bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spatio‐temporal Imaging of Cortical Desynchronization in Migraine Visual Aura: A Magnetoencephalography Case Study
Authors: Hall Stephen D. , Barnes Gareth R. , Hillebrand Arjan , Furlong Paul L. , Singh Krish D. , Holliday Ian E. 
Published: March 2004

Objective.—To determine cortical oscillatory changes involved in migraine visual aura using magnetoencephalography (MEG).Background.—Visual aura in the form of scintillating scotoma precedes migraine in many cases. The involvement of cortical spreading depression within striate and extra‐striate cortical areas is implicated in the generation of the disturbance, but the details of its progression, the effects on cortical oscillations, and the mechanisms of aura generation are unclear.Methods.—We used MEG to directly image changes in cortical oscillatory power during an episode of scintillating scotoma in a patient who experiences aura without subsequent migraine headache. Using the synthetic aperture magnetometry method of MEG source imaging, focal changes in cortical oscillatory power were observed over a 20‐minute period and visualized in coregistration with the patient's magnetic resonance image.Results.—Alpha band desynchronization in both the left extra‐striate and temporal cortex persisted for the duration of reported visual disturbance, terminating abruptly upon disappearance of scintillations. Gamma frequency desynchronization in the left temporal lobe continued for 8 to 10 minutes following the reported end of aura.Conclusions.—Observations implicate the extra‐striate and temporal cortex in migraine visual aura and suggest involvement of alpha desynchronization in generation of phosphenes and gamma desynchronization in sustained inhibition of visual function.
Effectiveness of Eletriptan in Acute Migraine: Primary Care for Excedrin Nonresponders
Authors: Diamond Merle L. , Hettiarachchi Jayasena , Hilliard Barbara , Sands George , Nett Robert 
Published: March 2004

Objective.—To evaluate the effectiveness of eletriptan as a treatment for acute migraine in patients who were poor responders to Excedrin and had not yet been exposed to a triptan.Background.—Self‐medication with over‐the‐counter drugs, such as Excedrin, is the most common treatment for migraine. Guidelines, however, recommend that triptans be used as first‐line treatment of moderate to severe migraine—the severity affecting approximately 80% of migraineurs. Since over‐the‐counter medications, such as Excedrin, continue to be used in many patients, it is important that clinicians have information on the efficacy of triptans as first‐line treatment and on treatment of migraineurs who have shown poor response to over‐the‐counter medications.Methods.—One hundred ten patients meeting criteria for migraine who were poor responders to Excedrin received open‐label treatment with a 40‐mg dose of eletriptan for one migraine attack. Efficacy assessments were made at 1, 2, 4, and 24 hours postdose and consisted of headache and pain‐free response rates, absence of associated symptoms, and functional response.Results.—At 1 hour, the headache response rate was 44%; at 2 hours, 81%. The pain‐free response rate at 1 hour was 14% and at 2 hours, 48%. At 2 hours, relief of baseline‐associated symptoms ranged from 74% to 80%. Functional response was achieved by 82% of patients by 2 hours, and 68% of patients achieved relief of migraine that was sustained across 24 hours with no need for a second dose of eletriptan or for rescue medication. Eletriptan was well tolerated with adverse events being transient and mild to moderate in intensity.Conclusion.—Previous studies have established the efficacy of eletriptan as a first‐line treatment for migraine. The results of this open‐label trial demonstrate that the 40‐mg dose of eletriptan had a high degree of efficacy and tolerability among patients who were poor responders to Excedrin.
Factors Related to School Absenteeism in Adolescents With Recurrent Headache
Authors: Breuner Cora Collette , Smith Mark Scott , Womack William M. 
Published: March 2004

