bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship Between Locus of Control, Amount of Pre‐Admission Analgesic/Ergot Overuse, and Length of Stay for Patients Admitted for Inpatient Treatment of Chronic Headache
Authors: Primavera J.P. , Kaiser R.S.
Published: May 2005

SYNOPSIS

This study was undertaken to assess the relationship between locus of control, medication overuse, end length of hospitalization for patients admitted for inpatient treatment of chronic headache with drug rebound. Thirty patients admitted for treatment using repetitive IV DHE were administered the Health Attribution Test (HAT). Two‐thirds of these patients had profile score representative of good health attitudes associated with favorable rehabilitation outcomes. There was a trend in the direction of predicting shorter lengths of hospital stay for those patients with “good” profiles, although the correlation did not reach statistical significance. The statistical relationship (r = .25; P = .09) found between the HAT's “Powerful Others” scale and preadmission levels of medication use was consistent with previously published control theory findings regarding high external locus of control in drug and alcohol abusers.

The findings of this study suggest that analgesic/ergot abusing chronic headache patients may differ from street drug abusers. This may account, in part, for the high levels of success for these patients at two year follow‐up after hospital discharge.
Precipitating Factors in Migraine: A Retrospective Review of 494 Patients
Authors: Robbins Lawrence
Published: May 2005

SYNOPSIS

The predominance of certain triggers for migraine was assessed in 494 migraine patients. Stress (62%) was the most frequently cited precipitant. Weather changes (43%), missing a meal (40%), and bright sunlight (38%) were also prominent factors. Sexual activity (5%) was the precipitant cited by the least number of patients. Significant differences were found between men and women in their responses to weather changes, perfumes, cigarette smoke, missing a meal, and sexual activity.

Spring was cited by 14% of patients as a time for increased migraine attacks, followed by fall (13%), summer (11%), and winter (7%).
SUNCT Syndrome in the Female
Authors: Pareja Juan A. , Sjaastad Ottar
Published: May 2005

SYNOPSIS

Two female patients suffering from SUNCT syndrome are presented. They are the first female SUNCT cases reported (of a total of 16 cases hitherto seen by us, reported to us, or published). Also some minor modifications of the hitherto known clinical symptomatology of SUNCT syndrome have been observed.

Attacks could be triggered in a variety of ways. A short latency between the application of a precipitating stimulus and the onset of pain was noted. An occasional inability of a given precipitating maneuver to activate the pain was also noted. The temporal pattern of pain was partly characterized by the typical, "plateau‐like" pattern, but with ultrashort exacerbations. In part, the pain attacks were characterized by steeple or spike‐like pain waves, that did not quite subside to the baseline (“repetitive pattern”). Autonomic signs such as lacrimation and conjunctival injection were rather marked, as is generally the case in SUNCT syndrome. Rhinorrhea was present in both patients, and in one patient the rhinorrhea was unusually marked. Carbamazepine treatment seemingly brought about a slight decrease in the frequency of attacks.
The Hereditary Syndrome of Thrombocytopathia, Bleeding Tendency, Extreme Miosis, Muscular Fatigue, Asplenia, Headache, etc
Authors: Sjaastad Ottar
Published: May 2005

SYNOPSIS

A new, autosomal dominantly inherited syndrome with a bleeding disorder was described in 1985 by Stormorken and his co‐workers.1,2 In this multifaceted syndrome, there were the following integral components: thrombocytopathia, extreme miosis with Argyll Robertson‐like traits, muscular fatigue, a tendency to spasms, asplenia, ichthyosis, dyslexia, etc.

Headache with migraine traits was also present in the family in all 4 generations in which this syndrome had been observed. Nasal and conjunctival bleeding were part of the headache picture in some of the individuals exhibiting the hemorrhagic syndrome. While the attack‐related bleeding disturbances only involved family members who also suffered from the hemorrhagic syndrome, the headache per se may seem to behave differently: The affected son's headache seems to have developed into a headache with tension headache traits, whereas the other, unaffected, son's headache has common migraine traits. The familial headache which in earlier generations clearly had migraine traits, therefore, may be inherited independently from the hemorrhagic disorder. In other words, a migraine or migraine‐like headache is most probably not an obligatory integral part of this syndrome. The thrombocytopathia in this disorder comprises abnormal serotonin storage, uptake, and release (Stormorken and co‐workers, to be published).

The admittedly somewhat farfetched possibility also exists that the headache, although being similar to migraine, differs essentially from it and may be an expression of the serotonin aberration.
The Physician Survey on the Post‐Concussion and Whiplash Syndromes
Authors: Evans Randolph W. , Evans Richard I. , Sharp Mark J.
Published: May 2005

SYNOPSIS

Background: The post‐concussion syndrome (PCS) and whiplash syndrome (WS) have been controversial topics among physician for many decades. There is little Information available on the opinions end practices of physicians.

Method: In June of 1992, we performed a national survey by mail of the four physician groups most Commonly treating these problems. The number of respondents and response rates were as follows: family physicians, 118, 16%; neurologists, 100, 21%; neurosurgeons, 97, 23%; orthopedists, 82, 13%. The survey Instrument contained items on demographics, definitions, causation, prognosis, medico‐legal aspects, testing, and treatment.

