bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic headache: new advances in treatment strategies.
Authors: Lake AE , Saper JR 
Published: January 2004

Neurology. 2002;59(5 suppl 2):S8‐S13.Chronic daily headache (CDH) affects approximately 4 to 5% of the population and encompasses a number of different diagnoses, including transformed migraine, chronic tension‐type headache (TTH), new‐onset daily persistent headache, and hemicrania continua. Although the pathophysiology of CDH is still poorly understood, some research has suggested that each of the various subtypes of CDH may have a different pathogenesis. The goals of prophylactic therapy are to reduce the frequency, severity, and duration of headache attacks; to improve responsiveness to treatment of acute attacks; to improve function; and to reduce disability. However, opinions differ as to exactly which are the best and most appropriate outcome measures for prophylaxis. Several pharmacologic treatment options exist, including antidepressants, anticonvulsants, muscle relaxants, serotonin agonists, ergots, serotonin antagonists, antianxiety agents, and other miscellaneous drugs. Tizanidine, an alpha(2)‐adrenergic agonist, has recently emerged as a promising prophylactic adjunct for CDH, which implicates a central alpha(2)‐adrenergic mechanism as an important factor in the pathophysiology of CDH. Comment: Drs. Lake and Saper provide a superb overview of frequent headache, and taken with Dr. Silberstein's article described above, the two reviews constitute the most up‐to‐date reviews on the subject. SJT
Complicated migraine and migraine variants.
Authors: Rothner AD 
Published: January 2004

Curr Pain Headache Rep. 2002;6:233‐239.This article reviews the less frequently encountered varieties of migraine. It is suggested that these disorders be approached by evaluating possible underlying etiologies before positively diagnosing migraine. This decreases the likelihood of “missing” structural or metabolic disorders. The classification, diagnostic evaluation, differential diagnosis, and treatment options of these disorders is reviewed and a selection of references appended for additional information. Comment: Dr. Rothner is one of the most prominent pediatric neurology headache specialists in the country, and he sees a variety of atypical presentations of migraine. This is an excellent review of such presentations. SJT
Serotonin reuptake inhibitors for dizziness with psychiatric symptoms.
Authors: Staab JP , Ruckenstein MJ , Solomon D , Shepard NT 
Published: January 2004

Arch Otolaryngol Head Neck Surg. 2002;128:554‐560.OBJECTIVE: To investigate the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) for the treatment of patients with dizziness and major or minor psychiatric symptoms, with or without neurotologic illnesses. DESIGN: Review of 60 consecutive cases of patients with dizziness who were treated with an SSRI for at least 20 weeks during the 30‐month period from July 1998 to December 2000. SETTING: Tertiary care, multidisciplinary referral center. PATIENTS: Sixty men and women, aged 13 to 81 years, with (1) psychogenic dizziness, (2) dizziness due to a neurotologic condition, as well as significant psychiatric symptoms, or (3) idiopathic dizziness. INTERVENTIONS: Open‐label treatment with an SSRI titrated to 1 of 3 end points: optimal clinical benefit, intolerable adverse effects, or no therapeutic response. MAIN OUTCOME MEASURE: Change in dizziness and psychiatric symptoms measured by the 7‐point, clinician‐rated, Clinical Global Impressions‐Improvement Scale. RESULTS: Thirty‐eight (63%) of 60 patients in the intent‐to‐treat sample and 32 (84%) of 38 patients who completed treatment improved substantially. The response rates did not differ between patients with major psychiatric disorders and those with lesser psychiatric symptoms. Patients whose only diagnosis was a psychiatric disorder and those with coexisting peripheral vestibular conditions or migraine headaches fared better than patients with central nervous system deficits. Before being treated with an SSRI, two thirds of the study patients took meclizine hydrochloride and/or benzodiazepines, with minimal benefit. CONCLUSIONS: Treatment with SSRIs relieved dizziness in patients with major or minor psychiatric symptoms, including those with peripheral vestibular conditions and migraine headaches. Patients fared far better with SSRI treatment than with treatment with vestibular suppressants or benzodiazepines. Comment: Migraineurs with vestibular symptoms are a challenging group to treat, especially given the labelling restrictions contraindicating triptans in patients with basilar migraine. How confident would most clinicians be in differentiating between these patient groups? DSM I included this abstract because of the comment in the paper that those patients with migraine and dizziness did very well with SSRI treatment. This open‐label study suggests that a randomized, controlled study of SSRIs in patients with migrainous vertigo may be useful. SJT
Perceptions and needs of patients with migraine: a focus group study.
Authors: Cottrell CK , Drew JB , Waller SE , Holroyd KA , Brose JA , O'Donnell FJ 
Published: January 2004