Objective.—To examine possible risk and protective factors for school absenteeism among adolescents referred to a hospital‐based behavioral treatment program.Design.—Data obtained from intake interviews, screening questionnaires, and baseline headache diaries of 283 consecutive adolescents referred for behavioral treatment of recurrent headache were reviewed for demographics, length of headache history, headache type, current headache activity, symptoms of anxiety and depression, perceived self‐efficacy regarding headache control, school performance, participation in extracurricular activities, and school absenteeism. The study population was divided into 2 groups at the median number of days missed due to headache in the previous 6 months that school was in session. Adolescents who missed 2 or less days of school due to headache (low absenteeism) were compared with those who missed more than 2 days (high absenteeism).Results.—Compared with the low absenteeism group, the high absenteeism group had higher scores on the Children's Depression Inventory (8.7 ± 6.5 versus 6.8 ± 6.2, P < .05) and lower academic performance (2.1 ± 1.0 versus 1.7 ± 0.8, P < .0001). The 2 groups were not statistically different in age, sex, length of headache history, type of headache, current headache frequency or intensity scores, anxiety scores, self‐efficacy ratings, or participation in extracurricular activities.Conclusions.—In a referred population, students who missed more school due to headache had higher depression scores and lower academic performance than students who missed less school. A directional relationship, however, cannot be implied from these results. Future studies should investigate the complex relationship between recurrent adolescent headache, potential risk or protective factors, and school absenteeism.
Blood Pool Scintigraphy of the Skull in Relation to Head‐Down Tilt Provocation in Patients With Chronic Tension‐Type Headache and Controls
Authors: Hannerz Jan , Schnell P.‐O. , Larsson Stig , Jacobsson Hans 
Published: March 2004

Objective.—To investigate the mechanisms behind the increase of chronic tension‐type headache during head‐down tilt.Background.—The pathophysiology of chronic tension‐type headache is unknown.Design and Methods.—Ten patients suffering from chronic tension‐type headache and 10 age‐ and sex‐matched controls were studied with respect to pain intensity and alterations in cranial blood volume using planar scintigraphy and radiolabeled autologous erythrocytes before, during, and after head‐down tilt, a procedure known to increase chronic tension‐type headache.Results.—Four of 8 patients with chronic tension‐type headache studied had increased cerebrospinal fluid pressure. During head‐down tilt, the pain increased significantly in the group with chronic tension‐type headache (P < .001) while the procedure did not cause headache in the controls. Blood volume significantly increased extracranially and decreased intracranially in both groups during head‐down tilt. The extracranial nasal blood volume was significantly related to the pain experienced by the patients with chronic tension‐type headache before and during head‐down tilt.Conclusions.—Although the changes in blood volume and, presumably, the increase of intracranial pressure were similar in the patients with chronic tension‐type headache and the controls, only the patients experienced pain and pain increase during head‐down tilt. This indicates that the pre‐head‐down tilt conditions must be different in the 2 groups and should be related to increased cerebrospinal fluid pressure/intracranial venous pressure in patients with chronic tension‐type headache compared with controls. A difference in central mechanisms may, however, also be of importance for the difference in headache provocation in the 2 groups during head‐down tilt.
Prophylactic Treatment of Pediatric Migraine
Authors: Lewis Donald W. , Diamond Sharon , Scott David , Jones Valarie 
Published: March 2004

Background.—Migraine occurs in 3% to 5% of young children and up to 18% of adolescents. Management requires a tailored regimen of pharmacological and behavioral measures that consider the headache burden and disability. Patients with frequent or disabling attacks (or both) may warrant preventive agents.Objective.—To investigate the patterns of prophylactic treatment of pediatric migraine within one pediatric neurology practice.Methods.—All charts of patients diagnosed with headache (International Classification of Diseases [ICD] code 784.0) and migraine (codes 346.0, 346.1, and 346.2) during January 2001 July 2001 were retrospectively reviewed to identify diagnosis, demographics, medical decision making, rationale for treatment selections, and outcome assessments. Migraine was diagnosed according to the 1997 proposed pediatric migraine revisions to the International Headache Society.Results.—Charts of 250 children and adolescents, aged 3.2 to 18 years (mean, 12), were reviewed. One hundred twenty‐six (50%) were prescribed prophylaxis, along with intermittent analgesic agents. Mean age of those provided with daily prophylaxis was 12.4 years (range, 3.9 to 18), and the mean age of those managed with intermittent therapies was 11.5 years.Preventive agents included amitriptyline (n = 73), cyproheptadine (n = 30), propranolol (n = 8), valproic acid (n = 3), naproxen (n = 3), nimodipine (n = 3), imipramine (n = 3), and topiramate (n = 3). Amitriptyline was the most commonly prescribed agent (58%). Ten patients initially treated with other agents were changed to amitriptyline. Fifteen patients required dosing adjustments, 2 stopped treatment, and 7 changed to other agents for lack of efficacy. Mean headache frequency before treatment was 10.9 per month (range, 4 to 15). After treatment, the mean headache frequency decreased to 4.1 per month (range, 0 to 12), a decrease of 62.4% (n = 54). The overall positive response rate was 89%.Cyproheptadine was the second most commonly prescribed agent (mean age, 8.8 years). Thirty patients were initially treated, 5 later changed to cyproheptadine, 6 required dosage changes, 5 changed to other agents for lack of efficacy, and 1 stopped treatment. Mean headache frequency before treatment was 8.4 per month (range, 4 to 15) and following treatment decreased to 3.75 per month (range, 0 to 12), a decrease of 55.3%. The overall positive response rate was 83%.Conclusions.—Fifty percent of patients with migraine were prescribed daily prophylactic medicines, reflecting a referral bias. The most commonly prescribed agents were amitriptyline (preferred for the older patients) and cyproheptadine (preferred for the younger patients). The overall positive response rates were 89% for amitriptyline and 83% for cyproheptadine during a 6‐month follow‐up. Headache frequencies were reduced with amitriptyline by 62% and with cyproheptadine by 55%. Long‐term follow‐up of this population is ongoing, and prospective studies are needed.
Efficacy and Safety of Levetiracetam in Pediatric Migraine
Authors: Miller G. Steve 
Published: March 2004

