bluuebunny/crossref_metadata_2025 huggingface dataset:
Headaches Associated with Low Spinal Fluid Pressure
Authors: Fernández Ernesto
Published: May 2005

SYNOPSIS

Post‐lumbar puncture headache (PLPHA) and spontaneous hypoliquorrheic headache are both associated with low spinal fluid pressure. A dull or throbbing occipital ache characteristically worsened by sitting or standing and eased by lying down is peculiar to both. Additional symptoms and signs may accompany the headache. In PLPHA the pain is triggered by leakage of cerebrospinal fluid through the dural rent, but the cause of the pain is probably due to intracranial arterial and venous dilatation. The same mechanism probably applies to spontaneous hypoliquorrheic headache in which the site of leakage is rarely found. The majority of cases subside without treatment over several days. Those that persist may be treated with epidural blood patch or saline infusion with good results. A simple, innocuous, yet underutilized form of treatment is caffeine sodium benzoate. This review will discuss the incidence, pathogenesis, prevention and treatment of these headaches.
Methionine‐Enkephalin in Migraine and Tension Headache. Differences Between Classic Migraine, Common Migraine and Tension Headache, and Changes During Attacks.
Authors: Ferrari Michel D. , Odink Jacobus , Frölich Marijke , Portielje Johanneke E.A. , Bruyn George W.
Published: May 2005

SYNOPSIS

We measured methionine‐enkephalin (MET) in platelets and platelet‐poor‐plasma of drug‐free patients with classic migraine, common migraine or tension headache (TH). Migraineurs were studied both between and during attacks. TH patients were characterized by low platelet‐MET and high plasma‐MET levels, whereas migraine patients showed high platelet‐MET and reduced plasma‐MET levels. During migraine attacks both platelet and plasma‐MET concentrations increased considerably. We suggest that determination of MET levels in platelets and plasma may be a useful marker to discriminate between TH and common migraine. The rise in MET during attacks may be directed against the ictal increase of serotonin.
Spontaneous Low Cerebrospinal Fluid Pressure Headache
Authors: Marcelis John , Silberstein Stephen D.
Published: May 2005

SYNOPSIS

A 69 year old man presented with headache on arising and relieved with recumbency. His clinical presentation, laboratory data, response to treatment and radiographic evaluation were consistent with spontaneous low cerebrospinal fluid pressure from CSF hyperabsorption. Cisternography showed rapid accumulation in the kidneys and urinary bladder, without evidence of CSF leak. His headache was eventually controlled with two blood patches and oral caffeine.
Lumbar Puncture Headache: A Review
Authors: Raskin Neil H.
Published: May 2005

SYNOPSIS

August Bier, the father of spinal anesthesia, suffered and reported the first lumbar puncture (LP) headache. On August 24, 1898 his assistant, a Dr. Hildebrandt, attempted to administer a spinal anesthetic to Dr. Bier; it was never completed because the syringe did not fit the already implanted spinal needle.1 Bier himself suggested that continued leakage of cerebrospinal fluid (CSF) through the dural puncture site was the cause of headache, a theory that has been embraced by the medical community; however, the mechanism is probably more complex. Nearly 50 years ago, J. Lawrence Pool, using an endoscopic technique to visualize the surface of the spinal cord and the cauda equina, frequently observed large collections of epidural fluid two to four days following lumbar puncture in patients without headache.2 Evidence that will be presented below suggests that CSF volume alterations may be the signal closest to the headache mechanism.
The Effects of Psychological Stress on Electromyographic Activity and Negative Affect in Ambulatory Tension‐Type Headache Patients
Authors: Rugh John D. , Hatch John P. , Moore Patricia J. , Cyr‐Provost Margaret , Boutros Nashaat N. , Pellegrino Christina S.
Published: May 2005

SYNOPSIS

Fourteen female dental hygiene students (seven with episodic tension‐type headache and seven who rarely or never experienced headache) wore an ambulatory electromyographic recorder and completed hourly subjective ratings of pain and negative affective states for six days while they carried out their normal daily activities. Three of the days were designated as high stress days by virtue of the fact that the students were required to take a major course examination or undergo a clinical evaluation on that day. The remaining three days were designated as low stress days by virtue of the fact that no unusual demands were made on the students, and they simply attended lectures as usual. All students showed significantly greater levels of electromyographic activity on the high stress days compared to the low stress days, but there was not a statistically significant difference between the headache and control groups. Headache group subjects reported significantly higher levels of pain compared to the control group, but their pain ratings did not differ between high and low stress days. Subjective ratings of negative affective states (anxiety, anger, sadness, and frustration) were significantly greater on high stress days compared to low stress days. Headache group subjects also exhibited a tendency to report higher levels of negative affective states than did control group subjects, but only in the case of frustration was the .05 level of statistical significance achieved.
Impairment of 5HT Binding to Lymphocytes and Monocytes From Tension‐Type Headache Patients
Authors: Giacovazzo M. , Bernoni R.M. , Di Sabato F. , Martelletti P.
Published: May 2005

SYNOPSIS

Serotonin (5HT) binds in a saturable and specific manner to high affinity binding sites present on the surfaces of human lymphocytes and monocytes. We reported that migraine patients have an increase in 5HT binding parallel to the progression of the attack, with the appearance of a subsequent phenomenon of cellular deactivation. The same experiment previously carried out in cluster headache patients revealed a lack of high affinity binding sites, independently of the pain period. Low levels of plasma 5HT were recently described by Anthony in chronic tension‐type headache. The implication of 5HT in tension headache was also hypothesized by Shukla with the demonstration of an increased 5HT uptake by platelets.

