bluuebunny/crossref_metadata_2025 huggingface dataset:
SUNCT Syndrome: VII. Ocular and Related Variables.
Authors: Sjaastad O. , Kruszewski P. , Fostad K. , Elsås T. , Qvigstad G.
Published: May 2005

SYNOPSIS

SUNCT is a unilateral headache syndrome with shortlasting attacks, accompanied by e.g. conjunctival injection and lacrimation on the painful side. Intraocular pressure (lOP), corneal indentation pulse (CIP) amplitudes, episcleral venous pressure, and corneal, tympanic, and facial temperature have been studied in 6 SUNCT patients. IOP and CIP amplitudes increased on the painful side during headache paroxysms, while episcleral venous pressure remained unchanged. Corneal temperature seemed to increase during attack on both sides. However, the number of observations during attacks is scanty. Outside of attacks, the corneal temperature on the symptomatic side seemed to be higher when compared with the non‐symptomatic side (generally ³0.5°C), provided that the attack frequency was high. The facial temperature seemed to be even on both sides or slightly higher on the symptomatic than on the non‐symptomatic side in the periocular area. This pattern seems to be different from the one in trigeminal neuralgia, in which the temperature has been reported to be lowest on the painful side of the face. During attacks, there seemed to be a tendency for the temperature to increase in the periocular area, but not over the mandible or in the neck. The results obtained could be caused by increased blood supply to the eye (and the surrounding skin) on the symptomatic side because of vasodilatation during repeated pain attacks. As far as the ocular changes are concerned, probably the arteriolar side of the vascular bed is involved.
Posttraumatic Headache: Permanency and Relationship to Legal Settlement
Authors: Packard Russell C.
Published: May 2005

SYNOPSIS

In our increasingly litigious society there is persistence of an attitude that posttraumatic headache (or other injuries) will either improve or disappear following resolution of a claim. In some states (Florida) in order for a person to initiate a claim, an injury must be considered permanent. This is often a difficult task with a subjective symptom. This retrospective study was performed to evaluate the reliability of criteria used to diagnose a “permanent” posttraumatic headache and whether these headaches stay “permanent” after legal settlement. Data was obtained by a structured telephone interview of fifty adult outpatients diagnosed as having permanent posttraumatic headache and their litigation settled at least one year previously. Patients with previous headaches, other accidents or head injuries were excluded. The average length of time from settlement to interview was 23 months. Forty‐six had been in automobile accidents and four either had falls or blunt trauma to the head. (Eight cases involved Workman's Compensation).

Criteria used at this clinic for determining permanency were either posttraumatic headache persisting for longer than one year with no evidence of further improvement (43 patients) or patients with headaches persisting longer than 6 months with a plateau (no change) in their pattern for three months or more with an adequate trial of treatment (in our judgment). These criteria did seem reliable. All fifty patients interviewed continued to report persistent headache symptoms one year or more following legal settlement. Improvement in headache pattern after legal settlement was only reported by four patients.
MRI in Migraineurs
Authors: Robbins Lawrence , Friedman Harold
Published: May 2005

SYNOPSIS

Forty‐six migraineurs and 69 age‐ and sex‐matched controls referred for MRI scans of the brain were evaluated for the incidence of intracranial pathology. Axial long TR/short TE and long TR/Iong TE and sagittal short TR/short TE scans were performed in all patients. Enhancement with Gd‐DTPA was performed in all controls and in nine migraineurs. Six of 46 (13%) of the migraineurs had white matter lesions versus three of 69 (4.3%) of the controls. The white matter lesions in migraineurs were seen in a younger age group than in the controls. These findings agree with recent MRI studies. Ischemia or an immune‐based white matter demyelination are possible mechanisms for the white matter lesions.
Tizanidine in Chronic Tension‐Type Headache: A placebo controlled double‐blind cross‐over study
Authors: Fogelholm Rainer , Murros Karl
Published: May 2005

SYNOPSIS

The efficacy of tizanidine in chronic tension‐type headache was compared with placebo in a randomized, double‐blind and cross‐over study in 37 women aged 20 to 59 years with a history of headache for 7 months to 30 years (median 5 years). The treatment periods were 6 weeks with an intervening 2 week wash‐out period. The treatment was started with 6 mg/ day divided into three doses, and the daily dose could be increased to 18 rag/day depending on the treatment response. The effect of the treatment was measured by visual analogue scale, verbal rating scale, number of days free of headache, number of analgesics needed, and the dose of trial medication needed. In all these measurements, tizanidine was statistically significantly more effective than placebo. The pre‐trial Beck Depression Inventory score did not predict the response to treatment, neither did the level of electromyographic activity of the trapezius muscle. Side‐effects, drowsiness and dry mouth were significantly more common during tizanidine treatment but they were usually mild. The results of the present trial suggest that tizanidine is effective in the treatment of chronic tension‐type headache in women.
Management of Acute Intractable Headaches Using IV Therapy in an Office Setting
Authors: Stiller John
Published: May 2005

SYNOPSIS

Twenty‐seven consecutive patients with acute intractable headaches were treated in an office setting with an intravenous protocol of an antiemetic, hydrocortisone sodium succinate, and dihydroergotamine (DHE). All patients had significant pain relief within 45 minutes. Patients who were not pain‐free post‐treatment uniformly reported decreasing pain at the time of departure from the office. No patients required further treatment (including narcotic medication) for acute headache. All patients were followed for at least 24 hours. Adverse reactions were transient and mild. Akathisia was not uncommon and has probably been underestimated in previous studies.
Headaches During Intracranial Endovascular Procedures: A Possible Model of Vascular Headache
Authors: Martins Isabel P. , Baeta Élia , Paiva Teresa , Campos Jorge , Gomes Leonor
Published: May 2005

SYNOPSIS

We report a series of 11 patients who developed headaches during intracranial endovascular procedures performed for the treatment of arteriovenous malformations (10 cases) or aneurysms (1 case).

