bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Guided Imagery on Quality of Life for Patients With Chronic Tension‐Type Headache
Authors: Mannix Lisa K. , Chandurkar Rohit S. , Rybicki Lisa A. , Tusek Diane L. , Solomon Glen D. 
Published: March 2003

Objective.—To determine the effect of adjuvant guided imagery on patients with chronic tension‐type headache.Background.—Management of chronic tension‐type headache often requires a combination of pharmacological and nonpharmacological therapies. Guided imagery is a relaxation technique based on visualizing pleasant images and body awareness.Methods.—One hundred twenty‐nine patients with chronic tension‐type headache completed the Headache Disability Inventory and the Medical Outcomes Study Short Form (SF‐36) at their initial visit to a specialty headache center and again 1 month after the visit. In addition to individualized headache therapy, patients listened to a guided imagery audiocassette tape daily for the month. One hundred thirty‐one control subjects received individualized therapy without guided imagery.Results.—Controls and the patients who listened to the guided imagery tape improved in headache frequency, headache severity, patient global assessment, quality of life, and disability caused by headache. More guided imagery patients (21.7%) than controls (7.6%) reported that their headaches were much better (P.004). The guided imagery patients had significantly more improvement than the controls in three of the SF‐36 domains: bodily pain (95% CI; guided imagery patients 11.0, controls 0.2), vitality (95% CI; guided imagery patients 10.9, controls l.7), and mental health (95% CI; guided imagery patients 7.8, controls 0.4).Conclusions.—Guided imagery is an effective adjunct therapy for the management of chronic tension‐type headache.
Headaches in a Pediatric Emergency Department: Etiology, Imaging, and Treatment
Authors: Kan Li , Nagelberg Joy , Maytal Joseph 
Published: March 2003

Objective.– To assess the spectrum of diagnoses, the use of CT scans of the brain, and pharmacological treatments in patients presenting to a pediatric emergency department with headaches as the chief complaint.Methods.– A 1‐year retrospective chart review of all children who presented to the emergency department with a headache as the chief complaint.Results.– One hundred thirty patients (0.7% of all pediatric emergency department visits, mean age = 9.3 years) were included in the study. Primary headaches included 11 migraine (8.5%) and 2 tension headaches (1.5%). Most of the secondary nonneurological headaches were associated with viral and respiratory illnesses (
n=37, 28.5%), while the majority of the secondary neurological headaches included 26 posttraumatic (20%), 15 possible ventriculoperitoneal shunt malfunctions (11.5%), and 3 cases of aseptic meningitis (2.3%). The neurological etiology in 9 of these children (6.9%) was found to be serious (subdural hematoma, epidural hematoma, proven ventriculoperitoneal shunt malfunction, brain abscess, pseudotumor cerebri, and aseptic meningitis). Fifteen patients could not be etiologically classified, either because no specific etiology was found or their discharge diagnoses could not clearly explain the headache. Approximately 10% (5/53) of the CT scans of the head that were performed showed new abnormal findings including hydrocephalus secondary to ventriculoperitoneal shunt malfunction (2), subdural hematoma (1), epidural hematoma (1), and skull fracture (1). Forty‐two patients (32%) were treated pharmacologically. Thirty‐nine of the 42 treated patients (93%) were given over‐the‐counter analgesics, and 9 (21%) were given prescribed analgesics.Conclusions.– The majority of the headaches in the pediatric emergency department were secondary to concurrent illness and minor head trauma, and required no pharmacological treatment or only treatment with minor analgesics. In a small minority of patients, headaches were secondary to serious neurological conditions, which required immediate medical attention. Computed tomography scans showed new abnormalities in a minority of patients and should be reserved for those with neurological diagnoses such as head trauma and ventriculoperitoneal shunt, as well as for those patients with recent onset of headaches with no clear etiological explanation, and for those with high‐risk medical conditions, such as hypocoagulabilities. Future prospective studies are needed to assess the efficacy of the various pharmacological treatments in this population.
Montelukast in the Prophylaxis of Migraine: A Potential Role for Leukotriene Modifiers
Authors: Sheftell F. , Rapoport A. , Weeks R. , Walker B. , Gammerman I. , Baskin S. 
Published: March 2003

