bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vivo Evaluation of a MPC Polymer Coated Continuous Flow Left Ventricular Assist System
Authors: Kihara Shin’ichiro , Yamazaki Kenji , Litwak Kenneth N. , Litwak Philip , Kameneva Marina V. , Ushiyama Hiroyuki , Tokuno Toshimasa , Borzelleca David C. , Umezu Mitsuo , Tomioka Jun , Tagusari Osamu , Akimoto Takehide , Koyanagi Hitoshi , Kurosawa Hiromi , Kormos Robert L. , Griffith Bartley P.
Published: March 2003

Abstract: The aim of this study was the evaluation of the thrombogenicity and the biocompatibility of the SunMedical EVAHEART left ventricular assist system (LVAS) coated with 2‐methacryloyloxyethyl phosphorylcholine (MPC) polymer compared to a diamond‐like carbon (DLC) coating. Four calves were implanted with the MPC polymer‐coated LVAS. Eight calves were implanted with DLC coated LVAS. The thrombogenicity and biocompatibility of the pumps were evaluated. At explant, 60.0 ± 37.2% (5‐85%) of the pump surface area was still coated with MPC polymer after the duration of 45.0 ± 32.0 days. In 1 out of 4 MPC and 2 out of 8 DLC coated pumps, there was a very small amount of thrombus around the seal ring; otherwise the blood contacting surfaces were free of thrombus. Major organs were normal except for a few lesions in kidneys from both groups. The MPC polymer coated EVAHEART LVAS seems to have low thrombogenicity and high biocompatibility similar to the DLC coated system. The current study demonstrated that the MPC polymer coating shows great promise for being used as an antithrombogenic substrate for the LVAS due to its ease of application, significant cost benefit, and reduction in anticoagulation therapy in acute postoperative period.
Environmental Narratives and the Need for Multiple Perspectives to Restore Degraded Landscapes in Australia
Authors: Robertson Margaret , Nichols Pam , Horwitz Pierre , Bradby Keith , MacKintosh David
Published: March 2003

ABSTRACT This article examines environmental narratives for their potential to contribute to the restoration of ecosystem health in areas recently degraded by agricultural activities, including Australian rural landscapes. Environmental narratives encompass oral environmental histories and other anecdotal sources of knowledge and perceptions that are bounded by the narrator's experiences, observations, and attachment to place. They are analogous to indigenous knowledge. Environmental narratives can make a significant contribution to ecological restoration. We argue that restoration ecologists should acknowledge the rigor of ecological knowledge gained through detailed observation of landscapes over lengthy time periods by nonscientists. Accordingly, we advocate a view of knowledge that permits multiple perspectives: local, indigenous, and scientific. Ecological restoration in fragmented agricultural landscapes is as much a cultural as a biophysical process. It requires an understanding of and respect for cultural attributes of landscapes, including the beliefs, values, and perceptions people hold about their local environment, such as a sense of loss felt for particular landscape components, features, or functions. Recent work in Australia shows environmental narratives emerging as a practical means of integrating these biophysical and cultural aspects in ecological restoration.
Familial Cluster Headache: Report of Three Families
Authors: D'Amico Domenico , Leone Massimo , Moschiano Franca , Bussone Gennaro
Published: March 2003

We report on three families in which cluster headache is present in more than one member. In one of these families a boy, his father, and paternal grandfather were affected. In the other two families, a father and son and mother and daughter were the affected members. Diagnoses were based on IHS criteria, after examining and taking the history directly from the patient in all but one of the seven cases; the seventh patient was deceased and the diagnosis was based on reports from the affected son. Considered in the light of other recent reports of familial cluster headache, these cases suggest that cluster headache can have a genetic component.
Repeat CT or MRI in Posttraumatic Headache
Authors: Landy Stephen H. , Donovan Timothy B. , Laster Robert E.
Published: March 2003

Repeat CT or MRI of the brain should be considered in posttraumatic headache. We describe two patients with posttraumatic headache who had negative CT scans on initial presentation. One patient later had bilateral subdural hematomas on CT, and the other had temporal lobe hemorrhage on MRI. We recommend considering repeat CT or MRI for persisting posttraumatic headache and mental status change.
Migraine Headache in a Prepaid Health Plan: Ascertainment, Demographics, Physiological, and Behavioral Factors
Authors: Stang Paul , Sternfeld Barbara , Sidney Stephen
Published: March 2003

Background: Migraine is a prevalent disorder whose relationship to other conditions remains poorly understood.

Methods: Associations between migraine and physiological, behavioral, and demographic characteristics were sessed in a retrospective cohort study of 79 588 enrollees in a large prepaid health maintenance organization who underwent a multiphasic preventive health checkup in 1971–1973.

Results: Migraine was found to be inversely associated with age and education and strongly associated with the female sex. The likelihood of migraine was significantly higher among blacks, smokers, those who drink more than six cups of coffee per day, those with Raynaud’s syndrome, and those with a family history of migraine. The magnitude of associations between migraine and other factors was, in general, reduced among those with a self‐reported physician diagnosis migraine compared to those whose migraine status was defined on the basis of reported symptoms.