Headache was precipitated either by balloon inflation (3 cases) or by embolization (8 cases), and had a very constant pattern. In all cases the pain started suddenly, reaching maximum intensity at once. Headache was focal, unilateral, ipsilateral to the occluded artery, nonthrobbing and short‐lasting (usually less than 10 minutes). It was not associated with gastrointestinal, autonomic, or aura‐like symptoms. Headache localization depended upon the catheterized artery, being constant for each of the major vascular territories. Yet, in all patients pain was felt in the cutaneous territory of the ophthalmic division of the trigeminal nerve.

The occurrence of headache was not associated with cortical deficit nor cortical irritation (assessed both clinically and by the EEG) and therefore seems to be directly related to the stimulation of the arterial wall. This type of pain can be used as a model of pure vascular headache. Its study can contribute not only to understand the pattern of intracranial vascular innervation but also to understand or to refute the vascular components of migraine.
MRI Findings in a Case of Ophthalmoplegic Migraine
Authors: Stommel Elijah W. , Ward Thomas N. , Harris Robert D.
Published: May 2005

SYNOPSIS

MRI using gadolinium contrast material can demonstrate lesions in cranial nerves. Tumors and Inflammatory lesions have been described.1,2 There is little published information on MRI of cranial nerve in patients with migraine headache with ophthalmoplegia.3 We present a case of ophthalmoplegic migraine with a cranial nerve abnormality which was subsequently shown to improve as the patient clinically improved. Implications from this finding are discussed in relation to the pathophysiology of ophthalmoplegic migraine.
Headache as a Presentation of Angina: Reproduction of Symptoms During Angioplasty
Authors: Bowen James , Oppenheim Gary
Published: May 2005

SYNOPSIS

We report a case of angina presenting as headache in a 59‐year‐old man. Headaches were relieved by nitroglycerin and were reproduced by occlusion of the first obtuse marginal artery during angioplasty. Headaches resolved after successful angioplasty. The temporal relationship between coronary artery occlusion and the headache suggests that headache angina is due to referred pain rather than a generalized vaso‐spastic disorder.
Cough Headache Presenting as a Toothache: A Case Report
Authors: Moncada Elizabeth , Graff‐Radford Steven B.
Published: May 2005

SYNOPSIS

Benign cough headache (BCH) presents as an intermittent, usually bilateral, severe bursting or explosive pain brought on by coughing. Some of the known conditions which can mimic the pain experienced in BCH are subarachnoid hemorrhage, increased intracranial pressure, intracranial tumors, and even toothache. Careful evaluation must be carried out in order to differentiate between these conditions. A case of BCH which presented as a toothache is reported. The evaluation for exertional headaches, and for headaches brought on by coughing, is discussed.
The Headache Self‐Efficacy Scale: Adaptation to Recurrent Headaches
Authors: Martin Nancy J. , Holroyd Kenneth A. , Rokicki Lori A.
Published: May 2005

SYNOPSISThis paper describes the development, construct and discriminant validity, and incremental utility of a headache self‐efficacy scale. The Headache Self‐Efficacy Scale is a 51 item scale designed specifically for recurrent headache sufferers. It assesses individuals' belief that they are able to do the things necessary to prevent a moderately painful headache when confronted with personally relevant headache precipitants. High self‐efficacy was associated with less depression, anxiety, and physical symptoms, and less use of passive coping strategies (P<.01), even when headache frequency, intensity and chronicity were controlled statistically. Self‐efficacy also explained unique variance in psychological and somatic symptoms beyond that explained by locus of control and general self‐efficacy. These findings suggest that adaptation to headaches is influenced by self‐efficacy beliefs, and that the assessment of self‐efficacy may provide useful information in the evaluation of recurrent headache sufferers.
Cervicogenic Headache: Responses to Nitroglycerin, Oxygen, Ergotamine and Morphine
Authors: Bovim G. , Sjaastad O.
Published: May 2005

SYNOPSIS

The responses in cervicogenic headache to four different agents have been studied. Nitroglycerin was given sublingually to 27 patients. Eighteen patients got more than 20% increase of their headache. Of those with any headache increase at all, 12 got bilateral and 12 unilateral pain. The typical late cluster headache response to nitroglycerin was not seen in cervicogenic headache. The provocative effect of nitroglycerin seemed less marked in cervicogenic than in cluster headache. Oxygen inhalation, a frequently used treatment for cluster headache, was given to 14 patients with cervicogenic headache. In general, the effect seemed uncertain and probably clearly inferior to the effect in cluster headache. Ergotamine treatment (given to 13 patients) also seemed to be of little avail in cervicogenic headache. Morphine injections given to 11 cervicogenic headache patients resulted in “marked” improvement in 4, but complete pain freedom was only seen in 2 cases. In our opinion, the present results add further evidence to the view that different etiologic and pathogenetic factors underlie cervicogenic headache and cluster headache.
Natural History of Cluster Headache
Authors: Pearce JMS
Published: May 2005