Results: Only a minority of respondents believe that PCS and WS are clearly defined syndromes. A substantial minority report that psychogenic and litigation factors are most responsible for the Conditions. Most of the physicians believe that PCS and WS have a 3–6 month recovery time. A significant minority Concur that symptoms of the two syndromes resolve when litigation is settled. Most of the physicians order tests to role out pathology although a minority order tests to reassure patients or because of litigation concerns. Only a minority of respondents believe that effective treatments are available. Not surprisingly, a multitude of Conventional and unconventional treatments are sometimes recommended.

Conclusions: Many aspects of PCS end WS are controversial among treating physicians. This Controversy can have a profound impact on the quality and cost of patient care. Ongoing research is required to discover more effective treatments for mild brain injury and chronic pain.
Post‐traumatic Stress Disorder in Chronic Post‐traumatic Headache Patients
Authors: Chibnall John T. , Duckro Paul N.
Published: May 2005

SYNOPSIS

The prevalence of post‐traumatic stress disorder (PTSD) was examined in a sample of chronic post‐traumatic headache patients. All subjects had been injured in a motor vehicle accident and had developed headache or experienced marked exacerbation of an existing headache condition as a result. Nearly 30% of the sample was diagnosed with PTSD. Depression and suppressed anger were significantly higher in subjects with PTSD compared to the rest of the sample. Those with PTSD were more likely to have a history of headache prior to the accident than subjects without PTSD. Comparisons between the PTSD and non‐PTSD groups on other headache and demographic variables were non‐significant. The importance of evaluating post‐traumatic headache patients for the presence of PTSD is discussed.
Home Administration of Intramuscular DHE for the Treatment of Acute Migraine Headache
Authors: Weisz Michael A. , EI‐Raheb Morad , Blumenthal Harvey J.
Published: May 2005

SYNOPSIS

Dihydroergotamine (DHE) has been used for the treatment of acute migraine headache for almost 50 years. Previous studies have emphasized use in emergency room, inpatient, or office settings. Twenty‐nine patients with migraine headache who had failed to obtain relief with conventional therapy were trained to self‐administer intramuscular DHE. The patients administered 0.5 mg DHE and 100 mg trimethobenzamide at the onset of their headache and an additional O.5mg DHE if satisfactory headache relief was not obtained. Twenty patients were successfully contacted and interviewed. Forty‐five percent of the patients had at least 50% relief of headache and continued to use the protocol. Eighty‐two percent of patients who initially had at least 50% headache relief continued to use the drug, whereas none of the patients who initially had less than 10% relief continued the protocol. Sixty‐one percent of patients whose headaches precluded continuation of activity had at least 50% response to initial treatment, whereas only 29% whose headaches were less severe had this response. Initial response to therapy was predictive of continued use of the treatment protocol and patients who described more severe headache had a higher response to the initial treatment. Thus, home administration of I.M. DHE offers an additional treatment regimen for patients with migraine headache.
Migraine and Major Depression: A Longitudinal Study
Authors: Breslau Naomi , Davis Glenn C. , Schultz Lonni R. , Paterson Edward L.
Published: May 2005

SYNOPSIS

Recent epidemiologic studies have reported an association between migraine and major depression. Little is known about the mechanisms that link the two disorders, or the natural history of their co‐occurrence. We examined the association between migraine and major depression in a sample of young adults, using longitudinal data.

Method: A random sample of 1,007 young adults (21–30 years of age) members of a large HMO in Southeast Michigan was interviewed in 1989; 97% of the sample were reinter‐viewed 3.5 years later, in 1992. A structured diagnostic interview was used to elicit information on DSM‐III‐R major depression and IHS migraine in lifetime (in the 1989 interview) and during the 3.5 year follow‐up interval (in the 1992 interview). Using Cox‐proportional hazards models with time‐dependent covariates, we estimated the relative risk for major depression associated with prior migraine and the relative risk for migraine associated with prior major depression.

Results: In this sample of young adults, the incidence of migraine per 1,000 person years, based on the prospectively gathered data, was 5.0 in males and 22.0 in females. The estimated relative risk for major depression associated with prior migraine, adjusted for sex and education, was 3.2 (95% CI 2.3–4.6). The adjusted relative risk for migraine associated with prior major depression was 3.1 (95% CI 2.0–5.0).

Conclusions: The study provides the first body of evidence that the previously observed cross‐sectional association between migraine and major depression can result from bidirectional influences, with each disorder increasing the risk for first onset of the other. The explanation that major depression in persons with migraine represents a psychologic response to migraine attacks would have been more plausible had we found an influence only from migraine to depression. By diminishing the plausibility of a simple causal explanation for the migraine‐depression comorbidity, the findings favor the shared mechanisms explanation.
Peripheral and Central Trigeminovascular Activation in Cat is Blocked by the Serotonin (5HT)‐I D Receptor Agonist 311C90
Authors: M.D., Ph.D. Goadsby Peter J. , M.D., Ph.D. Edvinsson Lars
Published: May 2005