Objective.–Clinical observation of a decrease in migraine frequency in patients with comorbid asthma taking montelukast, a specific D4 leukotriene receptor antagonist, or zafirlukast, another leukotriene receptor antagonist, prompted us to explore a possible role for leukotriene modifiers in the treatment of migraine. (A further prompt was a pharmacist colleague's observation that a number of patients on these agents reported a decreased sensitivity to perfume triggers and improvement in migraine.)Background.–Nonsteroidal anti‐inflammatory agents have been used widely in the treatment of migraine. Another class of anti‐inflammatory agents, known as leukotriene modifiers, have not been studied to date with regard to their possible role in the treatment of migraine. The name “leukotriene” is derived both from the parent molecule, which was originally isolated from leukocytes, and from its three double‐bond carbon backbone or triene structure. Both prostaglandins and leukotrienes are derived from the metabolism of arachidonic acid, with prostaglandins coming off the cyclooxygenase pathway and leukotrienes derived via the enzyme 5‐lipoxygenase. Both prostaglandins and leukotrienes mediate inflammatory responses. The latter have been studied with regard to their role in the pathophysiology of asthma.Methods.–A prospective, open‐label study evaluating the efficacy of montelukast, 10 mg or 20 mg, in the prophylaxis of migraine in 17 patients is presented in this paper. All 17 patients completed the study that consisted of a 2‐month baseline run‐in period and a 3‐month treatment phase.Results.–Montelukast was extremely well tolerated, and no adverse events were reported by any of the patients. Fifty‐three percent showed a reduction of greater than 50% (P<.025) in the frequency of severe attacks, with 41% showing a reduction of greater than 60%. Responders, including modest responders, rated the drug as excellent.Conclusions.–We conclude, given the limitations of an open‐label study design and the small sample size, that montelukast shows potential as an effective, well‐tolerated prophylactic agent in migraine. Double‐blinded, placebo‐controlled studies are warranted. In addition, the leukotrienes, as suggested previously in the literature, may play a role in the pathogenesis of migraine.
Use of Percutaneous Electrical Nerve Stimulation (PENS) in the Short‐term Management of Headache
Authors: Ahmed Hesham E. , White Paul F. , Craig William F. , Hamza Mohamed A. , Ghoname El‐sayed A. , Gajraj Noor M. 
Published: March 2003

Objective.–To evaluate the short‐term effects of percutaneous electrical nerve stimulation (PENS) in the management of three types of chronic headache.Background.–Traditional electroanalgesic therapies have been reported to be effective in the management of acute headache symptoms. However, no controlled studies have been performed in patients with chronic headache.Methods.–Thirty patients with either tension headache, migraine, or posttraumatic headache symptoms of at least 6 months' duration were randomized to receive PENS (needles with electricity) or “needles alone” according to a crossover study design. All treatments were administered for 30 minutes, three times a week for 2 consecutive weeks with 1 week off between the two different treatments. For the PENS treatments, an alternating electrical stimulation frequency of 15 and 30 Hz was used. Pain, activity, and sleep scores were assessed using a 10‐cm visual analog scale, with 0 corresponding to the best and 10 to the worst, during the 48‐hour period prior to the beginning of the two treatments, immediately before and after each treatment session, and 48 hours after completing each treatment modality.Results.–Compared with the needles alone, PENS therapy was significantly more effective in decreasing the overall VAS pain scores for tension‐type headache, migraine and posttraumatic headache (58%, 59%, and 52% versus 20%, 15%, and 20%, respectively). Similarly, PENS therapy produced greater improvement in the patients' physical activity (41% to 58% for PENS versus 11% to 21% for needles only) and quality of sleep (41% to 48% for PENS versus 12% to 20% for needles only). However, there were no differences in the pattern of the response to PENS therapy among the three headache groups.Conclusions.–Percutaneous electrical nerve stimulation appears to be a useful complementary therapy to analgesic and antimigraine drugs for the short‐term management of headache. Interestingly, the analgesic response to PENS therapy appears to be independent of the origin of the headache symptoms.
Tolosa‐Hunt Syndrome Preceded by Facial Palsy
Authors: Tessitore Enrico , Tessitore Alessandro 
Published: March 2003