SYNOPSIS

A follow‐up study of 123 patients with episodic cluster headaches and of 9 patients with chronic cluster headaches was undertaken after 10–25 years, (mean 14.7 and 13.9 years respectively). This shows a significant but low remission rate for both episodic and chronic cluster headache. It confirms the observation that some patients change from episodic to chronic pattern, and that occasionally chronic clusters may become episodic.
Idiopathic Stabbing Headaches Lasting a Few Seconds
Authors: Dangond Fernando , Spierings Egilius L.H.
Published: May 2005

SYNOPSIS

Four cases of idiopathic stabbing headache subjectively perceived as lasting several seconds are reported. The classification of the International Headache Society suggests that these headaches typically last “a fraction of a second”. The perception of such brief pains may be difficult to quantitate and, therefore, the duration of the headache should not be used as a strict diagnostic criteria.
Effectiveness of a Piroxicam Fast Dissolving Formulation Sublingually Administered in the Symptomatic Treatment of Migraine Without Aura
Authors: Nappi Giuseppe , Micieli Giuseppe , Tassorelli Cristina , Viotti Elena , Altavilla Teodoro
Published: May 2005

SYNOPSIS

In this study we evaluated the efficacy of a new preparation (Fast Dissolving Dosage Form ‐ FDDF) ofpiroxicam (40 mg in a single sublingual dose) in the acute treatment of migraine. The study plan was ofsingle blind type versus placebo and involved 40 patients with migraine without aura (according to the IHSClassification criteria) who had to take Piroxicam FDDF (or placebo) within 2 hours from the beginning of amigraine attack. Pain intensity and associated symptoms were evaluated in the basal condition and thenmonitored at serial intervals for 24 hours.In the group of patients treated with the active drug (n=20), a significant reduction of pain intensity(Visual Analogue Scale) was observed after only 15 minutes (P=0.0034). After an hour, headache hasdisappeared in 15 patients, become mild in 4 and remained unchanged in only one subject. Associatedsymptoms also quickly disappeared after Piroxicam FDDF administration and headache recurred in onlytwo patients within the 24 hour period. Sublingual administration of Piroxicam FDDF was well tolerated: nosystemic side‐effects were reported and only two subjects complained about mouth dysesthesias whichwere described as mild and short‐lasting.In conclusion, Piroxicam FDDF has been shown in this preliminary study to have striking efficacy in theacute treatment of migraine. The treatment is characterized by quick onset, long duration and goodtolerability.
The Role of Life Event Stress, Coping and Social Support in Chronic Headaches
Authors: Martin Paul R. , Theunissen Chris
Published: May 2005

SYNOPSIS

A group of chronic headache sufferers (migraine and tension‐type headache) was compared with twoindividually matched control groups of nonheadache subjects in terms of life event stress, and the stressmoderating factors of coping skills and social support. The headache group did not differ from the controlgroups on the measures of life event stress or coping but significant differences arose on the measure ofsocial support with the headache group achieving lower scores than the control groups. The findings wereinterpreted as suggesting that clinicians and researchers should pay more attention to social aspects ofheadaches, and that interventions aimed at teaching headache sufferers to mobilize social support shouldbe considered as components of treatment packages.
Intracranial Hypertension and Sumatriptan Efficacy in a Case of Chronic Paroxysmal Hemicrania Which Became Bilateral. (The Mechanism ofIndomethacin in CPH.)
Authors: Hannerz Jan , Jogestrand Tomas
Published: May 2005

SYNOPSIS

A female patient is described who had a four year long period of unilateral chronic paroxysmalhemicrania (CPH) which then became bilateral. For some years before the CPH started she suffered fromperiods of about one month with chronic hemicrania without nerve involvement. She also suffered fromchronic fatigue, back pain, arthralgia, vertigo, chronic constipation and spontaneous ecchymoses. Bloodtests showed chronic leukocytosis, low serum iron, and signs of inflammation in serum electrophoresisduring the five years she was studied. CPH attacks could be provoked by breathing 6% carbon dioxide inair. Lumbar cerebrospinal fluid pressure was pathologically increased (30 cm water). The attacksdecreased during indomethacin treatment but 275 mg was needed for satisfactory control of the attacks,i.e., more than the 150 mg which, according to the criteria for CPH, should be absolutely effective.Sumatriptan was found to suppress the CPH attacks as well as indomethacin. Due to these findings CPH isconsidered to be another manifestation of venous vasculitis. The beneficiary mechanism of indomethacinin CPH is considered to be due partly to its anti‐inflammatory effects and partly to its reduction of theintracranial blood flow.
Taurine Levels in Plasma and Cerebrospinal Fluid in Migraine Patients
Authors: Martínez F. , Castillo J. , Leira R. , Prieto J.M. , Lema M. , Noya M.
Published: May 2005

SYNOPSIS

Taurine is the amino acid with the highest concentration in the human body. Its physiologic functions arenot yet well understood. As a neurotransmitter or neuromodulator it may display inhibitory functions. We havemeasured taurine levels in plasma and cerebrospinal fluid of migraine patients during attacks, comparing themwith controls. Patients with migraine had significantly higher concentrations than controls. No sex or ageinfluence over the amino acid levels were observed. Plasma taurine levels in patients with classic migrainecorrelated negatively with severity of headache. Central taurine liberation during migraine crisis may be due tospontaneous depolarization or a defensive reaction in the context of cerebral homeostatic processes.
Painful Intervertebral Dysfunction: Robert Maigne's Original Contribution to Headache of Cervical Origin
Authors: Meloche Jacques P. , Bergeron Yves , Bellavance Andre , Morand Marcel , Huot Jean , Belzile Gabriel
Published: May 2005

