bluuebunny/crossref_metadata_2025 huggingface dataset:
Common Headaches: Type, Duration, Frequency and Implications
Authors: Blau J. N.
Published: May 2005

SYNOPSIS

Questionnaires completed by 327 preclinical medical and dental students showed that 97.9% had experienced headaches, most frequently attributed to insufficient sleep (38.8%), mental stress (38.8%), alcohol (38.5%), excess heat (36.7%), reading (31.5%), excess noise (29.9%) or light (27.7%), and sleeping too long (23.5%). The frequency and duration of these and other headaches are listed. 8% of the headache group had consulted a doctor. Only 2.1% of all students had never experienced a headache.

Two hypotheses are examined: (1) can headaches be normal?‐delineated by their disappearing soon after the noxious stimulus has ceased; (2) can pain in the head, as elsewhere in the body, act as a warning and therefore have protective, even survival value?
Naproxen Sodium in Menstrual Migraine Prophylaxis: A Double‐Blind Placebo Controlled Study
Authors: Sances G. , Martignoni E. , Fioroni L. , Blandini F. , Facchinetti F. , Nappi G.
Published: May 2005

SYNOPSIS

In this study, the efficacy of Naproxen sodium (Nxs) in the prophylaxis of Menstrual Migraine (MM) was tested, versus Placebo (PL). Forty women suffering from MM were admitted to a double‐blind treatment protocol with Nxs 550 mg twice each day by mouth or Placebo (PL), for 3 months; in the next 3 months all the women were treated with the active drug in an open study. The headache intensity and duration, as well as the number of days of headache and the analgesic consumption, were significantly reduced with Nxs compared to PL.

The efficacy of Nxs, shown also in improving premenstrual pain, and its good tolerability, support the use of this drug in the prophylactic therapy of MM.
A Comparative Study of Naproxen Sodium, Pizotyline and Placebo in Migraine Prophylaxis
Authors: Bellavance André J. , Meloche Jacques R
Published: May 2005

SYNOPSIS

318 patients satisfying the Ad Hoc Committee's criteria for common or classical migraine were entered into an 8 week single‐blind placebo recording phase to establish, by diary cards, the frequency and severity of their attacks. 176 patients completed this and had records indicating 4–8 episodes in the 8 week period, with sufficient severity to reduce activity and/or work; these patients wore randomized by a predetermined code, into three double‐blinded groups: naproxen sodium 550 mg bid (60 patients), pizotyline 0.5 mg tid (59 patients), or placebo (57 patients). The patients wore followed at monthly intervals for 12 weeks, with 25 dropping out (3 on naproxen sodium, and 2 each on pizotyline and placebo because of “side effects;” the remaining 18 because of noncompliance or reasons unrelated to therapy). Approximately 25% of patients in each of the 3 groups complained of side effects.

Statistical analysis showed that both naproxen sodium and pizotyline were better than placebo, and of overall equivalent (i.e. equal) efficacy in the prophylaxis of migraine. In some respects, naproxen sodium was slightly more effective than pizotyline in the first month of treatment.
Cervicogenic Headache: Diagnostic Criteria
Authors: Sjaastad O. , Fredriksen T.A. , Pfaffenrath V.
Published: May 2005

SYNOPSIS

Criteria for the diagnosis of cervicogenic headache are proposed, which include unilateral head pain, symptoms and signs of neck involvement, non‐clustering episodic moderate pain originating in the neck then spreading to the head, and response to root or nerve blockade; plus rarer and non‐obligatory features such as autonomic disturbances, dizziness, phonophotophobia, monocular visual blurring, and difficulty swallowing.
Angiographic Changes Suggestive of Vasospasm in Migraine Complicated by Stroke
Authors: Spierings Egilius L.H.
Published: May 2005

SYNOPSIS

A 30‐year‐old woman with a history of common migraine developed a permanent left homonymous hemianopia during a typical headache. CT scan demonstrated a right posterior cerebral infraction and angiography showed irregular narrowing of the ipsilateral posterior cerebral artery, suggestive of vasospasm. In the case no risk factors for atherosclerotic stroke were present except for smoking, and no other causes of stroke could be found.
The Headache‐Specific Locus of Control Scale: Adaptation to Recurrent Headaches
Authors: Martin Nancy J. , Holroyd Kenneth A. , Penzien Donald B.
Published: May 2005

SYNOPSIS

This paper describes the development, psychometric properties, and construct and incremental validity of a Headache‐Specific Locus of Control Scale (HSLC). The HSLC is a 33 item scale designed specifically for recurrent headache sufferers. It assesses the individual's perceptions that headache problems and headache relief are determined primarily by: the individual's behavior (Internal factors), Health Care Professionals, or Chance factors. The psychometric properties of the HSLC were satisfactory. Among our findings were that: (1) the belief that headache problems and relief are determined by chance factors was associated with higher levels of depression, physical complaints, reliance on maladaptive pain coping strategies ( p < .001), and greater headache‐related disability ( p <.01); (2) the belief that headache problems and relief are influenced primarily by the ministrations of health care professionals was associated with higher levels of medication use ( p <.01) and preference for medical treatment ( p <.001); and (3) the belief that headache problems are determined by the individual's responses and behaviors was associated with a preference for self‐regulation treatment ( p <.01). These findings suggest adaptation to headache problems is influenced not only by the frequency and severity of the headache episodes, but by locus of control beliefs. The assessment of locus of control beliefs may provide useful information not typically obtained from standard medical evaluations.
Treatment of Status Migrainosus: The American Experience
Authors: Raskin Nell H.
Published: May 2005

