bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Juvenile Migraine with Subcutaneous Sumatriptan
Authors: MacDonald John T.
Published: May 2005

SYNOPSIS

An open, prospective study was undertaken to assess the efficacy and safety of subcutaneous sumatriptan in 17 children, ages 6 to 16 years, with severe, recurrent migraine. A 6‐mg dose was used in 15 patients and relieved headache within I hour in six and by 2 hours in five others. Two smaller children received a 3‐mg dose and both were headache‐free within 2 hours. Most also reported marked improvement in associated symptoms such as nausea and photophobia. Four subjects had no clinical improvement after a 6‐mg dose. Side effects, such as neck pressure, were brief and mild. These findings suggest that subcutaneous sumatriptan can be both effective and safe as an abortive agent in juvenile migraine, but the appropriate dose in smaller children will need further investigation.
Empty Sella and Headache
Authors: Catarci Teresa , Fiacco Fabrizio , Bozzao Luigi , Pati Manuela , Magiar Alice Valeria , Cerbo Rosanna
Published: May 2005

SYNOPSIS

Empty sella is an anatomical condition caused by herniation of the subarachnoid space into the pituitary fossa through an incompetent seller diaphragm. Headache seems to be one of the most frequently reported symptoms. We studied 13 headache patients (12 females, 1 male) presenting with primary empty sella (PES) on CT scan. The characteristics of the headache were analyzed and plasma levels of pituitary hormones or cortisol assessed. We confirmed the nonspecific nature of the headache in PES even though the majority of our patients complained of daily headache, mostly localized anteriorly. Hormone plasma levels were within normal range in all the patients assessed. However, four patients reported earlier endocrine disorders and more than half of the patients presented with obesity.

In our opinion, PES should be suspected in middle‐aged overweight women with daily headache even in the absence of endocrine symptomatology.
Transcranial Doppler Monitoring of a Migraine with Aura Attack From the Prodromal Phase to the End
Authors: La Spina I , Calloni M.V. , Porazzi D.
Published: May 2005

SYNOPSIS

Transcranial Doppler sonography (TCD) was performed in a case of migraine with aura during the different phases of the attack. In the prodromic period our patient showed a slight central deficit of the seventh right cranial nerve and hypesthesia in her right arm. TCD indicated a remarkable decrease of the mean flow velocity (MFV) of the left middle cerebral artery (MCA). During the headache phase and when the signs and symptoms subsided, TCD showed an increase in MFV of both middle cerebral arteries with normal symmetry. An electroencephalogram (EEG) demonstrated a left temporal disorder. A month later a cranial CT scan, an EEG, and TCD were normal. In our opinion all these findings suggest a focal reduction in cerebral blood flow in the prodromic phase.
Acetazolamide for the Treatment of Chronic Paroxysmal Hemicrania
Authors: Warner John S. , Wamil Artur W. , McLean Michael J
Published: May 2005

SYNOPSIS

A 25‐year‐old patient presented with clinical characteristics of chronic paroxysmal hemicrania which failed to respond to indomethacin 300 mg daily. Total relief of headaches was obtained with acetazolamide 250 mg t.i.d.
Treatment of Childhood Migraine With Autogenic Training and Skin Temperature Biofeedback: A Component Analysis
Authors: Labbe' Elise E.
Published: May 2005

Using a controlled group outcome design, skin temperature biofeedback with autogenic training and autogenic training only was compared to a waiting list as a treatment for childhood headache. Thirty children with migraine headaches, ages 7 to 18 years were randomly assigned to one of the three conditions. Statistical analyses of headache activity indicated that children in the treatment groups improved in headache frequency and duration but not intensity as compared to the waiting list control group. These findings were consistent through a 6 month follow‐up. In terms of clinical improvement, 80% of the biofeedback group, 50% of the autogenics group, and none of the waiting list control group were symptom‐free. These findings were discussed in relation to past childhood headache studies and implications for current treatment of children with headaches.
Hypersensitivity to Substance P in the Etiology of Postlumbar Puncture Headache
Authors: Solomon Glen D. , Clark Jeffrey W. , DeSenanayake Preenie , Kunkel Robert S.
Published: May 2005

Objective.‐Postlumbar puncture headache may represent a model which could be used to test the hypothesis that headache pain is caused by the release of substance P in patients who are predisposed to headache due to hypersensitivity to substance P.

Methods.‐We measured substance P in CSF and plasma in 37 patients undergoing diagnostic lumbar puncture. In 9 patients, plasma samples were obtained before lumbar puncture, in 28 patients plasma was obtained after lumbar puncture. Patients were followed up by telephone to determine if they developed postlumbar puncture headache. Patients were also asked about a history of chronic or recurrent headaches. Substance P was determined by radioimmunoassay.

Results.‐The mean plasma substance P levels obtained before lumbar puncture was 1.0 ± 0.1 pg/mL and 1.3 ± 1.2 after lumbar puncture (P<0.0005). The mean plasma substance P levels in subjects who developed postlumbar puncture headache was 0.6 ± 0.6 pg/mL compared with 1.4 ± 1.5 in subjects who remained headache‐free (P<0.05). The mean CSF substance P levels in subjects who developed postlumbar puncture headache was 0.7 ± 0.5 pg/mL compared with 1.2 ± 0.8 in subjects who remained headache‐free (P<0.05). There were no significant differences in substance P levels between chronic headache sufferers and nonheadache subjects.

