bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparative Trial of Zolmitriptan and Sumatriptan for the Acute Oral Treatment of Migraine
Authors: Gallagher R. Michael , Dennish George , Spierings Egilius L.H. , Chitra Rohini 
Published: March 2003

Objective.–This randomized, double‐blind, parallel group multicenter study compared response rates and tolerability of zolmitriptan with sumatriptan in the acute treatment of migraine.Methods.–A sample consisting of 1445 outpatients with an established diagnosis of migraine was randomized to zolmitriptan, 2.5 mg or 5 mg, or sumatriptan, 25 mg or 50 mg. Patients took 1 tablet for moderate/severe migraine and a second identical tablet, if necessary, for recurrent headache of moderate/severe intensity 4 to 24 hours after the initial dose. Up to six attacks were treated during a 6‐month period. The primary outcome measure was headache response 2 hours after the initial dose. Secondary end points included 1‐hour and 4‐hour headache response and pain relief over 24 hours.Results.–A headache response at 2 hours was noted in 67.1% of patients taking zolmitriptan, 2.5 mg, and 64.8% of those taking zolmitriptan, 5 mg, versus 59.6% of patients taking sumatriptan, 25 mg, and 63.8% of those taking sumatriptan, 50 mg. At 2 and 4 hours, the differences between zolmitriptan, 2.5 mg, and sumatriptan, 25 mg, were statistically significant (odds ratio=1.49 and 1.67, respectively; both P<.001). Statistically significant differences between zolmitriptan, 2.5 mg, and sumatriptan, 50 mg, were seen at 2 and 4 hours post dose (odds ratio=1.21 and 1.23, respectively; both P<.05). At 1 hour post dose, the headache response rate for zolmitriptan, 2.5 mg, was numerically higher than response rates for sumatriptan, 25 mg and 50mg (odds ratio=1.16, odds ratio=1.06, though they failed to reach statistical significance; P=.061, P=.461 respectively). Differences between zolmitriptan, 5 mg, and sumatriptan, 25 mg, were statistically significant at 1, 2, and 4 hours (odds ratio=1.43, 1.46, and 1.78, respectively; all P<.001) and at 1 and 4 hours versus sumatriptan, 50 mg (odds ratio=1.28, P=.002; odds ratio=1.29, P=.012, respectively). Although not statistically significant at 2 hours, more patients responded to zolmitriptan, 5 mg, than to sumatriptan, 50 mg (odds ratio=1.16, P=.064). Patients receiving zolmitriptan, 2.5 mg or 5 mg, achieved more pain relief over 24 hours than patients receiving sumatriptan, 25 mg (odds ratio=1.47, and 1.54 respectively, both P<.001) or sumatriptan, 50 mg (odds ratio=1.17, P=.021; odds ratio=1.22, P=.005, respectively). All treatments were well tolerated.Conclusions.–Zolmitriptan, 2.5 mg and 5 mg, was at least as effective as sumatriptan, 25 mg or 50 mg, for all parameters studied. Zolmitriptan, 2.5 mg, was significantly more effective than sumatriptan, 50 mg, in terms of headache response at 2 and 4 hours. Patients taking zolmitriptan were significantly more likely to have pain relief over 24 hours than those taking sumatriptan.
The Migraine ACE Model: Evaluating the Impact on Time Lost and Medical Resource Use
Authors: Caro J. Jaime , Caro Graciela , Getsios Denis , Raggio Gabriel , Burrows Michael , Black Libby 
Published: March 2003

Objective.–To describe the Migraine Adaptive Cost‐Effectiveness Model in the context of an analysis of a simulated population of Canadian patients with migraine.Background.–The high prevalence of migraine and its substantial impact on patients' ability to function normally present a significant economic burden to society. In light of the recent availability of improved pharmaceutical treatments, a model was developed to assess their economic impact.Methods.–The Migraine Adaptive Cost‐Effectiveness Model incorporates the costs of time lost from both work and nonwork activities, as well as medical resource and medication use. Using Monte Carlo techniques, the model simulates the experience of a population of patients with migraine over the course of 1 year. As an example, analyses of a Canadian population were carried out using data from a multinational trial, surveys, national statistics, and the available literature.Results.–Using customary therapy, mean productivity losses (amounting to 84 hours of paid work time, 48 hours of unpaid work time, and 113 hours of leisure time lost) were estimated to cost $1949 (in 1997 Canadian dollars) per patient, with medical expenditures adding an average of $280 to the cost of illness.Conclusions.–With customary treatment patterns, the costs of migraine associated with reduced functional capacity are substantial. The migraine model represents a flexible tool for the economic evaluation of different migraine treatments in various populations.
Sumatriptan in Patients With Postdural Puncture Headache
Authors: Connelly Neil Roy , Parker Robert K. , Rahimi Armin , Gibson Charles S. 
Published: March 2003