The Tolosa‐Hunt syndrome consists of a painful ophthalmoplegia related to a granulomatous inflammatory process in the cavernous sinus, which may be documented by cerebral magnetic resonance imaging with gadolinium enhancement.Two cases of Tolosa‐Hunt syndrome preceded by facial palsy observed in 1998 at the Department of Neurosurgery of the Second University of Naples are presented here. Both patients developed Tolosa‐Hunt syndrome following an ipsilateral facial palsy that resolved in about 15 days with medical treatment. Cerebral magnetic resonance imaging with gadolinium enhancement showed, in both cases, inflammatory tissue in the cavernous sinus. The patients underwent corticosteroid therapy (prednisolone, 80 mg per day, intravenously) with pain regression. In the first case, the patient experienced recurrence of the syndrome that was definitively resolved with further corticosteroid treatment.The rare reports of facial palsy in patients with Tolosa‐Hunt syndrome suggest the inclusion of this disease in the so‐called multiple cranial nerve palsy syndrome. It is probable that Tolosa‐Hunt syndrome has an inflammatory pathogenesis.
The Misdiagnosis of Cluster Headache: A Nonclinic, Population‐Based, Internet Survey
Authors: Klapper Jack A. , Klapper Amy , Voss Tracy 
Published: March 2003

Objective.—We conducted the first nonclinic, Internet‐based survey of cluster headache to investigate this population with regard to diagnostic problems encountered, effective and ineffective medications, problems obtaining medications through third‐party payers, and symptoms as they relate to International Headache Society criteria.Background.—Previous cluster headache surveys have been at specialty centers. These patients might be different from cluster headache sufferers in the general population. An Internet‐based population of cluster headache sufferers who connected to a Web site responded to the questionnaire, and e‐mailed it back to our site to be analyzed. We analyzed a total of 789 respondents, 76% men and 28% women.Results.—Eighty‐seven percent of respondents qualified as having cluster headache according to International Headache Society criteria. However, diagnosis was delayed an average of 6.6 years from the onset of symptoms. The average number of physicians seen before the correct diagnosis was made was 4.3, and the average number of incorrect diagnoses was 3.9. Seventy‐one percent of respondents had undergone unnecessary magnetic resonance or computed tomography scans, and 4% had unnecessary sinus or deviated septum surgery. We found that many inappropriate medications such as propranolol, amitriptyline, and antibiotics were prescribed and that successful medications for clusters such as sumatriptan and oxygen were often denied due to a failure to understand the nature of this disorder. Seventy‐seven percent of respondents were smokers. Seventy‐four percent stopped smoking in an attempt to improve their condition; however, only 3% experienced relief.Conclusions.—The most alarming finding was the delay in diagnosing cluster headache in this population—an average of 6.6 years. The selection of medications demonstrated to be successful in the treatment of clusters proved effective for the majority of this population. Many respondents reported being denied some of these effective medications by their physicians or third‐party payers. Using International Headache Society criteria for cluster headache, 87% of the respondents should have been correctly diagnosed by the first physician seen.
Comparison of Intravenous Valproate Versus Intramuscular Dihydroergotamine and Metoclopramide for Acute Treatment of Migraine Headache
Authors: Edwards Keith R. , Norton Judith , Behnke Michele 
Published: March 2003

