bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Blockade of Greater Occipital and Supraorbital Nerves in Migraine Patients
Authors: Caputi Claudio A. , Firetto Vincenzo
Published: March 2003

A disturbance in the region of the head can provoke pain in the distribution of the trigeminal and upper cervical nerves due to a convergence of the afferent fibers of the three superior cervical roots on the neurones of the spiral nucleus of the trigeminal nerve. The therapeutic value of greater occipital and supraorbital nerve blockade in 27 patients with migraine, unresponsive to several combinations of pharmacological treatments, was investigated. Patients were given repeated anesthetic blocks, on alternate days, up to a maximum of 10 blocks. Perineural injections of 0.5 to 1.0 mL of 0.5% bupivacaine were given at the epicranial emergence points of the above nerves in relation to the distribution of the cephalic pain only if such nerves were conspicuously pain sensitive to pressure. Clinical evaluation was determined by a monthly Total Pain Index and recording of the number of migraine attacks and analgesic consumption each month. A patient was considered responsive when the Total Pain Index decreased by 50% or more in the first month after treatment. Twenty‐three patients (85%) responded beneficially and maintained a favorable response for the 6‐month period of observation. The treatment was considered to be of long‐lasting effectiveness and without any side effects. Four patients (15%) were unresponsive to treatment.

We hypothesize that the anesthetic blocks extinguished presumed foci of nociceptor discharges maintained by perivascular neurogenic inflammation, thereby reestablishing normal central neurone sensitivity.

In conclusion, blockade of the supraorbital and greater occipital nerves appears to be effective in the treatment of migraine; however, controlled studies are needed to confirm these preliminary findings.
Visual Evoked Potentials and Serum Magnesium Levels in Juvenile Migraine Patients
Authors: Aloisi Paolo , Marrelli Alfonso , Porto Claudio , Tozzi Elisabetta , Cerone Giuseppa
Published: March 2003

Changes in visual evoked potentials and decreased intracellular magnesium levels have been separately described in patients affected by migraine both during the attacks and in the interictal periods. An inverse correlation between increased P100 amplitude and lowered serum magnesium levels was found in children suffering from migraine with and without aura in a headache‐free period. A 20‐day treatment with oral magnesium pidolate seemed to normalize the magnesium balance in 90% of patients. After treatment, the reduced P100 amplitude confirmed the inverse correlation with the serum magnesium level. These data seem to suggest the hypothesis that higher visual evoked potential amplitude and low brain magnesium level can both be an expression of neuronal hyperexcitability of the visual pathways related to a lowered threshold for migraine attacks.
Study of Pressure Pain and Cellular Concentration of Neurotransmitters Related to Nociception in Episodic Tension‐Type Headache Patients
Authors: Mazzotta Giovanni , Sarchielli Paola , Gaggioli Alessandro , Gallai Virgilio
Published: March 2003

The pressure pain threshold of 30 patients affected by tension‐type headache was assessed and the values compared with those of a group of 30 age‐matched control subjects. In the patient group, pressure pain threshold values were related to the blood cell concentration of some neurotransmitters which are considered to be involved in the genesis and modulation of pain (β‐endorphin levels in peripheral blood mono‐nuclear cells [PBMCs], substance P and serotonin concentrations in platelets). The pressure pain thrashold was significantly lower in tension‐type headache patients than in control subjects (P<0.0006). Significantly lower levels of B‐endorphins‐in PBMCs and substance P in platelets, as well as significantly higher levels of serotonin in platelets were found in tension, type headache patients compared to the control subjects (P<0.0001). A significant positive correlation was found between pressure pain threshold values and b b‐endorphin levels in both control and patient groups (P<0.0001). On the contrary, a statistically significant negative correlation was evident between pressure pain threshold values and substance P levels in platelets in both patients and control subjects (P<0.01 and P<0.001, respectively). In both groups, there was a negative correlation between b b‐endorphins in PBMCs and substance P in platelets (patientsP<0.02, controls P<0.001 ).

The findings of altered β‐endorphin levels in blood mono‐nuclear cells and substance P levels in platelets could be the peripheral biochemical reflection of the low pressure paid threshold values in tension‐type headache patients, and support the hypothesis of an impairment of the antinociceptive systems in this form of headache.
Neurotology of Migraine
Authors: Baloh Robert W.
Published: March 2003

Neurotologic symptoms are common with migraine, yet relatively little is known about the pathophysiology of such symptoms. Motion sensitivity with bouts of motion sickness occurs in about two thirds of patients with migraine. Episodes of vertigo occur in about one fourth of patients and, in some, vertigo is the only symptom (so‐called “migraine equivalent”). Phonophobia is the most common auditory symptom, but fluctuating hearing loss and acute permanent hearing loss occur in a small Percentage. Migraine can mimic Meniere's disease and so‐called “vestibular Meniere's disease” is usually associated with migraine. The recent discovery of a mutation in a brain calcium‐channel gene in families with hemiplegic migraine and in families with episodic vertigo and ataxia suggests a possible mechanism for neurotologic symptoms in patients with more common varieties of migraine. A defective calcium channel, primarily expressed in the brain and inner ear, could lead to reversible hair cell depolarization and auditory and vestibular symptoms. This hypothesis is currently being investigated in other families with migraine headaches and neurotologic symptoms. Hopefully, such studies will lead to improved diagnosis and better treatments in the future.
Hypoalgesic Effect of Caffeine in Experimental Ischemic Muscle Contraction Pain
Authors: Myers Daniel E. , Shaikh Zakir , Zullo Thomas G.
Published: March 2003

