourteen months were recorded. Daily Geomagnetic activity (GMA) was obtained and graded to four levels of activity. No correlation was found between the frequency of the migraine attacks and the degree of GMA. The severity of the headache however was linearly correlated with the level of GMA, increasing from 25.9% of severe headaches in days with quiet GMA to 43.75% of severe headaches in days with stormy GMA.
Unmasking Latent Dysnociception in Healthy Subjects
Authors: Sicuteri Federigo , Del Bene Enrico , Poggioni Marco , Bonazzi Antonio
Published: June 2005

SYNOPSIS

Headache is the most common side effect of nitroglycerin, administered for angina pectoris. Two phases can be distinguished in nitroglycerin‐induced headache: the first phase (immediate headache), a mild sensation of temporal pulsating pain, can be due, at least in part, to the vasodilation provoked by nitroglycerin; the second phase (delayed headache), an increasing pain, possibly with nausea and vomiting, lasting even for a number of hours, is independent from the vasomotility, since it arises and persists when all vasomotor and metabolic nitroglycerin‐induced changes are over. The present investigation demonstrates that healthy subjects, neither suffering from idiopathic headache nor with a family headache history, never complain of delayed headache after nitroglycerin; healthy subjects not suffering from headache but who have one or both parents suffering from migraine, exhibit the delayed long‐lasting headache in 28.6% of cases; finally, 66.7% of their migrainous parents complain of the delayed long‐lasting headache after nitroglycerin. The following conclusions can be drawn: nitroglycerin‐induced delayed headache 1) is not a true side effect of nitroglycerin, since it is never present in healthy subjects; 2) is peculiar to migraine sufferers: or 3) is an index of migraine predisposition, as it may be present in healthy subjects, but only if they have one or two migrainous parents. The features of nitroglycerin‐induced delayed headache suggest an analogy with the phenomenon of overreaction, a painful and exaggerated response (in latency, intensity and duration) to a stimulus, that is the most typical aspect of central pain. In nitroglycerin‐induced delayed headache, which shows close similarities to the spontaneous attack of migraine, the trigger stimulus could be the moderate immediate headache which is probably correlated with the vasodilation provoked by nitroglycerin.
Trigger Factors in Migraine: a Study Conducted by the Belgian Migraine Society
Authors: Bergh Vic Van den , Amery Willem K. , Waelkens Jan
Published: June 2005

SYNOPSIS

Information on trigger factors provoking a migraine attack, was collected in 217 migraineurs (176 women, 41 men). In this selected group of patients, most patients were spontaneously aware of one or more trigger factors; 184 (85%) of the patients reported trigger factors with a median number of 3 different trigger factors. The main trigger factors were menstruation (48%) or ovulation (8.5%) in women, certain food (44.7%), alcoholic beverages (51.6%) and stress 148.8%). After excluding the menstrual cycle as a trigger factor, trigger factors were more frequent in women, in older patients and in patients with a longer duration of disease. Women with a menstrual cycle‐related migraine reported more trigger factors, other than the menstrual cycle itself, than women in whom the menstrual cycle had no influence on this migraine: this was especially so for food and beverages. The number and type of trigger factors in the women in whom the migraine was not menstrual cycle‐related, were fully comparable with those in men. Patients in whom alcohol acts as a trigger factor had also significantly more other trigger factors, especially food. The same holds true for patients reporting stress as a trigger factor, but the latter difference is not significant when the different subgroups of trigger factors (food, beverages, other)are considered. Certain trigger factors may be mutually related.
Sustained Headache Syndrome Associated with Tender Occipital Nerve Zones
Authors: Saadah Hanna A. , Taylor Fletcher B.
Published: June 2005

SYNOPSIS

A sustained headache syndrome can develop from headaches of diverse etiologies. Over seven years,112 patients with such a syndrome received 188 sets of injections in the occipital nerve regions andtwo‐thirds had prolonged relief. In such headaches, interrupting the pain cycle with occipital injectionscontaining 1% lidocaine plus betamethasone may be a useful adjunct to other preventive and abortivemedical therapies.
Identification of Blood Leukotrienes in Classical Migraine
Authors: Gazzaniga P. P. , Ferroni R , Lenti L. , Lombardi D. , Mina C. , Pulcinelli F.M. , Rizzo P.A. , Pontieri G. M.
Published: June 2005