Objective.–To determine the efficacy of sumatriptan in the management of patients presenting for an epidural blood patch for the management of postdural puncture headache.Background.–Postdural puncture headache can be quite severe, requiring invasive therapy (ie, epidural blood patch). Sumatriptan has been used successfully in patients with postdural puncture headache, however, its use has not been investigated in a controlled fashion.Methods.–Ten patients with postdural puncture headache presenting for an epidural blood patch were given either saline or sumatriptan subcutaneously. The severity of the headache was evaluated at baseline and 1 hour following injection. If the headache remained severe, an epidural blood patch was performed.Results.–Only one patient in each group received relief from the injection.Conclusions.–We do not recommend sumatriptan in patients who have exhausted conservative management of postdural puncture headache.
Evaluation of the Impact of Migraine and Episodic Tension‐type Headache on the Quality of Life and Performance of a University Student Population
Authors: Bigal Marcelo Eduardo , Bigal Janaína Maciel , Betti Michelle , Bordini Carlos Alberto , Speciali José Geraldo 
Published: March 2003

Objective.—To determine the prevalence of migraine and episodic tension‐type headache (ETTH) among university students as well as its impact on academic performance and quality of life.Background.—Headache is a very common symptom in clinical practice. The reduced capacities due to migraine can be profound, and more studies are needed to evaluate, in particular, school performance. Few studies have been conducted to evaluate the impact of tension‐type headache on work productivity, quality of life, and the impact of headache on school performance.Methods.—A total of 1022 students were interviewed. Two questionnaires were utilized, a standard one that permitted a diagnosis of migraine or ETTH according to the criteria of the International Headache Society and a second one consisting of a battery of tests on quality of life.Results.—A total of 256 students (25%) had migraine and 336 (32.9%) reported ETTH. When in pain, migraineurs demonstrated a 62.7% decrease in productivity while studying, compared with a 24.4% decrease in those with ETTH. Fifty percent of migraineurs tried to study despite the pain, compared with 53.2% of those with ETTH. With respect to all other items tested, there was a significantly higher impairment in the presence of migraine than in the presence of ETTH and in the presence of the latter compared with a control situation.Conclusions.—The present study confirms the profound impact of headache on the performance of university students, with this impact much more evident among migraineurs but also important among students with ETTH.
Hypnic Headache: Report of Two Cases
Authors: Vieira‐Dias Marta , Esperança Paula 
Published: March 2003

Hypnic headache constitutes one rare type of primary short‐lasting headache related to sleep.The authors describe two cases of hypnic headache that had a very good response to lithium carbonate. Although these two cases do not fulfill the proposed criteria for hypnic headache, as the pain was not bilateral, and, in case 2, it had a longer duration than previously described, we believe that the very good response to lithium carbonate favors this diagnosis.We believe that it is important to consider a diagnosis of hypnic headache because of the remarkable response to lithium carbonate shown by some patients with this condition.
Characteristics of Headache Associated With Acute Carbon Monoxide Poisoning
Authors: Hampson Neil B. , Hampson Lindsay A. 
Published: March 2003

