bluuebunny/crossref_metadata_2025 huggingface dataset:
Concentration and Uptake of 5-Hydroxytryptamine in Platelets from Cluster Headache and Migraine Patients
Authors: Waldenlind Elisabet , Ross Svante B , Sääf Jan , Ekbom Karl , Wetterberg Lennart
Published: March 2003

Concentrations of 5-hydroxytryptamine (5-HT) in platelets were determined in 33 cluster headache patients (17 males) and in 34 migraine patients (16 males) outside attacks. The 5-HT uptake into platelets was measured and the kinetic constants Vmax and Km determined in 26 cluster patients (14 males) and in 30 migraine patients (13 males). Significantly lower 5-HT concentrations in whole blood were found in cluster headache and migraine patients than in 50 healthy controls (19 males). The Vmax and Km values of the 5-HT uptake were significantly lower in cluster headache and migraine patients compared with 22 healthy controls (9 males). The 5-HT concentrations and the kinetics of the 5-HT uptake did not differ between cluster headache and migraine. In healthy controls a significant positive correlation was found between the 5-HT uptake rate at 0.25 μM and Km but not in cluster headache and migraine patients. The 5-HT concentrations in whole blood correlated positively with Vmax and Km, respectively, in cluster headache and with Km in healthy controls but not with Vmax nor with Km in migraine. There was no obvious relation between the kinetics of platelet monoamine oxidase (MAO) and the 5-HT uptake except for an increased incidence of low Vmax of MAO and low Km of the 5-HT uptake in cluster headache. The kinetics of the 5-HT uptake was apparently not related to the state of migraine. The results indicate a possible constitutional trait in cluster headache and migraine expressed as low 5-HT concentrations in whole blood and low Vmax and Km of the 5-HT uptake into platelets.
Functional Bases for a Central Serotonergic Involvement in Classic Migraine: A Speculative View
Authors: MacKenzie ET , Edvinsson L , Scatton B
Published: March 2003

The rôle of serotonin (5-HT) in the cerebrovascular bed is the subject of the following review. Cerebral blood vessels are supplied with 5-HT-containing fibres which originate in the raphé nuclei in the brainstem. The activation of this system may result in a constriction of large arteries and a dilatation of arterioles. Intra-arterial administration of 5-HT causes reduction in cerebral blood flow and metabolism provided it bypasses the blood-brain barrier. The findings, marked changes in plasma levels of 5-HT and in cerebral blood flow during a classic migraine attack, are suggestive of an involvement of the 5-HT system.
Cluster Headache: Histamine Skin Tests in the Painful Area
Authors: Bogucki Andrzej , Prusinski Antoni
Published: March 2003

Histamine skin tests were performed in the painful area and on the opposite side in ten cluster headache patients. The studies were carried out with and without local anaesthesia. No differences between histamine skin response in the painful region compared with the contralateral side were revealed. This study concerns the part of the triple response which is the result of a direct action of histamine on the skin vasculature (mediated by both H1 and H2) histaminergic receptors, i.e. wheal and redness, and the flare, which is the result of neuro-humoral mechanisms.
Cluster Headache: Clinical Efficacy of Lithium Salts in a Haemodialysis Treated Patient
Authors: Zuddas A , Mulas S , Zompo M Del , Corsini GU
Published: March 2003

Over the last ten years the efficacy of lithium salts in cluster headache has been well demonstrated. Our patient, who had been suffering from cluster headache for approximately 30 years, had been in haemodialysis treatment for the last ten years for chronic renal failure. Moreover, he was affected by heart failure and peptic ulcer. The patient was currently under therapy with Digitalis, Isorbide dinitrate, and ranitidine and was dialyzed three times a week for a total of five hours each time. Neither prophylactic headache therapy nor high doses of analgesic drugs had proved effective. Although this patient was in haemodialysis, lithium treatment was indicated. The administration of lithium carbonate 300 mg during dialysis days and 150 mg during non-dialysis days improved the attacks. Complete recovery from the attacks was obtained when the serum levels of lithium reached the therapeutic range. No side effects were noted.
Acute Migraine Attack Therapy: Comparison of Naproxen Sodium and an Ergotamine Tartrate Compound
Authors: Pradalier A , Rancurel G , Dordain G , Verdure L , Rascol A , Dry J
Published: March 2003

The efficacy of safety of naproxen sodium and ergotamine tartrate were compared for the treatment of acute migraine attack in a randomized, parallel trial with 114 participating patients. At the start of symptoms, patients took either three tablets of naproxen sodium (275 mg each) or one of an ergotamine combination (containing 2 mg ergotamine tartrate, 91.5 mg caffeine, and 50 mg cyclizine chlorohydrate). Patients were followed for three months or until six attacks were monitored, whichever came first. Both medications substantially shortened the duration of migraine attacks and reduced the severity of symptoms. When the test medications were taken within 2h of onset of attack, naproxen sodium was statistically significantly more effective than the ergotamine combination in reducing the severity of headache pain, nausea, and lightheadedness. The ergotamine combination was associated with significantly more vomiting, need for rescue medication, and side effects than was naproxen sodium. Four patients required discontinuation of the ergotamine combination and one of naproxen sodium. Both patients and investigators rated tolerance for naproxen sodium as superior to tolerance for the ergotamine combination. Naproxen sodium seems to be an effective and safe treatment for migraine attacks.
Dihydroergotamine Nasal Spray in the Treatment Of Attacks of Cluster Headache: A Double-Blind Trial Versus Placebo
Authors: Andersson Poul Gertz , Jespersen Lennard Tang
Published: March 2003

