bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extratrigeminal Episodic Paroxysmal Hemicrania. Further Clinical Evidence of Functionally Relevant Brain Stem Connections
Authors: Dodick David W. 
Published: March 2003

A woman, aged 59 years, developed a constant, left, occipital headache associated with episodes of discrete exacerbations occurring three to five times daily for 3 days, each lasting 15 to 20 minutes, and associated with left ptosis, conjunctival injection, and redness of the left ear. Pain‐free remissions, which usually lasted 2 weeks, ceased after a mild neck injury, but the headaches responded promptly to indomethacin.This case, illustrating a transition from an occipital episodic to chronic paroxysmal hemicrania, is discussed as a variation of the trigeminal‐autonomic cephalalgias.
Management of Chronic Daily Headache Utilizing a Uniform Treatment Pathway
Authors: Rothrock John F. 
Published: March 2003

Objective.—To determine if the use of a uniform treatment pathway might be effective in treating patients with primary chronic daily headache.Methods.—Thirty‐three consecutive patients with primary chronic daily headache were managed according to a treatment pathway which involved sequential administration of divalproex sodium, amitriptyline, amitriptyline plus phenelzine, or methadone.Results.—Twenty‐two patients (67%) reported a 50% or greater reduction in headache days per month following initiation of treatment. Most positive treatment responses (17 [77%] of 22) were attributed to divalproex sodium.Conclusion.—Implementation of a uniform treatment pathway may result in significant clinical improvement in a sizable proportion of patients with chronic daily headache.
Patients With Acenocoumarol Treatment and Migraine
Authors: Morales‐Asín F. , Iñiguez C. , Cornudella R. , Mauri J.‐A. , Espada F. , Mostacero E. 
Published: March 2003

Objective.– The aim of our study was to investigate the possible effect of acenocoumarol, which is indicated for nonneurological disease, on headache.Background.– It has been suggested that anticoagulation can have beneficial effects in the control of migraine attacks.Methods.– Four hundred randomized patients on oral anticoagulant therapy were asked to complete a questionnaire regarding their headaches.Results.– Headache was present before or during oral anticoagulation in 166 (66 migraineurs and 100 nonmigraineurs) of 326 respondents. The major finding was that oral anticoagulation produced improvement in 63% of patients with migraine versus 38% of patients with nonmigranous headache. Improvement was related to the severity of migraine but not to age.Conclusions.– Oral anticoagulant therapy can improve migraine. The way in which anticoagulant therapy acts on migraine is unknown, but potential mechanisms include its effect on platelet aggregability and pharmacological effects such as suppression of enhanced nitric oxide.
Behavioral Self‐management in an Inpatient Headache Treatment Unit: Increasing Adherence and Relationship to Changes in Affective Distress
Authors: Hoodin F. , Brines B.J. , Lake A.E. , Wilson J. , Saper J.R. 
Published: March 2003

Objective.–To evaluate prospectively the contribution of a psychological self‐management program to the amelioration of headache‐related distress of patients with intractable migraine treated in a comprehensive, multidisciplinary, inpatient program.Background.–Previous research has shown the effectiveness of this overall inpatient program but did not examine the relationships between the use of relaxation and other headache‐related behavioral factors.Methods.–Data from 221 admissions to a Commission on Accreditation of Rehabilitation Facilities‐accredited, nationally recognized, inpatient treatment unit were analyzed for the current study. On admission and on discharge (average length of stay, 12.9 days), subjects completed a 7‐day retrospective, self‐report questionnaire assessing health behavior compliance and emotional factors. The intervention consisted of intensive medical therapy in addition to cognitive‐behavioral treatment delivered in a group setting.Results.–Adherence increased significantly for relaxation practice and life‐style modifications of diet, exercise, and sleep regulation for headache prevention (P<.00001). Beck Depression Inventory scores decreased significantly (P<.00001), and a greater decrease in depression by the end of the program was reported by subjects who practiced relaxation most compared with those who practiced relaxation least.Conclusions.–Low baseline adherence rates for health behavior increased significantly during the final week of inpatient treatment. Behavioral self‐management variables, not headache reduction, were significantly associated with patients' reduction in affective distress.
Blood Nitrite Levels in Patients With Migraine During Headache‐Free Period
Authors: Shukla R. , Barthwal M.K. , Srivastava N. , Nag D. , Seth P.K. , Srimal R.C. , Dikshit M. 
Published: March 2003