Objective.—To evaluate systematically the characteristics of headache due to acute exposure to carbon monoxide.Background.—Headache is the most commonly reported symptom in acute carbon monoxide poisoning. While it is often described as throbbing and diffuse, a systematic characterization of carbon monoxide‐associated headache has never been published.Methods.—Patients referred for hyperbaric oxygen treatment of acute carbon monoxide poisoning were asked whether headache was part of their symptom complex. When present, specific details about the nature of the headache were collected from 100 consecutive patients through use of a standardized questionnaire.Results.—Information on carbon monoxide‐associated headache was collected from 34 female and 66 male patients with a mean carboxyhemoglobin level of 21.3%± 9.3%. The most common location for pain was frontal (66%), although more than one location was involved in 58% of patients. Nature of the pain at any time during its course was dull in 72% of patients and sharp in 36%. Headache was throbbing in 41%, continuous in 74%, and intermittent in 16% of those evaluated. Peak intensity of pain did not correlate with the carboxyhemoglobin level. Headache improved prior to hyperbaric oxygen treatment in 72%, resolving entirely in 21%. Of those with residual headache, pain improved with hyperbaric oxygen in 97%, resolving entirely in 44%.Conclusions.—The headache accompanying acute carbon monoxide poisoning is extremely variable in nature. “Classic” throbbing, diffuse headaches were rarely described by patients. There are no patterns which can be considered characteristic to aid in the diagnosis of carbon monoxide‐induced headache. Similarly, no trait was identified which might allow elimination of carbon monoxide poisoning from the differential diagnosis of headache.
Upper and Lower Cluster Headache: Clinical and Pathogenetic Observations in 608 Patients
Authors: Cademartiri Carola , Torelli Paola , Cologno Daniela , Manzoni Gian Camillo 
Published: March 2003

Objective, Background, and Methods.—Ever since it was proposed by Ekbom and Kugelberg back in 1968 on the basis of the different location of head pain during attacks, the differentiation of cluster headache into an upper syndrome (US) and a lower syndrome (LS) has been regarded as a purely academic distinction. To evaluate whether this differentiation is indeed well founded and to understand its possible significance in the light of current pathogenetic knowledge, we rigorously applied Ekbom and Kugelberg's classification criteria to a sample of 608 patients with cluster headache (CH; 440 men and 168 women), including 483 with episodic CH, 69 with chronic CH, and 56 with CH periodicity undetermined. Results.—Of these patients, 278 could be classified as US sufferers and 330 as LS sufferers. Our data analysis showed statistically significant clinical differences between the two syndromes: pain location was more common in the ocular, temporal, and nuchal regions among LS sufferers; in addition, patients with LS reported not only a higher rate of autonomic symptoms, but also a higher predominance of nasal congestion, ptosis, and forehead and facial sweating among these symptoms. Conclusions.—Based on current anatomofunctional knowledge and on the most recent pathogenetic findings, we believe that changes in hypothalamic activity posteroinferiorly may lead to activation of the caudal part of the spinal trigeminal nucleus by way of the hypothalamus, midbrain, and trigeminal nerve fibers and consequently to activation of the trigeminovascular system with a different location in the two syndromes. More specifically, there seems to be a larger and more extensive involvement of the subnucleus caudalis in LS compared with US, where only its ventrocaudal portions are likely to be affected.
Lifetime Prevalence and Characteristics of Recurrent Primary Headaches in a Population‐Based Sample of Swedish Twins
Authors: Svensson Dan A. , Ekbom Karl , Larsson Bo , Waldenlind Elisabet 
Published: March 2003

Objective.—To examine the lifetime prevalence and other characteristics of recurrent primary headaches in twins.Background.—The twin model may provide insights into the role of genetic and environmental influences in headache disorders. However, assumptions as to whether twins are representative of the general population, and whether monozygotic and dizygotic twins are similar have rarely been addressed.Methods.—The study population consisted of a random sample of 17‐ to 82‐year‐old twins from the Swedish Twin Registry (n = 1329). Structured interviews on the telephone by lay personnel and the International Headache Society criteria were used for assessment and diagnosis of recurrent primary headaches. Prevalence data of the general population for migraine and tension‐type headache was obtained from various published reports.Results.—A total of 372 subjects (29%) had ever had recurrent headaches. In total, 241 recurrent headache sufferers fulfilled the criteria for migraine or tension‐type headache, and the lifetime prevalence was 7.1% for migraine without aura, 1.4% for migraine always with aura, 1.9% for migraine occasionally with aura, 9.4% for episodic tension‐type headache, and 1.3% for chronic tension‐type headache. The lifetime prevalence of all migraine and all tension‐type headache, including another 84 subjects fulfilling all but one of the criteria for migraine or tension‐type headache, was 13.8% and 13.5%, respectively. The corresponding prevalence risk for women was 2.4 (95% confidence interval [CI] 1.7, 3.4) and 1.5 (95% CI 1.1, 2.1), respectively. Zygosity was not a significant predictor for migraine. In tension‐type headache, the prevalence risk for dizygotic twins and unlike‐sexed twins as compared with monozygotic twins was 1.9 (95% CI: 1.2, 3.1) and 1.8 (95% CI: 1.1, 2.9), respectively.Conclusion.—There is no twin‐singleton or monozygotic‐dizygotic difference for the risk of migraine. In tension‐type headache, twins seem to have a lower risk than singletons, and this is especially true for monozygotic twins.
Volume and Nature of Telephone Calls in a Specialty Headache Practice
Authors: Loder Elizabeth , Geweke Lynne 
Published: March 2003

