bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late‐Life (Migrainous) Scintillating Zigzags Without Headache: One Person's 27‐Year Experience
Authors: Fisher C. Miller 
Published: March 2003

Background.—Episodes of typical scintillating zigzags similar to the visual aura of migraine may occur without headache, especially after the age of 50. There is no record of one individual's long‐term experience.Present Material.—This paper is a personal account of all 41 episodes of scintillating zigzags that occurred between the ages of 59 and 85. Observations were made on several aspects of the visual event itself—evolution, pattern, scotoma, coloration, duration, lateralization, etc. The chronological distribution of spells, circumstances of occurrence, time of day, the season, etc were noted. The study was observational in nature. Documentation of this experience could be of value clinically and scientifically.Results.—The spells occurred irregularly, unrelated to season, time of day, activity at onset, diet, and temperamental state. The characteristic appearance was a flickering zigzag line that began centrally and migrated to the periphery. The display, which was stereotyped, was achromatic. The average duration was 15 minutes. Both visual fields were equally involved, never at the same time. The details of the scintillating zigzag line are actually complex and an account of the observations of others and of the author is included here.
Diagnosis of Migraine in Children Attending a Pediatric Headache Clinic
Authors: de Grauw Ton J. , Hershey Andrew D. , Powers Scott W. , Bentti Anna‐Liisa 
Published: March 2003

The International Headache Society (IHS) criteria for migraine are not sufficient to diagnose migraine in children. Specifically, the duration and localization of the headache are different in children and adults with migraine. This study compared the formal IHS criteria with pediatric‐amended IHS criteria and IHS criteria with the duration factor removed in children younger than 18 years. In addition, the older criteria by Vahlquist and by Prensky and Sommer were also compared. Finally, clinical diagnosis of migraine was compared with IHS criteria with the duration factor removed.The study showed that many children with a shorter duration headache have migraine and also that a number of children with a very long duration of headaches still fit the diagnosis of migraine. Unilateral headache is quite uncommon. The majority of children with migraine complained of bilateral headaches.It is concluded that the IHS criteria for pediatric migraine should be revised. We suggest making the duration factor a minor criteria for migraine in children or to exclude headaches lasting longer than 72 hours only in children younger than 15 years.
Influence of Colors on Habituation of Visual Evoked Potentials in Patients With Migraine With Aura and in Healthy Volunteers
Authors: Áfra J. , Mascia A. , Genicot R. , Albert A. , Schoenen J. 
Published: March 2003

Objective.– To investigate whether colored glasses influence the habituation of visual evoked potentials.Background.– We have previously shown that during pattern‐reversal stimulations lasting 2 minutes the amplitude of the visual evoked potential increases in migraine with and without aura between attacks, whereas it decreases in healthy volunteers. Red light was found to increase visually evoked EEG fast activity only in children with migraine with aura. Wearing rose‐tinted glasses for 4 months decreased attack frequency in parallel with a reduction of the visually evoked EEG fast activity.Methods.– We compared the change in amplitude of the visual evoked potential using five different tinted glasses in 12 patients with migraine with aura and in 10 healthy volunteers. During continuous stimulation at 3.1 Hz, five blocks of 50 responses were sequentially averaged using red, yellow, green, blue, and grey glasses and without glasses in a random order and analyzed in terms of latencies and N1‐P1 amplitudes. Amplitude changes were calculated for each block by comparison with the first block in every condition and analyzed statistically using Zerbe's method.Results.– In healthy volunteers, the visual evoked potential amplitude increased with red glasses compared to without glasses (P=.05) or with green glasses (P=.03). In patients with migraine with aura, no significant difference was detected using colored glasses. Our findings in healthy volunteers are in line with earlier reports of increased excitability of the human visual cortex when exposed to red light. The lack of such a pattern in patients with migraine with aura suggests that the visual cortex is interictally hypoexcitable rather than hyperexcitable, which is consistent with studies of transcranial magnetic stimulation.
Treatment of Chronic Daily Posttraumatic Headache With Divalproex Sodium
Authors: Packard Russell C. 
Published: March 2003