SYNOPSIS

Migraine headache involves the activation of trigeminal afterents that are predominantly found in the first or ophthalmic division of the nerve. The headache is often pounding and the connections of the trigeminal nerve, the trigeminovascular system, have therefore been implicated in the pathophysiology of migraine and studied extensively. Considerable attention has been given to the peripheral ramifications of the system as a possible locus of action for anti‐migraine drugs while little attention has been focused upon possible central sites of action. It has been shown that certain peptides can act as markers for the trigeminal system, in particular calcitonin gene‐related peptide (CGRP), and that CGRP is elevated in migraine. We have employed an animal model for activation of the trigeminovascular system to evaluate a new anti‐migraine compound, 311C90, that may have central and as well as peripheral trigeminal actions. Cats were anesthetized by halothane induction and alpha‐chloralose maintenance (60 mg/kg, intraperitoneal), intubated, paralyzed and ventilated. Biparietal craniotomies were carried out to measure cerebral blood flow using laser Doppler flowmetry (CBFLDF). The external jugular vein was cannulated and blood drawn, centrifuged and frozen until processing. Stimulation of the trigeminal ganglion resulted in a mean maximum increase in CBFLDF Of 39 ± 5% at 20/s. The 5HT1 agonist 311C90 was administered intravenously in two doses (30 and 100 μg/kg) to cover the range of doses likely to be effective clinically. At each dose the CBF LDF effect of trigeminal ganglion stimulation was inhibited. Stimulation of the trigeminal ganglion led to increases in both calcitonin gene‐related peptide and vasoactive intestinal polypeptide (VIP) levels in the external jugular vein. These were both attenuated markedly by administration of 311C90 in a dose of 100 μg/kg. No change in either neuropeptide Y or ß‐endorphin were seen during the study. These data demonstrate that trigeminal ganglion stimulation results in a brisk change in CBF LDF that can be modulated by 311C90. Furthermore the inhibition of VIP release indicates an action of the drug at the synapse in the trigeminal nucleus caudalis suggesting that this central site may have important advantages for the action of 311C90 in migraine.
Effects of Tizanidine Administration on Exteroceptive Suppression of the Temporalis Muscle in Patients with Chronic Tension‐Type Headache
Authors: Nakashima Kenji , Tumura Ririko , Wang Yuping , Shimoda Manabu , Sakuma Kenji , Takahashi Kazuro
Published: May 2005

SYNOPSIS

The aim of this study was to clarify the changes of inhibitory interneuronal activity in patients with chronic tension‐type headache with disorder of pericranial muscle after treatment, and the pharmacological mechanisms of tizanidine‐ an alpha2 adrenergic agonist. The effects of tizanidine on exteroceptive suppression (ES) of the temporalis muscle were examined in eighteen patients with chronic tension‐type headache with disorder of pericranial muscles, before and two weeks after the administration of tizanidine. The left mental nerve was stimulated, under the maximal voluntary contraction of the temporalis muscles. Two types of stimulation were used: weak stimulation with four times the sensory threshold, and strong stimulation with 10 times the sensory threshold. The rectified electromyographic activity was recorded from the right temporalis muscle. ES2 produced by four times the sensory threshold was lengthened after tizanidine administration. This fact suggests that tizanidine improves the inhibitory function in the central nervous system, and then relieves headache. However, ES produced by 10 times the sensory threshold did not change. This suggests that the effect of tizanidine may be relatively mild. The interneurones mediating ES2 may be modified by the alpha2 agonist.
Ophthalmoplegic Migraine‐Like Syndrome Due to Pituitary Apoplexy
Authors: Silvestrini Mauro , Matteis Maria , Cupini Letizia M. , Troisi Elio , Bernardi Giorgio , Floris Roberto
Published: May 2005

SYNOPSIS

A patient with a history of migraine without aura developed a complete left III nerve palsy a day after the onset of bilateral throbbing headache associated with vegetative symptoms. Magnetic resonance imaging showed a hemorrhagic pituitary adenoma as the probable cause of the symptoms, presumably by a compressive mechanism. This case suggests a further possible cause of ophthalmoplegia associated with migraine and confirms the clinical utility of magnetic resonance imaging in the differential diagnosis of ophthalmoplegic migraine and other conditions in which the symptomatology is secondary to intracranial lesions.
Migraine Treatment: The British Perspective
Authors: Wilkinson Marcia
Published: May 2005

Migraine occurs in about 10% of the population in the United States and the United Kingdom. In the United States there seem to be more complicated patients and the expectations of the patient are higher. In the United Kingdom there is a tendency to use single rather than compound formulations, and drugs such as barbiturates cannot be prescribed for migraine. In treating migraine the first and most important thing is to get the correct diagnosis which depends on the history and the absence of abnormal physical signs. Investigations do not confirm the diagnosis of migraine, they are only necessary to exclude other causes of headaches. Most sufferers from migraine have less than four attacks a month. Attack therapy is usually all that is required, and over the past 20 years efficient attack therapy has been developed. This depends mainly on sleep, an antinauseant, analgesics, ergotamine and more recently sumatriptan.
Psychopathology and Headache Syndromes in the Community
Authors: Merikangas Kathleen R. , Merikangas Kathleen R.
Published: May 2005

