bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Chronic Cervical‐Associated Headache With Botulinum Toxin A: A Pilot Study
Authors: Freund Brian J. , Schwartz Marvin 
Published: March 2003

Objective.–To see whether therapy with botulinum toxin A may prove to be an effective treatment for headache of musculoskeletal origin.Background.–Headache is a common finding associated with neck injury. Cervicogenic headache, which is believed to be attributable to injury of the ligaments, muscles, or joints of the cervical spine, is centered in the occipital region with pain referred to the frontotemporal region. Botulinum toxin A produces prolonged muscle relaxation, which is dose dependent and can be easily targeted to affected muscles.Methods.–This randomized, double‐blind, placebo‐controlled study compares outcome measures in 26 patients suffering from chronic headache subsequent to a cervical whiplash injury. One half of the patients received botulinum toxin A, 100 units, diluted in 1 mL of saline, while the other half received just saline (1 mL). Five cervical trigger points received 0.2 mL each of injectant via a 30‐gauge needle. Outcome measures included subjective head pain based on visual analog scales, as well as range of neck motion. Follow‐up assessments were carried out at 2 and 4 weeks after treatment.Results.–Fourteen subjects who received botulinum toxin A and 12 who received saline completed the study. At both 2 and 4 weeks post injection, the treatment group showed a significant improvement in pain and range of motion from preinjection levels (P<.01). The placebo group demonstrated no statistically significant changes at any posttreatment time.
Chronic Daily Headache: A Time Perspective
Authors: Spierings Egilius L.H. , Ranke Anniek H. , Schroevers Maya , Honkoop Peter C. 
Published: March 2003

Objective.–To determine the development and outcome of chronic daily headache in 258 headache practice patients, consisting of 50 men and 208 women. Chronic daily headache was defined as headaches occurring on at least 5 days per week for at least 1 year.Methods.–Two hundred fifty‐eight patients with headache were interviewed and evaluated. Ninety‐one patients were contacted by telephone for follow‐up.Results.–Twenty‐two percent of the patients had daily headaches from the onset, and 78% initially experienced intermittent headaches. Of the patients with initially intermittent headaches, 19% experienced an abrupt transition into daily headaches and 81%, a gradual one. In the patients with gradual transition, the transition of the initial, intermittent headaches into daily headaches took an average of 10.7 years. The initial headaches were mild in 33% of the patients and severe in 67%. The severe headaches were associated with nausea and vomiting significantly more often than the mild ones. However, the daily headaches that these patients ultimately developed were the same, regardless of whether the initial headaches were mild or severe.The patients who gradually developed daily headaches from initially intermittent headaches were contacted to determine the outcome of their headaches. Of these patients, 33% continued to have daily headaches and 67% again experienced intermittent headaches. Of the latter group, 88% of the patients who now had migraine also had migraine initially.
Influence of Disease Duration on Visual Evoked Potentials in Migraineurs
Authors: Yücesan Canan , Sener Özden , Mutluer Nermin 
Published: March 2003

Objective.–To determine the possible influence of the duration of migraine on pattern‐reversal visual evoked potentials.Methods.–An investigation was conducted in 49 patients with migraine without aura according to the International Headache Society criteria. Twenty‐two of these patients had had migraine for 2 years or less (group 1), and the other 27 patients had had the disease for 10 years or more (group 2). The control group consisted of 17 healthy subjects.Results.–Comparison of the mean P100 latency and amplitude showed no significant difference among the groups. There was, however, a good negative correlation between age and latency (r = −0.59, P = .003) in group 1, but no such correlation was observed for group 2 or the control group.Conclusions.–It was concluded that the duration of migraine has no influence on pattern‐reversal visual evoked potentials and that the pathogenesis of early‐ and late‐onset migraine may be different.
Cosinor Analysis of Heart Rate Variability in Ambulatory Migraineurs
Authors: Tabata Masako , Takeshima Takao , Burioka Naoto , Nomura Takashi , Ishizaki Kumiko , Mori Nozomi , Kowa Hisanori , Nakashima Kenji 
Published: March 2003