A double-blind trial of dihydroergotamine (DHE) nasal spray compared with placebo was carried out in patients with cluster headache. Twenty-five patients were included in the trial. In three patients, all receiving DHE, the pain attacks ceased after five attacks. In the other 22 patients, 133 attacks were treated with placebo and 137 attacks with DHE nasal spray (dosage, 1 mg of DHE). The trial showed that the treatment given has no effect on the attack frequency or the duration of the single attack. However, the treatment had a significant effect on the intensity of the single attacks. It can be concluded that the trial should be repeated, using a larger dosage of DHE. This should be ethically justifiable, since none of the patients had any adverse reactions locally in the mucous membrane of the nose or systemically.
Use of Headache Rating Scales: A Multiaxial Approach
Authors: Bech P , Kastrup M , Loldrup D
Published: March 2003

The basic principles of the rating scale procedure have been outlined, including the Likert scale, the Guilford criteria for item definitions, and the Guttman and Rasch criteria for item combinations. With these criteria, headache rates among the core symptoms of anxiety and depression. Next, we have discussed one of the prevailing scales for headache, the Waters Headache Questionnaire (WHQ), with a multiaxial approach. The WHQ thus contains a severity axis, a diagnostic axis, and a personality axis. Previous studies on the validity of the WHQ, including factor analysis, have shown that migraine and muscular headaches are not mutually exclusive categories. Studies to validate a two-dimensional diagnostic system of migraine and non-migraine headache by Rasch models are discussed. In the field of personality it was suggested, when using questionnaires like the WHQ, to focus on the concepts of acquiescence and dissimulation. Supplemental axes such as “severity of psychosocial stressors” and “social functioning” or “quality of life” should be considered in future research.
L-5-Hydroxytryptophan Versus Placebo in Childhood Migraine Prophylaxis: A Double-Blind Crossover Study
Authors: Santucci Margherita , Cortelli Pietro , Rossi Paola Giovanardi , Baruzzi Agostino , Sacquegna Tommaso
Published: March 2003

L-5HTP was tested versus placebo in a double-blind crossover study of 27 migraine children aged 6–12 years, who recorded their headaches in a headache diary for 1 month. Twenty-one patients subsequently started the trial. The mean daily dose of L-5HTP was 5 mg/kg body weight, and each treatment period with either L-5HTP or placebo lasted 12 weeks. In group A (L-5HTP—placebo; 10 patients) and group B (placebo—L-5HTP; 11 patients) both L-5HTP and placebo led to a significant reduction of the migraine index and frequency of migraine attacks during the 3rd month of each treatment period. However, we found a treatment x period interaction because the efficacy determinants decreased significantly during the first and the second treatment periods in both groups irrespective of the sequence of treatments. No differences were found between L-5HTP (first period of group A) and placebo (first period of group B).
Platelet Activity in Cluster Headache
Authors: D'Andrea Giovanni , Cananzi Antonio R , Toldo Moreno , Ferro-Milone Francesco
Published: March 2003

Platelets are known to be activated in common or classic migraine both during the attack and in headache-free periods. Platelet behavior is less well known in cluster headache. We have investigated beta-thromboglobulin (b-TG) and platelet factor four (PF4) plasma levels, markers of in vivo platelet activation, in patients during remission and during bouts of cluster headache with and without pain. The results indicated that statistically significantly higher levels of b-TG and PF4 occur in the patients during the remission period when compared with the control subjects. Such high levels seemed to persist between paroxysmal episodes in cluster periods. However, during the attacks of cluster headache b-TG and PF4 plasma levels decreased by 42% and 50%, respectively, in comparison with plasma concentrations measured outside of attack. Thus, although platelet activation also occurs in patients with cluster headache, the attack as such seems to be characterized by a marked reduction in platelet activation.
MMPI Patterns in Chronic Muscle Pain, Tension Headache and Migraine
Authors: Ellertsen Bjørn , Kløve Hallgrim
Published: March 2003

MMPI personality profiles were obtained from three clinical groups ( n = 79). One group consisted of men and women with chronic muscle pain (MP; n = 34), a second group of male and female chronic tension headache patients (TH; n = 12), and a third group of female migraine patients (M; n = 33). The M group was subdivided on the basis of source of referral and into groups of classic versus common migraine. Elevation of the MMPI subscales usually interpreted as neuroticism scales were found in all groups. A “psychosomatic V” pattern was found on these scales in the M group but not in female TH patients. The difference in scale configuration beween groups was caused primarily by different elevations on the depression scale. A relationship between severity of headache and elevation of the “psychosomatic V” was found in migraine patients. Male MP and TH patients showed a descending slope on the neuroticism scales, not observed in females. There was a tendency for common migraine patients to show a more elevated and psychosomatic configuration on the MMPI, as compared with classic migraine patients.
Do Migrainous Headaches Become More Consistently Lateralized?
Authors: Peatfield RC , Bond RA , Rose F Clifford
Published: March 2003