SYNOPSIS

Professor Robert Maigne, a French Orthopedic Medicine and Functional Rehabilitation specialist, hasput forward new concepts leading to a better understanding of common pain of spinal origin. Maigneexplains that pain in the spine is due to an intervertebral dysfunction of the mobile segment which consistsof the intervertebral disc, ligaments and the facet joints. Any benign mechanical dysfunction of the mobilesegment can induce a pain radiating in the dermatome at the same level as the vertebral problem. Maignealso described signs found in the skin (cellulalgia), in the muscles (myalgic bands) and in the bonyinsertions of tendons (tenalgia). These signs are to be found in the same dermatome, myotome andsclerotome as the spinal dysfunction. For headache of cervical origin due to painful intervertebraldysfunction, the most frequent dysfunctional mobile segment is located at the C2‐C3 level. This inducespain mostly in the posterior parts of the head and cellulalgia in the C2 and C3 dermatomes. Painfultumefaction is also found over the posterior aspects of the facet joints on palpation at this level. Thesefindings are key elements for the diagnosis of painful intervertebral dysfunction. The recognition of thesesigns is changing our understanding of the role of the cervical spine in headaches. Painful intervertebraldysfunction is very frequently found in chronic daily headaches.
Comparison of the Efficacy Between Flunarizine and Nifedipine in the Prophylaxis of Migraine
Authors: Lamsudin Rusdi , Sadjimin Tonny
Published: May 2005

SYNOPSIS

Background. Several calcium channel blockers have been evaluated in controlled clinical studies and some holdconsiderable promise for future. Efficacy in migraine prophylaxis has been claimed for drugs belonging to all threeclasses of calcium channel blockers (nifedipine‐like, verapamil‐like, and flunarizine‐like), but the extent and quality of theevidence varies, and a comparison of efficacy between different calcium channel blockers has not been reported.Objective.The objective of the study is to assess the comparison of efficacy and safety of flunarizine and nifedipinein migraine prophylaxis.Patients and methods.The study was conducted in a prospective, double‐blind, randomized controlled trial, parallelgroup design. 78 patients were studied for a 1‐month period during which all patients received placebo followed by a3‐month experimental period. Headache response to medication was measured monthly by compilation ofmigraine‐scores derived from quantitative data recorded by patients in a daily diary.1 Student's t‐test was used tocompare results from the flunarizine (10 mg) and nifedipine (20 mg) group for each month.Results.Both groups showed a significant reduction in the migraine‐scores after 3‐months. No significantdifferences were detected between groups, but there was a clinical significantly different reduction of migraine‐scoresbetween the groups in the first month after the run‐in period (58% vs 38%). It shows that the beneficial effect offlunarizine was more rapidly manifest than that of flunarizine. Tachycardia more frequently occurred in the nifedipinegroup than in the flunarizine treatment group.Conclusion.It concluded that flunarizine is a potentially more useful agent in the prophylaxis of migraine headache.
A Population‐Based Survey of Headache and Migraine in 22,809 Adults
Authors: Honkasalo M‐L. , Kaprio J. , Heikkilä K. , Sillanpää M. , Koskenvuo M.
Published: May 2005

SYNOPSIS

A population‐based epidemiological study of the prevalence of headache in a sample of 24,682 adults was carried out in Finland. Enquiries were made concerning the frequency of headache, migraine and characteristics of headache attacks in a questionnaire survey in 1981. Headache was classified as migraine, and headache without migrainous features. Possible somatic causes of headache were excluded by record‐linkage with three nation‐wide medical registries.

The prevalence of both headache types depended on age and gender. Among women the overall prevalence of migraine was 10.1% with a maximum of 11.5% in the 40‐49 age group. The prevalence rate among men was 2.5% and the female/male gender ratio was 4.0. Women with migraine had an average of 52.5 headache occasions during a year and men with migraine 61 headache occasions per year. At the individual level, headache without migrainous features was least invalidating. There were only 16.5 headache occasions a year among women and 11.5 among men. However, from a population perspective headache without migrainous features accounted for 46.5% of all headache occasions among women and for 60.8% among men. Thus, from the public health viewpoint, studies of “non‐clinical” headache, e.g. headache without migrainous features should be emphasized.
Abnormal Photoreactivity in Ictal Migraine: Reversal by Sumatriptan
Authors: Anzola G.P. , Magoni M. , Volta G. Dalla
Published: May 2005

SYNOPSIS

The reactivity of posterior cerebral artery (PCA) to light stimulation was studied with transcranial Doppler in 9 migraine patients (5 with aura, 4 without aura) within six hours of the onset of headache (mean 115 ± 78 minutes). The PCA mean flow velocity was recorded while the patient was in the dark and with the eyes closed and, subsequently, while the light was on and with the eyes open. Both symptomatic and asymptomatic sides were recorded. The same test was repeated thirty minutes after injection of sumatriptan 6 mg sub‐cutaneously and again on the third day after cessation of the attack. Photoreactivity was calculated, for each side and for each situation, as percent relative increase of the corresponding averaged mean flow velocity recorded in darkness. The results showed that, although absolute flow velocities were not statistically different between sides and situations, photoreactivity was significantly increased on the symptomatic side during attacks (+28% vs 15% respectively). After sumatriptan, photoreactivity became symmetrical and (nonsignificantly) inferior to the values recorded in the interictal period. These findings suggest that, during headache, peripheral resistance branches of PCA on the symptomatic side are hypersensitive to vasodilatory stimuli. This could represent the counterpart of the clinical scotomata and photophobia commonly experienced by migraine patients during attacks.
Migraine in Patients With Stroke and Antiphospholipid Antibodies
Authors: Silvestrini Mauro , Cupini Letizia Maria , Matteis Maria , De Simone Roberto , Bernardi Giorgio
Published: May 2005