It has been theorized that adenosine is a leading candidate for the metabolite responsible for ischemic muscle pain. The purpose of this study was to determine the effect of the non‐selective adenosine receptor antagonist, caffeine, on ischemic skeletal muscle contraction pain. Seven healthy adult volunteers with no history of pain disorders, systemic disease, or habitual caffeine use, were chosen for the two‐session, cross‐over, double‐blind study. Every subject received either 200 mg of caffeine (NoDoz ® , Bristol‐Myers) or identical placebo I hour before each of the two trials. Ischemia of the forearm was achieved by inflation of a blood pressure cuff to 250 mm Hg. Forearm muscle activity was generated by performance of wrist curls using a 5‐gram bar at a rate of 40 cycles per minute. Pain was rated at 15‐second intervals for I minute using a visual analog scale (0 to 10) with verbal descriptors. Significance was determined by univariate and multivariate analyses of variance and covariance including repeated measures. Pain ratings at 15 seconds in the caffeine trial were significantly lower (P<0.02) than those in the placebo trial. This effect continued at 30 seconds (P<0.05). However, by 45 seconds, pain in the caffeine trial was not significantly lower (P= ‐ 0.4) than that in the placebo trial. These results show that high‐dose caffeine exhibits considerable analgesic efficacy in experimental muscle pain, adding support for a role of adenosine in producing ischemic muscle contraction pain.
Crossover Comparison of Rizatriptan 5 mg and 10 mg Versus Sumatriptan 25 mg and 50 mg in Migraine
Authors: Goldstein Jerome , Ryan Robert , Jiang Kaihong , Getson Albert , Norman Barbara , Block Gilbert A. , Lines Christopher ,   Rizatriptan Protocol 046 Study Group
Published: March 2003

Rizatriptan is a selective 5‐HT1B/1D receptor agonist with rapid oral absorption and early onset of action in the acute treatment of migraine. This double‐blind, placebo‐controlled, crossover study compared rizatriptan 5 mg versus sumatriptan 25 mg, and rizatriptan 10 mg versus sumatriptan 50 mg. A total of 1329 patients were allocated to one of five groups for treatment of two attacks: rizatriptan 5 mg/sumatriptan 25 mg; sumatriptan 25 mg/rizatriptan 5 mg; rizatriptan 10 mg/sumatriptan 50 mg; sumatriptan 50 mg/rizatriptan 10 mg; placebo/placebo. For each attack, patients rated headache severity, presence of associated symptoms, and functional disability prior to dosing and at intervals through 4 hours thereafter. Patients also rated their satisfaction with medication. Rizatriptan 5 mg and 10 mg provided faster relief of headache pain and greater relief of migraine symptoms than the 25‐mg and 50‐mg doses of sumatriptan, respectively. The response to rizatriptan was better than sumatriptan on additional measures including functional disability and satisfaction with medication. All active treatments were highly effective compared to placebo and acted as early as 30 minutes after dosing. All active treatments were well‐tolerated and showed comparable safety profiles.
Musculoskeletal Abnormalities in Chronic Headache: A Controlled Comparison of Headache Diagnostic Groups
Authors: Marcus Dawn A. , Scharff Lisa , Mercer Susan , Turk Dennis C.
Published: March 2003

The presence of postural, myofascial, and mechanical abnormalities in patients with migraine, tension‐type headache, or both headache diagnoses was compared to a headache‐free control sample. Twenty‐four control subjects were obtained from a convenience sampling and each was matched by age and sex to three patients with headache (one with migraine [with or without aura], one with tension‐type headache, and one with diagnoses of both migraine and tension‐type headache [combined diagnosis]) who had been previously assessed by a physical therapist at a headache clinic. Physical therapy assessment findings were compared among the four groups.

There was a significant difference in the presence of postural abnormalities between the controls and the patients, with posture abnormalities more likely to be present in those with headache. The patients were also significantly more likely to have active trigger points and trigger points in the neck than were the control subjects. There were no significant group differences identified in the mechanical measures, nor were there any significant differences among the three headache categories. Determination of the clinical significance of these musculoskeletal abnormalities in patients with headache will require the development and testing of further standardized assessments as well as physical therapy treatment programs.
Headache After Resection of Acoustic Neuroma
Authors: Mosek Amnon C. , Dodick David W. , Ebersold Michael J. , Swanson Jerry W.
Published: March 2003

Long‐lasting severe headaches are reported to occur in up to 83% of patients who have undergone resection of acoustic neuroma, especially through a suboccipital approach. These headaches, however, are not well defined. The objective of this study was to assess the frequency and character of new‐onset headaches after resection of acoustic neuroma by a suboccipital approach with cranioplasty. Review of the medical record was followed by a telephone interview with 48 patients (67% female; mean age, 52 years) who had undergone resection of an acoustic neuroma through a suboccipital craniotomy during the 2 years before the study. Of the 48 patients, 58% had post‐operative head pain that lasted more than 7 days and could be categorized into two types. A moderate to severe, short‐term head pain with gradual resolution occurred in 35% of the patients, and a mild, unremitting pain was reported by 23%. Both types of pain had a dull ache or pressure quality and were adjacent to or confined to the incisional area. Overall, 77% of the patients were pain‐free within 4 months after operation. Age, sex, tumor size, or preoperative history of headache did not influence development of the postoperative pain.