We studied the 5HT binding on surfaces of lymphocytes and monocytes in 26 tension‐type headache patients (16 affected by chronic form (CTH) of the disease and 10 by episodic form (ETH) ). Fourteen clinically healthy subjects were used as controls. Circulating Iymphocytes and monocytes were tested for their ability to specifically bind 5HT, using (3H) labeled 5HT. The “in vitro” 5HT binding curves to lymphocytes and monocytes of tension‐type headache patients show a constant trend; during headaches, both CTH and ETH patients present a desensitization phenomenon with a complete loss of high affinity binding sites for 5HT. The 5HT binding curve observed in controls is indistinguishable from that of ETH patients studied outside the attack period. The total amount of 5HT bound appeared to be more markedly raised in CTH patients than in ETH patients when compared to control values.

The results obtained seem to demonstrate during tension‐type headache, the occurrence at a cellular level, of a disappearance of specific 5HT binding sites, which could be due to high 5HT turnover.
A Prospective Study of Chronic or Recurrent Headache in Systemic Lupus Erythematosus
Authors: Vázquez‐Cruz J. , Traboulssi H. , Rodriquez‐De la Serna A. , Geli C. , Roig C. , Diaz C.
Published: May 2005

SYNOPSIS

This study was conducted to analyze the prevalence and features of chronic or recurrent headache in Systemic Lupus Erythematosus (SLE), and also the relationship of such headache with other manifestations of the disease. A total of 76 patients (69 women and 7 men) with a mean age of 40 years (r: 24‐74 years) were included. An overall severity index for SLE was applied. Fifty‐two patients (68%) presented headache, 27 (52%) being vascular and 25 (48%) muscle contraction type. Headache in general was more frequent after the onset of SLE (p<.001). Prevalence of muscle contraction headache in particular was greater following manifestations of SLE. Family history of migraine was recorded in 54% of the patients with vascular headache. This antecedent was more common in patients in whom migraine started before the onset of SLE (p = .05). A greater number of neuropsychiatric symptoms was observed in the patients with vascular headache and family history (p<.02). Patients with thrombocytopenia presented headache less frequently (p<.05).

Our results showed headache, of both vascular and muscle contraction types, to be frequent in SLE. We note that there is an increased frequency of muscle contraction headache after the onset of SLE, and that there is a migraine‐like headache directly related to SLE. Migrainous patients with familial history have a greater probability to suffer neuropsychiatric manifestations. Finally, it is suggested that severity of SLE is not related to presence of headache.
Epidural Blood Patch Reduces the Incidence of Past Lumbar Puncture Headache
Authors: Heide W. , Diener H.‐C.
Published: May 2005

SYNOPSIS

In 50 patients, aged 16 to 58, an autologous blood patch was injected into the epidural space immediately after diagnostic lumbar puncture. The incidence of postpuncture headache was 22%, which was significantly lower than in a control group (40 patients, aged 17 to 54), where it amounted to 45%. Compared to the control group, the patients with epidural blood patch had significantly less postpuncture complaints between the 1st and 3rd day following lumbar puncture. Lower back pain as the only side effect was experienced by 30 to 40% of the patients in each of the 2 groups. We conclude that the epidural blood patch is practicable and effective in the prophylaxis of postpuncture headache, but cannot prevent its occurrence in all cases.
Repetitive Intravenous DHE in the Treatment of Refractory Headache
Authors: Silberstein Stephen D. , Schulman Elliott A. , Hopkins Mary McFadden
Published: May 2005

SYNOPSIS

We analyzed retrospectively the data for 300 patients with refractory headache who were treated with dihydroergotamine (DHE) at the Comprehensive Headache Center at German‐town Hospital. The patients had either chronic daily headache (with drug rebound ‐ 216, without rebound ‐ 42), short‐duration headache (18), or cluster headache (24). Treatment consisted of withdrawal of overused medications (usually analgesics and ergots), repetitive IV administration of DHE, and use of metoclopramide and prophylactic medications, together with educational and psychological support. Overall, 91% (range, 86% to 100%) of the patients became headache‐free, usually within 2 to 3 days. The average duration of hospitalization was 7.4 days. Side effects, reported in 157 (52%) of the patients, consisted primarily of nausea (32%), tightness and burning (8%), leg cramps (7%), vomiting (6%), and increased blood pressure (5%). The side effects generally resolved spontaneously or with adjustment of the DHE dose and/or adjunct medication, and necessitated withdrawal of therapy in only 2 patients (1 with drug‐related claudication; 1 with somatic complaints of uncertain origin).

We conclude that a regimen of repetitive intravenous DHE and metoclopramide can provide rapid relief of chronic intractable headache, and can ameliorate the effects of analgesic and ergot withdrawal in patients with chronic daily headache and rebound associated with overuse of these drugs.
Serotonin S2 Receptors and Migraine: A Study With the Selective Antagonist ICI 169,369
Authors: Davies P.T.G. , Steiner T.J.
Published: May 2005

SYNOPSIS

We report the first use of ICI 169,369, a selective S2 receptor antagonist, in acute and prophylactic treatment of migraine.

