bluuebunny/crossref_metadata_2025_split huggingface dataset:
Headache in the Emergency Department
Authors: Morgenstern Lewis B. , Huber John C. , Luna‐Gonzales Hortencia , Saldin Kamaldeen R. , Grotta James C. , Shaw Sandi G. , Knudson Lindsay , Frankowski Ralph F. 
Published: March 2003

Objective.—To perform an observational study of the demographics, clinical factors, and therapeutic efficacy in patients presenting to the emergency department with a chief complaint of headache.Background.—Acute headache presentations to the emergency department are a therapeutic dilemma for physicians.Methods.—Patients presenting with nontraumatic headache to the emergency department of Hermann Hospital in Houston, Texas, during a 16‐month period were prospectively ascertained by active and passive surveillance. The medical record was abstracted. Demographic and clinical information are presented with descriptive statistics. Relative benefit of individual therapies are compared with odds ratios (95% confidence intervals).Results.—Of the 38 730 patients who were prospectively screened, 455 presented with a chief complaint of headache. Seventy‐six percent were women, and the mean age was 37 years. Non‐Hispanic whites were more likely diagnosed with migraine compared with Hispanics or African Americans (P<.001). Three percent had subarachnoid hemorrhage. Neurologist follow‐up was ordered in 10%. The median time in the emergency department was 265 minutes. With the initial treatment, 44% resolved, 47% improved, and 9% had no change; none worsened. In comparison with all other therapies used, there was a trend suggesting the superiority of antiemetics (odds ratio, 2.66; 95% confidence interval, 0.81 to 8.61). Acetaminophen was less helpful (odds ratio, 0.27; 95% confidence interval, 0.10 to 0.70). When comparing specific agents to therapies which could be used at home, antiemetics led to headache resolution most often (odds ratio, 3.18; 95% confidence interval, 1.40 to 7.22); ketorolac showed a similar trend (odds ratio, 2.05; 95% confidence interval, 0.86 to 4.89).Conclusions.—Headache in the emergency department is a phenomena of young women who spend a long time waiting and receive many tests. A variety of therapies are used. Antiemetics may be especially useful for headache resolution.
Precipitating and Aggravating Factors of Migraine Versus Tension‐type Headache
Authors: Spierings Egilius L.H. , Ranke Anniek H. , Honkoop Peter C. 
Published: March 2003

Objective.—We conducted the present study to determine whether there are headache precipitating and aggravating factors that differentiate migraine from tension‐type headache and headache precipitating and aggravating factors that differentiate tension‐type headache from migraine.Methods.—We interviewed 38 patients with migraine and 17 patients with tension‐type headache (diagnosed using International Headache Society criteria) by telephone, using a questionnaire. The questionnaire inquired about the following precipitating and aggravating headache factors: (1) physical activity, (2) straining, (3) bending over, (4) stress/tension, (5) coughing/sneezing, (6) fatigue, (7) reading, (8) driving, (9) lack of sleep, (10) specific foods/drinks, (11) alcohol, (12) not eating on time, (13) smoke, (14) smell, (15) light, (16) noise, (17) menstruation, and (18) weather.Results.—The most common precipitating factors acknowledged by both groups of patients were stress/tension, not eating on time, fatigue, and lack of sleep. Weather, smell, smoke, and light were the precipitating factors that differentiated migraine from tension‐type headache. Excluding those factors that are part of the International Headache Society migraine diagnosis, the aggravating factors were straining, bending over, and smell. We found no precipitating or aggravating factors differentiating tension‐type headache from migraine.Conclusion.—Apparently there are precipitating and aggravating factors differentiating migraine from tension‐type headache but not vice versa. It is interesting that three of the migraine‐specific precipitating factors (ie, weather, smell, and smoke) involve the nose/sinus system, suggesting a greater significance of this system in headache than is generally considered.
Prevalence of Migraine in Patients With Systemic Lupus Erythematosus
Authors: Glanz Bonnie I. , Venkatesan Aradhana , Schur Peter H. , Lew Robert A. , Khoshbin Shahram 
Published: March 2003