SYNOPSIS

The association between migraine and antibodies against antiphospholipids is controversial. We investigated the prevalence and the clinical feature of migraine in patients with ischemic stroke and antiphospholipid antibodies. Data were obtained from the medical records of 162 consecutive patients with ischemic stroke over a 2‐year period. Ten patients with antiphospholipid antibodies were prospectively identified. A history of migraine was present in 6 of these patients and in only 5 of the 152 patients with negative results for antiphospholipid antibodies (chi‐square=47.68; P <.0001). In the former, migraine had been for a long time the only clinical problem before the occurrence of the ischemic stroke. These findings suggest that migraine is frequent and can be an early and a prominent symptom in the antiphospholipid antibodies syndrome. Further studies are needed to fully elucidate the association of migraine and antiphospholipid antibodies. A better knowledge of this association could allow an early identification of patients at high risk of stroke.
Subcutaneous Sumatriptan in the Acute Treatment of Migraine in Patients Using Dihydroergotamine as Prophylaxis
Authors: Henry P. , D'Allens H. , Abadie P. , Aliotti C. , Archirnbaud A. , Aurouze J , Boibelet J.‐P. , Bouchet J. , Brejoux G. , Cazal Y. , Deleuze J. , Ducarré M. , Dufour J. , Foissac R. , Giner M. , Guillemet S. , Jozereau P. , Lafuma G , Laugier J. , Longobardi B. , Manhas A. , Marteau E. , Mathas B. , Mauret D. , Maurin J.‐P. , Mongin G. , Paulet C. , Robert C. , Rousch D. , Sachetat P. , Salvi M. , Sdrigotti D. , Toores J. , Wien E. , Bertin Laurent
Published: May 2005

SYNOPSIS

The efficacy of sumatriptan, a 5‐HT 1 receptor agonist, in patients with migraine attacks occurring despite prophylactic treatment with oral dihydroergotamine, was assessed in a double‐blind placebo‐controlled study involving 76 patients. Thirty‐seven patients were treated with a subcutaneous injection of 6 mg sumatriptan self‐administered with an auto‐injector and 39 with placebo given by the same route. Patients having inadequate relief were allowed to use a second injection of test medication I hour later and rescue treatment between 2 hours and 24 hours after the first dose. Headache relief was achieved within 2 hours after sumatriptan in 26 patients (70%) compared to 8 patients (21%) in the placebo group (P<0.0001). Of these patients, 19 (51%) and 3 (8%) were, respectively, pain free at this time. A second injection of sumatriptan was used by 8 (22%) patients compared to 30 (77%) patients in the placebo group (P<0.0001), whereas rescue medication was used respectively by 13 (35%) and 22 (58%) patients (P < 0.024). The adverse event profile of sumatriptan was not affected by the concomitant use of dihydroergotamine and side‐effects were all minor and transient. Patient satisfaction was significantly higher in the sumatriptan group (75%) compared to patient satisfaction with placebo (16%). These results show that the high efficacy rate of subcutaneous sumatriptan and its safety profile remain unchanged in migraine patients receiving oral dihydroergotamine as pro‐phylaxis.
Polypharmacy in a Headache Centre Population
Authors: Oates Linda N. , Scholz Mary J. , Hoffert Marvin J.
Published: May 2005

SYNOPSIS

In this paper we report the prevalence of self‐medication and polypharmacy in our patient population at the John R. Graham Headache Centre at the Faulkner Hospital, Boston. One hundred fifty patients were interviewed when they called the Headache Centre and spoke to a triage nurse, A significantly higher number of women than men called in for triage counselling. Sixty‐nine percent of the patients reported taking non‐Headache Centre medications, either prescribed or over the counter (OTC); 39% of the patients took pain medications. Thirty‐one different medications were named by patients for a mix of diagnoses.
Italian Experience of Electromyographic‐Biofeedback Treatment of Episodic Common Migraine: Preliminary Results
Authors: Grazzi Licia , Bussone Gennaro
Published: May 2005

SYNOPSIS

Electromyographic biofeedback is commonly used successfully to treat tension‐type headache, while thermal biofeedback is considered the best behavioral therapy for migraine. Ten female patients with episodic common migraine (age 20‐35 years, age of disease onset 16.2 ± 5.1 years, illness duration 13.6 ± 10.7 years) were treated by 16 twice‐weekly electromyographic biofeedback and relaxation training sessions with breathing exercises. Follow‐up sessions were held 1, 3, 6 and 12 months after the end of treatment. A significant decrease in migraine episodes was noted after therapy. More importantly, pain episodes continued to decline up to the last follow‐up 12 months later. Electromyographic activity was within the normal range throughout treatment and follow‐up, and there was no relationship between electromyographic activity and pain index. It is concluded that the results, particularly after a year's follow‐up, are encouraging for the use of this technique to treat migraine. However, the behavioral changes and increased well‐being did not correlate with muscular tension. Control of breathing, peripheral temperature and muscle activity are probably important common factors mediating learned ability to influence sympathetic activity; it is probably the latter which leads to reduced pain in migraine patients.
Analgesic Use and Chronic Renal Disease in Patients With Headache
Authors: Rahman A. , Segasothy M. , Samad S.A. , Zulfiqar A. , Rani M.
Published: May 2005