Analysis of information collected from 468 patients with common or classical migraine does not suggest that those with a longer history are more likely to have headaches fixed to a single side of the head. This finding does not support the notion that successive unilateral headache attacks on one side cause damage that predisposes the patient to further attacks on the same side.
MMPI Profiles in Migraine Before and After Biofeedback Treatment
Authors: Ellertsen Bjørn , Troland Kari , Kløve Hallgrim
Published: March 2003

Migraine has been associated with specific personality traits. Typically, migraine patients show elevation on the “neurotic scales” on the MMPI, and the profiles usually reported can be classified as “psychosomatic”. A crucial matter is whether certain personality traits predispose to headache problems or whether they are an effect of such problems. To elucidate this problem, common and classic migraine patients (n = 13) were evaluated with the MMPI before and 2 years after biofeedback treatment. Two subgroups were identified on the basis of degree of clinical improvement. The least improved patients were significantly older and had a significantly longer headache history than the patients showing most improvement. No relationships between age, headache history, and improvement were found within subgroups. Clinical improvement was correlated with significant “normalization” of the MMPI profiles. Thus, personality traits as measured by the MMPI seem to be secondary to headache problems and not a predisposing cause.
Sweat Gland and Pupillary Responsiveness in Horner's Syndrome
Authors: Salvesen Rolf , Fredriksen Torbjørn A , Bogucki Andrzej , Sjaastad Ottar
Published: March 2003

Eight patients with Horner's syndrome (five with a 1st neuron lesion and three with a 2nd neuron lesion) were examined for their pupillary responses to pharmacologic stimulation with tyramine (2%) and with phenylephrine (1%) eye drops. The same patients were also evaluated for their forehead sweating pattern on stimulation with body heating and pilocarpine injection, using the Evaporimeter. Five patients had a brain stem (1st sympathetic neuron) lesion, while three patients had had a traumatic C8-Th1 root avulsion and hence had a preganglionic neuron lesion. The average response with the phenylephrine eye test and the pilocarpine sweat test differed markedly between the two groups; only the central neuron lesion group had a supersensitivity reaction to both drugs. These procedures may be of diagnostic value in localizing the lesion in patients with a Horner's syndrome of unknown etiology. Patients with 3rd neuron lesion have not been examined with this combination of techniques.
“Hemicrania Continua”: A New Clinical Entity or a Further Development from Cluster Headache?: A Case Report
Authors: Centonze V , Attolini E , Campanozzi F , Magrone D , Tesauro P , Vino M , Campanale G , Albano O
Published: March 2003

A case of “hemicrania continua” after cluster headache in the same subject is described. Indomethacin exerted an absolute, persistent effect on the present headache. Even though our data are insufficient to demonstrate a causal relation between the two forms of headache, they do suggest this real possibility.
“Hemicrania Continua”: A Case Report
Authors: Zukerman Eliova , Hannuch Suzanmeire Negro Minatti , Carvalho Deusvenir de Souza , Fragoso Yara Dadalti , Jenger Klaus Augusto
Published: March 2003

The case of a 42-year-old woman with a 31-year history of continuous unilateral, pulsating headache with occasional exacerbations is described. Complete relief was obtained with 150 mg indomethacin daily.
Chronic Paroxysmal Hemicrania: A Case Report: Long-Lasting Remission in The Chronic Stage
Authors: Sjaastad Ottar , Antonaci Fabio
Published: March 2003

In a 38-year-old woman who had had CPH since the middle 1960s and had been successfully treated with indomethacin (dosage usually within the limits of 50–175 mg/day) for approximately 10 years, the requirement for indomethacin was gradually reduced to nought in the spring of 1985. She was then pain-free without indomethacin for almost 11 years. In the late fall of 1986 she had a 3-week exacerbation. In recent months, she again seems to have a slowly increasing, although clearly fluctuating, indomethacin requirement. Long-lasting remissions may thus appear even in the chronic stage. The remission could be a spontaneous one or it could in some way be related to the protracted indomethacin treatment; the authors favour the former possibility. The recurrence of symptoms after a while shows that the attack-generating potential has not been permanently extinguished by indomethacin.
Platelet Activation in Muscle Contraction Headache and Migraine
Authors: Takeshima Takao , Shimomura Tokio , Takahashi Kazuro
Published: March 2003

In migraine, the role of platelets is regarded as an important factor. We investigated plasma beta-thromboglobulin (BTG), platelet factor 4 (PF4), and 5-hydroxytryptamine (5-HT) in migraine patients and muscle contraction headache (MCH) patients during headache-free periods. The mean values of the plasma BTG, PF4, and 5-HT concentrations in the migraine group and the MCH group were significantly higher than those in healthy controls. The mean value of the plasma BTG concentration was significantly higher in the migraine group than in the MCH group, but the differences in the mean plasma PF4 and 5-HT concentrations between the two groups were not significant. Continuous platelet activation exists in both MCH patients and migraine patients. From the biochemical point of view, we have provided evidence for a similarity between migraine and MCH.
Asymmetric Cerebral Blood Flow Patterns in Migraine
Authors: Levine Steven R , Welch K M A , Ewing James R , Robertson Wendy M
Published: March 2003