Ten selected patients documented their migraine attacks over a 2‐month period of open treatment with ICI 169,369, 30 mg orally, for acute therapy. They compared this treatment with others they had experience of. Four of these patients undertook a pharmacokinetic study comparing drug absorption in an acute attack to that when symptom‐free. Prophylaxis was then commenced with the same drug, 30 mg bd. Patients recorded symptoms in diary cards noting the effects of treatment on the usual frequency and severity of their attacks.

The pharmacokinetic study showed that drug absorption could be markedly impaired during an acute attack. Nevertheless, in 35 attacks treated acutely, half the patients reported some efficacy apparent to them. One third of patients considered ICI 169,369 to be better treatment on this one occasion than their own usual medication. Some benefit was also noted during prophylaxis. There was a statistically significant reduction in attack frequency from the baseline observed during acute therapy only, but this was arguably compatible with placebo response.

S2 receptor antagonism may have some beneficial effect in acute or prophylactic treatment of migraine, but it is not marked and does not support S2 receptor activation being important in its pathogenesis.
Migraine Patients Cognitively Impaired?
Authors: Leijdekkers Marijke L.A. , Passchier Jan , Goudswaard Plona , Menges Laurens J. , Orlebeke Jacobus F.
Published: May 2005

SYNOPSIS

In order to investigate the hypothesis that migraine has a detrimental effect on cognitive functioning, 37 female migraine patients and 34 nonheadache female controls underwent a battery of neuropsychologic tests. No significant difference in test performance between groups was found. There was no relation between the length of migraine history or medication use and the level of impairment of cognitive abilities. The patient and control groups differed significantly on several self‐report measures known to interfere with performance. Patients reported higher trait and state anxiety levels, higher debilitating anxiety and state depression, and less vigor. Statistical correction for these variables, however, did not result in significant group differences of cognitive performance. The results suggest that the general population of female migraine patients show no indication of cognitive impairment.
Headache Syndromes in the Eastern Province of Saudi Arabia
Authors: AI‐Rajeh Saad , Bademosi Olajide , Ismail Hassan , Awada Adnan
Published: May 2005

SYNOPSIS

The pattern of headache syndromes in 222 subjects (142 Saudi nationals, 80 non‐Saudis) seen at AI‐Khobar, Saudi Arabia is presented. Headaches were common, and accounted for 13% of all neurological outpatients. They affected mainly young adults, with a peak frequency in the third decade for Saudis and the fourth for non‐Saudis. They were rare in those under 10 and above 50 years old. Among Saudis, females outnumbered males especially in the second and fifth decades, while non‐Saudi males were more frequent than females in all age groups except the second decade.

The main types were tension headache (66%) and migraine (22%). Acute/chronic sinusitis was an uncommon cause of headache. Tension headache affected mainly individuals between 21 and 40 years of age (69%). It showed a female preponderance in Saudis aged 11‐20 and above 40 years, unlike the male predilection in non‐Saudis. Migraine showed a definite female predilection only in Saudis in the fourth decade (female to male ratio of 4:1 ). A positive family history for headache was present in 10% of the cases.

The major precipitating factor for headaches was stress related to family or working conditions. Other triggers included hunger and prolonged exposure to excessive heat or sunlight.

The pattern of headaches in Saudi nationals may be related to the prevalent sociocultural factors, and the differences observed between them and non‐Saudis probably reflect the demographic status of non‐Saudis in the Kingdom as a consequence of governmental recruitment policy.
Is Nimodipine Useful in Migraine Prophylaxis? Further Considerations
Authors: Leone Massimo , Frediani Fabio , Patruno Giorgio , Valentini Sergio , Bussone Gennaro
Published: May 2005

SYNOPSIS

Nimodipine is one of the most discussed calcium antagonists used in cerebrovascular diseases and, recently, in migraine prophylaxis. Its specificity in preventing cerebral arterial constriction has been invoked to explain nimodipine's efficacy in migraine. The discovery of neuronal receptors specific for dihydropyridines, however, favours a mechanism of action for nimodipine that is not exclusively vascular. This is in accordance with a view of migraine pathogenesis which implicates a primary neuronal event as the basis of the vascular changes observed in migraine patients.
A Controlled Evaluation of the Addition of Cognitive Therapy to a Home‐Based Biofeedback and Relaxation Treatment of Vascular Headache
Authors: Blanchard Edward B. , Appelbaum Kenneth A. , Nicholson Nancy. L. , Radnitz Cynthia L. , Morrill Belinda , Michultka Denise , Kirsch Cynthia , Hillhouse Joel , Dentinger Mark R
Published: May 2005

SYNOPSIS

Seventy‐six patients with vascular (migraine or mixed migraine and tension) headache (HA) participated in a controlled evaluation of a minimal‐therapist‐contact, largely home‐based, treatment program which combined relaxation (R) training with thermal biofeedback (TBF). One group received TBF+R administered in 3 office visit over 8 weeks, supplemented by audio tapes and manuals. A second group received the TBF + R plus instruction in cognitive stress coping techniques, all of which was administered in 5 office visits over 8 weeks. A third group monitored headache activity for 8 weeks. Evaluations, based on 4 weeks of HA diary at pre‐treatment and after treatment, revealed significantly greater reductions in HA activity and medication consumption for both treated groups than the HA monitoring controls who did not change. Significantly more of the treated patients had clinically significant reductions in HA activity than the controls. The two treated groups did not differ on any measure.
Chronic Cluster Headache Managed by Nervus Intermedius Section
Authors: Rowed David W.
Published: May 2005

SYNOPSIS

Cluster headache sufferers who become candidates for surgical treatment are those relatively rare patients who are refractory to all attempts at pharmacological relief.