Background.—Headache is a frequent occurrence among children and adolescents. Chronic headaches can be severe and disabling, and require prophylactic treatment; however, additional data on the use of prophylactic medications for migraine in children are needed.Objective.—To review the efficacy and safety of levetiracetam (Keppra) in pediatric patients with a history of recurrent headache.Design/Methods.—Data from 19 pediatric patients were retrospectively reviewed. The initial dose of levetiracetam was usually 125 or 250 mg twice daily, but varied depending upon clinical judgment.Results.—Charts of 9 girls and 10 boys (mean age, 11.9 years) were reviewed. A variety of medications, including triptans, had been used before initiating treatment with levetiracetam. Mean headache frequency before treatment was 6.3 per month (standard deviation [SD], 3.8; confidence interval [CI], 4.4 to 8.1). Duration of headaches ranged from 0.25 to 8 years. Migraine (63.2%) and migraine with aura (15.8%) were the most common types of headache reported. Most patients (89.5%) had headaches that were severe. After treatment, the mean headache frequency decreased to 1.7 per month (SD, 2.7; CI, 0.4 to 3.0), representing a reduction compared with baseline (P < .0001). Levetiracetam eliminated headaches in 10 patients (52.6%), and 7 patients (36.8%) had less severe and less frequent headaches. Levetiracetam did not have an effect on headaches in 2 patients (10.5%). Mean duration of treatment with levetiracetam was 4.1 months. Doses ranged from 125 to 750 mg twice daily. Sixteen patients (84.2%) reported no side effects on levetiracetam. One patient experienced asthenia/somnolence and dizziness, and irritable, hyperactive, and hostile behavior led to discontinuation of levetiracetam in another patient. A third patient experienced irritability and moodiness that attenuated after 1 month of treatment and did not require discontinuation.Conclusions.—In this small retrospective review, levetiracetam was found to be generally well tolerated and appears to be a promising candidate for additional evaluation in well‐controlled clinical trials of pediatric patients with migraine.
Cerebral Vasospasm and Headache During Sexual Intercourse and Masturbatory Orgasms
Authors: Valença Marcelo M. , Valença Luciana P. A. A. , Bordini Carlos A. , Da Silva Wilson Farias , Leite João P. , Antunes‐Rodrigues José , Speciali José G. 
Published: March 2004

Background.—The pathophysiology of the explosive type of headache associated with sexual activity is not completely understood. Five reported cases of patients with thunderclap headache, precipitated by sexual activity, in association with concomitant cerebral arterial narrowing, were found in the literature.Methods.—A 44‐year‐old woman with both coital and masturbatory headaches during orgasm associated with segmental reversible cerebral artery vasospasm was investigated. Cerebral anatomy and eventual spasm was documented by magnetic resonance imaging or digital angiography before, during, and after resolution of the orgasmic headache‐vasospasm clinical manifestation.Conclusion.—Findings of cerebral arterial narrowing, presented by some patients shortly after orgasmic headache attacks, support the hypothesis that segmental vasospasm may exert a role in the pathogenesis of this uncommon type of headache. The literature is reviewed, and possible mechanisms underlying the development of orgasmic headache are discussed.
Outpatient Intravenous Dihydroergotamine for Refractory Cluster Headache
Authors: Magnoux E. , Zlotnik G. 
Published: March 2004