ABSTRACT

The present study investigated the association between psychopathology and headache in a prospective longitudinal epidemiologic study of a cohort of 19‐ and 20‐year‐olds in Zurich, Switzerland. Prevalence rates of psychopathology by headache subtype were examined both cross‐sectionally and longitudinally. Psychiatric disorders were evaluated using a direct interview administered by experienced clinicians. Personality was assessed using the Freiburg Personality Inventory and the Symptom Checklist 90. In general, subjects with migraine had more affective and anxiety disorders and exhibited elevated rates of neuroticism and somatization compared to nonmigraine subjects. When examined by headache subtype, migraineurs with aura exhibited greater rates of psychopathology and more personality abnormalities than any of the other headache subtypes or controls. In contrast to clinical wisdom, subjects with tension‐type headache did not differ from controls in rates of psychopathology or on any of the personality or symptom factors.
Postconcussion Symptoms and Cognitive Functioning in Posttraumatic Headache Patients
Authors: Gfeller Jeffrey D. , Chibnall John T. , Duckro Paul N.
Published: May 2005

SYNOPSIS

Forty‐two patients with posttraumatic headache of at least three months duration following motor vehicle accident completed the Postconcussion Syndrome Checklist which assessed their experience of 10 commonly reported cognitive, emotional, and physical symptoms. The patients also completed the Beck Depression Inventory and a brief battery of neuropsychological tests. Results indicated that postconcussion symptoms remained quite prevalent among these subjects. More pronounced postconcussion symptomatology was associated with significantly greater impairment on 6 of 13 measures of neuropsychological functioning. Neither severity of subjects' postconcussion symptoms nor neuropsychological test performance were affected by litigation status. However, depressed subjects reported more severe cognitive and emotional symptoms than did nondepressed subjects. Additional information about postconcussion symptom prevalence and a description of the relationship between self‐reported symptoms, cognitive functioning on neuropsychological tests, and depression is provided. The implications of these findings are discussed.
Chronic Daily Headache in Children and Adolescents
Authors: Holden E. Wayne , Gladstein Jack , Trulsen Marlin , Wall Barbara
Published: May 2005

SYNOPSIS

Recurrent headache is a relatively frequent problem in children and adolescents, with the majority of the research attention focused on pediatric migraine. This study assessed differences in consequences to headaches, coping with headaches, and associated disability in children and adolescents attending a headache clinic who were diagnosed with migraine, chronic daily headache, or carried both diagnoses. Results, generally indicated higher levels of impairment for patient's with chronic daily headaches. These patients were also more likely to use blaming others and wishful thinking as coping mechanisms. Gender and racial status interacted with headache diagnosis to predict parent response patterns and disability outcomes. The results provide initial support for the applicability of Martin's functional model of chronic headaches to a pediatric population.
An Epidemiological Study of Headache Among the Monks of Athos (Greece)
Authors: Mitsikostas D.D. , Thomas A. , Gatzonis S. , Ilias A. , Papageorgiou C.
Published: May 2005

SYNOPSIS

The Monks of Athos in Greece constitute a particular group with unusual sleep schedule and specific diet. In order to study the frequency of headache among them, a special questionnaire was designed. Four hundred forty‐nine monks below the age of 50 were approached, 39 of whom suffered from frequent (more than one episode per month, in the last 6 months) headaches (8.68%). The prevalence of migraine was 1.78% (0.66% with aura and 1.11% without) and of tension‐type headache 3.34% (1.33% chronic and 2% episodic). Furthermore, 1.87% of monks suffered from mixed headaches (tension‐type and migraine attacks as well). Cluster headache was not traced.
Vitamin D and Calcium in Menstrual Migraine
Authors: Thys‐Jacobs Susan
Published: May 2005

SYNOPSIS

Two premenopausal women with a history of menstrually‐related migraines and premenstrual syndrome were treated with a combination of vitamin D and elemental calcium for late luteal phase symptoms. Both cited a major reduction in their headache attacks as well as premenstrual symptomatology within 2 months of therapy. These observations suggest that vitamin D and calcium therapy should be considered in the treatment of migraine headaches.
Alleviation of Migraines with Therapeutic Vitamin D and Calcium
Authors: Thys‐Jacobs Susan
Published: May 2005

SYNOPSIS

Two postmenopausal migraineurs who developed frequent and excruciating migraine headaches (one following estrogen replacement therapy and the other following a stroke) were treated with combination vitamin D and calcium. Therapeutic replacement with vitamin D and calcium resulted in a dramatic reduction in the frequency and duration of their migraine headaches.
Denial of Hospitalization by Insurers for Inpatient Treatment of Medication Rebound Headaches
Authors: Klapper J.A.
Published: May 2005

SYNOPSIS

Inpatient treatment with intravenous dihydroergotamine has been remarkably successful in managing chronic daily headaches due to excessive use of analgesics or ergotamine tartrate. Recently we have been denied authorization in appropriate patients for this procedure by third party payers on the grounds that it was “not medically necessary,”“based on anecdotal information,” or is “an outpatient procedure.”

Three cases are described in which the insurer's decision was either contested as an issue of substandard care, or the patient elected to pay for the procedure. The outcome in two cases was dramatically favorable, at least from the patient's and the physician's point of view. The third case is currently being appealed.