We found that new‐onset headache after resection of acoustic neuroma by a suboccipital approach with cranioplasty is much less common than previously reported and is best described as mild incisional pain rather than a severe headache. The literature regarding headaches after different surgica1 approaches for acoustic neuroma resection is reviewed, and possible explanations for development of the pain are discussed.
The Prevalence and Characteristics of Migraine in Twins From the General Population
Authors: Ulrich Vibeke , Gervil Morten , Fenger Kirsten , Olesen Jes , Russell Michael B.
Published: March 2003

We examined whether prevalence, age at onset, and cessation of migraine without aura and migraine with aura are different among twins and singletons.

The study population was recruited from the population‐based New Danish Twin Register and comprised 2026 monozygotic and 3334 same‐sex dizygotic twins born during 1953 to 1960. A simple questionnaire was used to screen for migraine. Twin pairs with at least one twin with possible migraine were interviewed by telephone by two physicians. A total of 1136 twin pairs were included in the telephone interviews. The criteria of the International Headache Society were used for diagnosis.

The questionnaire response rate was 87%, and the telephone interview participation rate was 90%. Of the 715 migraineurs, 498 had migraine without aura, 264 had migraine with aura, and 47 had both migraine with and without aura. The lifetime prevalence, age at onset, and cessation of migraine with and without aura did not differ in monozygotic and dizygotic twins. Males and females had a lifetime prevalence of migraine without aura of 7% and 19%, respectively. The female preponderance of migraine without aura was first apparent after aged 14 years; this may be related to an influence of female hormones. The lifetime prevalence of migraine with aura was 7% in males and 8% in females. The observed and expected number of those with both migraine with and without aura was not significantly different, suggesting that migraine without aura and migraine with aura are distinct types of migraine. Males with migraine without aura had a significantly lower mean age at onset than females with migraine without aura (16.5 years versus 21.5 years), while males and females with migraine with aura had similar ages at onset (20.8 years versus 21.8 years). About 20% of the twins had ceased having attacks of migraine with or without aura. More males than females with onset of migraine without aura before aged 15 years had ceased having attacks.

The prevalence of migraine without aura and migraine with aura in twins was similar to the prevalence in the general population. Being a twin did not affect age at onset or cessation of migraine. Previous observations on differences of migraine without aura and migraine with aura regarding gender was confirmed.
Supraorbital Neuralgia. On the Clinical Manifestations and a Possible Therapeutic Approach
Authors: Sjaastad O. , Stolt‐Nielsen A. , Pareja J.A. , Fredriksen T.A. , Vincent M.
Published: March 2003

The clinical manifestations of supraorbital neuralgia are apparently only incompletely known. The lack of awareness of this head pain may possibly be due to its rarity and problems with making the diagnosis. In the present work, the long‐term result of minor, decompressive surgery of the supraorbital nerve in five patients is reported. The immediate improvement was good and, after a mean observation time of more than 6 years, an improvement of 50% to 100% was observed (mean, circa 85%). In the two patients with the longest postoperative observation time, approximately 8 years, pain has not recurred.

The pain was severe, leading to suicidal thoughts in several patients. The long‐term course was intermittent or continuous. The pain was generally unilateral, but was bilateral in one patient. Generally, there was lack of, or only minor benefit from drug treatment, including carbamazepine and indomethacin. There was clearly tenderness over the supraorbital nerve, especially at its outlet, and in some subjects occasionally, a slight local loss of sensation. Definite trigger zones were not present. Supraorbital nerve blockade generally provided instant and considerable pain relief. The persistence of protracted unilateral forehead/ocular pain, tenderness over the nerve, and repeated blockade effect strongly suggests the diagnosis.
Migrainous Stroke Causing Bilateral Anterior Cerebral Artery Territory Infarction
Authors: Demirkaya Seref , Odabasi Zeki , Gokcil Zeki , Ozdag Fatih , Kutukcu Yasar , Vural Okay
Published: March 2003

A 38‐year‐old man developed bilateral anterior cerebral artery territory infarction during the course of a migraine. Magnetic resonance imaging showed bilateral ischemic lesions involving the cortex of the paramedian region of the frontal and parietal lobes, more prominent on the right. Cerebral angiography was normal. To our knowledge, this is the first report of bilateral anterior cerebral artery territory infarction from migraine.
Changing Pattern of Headache Pointing to Cerebral Venous Thrombosis After Lumbar Puncture and Intravenous High‐Dose Corticosteroids
Authors: Aidi Saadia , Chaunu Marie‐Pierre , Biousse Valérie , Bousser Marie‐Germaine
Published: March 2003

Objective.—To emphasize the diagnostic importance of change in the headache pattern which pointed to cerebral venous thrombosis in two patients after lumbar puncture and high‐dose intravenous methylprednisolone for suspected multiple sclerosis.

