bluuebunny/crossref_metadata_2025 huggingface dataset:
Lithium Carbonate in Cluster Headache: Assessment of Its Short- and Long-Term Therapeutic Efficacy
Authors: Manzoni Gian Camillo , Bono Giorgio , Lanfranchi Marina , Micieli Giuseppe , Terzano Mario Giovanni , Nappi Giuseppe
Published: March 2003

The short- and long-term effects of administration of lithium carbonate in cluster headache (CH) have been investigated. Of the 90 patients treated (78 males and 12 females), 68 had episodic CH and 22 had the chronic form of the disease. The doses used were almost always 900 mg/day. Eleven of the 22 patients with chronic CH showed a definite, constant improvement both short and long term. In 7 of the 22 patients, lithium treatment provided excellent results initially but was later followed by some transient worsening; in the remaining 4 only partial benefits were observed initially and treatment proved still less effective after a few months. The effects of cessation of lithium administration after at least five months of continuous treatment were studied in 9 cases. In 6 of them the attacks re-appeared immediately, whereas in 3 the attacks occurred again only after free intervals of four to six months. Of the 68 patients with episodic CH, 26 proved highly responsive to treatment, 26 only partially responsive, and 16 refractory. In 3 cases, after one to three years of continuous treatment, euthyroid goitre developed, which disappeared after the drug was discontinued.
Impaired 5-Hydroxytryptamine Tachyphylaxis in Migraine
Authors: Sicuteri F. , Panconesi A. , Franchi G. , Bianco P. L. Del , Anselmi B.
Published: March 2003

Tachyphylaxis (TPX) to the spasmogenic activity of 5HT can be demonstrated in vivo in the superficial hand dorsal veins in man by the computerized venotest. The 5HT-TPX is reverted by previous local naloxone administration. Tachyphylaxis to 5HT is usually absent in the migraineur. The restored 5HT spasmogenic effect by naloxone suggests the possibility of local opioid apparatus participation in TPX to 5HT.
Prophylactic Treatment of Classical and Non-Classical Migraine With Metoprolol—a Comparison with Placebo
Authors: Andersson P. G. , Dahl S. , Hansen J. H. , Hansen P. E. , Hedman C. , Kristensen T. Nygaard , Olivarius B. de Fine
Published: March 2003

A double-blind investigation with parallel groups was carried out in three Danish neurological clinics to evaluate the effect of metoprolol (Beloc(r), Betaloc(r), Seloken(r)) versus placebo in migraine patients. 71 patients were included; 62 completed the study. The following parameters were used in the evaluation: frequency of headache attacks, days with migraine, severity score (days intensity), and the consumption of pain-relieving tablets. The results of the study show that metoprolol 200 mg in Durules(r) (a controlled release formulation) once daily is more effective regarding all evaluated parameters than placebo and that metoprolol is well tolerated.
Effects of Dietary Protein-Tryptophan Restriction Upon 5-HT Uptake by Platelets and Clinical Symptoms in Migraine-Like Headache
Authors: Unge G. , Malmgren R. , Olsson P. , Theorell H. , Tornling G.
Published: March 2003

Ten women with recurrent migraine-like headache, flush, urticaria and itching excoriations were put on a protein/tryptophan reduced diet. The 5–HT uptake kinetics in platelets, the frequency of headache attacks and skin symptoms were recorded. On customary food the 5–HT uptake kinetics were severely disturbed. On diet, the platelet 5–HT uptake was normalized and, in parallel, the migraine-like symptoms and skin manifestations were reduced. The parallel between the improvement in active 5–HT uptake by platelets and clinical symptoms during dietary protein/tryptophan restriction supports the idea that impairment of the 5–HT uptake in platelets is a contributory factor in the pathogenesis of migraine-like headache and other 5–HT related symptoms.
Presence of alpha-Adrenoceptors in Human Temporal Arteries. Comparison Between Migraine Patients and Controls
Authors: Edvinsson L. , Tfelt-Hansen P. , Skärby T. , Gjerris F. , Olesen J.
Published: March 2003

Alpha-adrenergic mechanisms have frequently been implied in migraine pathophysiology. We have examined the noradrenaline reactivity of isolated human temporal arteries removed from six migraine sufferers (not during attack) and from six patients without migraine operated for intracranial disorders. Noradrenaline constricted these vessels in a concentration-dependent manner, the response being altered by phentolamine 10-8 M to 10-6 M. There was no statistically significant difference between migraine patients and controls with respect to maximal contractile force (Emas) or pD2 (negative logarithm of the concentration eliciting half maximal force). The pA2 value for phentolamine was 8.3 in vessels from controls and 7.6 in arteries from migraine sufferers. The small difference between migraine patients and controls was not statistically significant. We obtained clear evidence of alpha-adrenergic receptors in human temporal arteries but their sensitivity was independent of the migraine disorder.
Superior Laryngeal Neuralgia
Authors: Bruyn G. W.
Published: March 2003

This disorder has failed to achieve the status of general recognition among the cephalic neuralgias. Whether its orphanage derives from narrow-minded expulsion from the neurological domain of cephalic neuralgias to the ENT-field, or can be attributed to its rarity (though this did not keep glossopharyngeal neuralgia from rightfully assuming its place among equals), or to the hazy outlines of the disorder, remains a question more readily posed than answered. Yet, if it shares with Sluder's sphenopalatine neuralgia an uncertain clinical identity, there are a sufficient number of observable clinical data from which to conclude the reality of this neuralgia. A review of pertinent reports should enable the reader to make up his own mind.
Headache and Mood: A Time-Series Analysis of Self-Ratings
Authors: Dalkvist Jan , Ekbom Karl , Waldenlind Elisabet
Published: March 2003