SYNOPSIS

In five patients affected by classical migraine a longitudinal study was performed, dealing with the in vitro parameters of platelet aggregation, during prodromal, attack, post‐attack and interval phases. These patterns were compared with the analysis of blood leukotrienes, carried out by use of analytical reversed phase HPLC. Presence of leukotriene C4 (LTC4) during prodromal and attack phases, corresponded to a transient inhibition of epinephrine‐induced aggregation. Recovery towards normal or increased values of platelet aggregation occurred during both post‐attack and interval phases, which were accompanied by the presence in blood of 5–12 di‐hydroxyeicosatetraenoic acid (5–12 DHETE) and/or leukotriene B4 (LTB4) respectively, and by their subsequent metabolic breakdown products. Hypotheses on the role of leukotrienes in the pathogenesis of migraine are discussed.
Further Examination of Headache in a College Student Population
Authors: Attanasio Virginia , Andrasik Frank
Published: June 2005

SYNOPSIS

The purpose of the present study was two‐fold. The first was to examine further the prevalence of headache in a college sample. The second was to evaluate the test/re‐test reliability of the questionnaire measure of prevalence and its concurrent validity (by comparing information collected on it to like measures collected by systematic, daily headache diary records). Headache was found to be a widespread phenomenon that was affecting at least 45% of all students once per week, and 35–45% of the students experienced headache severe enough to disrupt planned activities. Headaches experienced by females tended to be more frequent, more intense, and of longer duration. Individual questionnaire items overall evidenced high test/re‐test reliability over 1, 4, and 8 weeks, although responses to inquiries about location and nature of headache pain were varied. However, questionnaire estimates of frequency, duration, and intensity showed little correspondence to data obtained from diary records. In general, questionnaire measures appear to underestimate frequency and duration, while overestimating intensity, when compared to actual recordings of headache activity. Thus, when used in isolation, global questionnaire measures of headache do not appear to provide accurate information about the occurrence of the problem.
Coexistent Internal Ophthalmoplegia and Cluster Headache
Authors: Turkewitz L. Jay , Batti James A.
Published: June 2005

SYNOPSIS

We present a patient with insulin dependent diabetes who developed severe retroorbital pain and subsequent internal ophthalmoplegia. Resolution unveiled typical cluster headache. We suspect this previously unreported coexistence of cluster headache with a diabetic third nerve palsy was a chance occurrence. The possibility of combined sympathetic and parasympathetic pupillomotor dysfunction was considered. The diagnosis of cluster headache was delayed by the masking coexistent clinical features of the oculomotor palsy.
A Short‐term Trial of an Analogue of Eel‐calcitonin in Headache
Authors: Patti Francesco , Scapagnini Umberto , Nicoletti Francesco , Prato Agatina , Rapisarda Epifanio , Guarcello Vincenzo , Clementi Giuseppe
Published: June 2005

SYNOPSIS

We investigated the therapeutic efficacy of short‐term (Asu1,7 )eel‐calcitonin treatment in subjects affected by headache. All 47 patients were initially treated for 20 days intramuscularly with vehicle alone (basal values). Subsequently, they received for another 10 days a daily injection of (Asu1,7 )eel calcitonin (40 I.U. per day i.m.). The effectiveness of the treatment was evaluated in terms of changes in frequency, intensity and duration of the migraine attacks, and pain intensity and duration of daily chronic headache. The levels of plasma calcitonin, before, during and at the end of the therapy were evaluated. The clinical results show a significant difference between the observation period (vehicle alone) and the treatment phase with a significant improvement due to (Asu1,7 )eel‐calcitonin treatment. In 32 patients plasma calcitonin levels were significantly modified after five days of treatment. Plasma calcium values showed no significant change.
Investigation of Some Biological Trait Markers in Migraine: Deuterated Tyramine Challenge Test, Monoamine Oxidase, Phenolsulfotransferase and Plasma and Urinary Biogenic Amine and Acid Metabolite Levels
Authors: Davis B.A. , Dawson B. , Boulton A.A. , Yu P.H. , Durden D.A.
Published: June 2005