Objective.—To determine the prevalence of migraine in patients with systemic lupus erythematosus (SLE), and to examine the relationships between headache type and other clinical, serologic, and treatment features of the disease.Background.—Headaches are common in SLE and are a significant source of patient disability. The exact prevalence of headaches in patients with SLE is unknown. The classification of headache syndromes in SLE is also unclear. Previous studies were based on small numbers of patients and the headache types and criteria to define headache types varied widely.Methods.—Four hundred fourteen patients meeting American College of Rheumatology criteria for the diagnosis of SLE were sent the University of California, San Diego Migraine Questionnaire. Patients who completed the questionnaire had their medical records reviewed for constitutional, respiratory, cardiac, vascular, skin, musculoskeletal, other neuropsychiatric, hematologic, renal, and immunologic manifestations of the disease. Recent corticosteroid, nonsteroidal anti‐inflammatory drug, antimalarial, and immunosuppressive medications were also recorded.Results.—One hundred eighty‐six patients completed the questionnaire. Sixty‐two percent of patients reported headaches: 39% met diagnostic criteria for migraine and 23% met criteria for nonmigrainous headache. Of the patients with migraine, 56% met criteria for migraine without aura and 44% met criteria for migraine with aura. There were no significant associations between headache type and other clinical, serologic, or treatment features of the disease.Conclusions.—There is a high prevalence of migraine in patients with SLE, and patients should be routinely evaluated for migraine symptoms.
A History of Migraine Is Not A Risk Factor to Develop an Ischemic Stroke in the Elderly
Authors: Mosek Amnon , Marom Ronella , Korczyn Amos D. , Bornstein Natan 
Published: March 2003

Objective.—To assess the prevalence of migraine in elderly patients hospitalized with ischemic stroke compared with vascular and nonvascular control groups.Background.—Migraine is a disease with a presumed vascular mechanism. While migraine is a common complaint of young victims of ischemic stroke, it is unclear whether a current or past history of migraine constitutes a risk factor for developing an ischemic stroke in the elderly.Methods.—We obtained current and past headache history from 100 consecutive patients hospitalized with ischemic stroke (aged 60 years or older) and compared the results with 100 patients hospitalized due to acute myocardial infarction and 100 hospitalized patients with no vascular disease.Results.—The sex and the age of the patients did not differ among the groups. The lifetime prevalence of migraine (8% of the patients with ischemic stroke, 8% of the nonvascular controls, and 15% of the patients with acute myocardial infarction) or of all types of headaches (27%, 30%, and 15%, respectively), did not differ significantly between the groups.Conclusions.—Based on the reported history, elderly migraineurs are not at increased risk to develop ischemic stroke.
Occipital Condyle Syndrome
Authors: Capobianco David J. , Brazis Paul W. , Rubino Frank A. , Dalton Jon N. 
Published: March 2003

Objective.—Review the clinical features of occipital condyle syndrome.Background.—Occipital condyle syndrome consists of unilateral occipital region pain associated with ipsilateral 12th cranial nerve paresis. It is typically due to metastasis to the skull base and is underdiagnosed.Design.—We report a retrospective case series of 11 patients (8 men, 3 women), aged 32 to 72 years.Results.—Eleven cases of occipital condyle syndrome were identified. All patients complained of severe occipital region pain. In addition, 2 patients complained of ipsilateral ear or mastoid pain, 2 noted associated vertex pain, and 2 had frontal region pain. Six of the 11 cases involved the right side. In all patients, the occipital pain was ipsilateral to the 12th nerve paresis. All patients were mildly dysarthric, and 3 had dysphagia. In 7 of the 11 patients, occipital region pain preceded the hypoglossal paresis by several days to 10 weeks. On examination, tenderness to palpation of the occipital region was noted in all patients. All 11 patients had unilateral hypoglossal paresis. Skull films were abnormal in 2 of 5 patients for whom they were obtained, and tomograms were abnormal in 1 of 2 patients. High‐quality computed tomography, bone scanning, and magnetic resonance imaging were abnormal in all cases in which they were performed. Nine patients had a known primary malignancy. The most common malignancies were breast cancer in women (2 of 3) and prostate cancer in men (4 of 8). In 2 patients, occipital condyle syndrome was the initial manifestation of a metastatic lesion. Radiation therapy was the treatment of choice for the occipital region pain.Conclusion.—Occipital condyle syndrome is a rare, but stereotypic syndrome. Early detection has important therapeutic implications. Evaluation of the craniovertebral junction with special attention to the occipital condyles should be a routine part of all brain and cervical spine radiologic examinations, and the possibility of occipital condyle syndrome, particularly when patients have persistent occipital pain and a history of cancer, should be considered.
Potential Validity of Conducting Research on Headache in Internet Populations
Authors: Lenert Leslie A. , Looman Theodora , Agoncillo Teodora , Nguyen Mihn , Sturley Ann , Jackson Christy M. 
Published: March 2003