SYNOPSIS

Dependence upon a variety of drugs ‐ ergotamine, analgesics, benzodiazepines, corticosteroids ‐is a major reason for patients to enter an intractable phase of their migrainous disorders. Repeated dosing of dihydroergotamine has proven to be remarkably effective in stabilizing the mechanism of migraine, allowing these patients to make the transition to a more reasonable as well as more specific form of therapy.
Sumatriptan in Acute Migraine: Pharmacology and Review of World Experience
Authors: Peroutka Stephen J.
Published: May 2005

SYNOPSIS

The introduction of sumatriptan, a novel abortive anti‐migraine agent, has generated a significant amount of preclinical and clinical interest during the past few years. At the scientific level, sumatriptan is unique in terms of its selective pharmacological properties. The effects of sumatriptan in various experimental paradigms have led to new insights into the pathophysiology of migraine. At the clinical level, sumatriptan appears to be an effective abortive anti‐migraine agent with minimal side effects. Its ability to decrease, rather than exacerbate, the nausea and vomiting of migraine appears to be an important advance in the treatment of migraine.
Psychophysiological Parameters of Migraine and Muscle‐Contraction Headaches
Authors: Lichstein Kenneth L. , Fischer Suzanne M. , Eakin Terry L. , Amberson Janis I. , Bertorini Tulio , Hoon Peter W.
Published: May 2005

SYNOPSIS

Previous headache studies have been unable to verify the presumed presence of headache. Attempting to correct this design fault, the present study assessed four psychophysiological measures (frontalis EMG, temporal BVP, temporal and finger skin temperature) and salient subjective measures in 13 migraineurs, eight muscle‐contraction headache sufferers, and 13 age‐matched normals. All subjects submitted to two 30‐minute sessions of quiet monitoring, and for the headache subjects, one of the sessions was headache active. A bogus, but convincing preliminary ”assessmentldquo; revealed insufficient headache activity in the headache active session, forcing subjects to reschedule that session in the future when a strong headache was present. A parallel manipulation was employed with the normal subjects. A MANOVA failed to discriminate within‐ or between‐group differences on the psychophysiological measures. Self‐reported pain was uncorrelated with the psychophysiological indices. These results cast further doubt on the validity of the psychophysiological measures employed in this study, the same ones routinely endorsed by headache researchers and therapists. We discuss problems of recruitment, compliance, and attrition in basic headache research.
The Role of Family Structure, Functioning, and Pain Modeling in Headache
Authors: Ehde Dawn M. , Holm Jeffrey E. , Metzger Dana L.
Published: May 2005

SYNOPSIS

In an initial attempt to examine relationships between family functioning and chronic headache disorders, the present study examined: a) family structure characteristics, b) family functioning, and c) family pain modeling. Subjects completed an assessment battery consisting of several measures of family functioning. Analyses showed that migraine sufferers (N = 42) as compared to headache‐free controls (N=59) were more likely to describe their families as emphasizing clear organization, structure, rules, and overall control, but less likely to encourage emotional expression. No differences were found between tension headache subjects (N = 43) and headache‐free controls. While only an initial exploration of the importance of family characteristics in chronic headache, these results suggest that there are important differences in headache subjects' (particularly migraine) reports of family environment and functioning.
Bioelectrical Impedance Assay (BIA) of Total Body Composition in Alcohol‐Induced Migraine Patients. Preliminary Report.
Authors: Martelletti P. , Andreoli A. , Bernoni R.M. , Sabato F. Di , Del Bolgia F , Baldi A. , Sasso G.F. , Bare R , De Lorenzo A. , Giacovazzo M.
Published: May 2005

SYNOPSIS

“Whole body composition” was investigated in 30 people subject to alcohol‐induced migraine. The control group was 30 people matched for age, sex, height and weight, who were not subject to migraine and who consumed moderate amounts of alcohol. The following were evaluated: anthropometric data, alcohol intake in grams per day, total body water, fat‐free mass, fat mass, and body mass index (kg/m 2 ). Two methods of measurement were used: skin fold thickness evaluation, and bioelectric impedance assay (BIA). BIA is a non‐invasive method based on the principle that lean tissues conduct a low frequency alternating current of electricity better than do fatty tissues.

Body mass index was increased in the alcohol‐induced migraine patients (p<0.04), as was fat mass, (p<0.03) as evaluated by skin fold measurements. Bioelectric impedance assay demonstrated a slight total body water increase in alcohol‐induced migraine patients (p<0.07).

Possibly, if this total body water increase was reflected at the neuronal level, the bioelectric properties of the migrainous brain may be altered, thus creating a hypothetical link with the phenomenon of spreading depression.
Recurrent Prolonged Coma Due to Basilar Artery Migraine. A Case Report.
Authors: Frequin S.T.F.M. , Linssen W.H.J.P. , Pasman J.W. , Hommes O.R. , Merx H.L.
Published: May 2005

SYNOPSIS

A 25 year old patient presented with recurrent prolonged episodes of life‐threatening coma varying from 3 to 10 days. The clinical recovery was slow. The history and technical examinations led to the diagnosis of basilar artery migraine (BAM).