Conclusions.‐Postlumbar puncture headache may be mediated by the release of substance P triggered by lumbar puncture, in patients predisposed to headache by a hypersensitivity to substance P. Hypersensitivity to substance P may also represent a mechanism for headache pain in other headache disorders.
Headache and Quality of Life
Authors: Cavallini Anna , Micieli Giuseppe , Bussone Gennaro , Rossi Francesco , Nappi Giuseppe
Published: May 2005

The present prospective‐type study quantified, by way of an ad hoc questionnaire, the impact of the headache attack in its various manifestations and the effect of headache on the quality of life of 400 headache sufferers. In addition, the functional status of episodic headache patients has been compared to that of patients with chronic daily headache.

We observed that during headache attacks, episodic headache patients were significantly more disabled by physical symptoms. On the contrary, patients with chronic daily headache showed a significantly greater occurrence of emotional disturbances. A difference was detectable for mental health which was significantly more compromised in chronic daily headache than in episodic headache patients (P <0.05).

During the interictal period, quality of life appeared more compromised in chronic daily headache than in episodic headache patients. Chronic daily headache subjects were characterized by higher disability scores in all the sections considered.

The results of this investigation confirm that headache negatively influence a patient's quality of life not only during attack phases but also during interictal periods and underline the importance that future studies on the efficacy of headache treatments should also evaluate the impact on patient's quality of life.
Secondary Syphilis and Headaches
Authors: Landy Stephen H. , McGinnis Judy
Published: May 2005

Secondary syphilis is associated with headaches. We describe two patients with headache from secondary syphilis and we recommend considering this in the differential diagnosis and evaluation of the headache patient.
Provocation of Unilateral Pain in Cluster Headache Patients by Breathing CO2
Authors: Hannerz Jan , Jogestrand Tomes
Published: May 2005

Ten patients with cluster headache in an active period and 6 controls were studied as to heart rate, blood pressure, blood flow in the common carotid arteries (CCA), end‐tidal PCO2 and pain before, during and after 6 minutes of breathing 6% CO2 In air. Heart rate increased significantly during C02 breathing in controls but not in patients. The cluster headache patients had significantly lower baseline end‐tidal PCO2 than controls. CCA blood flow increased significantly during CO2 breathing in both groups. Vascular resistance decreased during CO2 provocation and increased above baseline levels 5 minutes after provocation in both groups and related to the end‐tidal PCO2. Six of eight cluster headache patients, who had an increase of blood flow at provocation, reported slight to moderate unilateral pain in relation to the CO2 provocation in contrast to controls.

One patient treated with 6 mg sumatriptan 2.5 hours before the provocation had an end‐tidal PCO2 within the range of the controls, and did not get an increase of CCA blood flow or pain at provocation.

Six of the cluster headache patients were restudied when out of the active period. There was still no heart rate increase during CO2 breathing and end‐tidal PCO2 was still lower than in the controls. Unilateral headache was not provoked.
Headache Due to an Extra Joint Between Head and Neck
Authors: Stolt‐Nielsen A. , Fredriksen T.A. , Sjaastad O.
Published: May 2005

A girl, born in 1973, started having headache in preschool age. After a head trauma in 1985, there was a clear worsening of the headache, and the headache became chronic at around 14 years, making regular school attendance impossible. The headache was “symptom poor,” bilateral‐occipital, but with a clear left‐sided preponderance and occasionally spreading to the forehead. The headache was always worst in the morning hours, easing up by noontime. Neck rotation to the right could provoke long‐lasting exacerbations.

Neck movement was restricted on rotation to the left. A sore bony structure was discovered on palpation just underneath the mastoid process of the left side. This proved to correspond to a bony “bridge” with an extra joint between the first vertebra on the left side and the skull, medially to the mastoid process that could be demonstrated on x‐ray tomography and CT scanning. This bony bridge was removed surgically more than 2 years ago, and the pain disappeared on the day of operation and has not recurred in the intervening time. Such bony bridges have in the past been considered to be innocuous and not symptom producing. Although this may be the general rule, the present case tends to show that even to this rule, there are exceptions.
Rapid and Sustained Relief of Migraine Attacks With Intranasal Lidocaine: Preliminary Findings
Authors: Kudrow Lee , Kudrow David B. , Sandweiss Jack H.
Published: May 2005

In a noncontrolled study, 23 migraine headache patients were treated with intranasal instillation of 0.4 mL of a 4% lidocaine solution during attacks of varying intensities. Evaluated were pretreatment and posttreatment changes in pain intensity, nausea, and side effects. Posttreatment intensity ratings significantly improved over pretreatment ratings, as determined by a Sandler A analysis (0.077; P<.0005). Migraine attacks were aborted in 12 of 23 patients, of which 8 were completely relieved within 5 minutes. In no case did an aborted attack return to more than a dull level within 24 hours, as determined by follow‐up telephone calls.

A successful response of migraine attacks to lidocaine treatment was more apt to occur in patients having migraine solely, when compared to migraine patients who also had daily dull headaches; the difference was not significant. Unilateral attacks, however, were significantly more treatment‐responsive when compared to bilateral attacks (X2=3.85; P=.05). Nausea, associated with migraine attacks in 6 of 12 responders, was similarly aborted by lidocaine in 5 of 6 patients. Other side effects included mild nasal and eye burning of short duration (seconds), and oropharyngeal numbness of approximately 20 minutes' duration. Despite the abrupt and absolute relief of migraine attacks afforded by lidocaine in most of our study patients, its level of efficacy awaits results of double‐blind, placebo‐controlled studies.