Self-ratings with respect to headache and five mood dimensions were obtained twice daily from five patients suffering from migraine and six patients suffering from muscle-contraction headache during a mean period of 47.9 days (range: 38–61). The data were analysed by multiple regression, with the rated headache as dependent variable. Different time intervals between measurement of the independent variables and measurement of the dependent variable were used. A significant time-dependent relation was found between the migraine ratings and the alertness ratings. Significant time-dependent relations were also found between rated muscle-contraction headache and rated anger and alertness, respectively, but the trends were not very pronounced. In the case of no time lag, rated muscle-contraction headache tended to be negatively related to rated alertness, happiness and concentration. Significant periodic trends were found for both the migraine and the muscle-contraction headache. The major findings are discussed in terms of stress and biological rhythms.
Dopamine Blockade With Domperidone: Bridge Between Prophylactic and Abortive Treatment of Migraine? A Dose-Finding Study
Authors: Waelkens J
Published: March 2003

The feasibility of a “last moment” prevention of migraine with the selective dopamine receptor blocker domperidone (Motilium(r)) was evaluated in patients who experience typical, but minor prodromes several hours before the attack. Following a previous placebo-controlled trial, a dose-response study was done. In a randomized, double-blind cross-over setting, oral doses of 20 mg, 30 mg or 40 mg of domperidone were each given twice to 19 patients who were able to predict their attack several hours in advance. Taken at the very first appearance of the early warning symptoms, 20 mg, 30 mg and 40 mg prevented respectively 30%, 58% and 63% of the (imminent) attacks. Part of the attacks still occurring after domperidone, particularly after 20 mg, were reduced in severity. Irrespective of the dose given, the best response was observed when domperidone was taken 6 h, and even better, 12 h before the attack. Migraine-associated hypersensitivity of dopamine receptors might explain why dopamine blockade with domperidone is of benefit to the patient.
Histamine Release from Leucocytes During Migraine Attack
Authors: Selmaj Krzysztof
Published: March 2003

Spontaneous histamine release (SHR) from leucocytes (basophils) of 27 migraine patients was investigated during various phases of attack. Mean SHR during the first 3 h of attack (33.7%) was increased compared with the mean SHR from leucocytes of healthy persons (15.9%), but differed insignificantly from the mean SHR in symptom-free periods. Histamine release (HR) from leucocytes of healthy persons suspended in migraine sera from different time-periods of attack was also increased compared with HR in control sera, i.e. high HR could be induced by passive transfer of serum. But the mean HRs in sera from different time-periods of attack were insignificantly different from the mean HR in sera from symptom-free periods. The increased SHR may contribute to vascular hyperreactivity in migraine.
Chronic Paroxysmal Hemicrania. VII. Mechanical Precipitation of Attacks: New Cases and Localization of Trigger Points
Authors: Sjaastad Ottar , Saunte Carsten , Graham JR
Published: March 2003

Two new chronic paroxysmal hemicrania patients are described. In both, attacks can be precipitated mechanically by applying firm manual pressure to certain sensitive points on the neck, i.e. in the C2 area, in the transverse processes of the C4–C5 vertebrae, or beneath the posterior part o15 the skull on the symptomatic side. The most sensitive area seems to be the transverse process of C4–C5. Susceptibility to this type of attack is dependent on the flow of spontaneous attacks; attacks are easily precipitated in a phase with multiple spontaneous attacks, but are not readily precipitated otherwise. Under indomethacin protection, local tenderness is clearly diminished and attacks cannot be precipitated.
Intracranial Arteriovenous Malformation and Migraine
Authors: Bruyn GW
Published: March 2003

To define more closely the clinical relationship between migraine and intracranial arteriovenous malformation (iAVM), the clinical features of 57 reported instances and of 7 personal cases were analysed. Migraine attacks symptomatic of AVM include: late onset, frequent absence of (familial) migraine history, diminution or even inversion of the usual sex-ratio in migraine, brevity of attacks, disruption of the usual sequence of attack symptoms and, finally. unusual or permanent neurologic deficit. An attempt has also been made to clarify the epidemiological relationship. The reported frequency of migraine in cases of AVM, and AVM in cases of migraine is reflected against an inquiry into the number of annually diagnosed cases of AVM in 20 Dutch neurological/neurosurgical centres, covering 12.106 inhabitants in 8 of the 11 provinces. The annual incidence of migraine is estimated at 1:3,500 population, that of diagnosed iAVM is 120, i.e. 1:100,000. Coincidental occurrence of the two conditions works out at 1:4 x 108 per year. The presented case series of 7 seen in 2 of the 20 centres strongly militates against such a chance hypothesis.
Platelet Aggregability, Disaggregability and Serotonin Uptake in Migraine
Authors: Kruglak L , Nathan I , Korczyn AD , Zolotov Z , Berginer V , Dvilansky A
Published: March 2003