The etiology of the coma episodes is thought to be related to ischemic dysfunction of the rostral part of the brainstem due to severe spasm of the basilar artery demonstrated by arteriography.

Exceptional are the recurrent prolonged coma episodes of sudden onset, the severe spasm of the basilar artery, and the suppression‐burst and FIRDA pattern on the EEG examinations during the coma episodes.
On Pain Mechanisms in Cluster Headache
Authors: Hardebo Jan Erik
Published: May 2005

SYNOPSIS

Various possible pathophysiological mechanisms to explain the pain in cluster headache are reviewed. Several locations for the initiation of pain along the primary afferent pathways in cranial nerves are discussed, together with the local mechanisms that might be responsible. These include neurogenic inflammation of large cranial vessels, irritation of vascular pain fibres by compression of dilated vessels in bony canals, and irritative foci in or around cranial sensory ganglia. In particular, recent neuroanatomical and pharmacological findings on nociceptive innervation of the intracranial segment of the internal carotid artery are commented upon. The possibilities for referred pain to explain the location of pain is illustrated. Evidence for involvement of central pain modulatory systems in the pain production is discussed. Finally a synthesis is made of the probable peripheral and central pain mechanisms in the disease.
MSG and Hydrolyzed Vegetable Protein Induced Headache: Review and Case Studies
Authors: Scopp Alfred L.
Published: May 2005

SYNOPSIS

Monosodium glutamate (MSG), an established headache trigger, has become far more prevalent in canned, packaged and prepared foods over the past decade. The presence of MSG in food may be difficult to detect since the terms “natural flavor,”“flavoring,” or “hydrolyzed vegetable protein (HVP),” all may appear on food labels to refer to MSG, according to current FDA food labeling code. HVP typically contains 10–30% MSG.

Case studies are presented in which the elimination of all food sources of MSG resulted in decreased headache frequency. Information and food lists helpful in identifying dietary MSG and HVP are presented. When patients are put on an MSG‐free trial diet, mention needs to be given to identification of the wide variety of foods containing MSG and HVP.
The Relationship Between MMPI Cluster Membership and Diagnostic Category in Headache Patients
Authors: Robinson Michael E. , Geisser Michael E. , Dieter John N. , Swerdlow Bernard
Published: May 2005

SYNOPSIS

Only one study has examined MMPI cluster profiles in the headache population. The present study expanded on this previous investigation by using a large sample size (N=485) and a greater number of diagnostic categories. The five MMPI clusters replicated previous findings in the chronic pain literature. These MMPI cluster groups were compared to 5 diagnostic categories (migraine, cluster, post‐trauma, tension, mixed). No relationship was found between cluster type and headache diagnosis. While the diagnostic groups were found to differ on measures of pain severity, sex and age, cluster groups did not. It is proposed that MMPI scale types reflect a patient's response to pain and are more likely to be the result of coping resources than headache‐related personality style. Future research with additional, non‐painpopulations and prospective studies is suggested.
The Association of Frequent Headaches with Personality and Life Events
Authors: Passchier J. , Schouten J. , van der Donk J. , van Romunde L.K.J.
Published: May 2005

SYNOPSIS

The associations between personality traits, life events and frequent headaches were studied in a sample of 5766 adult subjects between 20 and 65 years of age from the general population. Subjects with at least weekly headaches had more life events and higher inadequacy, social inadequacy, rigidity and injuredness than subjects with less frequent headaches. These relationships were not observed in subjects of 50 years of age and older, with the exception of the association with inadequacy. From the traits measured, inadequacy had the highest odds ratios for frequent headaches and showed a modest interaction with the presence of a life event. These findings are in agreement with Sarason's interactional model.
Sexual Headaches: Case Report, Review, and Treatment with Calcium Blocker
Authors: Akpunonu Basil E. , Ahrens JoDee
Published: May 2005

SYNOPSIS

A case is reported in which a patient with sexual and orgasmic headaches was treated successfully with a calcium channel blocker, diltiazem. To the best of our knowledge, this is the first case of successful treatment of sexual headaches with calcium channel blockers reported in the English medical literature. The literature on sexually related headaches is reviewed, and classification, evaluation, differential diagnosis, pathophysiology, differential diagnosis, and treatment of sexual headaches are discussed.
The Effect of Hyperventilation in Cluster Headache Patients
Authors: Antonaci Fabio , Zhao Jing‐Ming , Schaanning Jan , Sand Trond , Sjaastad Ottar
Published: May 2005

SYNOPSIS

The effect of voluntary hyperventilation was assessed in 22 cluster headache patients (8 in a cluster period and14 in a remission) and 19 healthy individuals. Using an ear oximeter and a capnograph with a nasal probe, the oxygen saturation (SaO2) and the end‐tidal CO2 were monitored continuously. During the hyperventilation per se, cluster headache patients and controls showed absolute values of end‐tidal CO2 and of SaO2 Of the Same order of magnitude. In the posthyperventilation phase, however, the average of the lowest SaO2 levels was lower in controls than in cluster headache patients. In the posthyperventilation phase, headache patients outside the cluster period showed a trend more similar to that of the controls with respect to SaO2 than did those inside the cluster period. The observed discrepancy might, if reproducible, be a consequence of an altered chemoreceptor sensitivity in cluster headache patients during the bout.
Plasma and Saliva Levels of PGI2 and TXA2 in the Headache‐Free Period of Classical Migraine Patients. The Effects of Nicardipine
Authors: Puig‐Parellada R , Planas J,M. , Giménez J. , Sánchez J. , Gaya J. , Tolosa E. , Obach J.
Published: May 2005