Time and energy spent on combating the position of the third party payer on issues of standards of specialist care should be unnecessary. Publication of standards of care by specialists, and a requirement that these care standards must be provided by third party payers are needed in order that quality medical care can continue in this society.
Anger, Depression, and Disability: A Path Analysis of Relationships in a Sample of Chronic Posttraumatic Headache Patients
Authors: Duckro Paul N. , Chibnall John T. , Tomazic Terry J.
Published: May 2005

Anger and depression are common affective concomitants of chronic headache. Previous research suggests that the affective component of headache may contribute to the patient's perceptions of the degree to which the headache is disabling. The present study examined the relationship between anger expression, anger suppression, depression, and headache‐related disability (interference with function) in a sample of chronic posttraumatic headache patients. A path analytic model indicated a direct relationship between depression and perceived disability. Anger suppression and anger expression each had a direct influence on depression, but their effects on disability were mediated through depression. The results partially replicate a previous path analytic study of the relationships among these variables in a chronic headache sample.
MMPI and Critical Flicker Frequency (CFF) Analysis in Headache Patients With and Without Drug Abuse
Authors: Schnider Peter , Maly Joachim , Mraz Margit , Brantner‐Inthaler Sigrid , Zeiler Karl , Wessely Peter
Published: May 2005

Sixty‐three headache patients (migraine: n = 28; tension‐type headache: n = 35) who fulfilled the IHS criteria of ‘drug abuse’ were investigated by means of the Minnesota Multiphasic Personality Inventory (MMPI) and the Critical Flicker Frequency (CFF) analysis. The results were compared to those of 63 headache patients without drug abuse (matched‐pair case‐control study).

With respect to the MMPI results, no statistically significant differences between patients with drug abuse and patients without drug abuse were found. However, patients with drug abuse showed significantly decreased CFF values compared to patients without drug abuse. This was true both for patients with migraine and for patients with tension‐type headache.

Thus, CFF analysis may serve as a useful method to differentiate between headache patients with drug abuse and those without drug abuse.
Postangiography Headache
Authors: Ramadan Nabih M. , Gilkey Stephanie J. , Mitchell Mary , Sawaya Kara L. , Mitsias Panayiotis
Published: May 2005

In order to study the frequency and characteristics of post‐angiography headache, we interviewed 45 consecutive patients (mean age ± SD= 57 ± 15 years; M/F=15/30) who underwent transfemoral cerebral angiography for: ischemic cerebrovascular disease (n=33); suspected arteriovenous malformations (n=4; one confirmed); suspected cerebral aneurysm (n=5; two confirmed); and arterial dissection (n=3; one confirmed and one was a follow‐up study of a previously demonstrated dissection). Postangiography headache developed in 15 (33%) patients, 125 ± 99 min after the completion of the study. It was unilateral in nine (60%) patients, homolateral to the usual side of migraine headache in two of three migraineurs, and pulsating in six (40%). Nausea, vomiting, photophobia, and phonophobia accompanied postangiography headache in 20%, 7%, 33%, and 20% respectively. Postangiography headache fulfilled the International Headache Society criteria for migraine without aura (except for the number of attacks) in 27% of patients. Patients with and those without postangiography headache were comparable in mean age, sex, and indication for angiography. Fifty‐three percent (8/15) of patients with postangiography headache and 23% (7/30) of the non postangiography headache group reported prior recurrent headaches (P =0.047, likelihood ratio chi‐square). Postangiography headache has the characteristics of delayed arterial pain which may be related to a catheter‐induced or contrast dye‐induced release of vasoactive substances, notably nitric oxide and serotonin.
Cluster‐Like Headache in a Patient With a Trigeminal Neurinoma
Authors: Masson C. , Lehericy S. , Guillaume B. , Masson M.
Published: May 2005

We report a case of cluster‐like headache in a patient with a trigeminal neurinoma. Symptomatic cluster headache was suspected because of the absence of typical periodicity and the persistence of background headache. Magnetic resonance imaging findings were consistent with a trigeminal neurinoma.
Referred Ocular Pain Relieved by Suboccipital Injection
Authors: Ellis Brian D. , Kosmorsky Gregory S.
Published: May 2005

Pain originating from ophthalmic disease has been well documented. A series of patients presenting with eye or peri‐orbital pain attributed to cervical region dysfunction were diagnosed and treated with injections of subcutaneous lidocaine followed by triamcinolone acetonide. Twelve patients, 11 women and I man, ranging in age from 20 to 82 years had an evaluation including a complete eye examination, and laboratory tests and neuroimaging as dictated by the history to exclude structural abnormalities or systemic disease. All patients had marked focal suboccipital tenderness ipsilateral to the side of their headache and eye pain. A subcutaneous injection with 2% lidocaine followed by triamcinolone acetonide 40 mg was administered directly to the site of focal tenderness. After injection, five patients described total relief of pain, five patients described some degree of pain relief, and two patients had no relief of headache. Duration of pain relief ranged from several hours to 3 months. Patients may present with periorbital or eye pain as a result of disease affecting the cervical sensory roots with subsequent stimulation of the trigeminal apparatus. Subcutaneous injection of lidocaine and triamcinolone acetonide may be of help in the diagnosis of these patients and provide temporary relief.
Chronic Paroxysmal Hemicrania: Dissociation of the Pain and Autonomic Features
Authors: Pareja Juan A.
Published: May 2005