Objective.—While it is technically feasible to conduct migraine research on the Internet, can one be sure that the subjects who participate actually have the disorder? We examined this issue in 109 sequential subjects in an Internet study of migraineurs' symptoms.Background.—The increasing use of the Internet by the US population provides an opportunity for using this medium in clinical research, but, to be useful, the results of such research must be valid and generalizable.Methods.—Using postings to Internet newsgroups of migraineurs, we recruited subjects to a migraine research site. We examined reported symptoms by comparing them with the International Headache Society's criteria for diagnosis of migraine and by subjective review by a neurologist. We also attempted to contact the subject's primary care physicians to confirm their diagnosis.Results.—We found considerable evidence for the validity of the participants' self‐reported diagnoses. Most subjects with professed migraine reported quality of pain (97%) and associated symptoms (92%) consistent with that diagnosis, and review of their symptoms and questionnaire responses by the neurologist suggested that almost all subjects (97%) had migraine. Personal physicians confirmed a diagnosis of migraine in 90% of con‐ senting subjects (n=49).Conclusions.—The validity of self‐reported diagnosis of migraine does not appear to be an obstacle to conducting research in subject populations on the Internet.
Children's Ibuprofen Suspension for the Acute Treatment of Pediatric Migraine
Authors: Lewis Donald W. , Kellstein David , Dahl Georg , Burke Bonnie , Frank L. M. , Toor S. , Northam R. S. , White L. W. , Lawson L. 
Published: March 2003

Objective.—To compare the efficacy of a single over‐the‐counter dose (7.5 mg/kg, p.o.) of children's ibuprofen suspension vs. placebo for the acute treatment of pediatric migraine.Background.—Migraine occurs in 4% of young children. There is a paucity of controlled clinical research in the treatment of childhood migraine and there are currently no approved drugs in the USA for treatment of migraine in children 12 years of age. The purpose of this study is to assess the efficacy and tolerability of a single OTC dose of ibuprofen suspension for the acute treatment of childhood migraine.Methods.—Prospective, double‐blind, placebo‐controlled, parallel group, randomized study of children 6‐12 yrs with migraine (I.H.S.‐R1997) treating 1 attack with a 7.5 mg/kg liq. ibuprofen vs matching placebo. Efficacy measures: (1) Headache severity based upon a 4 pt scale (severe, mod., mild, no headache) at 30, 60, 90, 120, 180 and 240 minutes post dose, and (2) nausea, vomiting, and photo/phonophobia at 120 min. The 1° endpoint was cumulative % of responders (severe or mod. headache reduced to mild or none) by 120 minutes. Secondary endpoints were headache recurrence within 4‐24 hours and need for rescue medicines within 4 hours.Results.—138 enrolled; 84 treated/completed diary. 45 active agent, 39 placebo. The 2 groups were comparable (active: placebo) ‐ Ages: 9: 9.1, gender boy/girl ‐ 1.25: 1.6, and diagnosis: migraine w/o aura ‐ 86%: 79%. Concomitant use of prophylactic Rx: 24%: 10% (Table 3).

Endpoint
Ibuprofen (N=45)
Placebo (N=39)
P‐value

Cum. % responders, 2 hr (1° endpoint)
76%
53%
0.006

2 pt. improvement in severity, 2 hr
27 (62%)
11 (28%)
0.004

Median pain score at 2 hr
2
3
<0.02

Headache recurrence (within 4‐24 hr)
8 (18%)
14 (36%)
0.06

Need for rescue medication
1 (2%)
15 (38%)
<0.001

Nausea was eliminated in 60% of the ibuprofen treated patients and 39% of the placebo group (p<0.001). Vomiting, photophobia and phonophobia had marginal, but not statistically significant, decreases at 2 hours. A striking gender difference was noted (Table 4):