SYNOPSIS

The levels of Prostacyclin (PGI2 ) and Thromboxane A2 (TXA2 ) were assayed simultaneously (RIA) in the plasma and saliva of 9 patients suffering from classical migraine attacks. The assays were done during an attack‐free period. In relation to the control group we observed a significant decrease in the plasma levels of PGI2 together with a sharp increase in TXA2 in saliva. When the patients were treated with nicardipine, a calcium antagonist, the TXA2 increase in saliva did not occur. These results suggest both a systemic and local effect in the classical migraine attacks. We explain and discuss our results by referring to the PGI2 : TXA2 equilibrium system. Nicardipine action might be related to its ability to reduce the calcium entry into the cell induced by thromboxane.
Trigeminal Neuralgia Secondary to Tumor With Normal Exam, Responsive to Carbamazepine
Authors: Metzer W. Steven
Published: May 2005

SYNOPSIS

Trigeminal neuralgia is most commonly idiopathic, although it can be associated with multiple sclerosis. Tumors are rare causes of trigeminal neuralgia. A case is presented of trigeminal neuralgia with normal neurological examination and responsive to carbamazepine, secondary to a cerebellopontine angle meningioma.Literature relative to neoplastic etiologies of trigeminal neuralgia is reviewed. The role of electrodiagnostic testingin the evaluation of trigeminal neuralgia is considered. A normal neurological examination and responsiveness to carbamazepine do not exclude tumor as an etiology of trigeminal neuralgia.
Jolt Accentuation of Headache: The Most Sensitive Sign of CSF Pleocytosis
Authors: Uchihara Toshiki , Tsukagoshi Hiroshi
Published: May 2005

SYNOPSIS

We prospectively examined the clinical signs of 54 febrile patients associated with recent‐onset headache. They underwent lumbar puncture (LP) on suspicion of meningitis. The relation of each sign to cerebrospinal fluid (CSF) pleocytosis was estimated. Among 34 patients with pleocytosis, 33 had jolt accentuation(sensitivity: 97.1%), while only 5 of them had neck stiffness or Kernig's sign. Among 20 patients without pleocytosis, 12 had no jolt accentuation (specificity: 60%). We found jolt accentuation to be the most sensitive sign of CSF pleocytosis. If jolt accentuation is noted in a febrile patient associated with recent onset headache, the CSF should be examined even in the absence of neck stiffness or Kernig's sign.
Recurrent Classic Migraine Attacks Following Transdermal Scopolamine Intoxication
Authors: Gordon Carlos R. , Mankuta David , Shupak Avi , Spitzer Orna , Doweck Iiana
Published: May 2005

SYNOPSIS

A 20 year old male naval crew‐member suffering from sea sickness was treated with transdermal scopolamine (TS).After 5 months of continuous treatment, he developed scopolamine intoxication followed by the appearance of recurrent classic migraine attacks. He had never suffered from headache or migraine prior to TS intoxication. The migraine attacks comprised a prodrome of apathy, bad mood and loss of appetite lasting several hours. An aura of scintillating spots, left arm numbness and paresthesias lasting several minutes was followed by a severe throbbing unilateral headache with photo‐phobia, sonophobia and nausea. After one year of repeated follow‐up examinations, he continued to suffer from the attacks once every 10 to 14 days, with no identified precipitating factors.

We are not aware of similar cases in the medical literature. Although it is not possible to establish TS intoxication as a causal effect of the appearance of classic migraine in our patient, the temporal association and clinical course are very supportive of this assumption. Central nervous system neurotransmitter imbalance or cardiovascular alterations may possibly be implicated.
Short‐lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection, Tearing, etc. (SUNCT): III. Another Norwegian Case
Authors: Sjaastad O. , Zhao J.M. , Kruszewski P. , Stovner L.J.
Published: May 2005

SYNOPSIS

“SUNCT” is a recently reported head pain syndrome characterized by short lasting, unilateral neuralgiform paroxysms with conjunctival injection and tearing, and to a lesser extent nasal secretion, and (subclinical)sweating. Another case‐ that of a 56 year old male‐is reported herein. The attacks lasted 1/2–1 min. and occurred only infrequently, i.e. once or twice in 1–4 weeks, except for a week recently when there were up to 20 or more typical attacks per day, with the usual ipsilateral, autonomic accompaniments. Due to the benign nature and low frequency of attacks, the diagnosis would have been most difficult to establish prior to the occurrence of this short lasting period with more marked symptoms. A variety of precipitation mechanisms were present, partly concerning the V 2–3 areas, partly concerning the neck. Precipitation mechanisms in “SUNCT” to some extent seem to differ from those in trigeminal neuralgia. It is remarkable that all four hitherto reported cases are males.
Migraine ‐ Why and How a Cortical Excitatory Wave May Initiate the Aura and Headache
Authors: Hardebo Jan Erik
Published: May 2005