The case of a woman suffering from chronic paroxysmal hemicrania is presented. Most attacks were unilateral and recurred on the same side. On a few occasions, attacks were observed on the contralateral side. In addition, the patient reported some incomplete attacks on the usually symptomatic side with autonomic phenomena, but without pain. That “partial” attacks would exist has been suspected on theoretical ground. This is, however, the first time such attacks have been reported by a patient. Therefore, a double dissociation of the symptomatology seemed to exist: (1) a side shift of attacks, and (2) incomplete(“partial”) attacks. These unexpected findings occurred after two indomethacin treatment withdrawals. A possible central and “midline” origin of attacks or an indomethacin after‐effect or both are discussed as a likely explanation for such a dissociation of symptoms and signs.
Headache Characteristics in Hospitalized Patients With Lyme Disease
Authors: Scelsa Stephen N. , Lipton Richard B. , Sander Howard , Herskovitz Steven
Published: May 2005

We reviewed 49 patients consecutively hospitalized for neurologic Lyme disease to determine the frequency and characteristics of recent onset headaches in this group. All patients had positive serum Lyme ELlSAs and other neurologic illness excluded. Recent‐onset headache occurred in 26 of 49 patients (53%). Patients with headache more commonly had central nervous system involvement (54% vs 19%, P<.05) and flu‐like illness (58% vs 19%, P<.0005). Eight of 26 (31%) met criteria for meningitis or encephalitis with abnormal CSF examinations. All 8 had focal findings (6), cognitive dysfunction (1), or both (1). The remaining 18 patients had recent‐onset headaches resembling migraine (9), tension‐type headache (5), or neither (4). Antibiotic treatment resulted in complete headache resolution in 11 of 14 patients with available follow‐up data. Based on these findings, we conclude that recent‐onset headaches are common in patients hospitalized with Lyme disease. Of those with meningitis or encephalitis requiring intravenous antibiotics, all had focal neurologic findings or cognitive abnormalities, not just headaches.
SUNCT Syndrome: Trials of Drugs and Anesthetic Blockades
Authors: Pareja Juan A. , Kruszewski Piotr , Sjaastad Ottar
Published: May 2005

Nine patients with the SUNCT syndrome (Spanish and Norwegian patients) have, over many years, been given several drugs effective in the cluster headache syndrome, trigeminal neuralgia, and other headaches, as well as drugs not previously used in headache. Various cranial nerves were also anesthetized in an endeavor to ameliorate the suffering of those patients.

Although a partial effect was obtained with carbamazepine and corticosteroids in some patients, none of the drugs or anesthetic blockades had consistent, lasting, complete effect on headache paroxysms in SUNCT. The essentially negative outcome of this study aids in further characterizing SUNCT as a separate disorder, and, above all, in distinguishing it from trigeminal neuralgia and the cluster headache syndrome.
Noninvasive Investigation of Pericarotid Syndrome: Role of MR Angiography in the Diagnosis of Internal Carotid Dissection
Authors: Auer D. , Karnath H.‐O. , Nägele T. , Dichgans J.
Published: May 2005

A 52‐year‐old man presented with unilateral left periorbital and frontotemporal pain associated with a partial ipsilateral Horner's syndrome of the postganglionic type and representing a pericarotid syndrome. MRI demonstrated a perivascular subacute hematoma at the level of the cervical portion of the left internal carotid artery with a markedly reduced flow‐void signal. MR angiography confirmed the narrowed lumen of the dissected cervical internal carotid artery. There was also a right‐sided precavernous carotid aneurysm. Three months later the left‐sided pain had subsided, with complete resolution of the hematoma and incomplete restoration of the left carotid lumen seen on MR angiography. Dissection of the carotid wall may cause the oculosympathetic paralysis by producing a lesion of the superior cervical ganglion, the internal carotid nerve, or the perivascular sympathetic plexus. Whereas in pericarotid syndrome the most common cause is cervical carotid dissection, Raeder's syndrome additionally involving parasellar cranial nerves, may be caused by any paracavernous/cavernous lesion, including neoplasms and intracranial carotid aneurysms. The clinical distinction is useful to determine the appropriate diagnostic investigation, in view of the different pathoanatomical localization and different disease spectrum. As demonstrated in the present case, the combination of MRI and MR angiography is a reliable noninvasive tool to investigate the differential diagnosis of pericarotid syndrome, accurately depicting occlusive, stenotic or aneurysmal lesions of the carotid artery. We suggest that intraarterial angiography is no longer necessary.
Long‐term Results of Radiofrequency Rhizotomy in the Treatment of Cluster Headache
Authors: Taha Jamal M , Tew John M
Published: May 2005