Results.—Both patients had a diagnostic lumbar puncture for suspected multiple sclerosis and were treated with high‐dose intravenous methylprednisolone. Both developed a postlumbar puncture headache that was initially postural, typical of low cerebrospinal fluid pressure. Three days later, the headache became constant, lost its postural component, and was associated with bilateral papilledema. Magnetic resonance imaging of the brain disclosed superior sagittal and lateral sinuses thrombosis. The diagnostic difficulties of such cases and the potential role of lumbar puncture and corticosteroids as risk factors for cerebral venous thrombosis are discussed.

Conclusions.—When a typical postdural puncture headache loses its postural component, investigations should be performed to rule out cerebral venous thrombosis, particularly in the presence of other risk factors.
Cardiovascular Responses to Pain and Stress in Migraine
Authors: Hassinger Hilary J. , Semenchuk Elizabeth M. , O'Brien William H.
Published: March 2003

Objective.—The purpose of this study was to investigate how migrainous subjects and controls differ in their cardiovascular reactivity and recovery to a cognitive and an acute pain laboratory stressor.

Background.—Prior research suggests that individuals subject to migraine may respond physiologically to pain and stress differently than controls.

Methods.—Fifty‐two women (26 with migraine and 26 controls) participated in a single laboratory session. Multiple cardiovascular responses to a cognitive (mental arithmetic) and an acute pain (cold pressor task) stressor were recorded with cardiac impedance methods. The cardiovascular responses measured included systolic and diastolic blood pressure, heart rate, cardiac output, stroke volume, and total peripheral resistance.

Results.—Results indicated that the migrainous participants displayed different cardiovascular recovery patterns for total peripheral resistance, cardiac output, and stroke volume following the termination of the mental arithmetic task.

Conclusions.—These results support the hypothesis that individuals with migraine respond physiologically to stress differently than control individuals.
Improvement of Tension‐Type Headache When Treating Wrinkles With Botulinum Toxin A Injections
Authors: Carruthers Alastair , Langtry James A. A. , Carruthers Jean , Robinson Gordon
Published: March 2003

Botulinum toxin A has been used to treat a spectrum of neuromuscular diseases. In recent years, it has become an accepted treatment for dynamic facial wrinkles. Following treatment of glabella and forehead wrinkles with botulinum toxin A, 9 of 134 patients coincidentally reported improvement of tension‐type headache. We have retrospectively studied this group of patients in whom improvement of facial wrinkles closely paralleled improvement of tension‐type headache. This observation suggests a role for muscle action in tension‐type headache and a novel treatment.
Psychosocial Correlates and Impact of Chronic Tension‐type Headaches
Authors: Holroyd Kenneth A. , Stensland Michael , Lipchik Gay L. , Hill Kimberly R. , O'Donnell Francis S. , Cordingley Gary
Published: March 2003

Objectives.– To examine the psychosocial correlates of chronic tension‐type headache and the impact of chronic tension‐type headache on work, social functioning, and well‐being.

Methods.– Two hundred forty‐five patients (mean age = 37.0 years) with chronic tension‐type headache as a primary presenting problem completed an assessment protocol as part of a larger treatment outcome study. The assessment included a structured diagnostic interview, the Medical Outcomes Study Short Form, Disability Days/Impairment Ratings, Recurrent Illness Impact Profile, Beck Depression Inventory, State‐Trait Anxiety Inventory—Trait Form, Primary Care Evaluation for Mental Disorders, and the Hassles Scale Short Form. Comparisons were made with matched controls (N = 89) and, secondarily, with Medical Outcomes Study data for the general population, arthritis, and back problem samples.

Results.– About two thirds of those with chronic tension‐type headache recorded daily or near daily (25 days per month) headaches with few (12%) recording headaches on less than 20 days per month. Despite the fact that patients reported that their headaches had occurred at approximately the present frequency for an average of 7 years, chronic tension‐type headache sufferers were largely lapsed consulters (54% of subjects) or current consulters in primary care (81% of consulters).

Significant impairments in functioning and well‐being were evident in chronic tension‐type headache and were captured by each of the assessment devices. Although headache‐related disability days were reported by 74% of patients (mean = 7 days in previous 6 months), work or social functioning was severely impaired in only a small minority of patients. Sleep, energy level, and emotional well‐being were frequently impaired with about one third of patients recording impairments in these areas on 10 or more days per month. Most patients with chronic tension‐type headache continued to carry out daily life responsibilities when in pain, although role performance at times was clearly impaired by headaches and well‐being was frequently impaired.

Chronic tension‐type headache sufferers were 3 to 15 times more likely than matched controls to receive a diagnosis of an anxiety or mood disorder with almost half of the patients exhibiting clinically significant levels of anxiety or depression. Affective distress and severity of headaches (Headache Index) were important determinants of headache impact/impairment.