Background.—No information exists regarding the contribution of patient‐related telephone calls to the burden of headache practice. Objective.—To identify the nature and volume of patient‐related telephone calls to a specialty headache practice over a 1‐month period. Design and Methods.—The characteristics of all patient‐related calls to a single headache practitioner occurring during July 2001 were documented. Information was obtained on the caller, reason for call, length of call, timing and day of call, stated importance of call, patient's principal headache diagnosis, and principal comorbid psychiatric disorder, if any. Results.—One hundred sixty‐five outpatient headache‐related calls were received in July 2001, 3.17 for every hour of headache clinic scheduled. A total of 65% of all calls was generated by just 36% of callers. Of the 32 patients who placed more than one call during the study period, 50% had chronic daily headache, 53% had a personality disorder, and 38% had both. Twenty‐seven percent of all calls were placed by someone other than the patient, 58% involved requests for medication refills, and 17% reported a new symptom or medication side effect. Over half of all calls were placed on Mondays and Tuesdays. Relatively few occurred outside work hours; 18% of calls characterized as “emergency” and 36% of calls characterized as urgent involved requests for controlled substances. Most of these calls were placed by patients with personality disorders. None of the 11 calls characterized as emergency calls was judged so by the physician; only 19% of the urgent calls were judged so by the physician. Conclusions.—Telephone calls contribute substantially to the burden of caring for patients in a specialty headache practice. Patients with chronic daily headache and personality disorders contribute disproportionately to this telephone burden. Efforts to identify such patients at presentation and educate them regarding appropriate telephone use seem to be warranted.
Prevalence of Head Trauma in Patients With Difficult Headache: The North Norway Headache Study
Authors: Bekkelund Svein Ivar , Salvesen Rolf 
Published: March 2003

Objective.—To test whether chronic headache (>3 days/week) is more prevalent than episodic headache (<3 days/week) in patients with a previous history of significant head trauma.Method.—We included 903 consecutive patients referred to a specialist center for headache during a period of 2 years. As the main parameter, we selected self‐reported history of previous significant head trauma defined as loss of consciousness or hospitalization due to head trauma.Results.—One hundred eighty‐nine out of 903 patients with difficult headache referred to a neurologist had a previous history of head trauma (21%). We identified 297 patients with headache 3 days or more per week (33%). Of these patients with chronic headache, 68 (23%) reported previous significant head trauma compared with 121/714 (17%) in other patients with headache (P  =  .18). Shorter length of education was associated with chronic headache; however, age, sex, or specific headache syndromes such as migraine or tension headache were not related to chronicity.Conclusion.—Although the incidence of previous head trauma was prevalent in this highly selected group of patients with headache, such a history was not a predictor of chronicity.
Soluble Interleukin‐2 Receptors Increase During the Active Periods in Cluster Headache
Authors: Empl M. , Förderreuther S , Schwarz M , Müller N , Straube A 
Published: March 2003