Objective.—To evaluate the efficacy and safety of outpatient intravenous dihydroergotamine (DHE) for treatment of refractory cluster headache.Method.—Medical records were retrospectively reviewed of all patients with cluster headache who received outpatient intravenous DHE for treatment of refractory cluster headache between January 1992 and May 2000.Results.—One hundred four treatments were identified in 70 patients. There were 7 dropouts. Of the 97 completed treatments, 60 were for episodic cluster headache and 37 were for chronic cluster headache. Results for all treatments showed complete resolution of pain during the intravenous phase at 1 month in 61 (63%) of 97 cases, partial resolution in 13 cases (15%), and failure in 23 cases (24%). For the treatment of episodic cluster headache, there was complete resolution in 44 (73%) of 60 cases, partial resolution in 9 cases (13%), and failure in 7 cases (12%). For treatment of chronic cluster headache, there was complete resolution in 17 (46%) of the 37 cases, partial resolution in 4 cases (11%), and 16 failures (43%). As regards side effects and safety, the treatment triggered chest pain suspected of being vasospastic angina in 1 patient on day 7 of the treatment, when she was in the subcutaneous phase. Two patients dropped out due to fear of the injection, 1 because of palpitations, 1 because of chest tightness, and 2 others because of leg cramps, nausea, and diarrhea.Conclusions.—Outpatient intravenous DHE is a safe treatment. It is useful for refractory cluster headache, is more effective for the episodic form than the chronic form, and has a rapid onset of action. It did not change the evolution of the episodic form, but it did appear to induce remission in the chronic form or transform it to the episodic form. We advance a hypothesis to explain this.
Hourglass Deformity After Botulinum Toxin Type A Injection
Authors: Guyuron Bahman , Rose Kevin , Kriegler Jennifer S. , Tucker Tarvez 
Published: March 2004

Background.—Complications, such as eyelid ptosis, have been attributed to botulinum toxin type A. An “hourglass” deformity, which is the consequence of temporalis muscle atrophy, has not been reported previously.Objective.—To report a transient muscle deformity of the temporalis muscle caused by botulinum toxin type A.Methods.—Patients who underwent injection of 25 units of botulinum toxin type A into the temporal muscle, in a fan‐shaped fashion, during an ongoing study for treatment of migraine were noted to develop temporary depression of the temples. Preinjection and postinjection photographs were taken. Patients were also sent questionnaires to verify the observed information.Results.—Only 26 of 92 patients who underwent injection of botulinum toxin type A into the temporalis muscle subsequently reported depression of the muscle. When examined, all 92 patients exhibited this deformity ranging from minimal to significant. Patients who seemed to have less deformity were those who had excessive soft tissue overlying the muscle due to excess weight.Conclusion.—A newly recognized deformity is reported subsequent to the injection of botulinum toxin type A into the temporalis muscle. Informing patients of this transient deformity may minimize concern following treatment.
Migraine‐Associated Seizures With Recurrent and Reversible Magnetic Resonance Imaging Abnormalities
Authors: Mateo Ignacio , Foncea Nerea , Vicente Iñigo , Beldarrain Marian Gómez , Garcia‐Monco Juan Carlos 
Published: March 2004

Migraine and epilepsy are highly comorbid, but the nature of their association remains unclear. Exceptionally, reversible brain magnetic resonance imaging (MRI) abnormalities following migraine and seizures have been reported. There are no descriptions, however, of patients with recurrent brain MRI changes.We report a patient with repeated episodes of migraine‐with‐aura–associated seizures (migralepsy) and recurrent and reversible brain MRI abnormalities. Location of the abnormalities was always consistent with the neurologic deficits.The possibility that transient brain MRI abnormalities in a patient with migraine with aura followed by seizures may be due to migralepsy should be borne in mind to avoid misdiagnosis and potentially aggressive procedures.
Cost Considerations of Acute Migraine Treatment
Authors: Adelman James U. , Adelman Leon C. , Freeman Marshall C. , Von Seggern Randal L. , Drake Jaclyn 
Published: March 2004