Objective.—To clarify whether the circadian rhythm of heart rate variability parameters can be identified in patients with migraine during a headache‐free period and to identify any specific pattern of the circadian rhythm of heart rate variability, using time‐domain and spectral analysis and cosinor rhythm analysis of heart rate variability during normal daily activity.Methods.—Forty‐eight–hour Holter electrocardiograms were recorded for 27 patients with migraine during headache‐free periods and 24 healthy controls during free activity. The circadian rhythms of heart rate fluctuation parameters, that is, mean interval, standard deviation, root‐mean‐square successive differences (RMSSD), %RR50, and low (0.020 to 0.150 Hz) and high frequency (0.150 to 0.400 Hz) heart rate fluctuations were analyzed with the group mean cosinor method.Results.—The group mean cosinor analysis and the acrophase‐amplitude analysis demonstrated significant differences in circadian rhythm in SD, RMSSD, %RR50, and high frequency between the group with migraine and controls. The amplitudes of SD, RMSSD, %RR50, and high frequency in the group with migraine were smaller than those in controls, which implied parasympathetic hypofunction in migraineurs. There were no significant differences in the MESOR (midline estimating statistic of rhythms) of the analyzed heart rate parameters except for low frequency. The MESOR of low frequency in the migraineurs was significantly smaller than that in the controls.Conclusions.—Patients with migraine have hypofunction in the parasympathetic nervous system during normal daily activity in the headache‐free period.
Prevalence of Migraine, Tension‐type Headache, and Other Headaches in Hong Kong
Authors: Cheung Raymond T.F. 
Published: March 2003

Objective.—To assess the prevalence of migraine and other headaches in Hong Kong in 1998.Background.—A community‐based prevalence survey of headache was carried out from July 1992 to March 1993, and the prevalence rates were 1% for migraine, 2% for tension‐type headache, and 1% for other headaches. A similar survey was carried out in May and June 1998 to interview individuals aged 15 years or older. Recurrent headache was defined as having two or more headaches unrelated either to influenza or a common cold within the past 12 months.Methods.—Respondents with recurrent headache were offered a personal interview for clinical validation. Of 3156 randomly selected individuals, 1436 responded.Results.—Headache was due to influenza or a common cold in 270 (18.8%) respondents; recurrent headache affected 533 (37.1%) respondents. The overall prevalence rates were 4.7% for migraine, 26.9% for tension‐type headache, and 5.5% for other headaches. Clinical validation was available for 72 respondents. After adjustment for possible misclassification, the estimated prevalence rates became 12.5% for migraine, 18.7% for tension‐type headache, and 6.0% for other headaches. There was a female preponderance for all types of headache with a peak in the 25‐ to 34‐year‐age group for tension‐type headache.Conclusions.—All types of headache were more common in the 1998 study, and the prevalence rates were closer to those of Western communities.
Effectiveness of Amitriptyline in the Prophylactic Management of Childhood Headaches
Authors: Hershey Andrew D. , Powers Scott W. , Bentti Anna‐Liisa , DeGrauw Ton J. 
Published: March 2003

Objective.—To study the effectiveness of a standardized dose of amitriptyline, 1 mg/kg, for childhood headaches. Background.—Amitriptyline has been shown to be effective for the prophylaxis of migraine in adults. Studies in children, however, have been quite limited. In adults, the suggested effective dose range is 10 to 150 mg. In children, a standardized dosage is often not used, resulting in a dosage range in clinical practice that often varies from a very low dose to a dose equivalent to that used in adults. Methods.—Children with more than three headaches per month were treated with amitriptyline, slowly increasing the dose to 1 mg/kg per day. The frequency, severity, and duration of their headaches were initially evaluated and subsequently measured at each follow‐up evaluation. Two hundred seventy‐nine children had headaches occurring frequently enough to indicate prophylactic treatment. Of these children, 192 (68.8%) were treated with amitriptyline. The average age at presentation was 12.0 (± 3.0) years. The ratio of boys to girls was 1:1.74. The average frequency of headaches was 17.1 (± 10.1) days per month. The average severity was 6.84 (± 1.67) on a 10‐point pain scale. The average duration was 11.5 (± 15.0) hours. The most frequent diagnoses using International Headache Society criteria were migraine (60.6%), migraine with aura (7.9%), and tension‐type headache (10.4%). Of these children, 146 have been seen for at least one follow‐up examination, occurring on average 67.3 (± 32.3) days after beginning prophylactic treatment. Results.—A total of 84.2% of the children reported an overall perception of being better, while 11.6% reported being the same. The frequency of headaches improved to 9.2 (± 10.0) days per month. The average severity was reduced to 5.1 (± 2.1), and the average duration was reduced to 6.3 (± 11.1) hours. If daily or continuous headaches were excluded, the improvements were more marked. Minimal side effects were reported from these children and their families. Long‐term evaluation (156 to 415 days) showed continued sustained improvement. Conclusions.—Amitriptyline is an effective prophylactic medication for children with frequent headaches. A standardized dosing regimen results in a significant number of children responding with minimal side effects. The children are able to tolerate this dosing scheme and demonstrate good adherence to a dosing schedule of once a day.
Intravenous Valproate Sodium (Depacon) Aborts Migraine Rapidly: A Preliminary Report
Authors: Mathew Ninan T. , Kailasam Jayasree , Meadors Lori , Chernyschev Oleg , Gentry Paula 
Published: March 2003