Several disturbances in platelet function have been reported in migraineurs including serotonin (5–HT) metabolism and abnormal aggregability of platelets. The present work compared platelets taken from migraineurs during attacks and at headache-free periods with those of controls. The results demonstrated a tendency to increased aggregability during attacks compared to headache-free periods, and lower still in controls. Kinetic analysis of 5–HT uptake revealed normal K, increased V values and lower imipramine inhibition in m max migraineurs (both during headache and at headache-free periods). However, although the differences were significant statistically, they were small, and their clinical relevance remains to be proven.
Childhood Headache Risk: Warning Signs and Symptoms Present During the First Six Months of Life*
Authors: Guidetti Vincenzo , Ottaviano Salvatore , Pagliarini Marina
Published: March 2003

In the history of children suffering from non-organic headache, the presence of periodic syndromes can often be found. In previous observations we ascertained that periodic syndromes are a common finding in children showing physical and behavioural characteristics of “hyperreactivity” in the first months of their lives. We have tried to verify, through a prospective study, whether children with “hyperreactivity” in the first months of life are particularly prone to develop periodic syndromes and/or non-organic headache. We have developed an appropriate test for the assessment of hyperreactivity in the first 6 months of life. We have isolated 183 hyperreactive subjects; 102 of them have been followed-up to an average age of 10.8 years, together with a control group of 80 subjects followed-up to an average age of 10.2 years. Of the 102 hyperreactive infants, 54 (52.9%) suffered from common migraine, versus 12 (15%) of the control group; 66 (64.5%) hyperreactive infants suffered from periodic syndrome, versus 10 (12.5%) of the control group. There was frequently a co-existence of migraine and periodic syndrome. It is thus possible to identify infants who are particularly prone to develop periodic syndromes and headache.
Migraine in Patients With Cluster Headache
Authors: Andersson Poul Gertz
Published: March 2003

One hundred and twenty seven patients with cluster headache have been compared with 122 patients with migraine. Twenty of the patients with cluster headache have had migraine attacks but only 2 still have migraine attacks after the onset of cluster headache. No migraine patients had cluster headache. Among the 127 patients with cluster headache, one of the parents suffered from cluster headache in 4.7% of the cases. Among the 122 patients with migraine, 0.8% had a parent with cluster headache. Among the 122 patients with migraine 54.9% had parents with migraine, and in the cluster headache group 23.6% of the patients had one parent with migraine. The coexistence of migraine and cluster headache is rare. The two types of headache, as far as the heredity pattern is concerned, are independent entities.
Treatment of Acute Migraine Attack: Naproxen and Placebo Compared
Authors: Nestvold Knut , Kloster Reidar , Partinen Markku , Sulkava Raimo
Published: March 2003

A double-blind, cross-over, randomized study of acute migraine attack compared treatment results of naproxen with that of placebo. Each treatment period continued for either three months or six migraine attacks, whichever occurred first. The initial dose of naproxen was 750 mg, with additional 250–500 mg doses taken if and when required, to a maximum of five 250 mg tablets within a period of 24 h in each migraine attack. Forty-one patients were enrolled in the study; they had all experienced at least two but not more than eight migraine attacks a month during the preceding year. Thirty-two patients completed the two treatment periods. Naproxen was statistically significantly superior to placebo in reducing the severity of head pain, nausea, and photophobia; in shortening the duration of head pain, nausea, vomiting, photophobia, and lightheadedness; in diminishing the frequency of vomiting; and in decreasing the need for escape medication. Both patient and physician treatment preferences significantly favoured naproxen. Nine side effects were experienced by seven patients while receiving placebo and seven by five patients during naproxen treatment. Mild gastrointestinal discomfort was the main complaint. Only one patient withdrew from treatment because of a side effect, which occurred while receiving placebo.
Thermographic and Pupillary Asymmetry in Chronic Paroxysmal Hemicrania. A Case Study
Authors: Drummond Peter D
Published: March 2003

Facial temperature was measured thermographically and pupillary diameter recorded photographically during and between episodes of headache and during spontaneous remission of headache in a patient with chronic paroxysmal hemicrania (CPH). Heat loss from the orbit, nose, cheek and temple was 0.75–1.5°C greater on the symptomatic side during headache, and 0.25–0.75°C greater between headache episodes. Heat loss from these regions of the face was symmetrical during remission of headache. Extensive rhinorrhoea, and slight ptosis and miosis were observed during the active phase of CPH. These findings, which are similar to those previously reported in cluster headache, suggest that CPH is associated with an ocular sympathetic deficit and with overactivity in the greater superficial petrosal nerve.
Substance P Mechanism in Cluster Headache: Evaluation in Plasma and Cerebrospinal Fluid
Authors: Sicuteri Federigo , Fanciullacci Marcello , Geppetti Pierangelo , Renzi Daniela , Caleri Daniela , Spillantini Maria Grazia
Published: March 2003

Substance P (SP), present in sensory afferent neurons, seems to process nociceptive information in the trigeminal system. SP, released from peripheral trigeminal endings, causes typical cluster headache (CH) signs, e.g. vasodilatation, conjunctival and nasal edema and miosis. Opiates and somatostatin (SRIF), both active in relieving CH attack, inhibit SP release from the central and peripheral trigeminal system. In the present study, plasma and cerebrospinal fluid (CSF), SP-like immunoreactivity (SPLI) and enkephalinase activity (EKA), and plasma SRIF-like immunoreactivity (SRIFLI) have been evaluated during spontaneous and histamine induced attacks in the cluster phase. During the histamine provoked attacks, CSF SPLI and plasma SRIFLI and EKA were unchanged, while plasma SPLI decreased significantly. During spontaneously occurring attacks, plasma SRIFLI was found to be unmodified and a significant lowering of SPLI was detected when compared with controls. Moreover, both during and between attacks in the cluster phase, plasma EKA was increased in comparison with the values in controls. It remains to be seen whether variations of plasma SPLI and EKA levels play a role in the CH mechanism.
Metoprolol v. Clonidine in The Prophylactic Treatment of Migraine
Authors: Louis P , Schoenen J , Hedman C
Published: March 2003