Our findings raise new questions regarding the differential pathogenesis of migraine and cluster headache attacks. It is suggested here that the rapid effect of lidocaine in aborting migraine attacks, as shown by others in cluster headache, may be due to a conduction‐blocking action on pterygopalatine, internal carotid, and cavernous sinus ganglia. This implies that pain‐evoking mechanisms in migraine and cluster headache may similarly involve parasympathetic activity and calls into question the primacy of the trigeminovascular system to that of vaso‐parasympathetic efferents.
Intranasal Lidocaine for Cluster Headache
Authors: Robbins Lawrence
Published: May 2005

Thirty male patients with cluster headache were given 4% lidocaine solution to use intranasally as an abortive therapy. Four sprays of lidocaine were used ipsilateral to the pain, and two more were used, if necessary. Twenty‐seven percent of the men reported moderate relief, 27% obtained mild relief, and 46% stated that they had no relief from the lidocaine. Side effects were minimal. In this study, intranasal lidocaine was only a marginally helpful therapy for cluster headache. However, because of the ease of administration and lack of side effects, lidocaine may remain worthwhile as an adjunctive medication.
Specificity and Sensitivity of Temporalis ES2 Measurements in the Diagnosis of Chronic Primary Headaches
Authors: Wang Wei , De Pasqua Victor , Gerard Pascale , Schoenen Jean
Published: May 2005

We have evaluated the specificity and sensitivity of temporalis ES2 measurements for the diagnosis of primary headaches. Ninety‐four outpatients diagnosed according to IHS criteria were prospectively included: 25 had chronic tension‐type headache (code 2.2.), 15 episodic tension‐type headache (code 2.1.), 20 migraine without aura (code 1.1.) and 34 chronic daily headaches with daily analgesics/ergotamine abuse (code 8.2.). In chronic tension‐type, the sensitivity of the ES2 test was 84% at the 0.1 and the 0.5 Hz, but only 56% at the 2Hz stimulation rates. Its specificity was 100% at 0.1Hz, 90% at 0.5Hz and 95% at 2Hz compared to migraine; positive predictive values were at similar levels. Sensitivity of ES2 at 0.1 Hz was 67% in episodic tension‐type headache, but its positive predictive value versus migraine was excellent. Comparing chronic tension‐type headache and analgesic abusers, the specificity and positive predictive value of the ES2 test for diagnosing chronic tension‐type headache were less satisfactory (60%) while the negative predictive values, however, remained good (83% at 0.1Hz).

The results confirm that the temporalis ES2 test has a higher diagnostic sensitivity in chronic and episodic tension‐type headache, but that it has a high negative predictive value for both types of tension‐type headache compared to other primary headaches. For diagnostic purposes, the 0.1Hz stimulation rate seems optimal. The 2Hz stimulation rate is the least sensitive, although it may induce total disappearance of ES2 in up to 40% of patients. ES2 is of limited usefulness for separating chronic tension‐type headache and chronic drug‐abuse headache, possibly because the latter group comprises both tension‐type headache and migraine patients.
Site Specificity of Pain and Tension in Tension‐Type Headaches
Authors: Peterson Alan L. , Talcott G. Wayne , Kelleher William J. , Haddock C. Keith
Published: May 2005

Previous studies have not found a significant correlation between location of pain and electromyogram levels in chronic headache patients. However, these studies only examined a limited number of muscle groups and did not assess subjective tension levels. The present study evaluated a group of tension‐type (n = 43) and migraine and tension‐type (n = 30) headache patients. Measures were obtained at five muscle sites (frontalis, temporalis, masseter, splenius capitis, and trapezius) for patient ratings of headache pain, patient ratings of muscle tension, and electromyogram recordings cross‐sectionally. Neither subjective pain nor tension ratings were found to be significantly related to electromyogram levels. The site‐specificity relationship between chronic headache pain, subjective report of muscular tension, and electromyogram levels remains unclear.
Migraine Consultations: A Triangle of Viewpoints
Authors: Blau J.N. , MacGregor E.A.
Published: May 2005

Several studies have examined patientsapos; attitudes to a consultation for migraine and other headaches. However, a patient's assessment of the problem for which they seek treatment may differ from that of the referring primary physician which may, in turn, differ from the specialist's. This study set out to examine this triangle.The commonest reason for referral was failure of treatment response. This contrasted with the patient's different perception‐an increase in the frequency of attacks which we saw as headaches additional to migraine, accounting for failed treatment. Similarly, our view of the patient wanting reassurance paralleled their request for further information. These findings confirmed the hypothesis that recognizing and understanding a patient's fears were important factors towards a favorable outcome of a consultation.
Extratrigeminal Ice‐Pick Status
Authors: Martins Isabel Pavão , Parreira Elsa , Costa Ilda
Published: May 2005

We describe six patients with an identical type of headache, consisting of short episodes (lasting around 1 week) of daily attacks of ice‐pick‐like pain, recurring every minute in the same points of the scalp. In all of them, the pain was felt outside the cutaneous area of the trigeminal nerve (retroauricular, parietal, and occipital regions). All patients were examined in the emergency department of a general hospital over a period of 7 years because of these acute headaches. None of them had a history of migraine.