Although the primary treatment of chronic cluster headache is medical, surgical treatment is sometimes used. The authors reviewed the charts of seven patients (ages 36 to 68 years) with chronic cluster headache to identify who responded best to percutaneous stereotactic radiofrequency rhizotomy after medical treatment failed. All patients had immediate pain relief after surgery. At follow‐up (median 5 years, range 2 to 20 years), two patients remained pain‐free 7 and 20 years later (excellent results); three patients had mild pain recurrence that was well controlled on medications (good results) 6 to 12 months after surgery; and two patients had major pain recurrence 4 days and 2 months after surgery (poor results). Six patients had relief of vasomotor symptoms. One patient had transient diplopia and keratitis without permanent sequelae. Both patients with excellent results had pre‐operative major pain around the eye; both patients with poor results had major pain around the temple, ear, and cheek; and the three patients with good results had pain equally severe in the eye, temple, and cheek. There was no association between patient age or sex, pain duration, preoperative response to lidocaine blockade, or previous surgery with pain relief. No differences occurred in pain relief between patients with dense hypalgesia and patients with analgesia. The authors conclude that (1) some patients with chronic cluster headache treated by percutaneous stereotactic radiofrequency rhizotomy achieve long‐term pain relief, and (2) surgery on the trigeminovascular system alone may not cure the condition in patients with major pain around the temple, ear, and cheek.
Cost‐effectiveness of Computed Tomography in the Evaluation of Patients With Headache
Authors: Akpek Sergin , Arac Mehmet , Atilla Serhan , Önal Baran , Yücel Cem , Isik Sedat
Published: May 2005

We report a retrospective study to determine the cost‐effectiveness of cranial computed tomogrsphy in patients with headache without neurological finding. Five hundred ninety‐two neurologically normal patients were examined between 1990 and 1993 for the complaint of headache. Examination results were reevaluated from written report and image archive systems. Results were divided into three groups. In group P0, we included patients with normal cranialcomputed tomography findings. In group P1, patients showed some minor pathologies like ischemic or atrophic changes. These findings neither explained the reason for headache nor changed the clinical or therapeutic approach. The third group (P2) was to include patients with gross intracranial pathology like space‐occupying lesions or bleeding. Five hundred forty‐six of 592 patients were in the P0group (92%), and the remaining 46 patients were in the P1group (8%). No patient was found to have serious intracranial pathology detected by computed tomography. Cost of detection of a case with significant pathology was calculated. It is our opinion that computed tomography is an unrewarding technique in the evaluation of patients with chronic headache whose neurological examinations are normal.
Preventive Effects of Hyperbaric Oxygen in Cluster Headache
Authors: Pascual Julio , Peralta Galo , Sánchez Ubaldo
Published: May 2005

The effect of a 2‐week course of hyperbaric oxygen on both the duration and frequency of cluster headache attacks was tested in four patients suffering from chronic cluster headache with no clear response to pharmacological treatments. Two patients (two courses in one case) dramatically improved while on hyperbaric oxygen treatment, this positive response remaining for 2 and 31 days posttreatment. Case 3 only improved in frequency, while the remaining patient showed no benefit. These findings suggest that daily hyperbaric oxygen treatment can be used as a transient preventive treatment for desperate cluster headache sufferers.
Magnetic Resonance Imaging in Migraine and Tension‐Type Headache
Authors: De Benedittis Giuseppe , Lorenzetti Ariberto , Sina Clara , Bernasconi Vittorio
Published: May 2005

Cerebral magnetic resonance imaging was performed on 63 patients with chronic primary headache (28 with migraine with and without aura, 35 with tension‐type headache). Fifty‐four headache‐free individuals of the same age range were used as controls. The headache sufferers showed an incidence of focal white matter abnormalities on T2‐weighted magnetic resonance imaging significantly higher than the age‐matched control group (33.3% vs 7.4%). The incidence of white matter abnormalities did not correlate with age (except for patients older than 60 years), sex, headache history, headache status, or ergotamine consumption. Migraine (with and without aura) and tension‐type headache patients had similar prevalence of white matter abnormalities (32.1% vs 34.3%). The lesions were predominantly distributed in the frontal region, independent of the side of usual aura or headache. Our findings indicate that both migraine and tension‐type headache may be associated with early pathologic changes in the brain and may share, at least in part, common pathogenic pathways.
Headache in a Nonclinical Population in Dares Salaam, Tanzania. A Community‐Based Study
Authors: Matuja W.B.P. , Mteza I.B.H. , Rwiza H.T.
Published: May 2005

Headache is a common symptom that constitutes a major health problem to all countries in the world with a variable prevalence from about 20.2% in the African population to about 80% in populations of the civilized world. Community‐based studies in African populations are still scanty, and the impact on health facility utilization and sickness absence from work is unknown.

After a simple random selection, 1540 urban workers and students of higher education completed a standardized self‐administered questionnaire on headache. A total of 815 (52%), (620 (51%) men, 195 (60%) women) admitted to having suffered a headache requiring medication or medical consultation in the last year. Of these, 366 (23.7%) had recurrent headache not attributable to systemic disease. Of the total with recurrent headache, there was a significant preponderance of women over men with sex prevalence of 28.9% and 22.4%, respectively (X 2 P = 0.0001). Combined vascular‐muscular‐type of headache exceeded all types of headache, accounting for 35.8% of cases, followed by migraine accounting for 30.8% of cases. Organic disease was rare, accounting for 8.5% of cases, and psychogenic causes of headache were even rarer at less than 1.2% of cases.Within 2 months of onset of recurrent headaches, over 32% of sufferers had utilized the health facility at their place of work or study. A significant number of cases (175) had an average of 11.3 lost work days per year in comparison to a control group of 154 persons with an average of 5.7 lost work days per year for reasons other than headache (X 2 P = 0.0005).