Conclusions.– Chronic tension‐type headache has a greater impact on individuals' lives than has generally been realized, with affective distress being an important correlate of impairment. If treatment is to remedy impairment in functioning, affective distress, as well as pain, thus needs to be addressed.
Low Migraine Headache Recurrence With Naratriptan: Clinical Parameters Related to Recurrence
Authors: Sheftell F. , O'Quinn S. , Watson C. , Pait D. , Winter P.
Published: March 2003

Objective.–To evaluate clinical parameters that may affect the incidence of headache recurrence or the time to headache recurrence, or both, in migraineurs treated with naratriptan, 2.5‐mg tablets.

Background.–The incidence of headache recurrence within 24 hours of treatment with naratriptan, 2.5‐mg tablets (17%–28%), is lower than that reported for other currently available selective serotonin agonists. Identifying clinical parameters that influence headache recurrence may further reduce the incidence of headache recurrence or prolong the time to recurrence, or both, for naratriptan‐treated patients.

Methods.–We examined the effects of three clinical parameters (predose pain severity, headache duration prior to treatment, and relief status 4 hours post dose) on the incidence of and time to headache recurrence across four placebo‐controlled naratriptan clinical trials. The impact of these parameters on headache recurrence was examined individually and in combination.

Results.–Predose pain severity had no effect on the incidence of headache recurrence (overall 23%; moderate 22%, severe 23%). The median time to recurrence was longer for patients with moderate pain before treatment compared with patients with severe pain before treatment (14.5 hours versus 9.3 hours, respectively). Overall time to headache recurrence was 11.8 hours. Patients with headache recurrence reported a longer time until they treated the headache compared with patients without headache recurrence (median, 145 minutes versus 97.5 minutes). Patients who treated headache pain within 3 hours of onset had a lower incidence of headache recurrence (20%) than patients who treated their headache more than 3 hours after onset (28%). Patients with no pain 4 hours post dose had a lower incidence of and a longer time to headache recurrence compared with patients with mild pain 4 hours post dose (17% versus 32%; median, 17.8 hours versus 8.1 hours, respectively). The interaction of all three clinical parameters was significant in predicting headache recurrence.

Conclusions.–The overall incidence of headache recurrence is low after naratriptan, 2.5 mg, compared with other currently available selective serotonin agonists. Predose pain severity, time to treatment, and 4‐hour relief status appear related to the incidence of or time to headache recurrence, or both. Treating less severe migraine attacks, treating earlier within an attack, and obtaining complete relief post dose may enhance the low incidence of headache recurrence and achieve longer times to recurrence with naratriptan, 2.5 mg.
The Wavelength of Light Causing Photophobia in Migraine and Tension‐type Headache Between Attacks
Authors: Main Alan , Vlachonikolis Ioannis , Dowson Andrew
Published: March 2003

Objective.–To ascertain the wavelength of light that patients with migraine and tension‐type headache find uncomfortable between attacks.

Background.–Photophobia is an abnormal perceptual sensitivity to light experienced by most patients with headache during and, also, between attacks.

Methods.–We examined the discomfort threshold to light of low, medium, and high wavelengths in a group of patients with migraine (n=21), patients with tension‐type headache (n=19), and healthy controls (n=21).

Results.–The results indicate that the migraine group had significantly lower discomfort thresholds at the low (P=.001) and high (P=.031) wavelengths compared with both the tension‐type headache and control groups; the latter two groups had similar average discomfort levels at these two wavelengths. With the medium wavelength, the control group had significantly higher discomfort thresholds than the migraine (P=.002) and tension‐type headache (P=.031) groups; the latter two groups had similar discomfort levels at this wavelength. With unfiltered (white) light, the migraine group had the lowest discomfort threshold and the control group the highest (P=.026), whereas the tension‐type headache group had an intermediate discomfort threshold.

Conclusions.–There were significant differences between migraineurs, patients with tension‐type headache, and healthy controls in the wavelengths that are uncomfortable between attacks.
Etiology and Distribution of Headaches in Two Brazilian Primary Care Units
Authors: Bigal Marcelo E. , Bordini Carlos A. , Speciali J.G.
Published: March 2003

Objectives.–To determine (a) which patients seek primary care services with a complaint of headache, (b) the percentages of the various types of headache in this population, and (c) the impact of the care provided to these patients on the basic health care network.

Background.–Headache is one of the most frequent symptoms reported in medical practice, resulting in significant medical services costs and loss of patient productivity, as well as reduced quality of life.

Methods.–A prospective study was conducted in two towns (Ribeirão Preto and São Carlos) in the State of São Paulo, Brazil. The participants in the study consisted of 6006 patients (52.4% women) with highly varied acute symptoms. The patients ranged in age from 14 to 98 years.

Results.–Headache as the main complaint was reported by 561 (9.3%) of the patients considered, with 312 (55.6%) of those patients presenting with primary headache, 221 (39.4%) with headaches secondary to systemic disorders, and 28 (5.0%) with headaches secondary to neurological disorders. Migraine, the most prevalent primary headache, accounted for 45.1% of patients reporting headache as the single symptom. The most frequent etiologies of headaches secondary to systemic disorders were fever, acute hypertension, and sinusitis. The most frequent headaches secondary to neurological disorders were posttraumatic headaches, headaches secondary to cervical disease, and expansive intracranial processes. Of the 26 cases of drug abuse, 20 were secondary to alcohol (hangover). Headaches secondary to systemic disorders were more frequent in the extreme age ranges.