Although this pain is identical to idiopathic stabbing headache, it differs from it by its temporal profile (in “status”), its posterior (extratrigeminal) location, and its lack of association with migraine. While the bouts were usually severe and recurred in two patients, all had a self‐limited benign course and responded promptly to indomethacin.
Diagnostic Criteria for Screening Headache Patients for Temporomandibular Disorders
Authors: Schiffman Eric , Haley Dennis , Baker Camak , Lindgren Bruce
Published: May 2005

Patients with temporomandibular disorders frequently suffer from headache. The purpose of this study was to develop a simple screening exam which would allow the physician to identify headache patients with coexisting temporomandibular disorders. Twenty‐eight migraine and 27 tension headache patients were identified by board certified neurologist and then were examined by a dentist for signs of temporomandibular disorders. These patients were then compared to 63 patients with temporomandibular internal derangements and 62 patients with myofascial pain dysfunction. Comparisons of the clinical signs showed that the temporomandibular internal derangement and myofascial pain dysfunction patients differed significantly from the headache patients in regards to specific signs of jaw dysfunction. The presence of reciprocal clicking of the temporomandibular joint or pain with maximum jaw opening and pain upon palpation of the temporomandibular joint distinguished temporomandibular internal derangement patients from headache patients. These criteria have a sensitivity of 92% and specificity of 91%. Pain on palpation over the temporomandibular joint, or pain with maximum jaw opening using passive stretch, and pain with lateral movement of the jaw, distinguished myofascial pain dysfunction patients from headache patients. These criteria have a sensitivity of 77% end specificity of 85%. By using these screening tests, the physician can identify the concurrent existence of temporomandibuler disorders in headache patients and triage the patient to a clinician knowledgeable in the diagnosis and treatment of temporomandibular disorders for further evaluation.
SUNCT Syndrome: Cerebral SPECT Images During Attacks
Authors: Poughias L. , Aasly J.
Published: May 2005

Two patients with SUNCT syndrome (short‐lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing) were investigated. Blood flow velocity in the middle cerebral artery was monitored before, during, and outside four spontaneous attacks. An interhemispheric asymmetry was observed. In the second case, velocity decreased significantly on both sides during attacks in comparison with preattack values, Cerebral SPECT (single photon emission computed tomography) images were obtained during a bout and between attacks in one patient. The radiocompound was injected 5 to 10 seconds after the start of an attack. In both patients, normal tracer uptake and symmetric perfusion was observed during headache periods.
Applicability of the 1988 IHS Criteria to Headache Patients Under the Age of 18 Years Attending 21 Italian Headache Clinics
Authors: Gallai Virgilio , Sarchielli Paola , Carboni Franca , Benedetti Pietro , Mastropaolo Camillo , Puca Francomichele ,   The Juvenile Headache Collaborative Study Group
Published: May 2005

Seven hundred nineteen young patients attending 21 Italian headache care settings were evaluated by a diagnostic headache interview and a neurological examination. Headache disorders were classified according to the current 1988 criteria of the International Headache Society (IHS); 54.9% of the patients suffered from migraine, 33.9% from tension‐type headache, 1.9% from secondary headache, and 3.4% had non‐classifiable headache. A further 5.9% of the patients were not classified due to incomplete questionnaires.

Of the 395 patients with migraine, 44.5% were affected by migraine without aura, 29.9% by migraine with aura, 1.3% from other migraine forms, and 24.3% by migrainous disorders which do not fulfill the 1988 IHS diagnostic criteria for headache.

Among the 244 patients with tension‐type headache, 51.6% had episodic tension‐type headache, 15.2% chronic tension‐type headache, and 33.2% headache of the tension‐type which does not fulfill the 1988 IHS criteria for episodic and chronic tension‐type headache.

In young migraine patients, pain was of a pulsating type in 55.7%, severe in 57.8%, unilateral in 42.6%, and aggravated by routine physical activity in 38.9%. Tension‐type headache was described as pressing in 73.8%, mild or moderate in 75.7%, bilateral in 87.4%, and not aggravated by routine physical activity in 85.5%. The duration of pain was leas than 2 hours in 35% of the cases in migraine sufferers and less than 30 minutes in 26.7% of tension‐type headache sufferers. Nausea, phonophobia, and photophobia were present in at least half of the migraine patients and in one third of tension‐type headache patients, respectively. Vomiting occurred in 47.8% of migraine patients and 9% of tension‐type headache patients.

On the basis of the above results, a modification of the current 1988 IHS criteria can be proposed to increase their sensitivity for diagnosing migraine and tension‐type headache in children and adolescents. This should take into account that the attacks are of a shorter duration, the character of pain is not necessarily pulsating, and the location of pain may often be bilateral. The number of headache episodes should be reduced to less than five for the diagnosis of migraine and less than 10 for the diagnosis of tension‐type headache. Moreover, functional disability should not be considered a mandatory criterion for migraine in children and adolescents.