Conclusions: Migraine prevalence was found to be higher in blacks and other unspecified minorities than in the white population. The magnitude of the associations between migraine and behavioral risk factors was strongly influenced by the method of migraine ascertainment. The inverse association with level of education suggests that social causation or drift may have been operating in this disease in the early 1970s, 15 to 20 years earlier than recent population‐based studies would suggest. Further research is needed to fully appreciate the spectrum of disease and behaviors associated with migraine.
EEG and Topographic Frequency Analysis in Migraine Attack Before and After Sumatriptan Infusion
Authors: Thomaides Thomas , Tagaris George , Karageorgiou Climentini
Published: March 2003

Electroencephalographic changes occurring in patients with migraine have received much attention. Although in migraineurs a number of studies have been done after nitroglycerin‐induced attacks, there is no reported EEG study before and after nitroglycerin‐induced sumatriptan‐treated attacks. We, therefore, studied the EEG topographic frequency analysis in 19 symptom‐free, otherwise healthy, unmedicated patients with common migraine and in 19 age and sex‐matched controls before nitroglycerin, at the time of maximum pain, and 30 minutes after sumatriptan. During headache attacks, an increase of slow rhythmic activity of the theta and delta range and a decrease of activity in the alpha and beta range were observed. These abnormalities disappeared 30 minutes after a sumatriptan injection. This suggests that common migraine is associated with disturbances of cortical electrogenesis and may provide insight into the causes of migraine and aid in the development of effective therapies.
Impact of Sumatriptan on Workplace Productivity, Nonwork Activities, and Health‐Related Quality of Life Among Hospital Employees With Migraine
Authors: Mushet George R. , Miller David , Clements Bill , Pait Gayla , Gutterman Donna L.
Published: March 2003

This prospective, open‐label study evaluated the effects of subcutaneous sumatriptan versus usual therapy on workplace productivity, activity time outside of work, and health‐related quality of life in 43 men or women who were hospital employees diagnosed with migraine according to International Headache Society criteria. Patients treated migraines with their usual therapy for 12 to 18 weeks followed by subcutaneous sumatriptan for 6 months. Health‐related quality of life measurements obtained at baseline, after usual therapy, and after sumatriptan therapy included the Short Form‐36 Health Surveyº and the Migraine‐Specific Quality of Life Questionnaireº . Patient daily diaries were used to capture data on migraine symptoms and on Lost Workplace Productivity and Non‐workplace Activity Time. Traditional clinical efficacy measures were obtained to support the pharmacoeconomic data. Clinical data showed that the percentage of treated migraine days per patient on which the patient experienced relief (moderate or severe pain reduced to mild or none) was 75% with sumatriptan and 25% with usual therapy. The mean time to meaningful relief was 1.1 hours during the sumatriptan phase and 4.2 hours during the usual therapy phase. Lost Workplace Productivity and Nonworkplace Activity Time was 35% lower with sumatriptan therapy (1.5 hours) compared with usual therapy (2.3 hours). Time missed from work due to symptoms time worked with symptoms, and time normal activities were carried on with symptoms were each lower during sumatriptan therapy compared with usual therapy. Scores on each of the three Migraine‐Specific Quality of Life Questionnaire dimensions and on the Role‐Emotional dimension of the Short Form‐36 were significantly more favorable after sumatriptan than after usual therapy (P<0.05). These data demonstrate that treatment of migraines with sumatriptan for 6 months following usual therapy for 12 to 18 weeks was associated with improvement in clinical efficacy, reduction in lost workplace productivity and nonworkplace activity time, and enhancement of key dimensions of health‐related quality of life among employees of a large university hospital.
Divalproex Sodium: Migraine Treatment and Monitoring
Authors: Silberstein Stephen D. , Wilmore L. James
Published: March 2003

Divalproex sodium is an effective drug for the treatment of migraine. Most adverse drug events are transient and not of great clinical concern. Although rare, well‐documented examples of liver toxicity have been reported in children under 2 years of age on polypharmacy. Additional cases occur in children under 10 who are receiving polypharmacy, particularly those who have intractable seizures and degenerative central nervous system disease. Clinicians who treat migraineurs with divalproex sodium do not need to be overly preoccupied with monitoring of drug levels and liver function tests. The most valuable test is clinical observation of the patient.
Migraine With Aura: Segregation Analysis and Heritability Estimation
Authors: Kalfakis Nikolaos , Panas Marios , Vassilopoulos Demetrios , Malliara‐Loulakaki Sasa
Published: March 2003

A genetic study was performed in a group of 60 migraine patients and their first‐degree relatives as well as in a group of sex‐ and age‐matched controls. Segregation analysis showed that multifactorial inheritance seems to be the most probable mode of genetic transmission. Heritabilities were estimated according to the sex of probands and relatives.

Our findings favor multifactorial inheritance, but the contribution of a major gene can not be excluded.
Migraine Headache Following Stellate Ganglion Block for Reflex Sympathetic Dystrophy
Authors: Lehmann Lance J. , Warfield Carol A. , Bajwa Zahid H.
Published: March 2003

The alteration of extracranial blood flow in conjunction with clinical signs of autonomic nervous system dysfunction have led to various explanations concerning the pathophysiology of migraine headache.