Conclusions.–Headache is a very frequent symptom among patients seen at primary health care units and should be considered a public health problem. The dissemination of the diagnostic criteria of the International Headache Society among primary health care physicians is urgently needed in order to avoid the repeated return of patients or their referral to more differentiated emergency units, which overburden an already insufficient health care network.
Hyposerotonin‐Induced Nitric Oxide Supersensitivity in the Cerebral Microcirculation
Authors: Srikiatkhachorn Anan , Anuntasethakul Thiraporn , Maneesri Supang , Phansuwan‐Pujito Pansiri , Patumraj Suthiluk , Kasantikul Vira
Published: March 2003

Objective.–To investigate the relationship between hyposerotonin and cranial microvascular responses to nitric oxide (NO).

Background.–Although the mechanism underlying NO supersensitivity in migraine is still unclear, an alteration of the serotonin system is a possible explanation.

Methods.–Wistar rats were divided into control and hyposerotonin groups. Serotonin was depleted by intraperitoneal injection with 300 mg/kg of para‐chlorophenylalanine (PCPA), a tryptophan hydroxylase inhibitor. Three days after PCPA pretreatment, the animals were prepared for assessment of their NO‐induced vasomotor response using glyceryl trinitrate (GTN: 8 to 10 mg/kg, intravenously) as an NO donor. Pial circulation was visualized by the intravital fluorescein videomicroscopic technique. Images of vessels at 0, 5, 15, 30, and 60 minutes post GTN infusion were digitized and measured. At the end of monitoring, the rat brains were removed for ultrastructural study of the brain microvessels.

Results.–Infusion of GTN produced dose‐dependent pial arteriolar dilatation. This vasodilator effect was significantly increased in the PCPA‐treated groups, especially at 30 and 60 minutes. The percentage change from baseline diameter at 30 minutes after the 8‐mg/kg GTN infusion was 42.6 ± 3.1 for the hyposerotonin group and 16.8 ± 2.9 for the control group (P<.001). Electron microscopic study revealed that exposure to the NO donor produced considerable changes in cerebral microvessels, characterized by focal ballooning of endothelial cells, increased microvillous formation, and increased endothelial pinocytosis. These anatomical changes were significantly more prominent in the hyposerotonin group.

Conclusions.–A hyposerotoninergic condition can facilitate the NO‐induced physiological and pathological responses in meningeal and cerebral microvessels and, therefore, is a possible explanation for the supersensitivity to NO observed in patients with migraine.
MMPI‐2 Profiles in Chronic Daily Headache and Their Relationship to Anxiety Levels and Accompanying Symptoms
Authors: Mongini Franco , Ibertis Francesca , Barbalonga Erika , Raviola Fabio
Published: March 2003

Objectives.—To examine a group of patients with chronic daily headache using the revised version of the Minnesota Multiphasic Personality Inventory (MMPI‐2) and to determine whether the data acquired were related to the anxiety levels of the patients, as detected by the Spielberger State‐Trait Anxiety Inventory (STAI) 1, 2 and to the presence of a number of accompanying symptoms that are frequently observed in patients with chronic headache.

Background.—In the last decade, the MMPI‐2 was released and its items used to develop 15 “content scales.” Recently, this instrument was adapted to the Italian population.

Methods.—Five men and 30 women with chronic daily headache had a semistructured interview in which the presence of 21 behavioral or somatic symptoms was recorded. The Italian version of the MMPI‐2 and the STAI 1, 2 (Italian version) were employed. A configural analysis of the MMPI profiles was performed, and four types were distinguished: “conversion V” ( n = 5), elevation of the “neurotic triad” (
n = 5), the “emotionally overwhelmed” with scale elevation of the neurotic triad and of several other scales (
n = 18), and “the copers” with no scale elevation above 65 (
n = 4). Three patients could not be classified. The pain characteristics, the prevalence of accompanying symptoms, and the STAI 1, 2 scores were assessed in all patients and in the different MMPI groups, and the data were statistically analyzed (ANOVA and chi‐square analysis).

Results.—All patients with no MMPI‐2 scale elevation showed a tendency to a conversion V profile: in this group, the chronicity was markedly and significantly lower than in all other groups. Moreover, in this group, the STAI 1, 2 scores and the prevalence of some accompanying symptoms were significantly lower than in the other groups. Migraine characteristics did not differ significantly from group to group.