In a double-blind, cross-over trial, the migraine prophylactic effect of the b1-adrenoceptor antagonist metoprolol was compared with that of clonidine. The dosage of metoprolol was 50 mg b.i.d. and of clonidine 50 üg b.i.d. Thirty-one patients were included; twenty-three completed the entire study. Six patients withdrew during clonidine treatment, one during metoprolol treatment and one during the wash-out period (placebo). Metoprolol had a significantly better migraine prophylactic effect than clonidine regarding such parameters as the attack frequency, the number of migraine days and the sum of intensity score. Compared to baseline (placebo), metoprolol decreased these parameters, while clonidine did not. Metoprolol, but not clonidine, also. reduced the acute consumption of analgesics. No differences were found as regards side effects.
Anti-Spasmogenic Effects of Bencianol (ZY15051 on Human Cerebral Arteries In Vitro
Authors: Whalley ET , Paul KS , Gulati OP
Published: March 2003

Experiments were performed to assess the ability of bencianol (ZY15051) to reverse contractions of human basilar arteries in vitro that were induced by a wide range of substances implicated in the aetiology of migraine and cerebral arterial spasm. Bencianol caused a dose-related (1–100 μg ml-1) reversal of contractions induced by 5-hydroxytryptamine, nor-adrenaline, angiotensin II, prostaglandin F2a, and U-46619 (a thromboxane-A2 mimetic). Bencianol was more effective against contractions induced by EC50 compared to maximal concentrations of each agent, and was least effective against the thromboxane-A2 mimetic, U-46619. In addition, contractions induced by thromboxane-A2-like substances generated from guinea-pig lungs were also reversed by bencianol but only at the highest concentration used (100 mg ml-1). The relevance of this action of bencianol to migraine and cerebral arterial spasm is discussed.
Warning Symptoms in Migraine: Characteristics and Therapeutic Implications
Authors: Waelkens J
Published: March 2003

The characteristics of warning symptoms preceding the migraine headache attack in 49 patients with complete migraine are described. These symptoms are divided into non-evolutive and evolutive warning symptoms, based on specific characteristics of each. Non-evolutive symptoms precede the attack by 8 to 48 h in 88% of our patients and have a constant and modest intensity. Evolutive warning symptoms appear within a few minutes up to 6 h before the attack. These symptoms become more and more pronounced towards the onset of the headache. There was no striking similarity between symptoms during the attack and the warning symptoms. In a number of patients with complete migraine, migraine attacks can be prevented by taking domperidone, a peripheral dopamine antagonist, at the time of the non-evolutive warning symptoms. These data suggest that the mechanism leading to a migraine attack can be operative 8–48 h before the headache begins and is possibly dopaminergically mediated.
Functional Radiographs of the Craniocervical Region and the Cervical Spine. A New Computer-Aided Technique
Authors: Mayer E Th , Herrmann G , Pfaffenrath V , Pöllmann W , Auberger Th
Published: March 2003

Disabilities of the articulations of the head and cervical spine can often be detected only by exact measurement of functional radiographs. From two radiographs, one in flexion and one in extension, not only can the total mobility of the head be measured, but also the mobility of the individual articulations can be evaluated by taking exact measurements of the position of each vertebra. A method for semi-automatic measuring of such pairs of radiographs is presented. Edges and structures of the bones that are clearly visible in both radiographs are digitized on a graphics tablet. Then, by computer program, each vertebra of the first radiograph is shifted and rotated until it fits best to the respective vertebra of the second radiograph. Thus, for each articulation, the mobility angle and the location of the mobility axis relative to the adjacent vertebra, can be computed. First experiences with this method are presented.
Retro-Gasserian Glycerol Injection in the Treatment of Chronic Cluster Headache
Authors: Ekbom Karl , Lindgren Lars , Nilsson Bengt Y , Hardebo Jan Erik , Waldenlind Elisabet
Published: March 2003

Seven therapy-resistant patients with cluster headache (six of whom were chronic) were treated by percutaneous retro-Gasserian glycerol injections under general anesthesia. In four of the patients immediate and complete relief of attacks was obtained. There was a close correlation between pain relief and the degree of ophthalmic sensory loss. Quantitative estimation of thresholds for thermal perception and pain showed a good correlation to clinically evaluated sensory loss. As the analgesia waned, headaches returned, and the glycerol injections had to be repeated. Two patients were still considerably improved after 5 1/2 and nearly 3 years, respectively. In the other patients the results were less satisfactory at long-term follow-up study. Pure glycerol is highly hypertonic, and the damage of the trigeminal nerve root may be due to this property.
Dihydroergotamine Nasal Spray During Migraine Attacks: A Double-Blind Crossover Study with Placebo
Authors: Tulunay F Cankat , Karan Onur , Aydin Nursel , Culcuoglu Adil , Guvener Adnan
Published: March 2003