Objective.—To determine the effectiveness of divalproex sodium in the treatment of chronic daily posttraumatic headaches.Background.—Divalproex sodium has been found to be useful for the treatment of migraine and chronic daily headache. No studies have been done to evaluate effectiveness in posttraumatic headache.Methods.—A retrospective review was done of 100 patients treated with divalproex for chronic daily posttraumatic headache of 2 months or longer.Results.—Sixty percent of patients with chronic posttraumatic headache had mild to moderate improvement in their headaches after at least 1 month of divalproex sodium. Forty percent either showed no response (26%) or discontinued treatment because of side effects (14%). Fifty‐eight percent of patients showing improvement had a change in headache pattern from daily to episodic.Conclusions.—Divalproex sodium appears to be safe and effective for treatment of patients with persistent, chronic daily posttraumatic headaches.
Assessing the Impact of Migraine on Health‐Related Quality of Life: An Additional Use of the Quality of Well‐being Scale–Self‐administered
Authors: Sieber William J. , David Kristin M. , Adams Jim E. , Kaplan Robert M. , Ganiats Theodore G. 
Published: March 2003

Objectives.—To compare the interviewer‐administered Quality of Well‐being Scale (QWB) with a self‐administered form (QWB‐SA) for patients with migraine, and to compare the health status of migraineurs to other medical populations.Background.—With the increasing need to document the cost‐effectiveness of treatment for migraine, limitations with both the Medical Outcomes Study Short Form‐36 items and the QWB have been an impediment to research using cost‐effectiveness as an outcome. Demonstrating the sensitivity of an alternative instrument which addresses these limitations would facilitate cost‐effectiveness analyses on treatments for migraine.Methods.—Eighty‐nine adults (87% women) known to suffer from migraine were asked to complete both the interviewer‐administered QWB and the self‐administered version (QWB‐SA) on three occasions. The first occasion was on a day when no migraine was experienced in the previous 7 days. The second and third assessments were completed within 48 hours of the onset of a migraine.Results.—While both the QWB and the QWB‐SA successfully distinguished migraine from nonmigraine days, more migraines were reported on the QWB‐SA. Overall, both instruments showed similar patterns of patient dysfunction during a migraine attack. Each component of the QWB‐SA successfully distinguished migraine from nonmigraine days, and the QWB‐SA showed a linear sensitivity to pain intensity and disability during a migraine episode. Both instruments are able to detect a migraine's effect on multiple domains of quality of life. Study participants scored significantly lower on the QWB‐SA during a migraine episode than several comparison medical populations.Conclusions.—The QWB and the QWB‐SA appear to have sensitivity to migraine severity, and the ability to quantitate an effect in multiple quality‐of‐life domains. Both measures can be used to calculate quality‐adjusted life‐years, thus facilitating cost‐effectiveness and health policy work in this important clinical area.
Evaluating HIV‐Infected Patients With Headache: Who Needs Computed Tomography?
Authors: Gifford Allen L. , Hecht Frederick M. 
Published: March 2003

Objective.—To empirically test a clinical prediction rule for evaluating HIV‐infected patients complaining of headache and to identify those at low risk for intracranial mass lesion who do not need immediate computed tomography of the head.Design.—Two retrospective clinical cohorts of HIV‐infected patients clinically evaluated for headache.Methods.—To describe the headache clinical outcomes, medical records were abstracted from all HIV‐infected patients evaluated for headache with computed tomography of the head at two urban hospitals. Patients were categorized as low, intermediate, or high risk based on clinical criteria (focal neurological signs, altered mental status, history of seizure) and immune status (CD4 lymphocytes≤200/μL). Records were abstracted from a second unselected cohort of HIV‐infected outpatients with headache who were all treated and followed in primary care (N=101).Results.—Of 101 unselected HIV‐infected outpatients followed in primary care after headache, 1% (95% confidence interval [CI], 0% to 6%) had a treatable intracranial lesion. Of 364 HIV‐infected patients with headache sent for evaluation with computed tomography of the head, the rate of any abnormality was zero in the low‐risk group (95% CI, 0% to 10%; n=35); 9% in the intermediate‐risk group (95% CI, 2% to 16%; n=242); and 21% in the high‐risk group (95% CI, 12% to 29%; n=87).Conclusion.—Most HIV‐infected patients with headache may be treated with analgesics and followed up clinically. Those without focal neurological signs, altered mental status, seizure, or decreased CD4 lymphocytes are unlikely to have intracranial mass lesions.
Valproic Acid Is Effective in Migraine Prophylaxis at Low Serum Levels: A Prospective Open‐Label Study
Authors: Kinze Stephan , Clauss Michael , Reuter Uwe , Wolf Tilo , Dreier Jens Peter , Einhäupl Karl Max , Arnold Guy 
Published: March 2003