Differentiating migraine and tension‐type headache could be improved by the use of a grading system for accompanying symptoms (nausea, vomiting, phonophobia, and photo‐phobia) rather than merely the use of criteria for absence and presence.
SUNCT Syndrome: A Hungarian Case
Authors: Becser Noemi , Berky Mihaly
Published: May 2005

A Hungarian patient with short‐lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is presented in this paper. This male patient was first diagnosed as having first division trigeminal neuralgia. The location and duration of the attacks and the prominent accompanying autonomic feature on the symptomatic aide, such as conjunctival injection, lacrimation, nasal stuffiness, and the inefficacy of drugs, led to a reconsideration of the diagnosis. The pain paroxysms occurred frequently during a 3‐to 4‐month period, followed by a longer remission phase. Mechanical precipitating maneuvers were observed during bouts of pain. The clinical picture is reminiscent of the SUNCT syndrome, first described by Sjaastad et al in 1978.

SUNCT and trigeminal neuralgia are in many ways similar, although, some decisive differences have also been noted. Further observations are needed to distinguish the two disorders and to clarify this syndrome as a new headache type or as a trigeminal neuralgia variant.
fficacy, Safety, and Tolerability of Dihydroergotamine Nasal Spray as Monotherapy in the Treatment of Acute Migraine
Authors:   The Dihydroergotamine Nasal Spray Multicenter Investigators, Di Serio Frank J.
Published: May 2005

Recently, a new nasal spray formulation of dihydroergotamine was developed which facilitates at‐home treatment of migraine. We studied the efficacy, safety, and tolerability of dihydroergotamine nasal spray as monotherapy in the acute treatment of classic and common migraine in two, identical, double‐blind, randomized, placebo‐controlled trials. Of the 229 patients enrolled, 206 (102 dihydroergotamine nasal spray, 104 placebo) were included in the intent‐to‐treat analyses; 182 treated two headaches and 24 treated one headache. Based on both the patients' and physicians' ratings, dihydroergotamine nasal spray was significantly superior to placebo for reducing the severity of headache pain in both studies, and in relieving nausea in Study 2. The onset of significant efficacy with dihydroergotamine nasal spray compared to that with placebo for both severity of headache pain and relief of nausea occurred at I hour in Study 2 and at 3 hours in Study 1. Dihydroergotamine nasal spray was also significantly superior to placebo for the relief of headache pain in both studies. Based on the physicians' global evaluations of treatment efficacy for headache pain, 71% of the dihydroergotamine‐treated patients in Study 2 and 59% of their counterparts in Study 1 were considered to be responders. The dihydroergotamine‐treated patients had less newly‐occurring vomiting than the placebo‐treated patients. The majority of adverse events reported by the dihydroergotamine‐treated patients were nasopharyngeal. The results demonstrate the efficacy, safety, and tolerability of dihydroergotamine nasal spray as monotherapy in the treatment of acute migraine attacks.
Sinus Headaches Reconsidered: Referred Cephalgia of Rhinologic Origin Masquerading as Refractory Primary Headaches
Authors: Clerico Dean Michael
Published: May 2005

Headache associated with acute sinusitis is a well‐recognized entity; the diagnosis is easily made due to the associated nasal and sinus symptoms. However, the phenomenon of referred headache from chronic sinusitis or intranasal abnormalities or both without upper respiratory symptoms is not well understood. Only recently have the nasal and sinus cavities been adequately visualized by both the human eye and radiographic techniques; a fact that may account for the historic neglect in considering this region a factor in headache etiology. Modern techniques employed in the workup of sinusitis, namely the use of rigid nasal endoscopes and coronal‐plane CT scanning, have greatly enhanced the clinician's ability to evaluate and diagnose pathology in this area. This report describes a series of patients presenting with various primary headache syndromes without significant nasal or sinus symptoms who failed to respond to conventional antiheadache therapy. On nasal endoscopic and coronal CT examinations, various intranasal and sinus abnormalities were found (either anatomic variations or subclinical inflammation). Medical and/or surgical therapy addressing the sinonasal pathology resulted in improvement in every case, ranging from decreased severity of attacks to total resolution of headaches. A model explaining the possible mechanism of referred vascular‐type headache from sinus and nasal origin is proposed.
Is Abdominal Pain a Feature of Adult Migraine?
Authors: Blau J.N. , MacGregor E.A.
Published: May 2005

Recurrent abdominal pain in children, frequently diagnosed as “abdominal migraine,” is thought to evolve into more typical migraine headache during the teens and twenties. If this transformation occurred, we would expect some adult migraineurs to retain abdominal pain; but we could not recall this symptom being mentioned by patients. However, without direct questioning the absence cannot be assumed. We, therefore, asked 100 migraineurs about abdominal symptoms during migraine attacks: only one experienced unexplained abdominal pain. We conclude that abdominal pain is not a feature in adult migraineurs, leading us to support the notions that: (1) recurrent abdominal pain of childhood has a number of causes; (2) abdominal migraine may be an incorrect attribution and is liable to be over diagnosed; (3) abdominal migraine requires more precise definition; (4) the transition from childhood abdominal migraine to adult migraine needs precise prospective study.
The Event‐Related Potential P300 During Headache‐Free Period and Spontaneous Attack in Adult Headache Sufferers
Authors: Mazzotta Giovanni , Alberti Andrea , Santucci Antonella , Gallai Virgilio
Published: May 2005

