bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous Propofol: Unique Effectiveness in Treating Intractable Migraine
Authors: Krusz John Claude , Scott Virginia , Belanger Jeanne 
Published: March 2003

Objective.–To report the unique effectiveness of propofol, an intravenous anesthetic agent, in treating refractory migraines and other headaches in the setting of an outpatient headache center.Background.–We initially observed the dramatic abolition of ongoing migraine in patients (n=6) being treated with propofol in preparation for epidural and other nerve blocks in the headache and pain clinic. The reduction of headache severity was virtually 100%. We decided to treat an additional cohort of patients with intravenous propofol in the headache clinic; these patients had intractable migraines that were refractory to the usual abortive treatments. Subanesthetic doses of propofol were employed in this study. This is the first known report of the utility of this agent specifically for the treatment of intractable headache.Methods.–Seventy‐seven patients were treated for intractable headache in the clinic with intravenous propofol, for both migraine and nonmigrainous headache refractory to the usual methods of abortive treatment.Results.–The average reduction in headache intensity was 95.4% after an average of 20 to 30 minutes of intravenous propofol treatment, using a patient‐rated visual analog scale of 0 to 10. Sixty‐three of 77 patients reported complete abolition of their headache. The average dose of propofol was 110 mg, which is well within the usual range of preanesthetic doses and is clearly subanesthetic. Moreover, only three of the treated patients reported a return of the headache on the day following treatment.The neuropharmacology of propofol and the putative multiple mechanisms of action upon various neurotransmitter systems in the brain, particularly gamma aminobutyric acid A receptor subtypes, are discussed to explain the results in our patients.Conclusions.–The use of intravenous propofol may represent a new, rapid, and highly effective form of abortive headache treatment in the headache clinic or emergency room setting and may offer an alternative to other treatment modalities for acute migraine and other severe intractable headaches. The effectiveness of propofol raises many new questions about the pathophysiology of migraine and other headaches.
Treatment of Tension‐type Headache With Botulinum Toxin Type A: A Double‐Blind, Placebo‐Controlled Study
Authors: Rollnik Jens D. , Tanneberger Oliver , Schubert Margot , Schneider Udo , Dengler Reinhard 
Published: March 2003

Objective.–To determine whether injections of botulinum toxin could be of therapeutic value in the treatment of tension‐type headache.Background.–Botulinum toxin A is very effective at reducing muscle tenderness and pain in many diseases. Increased muscle tension may contribute to tension‐type headache.Methods.–We performed a double‐blind, placebo‐controlled study with 21 patients fulfilling the International Headache Society criteria for tension‐type headache. Participants were randomly assigned to treatment (pericranial injection of 10 × 20 mouse units botulinum toxin A) or placebo (injection of isotonic saline in the same manner).Results.–After 4, 8, and 12 weeks, no significant differences between placebo and treatment could be observed (with respect to visual analog scale, frequency and duration of headache attacks, consumption of analgesics, pressure pain threshold, total tenderness score, and quality‐of‐life parameters).Conclusions.–The findings of our study strongly support the hypothesis that peripheral mechanisms, such as increased muscle tenderness, only play a minor role in the pathogenesis of tension‐type headache.
Botulinum Toxin Type A as a Migraine Preventive Treatment
Authors: Silberstein Stephen , Mathew Ninan , Saper Joel , Jenkins Stephen ,   for the BOTOX Migraine Clinical Research Group
Published: March 2003