Objective.—To provide medication price data and cost‐reducing strategies for the acute treatment of migraine.Methods.—Retail prices for common acute care medications were found athttp://www.drugstore.com. Cost‐reduction tactics were obtained from literature searches and clinical experience.Results.—Several strategies can reduce cost without sacrificing treatment outcome. In mild to moderate migraine, low‐priced nonsteroidal anti‐inflammatory drugs can be used as first‐line medications due to their proven efficacy and favorable tolerability. For patients with more severe migraine, implementing a stratified care approach—using migraine‐specific medications early in acute treatment—is cost‐effective for most patients. Stratified care not only improves outcome and decreases disability, but also reduces cost.Pill splitting and early administration of triptans within an attack enhance their value. Supplying rescue medications, such as opioids, sedatives, and phenothiazines, can prevent emergency department visits. Minimizing multiple dosing of triptans and reducing utilization of expensive health care resources are key factors in reducing the cost of effective migraine treatment. An important affordability factor for patients with co‐payments is the number of triptan pills per package. Sumatriptan, naratriptan, and frovatriptan each contain 9 tablets per package, while most other triptan packages contain 6.Current triptan retail prices (per unit) include: Amerge 1 and 2.5 mg, $17.78; Axert 6.25 and 12.5 mg, $16.31; Frova 2.5 mg, $13.89; Imitrex 50 mg, $14.96; Imitrex 100 mg, $14.41; Imitrex Nasal Spray 20 mg, $21.61; Imitrex SQ 6 mg, $50.26; Maxalt 5 and 10 mg, $15; Maxalt‐MLT 5 and 10 mg, $15; Relpax 40 mg, $13.58; Zomig 2.5 mg, $13.67; Zomig 5 mg, $15.89; Zomig‐ZMT 2.5 mg, $13.67; and Zomig‐ZMT 5 mg, $15.89.Conclusions.—Practitioners can optimize the use of health care dollars without compromising quality of care through awareness of cost‐saving treatment strategies, as well as price variations among medications.
Selective Vasodilator Effect of Magnesium Sulfate in Human Placenta
Authors: Holcberg Gershon , Sapir Olga , Hallak Mordechai , Alaa Amash , Shorok Haj‐Yhia , David Yohay , Katz Miriam , Huleihel Mahmoud 
Published: March 2004

Problems:  To determine if magnesium sulfate (MgSO4) attenuates the vasoconstrictor effect of angiotensin II (Ag II), endothelin‐1 (ET‐1) and thromboxane mimetic (TX) in the human fetal–placental vasculature and if interleukin‐1 beta (IL‐1β) is involved in this process.Study design:  Isolated placental cotyledons (n = 18) were dually perfused with fetal perfusion pressure used as an index of vascular response. The vasoconstriction effect of bolus injection of various concentrations of Ag II (10−10–10−6 m) or ET‐1 (10−10–10−4 m) or TX (10−10–10−5 m) was established in the absence or presence of MgSO4 (7 mg% constant infusion during 10 hr). Statistical significance was determined by paired t‐test and anova.Results:  MgSO4 significantly attenuates the vasoconstrictor effect of Ag II in the fetal–placental vasculature in the human placenta (P = 0.02). Moreover, significant attenuation of vasoconstrictor response to ET‐1 (10−10–10−5 m) was observed in the presence of MgSO4 (P = 0.02). However, no attenuation of the vasoconstrictor response to TX was noted in the presence of MgSO4 (P > 0.5). Ag II and TX were shown to induce IL‐1β secretion by placental tissue. This effect was completely reduced by perfusion of MgSO4 (7 mg%; constant infusion).Conclusions:  MgSO4 significantly attenuates the vasoconstrictor effect of Ag II and ET‐1 in the fetal–placental vasculature in the human placenta, but not that of TX. Inhibition of local production of IL‐1β could be one of the mechanisms used by MgSO4 to reduce the vasoconstrictory effect of Ag II and TX in human placental cotyledone.