J Fam Pract. 2002;51:142‐147.OBJECTIVE: This study's purpose was to identify the areas that people find most difficult in living with migraines and, in that regard, what kinds of assistance would be most helpful to them and to other people who have migraine headaches. STUDY DESIGN: Four focus groups, each consisting of 4 to 8 participants, were held. Discussions, which were recorded and organized according to category and theme, focused on problems in living with migraines and effective treatment of migraines. POPULATION: Participants were 24 people who had been experiencing 1 to 2 migraines a month, each lasting 1 to 2 days, for at least 6 months. RESULTS: Five themes emerged: (1) impact on family, (2) misunderstanding by others, (3) effect on work, (4) physician care issues, and (5) issues related to medical insurance and drug companies. A majority of participants identified early treatment as the most important consideration for new migraine sufferers. Many participants preferred to have a relationship with their physicians in which they developed a treatment plan together rather than receiving generic educational materials. CONCLUSIONS: Results suggest that patients are interested in understanding their migraines and securing relevant information in addition to obtaining pain relief. Patients desired collaborative relationships with their physicians and a team approach to treatment. Suggestions for physicians who treat patients who have migraines are reviewed. Comment: This small study based on focus groups builds on earlier work by Russell Packard and John Edmeads that was intended to determine what patients really want from a healthcare consultation. In this era of direct‐to‐consumer (DTC) advertising of pharmaceuticals, it would be interesting to pursue further the issues raised by patients relating to medical insurance and drug companies. DSM Despite its small size, the article is a useful reminder from Dr. Holroyd's group that information is what patients seek most urgently, with treatment second. SJT
Self‐awareness of migraine: interpreting the labels that headache sufferers apply to their headaches.
Authors: Lipton RB , Stewart WF , Liberman JN 
Published: January 2004

Neurology. 2002;58(9 suppl 6):S21‐S26.Although people with migraine are aware of their headaches they are often not aware that they have migraine. This can lead to inappropriate or ineffective use of treatments, delays in seeking appropriate care, and miscommunication during clinical encounters. This article assesses self‐recognition of migraine and identifies terms used by migraine sufferers to describe their migraine headaches. Individuals were selected for telephone interview by random digit dialing in several large United States cities as a part of a clinical trials recruiting initiative. Individuals (n  =  30  758) aged 18 to 65 years of age were interviewed about their headaches using a validated computer‐assisted telephone interview. Among the 23  564 respondents who reported headache, their headaches were classified as migraine (with or without aura) by the criteria of the International Headache Society (IHS). The relationships among the terms subjects used for their headaches and their IHS diagnosis of migraine were assessed. Of the 23  564 respondents, 4967 individuals called their headache migraine and 3074 individuals reported headache that met the IHS criteria for migraine. The positive predictive value for self‐assessed migraine is 33.1%; the negative predictive value for a self‐assessment other than migraine is 92.3%. Therefore, individuals who called their headaches migraine were about three times more likely to meet IHS criteria for migraine. Among the 3074 individuals meeting IHS criteria for migraine, only 53.4% recognized their headaches as migraine (sensitivity 54%; specificity 83.8%). Among migraineurs, stress headaches (n  =  345) and sinus headaches (n  =  365) were the most common erroneous labels reported. Age influenced the erroneous terminology. Individuals less than 40 years of age were more likely to misidentify their migraine as stress headaches, whereas individuals 40 years of age and older were more likely to misidentify their migraines as sinus headaches. In a population sample, 54% of individuals with IHS migraine did not know that their headaches are migraine. Those who called their headaches migraine were much more likely to have migraine. Migraine awareness programs that rely solely on the term “migraine” may miss individuals who urgently need to be reached. Therefore, public education should target people with severe or disabling headache and aim to create awareness of the diagnostic possibilities. Comment: In the general population, and in contrast to the doctor's office, episodic tension‐type headache is more common than migraine. When a person in the general population self‐diagnoses nonmigraine, the diagnosis is likely to be correct. These tension or “stress” headaches do not frequently rise to a level that compels those afflicted to seek medical attention. SJT
Neurosurgical treatment of short‐lasting, unilateral, neuralgiform hemicrania with conjunctival injection and tearing.
Authors: Hannerz J , Linderoth B 
Published: January 2004

Br J Neurosurg. 2002;16:55‐58.Trigeminal neuralgia solely involving the upper trigeminal nerve branch is rare. The SUNCT syndrome (short‐lasting, unilateral, neuralgiform hemicrania with conjunctival injection and tearing) in which the periorbital pain lasts for 60‐120 s, and is accompanied by conjunctival injection and tearing is even less common. Unlike trigeminal neuralgia, SUNCT is usually not relieved by medication. Three patients with SUNCT were treated with retrogasserian glycerol rhizolysis, two of them twice. All five treatments provided complete pain relief and the duration of the effects was 2 to more than 4 years. One of these three patients also had a third treatment with compression of retroganglionic fibres with a Fogarthy balloon, according to Mullan, of the upper trigeminal nerve with excellent results. Comment: Although lamotrigine has shown promise, no pharmacologic treatment has been found to work consistently for SUNCT. Are we really at the surgical juncture? SJT
The role of concomitant headache types and non‐headache co‐morbidities in the underdiagnosis of migraine.
Authors: Diamond ML 
Published: January 2004