Objective.—This study was designed to investigate the efficacy and safety of intravenous valproate in the treatment of acute migraine attacks.Background.—Numerous studies have shown oral valproate therapy to be effective in preventing migraine. To date, no published studies have explored the use of valproate in the acute treatment of migraine.Design/Methods.—After obtaining written informed consent, 61 patients presenting to a clinic with acute migraine were infused with 300 mg of intravenous valproate sodium. Sixty‐six attacks were treated. The time at the beginning of infusion; the time at the end of infusion; the time to onset of relief of headache, nausea, and other associated symptoms; the time to meaningful relief; and the time to complete relief were recorded. Patient's pulse, blood pressure, and respiration were monitored. Adverse events were recorded.Results.—Mean time to onset of relief was 8 minutes, mean time to meaningful relief was 16 minutes, and mean time to complete relief was 25 minutes. A reduction in pain from severe or moderate to mild or no pain in 30 minutes was reported in 37 of 66 attacks; in 11 attacks, a reduction of more than 50% in headache severity in 30 minutes was reported. Thus, 48 (73%) of 66 attacks had significant improvement. After treatment with valproate, headache severity was significantly decreased (P<.0001); nausea, disability, and photophobia decreased; and patients became more alert. No serious adverse events were reported.Conclusion.—Intravenous valproate appears to be safe and effective for the acute treatment of migraine. Double‐blind, placebo‐controlled studies to further investigate the use of this agent in acute treatment of migraine attacks are warranted.
Oral Almotriptan in the Treatment of Migraine: Safety and Tolerability
Authors: Dodick David W. 
Published: March 2003

Objective.—To summarize safety and tolerability data on orally administered almotriptan from premarketing clinical trials.Background.—Almotriptan is a new 5‐HT1B/1D receptor agonist similar to sumatriptan in mode of action and therapeutic efficacy. In addition, the safety and tolerability profile of almotriptan has been demonstrated in a number of controlled clinical trials. Sumatriptan is generally safe and well tolerated; however, in controlled clinical trials, it has been associated with chest symptoms (pressure, warmth, and other unpleasant sensations) with an incidence of 3% to 5%.Design.—Three phase 1 dose‐finding and pharmacokinetic studies in healthy men and women volunteers were reviewed to assess the safety and tolerability of oral almotriptan at single doses ranging from 2 to 200 mg. The objective of one study was to evaluate cardiovascular safety. Two phase 2 trials assessed the safety and tolerability of single doses of 2 to 150 mg in migraine (n=911). Two phase 3 trials assessed the safety and tolerability of a single 12.5‐mg oral dose after three attacks (n=910) and repeated doses of 12.5 mg for multiple attacks over the long term (n=747). All studies were conducted in Europe. Data from the United States is currently being analyzed and will be published at a later date.Results.—In phase 2 and 3 trials comprising more than 2500 patients with migraine and 15  000 attacks, adverse events were infrequent and mild. The most common events—dizziness, nausea and vomiting, headache, fatigue, paresthesia, and drowsiness—were reported in fewer than 3% of patients. At the recommended therapeutic dose of 12.5 mg, the adverse events profile was not statistically different from placebo. The incidence of chest symptoms was 0.2% in the phase 3 trials. The long‐term safety and tolerability profile after treatment of more than 10  000 attacks was similar to that following the single‐dose studies. In all clinical trials, almotriptan demonstrated a very favorable adverse event profile, particularly with respect to nonischemic‐related chest symptoms.Conclusions.—Almotriptan was safe and well tolerated in nearly all adult patients with migraine, with and without aura, enrolled in these studies. The incidence of chest symptoms in preclinical studies was substantially lower than that reported for sumatriptan in premarketing studies, indicating that almotriptan may be better tolerated than sumatriptan at clinically anticipated doses. However, any potential difference in cardiovascular safety between almotriptan and sumatriptan cannot be determined or inferred from this data. Cardiovascular risk profiles for all drugs within this class (triptans) should be considered similar. Only extensive postmarketing data, not currently available, can potentially change this recommendation.
Effects of Aspirin During Exercise on the Incidence of High‐Altitude Headache: A Randomized, Double‐Blind, Placebo‐Controlled Trial
Authors: Burtscher Martin , Likar Rudolf , Nachbauer Werner , Philadelphy Michael , Pühringer Reinhard , Lämmle Thomas 
Published: March 2003