Objective.—We evaluated the efficacy of prophylactic valproic acid treatment (6 months) on the frequency of migraine attacks and the number of migraine headache days with respect to serum levels.Background.—Valproic acid, a GABAergic drug, has been shown to be effective for migraine prophylaxis. Results from several dose‐ and serum level‐adjusted studies have recommended valproic acid doses within a range of 500 to 1500 mg per day for migraine prophylaxis.Design and Methods.—In this prospective open‐label study, 52 patients received valproic acid doses of 300 to 1200 mg per day; 45 patients were treated per protocol. Valproic acid serum levels increased linearly in relation to the valproic acid dose and were between 21 and 107 μg/mL at the end of the treatment period. Patients were divided into two groups: those with valproic acid serum levels less than 50 μg/mL (group 1) and those with serum levels greater than 50 μg/mL (group 2).Results.—The frequency of migraine attacks was significantly reduced in group 1 from 3.5 ± 0.9 to 2.0 ± 0.9 attacks per month. Migraine headache days also decreased (6.4 ± 3.5 to 4.6 ± 2.9 days per month). In the high serum level group, a reduction of migraine attacks from 3.5 ± 0.9 to 2.8 ± 1.0 attacks per month and only a slight decrease in headache days (6.4 ± 3.5 to 6.1 ± 2.4 days per month) was observed. The outcome of group 1 (low serum level) was significantly better than that of group 2 with respect to both parameters (P<.05). Side effects were generally mild and temporary.Conclusions.—Due to the lack of additional benefit from higher valproic acid doses (more than 600 mg per day), we recommend daily valproic acid doses of 500 to 600 mg with a target serum level less than 50 μg/mL for the prophylactic treatment of migraine.
Prevalence of Migraine in Croatia: A Population‐Based Survey
Authors: Zivadinov Robert , Willheim Ksenija , Jurjevic Ante , Sepic‐Grahovac Dubravka , Bucuk Mira , Zorzon Marino 
Published: March 2003

Objectives.—The aim of the present study was to estimate the prevalence of migraine among Croatian adults. This is the first epidemiological study of migraine in Croatia in which the operational diagnostic criteria of the International Headache Society have been applied.Methods.—The study population consisted of all residents (aged 15 to 65 years) of Bakar, County of The Coast and Gorski Kotar, Croatia. A population‐based survey was undertaken using a “face‐to‐face, door‐to‐door” interview method. The participation rate was 73.3%. All participants were screened for headache history according to the International Headache Society criteria. Headache screen positive responders (65.7%) were interviewed by trained medical students with a structured detailed interview focused on migraine.Results.—A total of 720 lifetime migraineurs were identified. The lifetime prevalence of migraine was 22.9% (95% confidence interval, 20.9 to 25.1) in women, 14.8% (95% confidence interval, 13.1 to 16.8) in men, and 19% (95% confidence interval, 17.6 to 20.5) in both sexes. The highest lifetime prevalence of migraine was in women in the age group 40 to 49 years (38.1%). Among 636 active migraineurs, 399 (62.7%) were women and 237 (37.3%) were men; 55.8% had migraine without aura, 35.2% migraine with aura, and 6.9% migraine both with and without aura. The 1‐year prevalence of migraine, migraine without aura, migraine with aura, and migraine both with and without aura in women was 18%, 11.3%, 8.6%, and 2.2%, respectively. In men, the 1‐year prevalence of migraine, migraine without aura, migraine with aura, and migraine both with and without aura was 12.3%, 7.3%, 3%, and 0.7%, respectively.Conclusions.—The prevalence of migraine in this Croatian population showed rates quite similar to those reported in neighboring countries, such as Italy and France. Further studies are needed to estimate the prevalence rates of migraine in the total Croatian population.
Olanzapine as an Abortive Agent for Cluster Headache
Authors: Rozen Todd D. 
Published: March 2003