Objective.—To assess the safety and efficacy of botulinum toxin type A (BOTOX; Allergan, Inc) in the prevention of migraine.Background.—Current migraine preventive therapies are often unsatisfactory because of their limited efficacy, adverse effects, and drug interactions. Botulinum toxin type A injections often reduce the pain associated with conditions such as cervical dystonia, achalasia, rectal fissures, and myofascial pain syndrome. An open‐label, noncontrolled study of botulinum toxin type A suggested benefits for patients with migraine.Design and Methods.—This was a double‐blind, vehicle‐controlled study of 123 subjects with a history of two to eight moderate‐to‐severe migraine attacks per month, with or without aura. Participants were randomized to receive single administrations of vehicle or botulinum toxin type A, 25 U or 75 U, injected into multiple sites of pericranial muscles at the same visit. During a 1‐month baseline period and for 3 months following injection, subjects kept daily diaries in which they recorded migraine frequency, migraine severity, and the occurrence of migraine‐associated symptoms.Results.—Compared with vehicle treatment, subjects in the 25‐U botulinum toxin type A treatment group showed significantly fewer migraine attacks per month, a reduced maximum severity of migraines, a reduced number of days using acute migraine medications, and reduced incidence of migraine‐associated vomiting. Both the 25‐U and 75‐U botulinum toxin type A groups were significantly better than the vehicle group on subject global assessment. Botulinum toxin A treatment was well tolerated, with only the 75‐U treatment group exhibiting a significantly higher rate of treatment‐related adverse events than vehicle.Conclusions.—Pericranial injection of botulinum toxin type A, 25 U, was found to be a safe treatment that significantly reduced migraine frequency, migraine severity, acute medication usage, and associated vomiting.
Naratriptan Efficacy in Migraineurs Who Respond Poorly to Oral Sumatriptan
Authors: Stark Stuart , Spierings Egilius L.H. , McNeal Scott , Putnam Gayla P. , Bolden‐Watson Carolyn P. , O'Quinn Stephen 
Published: March 2003

Objectives.—To determine whether 347 patients would respond to a 50‐mg oral dose of sumatriptan, even though they considered themselves poor responders to this acute therapy for migraine, and to investigate whether oral naratriptan can be an effective acute therapy for migraine in the subset of patients who did not respond to sumatriptan under double‐blind, well‐controlled conditions. Background.—Although most migraineurs respond to sumatriptan, there remains a need for an effective alternative for those who do not respond. Naratriptan is a more potent and more lipophilic member of this class of agent and could prove beneficial in such patients. This is the first well‐controlled study to assess the value of another 5‐HT1B/1D agonist in this difficult patient subset. Methods.—This study comprised two migraine attacks. The first (attack 1) was a single‐blind assessment of the efficacy of sumatriptan (50 mg orally) in patients with a history of poor response to the drug. The second (attack 2) was a randomized, parallel group, double‐blind, placebo‐controlled trial of naratriptan (2.5 mg orally) in nonresponders to oral sumatriptan. Results.—Attack 1: About two thirds of this selected migraine population did not respond to sumatriptan. Attack 2: Naratriptan was statistically superior to placebo for headache relief at 2 hours and 4 hours, as well as for most other features of migraine attacks. These data suggest an intrinsic efficacy of naratriptan in this patient subset and not a coincidental response. No unexpected tolerability issues arose. Conclusions.—Naratriptan is an alternative therapy for migraineurs who respond poorly to oral sumatriptan. No response to one “triptan” does not necessarily predict no response to them all.
Further Development and Testing of the Migraine‐Specific Quality of Life (MSQOL) Measure
Authors: Patrick Donald L. , Hurst Bryan C. , Hughes Janette 
Published: March 2003

Objective.—To evaluate the longitudinal performance of the migraine‐specific quality of life (MSQOL) instrument. Methods.—Psychometric tests evaluated data obtained from 1383 migraineurs who completed the 20‐item MSQOL questionnaire during a noncomparative, long‐term, observational study of zolmitriptan (Zomig), 5 mg, for the acute treatment of migraine attacks of any intensity. Results.—There was a relationship between a history of a high frequency of migraine attacks and low baseline MSQOL scores, indicating a lower quality of life. Principal components analyses confirmed three domains and an overall score. Cronbach α coefficients for the overall score (.93) indicated high internal consistency. Responsiveness analysis over 180 days of treatment indicated a significantly greater improvement in MSQOL scores (P < .05) in treatment responders compared with nonresponders. The average effect size (0.25) and Guyatt responsiveness statistic (0.46) for the MSQOL instrument exceeded those for the eight domains of the Medical Outcomes Study Short Form Health Survey (MOS SF‐36) (−0.05 to 0.14 and 0.01 to 0.12, respectively). Change from baseline for responders in MSQOL total score was 4.7 to 5.4 compared with 1.1 to 2.7 for nonresponders. Conclusions.—Cumulative evidence for the MSQOL instrument meets established criteria for validity, consistency, and reproducibility and shows moderate responsiveness to treatment. This instrument fulfils the need for an MSQOL measure to be used as an adjuvant measure in the assessment of long‐term outcomes of therapy.
Interobserver Reliability in Physical Examination of the Cervical Spine in Patients With Headache
Authors: Van Suijlekom Hans A. , De Vet Henrica C.W. , Van Den Berg Suzanne G.M. , Weber Wilhelm E.J. 
Published: March 2003