SYNOPSIS

A large number of clinical and neurophysiological observations are reviewed that clearly indicate that the symptoms of migraine aura result from a spread of an excitatory wave along the cortex from a primary focus. This excitation may start as a consequence of information overload to a low threshold cortical area. The transient neuronal excitation is followed by a long‐lasting period of reduced cortical flow, which involves a substantial component of active constriction of resistance vessels, even persisting for several hours during the headache phase. When the excitatory wave has reached and activated free pain fiber endings in sufficiently many cortical vessels, off‐branching peripheral motor endings of these fibers may become activated via axon reflexes. These motor endings may be located in cortical microvessels or in small vessels around large dural vessels. This leads to a neurogenic inflammation in the vessel walls, experienced as headache by the sufferer. The wall of dural sinuses offers a rational explanation for the beneficial effect of most medications used in migraine.
Cerebral Hyperemia During Spontaneous Cluster Headaches With Excessive Cerebral Vasoconstriction to Hyperoxia
Authors: Kawamura Jan , Meyer John Stirling , Terayama Yasuo , Weathers Susan
Published: May 2005

SYNOPSIS

Values for local cerebral blood flow (LCBF) were measured in three dimensions utilizing xenon enhanced computerized tomography among patients during spontaneously occurring cluster headaches, during headache‐free intervals and immediately after terminating attacks by inhalation of 100% oxygen. Results were compared with values measured among age‐matched normal volunteers. LCBF values measured in five cluster patients while headache‐free did not differ from similar measures among age‐matched normal volunteers. In three patients during attacks of spontaneously occurring cluster headache, LCBF values for temporal cortex, basal ganglia and subcortical white matter were increased. Immediately after terminating attacks of cluster by 100% oxygen inhalation for five minutes, LCBF values for temporal cortex and basal ganglia became significantly decreased below normal values in five patients with spontaneously occurring cluster headache. Prompt relief of head pain by inhalation of 100% oxygen is associated with abolition of the hyperperfusion of both cortical and subcortical brain structures that occurs during spontaneously occurring cluster headaches and is followed by excessive cerebrovascular constriction. It remains to be determined whether the cerebral hyperemia occurring during cluster headaches is causally related to the head pain or is secondary to the pain itself. Rapid termination of head pain by hyperoxia associated with excessive cerebral vasoconstriction suggests that this vascular phenomenon is unique to cluster headache and offers clues to its pathogenesis.
Claudication: An Unusual Side Effect of DHE Administration
Authors: Schulman Elliott A. , Rosenberg Scott B
Published: May 2005

SYNOPSIS

DHE is effective in the treatment of acute and chronic migraine. The side effects most commonly observed are abdominal discomfort, muscle pain, diarrhea and anxiety.

DHE is a dehydrogenated amino acid ergot alkaloid and, as such, causes only limited vasoconstriction; indeed, its overall effects include peripheral vasodilatation.

The literature is replete with reports of clinical vasospasm and claudication occurring with therapeutic doses of ergotamine. There has not been any previous description of claudication caused by DHE.

This paper describes pulselessness in two patients during relatively short courses of DHE. Treatment consisted of calcium channel blockers and discontinuation of DHE. Recovery was complete.
Atypical MRI Findings of Venous Sinus Thrombosis in Pregnancy: Clinical Significance Relating to Episodic Vascular Headache
Authors: Turkewitz L. Jay , Jacobs Alan K. , Bidwell J. Keith
Published: May 2005

SYNOPSIS

Two cases of headache during pregnancy were associated with MRI findings suggestive of venous sinus thrombosis. The findings, however, were atypical, and of uncertain clinical significance. Venous sinus thrombosis typically does not occur during the first and second trimesters (less than 10 percent of reported cases). Thus, these two cases are doubly unusual. The correct significance of these equivocal MRI findings of possible venous sinus thrombosis must be understood so that unnecessary and potentially harmful therapies are not employed, and so that appropriate management of what may otherwise be a typical vascular headache syndrome may be undertaken.
Psychological Changes Accompanying Non‐Pharmacological Treatment of Chronic Headache: The Effects of Outcome
Authors: Blanchard Edward B. , Steffek Bruce D. , Jaccard James , Nicholson Nancy L.
Published: May 2005

SYNOPSIS

Several prior studies suggest that non‐drug treatment for chronic headache is accompanied by concomitant reductions in patients' anxiety, depression and somatization. It is currently unclear, however, whether such beneficial side effects are a function of degree of headache relief or are due simply to receiving treatment. Most work to date in this area has treated outcome as a dichotomous variable. The present report employed a regression approach which treats outcome (degree of headache relief) as a continuous variable in the study of 149 chronic headache patients and their accompanying psychological changes. Anxiety and depression were significantly reduced for headache patients regardless of degree of headache relief. With somatization, however, degree of headache relief had a significant effect; the greater the reduction in headache, the fewer somatic concerns were expressed, especially for mixed headache.
First Clinical Study of the Selective 5‐HT3 Antagonist, Granisetron (BRL 43694), in the Acute Treatment of Migraine Headache
Authors: Couturier E.G.M. , Hering R. , Foster C.A. , Steiner T.J. , Rose F. Clifford
Published: May 2005

