bluuebunny/crossref_metadata_2025_split huggingface dataset:
Divalproex in the Long‐term Treatment of Chronic Daily Headache
Authors: Freitag Frederick G. , Diamond Seymour , Diamond Merle L. , Urban George J. 
Published: March 2003

Objective.—The purpose of this study was to assess the safety and efficacy of divalproex sodium in the long‐term treatment of chronic daily headache. Correlations between treatment variables were assessed.Background.—Controlled and open‐label trials of divalproex sodium have previously demonstrated its efficacy and safety in the treatment of migraine and chronic daily headaches. These data were primarily short‐term and did not examine interaction between treatment variables.Methods.—Retrospective chart review with data extraction was conducted from headache diaries of 642 current patients under treatment with divalproex sodium for chronic daily headaches. One hundred thirty‐eight of the patients were treated with only divalproex sodium. Demographic variables including age, sex, initial and final body weights, adverse events, dose of divalproex sodium, duration of treatment, and the ability to differentiate their chronic daily headache into its migraine and tension‐type headache components were analyzed. Baseline and end of study headache frequency indices were obtained.Results.—The mean improvement was 47%, with an improvement in migraine of about 65%. At least a 50% reduction in headache frequency was reported by 93 of the 138 patients receiving treatment with only divalproex sodium. No correlation between response and age, sex, duration of treatment, and the prescribed dose of divalproex sodium was demonstrated. Adverse events occurred in approximately 35% of the patients. None were severe. Women were more likely to experience adverse effects than men. Weight gain, however, occurred less commonly in women (mean, 1.9 lbs) than in men (mean, 7 lbs). Initial body weight and age did not correlate with the weight change.Conclusions.—Divalproex sodium can be used for a prolonged period as a sole agent for the successful treatment of chronic daily headache. Nearly 75% of the patients had at least a 50% reduction in headache frequency, and adverse effects occurred in approximately one third. Weight gain was negligible and hepatotoxicity did not occur during treatment periods of up to 6 years.
Delivery Outcome in Women Who Used Drugs for Migraine During Pregnancy With Special Reference to Sumatriptan
Authors: Källén Bengt , Lygner Per Erik 
Published: March 2003

Objective.—To evaluate delivery outcome in women who used drugs for migraine during pregnancy with special reference to sumatriptan.Background.—The safety of the use of drugs for migraine during pregnancy is not established.Design and Methods.—Using the Swedish Medical Birth Registry which contains information on drug use reported by women at the first antenatal visit, 912 infants (born in 905 deliveries) whose mothers had used drugs for migraine were identified, the majority of whom (n = 658) had used sumatriptan.Results.—These women differed from the general population of women who had delivered by being older and more often of first parity, but they had similar smoking habits. Slightly more often, the infants were preterm, and they had a birth weight less than 2500 g; neither of these effects were statistically significant. There seemed to be no difference between infants exposed to sumatriptan and those exposed to other drugs used for migraine. No increase in the rate of congenital malformations was seen.Conclusions.—The data indicate that use of sumatriptan in early pregnancy does not result in a large increase in teratogenic risk, but do not rule out the possibility of a moderate increase in risk for a specific birth defect.
Impaired Circadian Rhythmicity of Nociceptive Reflex Threshold in Cluster Headache
Authors: Nappi G. , Sandrini G. , Alfonsi E. , Cecchini A. Proietti , Micieli G. , Moglia A. 
Published: March 2003

Background.—Alteration of circadian rhythmicity involving several endocrinologic and autonomic parameters has been observed in cluster headache.Objectives.—To explore whether circadian failure of the pain control system may exist in cluster headache.Methods.—The nociceptive flexion reflex threshold was studied in 25 patients with episodic cluster headache (14 active, 11 in remission) and 6 patients with chronic cluster headache, along with 10 normal volunteers throughout a 24‐hour period. The reflex response was evoked at the level of the biceps femoris by stimulating the sural nerve at the ankle. Single and population mean cosinor methods were used to detect the circadian rhythmicity.Results.—In the patients with episodic cluster headache, a significant reduction in the nociceptive flexion reflex threshold was observed in both the active subgroup and the subgroup in remission (P<.05). In these patients, persistence of a significant 24‐hour rhythm during both the active period and remission was observed, but a shift of the phase was observed during clinical activity when compared with the remission period. A lack of circadian nociceptive flexion reflex threshold rhythmicity was found in the patients with chronic cluster headache.Conclusions.—Our findings suggest that in cluster headache there may be impairment of the pain control system that is associated with periodic failure of the mechanisms involved in the organization of biological rhythms.
Prevalences of Migraine and Tension‐type Headache in Adolescent Girls of Shiraz (Southern Iran)
Authors: Ayatollahi S.M.T. , Moradi F. , Ayatollahi S.A.R. 
Published: March 2003