SYNOPSIS

The pattern of analgesic use, abuse and incidence of analgesic‐associated nephropathy in 79 patients with chronic headache was studied. Sixty‐eight of these patients had migraine. Most patients had consumed a combination of analgesics (81%) while 19% had taken single analgesics for their headache. Nonsteroidal anti‐inflammatory drugs were the most commonly used analgesics (96.2%) followed by paracetamol (70.9%) and aspirin, phenacetin and caffeine compounds (5.1%). Mefenamic acid was the commonest nonsteroidal anti‐inflammatory drug consumed (97.4%). Analgesic abuse which was defined as a minimum total of I kg of analgesics such as paracetamol or aspirin, phenacetin and caffeine compounds or 400 capsules/tablets of nonsteroidal anti‐inflammatory drugs was noted in 65 patients. Nonsteroidal anti‐inflammatory drugs were the most commonly abused analgesics (89.2%) followed by paracetamol (38.5%). Forty‐five of the 65 analgesic abusers had an intravenous urogram or ultrasound performed and renal papillary necrosis was documented in one patient. Three (4.6%) of the analgesic abusers had mildly raised serum creatinine levels. Mild proteinuria of less than 1 gm/ litre was present in 27.7% of abusers. In conclusion, although analgesic use and abuse is common in patients with chronic headache, the short term incidence of analgesic‐associated nephropathy (2.2%) and renal impairment (4.6%) was low. Prolonged observations will be necessary to ascertain the safety of these drugs for long term use.
A Contrast Enhanced Lesion of the III Nerve on MR of a Patient With Ophthalmoplegic Migraine as Evidence for a Tolosa‐Hunt Syndrome
Authors: Straube A. , Bandmann O. , Büittner U. , Schmidt H.
Published: May 2005

SYNOPSIS

A 23‐year‐old female with a six year history of migraine without aura twice developed a nearly complete internal and external III nerve paresis ipsilateral to her headache, two days after the onset of migraineous headache. An MR scan performed one week after the second episode showed a contrast enhanced lesion of the prepontine III nerve, where it enters the cavernous sinus on the left side. The headache, as well as the paresis ameliorated spontaneously. We suggest this is a further well documented case of “ophthalmoplegic migraine” which might reflect Tolosa‐Hunt syndrome.
Bilateral Horner's Syndrome in Cluster Type Headaches
Authors: Khurana Ramesh K.
Published: May 2005

SYNOPSIS

A patient with cluster type headaches demonstrated bilateral and alternating ocular sympathetic dysfunction during a spontaneous as well as a nitroglycerin‐induced attack. Biochemical evaluation revealed postganglionic pupillary dysfunction on the symptomatic side and preganglionic pupillary dysfunction contralaterally. These findings defy a simple explanation regarding a central or peripheral origin of the oculocephalic sympathetic dysfunction.
Headache Caused by a Single Lesion of Multiple Sclerosis in the Periaqueductal Gray Area
Authors: Haas David C. , Kent Paul F. , Friedman Deborah I.
Published: May 2005

SYNOPSIS

We report a severe acute headache that occurred in conjunction with a solitary fresh lesion of multiple sclerosis in the periaqueductal gray region of a 16‐year‐old girl. This unique natural event supports the recent proposition, based on observations of patients with implanted electrodes, that perturbations of the periaqueductal gray region can produce headache. It also suggests that headaches accompanying attacks of multiple sclerosis are due to disturbances in particular regions of the brain.
Towards a Functional Model of Chronic Headaches: Investigation of Antecedents and Consequences
Authors: Martin Paul R. , Milech Dan , Nathan Paula R.
Published: May 2005

SYNOPSIS

The traditional approach to classifying headache based on symptoms and assumed mechanisms is criticized as having limited utility when applied to tension‐type headache and migraine. The study reported here was designed to explore an alternative method of conceptualizing chronic headaches based on functional characteristics or controlling variables. One hundred and ninety nine chronic headache sufferers completed questionnaires which enquired about the antecedents and consequences of their headaches. An attempt to build a categorical model driven by functional characteristics using cluster analysis was unsuccessful but a subsequent attempt to construct a dimensional model using factor analysis proved more successful. This approach led to the emergence of five antecedent dimensions and six consequences dimensions (three pertaining to the responses of sufferers and three to the reactions of significant others) which were readily identifiable. The functional dimensions were significantly related to traditional diagnostic categories but at a low level. Three functional dimensions predicted response to psychological treatment.
Office‐Based Treatment of Acute Migraine With Dihydroergotamine Mesylate
Authors: Winner Paul , Dalessio Donald , Mathew Ninan , Sadowsky Carl , Turkewitz L. Jay , Sheftell Frederick , Silberstein Stephen D. , Solomon Seymour
Published: May 2005