Objective.—To evaluate olanzapine as a cluster headache abortive agent in an open‐label trial.Background.—Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs.Methods.—Olanzapine was given as an abortive agent to five patients with cluster headache in an open‐label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5‐mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose.Results.—Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache‐free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness.Conclusions.—Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache.
Information About Migraine Disability Influences Physicians' Perceptions of Illness Severity and Treatment Needs
Authors: Holmes William F. , MacGregor E. Anne , Sawyer James P.C. , Lipton Richard B. 
Published: March 2003

Objective.—To assess physician‐patient communication about headache‐related disability and to evaluate the influence of information about disability on physicians' perceptions of illness severity and the treatment needs of migraineurs.Background.—Evidence suggests that migraine is suboptimally treated in clinical practice, partly due to poor communication between physicians and their patients.Methods.—One hundred five neurologists and primary care physicians with an interest in headache participated in two interactive surveys, one in North America (n=42) and one in Europe (n=63). Each survey focused on the evaluation of four videotaped migraine cases. The first case was evaluated twice, initially after a typical symptom history that centered on diagnosis and then following a fuller history of migraine disability. Additional questions assessed the extent of the collection of migraine disability information in clinical practice.Results.—Physicians reported that they recorded symptoms relating to diagnosis (eg, pain location/intensity, associated symptoms) rather than information on headache‐related disability. Only about one third of patients volunteered disability information. When made available to them, physicians rated information on disability as one of the most important factors in assessing treatment needs. In particular, when physicians knew the patient's disability history: (1) the proportion of physicians who rated the patient's illness as “severe” increased by 128% in North America, 27% in Europe; (2) the proportion of physicians who recommended immediate treatment increased by 63% in North America, 37% in Europe; and (3) the proportion of patients recommended for a follow‐up visit increased by 15% in North America, 18% in Europe.Conclusions.—Physicians and patients often fail to discuss headache‐related disability during consultation. This information has a powerful influence on physicians' perceptions of illness severity, treatment choice, and the need for follow‐up. Tools to improve communication about headache‐related disability, such as the Migraine Disability Assessment questionnaire, may favorably improve migraine management.
Consumer Views on Management of Trigeminal Neuralgia
Authors: Zakrzewska J.M. 
Published: March 2003

Objective.—To assess consumers' views on treatments used for trigeminal neuralgia and to compare their assessments with those of clinicians.Methods.—A short self‐administered questionnaire was distributed to 133 individuals with trigeminal neuralgia and 21 clinicians attending national support group meetings in the United States and United Kingdom.Results.—Responses were obtained from 82% of those with trigeminal neuralgia and from 50% of the clinicians. All sufferers had used medical therapies (mean of three drugs), and 40% to 50% had undergone surgical treatment. All of the attendees with trigeminal neuralgia reported at least one side effect (mean ± SD, 4.9 ± 1.8). The clinicians underestimated the number of side effects, but both groups agreed that drowsiness and cognitive impairment are side effects that are particularly disliked. The mean current quality‐of‐life score, measured on a scale of 1 to 5 (5 = worse), was 2.7 ± 1.5. Only 37% of sufferers gave an opinion as to the best form of treatment.Conclusions.—Therapy leads to side effects which tend to be underestimated by clinicians. Patients currently find it difficult to make decisions about treatment. More collaborative research with active involvement of sufferers would improve the evidence base on which decisions can be made.
Sumatriptan Nasal Spray and Cognitive Function During Migraine: Results of an Open‐Label Study
Authors: Farmer Kathleen , Cady Roger , Bleiberg Joseph , Reeves Dennis , Putnam Gayla , O'Quinn Stephen , Batenhorst Alice 
Published: March 2003