Objective.—To determine the prevalences of migraine and tension‐type headache in teenaged girls attending schools in Shiraz (southern Iran).Background.—Studies of headache prevalence are numerous, and findings have varied according to the specific population and region involved. No data are available regarding headache prevalence among Iranian teenagers.Methods.—A random sample of 1868 teenaged girls (aged 11 to 18 years) was evaluated, and 507 subjects reported headache. The headache disorders were classified on the basis of a clinical interview, general physical and neurologic examinations, and the diagnostic criteria of the International Headache Society. Logistic regression was used for data analysis.Results.—Overall prevalence rate for migraine was 6.1% (95% CI, 5.0 to 7.2) and for tension‐type headache, 12.1% (95% CI, 10.6 to 13.6). Migraine and tension‐type headache were significantly associated.Conclusions.—It is concluded that exposition of subjects to sunlight, type of food, and a family history of headache had most significant effects on occurrence of migraine and tension‐type headaches.
A Polymorphism in the Interleukin‐1α Gene Influences the Clinical Features of Migraine
Authors: Rainero Innocenzo , Pinessi Lorenzo , Salani Giuliana , Valfrè Walter , Rivoiro Chiara , Savi Lidia , Gentile Salvatore , Giudice Rossana Lo , Grimaldi Luigi M.E. 
Published: March 2003

Objective.—To evaluate whether a particular genotype of the interleukin‐1α (IL1A) gene affects the clinical features of migraine.Background.—Proinflammatory mediators have been reported to play a role in the pathophysiology of migraine. Recent studies suggest that polymorphisms in the interleukin‐1 genes influence the age at onset and subsequent course of several chronic inflammatory diseases.Methods.—In a group of 269 patients with migraine, we tested the association of the −889 C/T biallelic polymorphism of the IL1A gene with several clinical features of the disease.Results.—Patients with migraine carrying the T/T genotype show an age at onset of the disease that is significantly (P < .01) lower than IL1A C/C or C/T carriers. In addition, the same genotype was significantly (P < .05) more frequent in patients with migraine with aura than in patients with migraine without aura.Conclusions.—The results of our study suggest a role for the IL1A gene in modifying the clinical features of migraine.
Dopamine Receptor Genes and Migraine With and Without Aura: An Association Study
Authors: Shepherd A. Graeme , Lea Rod A. , Hutchins Colin , Jordan Kathryn L. , Brimage Peter J. , Griffiths Lyn R. 
Published: March 2003

Objective.—To investigate the role of the dopamine receptor genes, DRD1, DRD3, and DRD5 in the pathogenesis of migraine.Background.—Migraine is a chronic debilitating disorder affecting approximately 12% of the white population. The disease shows strong familial aggregation and presumably has a genetic basis, but at present, the type and number of genes involved is unclear. The study of candidate genes can prove useful in the identification of genes involved in complex diseases such as migraine, especially if the contribution of the gene to phenotypic expression is minor. Genes coding for proteins involved in dopamine metabolism have been implicated in a number of neurologic conditions and may play a contributory role in migraine. Hence, genes that code for enzymes and receptors modulating dopaminergic activity are good candidates for investigation of the molecular genetic basis of migraine.Methods.—We tested 275 migraineurs and 275 age‐ and sex‐matched individuals free of migraine. Genotypic results were determined by restriction endonuclease digestion of polymerase chain reaction products to detect DRD1 and DRD3 alleles and by Genescan analysis after polymerase chain reaction using fluorescently labelled oligonucleotide primers for the DRD5 marker.Results.—Results of chi‐square statistical analyses indicated that the allele distribution for migraine cases compared to controls was not significantly different for any of the three tested gene markers (χ2  =  0.1, P  =  .74 for DRD1; χ2  =  1.8, P  =  .18 for DRD3; and χ2  =  20.3, P  =  .08 for DRD5).Conclusions.—These findings offer no evidence for allelic association between the tested dopamine receptor gene polymorphisms and the more prevalent forms of migraine and, therefore, do not support a role for these genes in the pathogenesis of the disorder.
Effects of Fluoxetine on Habituation of Pattern Reversal Visually Evoked Potentials in Migraine Prophylaxis
Authors: Ozkul Yasar , Bozlar Senay 
Published: March 2003