SYNOPSISGranisetron (BRL 43694), a selective 5‐HT3 receptor antagonist, was assessed as acute therapy for the first time in migraine patients. In an open pilot study 7 migraine attacks were treated in 6 patients. All but I patient experienced marked and rapid relief from the headache, and nausea and vomiting were rapidly resolved in the 6 cases where these symptoms accompanied the attack. No side effects were recorded. Development of granisetron for migraine was suspended during the study for extraneous reasons.
Magnesium Prophylaxis of Menstrual Migraine: Effects on Intracellular Magnesium
Authors: Facchinetti Fabio , Sances Grazia , Borella Paola , Genazzani Andrea R. , Nappi Giuseppe
Published: May 2005

SYNOPSIS

The effects of oral Magnesium (Mg) pyrrolidone carboxylic acid were evaluated in 20 patients affected by menstrual migraine, in a double‐blind, placebo controlled study. After a two cycles run‐in period, the treatment (360 mg/day of Mg or placebo) started on the 15th day of the cycle and continued till the next menses, for two months. Oral Mg was then supplemented in an open design for the next two months. At the 2nd month, the Pain Total Index was decreased by both Placebo and Mg, with patients receiving active drug showing the lowest values (P<0.03). The number of days with headache was reduced only in the patients on active drug. Mg treatment also improved premenstrual complaints, as demonstrated by the significant reduction of Menstrual Distress Questionnaire (MDQ) scores. The reduction of PTI and MDQ scores was observed also at the 4th month of treatment, when Mg was supplemented in all the patients. Intracellular Mg++ levels in patients with menstrual migraine were reduced compared to controls. During oral Mg treatment, the Mg++ content of Lymphocytes (LC) and Polymorphonucleated cells (PMN) significantly increased, while no changes in plasma or Red Blood Cells were found. An inverse correlation between PTI and Mg++ content in PMN was demonstrated. These data point to magnesium supplementation as a further means for menstrual migraine prophylaxis, and support the possibility that a lower migraine threshold could be related to magnesium deficiency.
Decreased Serum Interleukin‐2 Level in Patients With Chronic Headache
Authors: Shimomura Tokio , Araga Shigeru , Esumi Eisaku , Takahashi Kazuro
Published: May 2005

SYNOPSISSome cellular immune functions are impaired in cluster headache patients. Interleukin‐2 (IL‐2) is a polypeptide secreted by antigen or mitogen‐actuated T lymphocytes that functions as a growth factor for T cells. To investigate cellular immune functions in patients with chronic headache, we measured the IL‐2 concentration of sera in patients with migraine and in patients with tension‐type headache. Thirteen subjects suffering from migraine without aura (5 males and 8 females, mean age: 32.8 years) and 46 subjects (20 males and 26 females, mean age: 39.7 years) with tension‐type headache (TH) were selected for this study. Forty‐three normal healthy volunteers composed the control group (15 males and 28 females, average age 41.6 years}. The IL‐2 levels of sera were determined using enzyme‐linked immunosorbent assay (ELISA) techniques. The IL‐2 levels of sera were 3.18±1.8 U/ml (mean±SD) in the healthy controls, 2.29±2.6 U/ml in the patients with migraine and 1.59±1.0 U/ml in the patients with TH. The serum level of IL‐2 in the patients with migraine was significantly lower than in the controls. The serum level of IL‐2 in the patients with TH was significantly lower than in the controls. The central nervous system (CNS) has been considered to be involved in the development of the immune phenomena. In the patients with TH or migraine, reduction in platelet 5‐hydroxytryptamine (5‐HT) levels and sympathetic hypofunction have been observed. These phenomena might reflect decrease in 5‐HT levels in CNS in the patients with TH or migraine. The decreased serum IL‐2 level, observed in this study, might reflect a reduction in 5‐HT or catecholamine levels in CNS in the patients with migraine or TH.
Headache Syndromes as Detected by Configural Frequency Analysis
Authors: Koehler Thomas , Dulz Kay , Buck‐Emden Eckart
Published: May 2005

SYNOPSIS

Data on headache symptoms obtained in two samples (N=422 and 304) by means of questionnaires were subjected to configural frequency analysis (CFA). This not widely‐known method tests whether certain symptom combinations appear more often or less often than expected by chance. In both samples symptom combinations corresponding to the syndromes of migraine with aura, migraine without aura and tension headache did indeed occur with significant frequency. The same clear‐cut symptom patterns appeared when patients with preceding visual disturbances were excluded from analysis. These results seem to lend strong support to a categorical model of headache, rather than to the concept of headache as a spectrum.
The Impact of Cigarette Smoking on Headache Activity in Headache Patients
Authors: Payne Thomas J. , Stetson Barbara , Stevens Vivian M. , Johnson Cheryl A. , Penzien Donald B. , Van Dorsten Brent
Published: May 2005