Ergot derivatives have been used in the treatment of migraine for more than 50 years. We have compared the efficacy of dihydroergotamine (DHE) nasal spray with that of placebo in patients with classic or common migraine attacks. The study was performed in accordance with a double-blind, crossover design. In this study a great placebo effect was observed with a dose of 1.36 mg/attack, and the overall efficacy was rated by the patients to be 41% and 52% for placebo and DHE, respectively.
“Cervicogenic Headache”: Clinical Manifestation
Authors: Fredriksen Torbjørn A , Hovdal Harald , Sjaastad Ottar
Published: March 2003

The main criteria of “cervicogenic headache” are considered to be as follows: relatively rare and long-lasting unilateral attacks of severe headache, although seemingly of a non-excruciating character, signs of neck involvement, and lack of “cluster pattern”. In the present communication, the clinical manifestations in 11 patients fulfilling these criteria are described. All 11 patients selected in accordance with these criteria proved to be females, the age at onset ranging from 6 to 40 years (mean, 30 years). The mean duration of symptoms was 13 years. Six patients had had previous head/neck injuries. All patients had pain periorbitally, in the temporal region, and in the low occipital region (nape of the neck); less frequent were frontal, parietal, and facial pain and pain in the upper part of the occipital region. The duration of attacks was from 3 h to 3 weeks, and the interval between attacks lasted from 2 days to 2 months. The commonest accompanying phenomena were phonophobia, dizziness, ipsilateral eyelid edema, ipsilaterally blurred vision, and irritability. Some of the patients also had nausea ( n = 7) and vomiting ( n = 6). On physical examination, slight to moderate reduction of movements in the neck was noted, and five patients had ipsilaterally reduced sensation for touch in the trigeminal area. All the patients except one were severely afflicted. Attacks could, in addition to occurring spontaneously, be precipitated in all patients by head movements or by pressure at specific points in the neck.
Episodic Paroxysmal Hemicrania?
Authors: Kudrow Lee , Esperanca Paula , Vijayan N
Published: March 2003

Cyclic remissions in chronic paroxysmal hemicrania (CPH) have been considered to be transitory phenomena inevitably leading to the chronic stage. This conclusion has precluded the possibility of paroxysmal hemicrania having an episodic counterpart. Six case histories presented here establish the persistence of cyclic patterns for a mean of 23 years of illness, thus suggesting that the “pre-CPH” nomenclature may be presumptive, and, further, provide evidence for another classification: episodic paroxysmal hemicrania.
Pericranial Tenderness in Tension Headache: A Blind, Controlled Study
Authors: Langemark Michael , Olesen Jes
Published: March 2003

Forty patients with tension headache and 40 healthy comparable control persons were palpated by the same “blinded” observer. Tenderness in 10 pericranial muscles on each side was rated on a four-point scale. A Total Tenderness Score was calculated for each individual by adding the scores from all palpated areas. Headache patients had significantly higher scores than controls and also significantly higher tenderness in each point separately. Median normal values and confidence limits for tenderness are given. Among 23 patients with daily headache a correlation was found between headache intensity and Total Tenderness Score. It is likely that the pathologic tenderness in patients with tension headache is the source of nociception, but pain mechanisms are more complex, as evidenced by discrepancy between tenderness and pain in some patients. Pathologic tenderness should be a contributing criterion to the diagnosis of tension headache (muscle conctraction headache).
Post-Lumbar-Puncture Headache: The Significance of Body Posture: A Controlled Study of 300 Patients
Authors: Vilming Steinar T , Schrader Harald , Monstad Inge
Published: March 2003

In this single-blind, randomized study of post-lumbar-puncture headache (PPH) in 300 neurologic inpatients the significance of body posture after lumbar puncture (LP) was evaluated. Immediate mobilization was compared with bed rest for 6 h (3 h prone followed by 3 h supine posture). Contrary to the widely held belief, this investigation did not show significant differences between recumbent and ambulant patients as to frequency of PPH in the total material (39% versus 35%) or when men (31% versus 29%) and women (48% versus 41%) were evaluated separately. Headache associated with nausea was significantly more frequent in the recumbent than in the ambulant patients both in the total material (23% versus 13%) and in women (35% versus 16%). Thus, immediate mobilization seems to be preferable after LP.
Cluster Headache-Like Headache, Hageman Trait Deficiency, Retrobulbar Neuritis, and Giant Aneurysm: Autonomic Function Studies
Authors: Sjaastad O , Saunte C , Fredriksen TA , Carvalho D de Souza , Fragoso YD , Dale LG , Hørven I
Published: March 2003

A 56-year-old, previously reported woman with cluster headache-like headache with bouts of unilateral (the side of predominance changing through the years) severe headache had a familial history (three generations) of partial Hageman factor deficiency and bleeding episodes. A giant aneurysm was found to be lodged in the anterior communicating artery on the left side. Clinically, the features were atypical for cluster headache: onset at a young age (14 years), episodes of retrobulbar neuritis appearing at the side of pain, etc. Studies of forehead sweating indicated that the right side was the pathologic one, from an autonomic point of view, as did pupillometric studies. However, during attacks, which were left-sided at the time, forehead sweating was marked laterally on the left side and on the upper eyelid, but not on the right. The “signal” usually reaching the autonomically stigmatized side during attacks of cluster headache, therefore, did not seem to reach the sweat glands on that (the right) side during the attack in the present case. This headache may, therefore, be distinct from cluster headache, both from a clinical and from an autonomic function point of view.
“Mild” Cluster Headache(?)
Authors: Sjaastad O , Carvalho D de Souza , Zhao Jing-Ming
Published: March 2003