The event‐related potential P300 has been studied in 15 migraine without aura sufferers, and in 15 episodic tension‐type headache sufferers, during pain‐free periods and during spontaneous headache attacks. There were no variations of potential, either of P3 latency or N2 ‐P3 amplitude, in either group during the interictal period. Similarly, there were no variations of the P300 parameters in the group of tension‐type headache subjects during headache attacks; by contrast, a significant elongation of latency (P <0.01) and an increment of N2‐P3 wave amplitude (P<0.002) was observed in the group of migraineurs. The authors discuss the data in accordance with the etiopathogenic theories of migraine and the hypothesis that acetylcholine and norepinephrine are the neurotransmitters able to affect the event‐related potential P300, which reflects cerebral activity during sensory information processing and analysis.
Toward a Standard Drug Formulary for the Treatment of Headache
Authors: Klapper J. A.
Published: May 2005

The recent publication of drug formularies by third‐party payers has serious implications for the practice of medicine. These formularies list the medications for which the consumer can be reimbursed by the third‐party payer. The most restrictive of the five formularies I have received lists only two agents for the treatment of migraine headaches: Cafergot (at an incorrect dose of 1/100 mg) and Ergotrate which is no longer available. The most liberal of the formularies lists analgesics, Cafergot, Midrin, and Imitrex for the treatment of acute attacks, and as prophylactic agents, Inderal, Sansert, and analgesics (known to cause rebound headaches when used in this fashion in migraine patients). Abortive agents of proven value, such as DHE‐451 and NSAIDs,2 and preventative medications, such as calcium channel blockers,3 tricyclic antidepressants,4 serotonin reuptake inhibitors,5 methylergonovine,6 and divalproex sodium,7 are not available. No one could quarrel with a goal of developing a cost‐effective formulary. However, the authors of these formularies have clearly demonstrated their inability to provide even a current, accurate, and adequate formulary by existent standards of care in the treatment of migraine headache. While it is easy to criticize these formularies, it is more difficult to develo a comprehensive list that would satisfy the practitioners' need to provide relief for their patients with a minimum of side effects, and the needs of third‐party payers (presumed) to provide quality care at the most economical level.
Whiplash Around the World
Authors: Evans Randolph W.
Published: May 2005

The term “whiplash” was first used in 1928 by the American orthopedist Crowe, although the earliest use that I can find published was in 1945 by the American orthopedist Davis. Although widely used by the medical profession and public, many physicians find the term objectionable. However, when used appropriately to refer only to the mechanism of injury in a motor vehicle accident, the term can be worthwhile. In any case, “whiplash” is well‐entrenched in usage and is here to stay. But what term is used in other languages? Is there a term similar to “whiplash?” To determine terms for whiplash injuries in other languages, members of the American Academy of Neurology living in non‐English‐speaking countries were contacted by mail. Terms used in 11 other languages are listed. Some comments about whiplash injuries by respondents are excerpted. Further cross‐cultural studies may be helpful in studying the influence of physician and popular attitudes, as well as litigation on persistent neck complaints and headaches after motor vehicle accidents.
A Multivariate Study of Headache Associated With Ischemic Stroke
Authors: Ferro J.M. , Melo T.P. , Oliveira V. , Salgado A.V. , Crespo M. , Canhão P. , Pinto A.N.
Published: May 2005

Thirty‐four percent of 182 ischemic stroke patients registered during I year in a prospective hospital stroke data base complained of headache within a 72‐hour interval of stroke onset. Headache was more common in patients under 70 years of age, in nonsmokers, in those with a past history of migraine, and in subjects presenting transient loss of consciousness, nausea/vomiting, or visual field defects. Headache was more frequent in vertebrobasilar (57%) than in carotid (20%) territory strokes, more so in posterior cerebral artery (90%) and cerebellar infarcts (80%), and was infrequent in subcortical infarcts (7%) and lacunes due to single perforator disease (9%). In multiple regression analysis, vertebrobasilar stroke (odds ratio 6.9), lacunar stroke (odds ratio 0.06), and past history of migraine (odds ratio 6.7) were significant independent predictors of headache, suggesting that ischemic stroke location is the major determinant of stroke‐associated headache, most probably related to activation of the trigeminovascular system, whose threshold may be modified by individual susceptibility.
Development of a Brief 24‐Hour Migraine‐Specific Quality of Life Questionnaire
Authors: Hartmaier Susan L. , Santanello Nancy C. , Epstein Robert S. , Silberstein Stephen D.
Published: May 2005

The objective of this study was to develop a questionnaire to assess the short‐term quality of life decrements associated with an acute migraine headache attack. A total of 101 potential quality of life items were generated by interviewing migraineurs and migraine specialists and reviewing the literature. To reduce the items, 76 migraineurs (18 years and older) were asked to identify which of the 101 items affected their quality of life in the 24 hours following onset of a migraine and to rate them on a five‐point scale from “not very important” to “extremely important.” Reduction of the 101 items to a 15‐item questionnaire was performed by evaluating the results of subject‐perceived importance (number of times an item was chosen x mean importance score) in combination with principal components analysis. Five domains were identified: (1) work functioning, (2) social functioning, (3) energy/ vitality, (4) migraine headache symptoms, and (5) feelings and concerns. Each domain has three items and the correlation between the five domains, as measured by the Spearman correlation coefficient, ranged from 0.08 to 0.38 suggesting minimal overlap. The brief migraine quality of life questionnaire was pilot‐tested in two groups of 10 migraineurs and revised to improve clarity.
Validation of a New Quality of Life Questionnaire for Acute Migraine Headache
Authors: Santanello Nancy C. , Hartmaier Susan L. , Epstein Robert S. , Silberstein Stephen D.
Published: May 2005