Although asymmetric EEG abnormalities have been reported during the headache-free period in migraineurs, asymmetries of regional cerebral blood flow (rCBF) have not been studied. Headache-free rCBF values measured by 133Xe inhalation were lower in migraineurs than in controls. Interhemispheric CBF and regional (anterior versus posterior) CBF did not differ between the groups. When a novel scoring system was used to obtain a mean asymmetry index (MAI), the MAI of the classiccomplicated group was significantly higher than that of the controls but not significantly different from that of the common migraine group. These data suggest that in the headache-free interval rCBF asymmetries, variable in location, exist in classiccomplicated migraineurs. These rCBF changes may be related to the cause or the effect of the focal neurologic dysfunction that occurs during an attack in these patients
The Platelet and The Neuron: Two Cells in Focus in Migraine
Authors: Malmgren Rigmor , Hasselmark Lena
Published: March 2003

Reports of platelet abnormalities in migraine are abundant, and the present paper discusses the role of platelets in the migraine aetiology. Platelets are considered good models for pre-and post-synaptic functions in serotonergic neurons. We propose that migraine is associated with a lowered threshold for stimulus response in both platelets and serotonergic neurons and that the alterations in platelet function reflect central serotonergic disturbances. The platelet abnormalities in migraine approach those found in depression, and there are several links between the two disorders. The clinical significance of platelet hyperactivity in migraineurs for the occurrence of thrombotic disorders is also discussed. Studies of platelet functions in migraine, using platelets as models for serotonergic neurons, may broaden our understanding of the neuronal processes that take place during a migraine attack. The platelet can also be an investigative tool for better understanding of the modes of action of anti-migraine drugs.
The Effect of Metoclopramide and Prochlorperazine on the Absorption of Effervescent Paracetamol in Migraine
Authors: Tokola Riitta A
Published: March 2003

Antiemetics modify gastric emptying, a rate-limiting step in drug absorption. The absorption of effervescent paracetamol in water solution was studied in three groups of 10 female patients during acute migraine attacks. Paracetamol was preceded 30 min earlier by a rectal dose of metoclopramide, prochlorperazine maleate, or placebo. Each patient was retested with paracetamol when headache-free. Migraine attacks delayed slightly the absorption of paracetamol solution. Prior administration of rectal prochlorperazine had a minor delaying effect on paracetamol absorption. The peak concentration, the time to reach the peak, and the area under the time-concentration curve from 0 to 6 h of paracetamol were similar with the three treatments.
Systemic Symptoms Associated with Orbital Venous Vasculitis
Authors: Hannerz Jan
Published: March 2003

Orbital venous vasculitis has been suggested to cause characteristic periorbital pain in patients with pathologic changes in their orbital phlebograms. The orbital pain is characterized by being unilateral, not shifting side, boring and pressing, but not throbbing, increasing on eye strain, exposure to cold, or weather changes, and resistant to analgesics. It is ameliorated by steroids. Fifty patients with symptoms of orbital venous vasculitis were investigated for other symptoms that could be related to the vasculitis. When the 32 female patients were compared with a randomly selected age- and sex-matched control group, there was a significant increase of symptoms of chronic fatigue, cold feet, gut problems such as constipation and/or diarrhea, arthralgia, memory impairment, rotatory vertigo, spontaneous ecchymoses (all, p < 0.0001), back pain ( p < 0.012), and thrombophlebitis ( p < 0.022) in the patient group. These symptoms, although commonly occurring, seem in these patients to be related to the vasculitis. Blood tests of the fifty patients showed signs of inflammation which did not disagree with the hypothesis of an immunologic cause of the orbital venous vasculitis.
Nimodipine in Migraine Prophylaxis
Authors: Ansell E , Fazzone T , Festenstein R , Johnson E S , Thavapalan M , Wilkinson M , Wozniak I
Published: March 2003

Nimodipine is a compound that is thought to block the influx of calcium through channels in vascular smooth muscle. This paper describes a double-blind parallel-group comparison of 40 mg nimodipine three times a day and placebo. Sixty-eight patients received treatment after a run-in period of 2 months, and of these, 57 completed 8 weeks or more of the trial. All but five of these completed the full 6-month trial. The nimodipine and placebo groups showed no significant differences in the frequency of attacks. severity or duration of headache, or gastrointestinal or other symptoms.
Symptoms of Classic Migraine Attacks: Modifications Brought about by Metoprolol
Authors: Hedman C , Andersen AR , Andersson PG , Gilhus NE , Kangasniemi P , Olsson J-E , Strandman E , Nestvold K , Olesen J
Published: March 2003

There is little information available concerning whether, and to what extent, migraine-prophylactic agents interfere with the symptoms of migraine attacks. The present study is a placebo-controlled, double-blind study concerning metoprolol in classic migraine. The data refer to the symptoms of single migraine attacks. During metoprolol treatment more attacks were characterized as mild ( p = 0.002), and mean global rating (an integrated estimate of headache intensity and of other discomfort) was lower (4.2 versus 5.2, p = 0.003). The mean headache intensity per attack (1.97 versus 2.15) and the mean duration (5.5 versus 6.8 h) were not significantly different. Consumption of analgesics per attack was lower during metoprolol treatment (0.6 versus 1.1; p = 0.02). Attacks with associated symptoms accompanying the headache were fewer during metoprolol treatment ( p = 0.014). Total visual and non-visual aura symptoms occurred with similar frequency, but scintillations and paraesthesia were more frequent during metoprolol treatment, whereas speech disturbances were less frequent. In spite of lower consumption of analgesics, the symptoms appeared milder during metoprolol than during placebo. The pattern of changes indicates that metoprolol exerts its action via the sympathetic nervous system; peripheral vasoconstriction is hardly the underlying mechanism of action.
Cluster Headache: On The Significance of So-Called Minibouts
Authors: Sjaastad Ottar , Carvalho Deusvenir de Souza , Fragoso Yara D , Zhao Jing-Ming
Published: March 2003