Objective.—To investigate blood nitrite levels after migraine attacks and to assess whether or not the change in nitric oxide levels observed during acute migraine persist after the attacks.Background.—Involvement of nitric oxide has been suggested in the initiation of acute migraine. Recent studies have shown alteration in the platelet response and platelet nitrite levels during migraine attacks.Methods.—Patients with migraine with aura and patients without aura were included in the study. The study was conducted on 50 patients with migraine and 90 healthy controls. Blood from the patients was collected at least 7 ± 0.8 days after the last attack of migraine. Nitrite levels in the polymorphonuclear leukocytes, platelets, and plasma were estimated. Platelet aggregation response in some of these patients was also studied.Results.—No significant change in the polymorphonuclear leukocyte, platelet, and plasma nitrite levels in patients with migraine compared to controls was observed. Patients with migraine with aura had significantly lower polymorphonuclear leukocyte nitrite levels compared to those without aura (P<.05). In addition, no significant difference in the adenosine diphosphate–induced platelet aggregation was observed in the migraineurs compared to the healthy controls.Conclusions.—Results obtained indicate that the platelet aggregation response and the blood nitrite levels were not altered significantly after an attack in the patients with migraine.
Blood Flow Velocity and Pulsatility Index Differences in Patients With Unilateral Migraine
Authors: Chernyshev Oleg Y. , Vein Aleksandr M. , Mathew Ninan T. , Kolosova Olga A. , Kailasam Jayasree , Frolov Anna , Danilov Andrei B. , Meadors Lori , Gentry Paula , Alexandrov Andrei V. 
Published: March 2003

Objective.—To evaluate blood flow velocity and pulsatility in unilateral migraine without aura during the headache‐free period using transcranial Doppler (TCD) sonography.Methods.—Patients with unilateral headache were recruited during the headache‐free period. Maximum mean flow velocity (MFV) and pulsatility index (PI) were measured in the middle cerebral (MCA) and basilar arteries. Controls were headache‐free individuals without cerebrovascular disease.Results.—Twenty‐five patients with right‐sided migraine, 25 patients with left‐sided migraine, and 19 controls were studied. The MCA PI was higher on the right headache side versus the left headache side (0.97 ± 0.2 versus 0.86 ± 0.1 cm/s, P = .02) and versus controls (0.9 ± 0.2 cm/s, NS). The basilar artery MFV was higher in patients with right‐sided headache versus left‐sided headache (39.5 ± 5.6 versus 34.7 ± 8.2 cm/s, P = .02) and versus controls (38.2 ± 8 cm/s, NS). No decrease in MFV with age was observed in patients with migraine.Conclusions.—Middle cerebral artery flow pulsatility and basilar artery velocity are higher in patients with right‐sided migraine compared with left‐sided migraineurs, during the headache‐free period. Although these parameters were similar to controls, the differences found during the headache‐free period in migraineurs may indicate vascular involvement predisposing to the unilateral headache recurrence.
Coping Strategies in Episodic and Chronic Tension‐type Headache
Authors: Rollnik Jens D. , Karst Matthias , Fink Matthias , Dengler Reinhard 
Published: March 2003