Objective.—To assess interobserver reliability of two expert headache neurologists when examining the cervical spine of patients with headache. Background.—The diagnosis of cervicogenic headache involves the physical examination of the cervical spine. Methods.—Twenty‐four patients diagnosed as having migraine, tension‐type headache, or cervicogenic headache were included in the study. After interview, each patient's cervical spine was examined in a structured way. Reliability was assessed by Cohen's kappa. Results.—Reduced range of motion in the cervical spine showed kappa scores indicating moderate agreement. Provocation of headache revealed moderate‐to‐substantial agreement. Assessment of zygapophyseal joint pressure pain showed slight‐to‐fair agreement. The kappa values of the circumscribed characteristic tender points showed agreement ranging from “not better than chance” to “substantial agreement.” Conclusions.—Our study showed that the interobserver reliability of expert headache neurologists was satisfactory in the majority of the physical examination tests of the cervical spine in patients with different headache syndromes. However, standardization of the clinical tests in order to improve their reliability is recommended.
Olfactory Hallucinations During Migraine in an Adolescent With an MRI Temporal Lobe Lesion
Authors: McAbee Gary , Sagan Allison , Winter Lori 
Published: March 2003

Objective.—To report the first example of an abnormal magnetic resonance imaging (MRI) test in a patient with migraine and olfactory hallucinations and to provide additional evidence for a possible role of the temporal lobe in migraine. Background.—The relationship between the temporal lobe and migraine with or without hallucinations is unclear and continues to evolve. Clinical and functional neuroimaging studies (positron emission tomography/single photon emission computed tomography) have lent support to the possibility of a relationship. Anatomical neuroimaging with computed tomography has previously been normal. Methods.—The history and findings of an adolescent with migraine and olfactory hallucinations is reported. Results.—Brain MRI demonstrated a mass in the temporal lobe. Conclusions.—Magnetic resonance imaging should be considered in patients with olfactory hallucinations and migraine. In addition, the role of the temporal lobe in migraine warrants further study.
The Efficacy of Divalproex Sodium in the Prophylactic Treatment of Children With Migraine
Authors: Caruso June M. , Brown William D. , Exil Gerald , Gascon Generoso G. 
Published: March 2003

Objective.—To determine the beneficial use of divalproex sodium as a prophylactic treatment for migraine in children.Background.—Previous studies for treatment of migraine in adults have shown a greater than 50% reduction in migraine attack frequencies. Few data exist, however, regarding the efficacy and safety of divalproex sodium use in children with migraine.Methods.—We studied the incidence of headache relief in our patients with migraine aged 16 years and younger treated with divalproex sodium prophylactically at our institution from July 1996 to December 1998 to determine medication dosage used, concomitant headache medications, and possible adverse effects.Results.—A total of 42 patients, ranging in age from 7 to 16 years (mean age, 11.3 years), were treated with divalproex sodium for headache. All had a history of migraine with or without aura. Baseline headache frequency during a minimum 6‐month period was one to four headaches per month. Divalproex sodium dosage ranged from 15 mg/kg/day to 45 mg/kg/day. Of the 42 patients, 34 (80.9%) successfully discontinued their abortive medications. After 4 months' treatment, 50% headache reduction was seen in 78.5% of patients, 75% reduction in 14.2% of patients, and 9.5% of patients became headache‐free.Conclusion.—These results indicate divalproex sodium to be an effective and well‐tolerated treatment for the prophylaxis of migraine in children.
Perceptions of Pain in Women With Headache: A Laboratory Investigation of the Influence of Pain‐Related Anxiety and Fear
Authors: Bishop Kelly L. , Holm Jeffrey E. , Borowiak Dana M. , Wilson Brian A. 
Published: March 2003