Three cases of what could be considered “mild” cluster headache have been described. All three patients were generally able to carry out their work during attacks; all three were men and had unilateral headache with the predominant pain in the ocular region. Relatively few symptoms and signs indicated autonomic system involvement, but at least tearing was invariably present on the symptomatic side. The bouts were generally short-lasting in two of the patients (and partly in the third one), fitting the pattern of “mini-bouts”. Thus, in one of the cases four of the five major criteria (male sex, excruciating severity, cluster phenomenon, autonomic involvement, and unilaterality) were present. In the two other patients the full-blown cluster phenomenon was lacking. Such cases may represent the left-side slope of a “Gaussian severity distribution scale” with regard to cluster headache.
Chronic Paroxysmal Hemicrania: XIII. The Pupillometric Pattern
Authors: Carvalho Deusvenir de Souza , Salvesen Roll , Sand Trond , Smith Stephen E , Sjaastad Ottar
Published: March 2003

Pupillometric studies were carried out in eight patients with chronic paroxysmal hemicrania (CPH) and in age- and sex-matched controls in the basal condition and after instillation of 2% tyramine (CPH, n = 5; controls, n = 17), 1% OH-amphetamine (CPH, n = 6; controls, n = 12), and 1% phenylephrine (CPH, n = 6; controls, n = 17). The pupil on the symptomatic and non-symptomatic sides in CPH patients was significantly smaller in the basal condition than in controls, particularly on the symptomatic side. The mydriatic responses to pharmacologic stimulation were essentially similar on the symptomatic and non-symptomatic sides. An evaporimetric study of the forehead sweat glands, using the body heating and pilocarpine tests, was also carried out in these patients and in age- and sex-matched controls. “Early”, “intermediate”, and “late” measurements demonstrated symmetry of forehead sweating. The findings for both methods of examination thus contrast with those in cluster headache patients. Pupillometric and forehead sweating patterns therefore suggest differences in the pathogenesis of the two headache entities. These tests may be used to distinguish CPH and cluster headache clinically.
Neurotic Traits and Disease Duration in Headache Patients
Authors: Invernizzi Giordano , Gala Costanzo , Buono Manuela , Cittone Luisa , Tavola Tiziana , Conte Giovanni
Published: March 2003

The purpose of this study was to test the hypothesis that duration of illness is correlated with neurotic personality traits. Four hundred and eighteen patients with migraine, tension, and mixed headaches were studied. The MMPI was used to evaluate the patients' personality characteristics. Scales employed were: scale 1–hypochondriasis, scale 2–depression, scale 3–hysteria, and scale 7–psychasthenia. The MMPI scale scores were analysed with regard to sex, diagnosis, and duration of illness. Patients with mixed headaches showed significantly more elevated scores on the MMPI scales than those suffering from migraine and tension headaches. No correlation was found between any of the MMPI scale scores and the duration of illness. No interaction was found between duration of illness and the diagnostic categories of headache in determining the MMPI neurotic scale scores. It is hypothesized that the higher MMPI scores found in patients with mixed headache is characteristic of these patients.
Possible Involvement of Dopaminergic Mechanisms in the Antimigraine Action of Flunarizine
Authors: Piccini Paola , Nuti Angelo , Paoletti Anna Maria , Napolitano Alessandro , Melis Gian Benedetto , Bonuccelli Ubaldo
Published: March 2003

Flunarizine, a calcium antagonist widely used in the prophylactic treatment of migraine, may interfere with dopaminergic systems. Flunarizine therapy can in fact induce extrapyramidal side effects and can increase basal as well as stimulated prolactin levels. To better define the mechanism of flunarizine action in migraine, we studied prolactin and growth hormone responses to thyrotropin releasing hormone and sulpiride in 13 female migraineurs before and after 60 days of flunarizine therapy. The treatment did not modify basal prolactin and growth hormone levels, but prolactin response to thyrotropin releasing hormone was enhanced. A paradoxical increase of growth hormone to thyrotropin releasing hormone observed before therapy was blunted after flunarizine treatment. These data indicate a modulatory action of flunarizine on dopaminergic systems which might to some extent explain the antimigraine action of this drug.
Cluster Headache and “Dynamite Headache”: Blood Flow Velocities in the Middle Cerebral Artery
Authors: Hannerz Jan , Hellström Gunnar , Klum Trude , Wahlgren Nils Gunnar
Published: March 2003

Nitroglycerin (NG) induces in cluster headache patients and controls an increase in systemic diastolic blood pressure and/or heart rate and a decrease in blood flow velocity in the middle cerebral artery (VMCA). Termination of NG induced cluster headache-like attack was correlated to an increase of VMCA compared to the VMCA before NG administration ( p < 0.01). This increase was not found in patients without attack or in controls. The NG induced “dynamite headache” in the controls subsided when blood pressure and heart rate were normalized, but the decrease of VMCA still prevailed. Orbital phlebograms have shown pathologic changes in cluster headache and in Tolosa-Hunt syndrome but not in controls. Ocular sympathetic nerves are involved in cluster headache but seldom in Tolosa-Hunt syndrome. It is suggested that the start of a cluster headache attack is due to an increase and the termination of the attack to a decrease of blood flow to the sympathoplegic phlebopathic cavernous sinus.
Cerebrovascular Reactivity in Migraineurs as Measured by Transcranial Doppler
Authors: Thomas T Darrell , Harpold Gary J , Troost B Todd
Published: March 2003