Objective.—To determine the effectiveness and tolerability of intravenous valproate for the acute treatment of migraine headache with or without aura (International Headache Society diagnostic criteria 1.1 and 1.2) compared with intramuscular metoclopramide 10 mg followed 10 minutes later by intramuscular dihydroergotamine 1 mg.Background.—Divalproex sodium is approved for prophylaxis of migraine headache. We studied the possible effectiveness of intravenous sodium valproate for the treatment of acute migraine headache. Valproate offers a treatment option for patients with migraine who recently have used a triptan or dihydroergotamine, theoretically avoiding the risk of drug interactions or cardiovascular complications.Design/Methods.—In an open‐label randomization, patients with an established diagnosis of migraine with or without aura were administered either intravenous valproate or intramuscular dihydroergotamine with metoclopramide to treat moderate‐to‐severe migraine headache of 24 to 96 hours' duration. Forty patients alternately received either 500 mg intravenous valproate or 10 mg metoclopramide intramuscularly followed by 1 mg dihydro‐ ergotamine. Patients rated severity of headache and the presence or absence of nausea, photophobia, or phonophobia at baseline, and at 1, 2, 4, and 24 hours.Results.—With intravenous valproate, 50% of patients reported headache improvement from moderate or severe to none or mild at 1 hour following treatment, 60% reported such improvement at 2 hours, 60% at 4 hours, and 60% at 24 hours. Corresponding improvement rates for dihydroergotamine were 45% at 1 hour, 50% at 2 hours, 60% at 4 hours, and 90% at 24 hours. Intravenous valproate and intramuscular dihydroergotamine provided similar relief from associated migrainous symptoms (nausea, photophobia, and phonophobia) during the first 4 hours following treatment. While none of the patients who received intravenous valproate experienced drug‐related side effects during treatment, 15% of patients who took dihydroergotamine experienced one or more episodes of nausea and diarrhea during the first 4 hours of treatment.Conclusions.—Intravenous valproate is similar in effectiveness to dihydroergotamine/metoclopramide as abortive therapy for prolonged moderate‐to‐severe acute migraine headache. Although the results were not statistically significant (P = .3635), intravenous valproate appears to offer a safe, effective, and well‐tolerated treatment for patients with acute migraine. Relative to dihydroergotamine/metoclopramide, however, headache relief was not as likely to be sustained at 24 hours as with intravenous valproate.
Behavioral Response to Headache: A Comparison Between Migraine and Tension‐type Headache
Authors: Martins Isabel Pavão , Parreira Elsa 
Published: March 2003

Objective.—To compare patients with migraine and tension‐type headache in their behavior during the attacks and the maneuvers used to relieve the pain.Background.—Patients with headache often perform nonpharmacological measures to relieve the pain, but it is not known if these behaviors vary with the diagnosis, clinical features, and pathogenesis.Methods.—One hundred consecutive patients with either migraine (n = 72 ) or tension‐type headache (n = 28) were questioned (including the use of a checklist) concerning their usual behavior during the attacks and nonpharmacological maneuvers performed to relieve the pain. The results of the two types of headache were compared.Results.—Patients with migraine tended to perform more maneuvers than individuals with tension‐type headache (mean, 6.2 versus 3). These maneuvers included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet, and becoming immobile during the attacks. The only measure predominantly reported by patients with tension‐type headache was scalp massage. However, the benefit derived from these measures was not significantly different between the two groups (except for a significantly better response to isolation, local pressure, local cold stimulation, and symptomatic medication in migraineurs).Conclusions.—The behavior of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed to prevent its worsening or to improve associated symptoms. These behavioral differences may be due to the different pathogenesis of the attacks or to different styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.
Sleep Disturbances After Whiplash Injury: Objective and Subjective Findings
Authors: Schlesinger Ilana , Hering‐Hanit Rachel , Dagan Yaron 
Published: March 2003