The present study compared the responses of women with headache (chronic tension‐type, n = 27; migraine, n = 27) and controls (n = 27) to an acute pain laboratory task, the cold pressor test. Participants' pain perception (ie, threshold and tolerance) and their fear/anxiety associated with pain were assessed during days 1, 2, or 3 of menses.Analyses pertaining to participants' responses to the cold pressor test (ie, pain threshold and tolerance) failed to show statistically significant group differences, even when covarying pain‐related anxiety/fear. Analyses did, however, reveal significant group differences between migraineurs and controls in cognitive anxiety. Correlational analyses also revealed that cognitive anxiety, somatic anxiety, fear, and escape/avoidance were all significantly correlated with pain tolerance in the group with chronic tension‐type headache, but not in the other two groups. Subsequent multiple regressions, however, showed that the relationship between anxiety and pain tolerance was primarily a function of somatic anxiety. These results suggest that headache frequency plays a role in mediating the relationship between fear of pain and pain tolerance and that the models by Lethem and colleagues and McCracken may be relevant for understanding tension headache sufferers' responses to head pain.
Prevalence and Clinical Characteristics of Headache in Medical Students in Oman
Authors: Deleu D. , Khan M.A. , Humaidan H. , Al Mantheri Z. , Al Hashami S. 
Published: March 2003

Objectives.—To perform a descriptive epidemiological study of headache in medical students at Sultan Qaboos University, analyzing prevalence, symptom profile, and pattern of health care utilization.Background.—Headache is one of the most common complaints in medical practice. To our knowledge, headache has not been the subject of investigation in medical students in the Arabian Gulf.Methods.—Lifetime and last‐year prevalence of headache was based on a detailed structured headache assessment questionnaire. Besides demographic data, headache characteristics and pattern of health care utilization were evaluated. In addition, questions were included referring to the use of traditional remedies. Interviewers included three previously trained final‐year medical students. The evaluation was done per cohort, and the students were guided through the assessment questionnaire by the interviewers. Migraine and tension‐type headache were diagnosed according to the criteria of the International Headache Society.Results.—Four hundred three students (95.3%) completed the questionnaire: 151 men (37.5%) and 252 women (62.5%). The lifetime and last‐year prevalence of headache was 98.3% and 96.8%, respectively. A positive family history of headache was found in 57.6% of students. The prevalence rate of migraine and tension‐type headache was found to be the same (12.2%), with a difference in distribution across sexes: 6.6% of the men and 15.5% of the women had migraine, while 13.9% of the men and 11.1% of the women suffered from tension‐type headache. Only 23.3% of students sought medical assistance during headache episodes, and 80.3% took medication: 24.6% took prescribed medication, 72.9% took nonprescription medication, and only 2.5% took traditional remedies. Acetaminophen (83.1%) followed by mefenamic acid (24.6%) were the most commonly used drugs.Conclusions.—The results of this prospective epidemiological study show that headache is highly prevalent among medical students at this university. The high prevalence rate of migraine sufferers in this student population might be due to the high female‐to‐male ratio (1.7:1). It is likely that analgesic use/overuse also coexists with headache in medical students at Sultan Qaboos University, since a large majority of them rely on nonprescription medications.
Quality‐of‐Life Differences Between Patients With Episodic and Transformed Migraine
Authors: Meletiche Dennis M. , Lofland Jennifer H. , Young William B. 
Published: March 2003