Ablative surgical procedures have been directed against either the trigeminal nerve or the nervus intermedius/greater superficial petrosal (NI/GSP) pathway. Both carry nociceptive impulses from the head and face, and the NI also carries parasympathetic fibres which appear to be responsible for the autonomic concomitants of cluster headache.

Trigeminal operative procedures are not consistently helpful in chronic cluster headache, while NI section has been shown to give potentially long lasting relief but carries the potential risks of cerebellopontine angle surgery.

In eight selected cases of chronic cluster headache we have demonstrated a high early success rate for pain relief, with few complications, in the performance of NI section, combined, when indicated, with microvascular decompression of the trigeminal main sensory root. We believe that cochlear nerve monitoring helps prevent postoperative hearing impairment.

An intimate relationship between the NI and arterial loops of the anterior inferior cerebellar artery (AICA) or the internal auditory artery has been frequently observed in our chronic cluster headache patients.
A Non‐Pharmacological Treatment of Vascular Headache During Pregnancy
Authors: Hickling Edward J. , Silverman Daniel J. , Loos Warren
Published: May 2005

SYNOPSIS

This study investigates the use of biofeedback, relaxation and psychotherapy on five patients with severe, vascular headaches that occurred during the course of pregnancy. The subjects received between four and twelve sessions of treatment overall. The subjects all showed a marked reduction or complete cessation of headaches during treatment, the term of pregnancy, and during a follow‐up evaluation months after the birth of the child. Possible alternate explanations for improvement are discussed along with the study's limitations. This preliminary investigation strongly suggests that psychological treatment may be a particularly useful intervention for management of headaches that occur in pregnant women.
Double Blind Comparison of Lithium and Verapamil in Cluster Headache Prophylaxis
Authors: Bussone G. , Leone M. , Peccarisi C. , Micieli G. , Granella F. , Magri M. , Manzoni G.C. , Nappi G.
Published: May 2005

SYNOPSIS

Chronic Cluster Headache (CCH) treatment is troublesome; since there are no pain‐free periods, it must be continuous. The most effective CCH prophylactic drug today is lithium carbonate but long‐term use of this drug is limited by the possibility of side effects. Recently, calcium antagonists have been successfully employed to prevent migraine, and preliminary studies also indicate that verapamil in particular is an efficacious treatment for CCH. We have conducted a multicenter trial employing a double‐dummy, double blind, cross‐over protocol, comparing verapamil with the established efficacy of lithium carbonate, inpreventing CCH attacks. Both lithium carbonate and verapamil were effective in preventing CCH butverapamil caused fewer side effects and had a shorter latency period. We did not observe any correlation between plasma levels of the two drugs and their clinical efficacy. Both the drugs tested here may exert their effect by restoring a normal inhibitory tone to the pain modulating pathways from the trigemino‐vascular system, a circuit putatively implicated in CCH.
Circadian Variation of Pain Sensitivity in Pericranial Musculature
Authors: Göbel Hartmut , Cordes Peter
Published: May 2005

SYNOPSIS

This study investigated whether pain sensitivity of the pericranial musculature remains constant over the course of the day. Changes in the entire, uniformly metrically divided supra‐threshold sensitivity range were measured. In 24 healthy volunteer subjects, pain was induced experimentally at 0200, 0600, 1000,1400, 1800, and 2200 hours in the pericranial musculature. Blood circulation in both superficial temporal and occipital arteries was reduced by applying a cuff to the head pumping up to 200 mmHg during rhythmic chewing on a spring, thereby producing a continuously increasing bilateral, dull, frontal headache. The subjects rated the intensity continuously using a category sub‐dividing procedure ranging from pain threshold to pain tolerance limit. At low levels of headache intensity there were no significant diurnal differences in pain sensitivity. Sensitivity to very intense headache, however, varied significantly over the course of the day: sensitivity was greatest at 0200 hours; it decreased at a constant rate until1400 hours, and increased again continuously until 2200 hours (pó.05). Also the findings showed significant effects of sex on the pain sensitivity of pericranial musculature for all pain intensities: women are approx. twice as sensitive as men (pó.0.05). These results suggest that not only sex, but also time of day, must be taken into consideration in the clinical determination of pain sensitivity of pericranial musculature in the course of headache diagnostics.
Cognitive Correlates of Headache Intensity and Duration
Authors: Demjen Stefan , Bakal Donald A. , Dunn Bruce E.
Published: May 2005

SYNOPSIS

Cognitive processes and cognitive styles of persistent headache sufferers were examined in relation to indices of intensity and duration of head pain. One hundred and eight persistent headache patients, referred for cognitive‐behavioral management of their disorder, completed questionnaires designed to assess: distressing thoughts and feelings experienced during headache attacks, evaluation of the experienced pain, perceived influence of stress and worry on headaches, and capacity to verbally express emotions.

The results showed that the intensity of head pain correlated with measures of headache‐related distress and‐with the proportion of headache‐related distress to situation‐related distress. Duration of head pain was also associated with the proportion of headache‐related distress to situation‐related distress, and additionally with a tendency to deny the influence of stress and worry on headaches and with difficulty in expressing emotions.