Objective.—To study the importance of coping with illness strategies in tension‐type headache (TTH).Background.—The pathophysiology of TTH is complex, and coping with illness strategies might contribute to the transformation to a chronic form.Methods.—We examined 89 subjects (mean age, 45.6 ± 14.8 years; range, 18 to 72 years) with episodic (n = 37) and chronic (n = 52) TTH. Patients were required to fill in a Freiburg Questionnaire of Coping with Illness (FQCI), a von Zerssen Depression Scale, quality‐of‐life questionnaires, and a headache home diary (over 4 weeks). In addition, pressure pain thresholds (temporal muscles) and total tenderness scores were obtained.Results.—Patients with chronic TTH exhibited poorer quality‐of‐life measures, slightly more depressive symptoms, and significantly stronger avoidance behavior and endurance strategies on FQCI scales F4 and F5 (P<.05). There was no difference between episodic and chronic TTH with respect to measures of muscle tenderness or pain thresholds.Conclusions.—We conclude that disadvantageous coping with illness strategies might contribute to a transformation to chronic TTH.
Hemiplegic Migraine During Pregnancy: Unusual Magnetic Resonance Appearance With SPECT Scan Correlation
Authors: Barbour Peter J. , Castaldo John E. , Shoemaker Elliot I. 
Published: March 2003

Objective.—This article discusses the pathophysiology and implications for treatment of hemiplegic migraine within a case study presentation.Background.—We evaluated a 31‐year‐old white woman for hemiplegia in her 36th week of pregnancy. She initially presented with severe headache, dysarthria, lethargy, and left‐sided numbness and weakness. Hemiplegic migraine remains a diagnosis made by exclusion; neurologic examination of these patients is localizing, but nonspecific.Design.—Magnetic resonance imaging and single photon emission computed tomography scanning were performed on this patient during an exacerbation of headache associated with dense hemiplegia.Results.—Magnetic resonance imaging showed a superficial cerebral hemispheric signal abnormality with enhancement. Single photon emission computed tomography scanning confirmed hyperperfusion of that hemisphere.Conclusions.—We believe the imaging evidence in our patient suggests that hemiplegia was caused and sustained by hyperperfusion. This case lends supportive evidence to a primarily vasodilatory mechanism and hyperperfusion as an etiology of the paralysis in such headaches and perhaps migraine with aura.
Headache Syndromes Amongst Schoolchildren in Riyadh, Saudi Arabia
Authors: Al Jumah M. , Awada A. , Al Azzam S. 
Published: March 2003

We evaluated 1400 randomly selected Saudi children in grades 1 through 9 to determine the prevalence of migraine and tension‐type headache.Of the 1400 distributed questionnaires, 1181 (84.3%) were completed properly and so served as the basis for analysis. There were 573 boys (48.5%) and 608 girls (51.5%). Ages ranged from 6 to 18 years. Five hundred eighty‐eight children (49.8%; 272 boys and 316 girls) had recurrent headache episodes not related to febrile illness in the year preceding the survey. Eighty‐four children (7.1%; 37 boys and 47 girls) had recurrent episodes of migraine, and 504 (42.7%; 232 boys and 272 girls) had recurrent episodes of nonmigraine headache. For both boys and girls, the age‐specific prevalence rate for nonmigraine headache rose steadily from around 15% at aged 6 to 7 years to nearly 60% after aged 15. For migraine, there was a sharp increase in the prevalence rate (from around 2% to around 9%) at aged 10 to 11, also in both boys and girls. Age‐adjusted prevalence for migraine between aged 6 and 15 was 6.2%. Due to the relatively poor sensitivity of some of the IHS criteria in children, this figure may underestimate the true magnitude of migraine in the population studied.
Effects of the Headache State on Objective and Perceived Performance
Authors: Hovanitz Christine A. , Christianson Amy L. , Stokes‐Crowe Linda , Scheff Jackie 
Published: March 2003

The reduced ability to perform tasks is generally reported by those who experience headache. However, in an experimental study, participants reporting onset of headache chose more ambitious tasks than participants remaining headache free. The purpose of this study was to reevaluate the objective ambition of subjects with headache onset, and to determine if perceptions of expended effort and performance accuracy contributed to this seemingly maladaptive behavior. These effects were evaluated while controlling for headache proneness.A nonclinical sample was used. Measures of ambition, performance accuracy, perceived effort, and perceived accuracy for a headache‐developing group (n = 25) and a sex‐matched, headache‐free group (n = 25) were compared during a series of mental arithmetic problems.Ambition among participants after headache onset was significantly higher than for the control group. There was little indication that inaccurate perceptions of effort or accuracy contributed to the observed heightened ambition. However, perceived accuracy was poorer for the headache‐developing group after onset of a headache state. Headache proneness did not eliminate the significance of any relationship between objective or subjective performance and headache state.
Headache Associated with Epileptic Seizures: Epidemiology and Clinical Characteristics
Authors: Förderreuther Stefanie , Henkel Anja , Noachtar Soheyl , Straube Andreas 
Published: March 2003