Reflex sympathetic dystrophy, a painful disorder of the sympathetic nervous system, can be treated by blocking the sympathetic nerves located in the stellate ganglion, resulting in vasodilation, ptosis, miosis, and anhydrosis. In theory, these changes could trigger a migraine headache attack secondary to autonomic dysfunction reflecting an imbalance between sympathetic and parasympathetic nervous systems. This may be especially true in a patient with a previous history of meningitis that may have resulted in a disorder of cerebrovescular regulation. We report a 56‐year‐old man with no previous history of migraine who developed migraine with aura after a stellate ganglion block. Those episodic headaches occurred with decreasing frequency end severity for over 6 months, with eventual complete resolution. This interesting phenomenon has not been reported in the English literature and may help to better understand the pathophysiology of migraine.
Prevalence of Primary Headache Syndrome in Adults in the Qassim Region of Saudi Arabia
Authors: Abduljabbar Mohammad , Ogunniyi Adesola , Al Balla Suliman , Alballaa Saleh , Al‐Dalaan Abdullah
Published: March 2003

Background and Purpose: Headache occurs worldwide, but documentation on the burden of headache in Saudi communities is quite limited. The aim of this study was to determine the prevalence of primary headache in a rural community in the Qassim region of Saudi Arabia.

Methods: A door‐to‐door survey of subjects older than 15 years of age was used for completion of a structured questionnaire to determine headache types based on defined criteria. Physical examination was used to exclude secondary causes.

Results: Of 5891 inhabitants, 473 suffered from headaches. The crude lifetime prevalence rate was 8% (95% CI, 7.3% to 8.7%) and with age adjustment was 9.3% (8.6% to 10%). Headache sufferers were predominantly women. The age‐specific rate increased progressively, peaking in the sixth decade. Tension‐type headache diagnosed in 185 subjects predominated (3.1%), while the prevalence of migraine was 2.6%.

Conclusion: The findings agree with the reported prevalence of 10% to 12% in other communities in the Kingdom of Saudi Arabia, but lower than the rates in Western countries. The lower rates are probably related to sociocultural factors.
Subcutaneous Sumatriptan in the Clinical Setting: The First 50 Consecutive Patients With Acute Migraine in a Pediatric Neurology Office Practice
Authors: Linder Steven L.
Published: March 2003

An open prospective study was undertaken to assess the efficacy and safety of subcutaneous sumatriptan in 50 consecutive children ages 6 to 18 years with severe migraine. There were 28 females and 22 males. The dose of sumatriptan was 0.06 mg/kg. Parameters included overall efficacy, time to relief, recurrence rate, adverse events, and objective global rating. Overall efficacy, defined by headache reduction from severe or moderate to mild or none, was 78%. Twenty‐six percent responded within 30 minutes, 46% responded in 60 minutes, and 6% responded between I to 2 hours. Twenty‐two percent had no response or a suboptimal response. Recurrence rate was only 6%. There was a difference in efficacy between male and female, as 91% of the males responded, while only 68% of the females responded. The males had more migraine alone while the females had migraine often with a coexistent tension‐type headache. Eighty percent of all the patients had some adverse event which was usually mild and transient; however, one patient developed a transitory confusional state which resolved in 2 hours. Eighty‐four percent reported a global rating of good to excellent, while 16% rated the treatment only fair to poor. These findings suggest that subcutaneous sumatriptan can be both effective and safe in childhood migraine, especially in dealing with migraine alone,
Headaches Associated With Chronic Use of Analgesics: A Therapeutic Approach
Authors: Pini Luigi‐Alberto , Bigarelli Massimo , Vitale Grovanni , Sternieri Emilio
Published: March 2003

We evaluated 102 patients attending the Headache Study Center of the University of Modena who were suffering from chronic daily headache with daily drug intake. Patients underwent either day hospital treatment followed by a standard prophylactic therapy or they started prophylactic therapy immediately. After 30 and 120 days, both the Headache Index and the daily drug intake had significantly improved (P<0.001), and there were no differences in reduction of mean values of the Headache Index or daily drug intake with respect to the two treatments, nor with regard to the prophylactic therapy chosen. Twenty‐eight percent of patients reverted to daily drug intake after a 4‐month follow‐up; these patients took bar‐biturate‐containing mixtures in a higher percentage than other drugs, and within the group of relapsing patients the outpatients relapsed to analgesic intake more than the day hospital‐treated patients (P<0.05).
Lipid Composition of Platelets in Patients Suffering From Migraine Without Aura
Authors: Vecino Ana M. , Alvarez‐Cermeño José C. , Jimenez‐Huete Adolfo , Navarro José L. , Cesar Jestis M.
Published: March 2003

Patients with migraine have a platelet hyper‐aggregability. As this alteration could be the consequence of an abnormal lipid composition of platelet membranes, we studied the phospholipid specimens and the cholesterol/phospholipid ratio in platelets of seven patients suffering from migraine. The holesterol/phospholipid ratio was 0.7 ± 0.1 (normal 0.6 ± 0.1, molar ratio). The proportion of five main platelet phospholipids components including phosphatidylcholine, phosphatidylethanolamine, sphingomyelin, phosphatidylserine, and phosphatidylinositol, were also normal. These data suggest that platelet hyperactivity in patients with migraine is not due to an altered lipid content of these cells.
The Relationship Between Stress, Headache, and the Menstrual Cycle in Young Female Migraineurs
Authors: Holm Jeffrey E. , Bury Lisa , Suda Kim T.
Published: March 2003