Objective.—To investigate the effects of fluoxetine in migraine prophylaxis on habituation of visually evoked potentials. Background.—Habituation of pattern reversal visually evoked potentials was found to be abnormal in migraine between attack, and this abnormality was most likely due to serotonergic pathway dysfunction in the brain stem. Methods.—One hundred nineteen subjects were included in the study: 40 healthy volunteers and 79 migraineurs not taking any prophylactic migraine medication (44 without aura and 35 with aura). Visually evoked potentials in migraineurs were recorded in the headache‐free interval. Amplitude change of the visually evoked potentials (N1‐P1) was measured between the first and fifth block of 50 sequential averagings during continuous stimulation at 3.1 Hz. All migraineurs were placed on fluoxetine 20 mg/day for prophylaxis of migraine. One month later, visually evoked potentials were recorded again. Results.—Mean amplitude changes in the fifth block expressed as percentages of the first block were −13.4% ± 19.2% in healthy volunteers, 9.8% ± 23.3% in migraine without aura, and 4.4% ± 8.7% in migraine with aura during the baseline period. The difference was significant between migraineurs and healthy volunteers (both P = 0.0001), but not between migraineur groups. After treatment, amplitude changes were −9.3% ± 14.5% in migraine without aura and −10.1% ± 11.5% in migraine with aura. Habituation pattern tended to normalize with prophylactic treatment, and mean amplitude changes were not significant between migraineurs and healthy volunteers (both P = 0.4). Conclusions.—We concluded that the fluoxetine prophylaxis corrects the interictal deficit of habituation in migraineurs.
Prevalence of Migraines in NCAA Division I Male and Female Basketball Players
Authors: Kinart Chad M. , Cuppett Marchell M. , Berg Kris 
Published: March 2003

Objective.—The purpose of this study was to describe the overall prevalence of migraines within National Collegiate Athletic Association Division I men's and women's basketball players. In addition, the prevalence of migraines was determined across gender and ethnic groups for the same sample. Background.—Although numerous studies have assessed the prevalence of migraines within the general population, college students, professional groups, industrial/work place settings, and overseas populations, little has been done with athletes. To the best of our knowledge, no study of the incidence of migraines in athletes has been previously conducted. It has also been reported that migraines cause depression, insomnia, fatigue, anorexia, nausea, and vomiting, all of which might hinder athletic performance. Sports medicine clinicians and researchers also agree that migraines in athletes are probably underreported and often misdiagnosed. Methods.—Seven hundred ninety‐one Division I men and women basketball players representing 51 colleges and universities were mailed a previously validated survey asking questions about headaches. All surveys were analyzed with a validated diagnostic algorithm consistent with the International Headaches Society's (IHS) criteria for headache diagnosis. Descriptive statistics were used to report the prevalence rate for gender and ethnic groups, as well as the entire sample. Chi‐square tests were performed (P = 0.05) to determine if there were any differences in the prevalence of migraines among gender and ethnic groups. Results.—Results showed that 2.9% (n = 23 of 791) of the total sample was classified as having migraines meeting IHS guidelines. In addition, 0.9% (n = 3 of 332) of men and 4.4% (n = 20 of 459) of women were classified as having migraines meeting IHS guidelines. Additionally, results showed that women reported migraines (χ2 = 8.140, P = 0.004) more often than men. When comparing the prevalence rates of migraines between ethnic groups, results showed that Caucasians had a rate of 3.3% (n = 14 of 429), whereas African Americans had a rate of 3.1% (n = 9 of 287). There was no significant difference found between ethnic groups in migraine prevalence (χ2 = 2.491, P = 0.2888). Conclusions.—In conclusion, it was found that the prevalence of migraines in National Collegiate Athletic Association Division I men's and women's basketball players was generally less than in the general population, that women showed an increased prevalence of migraines when compared with men, and that Caucasians and African Americans did not differ in prevalence of migraines.
Triptans for Migraine Management in Adolescents
Authors: Winner Paul 
Published: March 2003