Objective.—To evaluate the efficacy of aspirin for headache when exercising during acute high‐altitude exposure.Background.—Aspirin effectively prevents headache when mostly resting during acute high‐altitude exposure. However, the majority of individuals exposed to high altitude perform mountaineering activities, which might trigger headache.Design.—Randomized, double‐blind, placebo‐controlled trial.Methods.—Thirty‐one healthy volunteers (20 men, 11 women; aged 22 to 59 years) were transported to an altitude of about 3000 meters and climbed up to 3800 meters. They then descended to a mountain hut at 3480 meters and spent 2 nights there. Tablets (placebo or 320 mg aspirin) were administered three times at 4‐hour intervals, beginning 2 hours before arrival at high altitude. Headache scoring and measurements of heart rate, blood pressure, and arterial oxygen saturation were performed.Results.—Ninety‐three percent (14 of 15) of the placebo group and 56% (9 of 16) of the aspirin group developed headache when mountaineering activities were performed during acute exposure to high altitude (P<.05). Five hours after arrival at high altitude, mean resting oxygen saturation was 86.1% ±  2.1% with aspirin and 85.7 % ±  2.8% with placebo (P = .66). However, subjects in the aspirin group developed headache at saturation values less than or equal to 86%, while those in the placebo group developed headache at saturation values less than 90%.Conclusions.—Although the prophylactic intake of about 1 gram of aspirin reduced the headache incidence when exercising during acute high‐altitude exposure, the incidence of headache was higher than previously shown for resting conditions. Aspirin resulted in tolerance to lower arterial oxygen saturation without development of headache; exercise had the opposite effect.
The Outcome of Treating Patients With Suspected Rebound Headache
Authors: Warner John S. 
Published: March 2003

Objective.—To prospectively document the outcome of patients suspected of having rebound headache.Background.—Previous publications on rebound headache have, for the most part, implied that the patients improve, but have failed to specify the percent who improved, the pattern of improvement, or the end point that is achieved.Methods.—This was a prospective study of 50 consecutive patients presenting with chronic daily headache of over 2 months' duration who were suspected of having rebound headache from the medications that they were using for pain relief, and who were eligible to follow our usual treatment protocol, ie, abrupt termination of the offending medications and use of subcutaneous injections of dihydroergotamine for excruciating headache.Results.—One year after the initial patient was enrolled and 8 months after the last patient was enrolled, 29 patients (58%) achieved the goal of 6 or more consecutive headache‐free days; the mean time to achieve this goal was 84 days. Another 9 patients showed varying degrees of improvement; 1 continued to improve and achieved 5 consecutive headache‐free days after having omitted her medications for 10 months. Eleven patients failed to stop their medications or stopped their medications for only a brief interval. One patient continued to have daily headaches after having essentially omitted all pain relief medications for 12 months and was the only true treatment failure in the group.Conclusions.—Most patients suspected of having rebound headache comply with the instructions to omit the offending agents and can be helped. This information might help other physicians who are treating patients suspected of having rebound headache.
Self‐reported Photophobic Symptoms in Migraineurs and Controls Are Reliable and Predict Diagnostic Category Accurately
Authors: Mulleners W.M. , Aurora S.K. , Chronicle E.P. , Stewart R. , Gopal S. , Koehler P.J. 
Published: March 2003