This study examined the relationship between the menstrual cycle, the stress process, andmigraines. Women migraineurs (N=12) and a matched control sample (N=12) completed a set ofquestionnaires assessing stress, appraisal, and coping at premenses, menses, and ovulation. Inaddition, migraineurs completed a month of daily headache recording. Analyses revealed that themenstrual cycle affected subjects' use of coping strategies and migraineurs' headache activity.Analyses also showed that the covariation between stress and migraine varied across the menstrualcycle. These results support the hypothesis of a three‐way relationship between menstrual cycle,stress, and migraine. We suggest that physiological and/or psychological changes associated withpremenses may enhance or strengthen the relationship between stress and migraine.
Divalproex Sodium in Headache: Literature Review and Clinical Guidelines
Authors: Silberstein Stephen D.
Published: March 2003

Divalproex sodium is an anticonvulsant agent approved for use either alone or in combination with other antiepileptic drugs for simple and complex absence seizures and mania. Four double‐blind placebo‐controlled studies have confirmed that divalproex sodium/valproate is an effective migraine treatment. In all of the clinical studies, whether open, retrospective, or placebo‐controlled and double‐blind, valproate was an effective preventive treatment for migraine. There was a reduction in the number of migraine attacks, and migraine duration and intensity were also reduced in some instances. It is equally as effective in patients with severe frequent migraines as in those with less severe migraines. In clinical trials, the most frequent adverse events reported by patients treated with divalproex sodium were nausea, asthenia, dyspepsia, dizziness, somnolence, and diarrhea, with most adverse events being mild to moderate in severity.
Juvenile Idiopathic Stabbing Headache
Authors: Soriani S. , Battistella P.A. , Arnaldi C. , De Carlo L. , Cernetti R. , Corrà S. , Tosato G.
Published: March 2003

We report on 83 juvenile patients with idiopathic stabbing headache, subjectively perceived as lasting from a fraction of a second to a few minutes. This sample was selected from among 2543 outpatients referred because of recurrent headache to the Paediatric Neurology Services of Ferrara and Padua (Italy). Other painful syndromes were excluded by clinical examination and appropriate tests Idiopathic stabbing headache in the pediatric age group contrary to the adult form, is usually not associated with other primary headache syndromes. We suggest that this clinical picture should be more clearly defined in the future, in order to better understand its relationships with other primary headaches.
Atenolol Prophylaxis in Migraine Secondary to an Arteriovenous Malformation
Authors: Kowacs Pedro André , Werneck Lineu César
Published: March 2003

The migrainous syndrome secondary to a parieto‐occipital arteriovenous malformation usually presents as unilateral headache with visual aura of progressive severity. We report successful prevention by atenolol of migraine with visual aura associated with an occipital vascular malformation. Effectively preventing migraine delayed specific therapeutic measures, thereby exposing the patient to the risk of an intracranial hemorrhage. The authors consider that prophylactic therapy should not be started whenever such an association is suspected.
Pathogenesis of Posttraumatic Headache and Migraine: A Common Headache Pathway?
Authors: Packard Russell C. , Ham Lesley P.
Published: March 2003

In recent years, research implicating biochemical abnormalities in various pathological conditions has spiraled. Headache is an area in which numerous research studies have been conducted examining biochemical alterations. We have noticed several similarities in biochemical changes reported to occur in migraine and in experimental traumatic brain injury. The most common symptom in mild head injury or mild traumatic brain injury is headache which, in many instances, resembles migraine but has a poorly understood pathophysiology. Biochemical mechanisms believed to be similar in both conditions include: increased extracellular potassium and intracellular sodium, calcium, and chloride; excessive release of excitatory amino acids; alterations in serotonin; abnormalities in catecholamines and endogenous opioids; decline in magnesium levels and increase in intracellular calcium; impaired glucose utilization; abnormalities in nitric oxide formation and function; and alterations in neuropeptides. In this paper, these preposed biochemical alterations will be reviewed and compared. Very similar alterations suggest posttraumatic headache associated with mild head injury and migraine may share a common headache pathway.
Oral Narcotic Protocol to Reduce Narcotic Injections in Refractory Migraine Patients
Authors: Von Seggern Randal L. , Adelman James U.
Published: March 2003

Refractory headache patients who require narcotic injections for acute attacks frequently utilize health care facilities. The experience is often unpleasant and costly to the patient and health care system.

We have developed an oral narcotic protocol for home administration. The patient starts with an antiemetic suppository, followed in 30 minutes by oral metoclopramide. After controlling nausea and vomiting, the patient administers a high dose of oral narcotic plus a hypnotic. The dosing of the narcotic analgesics incorporates seldom‐used, but well‐published pharmacokinetics. This protocol allows the patient to successfully treat a severe headache without using a health care facility.