SYNOPSIS

The Regional Migraine Field Trial assessed the efficacy and safety of dihydroergotamine mesylate (D.H.E. 45 (r) ) for migraine in the office setting. Patients were admitted to the study provided they met the International Headache Society definition of migraine with or without aura. Thirty‐eight neurologists enrolled 311 patients (274 women and 37 men) between the ages of 13 and 70 years in this open‐design study. Ninety‐five percent of the patients had moderate or severe headache pain at entry, and 62% had nausea. All patients received a single intramuscular injection of D.H.E. 45 (r) 1 mg. A second intramuscular injection of 1 mg was given 60 minutes after the first injection, if needed. An antiemetic was administered concomitantly with D.H.E. 45 (r) , if needed. Rescue therapy was given at the investigators' discretion. Efficacy was judged by the relief of pain, patients' ability to function, need for a second injection, need for rescue medication, and need for an antiemetic. At 30 and 60 minutes, 46% and 72% of patients had only mild or no head pain, respectively. At 24 hours, 77% of all patients had mild or no head pain. D.H.E. 45 (r) also improved functional ability. At 30 and 60 minutes, 58% and 75% of patients had only mild or no disability, respectively. At 24 hours, 81% had mild or no impairment. Nausea was present in 62% of patients at the outset, 40% of patients at 30 minutes, and 30% at 60 minutes. An antiemetic was given to 43% of patients at the outset. The presence of nausea was similar whether or not patients received an antiemetic. Rescue medication was needed for 11% of patients, and adverse events were reported by 9%. In conclusion, D.H.E. 45 (r) is effective therapy for acute migraine. A second dose provides additional relief, if needed.
Cluster Headache: The Ventilatory Response to Transient Hypoxia with Pure Nitrogen
Authors: Shen Jie Ming , Schaanning Jan , White Linda , Kruszewski Piotr , Bjaanes Elisabeth , Sjaastad Ottar
Published: May 2005

SYNOPSIS

To determine whether the carotid body plays a pathogenetic role in cluster headache, 20 cluster headache patients have been studied. Of these, 11 patients were in the interparoxysmal cluster phase, and 9 were in remission. Comparison was made with healthy subjects matched for sex, age, and smoking habits. Transient hypoxia was induced by inhalation of 1–8 breaths of 100% nitrogen (N2), until the arterial oxygen saturation (SaO2) decreased to around 80%. Changes in ventilation (tidal volume, inspiratory minute ventilation (VI ), and end‐tidal PCO2 (PETCO2)), were analyzed breath‐by‐breath.

Under basal conditions, cluster headache patients had a slightly higher SaO2 and VI when compared to controls. PETCO 2 was significantly lower (P < 0.05) during the cluster period as measured by Wilcoxon signed rank test for paired data, and during remission, according to the Student's paired t‐test, in comparison with controls. After exposure to N2, no significant difference was found in the rate of reduction of SaO2 between any of the groups. A higher absolute increase in VI , but a relative (%) decrease in VI at moderate hypoxia were measured, the differences between patients and controls being on the border of the level of significance. Chemoreceptor sensitivity of the carotid body, expressed as the slope of a regression curve obtained by plotting the increase in VI against the reduction in SaO2, showed no statistical difference between the groups. The results do not support the hypothesis of a pathogenetic role for the carotid body in cluster headache.
Hemicrania Continua and Symptomatic Medication Overuse
Authors: Young William B. , Silberstein Stephen D.
Published: May 2005

SYNOPSIS

Hemicrania continua (HC) is a rare, strictly unilateral, non‐paroxysmal headache disorder characterized by its absolute responsiveness to indomethacin. The pain is usually moderate in intensity and frequently associated with a superimposed“jabs and jolts” headache.

We report two cases of HC which presented as chronic daily headache (CDH) with abortive medication overuse.

CDH can be due to transformed migraine (TM), new daily persistent headache (NDPH), chronic tension‐type headache, and HC. All can be unilateral, and all can be associated with medication overuse. Our two cases meet the criteria for HC based on indomethacin responsiveness. One meets the criteria for TM, the other NDPH. Is HC a distinct disorder, or a subset of these other disorders? CDH with medication overuse includes in its differential diagnosis HC.
Cluster Headache: Transcranial Doppler Assessment of Dynamic Cerebral Circulatory Changes During Hypocapnia and Attack
Authors: Shen Jie Ming , Johnsen Hans‐Jørgen , Juul Roar
Published: May 2005

SYNOPSIS

Transcranial Doppler ultrasound (TCD) investigations have been carried out in cluster headache patients (8 during remission and 6 during bout) and 14 healthy subjects, to assess cerebral vasomotor reactivity (VMR) to hypocapnia induced by voluntary hyperventilation. VMR was expressed as the relative change in blood flow velocity (V) (%) as a function of the reduction in end‐tidal PCO2 (PETCO2) (kPa), i.e. V/PETCO2. TCD with simultaneous PETCO2 monitoring, was also performed in 5 patients during spontaneous attacks.

Prior to hyperventilation, there was bilaterally lower anterior cerebral artery velocity (VACA) during the bout than during remission (P <0.05 on the symptomatic side), and also lower than in the controls. During remission, VACA was higher on the symptomatic side than on the other side (P <0.05). ACA also showed a lower VMR during the bout than during remission, and it was also lower than in controls (bout vs. remission on the non‐symptomatic side, P <0.01; on the symptomatic side, P > 0.1). Approximately 30 minutes after the onset of attack, PETCO2 started to decrease gradually from 4.65 to 4.10 kPa in one patient with severe attack. The VACA decreased markedly and bilaterally already at an early stage of the attack, i.e. prior to the hyperventilation. Middle cerebral artery velocity tended to decrease 30 minutes after the onset of attack on the symptomatic side, and 50 minutes after onset on the non‐symptomatic side. It is concluded that the vascular hanges observed most likely are secondary phenomena during the cluster headache attack.
Embolization of a Tentorial Dural Arterio‐Venous Fistula Presenting as Atypical Trigeminal Neuralgia
Authors: Ott D. , Bien S. , Krasznai L.
Published: May 2005

SYNOPSIS

A patient with a tentorial dural AV fistula causing atypical trigeminal neuralgia (TN) successfully treated by embolization is reported. The patient developed persisting throbbing facial pain in the distribution of the secondand third division of the right trigeminal nerve (V2,V3) after a history of typical neuralgia for one year, preceded by a two month spell of TN 6 years previously and accompanied by right‐sided pulsatile tinnitus for 10 years. The patient's mother, brother and sister were also said to be affected by typical trigeminal neuralgia.