Objective.—A controlled objective and subjective evaluation of sleep in a consecutive series of persons who had had a whiplash injury, shortly following the injury and 3 to 5 months later.Methods.—In whiplash‐injured subjects and healthy controls, sleep characteristics were monitored objectively throughout the night by means of an actigraph. The following morning, participants in both groups filled out a prestructured “sleep log” that conveyed their subjective impressions as to how they had slept. The correlation between objectively measured sleep characteristics and the symptoms and physical findings, respectively, resulting from whiplash injury were also examined.Results.—Actigraphic monitoring did not reveal a significant group difference between whiplash‐injured subjects and controls with respect to any of the sleep characteristics recorded. In self‐maintained “sleep logs,” however, the whiplash‐injured subjects reported a significantly prolonged sleep latency and significantly impaired sleep quality compared with controls (P<.001 and P<.04, respectively). In whiplash‐injured subjects, the number of arousals was positively correlated with the number of symptoms and with the number of physical signs of whiplash injury (P<.01 and P<.001, respectively). Sleep efficiency was inversely correlated with the number of injury‐related findings on physical examination (P<.009).Conclusion.—Sleep, as monitored by actigraph in whiplash‐injured subjects, was not adversely affected by whiplash injury. The subjective impressions of the subjects, as recorded in “sleep logs,” suggest the opposite conclusion. A significant correlation exists between certain symptoms and signs of whiplash injury and abnormalities in given sleep characteristics as detected by actigraph.
Electroencephalographic Abnormalities in Aseptic Meningitis and Noninfectious Headache. A Comparative Study
Authors: Pollak Lea , Klein Colin , Schiffer Juana , Flechter Shlomo , Rabey Jose Martin 
Published: March 2003

Background.—The finding of abnormalities on electroencephalogram (EEG) during the course of aseptic meningitis is often considered to be indicative of parenchymal brain involvement, even in absence of clinical signs of encephalitis.Objective.—To investigate if patients with aseptic nonherpetic meningitis who have abnormal EEG recordings during the acute stage of the disease differ in clinical characteristics or cerebrospinal fluid findings from patients with aseptic meningitis and normal EEG recordings.Methods.—The EEG records of 82 patients with aseptic meningitis were reviewed. A comparative group consisted of 41 age‐matched patients with severe headaches without evidence of meningeal inflammation.Results.—Significantly more patients with aseptic meningitis (28%) demonstrated abnormalities on EEG than controls (12%) (P = .048). Patients with aseptic meningitis and abnormal EEG findings (n = 23) did not differ in age, duration of symptoms, clinical course, cerebrospinal fluid cell count, or protein level from those with normal EEG findings (n = 59). However, all patients with aseptic meningitis who were confused (n = 5) also revealed EEG abnormalities (P<.00012).Patients with headache with normal EEG recordings did not differ from those with abnormal EEGs in age, sex, or duration of symptoms. Nevertheless, patients with common migraine (n = 9) showed abnormalities on EEG (P = .06) more frequently.Conclusions.—The finding of an abnormal EEG in patients with aseptic meningitis, clear mental state and absence of focal neurological signs should not be used as proof of encephalitis. Because pathological examination is usually not performed, it remains unclear if EEG abnormalities in patients with aseptic meningitis indicate a silent parenchymal inflammation, or reflect an infectious encephalopathy.
Transitional Interpersonality Thunderclap Headache
Authors: Jacome Daniel E. 
Published: March 2003

Objective.—To report a patient with multiple personality disorder who experienced severe acute headaches without warnings, solely during the transition between her host personality and her pain‐prone personality.Background.—The initial detailed description of headache in multiple personality disorder was made by Packard and Brown and published in this journal 15 years ago.Methods.—Clinical history, neurologic examination, electroencephalogram, and brain magnetic resonance imaging.Results.—A 54‐year‐old Holocaust survivor with an established diagnosis of multiple personality disorder had recurrent, excruciating, acute (“thunderclap”) headaches only when switching between her domineering personality and her pain‐prone personality, who suffered from chronic back pain. None of her personalities otherwise suffer from headaches. Electroencephalogram and brain magnetic resonance imaging were normal.Conclusion.—This is an independent and current confirmation of the existence of transitional headaches in a patient with multiple personality disorder. They may occur as an isolated event during the switch process and have features of benign thunderclap headache.