Eleven patients in our practice were prescribed the oral narcotic protocol. Their need for narcotic injections at our office or emergency department was monitored for up to 1 year before and after the start of the protocol. Combined office visits were reduced from 81 to 53 (34.6%) and emergency department visits from 47 to 26 (44.7%). An annual cost savings of $1960 for office visits and $3024 for emergency department visits was realized. This was offset by an oral narcotic protocol medication cost of only $392. This treatment method has been well accepted by patients and has proven to be a safe and cost‐effective approach to treating refractory migraine patients.
Alteration of Central Excitation Circuits in Chronic Headache and Analgesic Misuse
Authors: Fusco Bruno M. , Colantoni Ornella , Giacovazzo Mario
Published: March 2003

Central excitatory circuits could be involved in the pathophysiology of pain; particularly, the genesis of chronic pain. The “second pain” is the sensation that follows the initial pain after an appropriate nociceptive stimulus. The second pain is amplified by repeating the stimulus after brief intervals (temporal summation). This phenomenon is the psychophysicaI correlate of the excitatory pain circuits. The temporal summation of the second pain was evaluated in four groups of subjects: one group affected by migraine without aura, one by episodic tension headache, one by chronic daily headache, and a group of healthy subjects. A percutaneous electrical shock was used as the nociceptive stimulus. The intensity of the second pain was significantly greater in the group of patients with chronic headache in comparison with the other groups. The patients with chronic headache were subdivided into three groups on the basis of their clinical history: a group with transformed migraine; a group with chronic headache ab initio a form related to the first one; (both groups suffered from chronic daily headache with a frequent superimposition of episodes of migraine attacks) and the third group consisted of patients with chronic tension headache. The temporal summation of the second pain was altered in the first two groups. The patients with chronic migraine abused ergotamine given as a symptomatic drug. Those who were able to discontinue this drug were retested and reported a decrease of the second pain in comparison to the previous measurements. The results of the present study indicate that central excitatory circuits could be involved in the mechanism leading to the development of chronic daily headache.
Fatigue and Sleep in Chronic Headache Sufferers: An Age‐ and Sex‐Controlled Questionnaire Study
Authors: Spierings Egilius L.H. , van Hoof Marie‐Jose
Published: March 2003

We studied fatigue and sleep in chronic headache sufferers in comparison to age‐ and sex‐matched controls. We determined the prevalence and intensity of fatigue as well as several sleep features. The study was conducted in a headache center through the use of a questionnaire. One hundred thirteen headache sufferers (59 men and 54 women) and 110 controls (56 men and 54 women) were included in the analysis. Fatigue was found to be equally common in the headache sufferers (70.3%) and in the controls (60.0%). However, the headache sufferers rated the intensity of their fatigue significantly higher (4.1 versus 2.8 cm on a 10‐cm visual analog scale). When the sexes were considered separately, the difference in intensity of the fatigue between the two groups was significant only for the women (5.1 versus 3.0 cm). With regard to sleep, the headache sufferers slept significantly shorter (6.7 hours) than the controls (7.0 hours). It also took them longer to fall asleep (31.4 versus 21.1 minutes) and longer to fall back asleep after waking up at night (28.5 versus 14.6 minutes). When the sexes were considered separately, the differences in sleep features between the two groups were significant only for the men.

On the basis of these results, we conclude that chronic headache sufferers feel more tired, especially the women, and do not sleep as well at night, especially the men. Further study is necessary to determine the significance of these findings in relation to chronic headache suffering.
Postlumbar Puncture Headache and its Relation to Chronic Tension‐Type Headache
Authors: Hannerz Jan
Published: March 2003

One hundred consecutive patients, the majority suffering from bilateral chronic tension‐type headache, investigated with lumbar puncture, were studied as to age, sex, body mass index, diagnosis, lumbar cerebrospinal fluid pressure, and signs of inflammation in the serum in relation to postlumbar puncture headache. Patients younger than 40 years of age were significantly more prone to develop postlumbar puncture headache than patients older than 40 years of age ( P =0.01). Sex, body mass index, cerebrospinal fluid pressure, and signs of inflammation in the serum were not related to the frequency of postlumbar puncture headache in the present study. Postlumbar puncture headache occurred significantly more often in patients with bilateral chronic tension‐type headache than in patients with unilateral headache ( P =0.02) and in patients without headache ( P <0.01). In a regression analysis with age, sex, and chronic tension‐type headaches, only bilateral headache contributed significantly to the prediction of postlumbar puncture headache ( P <0.01). Age did not contribute apart from the common variance with chronic tension‐type headache/no chronic tension‐type headache. The results may indicate that postlumbar puncture headache and chronic tension‐type headache have etiologic mechanisms in common, mechanisms presumably localized intracranially rather than extracranially.
Oral Rizatriptan Versus Oral Sumatriptan: A Direct Comparative Study in the Acute Treatment of Migraine
Authors: Tfelt‐Hansen Peer , Teall Judith , Rodriguez Francisco , Giacovazzo Mario , Paz Jose , Malbecq William , Block Gilbert A. , Reines Scott A. , Visser W. Hester
Published: March 2003