Endpoint
Ibuprofen
Placebo
P‐value

Cum. % responders
76%
53%
0.006

BOYS
84%
43.4
<0.0006

GIRLS
65%
66.7
0.8

Headache recurrence
5
13
<0.005

BOYS
0
8
<0.001

GIRLS
5
5
NS

No AE's were reported.Conclusion.—Children's ibuprofen suspension at an OTC dose of 7.5 mg/kg is an effective and well‐tolerated agent for pain relief in the acute treatment of childhood migraine, particularly in boys. There is a striking difference in gender response rates and placebo responder rates between girls and boys. The boys responded at a statistically significant rate, and girls failed to do so because of a very high placebo responder rate. Multi‐center trials are recommended.
Further Evaluation of Rizatriptan in Menstrual Migraine: Retrospective Analysis of Long‐term Data
Authors: Silberstein Stephen D. , Massiou Helene , McCarroll Kathleen A. , Lines Christopher R. 
Published: March 2003

Objective.—To determine the long‐term efficacy of oral rizatriptan 10‐mg wafers in the treatment of menstrual migraine attacks. Methods.—Data from an extension study where patients with migraine used rizatriptan 10 mg to treat moderate or severe migraine attacks occurring over periods of up to 6 months were included in a retrospective analysis. Patients used a diary card to record details of each migraine attack and onset of menstruation. Attacks in women were classified as menstrual or nonmenstrual according to 3 time windows relative to onset of menstruation (day 0): −3 to +3 days (7‐day window), −2 to + 2 days (5‐day window), and 0 to +1 days (2‐day window). The analysis looked at the efficacy of rizatriptan 10 mg by menstrual category of attack for each definition on three measures: pain relief at 2 hours (reduction of pain to mild or none), pain free at 2 hours, 24‐hours sustained pain free (pain free at 2 hours with no headache recurrence and no use of additional medications from 2 to 24 hours). Results.—Ninety‐five women used rizatriptan 10 mg to treat a total of 1,839 attacks. The percentage of menstrual attacks was 30% for the –3 to +3 days definition, 23% for the −2 to +2 days definition, and 11% for the 0 to +1 days definition. Rizatriptan 10 mg was equally effective in menstrual and nonmenstrual migraine attacks regardless of the definition used. For example, using the −3 to +3 days definition, 78% of menstrual migraine attacks were relieved at 2 hours after dosing compared with 78% of nonmenstrual attacks. Pain relief rates for the other definitions were as follows: −2 to +2 days, menstrual  =  78%, nonmenstrual  =  78%; 0 to +1 days, menstrual  =  79%, and nonmenstrual  =  78%. No differences between menstrual and nonmenstrual attacks were found for the 2‐hour pain free and 24‐hour sustained pain free measures for any of the three definitions. Conclusion.—Rizatriptan 10‐mg wafers were equally effective in the treatment of menstrual and nonmenstrual migraine attacks occurring over 6 months, regardless of the precise definition of menstrual association used and even when the outcome criteria were very stringent. These data provide further evidence that triptans are effective treatments for menstrual migraine.
Temporal Epileptogenesis: Localizing Value of Scalp and Subdural Interictal and Ictal EEG Data
Authors: Blume Warren T. , Holloway Giannina M. , Wiebe Samuel 
Published: March 2003

Summary:  Purpose: To determine the value of scalp epileptiform EEG data and subdural interictal spikes in localizing temporal epileptogenesis among patients requiring invasive recordings. For this delineation, we related such factors to site of subdural seizure origin in 27 consecutive patients.Methods: Patients with temporal lobe epilepsy whose noninvasive lateralizing data were inconclusive and therefore required subdural electroencephalography were studied. All patients had (a) 24‐h scalp telemetered EEGs, (b) adequate bitemporal subdural placements with an inferomesial line extending from a posterior burr hole anteriorly to <2.5 cm from anterior uncus and a lateral line reaching within 2.5 cm of the temporal tip, and (c) ≥2 subdurally recorded seizures.Results: Three hundred one (96%) of 314 subdurally recorded clinical seizures involving all 27 patients arose from a discrete focus; 266 (85%) arose from mesial temporal regions, which was the origin of the majority of seizures in 24 (89%) patients. The majority of subdural seizures arose ipsilateral to the majority of scalp EEG spikes in 22 (81%) of 27, and most subdural seizures of 15 (75%) of 20 arose ipsilateral to scalp seizures. Lateralization of interictal subdural spikes correlated with that of subdural seizures in 74–92% of patients, depending on the method of spike compilation; for example, most subdural seizures arose from the same lobe of most consistent principal temporal spikes in 92% of patients. These indices of epileptogenesis also appeared more commonly on the side of effective (≥90% improvement) temporal lobectomy than contralaterally in the following proportions: most consistent principal subdural spikes, 86% of patients ipsilateral vs. 9% contralateral; scalp‐recorded clinical seizures, 55% vs. 18%; scalp EEG spikes, 45% vs. 9%.Conclusions: Even among patients whose scalp data are sufficiently complex to require invasive recording for clarification, lateralization of temporal scalp interictal and ictal epileptiform activity and subdural interictal spikes should be included when assessing the side of temporal epileptogenesis.
Lamotrigine Therapy of Epilepsy in Tuberous Sclerosis
Authors: Franz David Neal , Tudor Cynthia , Leonard Jennifer , Egelhoff John C. , Byars Anna , Valerius Kristin , Sethuraman Gopalan 
Published: March 2003