These findings were taken as support of our previously stated hypothesis that head pain of increased severity is associated with a cognitive shift whereby the patient's primary concern moves from situational and interpersonal distress to distress associated with the disorder itself.1 In addition, these findings point to affective distress and lack of emotional expressiveness as correlating differentially with the headache dimensions of intensity and duration.
A New 5‐HT2 Antagonist (Ritanserin) in the Treatment of Chronic Headache With Depression. A Double‐Blind Study vs Amitriptyline
Authors: Nappi Giuseppe , Sandrini Giorgio , Granella Franco , Ruiz Luigi , Cerutti Giorgio , Facchinetti Fabio , Blandini Fabio , Manzoni Gian Camillo
Published: May 2005

SYNOPSIS

The exact relationship between depression and chronic headache remains unclear. Considerable clinical and pharmacological evidence suggests the existence of a common biological terrain. Many antidepressant drugs are effective in the treatment of migraine and chronic headache disorders.

Ritanserin, a new very selective serotonin‐2 (5‐HT2) antagonist, has recently shown both analgesic and antidepressant properties. The present study compares in a double‐blind design, the effectiveness of ritanserin and amitriptyline, a well‐known antidepressant extensively used in migraine prophylaxis.

Thirty‐eight patients (30 females and 8 males ranging in age from 20 to 50 yrs) were classified according to the International Headache Society criteria as: patients with chronic tension‐type headache (CTH) (11 cases) and patients with coexisting migraine and CTH (MCTH) (27 cases).

Only patients with a score equal to or higher than 18 on the Hamilton Rating Scale for Depression (HRSD) were included.

Ritanserin was highly effective in reducing Pain Total Index and analgesic consumption in chronic headache, and its activity was similar to that observed during amitriptyline treatment. A significant improvement of HRSD and HRSA(Hamilton Rating Scale for Anxiety) scores was observed during both treatments. The main results of our study concern the demonstration of antiheadache and antidepressive properties of ritanserin.

To better define the profile of the patients and their clinical responsiveness to the treatment, dexamethasone suppression test, clonidine test and nociceptive flexion reflex were investigated in our patients.

Our data confirm the usefulness of these methods as markers of chronic headache with depression.
Prediction of Migraine Using Psychophysiological and Personality Measures
Authors: Leijdekkers Marijke L.A. , Passchier Jan
Published: May 2005

SYNOPSIS

The topics of interest in this study are whether migraine patients exhibit a stereotypic reaction to a stressful stimulus which is different from the reaction of non headache controls and whether it is possible to predict headache activity within the migraine population.

Our study population comprised 37 female migraine patients and 34 matched controls. Heart rate, skin conductance, pulse amplitude of the temporal artery and an EMG of the temporal muscle were registered during a baseline situation and during a mental stressor. In addition, state anxiety, trait anxiety, facilitating anxiety and stress tolerance were assessed.

Migraine patients reported higher levels of trait anxiety, greater fear of failure, lower stress tolerance and higher levels of state anxiety than non headache controls. Physiological baseline levels and stress reactions did not differbetween migraine patients and controls.

Linear combinations of psychological and psychophysiological data sets did not show an acceptable degree of accuracy in the classification of individual response profiles into groups.

Within the migraine group, 54% of the average duration of migraine attacks and 33% of the variation in average maximum headache intensity could be explained by a combination of psychological, psychophysiological and socio‐demographic variables.

It is concluded that measures from both the psychological and the physiological domain should be included when studying the effects of stress in migraine.
Association of Sustained Oxyhemoglobin Desaturation and Onset of Cluster Headache Attacks
Authors: Kudrow Lee , Kudrow David B.
Published: May 2005

SYNOPSIS

Ten episodic cluster headache patients in their active cluster period, ten patients in remission and five control subjects were monitored for minute to minute changes in oxygen saturation (SaO2) and pulse rate before and after nitroglycerin (NTG) administration.

A transient but significant decrease in SaO2 and increase in pulse rate of 25 minutes duration occurred following NTG in all groups. These changes may reflect physiologic hemodynamic effects of NTG as a smooth muscle relaxant. Subsequently, SaO2 levels and pulse rate recovered to baseline values in remission and control groups. In contrast, SaO2 values in the active cluster group decreased further and after an extended period culminated in cluster headache attacks in 10/10 patients.

Three major changes, therefore, distinguished active cluster patients from remission and control groups. First, the magnitude of oxygen desaturation increased after the physiological effects of NTG ceased. Second, oxygen desaturation was sustained for an additional 9 to 30 minutes duration. Third, the hypoxemic state culminated in attacks in all cases.