Objective.—To review triptan efficacy and tolerability data for adolescent migraine sufferers to assist clinicians in selecting triptans for this age group. Background.—Migraine is a common cause of headache among adolescents. To date, no medications, including those with proven headache relief in adults, have been approved for treatment of migraine in adolescents. Methods.—Recent triptan clinical trials conducted in adolescent migraine sufferers 12 to 17 years of age were reviewed and results were summarized. Results.—The success of individual triptan clinical trials conducted in adolescent appears related to time to treatment (1.9 to 6 hours), placebo response (25% to 57%), and day of the week (weekday versus weekend). Overall, triptan tolerability in adolescents is similar to that reported in adults. Conclusion.—Study results suggest that the triptan class of antimigraine drugs may effectively alleviate migraine in adolescents. Future research should address placebo response and earlier treatment paradigms.
Migraine Medication Attributes Important for Patient Compliance: Concerns About Side Effects May Delay Treatment
Authors: Gallagher R. Michael , Kunkel Robert 
Published: March 2003

Objectives.—To determine the level of concern among migraineurs about migraine prescription medication tolerability and adverse effects and the impact of these concerns on their self‐management of migraine.Methods.—Self‐completion questionnaires were mailed from the National Family Opinion household panel to a prequalified sample of 4000 adults (aged 18 years or older) who reported severe headache and migraine. Those who met the International Headache Society symptom criteria for migraine and reported use of prescription medication to treat their migraines were included in the descriptive analysis.Results.—A total of 2444 (61%) sufferers of severe headache/migraine returned a completed survey, and 56% of these (n  =  1160) met the target criteria for the study. Of those meeting the criteria, pain relief and speed of onset were important product attributes for 75% to 77% of sufferers, and the absence of adverse effects was important to over 40%. Two‐thirds of sufferers specifically had delayed or avoided taking a current prescription medication because of concerns about adverse effects. These concerns led to a delay in taking medication in 37% of treated migraine episodes and to medication avoidance in 44% of untreated attacks during the previous 6 months, resulting in more intensive and longer duration of pain, the need to rest and cancel social activities, and suboptimal performance. Almost 8 of 10 (79%) sufferers showed an interest in trying a novel product with similar efficacy but fewer adverse effects than other prescription migraine medications.Conclusions.—Adverse effects are an important factor in migraine management, and concern about adverse effects significantly affected patient compliance.
Disability and Chronic Posttraumatic Headache
Authors: Marcus Dawn A. 
Published: March 2003

Objective.—To test the hypothesis that chronic posttraumatic headache is associated with greater severity and psychological distress than headache of nontraumatic origin.Methods.—Two hundred eighty‐nine consecutive patients with chronic headache attending a university headache clinic were evaluated. Questionnaires about headache symptoms, quality of life (Medical Outcome Survey SF‐36 Health Survey), and psychological distress were completed.Results.—Frequent headache (>4 days per week) occurred more often with traumatic (84%) than nontraumatic headache (60%). Traumatic headache resulted in greater reduced activity (3.31  ±  1.06 days per week versus 2.62  ±  1.11 days per week with nontraumatic headache; P  <  .001) and complete disability (2.89  ±  1.17 days per week versus 2.25  ±  1.17 days per week with nontraumatic headache; P  <  .001). Physical function was also rated significantly lower in patients with traumatic headache (SF‐36 score: 59.8  ±  27.7 versus 71.6  ±  26.4 with nontraumatic headache; P  <  .01). These differences were not attributable to differences in headache frequency or gender between patients with traumatic and nontraumatic headache. Psychological symptoms were similar between patients with traumatic and nontraumatic chronic headache.Conclusions.—Chronic traumatic headache is associated with increased headache frequency and disability compared with nontraumatic headache. Headache evaluation should include an investigation for origin of headache and consideration for more aggressive treatment in patients with traumatic headache.
Clinical Pharmacokinetics of Frovatriptan
Authors: Buchan P. , Keywood C. , Wade A. , Ward C. 
Published: March 2003