Objective.—To investigate whether cytokines are altered during the active period of cluster headache.Background.—Patients with cluster headache show activation of the hypothalamus in PET studies and via endocrinologic parameters. Data also suggest an inflammatory process occurs in cluster headache. A connection between the presumed inflammatory cause, an immunological activation, and the hypothalamus could be generated by certain cytokines.Design and Methods.—ELISA was used to determine the serum levels of soluble interleukin‐2 receptors, interleukin‐1, interleukin‐6, and 2 soluble interleukin‐6 receptors (sIL‐6R and soluble gp130) in 18 patients with cluster headache (6 women and 12 men) during the cluster period and in 17 healthy controls who were headache‐free (3 women and 14 men).Results.—Patients with cluster headache had significantly increased soluble interleukin‐2 receptors (413.6±223 U/mL vs. 290.0±112 U/mL; P < .05) compared with controls. Serum levels of interleukin‐1 (0.29±0.30 pg/mL vs. 0.13±0.13 pg/mL, n.s.), interleukin‐6 (0.87±0.6 pg/mL vs. 0.91±0.7 pg/ml; n.s.), soluble interleukin‐6 receptors (33,131±8,349 pg/mL vs. 35,063±7,606 pg/mL; n.s.), or soluble gp130 (289±59 pg/mL vs. 283±20 pg/mL; n.s.) did not differ between the 2 groups, although patients with cluster tended to have higher interleukin‐1 values.Conclusions.—Because elevated soluble interleukin‐2 receptors indicate T cell activation, our findings suggest immune activation during cluster headache. Because interleukin‐2 can activate the hypothalamus and stimulate the release of Corticotropin‐releasing Factor (CRF), interleukin‐2 could link a putative immunological cause of cluster headache with the observed hypothalamic activation. Systemic changes of interleukin‐1 or the interleukin‐6 system do not seem to play a role in cluster headache, as no alterations of serum levels were observed. Even so, unchanged serum levels do not exclude limited local production.
Clinical Efficacy of Frovatriptan: Placebo‐Controlled Studies
Authors: Ryan R. , Géraud G. , Goldstein J. , Cady R. , Keywood C. 
Published: March 2003

Objective.—To confirm the clinical efficacy of frovatriptan 2.5 mg.Background.—Frovatriptan is a new 5‐hydroxytryptamine (5‐HT)1B/1D receptor agonist being developed for the acute treatment of migraine with or without aura. Results from preclinical and clinical pharmacology studies showed frovatriptan to be a potent 5‐HT1B receptor agonist with a long terminal elimination half‐life (26 hours) and a broad therapeutic index.Design.—Three randomized, placebo‐controlled, double‐blind, parallel‐group trials, in a total of 2676 patients, were performed to confirm the clinical efficacy of frovatriptan 2.5 mg for the acute treatment of migraine.Results.—In all three studies, headache response 2 hours after frovatriptan dosing was significantly greater than that seen with placebo (P.001) with approximately a two‐fold measure of effect over placebo for headache response at 2 and 4 hours postdosing. Time to headache response occurred within 1.5 hours in a substantial proportion of patients. The incidence of 24‐hour headache recurrence with frovatriptan was low (10% to 25%). Frovatriptan therapy also was associated with a high degree of patient satisfaction.Conclusions.—Frovatriptan represents a consistently effective acute treatment for migraine and accompanying symptoms.
Distinguishing Subtypes of Temporal Lobe Epilepsy with Background Hippocampal Activity
Authors: Zaveri Hitten P. , Duckrow Robert B. , De Lanerolle Nihal C. , Spencer Susan S. 
Published: March 2003

Summary:  Purpose: Two subtypes of temporal lobe epilepsy (TLE) can be defined through clinical observations and analysis of hippocampal tissue resected during surgical procedures for intractable TLE: (a) mesial temporal sclerosis (MTS), which is characterized by extensive changes to the hippocampus and good surgical outcome; and (b) paradoxical temporal lobe epilepsy (PTLE), which is characterized by minimal cell loss and comparatively poorer surgical outcome. Patients in both subtypes have seizures that appear to begin in the medial temporal lobe, but documented differences in substrate and outcome between these subtypes has defined a need to distinguish MTS and PTLE patients before surgery. This report describes a retrospective study to investigate the feasibility of doing so during intracranial monitoring.Methods: Background EEG epochs, 5 min in duration, were recorded from the anterior hippocampus in 14 (10 MTS and four PTLE) patients with consistent localization of seizure onset to medial temporal structures. The power spectral density (PSD) of the EEG epochs was calculated by a Fourier spectral estimator, and the total signal power and power of the delta, theta, alpha, beta, and gamma frequency bands were submitted to group‐to‐group comparison.Results: Spectral peaks were observed in the delta band in all PSD estimates and in the theta band in nine of 14 (seven MTS, two PTLE) estimates. The MTS and PTLE subtypes could be distinguished by the total signal power and delta band power. These power measurements were greater in the PTLE subtype.Conclusions: Both delta and theta spectral components are present in hippocampal background EEGs recorded from patients with TLE. The results indicate that group differences exist in spectral measures of background hippocampal signals recorded from MTS and PTLE subtypes. This suggests both that substrate differences in cellular composition and connectivity are reflected in hippocampal background EEGs and that spectral measurements of these signals may hold promise for tests to identify the group membership of individual patients.