Objective.—To examine measures of cognitive function during acute migraine, before and after treatment with sumatriptan nasal spray, 20 mg.Background.—Migraineurs frequently report symptoms of cognitive impairment during migraine. The efficacy of sumatriptan for treatment of migraine‐related cognitive impairment is undocumented.Methods.—This open‐label, single‐attack study of 28 subjects used the Headache Care Center‐Automated Neuropsychological Assessment Metrics, a computerized neuropsychological assessment battery, to measure cognitive function under three patient conditions: migraine‐free, untreated migraine, and following sumatriptan (primary outcome). Headache response and pain‐free response, percent effectiveness, and clinical disability were measured.Results.—Cognitive function (simple reaction time, sustained attention/concentration, working memory, visual‐spatial processing) and alertness/fatigue were adversely affected during migraine compared with migraine‐free performance (P<.05), and rapidly restored following sumatriptan nasal spray, 20 mg (P<.05). Headache and pain‐free response were 86% and 68%, respectively, at 135 minutes postdose. Changes in migraine pain severity, clinical disability, and percent effectiveness following treatment with sumatriptan nasal spray, 20 mg, were significantly correlated with cognitive function measures across all subtests (P<.001).Conclusions.—Sumatriptan nasal spray, 20 mg, restored migraine‐related cognitive function and clinical disability.
Endothelin‐1 Plasma Levels in Cluster Headache
Authors: Franceschini R. , Tenconi G.L. , Leandri M. , Zoppoli F. , Gonella A. , Staltari S. , Barreca T. 
Published: March 2003

Background and Objective.—A role for endothelin‐1, a potent vasoconstrictor peptide, in some cerebrovascular diseases has been proposed. To obtain preliminary data about peripheral concentrations of endothelin‐1 in acute cluster headache, we measured the plasma endothelin‐1 secretory pattern in 10 men with cluster during and independent of a headache attack.Methods.—We collected blood samples for plasma endothelin‐1 determinations at 0, 15, 30, 45, 60, 90, and 120 minutes during a cluster attack and closely monitored blood pressures. We repeated the same sampling during an asymptomatic period.Results.—The mean values of plasma endothelin‐1 (before a cluster headache, 3.3 ± 0.3 pg/mL) significantly increased (F = 2.578, P<.05) during an attack, reaching their peak at 30 minutes (5.0 ± 0.5 pg/mL, P<.05). We found no significant variations in mean arterial pressure.Conclusion.—Endothelin‐1 may play a role in the pathophysiology of cluster attacks. The increase in plasma observed during cluster attacks may be linked to alterations in systemic hemodynamics and vascular tone.
Epidemiological and Clinical Characteristics of Migraine in Sivas, Turkey
Authors: Kececi Hulusi , Dener Sefik 
Published: March 2003

Objective.—To investigate the epidemiology of migraine in Sivas, Turkey, including its prevalence, clinical characteristics, and impact according to age, sex, and socioeconomic status.Methods.—Thirteen hundred twenty subjects were personally interviewed by a neurologist. Each household member with headache was asked questions regarding their headaches including age at onset, frequency, duration, character, location, severity, aggravating and ameliorating factors, and prodromal and associated symptoms. Migraine diagnoses were determined in accordance with the classification criteria of the International Headache Society.Results.—Migraine was identified in 173 subjects (45 males and 128 females), and lifetime prevalence of migraine was 7.9% (95% CI, 5.66 to 10.1) in males and 17.1% (95% CI, 14 to 20) in females. Aura was reported by 1.4% of males and 3.3% of females.Conclusion.—Migraine prevalence in Turkey is similar to that reported in Europe and the United States.