Cluster headache periods (bouts) have, at the lower end of the scale, been supposed to last for periods as short as 1–2 weeks. Patients who usually have bouts of ordinary duration occasionally have brief attacks in the remission phase (“abortive attacks”). The group described here had a temporal pattern, clearly at variance with both these patterns: The six patients had mostly or entirely bouts of < 1 week's duration. We have termed such short-lasting bouts minibouts, on the supposition that such cases belong within the cluster headache, cycle. All the patients were men and had a history of unilateral headache without side shift, and usually the solitary attacks had some autonomic accompaniments, although of a moderate degree. In four cases only mild attacks occurred, whereas in two cases the attacks were rather severe and not consistent with full working ability. The group as such may not be homogeneous. The nosologic status of patients with bouts lasting only 1–2 days is somewhat uncertain. As long as the substrate of cluster headache is not outlined, the lower end of duration of minibouts cannot be accurately identified. The fact that three patients recently have experienced bouts of ordinary length strengthens the view that such cases really belong to the cluster headache cycle.
Horner's Syndrome Sweat Gland and Pupillary Responsiveness in Two Cases with a Probable 3Rd Neurone Dysfunction
Authors: Salvesen R , Souza Carvalho D de , Sjaastad O
Published: March 2003

Two patients with a Horner's syndrome due to a probable 3rd neurone lesion were examined with regard to the pupillometric and evaporimetric patterns. The results are compared with those found in patients with a Horner's syndrome due to a 1st or 2nd neurone lesion, previously described by our group. Concurring with observations by others, the pupil on the symptomatic side did not dilate at all when stimulated with hydroxy-amphetamine eye drops. Postganglionic dysfunction may thus be distinguished from 1st and 2nd neurone dysfunction. Supersensitivity was present on the side of the Horner's syndrome, both on pupillometry (phenylephrine stimulation) and in the medial part of the forehead at evaporimetry (pilocarpine stimulation). The lateral part of the forehead, however, did not demonstrate deficient evaporation in these postganglionic sympathetic lesions.
Hemicranial Attacks or Permanent Hemicrania — A Sequel of Upper Cervical Root Compression
Authors: Jansen J , Markakis E , Rama B , Hildebrandt J
Published: March 2003

After many years of unsuccessful conservative treatment 16 patients suffering from hemicrania are relieved of their pain or are improved by operative treatment. Hemicranial attacks or permanent hemicrania is found to be caused by upper cervical nerve root compression. Vascular compression of C2 ( n = 9) or scar tissue surrounding C2 ( n = 1) or C3 ( n = 1) is the pathology identified in cases of cervicogenic headache or “cluster headache-like” headache. Compression attributable to tumor, prolapsed disc, or spondylotic changes is found to be a cause of permanent headache. Only in those patients with permanent headache are radiological or electrophysiological findings helpful for diagnosis. In patients with hemicranial attacks and compression of nerve root C2 ( n = 10) or C3 ( n = 1), only vasoactive tests (provoking or relieving pain) or local anaesthesia prove to be helpful in diagnosing and localizing the origin of pain. The operation involves freeing the nerve roots from vascular compression. In two patients the C2 ganglion is resected. Thirteen patients subsequently become pain free. In three patients, hemicrania improves. Four of the 16 patients experience a recurrence of pain after the decompressive operation. After additional thermorhizotomy two patients have no further complaints and one patient has improved. One patient can tolerate his pain with occasional analgesics. The problem of referred pain into the fronto-ocular region is discussed.
Cluster Headache and Vertigo
Authors: Vijayan N
Published: March 2003

The term “cluster vertigo” was originally used by Gilbert to describe episodes of vertigo in patients with Ménière's syndrome. Since these patients also had co-existing cluster headache, he suggested that both disorders could have had a common pathophysiology. There is no evidence in the literature for an increased incidence of Ménière's syndrome in cluster headache patients, so the argument that cluster headache and Ménière's syndrome may have a common pathogenesis cannot be supported. Subsequent authors have used the term “cluster vertigo” to denote a variant form of cluster headache and have confused the matter further. This was not the intention of the original author. The terminology is misleading and should not be used to describe a sub-type of cluster headache. A case of cluster headache with accompanying vertigo is described as a contrast to the patients described by Gilbert in whom headache and episodes of vertigo occurred independently.
Cluster Headache: Transcranial Doppler Ultrasound and rCBF Studies
Authors: Dahl Arve , Russell David , Nyberg-Hansen Rolf , Rootwelt Kjell
Published: March 2003

Transcranial Doppler and rCBF examinations were carried out in 25 cluster headache patients. Spontaneous and glyceryl trinitrate (nitroglycerin) provoked attacks were accompanied by a bilateral decrease in middle cerebral artery blood flow velocities. This decrease was more pronounced on the symptomatic side but the difference did not reach statistical significance. Mean hemispheric blood flow and rCBF were within normal limits during provoked attacks and similar to those found when patients were attack-free. During cluster periods middle cerebral artery velocities were significantly higher on the symptomatic side. Glyceryl trinitrate caused a bilateral middle cerebral artery velocity decrease which was significantly greater on the symptomatic side. Attacks provoked by glyceryl trinitrate appeared to begin when the vasodilatory effect of this substance was receding.
Contralateral Trigeminal Dysaesthesias Associated with Second Cervical Nerve Compression: A Case Report
Authors: Rosenberg William S , Swearingen Brooke , Poletti Charles E
Published: March 2003