Conclusions.—Hysterical traits were observed in a number of patients with chronic daily headache and might constitute a predisposing factor for this condition. With time, the personality profile deteriorates, either through an increase in the hysterical traits or through its transformation, with a parallel increase in anxiety levels and the presence of accompanying symptoms.
LASH: A Syndrome of Long‐lasting Autonomic Symptoms With Hemicrania (A New Indomethacin‐ Responsive Headache)
Authors: Rozen Todd D.
Published: March 2003

A patient presented with a unique, stereotypical, episodic headache disorder marked by long‐lasting autonomic symptoms with associated hemicrania (LASH). The autonomic symptoms clearly overshadowed the headache as the major component of the syndrome. Indomethacin controlled both the autonomic symptoms and the headache, suggesting that this is a new type of indomethacin‐responsive headache. It may also complete the indomethacin‐responsive headache spectrum.
Assessing the Relative Incidence of Mitochondrial DNA A3243G in Migraine Without Aura With Maternal Inheritance
Authors: Di Gennaro G. , Buzzi M.G. , Ciccarelli O. , Santorelli F.M. , Pierelli F. , Fortini D. , D'onofrio M. , Costa A. , Nappi G. , Casali C.
Published: March 2003

Objective.—To determine whether patients with migraine without aura with maternal “inheritance” are affected by a monosymptomatic form of the MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes) or carry the most common mitochondrial DNA (mtDNA) mutation associated with MELAS, namely the A3243G transition in the transfer RNA (tRNA)Leu(UUR) gene.

Background.—The association between migraine and abnormal mitochondrial function has been suggested on clinical, biochemical, and neuroradiological grounds. Migraine attacks with vomiting and cerebral infarctions, most often in the posterior cerebral regions, which are reminiscent of complicated migraine, are typical features of MELAS. The observation that migrainous patients have affected mothers more often than affected fathers suggests a possible role for maternally transmitted genetic factors.

Methods.—We studied 25 patients with migraine with aura whose mothers were also affected. A sensitive polymerase chain reaction restriction fragment length polymorphism analysis was used to detect mutated genomes.

Conclusions.—We failed to detect the MELAS mutation, but migraine may still be associated with point mutations of mtDNA other than A3243G or with as‐yet‐unidentified nuclear DNA factors related to mitochondrial function.
Repetitive Intravenous Prochlorperazine Treatment of Patients With Refractory Chronic Daily Headache
Authors: Lu Shiang‐Ru , Fuh Jong‐Ling , Juang Kai‐Dih , Wang Shuu‐Jiun
Published: March 2003

Objectives.—To investigate the efficacy and long‐term outcome of intravenous prochlorperazine for the treatment of refractory chronic daily headache.

Background.—Unlike dihydroergotamine, the treatment results of intravenous neuroleptics as first‐line agents for refractory chronic daily headache have rarely been reported.

Methods.—We retrospectively analyzed the data of inpatients with refractory chronic daily headache who received intravenous repetitive prochlorperazine treatment from November 1996 to March 1999. A semistructured telephone follow‐up interview was done in September 1999.

Results.—A total of 135 patients (44 men, 91 women) were recruited, including 95 (70%) with analgesic overuse. After intravenous prochlorperazine treatment, 121 (90%) achieved a 50% or greater reduction of headache intensity, including 85 (63%) who became headache‐free. The mean hospital stay was 6.2 ± 2.7 days, and mean total prochlorperazine used was 98 ± 48 mg. Acute extrapyramidal symptoms occurred in 21 patients (16%). One hundred twenty‐four patients (92%) were successfully followed up, with a mean duration of 14.3 ± 7.5 months. Compared with pretreatment status, 93 patients (75%) considered their headache intensity decreased, and 86 patients (69%) considered their headache frequency decreased, although 40 (32%) still had a daily headache. Of the 87 patients with analgesic overuse who could be followed, 61 (70%) no longer overused analgesics. Poor response to prochlorperazine treatment (relative risk, 1.8) and presence of major depression (relative risk, 1.8) were predictors of persistent chronic daily headache at follow‐up.

Conclusions.—Prochlorperazine was effective and safe in the treatment of patients with refractory chronic daily headache with or without analgesic overuse. Compared with dihydroergotamine, prochlorperazine seemed less effective at achieving “freedom from headache” during hospitalization, but had a similar outcome at follow‐up.
Polysomnography in Hypnic Headache Syndrome
Authors: Dodick David W.
Published: March 2003

Hypnic headache syndrome is an unusual chronic headache that usually begins after age 60 years and occurs exclusively during sleep. Despite the relationship between the headache and sleep, no formal sleep evaluation with overnight polysomnography has been reported for this syndrome. Three patients with long‐standing hypnic headache underwent overnight polysomnography. The results were quite variable, ranging from normal to marked sleep insufficiency. A hypnic headache was captured in one patient arising out of rapid eye movement sleep at a time of severe oxygen desaturation. Formal sleep evaluation should be considered in patients with hypnic headache because there may be pathophysiologic and therapeutic implications.
Reduction in the Intensity of Abortive Migraine Drug Use During Coumarin Therapy
Authors: Rahimtoola H. , Egberts A.C.G. , Buurma H. , Tijssen C.C. , Leufkens H.G.
Published: March 2003

Objective.—To investigate the impact of coumarin therapy on migraine attack frequency.

Background.—Sporadic case reports and clinical studies have described beneficial effects of coumarin therapy on migraine severity.