Objectives.—To assess the reliability of self‐reported photophobia across different patient populations and to examine how visual stress thresholds and photophobic symptoms may be predictive of diagnosis.Background.—Relatively little is known about interictal photophobia in migraine. In particular, the variability of photophobia across different patient groups has not previously been studied, and a pathophysiological hypothesis to account for the symptoms is not agreed upon.Methods and Results.—Study 1 compared 99 self‐selected Dutch patients and 101 headache‐free controls using survey methods. Patients both with and without aura were significantly more likely to report symptoms, such as the wearing of sunglasses in normal daylight, consistent with interictal photophobia. Study 2 replicated these findings in a series of consecutive referrals to a headache clinic in the United States. Study 3 used a specially designed laboratory test to examine the threshold for visual stress in those patients who had participated in study 2. Visual stress thresholds were significantly lower in patients than in controls. A discriminant function analysis of data from both studies 2 and 3 showed that diagnostic category (migraine; control) could be predicted from photophobic symptoms and visual stress thresholds at a level significantly better than chance.Conclusions.—We suggest that interictal photophobia is common in migraine and similar across different patient populations. One pathophysiological hypothesis is that interictal photophobia is associated with cortical hypersensitivity to stimulation. The predictive validity of interictal photophobic symptoms suggests that clinical diagnosis may be aided by questioning the patient about light sensitivity in the period between attacks.
Efficacy of Intravenous Magnesium Sulfate in the Treatment of Acute Migraine Attacks
Authors: Demirkaya Şeref , Vural Okay , Dora Babür , Topçuoğlu Mehmet Akif 
Published: March 2003

Objective.—To study the efficacy and tolerability of 1 g of intravenous magnesium sulfate as acute treatment of moderate or severe migraine attacks.Background.—Migraine is a common disorder in which not only the pain but also the accompanying symptoms such as nausea and vomiting reduce activity and productivity of sufferers. Many drugs used for the treatment of acute migraine attacks have many side effects, are not well tolerated, are ineffective in some patients, or cannot be used during pregnancy or in patients with ischemic heart disease. Magnesium deficiency has been proposed to play a role in the pathophysiology of migraine, and recently treatment of migraine with magnesium has gained considerable interest.Methods.—This was a randomized, single‐blind, placebo‐controlled trial including 30 patients with moderate or severe migraine attacks. Fifteen patients received 1 g intravenous magnesium sulfate given over 15 minutes. The next 15 patients received 10 mL of 0.9% saline intravenously. Those in the placebo group with persisting complaints of pain or nausea and vomiting after 30 minutes also received 1 g magnesium sulfate intravenously over 15 minutes. The patients were assessed immediately after treatment, and then 30 minutes and 2 hours later. Intensity of pain, accompanying symptoms, and side effects were noted.Results.—All patients in the treatment group responded to treatment with magnesium sulfate. The pain disappeared in 13 patients (86.6%) ; it was diminished in 2 patients (13.4%); and in all 15 patients (100%), accompanying symptoms disappeared. In the placebo group, a decrease in pain severity but persisting nausea, irritability, and photophobia were noted in 1 patient (6.6%). Accompanying symptoms disappeared in 3 patients (20%) 30 minutes after placebo administration. All patients initially receiving placebo were subsequently given magnesium sulfate. All of these patients responded to magnesium sulfate. In 14 patients (93.3%), the attack ended; in 1 patient (6.6%), pain intensity decreased; and in all 15 patients (100%), accompanying symptoms disappeared. Both the response rate (100% for magnesium sulfate and 7% for placebo) and the pain‐free rate (87% for magnesium sulfate and 0% for placebo) showed that magnesium sulfate was superior to placebo. Twenty‐six patients (86.6%) had mild side effects which did not necessitate discontinuing treatment during magnesium sulfate administration.Conclusion.—Our results show that 1 g intravenous magnesium sulfate is an efficient, safe, and well‐tolerated drug in the treatment of migraine attacks. It is possible that magnesium sulfate could be used in a broader spectrum of patients than other drugs commonly used for attack treatment. In view of these results, the effect of magnesium sulfate in acute migraine should be examined in large‐scale studies.