Rizatriptan is a potent, oral, 5‐HT1B/1D agonist with more rapid absorption and higher bioavailability than oral sumatriptan. It was postulated that this would result in more rapid onset of effect. This randomized, double‐blind, triple‐dummy, parallel‐groups study compared rizatriptan 5 mg, rizatriptan 10 mg, sumatriptan 100 mg, and placebo in 1268 outpatients treating a single migraine attack. Headache relief rates after rizatriptan 10 mg were consistently higher than sumatriptan at all time points up to 2 hours, with significance at 1 hour (37% versus 28%, P=0.010). All active agents were significantly superior to placebo with regard to headache relief and pain freedom at 2 hours (P≤0.001). The primary efficacy endpoint of time to pain relief through 2 hours demonstrated that, after adjustment for age imbalance, rizatriptan 10 mg had earlier onset than sumatriptan 100 mg (P=0.032; hazard ratio 1.21). Rizatriptan 10 mg was also superior to sumatriptan on pain‐free response (P=0.032), reduction in functional disability (P=0.015), and relief of nausea at 2 hours (P=0.010). Significantly fewer drug‐related clinical adverse events were reported after rizatriptan 10 mg (33%, P=0.014) compared with sumatriptan 100 mg (41%). We conclude that rizatriptan 10 mg has a rapid onset of action and relieves headache and associated symptoms more effectively than sumatriptan 100 mg.
Neuroimaging Diagnosis of Tolosa‐Hunt Syndrome: MRI Contribution
Authors: de Arcaya A. Alvarez , Cerezal L. , Canga A. , Polo J.M. , Berciano J. , Pascual J.
Published: March 2003

Objective.—To present our experience in the neuroradiological diagnosis of six patients with Tolosa‐Hunt syndrome.

Methods.—Computerized tomograms and MRI, with and without contrast enhancement, of the cranium and orbits of patients fulfilling IHS criteria for the diagnosis of Tolosa‐Hunt syndrome were analyzed.

Results.—Standard CT scan, with and without contrast enhancement, disclosed an enlarged cavernous sinus in one patient and was normal in the remaining five. In comparison, MRI was clearly abnormal in the four patients on whom it was performed, showing a convex enlargement of the symptomatic cavernous sinus by an abnormal tissue isointense with gray matter on short TR/TE images and iso‐hypointense on long TR/TE scans. This abnormal tissue markedly increased in signal intensity after contrast injection and, in two patients, extended into contiguous regions, mainly the orbital apex and subtemporal fossa ipsilaterally. One patient had follow‐up studies after successful treatment with corticosteroids. Although diminished in size, the abnormal tissue was still visible on MRI after 3 months of treatment and only disappeared after 6 months of treatment.

Conclusions.—These MRI findings help in the differential diagnosis of the Tolosa‐Hunt syndrome from conditions such as meningioma, lymphoma, and sarcoidosis, as well as confirming the similarities of the Tolosa‐Hunt syndrome and orbital pseudotumor. In the presence of painful ophthalmoplegia, the finding by MRI of cavernous sinus enlargement, with the herein described signal and extension characteristics and slow resolution with corticosteroid treatment, is highly suggestive of the Tolosa‐Hunt syndrome.
Safety of Divalproex Sodium in Migraine Prophylaxis: An Open‐Label, Long‐term Study
Authors: Silberstein Stephen D. , Collins Stephen D. ,   Long‐term Safety of Depakote in Headache Prophylaxis Study Group
Published: March 2003

Context.—The adverse event profile of long‐term divalproex therapy for epilepsy is well established, but little is known about the tolerability or safety of divalproex in long‐term migraine prophylaxis.

Objective.—Evaluate the long‐term safety and efficacy of divalproex sodium in migraine prophylaxis.

Design.—Open‐label, long‐term study, of up to 3 years, of patients who completed one of two multicenter, double‐blind, randomized, placebo‐controlled studies.

Setting.—Eighteen headache/neurology centers throughout the United States.

Patients.—One hundred sixty‐three patients: 46 treated with placebo, 117 treated with divalproex for migraine in previous studies.

Intervention.—Divalproex therapy initiated at 500 mg/day (250 mg twice daily), with adjustment in dose and dosing frequency possible after 1 to 3 days.

Main Outcome Measures.—Number and proportion of patients reporting treatment‐emergent adverse events, prevalence and incidence for each treatment‐emergent adverse event, vital signs, body weight, 4‐week migraine rates and proportion of patients with 50% or greater reduction in rate over time.

Results.—Treatment lasted more than 180 days for 71% of patients and more than 360 days for 48% of patients. Improvements in the 4‐week, change‐from‐baseline migraine rates were seen during each of the 3‐ and 6‐month time intervals.

Conclusions.—Divalproex is effective for migraine prophylaxis, and initial benefits are maintained for periods in excess of 1080 days.
An Analysis of the “Carry‐over Effect” Following Successful Short‐term Treatment of Transformed Migraine With Divalproex Sodium
Authors: Rothrock John F. , Mendizabal Jorge E.
Published: March 2003

Objective.– To determine whether successful short‐term prophylactic treatment of transformed migraine may be followed by a continued respite from headaches once the treatment has been discontinued (“carry‐over effect”).

Background.– The optimal duration of prophylactic treatment for pervasive headache and for migraine, in particular, is unknown.

Methods.– We prospectively evaluated a series of patients with transformed migraine, all of whom were managed according to a uniform treatment protocol involving prophylactic therapy with divalproex sodium for a period not exceeding 12 weeks. All patients reporting a positive treatment response were followed for at least 2 months after the discontinuation of divalproex sodium, and the incidence of the carry‐over effect in that group was assessed.