In summary, headache is probably rare in the African population as previously reported. However, the clinical manifestation of headache is similar to those observed in the civilized world. Whenever services are available, patients with headache will seek medical consultation. A significant number of days are lost from work due to severe headache in an urban population in Tanzania. This study underscores the need for early correct diagnosis and treatment of headache to reduce the number of work absences due to headache.
Exteroceptive Suppression of Temporalis Muscle Activity: A Blind Study of Tension‐Type Headache, Migraine, and Cervicogenic Headache
Authors: Zwart John‐Anker , Sand Trond
Published: May 2005

Exteroceptive suppression of temporalis muscle activity (ES2 duration) has been reported to be reduced in chronic tension‐type headache in previous open studies (with varying stimulus and analysis methods). We studied ES2 duration and latency in 11 patients with chronic tension‐type headache, 10 patients with cervicogenic headache, 11 migraine patients, and 9 headache‐free control subjects. The investigator was blinded as to the diagnostic category. Electrical stimuli of 0.5 ms duration and at least three times sensory threshold (median 9.6 mA) were used. ES2 was obtained in all but one (control) subject and the control ES2 duration mean was 33.5 (SD 8.5) ms (80% EMG amplitude reduction criterion). Mean ES2 duration differences were not found between the four groups. None of the headache patients had ES2 durations below the control group range. ES2 duration tended to decrease with increasing duration of headache history. Consistent asymmetries of ES2 latency and duration were not found among patients with (unilateral) cervicogenic headache. Thus, the role of ES2 in headache diagnosis still seems to be unsettled.
Relationships Between Food, Wine, and Beer‐Precipitated Migrainous Headaches
Authors: Peatfield R.C.
Published: May 2005

Five hundred seventy‐seven consecutive patients attending the Princess Margaret Migraine Clinic from 1989 to 1991 have been questioned about dietary precipitants of their headaches. Four hundred twenty‐nine patients had migraine, of which 16.5% reported that headaches could be precipitated by cheese or chocolate, and nearly always by both. Of the migraine patients, 18.4% reported sensitivity to all alcoholic drinks, while another 11.8% were sensitive to red wine but not to white wine; 28% of the migrainous patients reported that beer would precipitate headaches. There was a definite statistical association between sensitivity to cheese/chocolate and to red wine (P<0.001) and also to beer (P<0.001), but none between diet sensitivity and sensitivity to alcoholic drinks in general. None of 40 patients with tension headache (diagnosed by International Headache Society criteria) reported sensitivity to foods, and only one was sensitive to alcoholic drinks. The prevalence of sensitivity among 46 patients with some migrainous features was intermediate between the migraine and tension headache categories. It is concluded that cheese/chocolate and red wine sensitivity, in particular, have closely related mechanisms, in some way related more to migraine than to more chronic tension‐type headache, while quite separate mechanisms play a major role in sensitivity to alcoholic drinks in general.
Headaches Associated With Nasal Obstruction Due to Deviated Nasal Septum
Authors: Low W. K. , Willatt D.J.
Published: May 2005

A deviated nasal septum not only can cause a blocked nose, but may also be associated with headaches. This study evaluates the nature of these headaches, the effect of submucous resection of the nasal septum, and the factors associated with postoperative headache relief. Deviated nasal septa were corrected by submucous resection in 99 men and 17 women. Patients were studied at 4 to 48 months (mean 18 months) postoperatively. Fifty‐five of the 116 patients studied (47.4%) had preoperative recurring headaches. Thirty‐five of the 55 patients with headaches (63.6%) experienced relief (complete or partial) of their headaches at a mean follow‐up period of 18 months. Patients were more likely to be relieved of their headaches following submucous resection if the headaches were most intense over the frontal region, pressure like in nature, and if the submucous resection resulted in relief of nasal obstruction. It is possible that headaches recur in the long term, and it is postulated that central mechanisms play a role.
Raeder's Paratrigeminal Syndrome Due to Spontaneous Dissection of the Cervical and Petrous Internal Carotid Artery
Authors: Selky Aki K. , Pascuzzi Robert
Published: May 2005

The combination of pain, ipsilateral oculosympathetic defect (ptosis and miosis), and ipsilateraltrigeminal dysfunction constitutes Raeder's syndrome. We describe a patient with an acute presentation of Raeder's syndrome due to spontaneous internal carotid artery dissection. True trigeminal dysfunction due to carotid dissection is rare, and the potential mechanisms for its involvement are reviewed in this paper. Finally, we remind clinicians to consider dissection in the differential diagnosis of Raeder's syndrome because of its potential for ischemic cerebral neurologic sequelae and suggest early cranial and neck imaging in the evaluation of such patients.