Objective.—To review available data on the clinical pharmacokinetics of frovatriptan.Background.—Preclinical data suggest that the pharmacokinetic profile of frovatriptan may differ from that of the currently available triptans.Methods.—Studies of healthy volunteers, subjects with renal or hepatic impairment, elderly subjects, and patients with migraine during and between attacks were reviewed.Results.—Oral bioavailability of frovatriptan is 22% to 30%, and although the time to maximum concentration is typically 2 to 3 hours, approximately 60% to 70% of plasma maximum concentration is achieved within 1 hour of dosing. Frovatriptan distributes into erythrocytes, with binding reversible and time dependent. The relatively long terminal elimination half‐life (about 26 hours) confers good systemic exposure and may produce a long duration of therapeutic action, thus reducing migraine recurrence and the need for redosing. Systemic exposure to frovatriptan generally correlates with dose between 1 and 100 mg. Blood and plasma frovatriptan concentrations are consistently higher in females, but there is no need to adjust dose according to gender. Pharmacokinetics are essentially unaffected by food and were predictable after repeat dosing; steady state is approached in about 4 to 5 days. Pharmacokinetics were changed only slightly in subjects with renal impairment or mild‐to‐moderate hepatic impairment, elderly individuals, and during migraine attacks. Frovatriptan is principally metabolized by the CYP1A2 isoenzyme of cytochrome P‐450 and is cleared by the kidney and liver, each having sufficient capacity to compensate for impairment of the other.Conclusions.—Frovatriptan can be taken without regard for food intake, and because of the large therapeutic margin and shallow dose‐response curve, there is no need for dosage adjustment in the elderly, in women taking a combined oral contraceptive, in patients with mild‐to‐severe renal impairment, mild‐to‐moderate hepatic impairment, or according to gender. The long duration of exposure may reduce the likelihood of early migraine recurrence.
Time Course of Postoperative Recovery of N‐Acetyl‐Aspartate in Temporal Lobe Epilepsy
Authors: Serles W. , Li L. M. , Antel S. B. , Cendes F. , Gotman J. , Olivier A. , Andermann F. , Dubeau F. , Arnold D. L. 
Published: March 2003

Summary:  Purpose: To assess the time course of increases in N‐acetyl‐aspartate/creatine (NAA/Cr), which can be measured using proton MR spectroscopic imaging (1H‐MRSI), in patients with intractable nonlesional temporal lobe epilepsy (TLE) after successful epilepsy surgery.Methods: We performed pre‐ and postoperative 1H‐MRSI in 16 seizure‐free (SF) patients and 16 not seizure‐free (NSF) TLE patients. We calculated a mixed‐design analysis of variance (ANOVA) between SF and NSF groups, ipsi‐ and contralateral to the side of operation, and pre‐ and postoperative NAA/Cr measurements. We applied nonlinear regression between pre‐ and postoperative NAA/Cr differences and the time interval between 1H‐MRSI scans to fit a negative exponential model to NAA recovery.Results: Mixed‐design ANOVA revealed that (a) postoperative NAA/Cr was significantly higher in SF than in NSF patients (p = 0.02) and that (b) in the SF group, postoperative NAA/Cr values were significantly higher than preoperative values (p < 0.05) and returned to the normal range in most patients. According to our nonlinear regression model, in SF patients, there was a 50% increase relative to preoperative NAA/Cr values after 5.8 months, whereas an improvement of 95% was reached after 25 months.Conclusions: Our results extend preliminary observations of postoperative NAA recovery of SF patients by characterizing the time course of recovery as an exponential function with a half‐time of ∼6 months. The reversal of neuronal metabolic dysfunction remote from the epileptic focus may underlie the clinical observation of improvement of cognitive dysfunction after successful epilepsy surgery.