Summary:  Purpose: Lamotrigine (LTG), a newer antiepileptic drug (AED), has activity against both partial‐onset and generalized seizures. Its reported benefits for behavior, and its effectiveness in Lennox–Gastaut syndrome and other forms of refractory epilepsy, make it a logical choice for treatment of epilepsy in tuberous sclerosis complex (TSC). We present our experience with LTG therapy of epilepsy in 57 patients with TSC.Methods: Patients fulfilled the diagnostic criteria for clinically definite TSC. LTG was initiated and increased until improvement in seizure frequency was noted, intolerable side effects occurred, or maximal doses were reached. Seizure frequency and behavioral changes were recorded during LTG therapy and compared with those prior to the introduction of LTG.Results: Twenty‐four (42%) were seizure free, and 21 (37%) had a >50% reduction in seizure frequency. Eighteen (32%) had subjectively improved behavior and/or alertness with daily activities. Thirty‐eight (67%) had no change in this regard, whereas one (2%) became worse. Responders were more likely to not have a history of infantile spasms, and to have experienced only partial seizures (p < 0.05). Otherwise no phenotypic correlations with response were apparent.Conclusions: Among patients with TSC and epilepsy, LTG was effective and well tolerated, including as initial monotherapy. Improved alertness and behavior were apparent in many patients. The incidence of side effects is similar to that reported for other pediatric populations with symptomatic partial epilepsy. The usefulness of LTG in TSC may relate to an underlying defect of glutamatergic neurotransmission in partial epilepsy.
Hormone Profiles in Young Adults with Epilepsy Treated with Sodium Valproate or Lamotrigine Monotherapy
Authors: Stephen Linda J. , Kwan Patrick , Shapiro David , Dominiczak Marek , Brodie Martin J. 
Published: March 2003

Summary:  Purpose: Treatment with sodium valproate (VPA) may be associated with polycystic ovarian syndrome (PCOS) in some women with epilepsy. By comparing hormone profiles in young adults taking VPA or lamotrigine (LTG) as monotherapy, this study aimed to explore whether a pharmacologic effect of VPA could be responsible for this observation.Methods: Hormone profiles in men and women taking VPA (n = 40) or LTG (n = 36) monotherapy for epilepsy were compared. None of the women were receiving hormonal contraception or replacement. Patients gave details of seizure type and frequency, menstrual cycle, and medical and drug history. Body mass index was calculated, and fasting insulin, glucose, cholesterol, triglycerides (TG), high‐ and low‐density lipoproteins, testosterone, dihydroepiandosterone (DHEA), androstenedione, sex hormone–binding globulin (SHBG), free androgen index (FAI), luteinising hormone (LH), follicle‐stimulating hormone (FSH), and antiepileptic drug (AED) concentrations were measured.Results: There were no differences between treatment groups for both sexes in age and seizure control. Only four obese VPA‐treated women were hyperinsulinaemic (p = 0.05); three with abnormal menstrual cycles; one with raised testosterone. Testosterone (p = 0.02), FAI (p = 0.03), and TG (p = 0.02) levels were higher, however, in women taking the drug. Obese patients of both sexes (p = 0.01) and VPA‐treated men (p = 0.03) had higher insulin concentrations.Conclusions: VPA therapy may be associated with subclinical elevation in fasting insulin levels. Testosterone and TG levels were higher in VPA‐treated women compared with the levels in those taking LTG. However, only a minority of obese females exhibited biochemical characteristics suggestive of PCOS. Biochemical screening may allow women at risk of developing PCOS to avoid VPA.