Transcranial Doppler ultrasound is a relatively new diagnostic modality which allows the non-invasive assessment of intracranial circulation. A total of 10 migraine patients were studied and compared to healthy controls without headaches. Migraineurs during the headache-free interval demonstrated excessive cerebrovascular reactivity to CO2, evidenced by an increase in middle cerebral artery blood flow velocity of 47% ± 15% compared to 28% ± 14% in controls ( p = 0.026). Differences between the two study groups revealed no significant decrease in middle cerebral artery blood flow velocity with hypocapnia. However, the differences between middle cerebral artery blood flow velocity during hyperventilation and CO2 inhalation were significantly different ( p = 0.004) comparing migraineurs and controls. Instability of the baseline blood flow velocities was also noted in migraineurs during the interictal period. Characteristics which may allow differentiation of migraineurs from other headache populations could possibly be obtained from transcranial Doppler ultrasound flow studies.
Changes in Cerebral Haemodynamics in Cases of Post-Lumbar Puncture Headache: A Prospective Transcranial Doppler Ultrasound Study
Authors: Göbel Hartmut , Klostermann Horst , Lindner Volker , Schenkl Sabine
Published: March 2003

We used transcranial Doppler ultrasonography in 45 patients to investigate if changes in haemodynamics in the major arteries of the brain base occurred after lumbar puncture and whether or not patients with or without post-lumbar puncture headache differ with respect to their cerebral haemodynamic parameters before and after lumbar puncture. Before lumbar puncture, patients with post-lumbar puncture headache differed from patients without post-lumbar puncture headache in that they showed significantly higher flow velocities and significant asymmetry of flow velocities with lateralization to the right ( p £ 0.05). Patients without post-lumbar puncture headache, on the other hand, showed non-significant flow velocity lateralization to the left. Forty-eight hours after lumbar puncture, both groups demonstrated symmetrical flow velocities. In addition, only patients with post-lumbar puncture headache showed a significant reduction in the flow velocity of the right middle cerebral artery ( p £ 0.05). These findings suggest that it is not only absolute flow velocity that plays a part in the event of headache, the interhemispheric relation of cerebral haemodynamics also plays a fundamental role.
Ovarian Steroid Levels in Migraine With and Without Aura
Authors: Nagel-Leiby Sandra , Welch KMA , Grunfeld Saul , D'Andrea Giovanni
Published: March 2003

Radioimmunoassays were used to measure interictal levels of ovarian steroids (oestradiol, total oestrogens and progesterone) in migraine patients at the onset of menses and coincident with the luteinizing hormone surge preceding ovulation. Results of these verified bio-chemically-contrasting points of the ovarian cycle were used to compare 13 migraine patients without aura and 6 migraine patients with aura with 17 non-migraine women. No group differences were found for physiological basal levels of ovarian steroids measured at menses. Preceding ovulation elevation in oestradiol levels relative to normal was found in migraine patients with aura but not in migraine patients without aura. These results suggest that a variation in oestradiol levels is an important factor in the different clinical expressions of migraine.
Platelet Aggregation of Migraineurs During and Between Attacks
Authors: Kovács Katalin , Hermán Ferenc , Filep János , Jelencsik Ilona , Magyar Kálmán , Csanda Endre
Published: March 2003

Platelet aggregation induced by ADP, collagen and platelet-activating factor was studied in common (migraine without aura) and classical migraine (migraine with aura) patients during and between attacks. The EC 50 * values for ADP and platelet-activating factor were significantly higher, whilst that for collagen was significantly lower in classical migraine patients during headache-free intervals compared to healthy volunteers. The EC50 values obtained for common migraine sufferers during symptom-free periods were similar to those of controls. During attacks, the EC 50 value for ADP, but not for collagen and platelet-activating factor, was significantly higher than that of the controls. In healthy subjects a positive correlation was found between ADP and collagen-induced aggregation. In contrast, there was a U-shaped correlation matrix in classical migraine patients. The present observations show that platelet aggregation is altered in migraine patients and this raises the possibility that platelet-activating factor may be involved in the pathogenesis of migraine.
How Caloric Vestibular Irritation Influences Migraine Attacks
Authors: Kolev Ognyan
Published: March 2003

Stimulation of the vestibular system by cold irritation of the ear was performed in 12 patients during a migraine attack. In eleven of the subjects the headache was changed. The changes varied from completely disappeared to a slight decrease. The duration of the changes was either several minutes, during the vestibular irritation, or days. All changes were related to the induced sensation of vertigo. We discuss the probable mechanisms of these vestibular influences.
Migraine, Serum Serotonin and Platelet 5–HT2 Receptors
Authors: Ribeiro Carlos Alberto Fontes , Cotrim Maria Dulce , Morgadinho Maria Teresa , Ramos Maria Isabel , Santos Elisa Seabra , Macedo Tice dos Reis Anastácio de
Published: March 2003