Objective.—To determine whether there are any differences in health‐related quality of life between patients with migraine and those with transformed migraine.Background.—There are no published reports comparing the health‐related quality of life between patients with migraine and patients with transformed migraine.Methods.—We conducted a retrospective analysis examining the health‐related quality of life of patients with transformed migraine and migraine seen at a specialty headache clinic. Data collected included the Short Form‐36 (SF‐36) and the Migraine Disability Assessment questionnaires as well as demographic information. Both of these forms are part of the initial evaluation at the headache clinic. A t test with Bonferroni correction was used to test for significant differences in the SF‐36 domains between the groups.Results.—Data were collected for 90 patients, 46 with transformed migraine and 44 with migraine. There were no significant differences between groups with respect to sex, race, or age. Over the last 90 days prior to their first visit, patients with transformed migraine reported having a headache an average of 69 days compared with patients with migraine who averaged 18 days with headache (P<.05). Compared with patients with migraine, patients with transformed migraine had statistically (P<.05) and clinically significant (difference >5 points) lower mean scores on seven of the eight SF‐36 domains and both the mental and physical summary scores of the SF‐36.Conclusions.—The results of this study suggest that patients with transformed migraine have a lower health‐related quality of life than patients with migraine. These findings indicate that the headache chronicity associated with transformed migraine has a significant influence on quality of life. The results highlight the importance of effective management of headaches to avoid the progression of migraine to the more disabling transformed migraine.
Event‐Related Potentials in Posttraumatic Headache
Authors: Alberti Andrea , Sarchielli Paola , Mazzotta Giovanni , Gallai Virgilio 
Published: March 2003

Objectives.—To assess impairment of cognitive functions occurring in patients with posttraumatic headache as a consequence of a minor cranial trauma in the absence of organic damage involving the central nervous system.Background.—The term posttraumatic syndrome defines a stereotypic set of symptoms following traumatic brain injury that are subjective and varied. A deficit of cognitive function and impairment of the rapid processes of learning, attention, and short‐term memory have frequently been identified. Moreover, headache is the most frequent symptom reported by the patients.Due to the nature of the symptoms, a great limitation in defining the posttraumatic syndrome is represented by the lack of methods and diagnostic tools that allow quantification of the subjective disturbances and evidence of the signs indicative of central nervous system involvement in this pathological condition.Methods.—Twenty‐five subjects (16 women, 9 men; mean age, 28 ± 9 years) were examined between 3 and 6 months after the traumatic event. The P300 event‐related potential was recorded by an odd‐ball paradigm with an acoustic modality. The patients underwent electroencephalography and brain stem auditory evoked potentials; magnetic resonance imaging was performed to exclude the presence of cerebral lesions.Results.—The mean latency of P300 was increased in both central electrodes (Cz and Pz) in patients with posttraumatic syndrome compared with controls (P<.001); assuming the value of mean ± 2 SD was the cutoff point between normal and abnormal results, the P300 latency results were altered in 13 patients (52%).In the patient group, a significant correlation was demonstrated between Zung Depression Scale score and P3 and N2 wave latencies (r = 0.54, P <.004; r = 0.56, P<.003) and between Zung Anxiety Scale scores and P3 wave latencies (r = 0.46, P<.02).Conclusions.—These data suggest the usefulness of the P300 event‐related potential in evaluating cognitive disturbances in patients affected by posttraumatic syndrome. Alteration of cognitive potential in such patients, even in the absence of lesions detectable by neuroimaging, indicate the functional impairment of specific cerebral areas that can occur after a traumatic event.
Childhood Headache, Stress in Adolescence, and Primary Headache in Young Adulthood: A Longitudinal Cohort Study
Authors: Waldie Karen E. 
Published: March 2003

Objectives.—To determine the association between childhood history of headache, adolescent stress, and headache syndromes (determined by International Headache Society criteria) in young adulthood.Background.—The association between stress and tension‐type headache has recently been challenged. Little is known about stress and other headache subtypes, particularly among young people from the general population.Design.—Members of the longitudinal Dunedin Multidisciplinary Health and Development Study participated in this study. Study members were asked about headache characteristics/symptoms at aged 26 (96% of the living cohort), and historical records were examined to ascertain headache history (younger than 12 years) and the reporting of stressful life events at aged 15 years.Results.—Study members with childhood headache were significantly more likely to report adolescent stress than those without headache. High‐intensity stress during mid adolescence increased the likelihood of migraine diagnosis. In those with combined headache (migraine as well as tension‐type headache), this relation held only for those with a history of headache. Stress associated with bodily changes during mid adolescence was the only significant predictor of tension‐type headache.Conclusions.—Childhood headaches are related to the appraisal of life events reported during mid adolescence. Childhood headaches also appear to confer a specific risk for the development of combined headache. There was little evidence for a prospective relation between stress in mid adolescence and tension‐type headache in young adulthood, supporting claims that proximal (rather than distal) stress is associated with this disorder.