Design and Methods.—A retrospective follow‐up study based on a prescription database covering a population of 450 000 was conducted. All patients using an abortive migraine drug (ergotamine or sumatriptan) and subsequently treated with either coumarin (index group) or low‐dose acetylsalicylic acid (control group) were analyzed. The impact of coumarin and low‐dose acetylsalicylic acid on the frequency of migraine attacks was assessed by measuring the intensity of ergotamine and sumatriptan use, in defined daily doses per month per patient, before and during coumarin or acetylsalicylic acid treatment. In addition, a “therapeutic intensity reduction” was determined for each patient.

Results.—The study population consisted of 92 patients; 35% had been prescribed coumarin and 65% had been prescribed low‐dose acetylsalicylic acid after the initiation of ergotamine or sumatriptan. Two thirds of the study population was treated with ergotamine. Overall, ergotamine and sumatriptan use for the coumarin cohort decreased from 6.4 defined daily doses per month prior to coumarin treatment to 3.0 defined daily doses during coumarin treatment, compared with a reduction from 5.2 defined daily doses per month to 4.4 defined daily doses per month for the low‐dose acetylsalicylic acid cohort (P>.05). The therapeutic intensity of ergotamine and sumatriptan use was significantly decreased by 40% for the coumarin cohort, compared with 4.7% for the low‐dose acetylsalicylic acid cohort (P=.004).

Conclusions.—We observed that coumarin treatment was clearly associated with a reduction in the therapeutic intensity of abortive migraine drug use in comparison with low‐dose aspirin treatment. This suggests that, overall, the coumarin cohort had experienced a substantial reduction in the frequency of migraine attacks during anticoagulation treatment. Our findings, as well as those of others, justify a controlled clinical trial to further establish the effects of coumarin therapy on migraine severity and its possible role in the prophylactic management of patients suffering from migraine.
Spectral Analysis of Visual Potentials Evoked by Pattern‐Reversal Checkerboard in Juvenile Patients With Headache
Authors: Marrelli Alfonso , Tozzi Elisabetta , Porto Claudio , Cimini Nicola , Aloisi Paolo , Valenti Marco
Published: March 2003

Changes in visual evoked potentials, mainly affecting the amplitude of the major positive wave, are referred to by many authors and are related to the pathophysiological basis of primary headache.

We performed both transient pattern‐reversal visual evoked potentials and spectral analysis by means of fast Fourier transform of 8‐Hz steady‐state pattern‐reversal visual evoked potentials in 34 children affected with migraine (14 with aura, 20 without aura), and compared them with 14 patients with tension‐type headache and 10 healthy subjects. The amplitude of the response to the transient stimulation (P100) was higher and the latency shorter in the patients with headache compared with the controls, but the difference was not statistically significant. The absolute power of the first harmonic (1F) obtained by the spectral analysis of the steady‐state stimulation was increased in all the patients with headache compared with the controls, and the increase was significant in patients with migraine.

These data seem to confirm the hypothesis of abnormal processing of visual input in migraineurs and could be interpreted as neurophysiological support for the theory that different headache types are related conditions.

Furthermore, the spectral analysis of steady‐state pattern‐reversal visual evoked potentials could be proposed as a test to diagnose migraine.
Topiramate in Migraine Prevention: A Double‐Blind, Placebo‐Controlled Study
Authors: Storey J. R. , Calder C. S. , Hart D. E. , Potter D. L.
Published: March 2003

Objective.—To evaluate the efficacy of topiramate in the preventative treatment of episodic migraine.

Background.—Topiramate is a broad‐spectrum antiepileptic drug effective for treatment of multiple seizure types in adults and children. Antiepileptic agents have demonstrated efficacy in migraine prevention, and open‐label experience from our clinic has suggested that topiramate might be effective for this use. We consequently conducted a single‐center, double‐blind, placebo‐controlled trial to evaluate the efficacy and safety of topiramate for the preventative treatment of migraine.

Methods.—Forty patients, aged 19 to 62 years (mean, 38.2 years), were randomly assigned in a 1:1 ratio to receive topiramate (n = 19; all women) or placebo (n = 21; 20 women, 1 man). Following a prospective baseline phase of 4 weeks, the study drug dose was titrated weekly in 25‐mg increments over 8 weeks to 200 mg per day or to the maximum tolerated dose. The titration phase was followed by an 8‐week maintenance phase.

Results.—During the entire double‐blind phase, topiramate‐treated patients experienced a significantly lower 28‐day migraine frequency (3.31 ± 1.7 versus 3.83 ± 2.1; P = .002) compared to placebo, irrespective of use of concomitant migraine prevention medications. The mean 28‐day migraine frequency was reduced by 36% in patients receiving topiramate as compared with 14% in patients receiving placebo (P = .004). Twenty‐six percent of the patients on topiramate and 9.5% of the patients on placebo achieved a 50% reduction in migraine frequency (P > .05). The mean dose of topiramate was 125 mg per day (range, 25 to 200 mg per day). Topiramate was well tolerated; 2 of 19 topiramate‐treated patients discontinued treatment due to adverse events. Adverse effects that occurred more frequently in topiramate‐treated patients included paresthesia, weight loss, altered taste, anorexia, and memory impairment.

Conclusions.—Preventative therapy with topiramate significantly reduced migraine frequency. Larger multicenter clinical studies may further delineate the role of topiramate in migraine prevention.