This 70–year-old woman presented with a left C2 solitary metastatic lesion producing ipsilateral occipital pain associated with contralateral fronto-orbital dysaesthesias. Examination revealed analgesia in the left C2 dermatome and hyperaesthesia in the right forehead. These symptoms and findings resolved following a course of radiation therapy to the C2 metastasis. Ipsilateral trigeminal dysaesthesias produced by cervical lesions have been described, however, contralateral cervicogenic trigeminal dysaesthesias have not. Relevant experimental data are analysed; neural pathways are suggested by which a cervical lesion, especially at C2 or C3, may produce trigeminal dysaesthesias referred ipsilaterally or contralaterally.
Complicated Migraine Studied by Phosphorus Magnetic Resonance Spectroscopy
Authors: Barbiroli B , Montagna P , Cortelli P , Martinelli P , Sacquegna T , Zaniol P , Lugaresi E
Published: March 2003

The brain and skeletal muscle of eight adult patients with migraine with prolonged auras or migraine strokes leaving a permanent hemianopic defect were studied by phosphorus magnetic resonance spectroscopy. Biochemical assays performed on muscle biopsy and platelets had revealed abnormal mitochondrial enzyme activities. Brain magnetic resonance spectroscopy showed an abnormally low phosphocreatine to inorganic phosphate ratio in all patients, apparently due to decreased phosphocreatine and increased inorganic phosphate contents. Muscle phosphorus magnetic resonance spectroscopy showed low recovery from exercise in seven patients. Three patients had an increased phosphocreatine/inorganic phosphate ratio at rest, and the exercise transfer characteristics were abnormal in four patients for relatively low levels of exercise. The mitochondrial metabolic defects present in platelets and muscle of complicated migraine patients are therefore also expressed in the brain.
Migraine and Menstruation: A Pilot Study
Authors: MacGregor EA , Chia H , Vohrah RC , Wilkinson M
Published: March 2003

Objective: To define the term “menstrual” migraine and to determine the prevalence of “menstrual” migraine in women attending the City of London Migraine Clinic.

Design: Women attending the clinic were asked to keep a record of their migraine attacks and menstrual periods for at least 3 complete menstrual cycles.

Results: Fifty-five women completed the study. “Menstrual” migraine was defined as “migraine attacks which occur regularly on or between days -2 to +3 of the menstrual cycle and at no other time”. Using this criterion, 4 (7.2%) of the women in our population had “menstrual” migraine. All 4 women had migraine without aura. A further 19 (34.5%) had an increased number of attacks at the time of menstruation in addition to attacks at other times of the cycle. Eighteen (32.7%) had attacks occurring throughout the cycle but with no increase in number at the time of menstruation. Fourteen (25.5%) had no attacks within the defined period during the 3 cycles studied.

Discussion: A small percentage of women have attacks only occurring at the time of menstruation, which can he defined as true “menstrual” migraine. This group is most likely to respond to hormonal treatment. The group of 34.5% who have an increased number of attacks at the time of menstruation in addition to attacks at other times of the month could be defined as having “menstrually related” migraine and might well respond to hormonal therapy. The 32.7% who have attacks throughout the menstrual cycle without an increase at menstruation are unlikely to respond to hormonal therapy. The 25.5% who do not have attacks related to menstruation almost certainly will not respond to hormonal therapy.
Single Photon Emission Computed Tomography (SPECT) with 99mTc-HMPAO (Hexamethyl Propylenamino Oxime) in Chronic Paroxysmal Hemicrania-A Case Report
Authors: Schlake Hans-Peter , Böttger Ingolf Gerhard , Grotemeyer Karl-Heinz , Husstedt Ingo Wilhelm , Schober Otmar
Published: March 2003

The case of a 69–year-old woman with chronic paroxysmal hemicrania (CPH) is presented in whom cerebral perfusion was investigated using the flow tracer 99m Tc-hexamethyl propylenamino oxime (HMPAO) and single photon emission tomography (SPECT). There was a bilateral hypoperfusion in the fronto-parietal region between attacks-without medication as well as under effective treatment with verapamil. During an attack, however, SPECT investigation showed a normal cerebral perfusion. Further investigation is required to find out whether these SPECT findings are due to primary alterations of brain perfusion in CPH or are only of epiphenomenological nature. The observed effectiveness of verapamil in the prophylactic treatment of CPH should be verified in a greater number of patients.
Event-Related Slow Potentials and Associated Catecholamine Function in Migraine
Authors: Nagel-Leiby Sandra , Welch KMA , D'Andrea Giovanni , Grunfeld Saul , Brown Eileen
Published: March 2003