Our findings suggest that the active cluster period may be characterized by an impaired mechanism to autoregulate, and thus compensate, for hypoxemia. It is further proposed that persistence of hypoxemia and the cluster attack onset may share a common mechanism, coupling the two events. We suggest that abnormal central and/or peripheral chemoreceptor activity may be responsible for these events.
Serious Migraine: A Study of Some Epidemiological Aspects
Authors: Pascual J. , Polo J. M. , Berciano J.
Published: May 2005

SYNOPSIS

Data are scant concerning some epidemiological aspects of those severe headaches which cause serious personal and economic morbidity. Our purpose was to study the incidence and other epidemiological features of patients suffering from severe migraine exacerbations, in an unselected population. The 64 patients who suffered from severe migraine bouts represented 10.5% of all the new walk‐in neurological consultations in the area covered in this study. 70% of these patients were between 10 and 39 years old. Although females clearly predominated in all ages after fifteen, below this age there was a slight male predominance. The calculated incidence of serious migraine exacerbations was 90 per 100,000 people per year, the corrected incidence for females being 143/100,000 and for males 37/100,000. The highest incidence for females was in 15–19 year‐olds (377/100,000) and for males in 10–14 year‐olds (166/100,000). Our data seem to confirm the periodic nature of this condition since in 80% of patients the migraine bouts (ie: groups of attacks) lasted between two and nine months. Also they support the reported existence of genetic and hormonal factors in the susceptibility to migraine exacerbations. Our results may help in planning the public health aspect of migraine and add some light to the natural history of this common condition.
Platelet Monoamine Oxidase Activity in Female Migraine Patients
Authors: Mosnaim Aron D. , Huprikar Shankar , Wolf Marion E. , Diamond Seymour
Published: May 2005

SUMMARY

Platelet monoamine oxidase activity (MAO) in a group (n = 17) of white, female migraineurs during an acute migraine attack was similar to both the values obtained for the same group of patients two to three weeks after the headache episode (pain‐free period) and to the results obtained for a group (n = 18) of sex and race‐matched, age‐comparable, drug‐free healthy volunteers (blind study; substrate p‐tyramine, 38.7 ± 5.7, 41.9 ± 8.8 and 43.0 ± 3.4 or p‐methoxybenzylamine, 178.9 ± 11.3, 177.2 ± 6.9 and 181.0 ± 9.7 nmole/hr/10 9 platelets ± SD, respectively). With each patient serving as its own control, MAO activity during the migraine episode and when pain‐free failed to show a significant trend. Neither a number of other medical conditions nor the use of several medications appeared to significantly influence our results. The present work, while dealing only with a small but well defined patient population, argues against the possible usefulness of platelet MAO activity as a biological marker for migraine headaches.
A Protocol for Butalbital, Aspirin and Caffeine (BAC) Detoxification in Headache Patients
Authors: Sands George H.
Published: May 2005

SYNOPSIS

The abuse of the combination drug containing butalbital 50 mg, aspirin 325 mg and caffeine 40 mg (or BAC), is commonly recognized by headache specialists as causing headaches. Despite this widespread problem, there is not a published treatment regimen for the BAC detoxification of patients. I describe such a protocol which was used four times in three patients. These patients fulfilled the diagnostic criteria of the IHS Headache Classification for headaches induced by chronic substance abuse (8.2) and analgesics abuse headache (8.2.2). These patients took between 150 and 420 BAC/month for 2–15 years. Two patients had previously undergone inpatient detoxification. One patient unsuccessfully tried detoxification twice as an outpatient.

All patients were required to have psychological support prior to hospitalization for this protocol. BAC was discontinued. A pentobarbital challenge test corroborated butalbital dosage. The patients were given phenobarbital and caffeine which were tapered over several days. Dihydroergotamine (DHE) with metoclopramide was used (Raskin). Propranolol 60 mg bid was started. No narcotics were permitted. After hospital discharge, patients were allowed to continue subcutaneous DHE, as needed. One patient restarted BAC use after 8 months without it. The other two patients were still BAC free 18 and 14 months after detoxification.
Dissociation between Pain and Autonomic Disturbances in Cluster Headache
Authors: Drummond Peter D.
Published: May 2005

SYNOPSIS

The relationship between pain and autonomic disturbances in cluster headache was studied in 54 patients whose attack always recurred on the same side, and in 7 others whose attack had affected either side on different occasions. In one of these seven patients, facial flushing and ocular sympathetic deficit was observed on the original side of headaches. In most patients, the orbital region was warmer on the painful side but in three cases this region was cooler during and between attacks. Lacrimation and rhinorrhoea were more common in severe attacks, and the temperature difference between the orbits increased with increasing severity of pain. These findings support the view that certain autonomic disturbances in cluster headache are provoked by pain. Residual autonomic dysfunction could influence autonomic activity during cluster headache. If so, residual dysfunction on the pain‐free side could explain the dissociation between autonomic disturbances and pain observed in a few cases.
Sinus Bradycardia, Junctional Rhythm and Blood Pressure Increase During Repeated Cluster Headache Attacks
Authors: Attanasio A. , Capria A. , Quatrana M. , Piccolo C.G.C. , Bisceglia A. , Formisano R. , Cerbo R.
Published: May 2005

SYNOPSIS

We have observed in a patient, during four subsequent spontaneous attacks of cluster headache, recurrence of marked bradycardia and junctional rhythm constantly associated with systolic and diastolic blood pressure increase.
Analgesic Use: A Study of Treatments Used by Patients for Migraine Prior to Attending the City of London Migraine Clinic
Authors: MacGregor E.A. , Vohrah C. , Wilkinson M.
Published: May 2005

SYNOPSIS

Eighty‐three unselected patients attending the City of London Migraine Clinic for the first time were askedabout their drug intake and use of alternative treatment.