Neurology. 2002;58(9 suppl 6):S3‐S9.That migraine is significantly underdiagnosed in the United States and other countries is well established. New data from a follow‐up survey to the American Migraine Study II reveal that the presence of concomitant headache types and co‐morbid conditions significantly affects the ability to detect and diagnose migraine. This article describes these data and explores the contribution of concomitant headache types and co‐morbidities to the problem of underdiagnosis of migraine. Migraine continues to be underdiagnosed because of failure to recognize it (missed diagnosis) and because of misdiagnosis of migraine as another headache type. First, a diagnosis of migraine may be missed in the presence of other headache types that occur proportionally more frequently than migraine and thereby overshadow migraine. Second, migraine may be misdiagnosed when health‐care providers inappropriately interpret specific symptoms and co‐morbid conditions as indicators of the presence of a non‐migraine headache type such as sinus or tension. By becoming aware of these diagnostic pitfalls and being more judicious and deliberate in diagnosing migraine and other headache types, health‐care providers can improve the diagnosis of migraine and patients to receive appropriate therapy. Comment: The diagnosis of migraine is less likely to be made if the patient has several types of headache presentations over time. Thus, a patient with the full spectrum of migraine, from episodic tension‐type through migrainous (probable migraine) headache and on to migraine per se is far less likely to receive a diagnosis of migraine than a patient who experiences attacks of “pure” migraine. SJT
The co‐occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway.
Authors: Hagen K , Einarsen C , Zwart JA , Svebak S , Bovim G 
Published: January 2004

Eur J Neurol. 2002;9:527‐533.We have evaluated the association between headache and musculoskeletal symptoms in a large cross‐sectional population‐based study. Between 1995 and 1997, all 92 566 adults in Nord‐Trondelag County in Norway were invited to participate in a health survey. A total of 51  050 (55%) responded to questions concerning headache and musculoskeletal symptoms. Both migraine and non‐migrainous headache were strongly associated with musculoskeletal symptoms. However, frequency of headache had a higher impact than headache diagnosis on this association. Thus, the prevalence of chronic headache (headache>14 days/month) was more than four times higher (OR  =  4.6; 95% CI 4.0‐5.3) in the group of individuals with musculoskeletal symptoms than in those without. Individuals with neck pain were more likely to suffer from headache as compared with those with musculoskeletal symptoms in other restricted areas. In conclusion, there was a strong association between chronic headache and musculoskeletal symptoms, which may have implications for the choice of treatment. Comment: This study describes an important association between frequent headache and cervical musculoskeletal pain. Further work to explore the relationship between fibromyalgia and headache may help our understanding and treatment of these common and often disabling conditions. DSM
Genetic and environmental influences on expression of recurrent headache as a function of the reporting age in twins.
Authors: Svensson DA , Larsson B , Waldenlind E , Pedersen NL 
Published: January 2004

Twin Res. 2002;5:277‐286.To explore age‐related mechanisms in the expression of recurrent headache, we evaluated whether genetic and environmental influences are a function of the reporting age using questionnaire information that was gathered in 1973 for 15‐ to 47‐year‐old Swedish twins (n  =  12,606 twin pairs). Liability to mixed headache (mild migraine and tension‐type headache) was explained by non‐additive genetic influences (49%) in men aged from 15 to 30 years and additive genetic plus shared environmental influences (28%) in men aged from 31 to 47 years. In women, the explained proportion of variance, which was mainly due to additive genetic effects, ranged from 61% in adolescent twins to 12% in twins aged from 41 to 47 years, whereas individual specific environmental variance was significantly lower in twins aged from 15 to 20 years than in twins aged from 21 to 30 years. Liability to migrainous headache (more severe migraine) was explained by non‐additive genetic influences in men, 32% in young men and 45% in old men, while total phenotypic variance was significantly lower in young men than in old men. In women, the explained proportion of variance ranged from 91% in the youngest age group to 37% in the oldest age group, with major contributions from non‐additive effects in young and old women (15‐20 years and 41‐47 years, respectively) and additive genetic effects in intermediate age groups (21‐40 years). While total variance showed a positive age trend, genetic variance tended to be stable across age groups, whereas individual specific environmental variance was significantly lower in adolescent women as compared to older women. Comment: Does this mean that most of the genetic contribution to headache in women is likely to occur during adolescence, which would be in agreement with the peak incidence? Some clinical interpretation would be helpful here. DSM
The Quality Standards Subcommittee of the American Academy of Neurology, The Practice Committee of the Child Neurology Society. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.
Authors: Lewis DW , Ashwal S , G et al. Dahl 
Published: January 2004