SYNOPSIS

A search for biological “trait” markers in migraine patients was undertaken. Migraine and control subjects were challenged with an oral dose of deuterated r ‐tyramine. Deuterium‐labelled conjugated and unconjugated r ‐tyramine and r ‐hydroxyphenylacetic acid in 24 hour urine samples, as well as several endogenous biogenic amines and their acidic metabolites in blood and urine, were identified and quantitated by mass spectrometry with selected ion monitoring. In contrast to earlier reports, urinary conjugated r ‐tyramine was not significantly reduced in migraine. Platelet monoamine oxidase (with r ‐tyramine as substrate) and phenolsulfotransferase (with phenol as substrate) activities were significantly reduced. Plasma unconjugated vanilmandelic acid and conjugated phenylacetic acid and urinary unconjugated 3‐methoxy‐4‐hydroxyphenylethylene glycol were significantly elevated in migraine. These parameters would not, however, be suitable as biological markers because the differences compared to controls did not attain a sufficiently high level of statistical significance.
A Comparison of Naproxen Sodium, Acetaminophen and Placebo in the Treatment of Muscle Contraction Headache
Authors: Miller Daniel S. , Talbot Cheryl A. , Simpson William , Korey Andrew
Published: June 2005

SYNOPSIS

The purpose of the present study was to compare the efficacy and safety of naproxen sodium (550 mg), acetaminophen (650 mg) and placebo in the treatment of muscle‐contraction, or tension headache.

Six investigators participated in this randomized, double‐blind, 3‐way parallel study, in which 149 patients were entered. Each patient treated one episode of moderate‐to‐severe headache with the test medication. The intensity of the headache pain was recorded on 10 cm visual analogue scales (VASs) by patients for up to 12 hours after treatment with the study medication. In addition, the degree of pain relief (PR) was recorded in a similar manner. Mean pain intensities (Pls), percentage changes in mean pain intensities, pain intensity differences (PIDs) and the sum of these differences (SPIDs) were calculated.

From the data collected in 124 patients eligible for efficacy analysis, naproxen sodium was shown to provide a significantly greater percentage change in mean PI compared to acetaminophen (p<0.01) or placebo (p<0.001). Mean PID and SPID scores also showed naproxen sodium to be significantly more effective in relieving pain compared to acetaminophen (p<0.02) or placebo (p<0.001). Mean pain relief scores and calculated total pain relief (TOTPAR) scores correlated well with the reduction in pain intensity. During the trial 13 patients reported side effects including nausea, dizziness and drowsiness. None of the side effects were considered clinically significant.

The results from this study demonstrated naproxen sodium to be a well tolerated analgesic, which provided statistically significantly superior analgesia compared to acetaminophen or placebo in the treatment of muscle‐contraction or tension headaches.
Radiographic Pathology of the Temporomandibular Joints, and Head Pain
Authors: Tilds Barry N. , Miller Peter R.
Published: June 2005

SYNOPSIS

The rationale for the use of many diagnostic tests in head pain patients must be questioned, since most studies include only symptomatic individuals. In previous works by the authors, it has been documented that x‐ray techniques to view osseous structures, other than high resolution computerized tomography (CT), are likely to be inadequate.1 CT was found to be a valuable aid in the detection of bony abnormalities in patients with post‐traumatic head pain. 2 There is no doubt that the detection of fractures and other osseous defects with this technique provided an accurate diagnosis as to the cause of pain and enabled successful treatment planning with these trauma patients. Most non‐trauma head pain patients complain of similar types of pains, but upon evaluation of their CT findings, no correlation could be made between the duration, intensity or frequency of the pain and the structural damage found, if in fact any pathology was visualized on the CT scans.

After reviewing numerous publications concerning head pain related to temporomandibular joint (TMJ) problems, and clinically evaluating many patients who had undergone various x‐ray procedures as diagnostic modalities for the pain, it was decided to compare a group of pain free subjects and patients who were treated for head and/or facial pain that was proven to be unrelated to TMJ problems, with a group of subjects confirmed to have non‐traumatic induced TMJ symptoms.

Our subjects in this pain free study group exhibited pathology equal to or greater than those patients suffering with pain from the TMJ. Upon analysis of our data, we feel that we can state that CT findings of pathology within the TMJ, not associated with trauma, can in no way quantitate or qualitate any relation to pain.
Ergotamine Dependency‐ a Review
Authors: Saper Joel R.
Published: June 2005

SYNOPSIS

Ergotamine tartrate has been recognized as the drug of first choice for the treatment of acute attacks of migraine. This paper draws attention to a common but poorly delineated state of addiction that can develop when ergotamine tartrate usage exceeds two or three days per week. This syndrome is characterized by a self‐sustaining, rhythmic headache/medication cycle, with daily or almost daily migraine headaches and the irresistible and predictable use of ergotamine tartrate as the only means of alleviating the headache attacks. This report further delineates the clinical features, criteria for recognition, and treatment alternatives for this syndrome. In order to avoid this condition, usage should be restricted to 2 days per week.