Thirty‐one of those questioned took regular daily doses of medication. Fifteen were taking a combination of drugs bought 'over the counter' (OTC) and drugs prescribed by their GP; eleven took OTC drugs only; and 5 took prescription drugs only. It was noticeable that those taking drugs prescribed both by the GP and obtainable over the counter were more likely than the other groups to be taking several drugs rather than a single type. Thirty five of the 83 (42.2%) had tried alternative treatments for their attacks.
Vasospasm Contributes to Monosodium Glutamate‐lnduced Headache
Authors: Merritt James E. , Williams Patricia Bell
Published: May 2005

SYNOPSIS

Consumption of monosodium glutamate has long been considered to precipitate headaches in susceptible patients. In this study the direct effects of glutamate and its metabolite, glutamine, on arterial contractility were examined using rings of rabbit aorta. In a high concentration glutamate caused significant concentration‐dependent contractions (EC 50 , 10 ‐1 M; maximum tension, 188.4±33.3 mg wt tension/mg tissue). Agonists and antagonists for a‐adrenergic, histaminergic, serotonergic, cholinergic, and GABA‐nergic receptors as well as inhibition of prostaglandin synthesis failed to influence glutamate contractions. At high concentrations (10 ‐5 M) the calcium channel blocker, verapamil, inhibited the glutamate response. Glutamate and glutamine both exhibited concentration dependent relaxation of norepinephrine (NE), phenylephrine (PE), histamine, serotonin (5‐HT), and prostaglandin F 2a (PGF 2a )‐induced contractions. Kainic acid (10 ‐4 M), an agonist of one subpopulation of central glutamate receptor, potentiated glutamate‐induced vasoconstriction; a higher concentration (10 ‐3 M) produced an irreversible inhibition of glutamate contractility. Only the central glutamate receptor antagonist, ketamine (10 ‐4 ‐10 ‐2 M), induced a reversible, concentration dependent inhibition of glutamate‐induced contractions. Glutamate contractility was not dependent on extracellular calcium, an intact endothelium or neuronal function. These results demonstrate a direct effect of glutamate on peripheral arterial tone. Dietary consumption of large quantities of MSG may represent a serious health hazard to certain individuals with pre‐existing vascular disease.
Health Status in Patients with Tension Headache Treated with Acupuncture or Physiotherapy
Authors: Carlsson Jane , Augustinsson Lars‐Erik , Blomstrand Christian , Sullivan Marianne
Published: May 2005

SYNOPSIS

Sixty‐two female patients with chronic tension headache were randomly divided into two treatment groups ‐ acupuncture and physiotherapy. Their overall function (Sickness Impact Profile), and mental well‐being (Mood Adjective Check List) and the intensity and frequency of headache were assessed before and after treatment. Before treatment the patients showed significantly more dysfunction and less positive mental well‐being than a general population sample. Both treatment groups improved in overall function, the physiotherapy group somewhat more, The mental well‐being increased only in the physiotherapy group. The intensity and frequency of headache was significantly reduced in both the physiotherapy group and the acupuncture group. The intensity of headache was significantly more improved in the physiotherapy group. The improvement of headache intensity persisted unchanged 7–12 months after treatment.
Contingent Negative Variation in Migraine
Authors: Böcker K.B.E. , Timsit‐Berthier M. , Schoenen J. , Brunia C.H.M.
Published: May 2005

SYNOPSIS

The Contingent Negative Variation (CNV) is an event‐related slow potential. It was recorded in healthy volunteers (n = 8) and in patients suffering from migraine without (n = 12) or with (n = 5) aura, during one (CNV1) and three second (CNV3) foreperiods in a forewarned reaction time task. CNV1 was recorded at the vertex while CNV3 was recorded at multiple electrode sites to assess topographical differences. Seven out of twelve migraine patients without aura had increased CNV1 amplitudes. CNV3 amplitudes were increased as well, but only at electrode positions C3 and C4 and not at F 2 . CNV3, which allows for analysis of both an early and a late CNV component, could improve the discrimination of migraine without aura beyond that of CNV1. In migraine with aura all CNV parameters were at control levels, confirming previous results.

The data obtained are discussed in terms of arousal, activation and stress and the “biobehavioral medal of migraine” (Welch, 1986).
Drug Induced Refractory Headache ‐ Clinical Features and Management
Authors: Mathew Ninan T. , Kurman Rochelle , Perez Francisco
Published: May 2005

SYNOPSIS

Two hundred patients who were taking daily symptomatic or immediate relief medications, often in excessive quantities, yet suffering from daily or near daily severe headaches were studied. One hundred and sixteen (58%) of them were also taking concomitant prophylactic medications and they were ineffective. Low tyramine, low caffeine dietary instructions and biofeedback training were given to all patients. The effect of continuing symptomatic medications, discontinuing symptomatic medications, and adding or changing prophylactic medi‐cations were studied in the various treatment groups. It is concluded that; 1.) Daily use of symptomatic or immediate relief medications result in chronic daily headache. 2.) Discontinuing daily symptomatic medications itself result in improvement of headache. 3.) Concomitant use of symptomatic medications nullifies the effect of prophylactic medi‐cations. 4.) Discontinuing daily symptomatic medications enhances the beneficial effect of prophylactic medications.
The VER as a Diagnostic Marker for Childhood Abdominal Migraine
Authors: Mortimer M.J. , Good P.A.
Published: May 2005