SYNOPSIS

The present study was designed to explore the relationship between cigarette smoking and headache activity in a sample of patients presenting for treatment. Subjects completed various self‐report measures and monitored headache activity four times per day over a 4‐week period. Analyses revealed that smokers experienced greater weekly peak headache intensity, and reported higher levels of depression and general physical symptoms. Among smokers, nicotine content of the preferred brand was associated with mean headache index and weekly headache‐free days, as well as depression and anxiety scores. Daily smoking rate and pack‐year history were related to level of general physical symptoms only. Thus, both smoking status and the nicotine content of the preferred cigarette appear to adversely impact headache activity. Further, smokers who are more anxious or depressed may increase their headache activity via their preference for higher nicotine‐content cigarettes. These results are discussed in the context of possible mechanisms underlying these effects, and implications for the clinical management of headache sufferers who smoke. Key words: cigarette smoking, headaches.
Propranolol in the Management of Recurrent Migraine: A Meta‐analytic Review
Authors: Holroyd Kenneth A. , Penzien Donald B. , Cordingley Gary E.
Published: May 2005

SYNOPSIS

We used meta‐analytic statistical techniques to synthesize findings from studies that evaluated propranolol HCI for the prevention of recurrent migraine (2,403 treated patients). The modal migraine sufferer treated in these studies was a female, about 37 years of age, who suffered from common (rather than classical) migraines and reported a 17‐year history of problem migraines. The modal treatment was 160 mg. propranolol per day. Meta‐analysis revealed that, on average, propranolol yielded a 44% reduction in migraine activity when daily headache recordings were used to assess treatment outcome, and a 65% reduction in migraine activity when less conservative measures (e.g., clinical ratings of improvement, global patient reports) were used. Meta‐analysis thus revealed substantial support for short‐term effectiveness of propranolol. However, little information was available concerning the long‐term effectiveness of propranolol.
Criteria for the Diagnosis of Migraine in Clinical Practice
Authors: Solomon Seymour , Lipton Richard B.
Published: May 2005

SYNOPSIS

Criteria for the diagnosis of migraine have evolved from generalized descriptions to specific rules designed to ensure the selection of homogenous groups of patients for research studies. For clinical practice, the former are insufficiently specific and the latter are too complex. For care of headache patients by primary care physicians, we propose that the diagnosis of migraine without aura (common migraine) is war‐rented if any two of the following symptoms are present: unilateral site, throbbing quality, nausea, photophobia or phonophobia. These criteria are derived from a study comparing the features of 100 patients with migraine without aura and 100 patients with chronic daily headache. The proposed criteria for the diagnosis of migraine without aura were highly sensitive and adequately specific in discriminating groups. These simple criteria should facilitate the diagnosis of migraine by primary care physicians.
Flunarizine in Migraine: A Minireview
Authors: Leone Massimo , Grazzi Licia , Mantia Loredana La , Bussone Gennaro
Published: May 2005

SYNOPSIS

Flunarizine is a non‐selective calcium antagonist. It distributes preferentially in the adipose tissue and passes the blood brain barrier. Numerous controlled clinical studies have established that flunarizine is efficacious in migraine prophylaxis, including double‐blind studies in which the drug was compared with placebo or other antimigraine drugs. To avoid side effects a special schedule or administration is necessary. Flunarizine has no myogenic effect on smooth muscle cells of the vessles. It is said to be the only calicum antagonist able to protect brain cells against hypoxic damage. In addition, the considerable body of information which shows flunarizine capable of directly influencing the central nervous system, suggests that the drug's anti‐migraine action may depend on its ability to influence central phenomena.
Visual Evoked Potentials and Background EEG Activity in Migraine
Authors: Dijk J.G. van , Dorresteijn M. , Haan J. , Ferrari M.D.
Published: May 2005

SYNOPSIS

To investigate whether quantification of the background EEG during a visual evoked potential (VEP) study is of value for the diagnosis of migraine we studied 8 unmedicated migraineurs between attacks, and 10 age‐matched controls. Three paradigms were used: the first two concerned pattern‐reversal VEPs with different analysis times (500 and 1500 ms), and in the third paradigm the pattern did not reverse. Power spectra were calculated for individual responses, and the delta, theta, alpha and beta areas of the averaged spectre were noted as indicators of background reactivity.

Alpha and beta powers were consistently but not significantly higher in the migraine group. The difference was too small to be of value as a diagnostic test. Alpha power was (not significantly) lower in the presence of photic stimulation than in its absence. As this was the case in both groups photic stimulation does net explain the higher alpha powers in the migraine group.

We conclude that EEG background activity during the VEP does not distinguish reliably between migraineurs and controls.
Shortlasting, Unilateral, Neuralgiform Headache Attacks With Conjunctival Injection, Tearing, and Subclinical Forehead Sweating ("Sunct" Syndrome): II. Changes in Heart Rate and Arterial Blood Pressure During Pain Paroxysms.
Authors: Kruszewski Piotr , Fasano Maria Luisa , Brubakk AIf O. , Shen Jie Ming , Sand Trond , Sjaastad Ottar
Published: May 2005

SYNOPSIS

The recently described “Sunct” syndrome is a rare picture of unilateral, shortlasting headache attacks accompanied by autonomic phenomena (conjunctival injection, tearing, etc.) on the symptomatic side. Heart rate and blood pressure were monitored in two elderly “Sunct” patients during and outside headache attacks. An ultrasound Doppler servo method was used for the non‐invasive, continuous, beat‐to‐beat determination of instantaneous arterial blood pressure. In a third patient, systolic and diastolic blood pressure, both outside and during pain paroxysms, were assessed using the standard Korotkoff method. Heart rate was found to be significantly decreased during pain paroxysms. Systolic blood pressure was observed to be significantly increased during attacks, when compared with the inter‐attack period, while a less consistent pattern was observed for diastolic blood pressure. Some of the changes in the cardiovascular system seemed to start prior to pain onset. Therefore, it seems unlikely that these changes were caused by pain activation of the sympathetic nervous system or the oculocardiac reflex.
Changes in Neutrophil Met‐Enkephalin Containing Peptides in Episodic Cluster Headache
Authors: Figuerola Maria de Lourdes , Vindrola Osvaldo , Beatrizini Marta , Leston Jorge Alberto
Published: May 2005