Plasma norepinephrine and dopamine and event-related slow potentials were measured at menses and ovulation in migraine with and without aura relative to normal subjects. The results indicated that at menses, but not ovulation, plasma dopamine was increased and norepinephrine was decreased relative to normal. This catecholamine imbalance was greater in migraine without aura than in migraine with aura. Conversely, event-related slow potentials measured over the posterior cortex at ovulation but not at the menses was altered relative to normal. Early epoch negativity was reduced in migraine with aura, whereas late epoch negativity was reduced in migraine without aura. The results suggested that (a) migraine without aura may involve dynamic shifts in the function of both norepinephrine and dopamine responsive neurons; (b) pathophysiology of migraine with aura is less dependent on catecholamine imbalance (norepinephrine alone affected); (c) these pathophysiological mechanisms are most prevalent in or restricted to posterior cortical regions but may be modulated by brainstem mechanisms.
Magnetic Resonance Imaging of The Brain in Patients With Migraine
Authors: Igarashi Hisaka , Sakai Fumihiko , Kan Shinichi , Okada Jun , Tazaki Yoshiaki
Published: March 2003

Magnetic resonance imaging (MRI) was studied in 91 patients with migraine and in 98 controls. Risk factors known to cause MRI lesions were carefully examined. In 36 patients with migraine (39.6%), small foci of high intensity on T2-weighted and proton-density-weighted images were seen in the white matter. Of patients with migraine who were less than 40 years old and without any risk factor, 29.4% showed lesions on MRI; this was significantly higher than the 11.2% for the group of age-matched controls ( n = 98). The lesions were distributed predominantly in the centrum semiovale and frontal white matter in young patients, but extended to the deeper white matter at the level of basal ganglia in the older age group. The side of the MRI lesions did not always correspond to the side of usual aura or headache. Migraine-related variables such as type of migraine, frequency, duration or intensity of headache or consumption of ergotamine showed no significant correlation with the incidence of MRI abnormalities. Our data indicated that migraine may be associated with early pathologic changes in the brain.
Anticardiolipin Antibodies in Cluster Headache
Authors: Hering R , Couturier EGM , Asherson RA , Steiner TJ
Published: March 2003

Antiphospholipid antibodies have occasionally been observed in migraine patients, but a recent study of a large series suggested the association was with other concurrent conditions, not specifically with migraine. We wondered about an association with other vascular headaches and measured anticardiolipin antibody levels in 20 cluster headache patients during the cluster period (three during an acute attack). Platelet counts were normal and VDRL negative in all patients. No elevated anticardiolipin antibody levels were found. There appears to be no important association between the presence of anticardiolipin antibodies and cluster headache, and we argue that there is no further rationale for seeking one.
Blood Flow Velocity Changes in Migraine Attacks-A Transcranial Doppler Study
Authors: Zwetsloot CP , Caekebeke JFV , Jansen JC , Odink J , Ferrari MD
Published: March 2003

A pulsed Doppler device was used to measure blood flow velocities in the common carotid artery, the extracranial part of the internal carotid artery, the external carotid artery, the middle cerebral artery, and the anterior cerebral artery in 31 migraineurs without aura ( n = 27) and with aura ( n = 4), both during and outside an attack. The aims were to compare blood flow velocity during and between migraine attacks and to study asymmetries of the blood flow velocity. Compared with blood flow velocity values obtained in the attack-free interval, blood flow velocity was lower during attacks without aura in both common carotid arteries, but not in the other extra- and intracranial vessels which were examined. However, during attacks of migraine with aura, blood flow velocity tended to be lower in all examined vessels. There were no asymmetries of the blood flow velocity. We suggest that during migraine attacks without aura there is a dissociation in blood flow regulation in the common carotid and middle cerebral arteries.
A Population-Based Analysis of the Diagnostic Criteria of the International Headache Society
Authors: Rasmussen Birthe Krogh , Jensen Rigmor , Olesen Jes
Published: March 2003

In 740 representative normal subjects a diagnostic headache interview and a neurological examination provided the necessary information to classify headache disorders according to the operational diagnostic criteria of the International Headache Society (IHS). Sixteen per cent (n = 119) had migraine, 78% (n = 578) tension-type headache. In migraineurs, pain was of a pulsating quality in 78%, severe in 85%, unilateral in 62%, and aggravated by routine physical activity in 96%. Tension-type headache was of a pressing quality in 78%, mild or moderate in 99%, bilateral in 90%, and 72% had no aggravation by physical activity. The accompanying symptoms of nausea, photo- and phonophobia occurred frequently and were usually moderate or severe in migraine subjects, and if present in subjects with tension-type headache, they were usually mild. Only two subjects had unclassifiable headache. The IHS Classification is thus exhaustive. The criteria may be improved by mandatory demands to the criterion of pain intensity leaving other features of pain as supportive for the diagnosis and by including graded severity of accompanying symptoms. A specific proposal is given.
Multiple Clinical and Paraclinical Analyses of Chronic Tension-Type Headache Associated or Unassociated With Disorder of Pericranial Muscles
Authors: Schoenen Jean , Gerard Pascale , Pasqua Victor De , Sianard-Gainko Jeannette
Published: March 2003