SYNOPSIS

Abdominal migraine is a common childhood migraine equivalent, for which diagnostic criteria have not been defined. As in other children with migraine equivalents this leads to difficulties in diagnosis and determination of prevalence. By recording the fast wave activity (beta rhythmn) in the visual evoked response (VER) to red and white flash, the pattern stimulation, 27 out of 28 children with clinically diagnosed abdominal migraine revealed significant differences compared with normal controls, outside the attack phase. Comparisons with children diagnosed as migraine with or without aura revealed, from the VER findings of higher amplitude fast wave activity and the presence of paroxysmal sharp wave activity, that abdominal migraine appears to be a specific form of childhood migraine. We found that both clinically and electrophysiologically, abdominal migraine changes with age; older children exhibiting a shorter duration of abdominal pain during attacks, and less evidence of sharp wave activity in the VER.
99m TC HM‐PAO SPECT in Pediatric Migraine
Authors: Battistella P.A. , Ruffilli R. , Pozza F. Dalla , Pitassi I. , Casara G.L. , Boniver C. , Suppiej A. , Bendagli B. , Condini A.
Published: May 2005

SYNOPSIS

99m TC HM‐PAO SPECT brain imaging was performed during the headache‐free period in 19 young migraineurs, affected by common migraine (CM, 10 cases), classic migraine (CLM, 6 cases) and hemiplegic migraine (HM, 3 cases). SPECT findings were negative in all 10 patients with CM, in 3 cases of CLM and in 2 cases of HM. Positive findings in the remaining 4 patients (3 cases of CLM and I of HM) showed a decreased tracer distribution in the temporo‐occipital regions (2 cases) and parietal regions (2 cases): the two with decreased temporo‐occipital perfusion reported prodromal symptoms exclusively contralateral to the areas of hypoperfusion. An impaired regional cerebral vascular autoregulation may exist even during headache‐free intervals in patients suffering from classic and hemiplegic migraine.
Cerebral Vein Thrombosis Shown by MRI
Authors: Salvati Carl A.
Published: May 2005

SYNOPSIS

A 46 year old man with a short history of left facial pain and numbness, and subsequently headaches, had a normal physical examination and a normal CT scan of head. Lumber puncture yielded normal CSF under increased pressure. MRI showed thrombosis of the superior sagittal sinus, subsequently confirmed by angiography. MRI is a sensitive test for detecting intracranial venous thrombosis, and may be the investigation of choice when this disorder is suspected.
Relaxation Training in School Classes Does Not Reduce Headache Complaints
Authors: Passchier J. , van den Bree M.B.M. , Emmen H.H. , Osterhaus S.O.L. , Orlebeke J.F. , Verhage F.
Published: May 2005

SYNOPSIS

The effect of teacher‐presented Progressive Relaxation Training (PRT) on headaches, fear of failure and school problems was studied in school students. During ten physical education lessons, students received either PITT (n = 110) or placebo training (n=92). The effect of the training was investigated in students who indicated the presence of headaches in a pre‐training diary. No significant differences were found between both training groups regarding headache frequency, duration and intensity and the psychological variables. On the basis of these and previous findings, it is recommended to present PRT to fairly small groups of self‐selected subjects instead of complete classes.
Pharmacokinetics of Tiaprofenic Acid After Oral Administration in Fasting Patients During and Between Migraine Attacks
Authors: Pini Luigi‐Alberto , Bertolotti Marco , Bergonzini Giuliano , Casalgrandi Leonello , Giroldi Liviana , Sternieri Emilio
Published: May 2005

SYNOPSIS

This study examined the pharmacokinetics of 300 mg of tiaprofenic acid, a NSAID belonging to the 2‐arylpropionic class, as a single oral dose, in 10 migraine patients during and out of migraine attacks. Plasma concentration of tiaprofenic acid was determined by HPLC analysis. Drug absorption appeared to be the same during and out of migraine attacks (absorption half life: during attack, 0.249±0.122 hr; out of attack, 0.249 ± 0.105 hr; maximum plasma concentration: during attack, 37.8±9.8 ug/ml; out of attack, 40.1 ± 13.2 ug/ml). The other pharmacokinetic parameters evaluated were not affected by headache attacks as well. We conclude that tiaprofenic acid absorption and metabolism are not affected by migraine attacks. Also, our data suggest that tiaprofenic acid might be useful in the treatment of migraine.
Noninvasive Trigeminal Evoked Potentials: Normative Data and Application to Neuralgia Patients
Authors: Dalessio Donald J. , Mclsaac Heather , Aung Maung , Polich John
Published: May 2005

SYNOPSIS

A mild electric shock applied to the lower lip was used to elicit reliable evoked potentials from the trigeminal nerve in 20 normal young adults. The wave forms were morphologically similar to those observed with invasive procedures. No substantial differences for either the right or left side of stimulation, recording electrode, or subject sex were obtained for any of the individual potential amplitudes or latencies. The same procedures were applied to 10 patients who had been treated with retrogasserian glycerol injections for trigeminal neuralgia. Trigeminal evoked potentials were elicited in all patients, although the quality of the individual wave forms was more variable than that observed for the normal subjects. Comparison of the treated with the unaffected face side in the patients demonstrated significantly smaller N2‐P2 amplitudes and longer N2 latencies for the affected face side. The results suggest that these procedures produce reliable evoked potential measures of trigeminal nerve function noninvasively which can provide an objective index of treatment efficacy.