SYNOPSIS

We have previously demonstrated an increase in plasma met‐enkephalin levels during the pain attacks in episodic cluster headache.2 The present study was undertaken in orderto clarify the sourceof the plasma met‐enkephalin increase.

Recent evidence has shown that peripheral blood polymorphonuclear cells contain peptides derived from the proenkephalin A system, which can be released by specific stimuli. We studied neutrophil met‐enkephalin containing peptides (NMECP) in 27 episodic cluster headache patients: 24 in a cluster period (6 of them during a pain attack), and 3 in the remission period. Neutrophil met‐enkephalin containing pep‐tide levels (after sequential enzymatic digestion with trypsin and carboxypeptidase B) were determined by radioimmunoassay with specific antiserum. Neutrophil peptide concentration (pmol/mg prot) was lower (p<0.01) in patients during the pain attack (14.4 ± 0.36) than after their pain had subsided {36.7 ± 0.31) and lower than in the remission period patients (35.8 ± 0.4).

We conclude that neutrophil met‐enkephalin containing pep‐tides decrease during pain in episodic cluster headache, and that they may be involved in the concomitant plasma met‐enkephalin increase.
Solved and Unsolved Headache Problems
Authors: Lance James W.
Published: May 2005

SYNOPSIS

Two unusual cases of vascular headache, one caused by jugular venous compression from a goiter and one triggered by flushing associated with a CGRP‐producing renal tumour, are reported. Their histories are compared with those experiencing other headaches of vascular origin. Two patients with a primary neural irritative lesion, one with a sphenoid sinus carcinoma and one with Tolosa‐Hunt syndrome, presented with headaches resembling migraine. These case‐histories are used to illustrate the interaction of nervous system and vascular system in the production of headache which has implications for the pathophysiology of migraine and cluster headache.
Myocardial Ischemia Related to Ergot Alkaloids: A Case Report and Literature Review
Authors: Galer Bradley S. , Lipton Richard B. , Solomon Seymour , Newman Lawrence C. , Spierings Egilius L.H.
Published: May 2005

SYNOPSIS

Ergotamine tartrate and methysergide are widely used headache treatments with important vasoconstrictive properties. We report a 31‐year‐old man with cluster headaches who developed severe, prolonged myocardial ischemia following combination therapy with ergotamine tartrate and methysergide. We reviewed the cardiovascular complications of each agent alone and in combination. Given the pharmacologic similarity of these agents, we propose that they may have additive or synergistic cardiac toxicity, at least in vulnerable individuals. We recommend caution when these agents are used together.
Post‐Traumatic Migraine: Chronic Migraine Precipitated by Minor Head or Neck Trauma
Authors: Weiss Howard D. , Stern Barney J. , Goldberg Jorge
Published: May 2005

SYNOPSIS

Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries (“posttraumatic migraine” ‐ PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a “whiplash” neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range I to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti‐migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. Physicians must be aware of PTM, as it is both common and treatable.
Autonomic Nervous System Function in Migraine Without Aura
Authors: Cortelli Pietro , Pierangeli Giulia , Parchi Piero , Contin Manuela , Baruzzi Agostino , Lugaresi Elio
Published: May 2005

SYNOPSIS

Autonomic nervous system functions were studied in 13 females with migraine without aura during headache‐free intervals, using physiological, pharmacological and biochemical methods.

Heart‐rate in the resting condition and blood pressure rises in the cold‐face and isometric handgrip tests were higher than in controls. Normal cardiovascular responses to the Valsalva manoeuvre and to noradrenaline infusion suggest that the baroreflex arc is intact. Normal heart rate responses to the Valsalva manoeuvre, to the cold‐face test and to deep breathing confirmed a normal cardiac parasympathetic function. Clonidine infusion showed a sedative and depressor effect and an inhibition of plasma NA similar to those occurring in controls, suggesting a normal central sympathetic tone. As a whole, the physiological, pharmacological and biochemical tests were consistent with a non‐specific sympathetic hyperactivity, but do not confirm any impairment of the autonomic control of the cardiovascular system in migraine patients in headache‐free intervals.
Ketorolac in Acute Headache Management
Authors: Harden R. Norman , Carter Timothy D. , Gilman Charles S. , Gross Alan J. , Peters John R.
Published: May 2005

SYNOPSIS

Twelve patients presenting to an emergency department in headache crisis were treated with Ketorolac tromethamine 60 mg. intramuscularly. All improved sufficiently to require no further emergent treatment. There was statistically significant improvement on all segments of the short form McGill Pain Questionnaire. This open label trial suggests that Ketorolac Tromethamine may be a useful agent in the treatment of heed‐ache crisis, and a controlled study to examine this is warranted.