In spite of recent theories about the aetiopathogenesis of migraine, serotonin continues to play a central role, explaining the efficacy of almost all migraine prophylactic drugs. In migraineurs with and without aura we measured (by HPLC-EC) the serum serotonin (5–HT) and 5–hydroxyindoleacetic acid (5–HIAA) levels between as well as during headache attacks. Between attacks of migraine with aura and at the beginning of attacks of both types of migraine the serum 5–HT and 5–HIAA concentration was significantly increased. These results were corroborated by 3H-spiperone binding to platelet membranes: in migraineurs with aura in the attack-free interval, there was a significant decrease in its Bmax, which suggests down-regulation of 5–HT2 receptors. In conclusion, we have verified that migraine with aura differs biochemically from migraine without aura.
Neuroendocrine Dysfunction in Cluster Headache
Authors: Leone M , Patruno G , Vescovi A , Bussone G
Published: March 2003

Current views on cluster headache pathogenesis indicate a primary central nervous system dysfunction, in particular a hypothalamic involvement. To confirm the hypothalamic involvement in cluster headache we evaluated the hypothalamic-pituitary axis responsiveness with the thyrotrophin releasing hormone (TRH) test. A dose of 200 μg of TRH was administered i.v. to nine healthy controls, 32 patients with cluster headache during cluster period and 16 in remission period. Delta maximum thyrotrophin (TSH) was significantly lower in patients with cluster headache during cluster period ( p < 0.05 versus healthy controls and cluster headache patients in remission). No difference was observed between healthy controls and cluster headache patients in remission. A monoaminergic dysfunction at the hypothalamic level is hypothesized.
C2 and C3 Pain Dermatomes in Man
Authors: Poletti Charles E
Published: March 2003

This report defines the C2 and C3 pain dermatomes by the distribution of: the hypalgesia clearing after surgical root decompression; the dysaesthesias produced by electrical root stimulation; and the hypalgesia produced by anaesthetic root block. The C2 pain dermatome, so defined, consists of an occipital parietal area 6–8 cm wide, ascending paramedially from the subocciput to the vertex. The C3 pain dermatome is a craniofacial area including the scalp around the ear, the pinna, the lateral cheek over the angle of the jaw, the submental region and the lateral and anterior aspects of the upper neck. These C2 and C3 pain dermatomes do not overlap and are smaller than the C2 and C3 tactile dermatomes described in the literature.
Evidence for 5-HT1B/1D Receptors Mediating the Antimigraine Effect of Sumatriptan and Dihydroergotamine
Authors: Buzzi Maria Gabriella , Moskowitz Michael A
Published: March 2003

Neurogenic plasma extravasation, endothelial cell activation (increase in vesicle number and vacuole formation), platelet aggregation and adhesion, and mast cell degranulation occur selectively in postcapillary venules of the dura mater following electrical trigeminal ganglion stimulation, and are mediated by release of neuropeptides from perivascular unmyelinated C fibres. Pre-treatment with the antimigraine drugs dihydroergotamine and sumatriptan, two drugs that bind with high affinity to 5-HT1B/1D receptors, markedly attenuated plasma protein extravasation induced by electrical trigeminal ganglion stimulation. Trigeminal stimulation increased plasma calcitonin gene-related peptide levels in rat superior sagittal sinus. Pre-treatment with dihydroergotamine and, to a lesser extent, sumatriptan, attenuated this increase. Both drugs reduced morphological changes in post-capillary venules and mast cells within dura mater following electrical trigeminal ganglion stimulation. Plasma protein extravasation was selectively blocked in dura mater (but not in extracranial tissues) by pre-treatment with those receptor agonists showing a rank order of potency suggesting a 3-HT1B/1D interaction (5-CT > 5-BT > DHE > sumatriptan > 8-OH-DPAT). Pre-treatment with 5-HT2 and 5-HT3 antagonists was not effective. Taken together, these data are consistent with the interpretation that putative 5-HT-1B/1D receptors located on sensory fibres are coupled to inhibition of peptide release and blockade of neurogenic inflammation. An important therapeutic action of ergot alkaloids and sumatriptan in migraine headaches is so defined.
Cluster Headache Course Over Ten Years in 189 Patients
Authors: Manzoni Gian Camillo , Micieli Giuseppe , Granella Franco , Tassorelli Cristina , Zanferrari Carla , Cavallini Anna
Published: March 2003

One-hundred-and-eighty-nine cluster headache patients, referred to Parma and Pavia Headache Centres between 1976 and 1986 with a disease duration of over 10 years, were interviewed about the course of cluster headache. They were classified as episodic (n = 140) or chronic (n = 49) cluster headache patients on the basis of course during the year of onset. Episodic patients showed the following outcome: maintenance of an episodic form (primary episodic form) in 80.7% of cases, shift towards a chronic form (secondary chronic form) in 12.9% and shift towards an intermediate pattern (“combined” form) in 6.4%. In chronic patients, cluster headache was still chronic (primary chronic form) at the moment of observation in 52.4% of cases, while it turned into an episodic form (“secondary” episodic form) in 32.6% and into a “combined” form in 14.3%. Nineteen patients (10%) had had no attacks for at least three years at the moment of examination. We can conclude from our data that: cluster headache is a disease of long duration, perhaps lifelong; episodic cluster headache tends to worsen; chronic cluster headache may easily turn into a better prognostic episodic form; prophylactic drugs are unable to induce recovery. The following factors seem related to a poor outcome: a later onset, the male gender and a disease duration of over 20 years for the episodic forms.