Objective.—To investigate the incidence and characteristics of seizure‐associated headaches and the modalities of treatment. Background.—Systematic investigations of the characteristics of seizure‐associated headaches are rare. Although data in the literature on the incidence of postictal headaches range between 37% and 51%, experiences with their treatment are limited and pathophysiological concepts do not exist. Methods.—One hundred ten epileptic outpatients from an epilepsy referral center participated in a semi‐standardized interview about headaches associated with epileptic seizures. The characteristics of these patients and of 15 additionally recruited patients with known postictal headaches were analyzed. Results.—The incidence of seizure‐associated headaches was 43% (n = 47). Forty‐three patients had exclusively postictal headaches. One patient had exclusively preictal headaches. Three patients had both pre‐ and postictal headaches. The duration of postictal headaches was longer than 4 hours in 62.5% of the patients. In the majority of patients, postictal headaches occurred in more than 50% of the seizures. Postictal headaches were treated by self‐medication in 19 patients (30%). No patient treated headaches according to a medical prescription. In 11 patients, postictal migraine was untreated. Postictal headaches were associated with focal seizures in 23 patients and/or with generalized seizures in 54 patients. According to the headache classification of the International Headache Society, headaches were classified as migraine‐type in 34% of patients and as tension‐type headache in 34% of patients. Headaches could not be classified in 21% of patients. Patients with and without postictal headaches did not differ as to localization of the epileptogenic zone or to the number of prescribed antiepileptic drugs. There was no relationship between the localization of the epileptogenic focus, localization of the headache, or the headache classification. Conclusions.—Headaches associated with partial and generalized seizures are frequent and undertreated. Treatment should consider both the headache syndrome and the general guidelines for treating primary headaches. The pathophysiology of seizure‐associated headaches cannot be explained by the epileptic syndrome.
Efficacy of Topiramate in Migraine Prophylaxis: A Retrospective Chart Analysis
Authors: Von Seggern Randal L. , Mannix Lisa K. , Adelman James U. 
Published: March 2003

Objective.— Topiramate, a broad‐spectrum anticonvulsant with multiple mechanisms of action, may be effective in preventing migraine headaches. We report the results of a retrospective chart review of patients treated with topiramate for prophylaxis of migraine.Methods.—Patients with a diagnosis of migraine who had at least one follow‐up visit after 4 weeks on topiramate were eligible; 69 patients (56 women and 13 men) aged 18 to 68 years met these criteria. Charts were reviewed for frequency of mild or moderate/severe headaches at the start of topiramate (baseline) and at all subsequent visits up to 24 weeks.Results.—The 28‐day frequency of moderate/severe migraines declined significantly from baseline to end of treatment (10.6 ± 8.4 to 7.4 ± 7.7, respectively; P = 0.0004), whereas that of mild headaches did not demonstrate a significant change (from 11.8 ± 8.9 to 11.0 ± 10.0). Among the 38 patients who had not responded previously to 9 preventive medications, the monthly frequency of moderate/severe (but not mild) headaches decreased significantly from baseline to end of treatment. Patients who previously had not responded to <9 prior medications experienced significant declines in both mild and moderate/severe headaches. The most common adverse events were paresthesias, drowsiness, diarrhea, decreased appetite, and weight loss. Twenty‐seven patients discontinued topiramate therapy, 20 as a result of adverse events and 7 due to lack of response.Conclusion.—Topiramate may be effective in reducing the frequency of both mild and moderate/severe migraine headaches. In particular, topiramate may offer relief to patients with moderate/severe migraines who do not respond to other treatments.
Effectiveness of Multidisciplinary Intervention in the Treatment of Migraine: A Randomized Clinical Trial
Authors: Lemstra Mark , Stewart Brad , Olszynski W. P. 
Published: March 2003