Neurology. 2002;59:490‐498.OBJECTIVE: The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence. For this parameter, the authors reviewed available evidence on the evaluation of the child with recurrent headaches and made recommendations based on this evidence. METHODS: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a four‐tiered scheme of evidence classification. RESULTS: There is inadequate documentation in the literature to support any recommendation as to the appropriateness of routine laboratory studies or performance of lumbar puncture. EEG is not recommended in the routine evaluation, as it is unlikely to define or determine an etiology or distinguish migraine from other types of headaches. In those children undergoing evaluation for recurrent headache found to have a paroxysmal EEG, the risk for future seizures is negligible; therefore, further investigation for epilepsy or treatments aimed at preventing future seizures is not indicated. Obtaining a neuroimaging study on a routine basis is not indicated in children with recurrent headaches and a normal neurologic examination. Neuroimaging should be considered in children with an abnormal neurologic examination or other physical findings that suggest CNS disease. Variables that predicted the presence of a space‐occupying lesion included 1) headache of less than 1‐month duration; 2) absence of family history of migraine; 3) abnormal neurologic findings on examination; 4) gait abnormalities; and 5) occurrence of seizures. CONCLUSIONS: Recurrent headaches occur commonly in children and are diagnosed on a clinical basis rather than by any testing. The routine use of any diagnostic studies is not indicated when the clinical history has no associated risk factors and the child's examination is normal. Comment: An important paper which summarizes the evidence for reaching a clinical diagnosis in children with recurrent headaches, while at the same time avoiding unnecessary and potentially harmful investigations. DSM
Contrasts in cortical magnesium, phospholipid and energy metabolism between migraine syndromes.
Authors: Boska MD , Welch KM , Barker PB , Nelson JA , Schultz L 
Published: January 2004

Neurology. 2002;58:1227‐1233.BACKGROUND: Previous single voxel (31)P MRS pilot studies of migraine patients have suggested that disordered energy metabolism or Mg(2+) deficiencies may be responsible for hyperexcitability of neuronal tissue in migraine patients. These studies were extended to include multiple brain regions and larger numbers of patients by multislice (31)P MR spectroscopic imaging. METHODS: Migraine with aura (MWA), migraine without aura (MwoA), and hemiplegic migraine patients were studied between attacks by (31)P MRS imaging using a 3‐T scanner. RESULTS: Results were compared with those in healthy control subjects without headache. In MwoA, consistent increases in phosphodiester concentration [PDE] were measured in most brain regions, with a trend toward increase in [Mg(2+)] in posterior brain. In MWA, phosphocreatine concentration ([PCr]) was decreased to a minor degree in anterior brain regions and a trend toward decreased [Mg(2+)] was observed in posterior slice 1, but no consistent changes were found in phosphomonoester concentration [PME], [PDE], inorganic phosphate concentration ([Pi]), or pH. In hemiplegic migraine patients, [PCr] had a tendency to be lower, and [Mg(2+)] was significantly lower than in the posterior brain regions of control subjects. Trend analysis showed a significant decrease of brain [Mg(2+)] and [PDE] in posterior brain regions with increasing severity of neurologic symptoms. CONCLUSIONS: Overall, the results support no substantial or consistent abnormalities of energy metabolism, but it is hypothesized that disturbances in magnesium ion homeostasis may contribute to brain cortex hyperexcitability and the pathogenesis of migraine syndromes associated with neurologic symptoms. In contrast, migraine patients without a neurologic aura may exhibit compensatory changes in [Mg(2+)] and membrane phospholipids that counteract cortical excitability. Comment: If the theory of hyperexcitability of migraine brain is correct, basic scientists will need to find clear markers for the neuronal abnormalities that underlie this excitability. Using their techniques, these researchers could not find such markers. SJT
Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis.
Authors: Katsarava Z , Lehnerdt G , Duda B , Ellrich J , Diener HC , Kaube H 
Published: January 2004

Neurology. 2002;59:1450‐1453.Trigeminal pain processing was studied in 14 patients with unilateral migraine attacks and 14 age‐ and sex‐matched patients with comparable unilateral headache from frontal sinusitis. Using a nociception‐specific blink reflex method (nBR), a facilitation of nBR responses predominantly on the headache side was observed in migraine, but not in sinusitis. The facilitation of trigeminal nociception may be specific for migraine rather than a consequence of peripheral pain such as frontal sinusitis. Comment: Here we have evidence for the central hyperexcitability of migraine, not found in the previously cited article by Boska et al. SJT