Thirty-two female patients fulfilling the diagnostic criteria of chronic tension-type headache underwent multiple clinical (severity index before and after biofeedback therapy; anxiety score) and paraclinical (pericranial EMG levels and pressure-pain thresholds, temporalis exteroceptive silent period) assessments. Twenty-three patients (72%) had at least one increased EMG level and/or at least one decreased pain threshold and qualified for the subgroup “associated with disorder of pericranial muscles” (code 2.2.1). Nine patients (28%) were within the normal range for both investigations and would have been classified in the subgroup “unassociated with such disorder” (code 2.2.2). No significant differences were found between these two groups of patients for headache severity, anxiety, response to biofeedback therapy or duration of temporalis second exteroceptive silent period. The various clinical and paraclinical parameters were not significantly correlated to each other. It is therefore suggested that the subdivision of chronic tension-type headache in two subgroups based on pericranial EMG levels and/or pain sensitivity might be artificial. Since both of the latter and temporalis silent periods vary independently, they appear complementary in the study of tension-type headache patients and probably represent peripheral abnormalities, which are induced to varying intensities by a common central nervous system dysfunction.
Platelet Glycine, Glutamate and Aspartate in Primary Headache
Authors: D'Andrea G , Cananzi AR , Joseph R , Morra M , Zamberlan F , Milone F Ferro , Grunfeld S , Welch KMA
Published: March 2003

Platelet levels of glutamic and aspartic acid and glycine were measured in patients with migraine with aura, migraine without aura, tension headache and cluster headache. High levels of these amino acids were found in patients with migraine with aura compared to normal subjects and other headache groups. During headache, glutamate levels further increased in migraine with aura patients. These findings may have relevance to the neurological symptoms of migraine with aura.
Some Clinical Comparisons Between Common and Classical Migraine: A Questionnaire-Based Study
Authors: Davies PTG , Peatfield RC , Steiner TJ , Bond RA , Rose F Clifford
Published: March 2003

In a questionnaire-based study we compared the clinical features of migraine with aura (classical migraine) and migraine without aura (common migraine) in 354 and 397 patients, respectively, attending The Princess Margaret Migraine Clinic. Other than those related to the aura, no significant differences were seen in any clinical features of the attack (e.g. frequency or duration of attacks, time of day at onset, location of headache at onset, severity of headache, or nausea and vomiting). Common migraine attacks were significantly more likely to occur at weekends ( p = 0.002). Dietary triggers tended to be more troublesome in classical migraineurs while pregnancy and the menstrual cycle affected both migraine types equally. Classical migraine patients were twice as likely to have a history of hypertension ( p < 0.05) and showed a slightly but not significantly greater tendency to depression. Family histories of migraine were similar in each migraine type. We conclude that classical and common migraine are fundamentally similar in their clinical characteristics and that the occurrence of focal neurological symptoms during a migraine attack has little influence on the rest of the attack.
Long-Term Results of Migraine Prophylaxis with Flunarizine and Beta-Blockers
Authors: Wöber Christian , Wöber-Bingöl Çiçek , Koch Gabriela , Wessely Peter
Published: March 2003

We followed-up 64 migraine patients after discontinuation of successful interval prophylaxis with flunarizine, propranolol or metoprolol, to investigate how long the therapeutic success would last, if further prophylaxis would be successful again, and what factors would influence the prognosis. We found that 16 out of 64 patients experienced a lasting reduction of migraine frequency, whereas 48 patients did improve initially, but later experienced a relapse. Further prophylaxis was effective in 29, poorly effective in 11, and ineffective in 8 of these patients; in 7 of the 8 non-responders prophylaxis was not changed. Negative prognostic factors were frequent attacks, a history of analgesic abuse and/or analgesic withdrawal therapy and ineffective previous prophylaxis. In conclusion, the therapeutic success decreases dramatically in the majority of patients several months after discontinuation of prophylaxis; further prophylaxis is more effective if the substance class is changed; increased analgesic intake is the most important prognostic factor. As a strategy for migraine prophylaxis we propose sequential changing of interval prophylaxis or -in patients with negative prognostic factors — long-term prophylaxis.
Brainstem Auditory Evoked Potentials in Migraine After Rausedyl Provocation
Authors: Bánk József
Published: March 2003

Brainstem auditory evoked potentials were recorded in 34 migraine patients (21 F and 13 M, mean age 37.4 ± 8.1 years) after Rausedyl (2.5 mg reserpine) provocation. Intramuscular injection of reserpine induces a typical headache in migrainous controls. The findings were compared with those of 40 healthy controls (25 F and 15 M with a mean age of 40 ± 8.9 years). We evaluated I, III, V and I-III, III-V, I-V peak and interpeak latencies. We did not find significant differences after provocation in the control group. In the migraine group, V waves were delayed significantly and consecutively I-V interpeak latencies were increased. Our results indicate an impairment of the rostral brainstem function after reserpine provocation in migraine patients.
Serum and Salivary Magnesium Levels in Migraine and Tension-Type Headache. Results in a Group of Adult Patients
Authors: Sarchielli Paola , Coata Giuliana , Firenze Caterina , Morucci Piero , Abbritti Giuseppe , Gallai Virgilio
Published: March 2003

It has been suggested that magnesium plays a central role in different etiopathogenetic conditions involved in the onset of migraine. We measured, by atomic absorption spectrophotometry, serum and salivary magnesium levels in drug-free migraine patients with and without aura and in tension-type headache patients. Migraine sufferers with and without aura and tension-type headache had significantly lower levels of serum and salivary magnesium concentrations in the interical periods than a group of healthy young individuals. Serum magnesium levels tended to be further reduced during attacks in all patient groups studied. A statistically significant decrease in salivary magnesium levels was evident only for migraine patients with aura. Serum magnesium levels and to a lesser extent salivary magnesium levels might express indirectly the lowering of brain extracellular magnesium concentration which occurs in migraine patients both in the intererictal periods and ictally.