Objective.—To test the effectiveness of a multidisciplinary management program for migraine treatment in a group, low cost, nonclinical setting. Design.—A prospective, randomized, clinical trial. Background.—Although numerous studies document the efficacy of pharmacological migraine management, it is unclear whether an effective long‐term management approach exists. Methods.—Eighty men and women were randomly assigned to 1 of 2 groups. The intervention group consisted of a neurologist and physical therapist intake and discharge, 18 group‐supervised exercise therapy sessions, 2 group stress management and relaxation therapy lectures, 1 group dietary lecture, and 2 massage therapy sessions. The control group consisted of standard care with the patient's family physician. Outcome measures included self‐perceived pain intensity, frequency, and duration; functional status; quality of life; health status; depression; prescription and nonprescription medication use; and work status. Outcomes were measured at the end of the 6‐week intervention and at a 3‐month follow‐up. Results.—Forty‐one of 44 patients from the intervention group and all 36 patients from the control group completed the study. There were no statistically significant differences between the 2 groups before intervention. Intention to treat analysis revealed that the intervention group experienced statistically significant changes in self‐perceived pain frequency (P  =  .000), pain intensity (P  =  .001), pain duration (P  =  .000), functional status (P  =  .000), quality of life (P  =  .000), health status (P  =  .000), pain related disability (P  =  .000), and depression (P  =  .000); these differences retained their significance at the 3‐month follow‐up. There were no statistically significant changes in medication use or work status. Conclusions.—Positive health related outcomes in migraine can be obtained with a low cost, group, multidisciplinary intervention in a community based nonclinical setting.
Triptans Versus Analgesics
Authors: Robbins Lawrence 
Published: March 2003

Objective.—To retrospectively assess patient preferences between triptans and analgesics in treating migraine headache. Methods.—The study assessed patient preferences for triptans versus commonly used migraine analgesic preparations. Over a 3‐month period, 663 patients with migraine between the ages of 17 and 62 years completed an office‐based survey. Results.—Most patients preferred a treatment regimen that included either a triptan alone (52%) or a triptan with an analgesic medication within 1 hour (18%). Overall, 70% of patients who had been given triptans in the past chose to continue to use them, either alone or with an analgesic. Patients who preferred analgesics alone comprised 21% of the total. Nine percent preferred not to take either triptans or analgesic medications. Among the patients who preferred triptans, 62% stated that increased efficacy was the primary reason for their preference. Thirty percent cited both efficacy and decreased adverse events. The remaining 8% believed that decreased adverse events was the basis for their preference. Conclusions.—Despite cost and other limitations of triptans, most patients prefer them over nontriptan medications. Enhanced efficacy was the main reason for choosing triptans over analgesics.
Analysis of the Patients Attending a Specialist UK Headache Clinic over a 3‐Year Period
Authors: Dowson Andrew J. 
Published: March 2003

Objective.—This study analyzed the profile of patients who attended a specialist UK headache clinic over a 3‐year period.Methods.—An audit was conducted of the clinical records of patients attending the specialist headache clinic at King's College, London, between January 1997 and January 2000. Data were collected for diagnoses given, current medications taken, medications prescribed and recommended, and investigations conducted. Results were calculated as numbers and proportions of patients for the 3‐year period and for the 3 separate 12‐month periods.Results.—A total of 458 patients were included in the audit. Most patients were diagnosed as having chronic daily headache (CDH, 60%) or migraine (33%). Prior to the clinic visit, most patients with CDH and migraine treated their headaches with analgesics, and there was little use of prophylactic medication. In the clinic, 74% of patients with CDH and 85% of migraineurs were prescribed prophylactic medication, and 81% of migraineurs were given triptans for acute treatment. Diagnostic testing was performed in 12% of the patients, and all results were normal or negative.Conclusions.—CDH and migraine were the most common headache types encountered in this UK secondary‐care clinic. Review of treatment patterns used prior to the initial clinic evaluation suggests that management of CDH and migraine in UK primary care is suboptimal, and educational initiatives are needed to improve headache management.