A right‐sided dilated vein of Rosenthal due to a dural AV fistula fed by branches of the meningeal, occipital and meningo‐hypophyseal trunk of the internal carotid artery was thought to cause trigeminal nerve compression. Complete resolution of symptoms after partial intra‐arterial embolization of the main feeding arteries with N‐butyroacrylate is described.
Cluster‐Tic Syndrome and Basilar Artery Ectasia: A Case Report
Authors: Ochoa J.J. , Alberca R. , Cañadillas F. , Blanco A.
Published: May 2005

SYNOPSISA 54‐year‐old patient presented with two types of pain. The first was similar to trigeminal neuralgia and the second was similar to cluster headache. Clinical diagnosis was cluster‐tic syndrome. Neuro‐imaging studies disclosed an ectatic basilar artery. The significance of this finding is difficult to ascertain.
Prevalence of Headache in a Representative Sample of the Population in a French Department (Haute‐Vienne ‐ Limousin)
Authors: Munoz M. , Dumas M. , Boutros‐Toni F. , Coquelle D. , Nicolas A. , Ndzanga E. , Boa F. , Vallat J.M. , Dartigues J.F.
Published: May 2005

SYNOPSIS

In 1986–1987, a neuroepidemiologic survey was undertaken to study the prevalence of the most frequently encountered neurologic disorders, and in particular headache, in a representative sample of the population in the Haute‐Vienne Department(Limousin). A door‐to‐door survey was made using a protocol developed by the W.H.O. at the beginning of the 1980's. Thecalculated prevalences (according to Poisson's distribution) per 100,000 inhabitants were 5,059 for non migraine headache,and 4,270 for migraine headache. This disorder preferentially affected young adults and essentially involved females. It wasthe most frequently encountered disorder (50%) during the different surveys of similar methodology.
Disruption of the Immunopeptidergic Network in Dietary Migraine
Authors: Martelletti Paolo , Stirparo Giuseppe , Rinaldi Cristina , Frati Luigi , Giacovazzo Mario
Published: May 2005

SYNOPSIS

This investigation is devoted to the study of the time‐course of a cytokines panel (IL‐4, IL‐6, IFN‐gamma,GM‐CSF) in plasma samples from migraine patients. The data obtained during challenged migraine crises was compared to the baseline values. Time‐data series analysis showed a fall after a challenge test for IL‐4 and IL‐6 plasma levels and an opposite trend for gamma‐IFN and GM‐CSF levels. The implication of this phenomenon in dietary migraine is not readily evident. There may possibly be an activation of this cytokine network together with the well‐known impairment in the neuropeptidergic system, consideringthe close links between interleukins and other cytokines and the neuro‐mediators of pain, such ashistamine and 5‐HT.
Platelet Substance P and 5‐Hydroxytryptamine in Migraine and Tension‐Type Headache
Authors: Nakano Toshiya , Shimomura Tokio , Takahashi Kazuro , Ikawa Shiro
Published: May 2005

SYNOPSIS

Levels of substance P (SP) and 5‐hydroxytryptamine (5‐HT) in platelets were measured in 25 patients with migraine,31 patients with tension‐type headache (TH) and 27 healthy controls. The mean concentration of SP in platelets was 355.3 pg/10 9 platelets in patients with migraine, 290.8 pg/10 9 platelets in patients with TH and 180.8 pg/10 9 platelets in the controls. The concentrations of platelet SP in the migrainous patients and in the TH patients were significantly higher than those in the controls. The mean concentration of 5‐HT in platelets was 619.7 ng/10 9 platelets in patients with migraine, 579.3 ng/10 9 platelets in patients with TH and 811.9 ng/10 9 platelets in the controls. The concentration of platelet 5‐HT in the patients with TH was significantly lower than that in the controls. The platelet SP/5‐HT ratio in the migrainous patients and in the TH patients were significantly higher than that in the controls. There was significant negative correlation between the concentrations of platelet SP and those of platelet 5‐HT. These results may support the hypothesis that SP released from the terminals of the trigeminal nerves causes migraine either through direct actions on the vessels or by releasing 5‐HT from the platelets. The high levels of platelet SP in TH patients might reflect release of SP from the pain sensory system.
Headaches and Women: Treatment of the Pregnant and Lactating Migraineur
Authors: Silberstein Stephen D.
Published: May 2005

SYNOPSIS

Migraine is a hormonally sensitive episodic headache disorder which may worsen during the first trimester, but usually improves during later pregnancy. Its treatment can be difficult because of the risks of injury to the fetus and newborn. These risks include teratogenicity, embryo mortality, fetal growth abnormalities, and perinatal effect. This paper reviews the effects of drugs on the fetus and newborn, their FDA classification, and their use during both pregnancy and lactation. Specific recommendations are given.