Results.– A short‐term carry‐over effect occurred in 12 (60%) of 20 patients, but more sustained relief occurred in only 8 (40%).

Conclusions.– The successful short‐term treatment of transformed migraine with divalproex sodium will often produce a short‐term carry‐over effect, but this response will be sustained only in a minority of patients.
Prophylactic Treatment of Migraine With β‐Blockers and Riboflavin: Differential Effects on the Intensity Dependence of Auditory Evoked Cortical Potentials
Authors: Sándor Peter S. , Áfra Judit , Ambrosini Anna , Schoenen Jean
Published: March 2003

Objective.– To investigate the influence of different pharmacological treatments on the intensity dependence of auditory evoked cortical potentials in migraineurs.

Background.– Between attacks, patients with migraine show abnormalities in cortical information processing and decreased brain mitochondrial energy reserve. Both are most probably relevant for migraine pathogenesis, and they could be differentially modified by prophylactic drug therapy.

Design.–The intensity dependence of the auditory evoked cortical potentials is, on average, increased in migraine. We have studied this intensity dependence in 26 patients before and after a 4‐month period of prophylaxis with beta‐blockers (n=11, all migraine without aura; metoprolol or bisoprolol) or riboflavin (n=15, migraine without aura: 13, migraine with aura: 2). Recordings were performed at least 3 days before or after an attack.

Results.– After the treatment with beta‐blockers, the intensity dependence of the auditory evoked cortical potentials was significantly decreased (before: 1.66 ± 1.02 μV/10 dB; after: 0.79 ± 1.06 μV/10 dB, P=.02). The decrease in intensity dependence was correlated significantly with clinical improvement (r=.69, P=.02). There was no change in intensity dependence after riboflavin treatment (before: 1.80 ± 0.81 μV/10 dB; after: 1.56 ± 0.83 μV/10 dB, P=.39), although the majority of patients showed improvement.

Conclusions.– These results confirm that beta‐blockers and riboflavin act on two distinct pathophysiological mechanisms. Combining both treatments might enhance their efficacy without increasing central nervous system side effects.
Prophylactic Pharmacological Treatment of Chronic Daily Headache
Authors: Redillas Carol , Solomon Seymour
Published: March 2003

Objective.—To review all the prophylactic pharmacological treatments for chronic daily headache from the past decade.

Background.—Chronic daily headache is among the most common diagnoses seen in specialized headache centers. Prior to 1988, there were no criteria for the diagnosis of chronic tension‐type headache and chronic daily headache. An expanded chronic daily headache classification has been proposed.

Methods.—A MEDLINE search was performed using the following key words: chronic daily headache, intractable headache, transformed migraine, chronic tension headache, and chronic tension‐type headache. We limited our review to those studies published in English in the last decade, including published abstracts and letters to the editor. Double‐blind studies carried out prior to 1988 were also included.

Results.—Pharmacological treatments for chronic daily headache include antidepressants (tricyclics, tetracyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors), anticonvulsants, muscle relaxants, 5‐HT1 agonists, ergots, 5‐HT2 antagonists, antianxiety agents, and miscellaneous drugs. Many of these reports are anecdotal, and most are open rather than double‐blind studies.

Conclusions.—There is a great variety of pharmacological treatments available for chronic daily headache. Only the antidepressants have been extensively studied. Other medications may be used if these fail. Recommendations based on our experience at the Headache Unit of the Montefiore Medical Center are outlined here.
Dynamic Assessment of Abnormalities in Central Pain Transmission and Modulation in Tension‐type Headache Sufferers
Authors: Neufeld Jonathan D. , Holroyd Kenneth A. , Lipchik Gay L.
Published: March 2003

Objective.—To examine and compare central pain processing and modulation in young tension‐type headache sufferers with that of matched healthy controls using an induced headache “challenge” paradigm.

Background.—Recent research has suggested that abnormalities in central pain processing and descending pain modulation may contribute to chronic tension‐type headache. These abnormalities, if they contribute to headache pathogenesis, should be present in young adult tension‐type headache sufferers. Recent research using static measures of physiological variables, such as muscle tenderness and exteroceptive suppression, has identified chronic muscle tenderness as a characteristic of young tension‐type headache sufferers, but other central nervous system functional abnormalities may require a dynamic “challenge” to be observed.

Methods.—Twenty‐four young women meeting the International Headache Society diagnostic criteria for tension‐type headache (headache‐prone) and a matched group of 24 healthy women who reported fewer than 10 problem headaches per year (control) participated in a double‐blind, placebo‐controlled, crossover study. Subjects completed jaw clenching and a placebo condition on different days in counterbalanced order. Pericranial muscle tenderness, pressure‐pain thresholds on the temporalis, and exteroceptive suppression periods were assessed before and after each procedure. Head pain was recorded for 12 to16 hours following each condition.