A brief migraine‐specific quality of life questionnaire was developed to assess the quality of life decrement associated with an acute migraine attack in the 24‐hour period following headache onset, The migraine quality of life questionnaire has 15 questions across five domains (work functioning, social functioning, energy, concerns, and symptoms). A prospective, observational study was conducted to evaluate the characteristics of internal consistency, construct and discriminant validity, and responsiveness of the migraine quality of life questionnaire. One hundred thirty‐eight subjects with migraine were recruited. One hundred seven subjects completed a baseline and a 24‐hour postmigraine quality of life questionnaire, along with a migraine diary for recording headache severity, activity limitation, associated symptoms, duration of headache, and use of migraine medication. All five migraine quality of life questionnaire domains showed good internal consistency (Cronbach's alpha, 0.74–0.95). The strongest correlations were seen between activity limitation and associated symptoms and the migraine quality of life questionnaire work, social, and energy domains. Significant differences in mean questionnaire scores between subjects were found with frequency of medication use, global change in symptoms, headache duration, and severity. All five domains showed significant responses within subjects from a migraine‐free period to an acute migraine period (P<0.0001). In summary, the migraine quality of life questionnaire showed good internal consistency, construct and discriminant validity, and responsiveness to acute migraine attacks.
Respiratory Studies in SUNCT Syndrome
Authors: Kruszewski Piotr , White Linda R. , Shen Jie M. , Pareja Juan A. , Zhao Jing M. , Schaanning Jan , Sjaastad Ottar
Published: May 2005

Seven SUNCT patients (six men, one woman) took part in this study. In four patients, respiratory variables were compared during and outside attacks. In five patients, peripheral chemosensitivity was tested and compared with a control group matched with respect to age. sex, and smoking habits. The results indicate that SUNCT patients hyperventilate during attacks. Moreover, they appear to hyperventilate slightly under basal conditions. The tests for peripheral chemoreceptor activity indicated no differences between the SUNCT and the control groups except for one variable, namely the mean ventilatory response to a single breath of 13% CO2. It is possible that this indicates a blunted response of the peripheral chemoreceptors. On the other hand, it may also represent a chance finding, since none of the other results presented suggested such a conclusion, and the size of the test group was very small. The results do not indicate that a reduction in oxygen saturation can trigger SUNCT since low levels of oxygen saturation were only rarely accompanied by SUNCT, whereas many attacks were not associated with any appreciable lowering in arterial oxygen saturation.
CPH and Hemicrania Continua: Requirements of High Indomethacin Dosages ‐An Ominous Sign?
Authors: Sjaastad O. , Stovner L.J. , Stolt‐Nielsen A. , Antonaci F. , Fredriksen T.A.
Published: May 2005

Two female patients, one with chronic paroxysmal hemi‐crania and one with hemicrania continua, had a continuously high requirement of indomethacin, ie, 3 225 mg per day, for 4 and 7 years, respectively. In the hemicrania continua patient, a right (symptomatic side) C7 root affection due to disc herniation was demonstrated. Removal of the disc relieved the arm pain completely, and reduced the head pain and indomethacin requirement considerably initially. The other patient suffered from the unremitting form of chronic paroxysmal hemicrania with right‐sided attacks from the age of 16. Indomethacin, 200 to 250 mg per day generally kept the headache at bay, but during exacerbations, especially during menstrual periods, the dosage transitorily had to be increased to 250 to 350 mg per day. ACT scan with contrast at aged 18 (1987) was negative. In 1992, she started having new symptoms, including numbness on the ipsilateral side of the face and arm and difficulty swallowing. An MR scan showed a meningioma originating in the roof of the cavernous sinus on the symptomatic side. The meningioma was surgically removed. The postoperative indomethacin requirement was reduced, but only transiently. Patients with chronic paroxysmal hemicrania (CPH) and hemicrania continua (HC) with a continuously high indomethacin requirement may have grave additional disorders and should consequently be followed closely.
Hemiplegic Migraine With CSF Abnormalities
Authors: Motta Ewa , Rosciszewska Danuta , Miller Krzysztof
Published: May 2005

A 30‐year‐old woman with hemiplegic migraine and an elevated CSF protein level with considerable pleocytosis is described. Fourteen other cases of hemiplegic migraine with cerebrospinal fluid abnormalities reported in the literature are reviewed.
Migraine Symptoms: Results of a Survey of Self‐Reported Migraineurs
Authors: Silberstein Stephen D.
Published: May 2005