Results.—Headache‐prone subjects were more likely than controls to experience headaches after both the jaw clenching and placebo procedures, but neither group was significantly more likely to experience headaches following jaw clenching than placebo. In pretreatment measurements, headache‐prone subjects exhibited greater muscle tenderness than controls, but pressure‐pain detection thresholds and exteroceptive suppression periods did not differ in the two groups. Control subjects showed increases in muscle tenderness and exteroceptive suppression periods following both the clenching and placebo procedures, whereas headache‐prone subjects exhibited no significant changes in any of the physiological measures following either experimental manipulation.

Conclusions.—These results confirm previous findings indicating abnormally high pericranial muscle tenderness in young tension headache sufferers even in the headache‐free state. In addition, the results suggest that the development of headaches following noxious stimulation is more strongly related to headache proneness and associated abnormalities in central pain transmission or modulation (indexed by pericranial muscle tenderness and exteroceptive suppression responses) than muscle strain induced by jaw clenching.
Treatment of Chronic Cervical‐Associated Headache With Botulinum Toxin A: A Pilot Study
Authors: Freund Brian J. , Schwartz Marvin
Published: March 2003

Objective.–To see whether therapy with botulinum toxin A may prove to be an effective treatment for headache of musculoskeletal origin.

Background.–Headache is a common finding associated with neck injury. Cervicogenic headache, which is believed to be attributable to injury of the ligaments, muscles, or joints of the cervical spine, is centered in the occipital region with pain referred to the frontotemporal region. Botulinum toxin A produces prolonged muscle relaxation, which is dose dependent and can be easily targeted to affected muscles.

Methods.–This randomized, double‐blind, placebo‐controlled study compares outcome measures in 26 patients suffering from chronic headache subsequent to a cervical whiplash injury. One half of the patients received botulinum toxin A, 100 units, diluted in 1 mL of saline, while the other half received just saline (1 mL). Five cervical trigger points received 0.2 mL each of injectant via a 30‐gauge needle. Outcome measures included subjective head pain based on visual analog scales, as well as range of neck motion. Follow‐up assessments were carried out at 2 and 4 weeks after treatment.

Results.–Fourteen subjects who received botulinum toxin A and 12 who received saline completed the study. At both 2 and 4 weeks post injection, the treatment group showed a significant improvement in pain and range of motion from preinjection levels (P<.01). The placebo group demonstrated no statistically significant changes at any posttreatment time.
Nasal Surgery for Contact Point Headaches
Authors: Tosun Fuat , Gerek Mustafa , Özkaptan Yalçin
Published: March 2003

Headache due to the pressure on nasal mucosa of anatomical variations, nasal polyps, or mucosal swelling in the absence of inflammation of the paranasal sinuses is a clinical entity that has gained wide acceptance. In this paper, the outcomes of surgical treatment in 30 patients whose headaches were believed to be the result of intranasal contact points are presented. Total relief of the headache and significant improvement were achieved in 43% and 47% of the patients, respectively, after endoscopic endonasal surgery. The intensity of the headache was the same as preoperatively in 10% of the patients. In the absence of any other identifiable etiological factors, intranasal mucosal contacts must be kept in mind as a cause of the headache.
Chronic Daily Headache: A Time Perspective
Authors: Spierings Egilius L.H. , Ranke Anniek H. , Schroevers Maya , Honkoop Peter C.
Published: March 2003

Objective.–To determine the development and outcome of chronic daily headache in 258 headache practice patients, consisting of 50 men and 208 women. Chronic daily headache was defined as headaches occurring on at least 5 days per week for at least 1 year.

Methods.–Two hundred fifty‐eight patients with headache were interviewed and evaluated. Ninety‐one patients were contacted by telephone for follow‐up.

Results.–Twenty‐two percent of the patients had daily headaches from the onset, and 78% initially experienced intermittent headaches. Of the patients with initially intermittent headaches, 19% experienced an abrupt transition into daily headaches and 81%, a gradual one. In the patients with gradual transition, the transition of the initial, intermittent headaches into daily headaches took an average of 10.7 years. The initial headaches were mild in 33% of the patients and severe in 67%. The severe headaches were associated with nausea and vomiting significantly more often than the mild ones. However, the daily headaches that these patients ultimately developed were the same, regardless of whether the initial headaches were mild or severe.

The patients who gradually developed daily headaches from initially intermittent headaches were contacted to determine the outcome of their headaches. Of these patients, 33% continued to have daily headaches and 67% again experienced intermittent headaches. Of the latter group, 88% of the patients who now had migraine also had migraine initially.
Influence of Disease Duration on Visual Evoked Potentials in Migraineurs
Authors: Yücesan Canan , Sener Özden , Mutluer Nermin
Published: March 2003

Objective.–To determine the possible influence of the duration of migraine on pattern‐reversal visual evoked potentials.

Methods.–An investigation was conducted in 49 patients with migraine without aura according to the International Headache Society criteria. Twenty‐two of these patients had had migraine for 2 years or less (group 1), and the other 27 patients had had the disease for 10 years or more (group 2). The control group consisted of 17 healthy subjects.

Results.–Comparison of the mean P100 latency and amplitude showed no significant difference among the groups. There was, however, a good negative correlation between age and latency (r = −0.59, P = .003) in group 1, but no such correlation was observed for group 2 or the control group.

Conclusions.–It was concluded that the duration of migraine has no influence on pattern‐reversal visual evoked potentials and that the pathogenesis of early‐ and late‐onset migraine may be different.