Migraine is an episodic headache disorder associated with various combinations of neurologic, gastrointestinal, and autonomic symptoms. Gastrointestinal disturbances including nausea, vomiting, abdominal cramps, or diarrhea are almost universal. Sensory hyperexcitability manifested by photophobia, phonophobia, and osmophobia are frequently experienced. Other symptoms include blurry vision, nasal stuffiness, tenesmus, polyuria, pallor, and sweating, Our telephone interview survey of 500 self‐reported migraine sufferers was performed in 1994. The most common reported symptoms associated with migraine were pain, nausea, problems with vision, and vomiting. Nausea occurred in more than 90% of all migraineurs; nearly one third of these experienced nausea during every attack. Vomiting occurred in almost 70% of all migraineurs; nearly one third of these vomited in the majority of attacks. In those who experienced nausea, 30.5% indicated that it interfered with their ability to take their oral migraine medication; in those with vomiting, 42.2% indicated that it interfered with their ability to take their oral migraine medication. The most important features of a migraine medication were rapid and effective relief of headache pain, decreasing the likelihood of headache recurrence, and not causing nausea. Many migraine patients suffer needlessly because their nausea and vomiting are both unreported to, and unrecognized by physicians. The presence of these symptoms is crucial to diagnose migraine not accompanied by aura.
Triggers of Headache Episodes and Coping Responses of Headache Diagnostic Groups
Authors: Scharff Lisa , Turk Dennis C. , Marcus Dawn A.
Published: May 2005

The frequency of common headache instigators or “triggers” and the use of specific behavioral responses to headache episodes were determined using the self‐reports of patients with migraine, tension‐type, and combined migraine and tension‐type headache. Headache diagnostic groups were compared on the nature of headache triggers identified. The diagnostic groups were also compared on the frequency with which they engaged in a set of behavioral responses during headache episodes. No diagnostic group differences were found in triggering stimuli. Emotional, dietary, physical, environmental, and hormonal factors were all reported to be equally likely to precipitate a headache episode regardless of headache diagnosis. There were, however, differences in specific behavioral responses to headache episodes depending upon headache diagnosis. Discriminant analyses were performed to determine the best predictors of headache diagnoses. Migraine patients were significantly more likely to avoid noise, light, social activity, and physical activity compared with tension‐type and combined headache patients. When average headache severity was taken into account, the diagnostic group differences in coping responses disappeared. It is concluded from the results of this study that headache severity has a greater impact on coping response than does specific headache diagnosis.
Classification of Pediatric Migraine: Proposed Revisions to the IHS Criteria
Authors: Winner Paul , Martinez Walter , Mate Lazlo , Bello Luis
Published: May 2005

The International Headache Society classification lends itself to modification to significantly improve the diagnostic sensitivity of migraine in the pediatric population. Children and adolescents require special modifications relating to duration, location, quality of intensity, and symptoms related to photophobia and phonophobia. We propose specific criteria for pediatric migraine with and without aura which are more sensitive.

Forty‐five children and adolescents seen at a headache center were evaluated, retrospectively, comparing diagnostic criteria of the International Headache Society, Vahlquist, and the proposed revised IHS classification for clinical diagnosis by a single examiner (pediatric neurologist)‐comparing diagnostic rates for migraine of the total sample: IHS (53%), Vahlquist (69%), and IHS‐R (80%) and evaluating a subset of those patients less than 12 years (n=22): IHS (50%), Vahlquist (68%), and IHS‐R (73%). The proposed revisions to IHS for pediatric migraine were more sensitive than existing criteria. These revisions may help to form the basis for future research guidelines and for further modifications to improve the diagnostic sensitivity of pediatric migraine using the IHS model.
An MRI Study of Lumbar Puncture Headaches
Authors: Iqbal Javed , Davis Larry E. , Orrison William W.
Published: May 2005

We studied 11 patients undergoing a routine lumbar puncture to determine if there were cerebrospinal fluid leaks at the puncture site and whether the maximum volume of leakage correlates with a lumbar puncture headache. Patients completed a headache questionnaire before and after the lumbar puncture. Limited magnetic resonance imaging of the lumbar spine was obtained 8 to 36 hours after the lumbar puncture and two patients also had later imaging. In a blinded fashion, the largest diameter of cerebrospinal fluid leakage into the paraspinous area was determined from T2 weighted magnetic resonance images and the maximum possible fluid volume was calculated. Six patients had a small cerebrospinal fluid leakage (< 10 mL), two had a medium leakage (10 to 110 mL), and three had a large leakage (> 110 mL). The volume of cerebrospinal fluid leakage did not corre late with occurrence of a lumbar puncture headache. The study demonstrates that cerebrospinal fluid usually leaks into the paraspinous area after a lumbar puncture, but the volume of escaped fluid does not correlate with a lumbar puncture headache.
Adult Onset Familial Hemiplegic Migraine
Authors: Rajput Vijay , Kramer Eric D.
Published: May 2005

Familial hemiplegic migraine and its associated signs and symptoms have previously been well described. The condition demonstrates autosomal dominant inheritance and has been recently assigned to a locus on chromosome 19. Previous reports of familial hemiplegic migraine have indicated that expression always occurs early in life. We describe a patient who presented with multiple episodes of reversible hemiplegia followed by headache at the age of 75. Seven other family members were found to have been affected in a similar manner. We believe this case represents a unique description of familial hemiplegic migraine presenting in later life.
Oscillocusis: An Unusual Auditory Aura in Migraine
Authors: Whitman Bradley W. , Lipton Richard B.
Published: May 2005

We report a 14‐year‐old girl with a migraine aura characterized by the sense that ambient sounds were fluctuating in intensity, as if emanating from a radio while the volume control was being altered.These auditory oscillations lasted 5 to 10 minutes and were followed by a typica l migraine headache. By analogy with oscillopsia, we term this unique form of migraine aura “oscillocusis.”