摘要:

Thirty‐four percent of 182 ischemic stroke patients registered during I year in a prospective hospital stroke data base complained of headache within a 72‐hour interval of stroke onset. Headache was more common in patients under 70 years of age, in nonsmokers, in those with a past history of migraine, and in subjects presenting transient loss of consciousness, nausea/vomiting, or visual field defects. Headache was more frequent in vertebrobasilar (57%) than in carotid (20%) territory strokes, more so in posterior cerebral artery (90%) and cerebellar infarcts (80%), and was infrequent in subcortical infarcts (7%) and lacunes due to single perforator disease (9%). In multiple regression analysis, vertebrobasilar stroke (odds ratio 6.9), lacunar stroke (odds ratio 0.06), and past history of migraine (odds ratio 6.7) were significant independent predictors of headache, suggesting that ischemic stroke location is the major determinant of stroke‐associated headache, most probably related to activation of the trigeminovascular system, whose threshold may be modified by individual susceptib

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506315.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

The objective of this study was to develop a questionnaire to assess the short‐term quality of life decrements associated with an acute migraine headache attack. A total of 101 potential quality of life items were generated by interviewing migraineurs and migraine specialists and reviewing the literature. To reduce the items, 76 migraineurs (18 years and older) were asked to identify which of the 101 items affected their quality of life in the24hours following onset of a migraine and to rate them on a five‐point scale from “not very important” to “extremely important.” Reduction of the 101 items to a 15‐item questionnaire was performed by evaluating the results of subject‐perceived importance (number of times an item was chosen x mean importance score) in combination with principal components analysis. Five domains were identified: (1) work functioning, (2) social functioning, (3) energy/ vitality, (4) migraine headache symptoms, and (5) feelings and concerns. Each domain has three items and the correlation between the five domains, as measured by the Spearman correlation coefficient, ranged from 0.08 to 0.38 suggesting minimal overlap. The brief migraine quality of life questionnaire was pilot‐tested in two groups of 10 migraineurs and revised t

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506320.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

A brief migraine‐specific quality of life questionnaire was developed to assess the quality of life decrement associated with an acute migraine attack in the 24‐hour period following headache onset, The migraine quality of life questionnaire has 15 questions across five domains (work functioning, social functioning, energy, concerns, and symptoms). A prospective, observational study was conducted to evaluate the characteristics of internal consistency, construct and discriminant validity, and responsiveness of the migraine quality of life questionnaire. One hundred thirty‐eight subjects with migraine were recruited. One hundred seven subjects completed a baseline and a 24‐hour postmigraine quality of life questionnaire, along with a migraine diary for recording headache severity, activity limitation, associated symptoms, duration of headache, and use of migraine medication. All five migraine quality of life questionnaire domains showed good internal consistency (Cronbach's alpha, 0.74–0.95). The strongest correlations were seen between activity limitation and associated symptoms and the migraine quality of life questionnaire work, social, and energy domains. Significant differences in mean questionnaire scores between subjects were found with frequency of medication use, global change in symptoms, headache duration, and severity. All five domains showed significant responses within subjects from a migraine‐free period to an acute migraine period (P<0.0001). In summary, the migraine quality of life questionnaire showed good internal consistency, construct and discriminant validity, and responsiveness to acute migra

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506330.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Exteroceptive suppression of temporalis muscle activity (ES2 duration) has been reported to be reduced in chronic tension‐type headache in previous open studies (with varying stimulus and analysis methods). We studied ES2 duration and latency in 11 patients with chronic tension‐type headache, 10 patients with cervicogenic headache, 11 migraine patients, and 9 headache‐free control subjects. The investigator was blinded as to the diagnostic category. Electrical stimuli of 0.5 ms duration and at least three times sensory threshold (median 9.6 mA) were used. ES2 was obtained in all but one (control) subject and the control ES2 duration mean was 33.5 (SD 8.5) ms (80% EMG amplitude reduction criterion). Mean ES2 duration differences were not found between the four groups. None of the headache patients had ES2 durations below the control group range. ES2 duration tended to decrease with increasing duration of headache history. Consistent asymmetries of ES2 latency and duration were not found among patients with (unilateral) cervicogenic headache. Thus, the role of ES2 in headache diagnosis still seems to be unse

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506338.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Seven SUNCT patients (six men, one woman) took part in this study. In four patients, respiratory variables were compared during and outside attacks. In five patients, peripheral chemosensitivity was tested and compared with a control group matched with respect to age. sex, and smoking habits. The results indicate that SUNCT patients hyperventilate during attacks. Moreover, they appear to hyperventilate slightly under basal conditions. The tests for peripheral chemoreceptor activity indicated no differences between the SUNCT and the control groups except for one variable, namely the mean ventilatory response to a single breath of 13% CO2. It is possible that this indicates a blunted response of the peripheral chemoreceptors. On the other hand, it may also represent a chance finding, since none of the other results presented suggested such a conclusion, and the size of the test group was very small. The results do not indicate that a reduction in oxygen saturation can trigger SUNCT since low levels of oxygen saturation were only rarely accompanied by SUNCT, whereas many attacks were not associated with any appreciable lowering in arterial oxygen saturation.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506344.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Patients seeking relief for chronic headache at specialized headache treatment centers are offered a multidisciplinary approach to treating their disorder. Neurologists, who specialize in headache, offer both inhospital and outpatient treatment programs. Clinicians and researchers experienced in headache disorders have advocated inpatient treatment for certain patients. Hospital programs address such issues as elevated anxiety and depression levels, overuse of analgesics, and related factors. This study was undertaken to investigate those differences, long observed by clinicians, between patients assigned to inpatient or outpatient care or to both. In view of the ever‐tightening purse strings of third‐party payers, the results may aid in delineating some of the forthcoming practice guidelines for dealing with headache sufferers. This study suggests: (a) significant differences do exist between the groups, (b) hospitalized patients may indeed require more complex interventions than those managed with outpatient care, and (c) documenting some of the etiologic factors that predict hospitalization may help alert providers at the front end and preclude some of the current need for hospital c

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506349.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Five hundred seventy‐seven consecutive patients attending the Princess Margaret Migraine Clinic from 1989 to 1991 have been questioned about dietary precipitants of their headaches. Four hundred twenty‐nine patients had migraine, of which 16.5% reported that headaches could be precipitated by cheese or chocolate, and nearly always by both. Of the migraine patients, 18.4% reported sensitivity to all alcoholic drinks, while another 11.8% were sensitive to red wine but not to white wine; 28% of the migrainous patients reported that beer would precipitate headaches. There was a definite statistical association between sensitivity to cheese/chocolate and to red wine (P<0.001) and also to beer (P<0.001), but none between diet sensitivity and sensitivity to alcoholic drinks in general. None of 40 patients with tension headache (diagnosed by International Headache Society criteria) reported sensitivity to foods, and only one was sensitive to alcoholic drinks. The prevalence of sensitivity among 46 patients with some migrainous features was intermediate between the migraine and tension headache categories. It is concluded that cheese/chocolate and red wine sensitivity, in particular, have closely related mechanisms, in some way related more to migraine than to more chronic tension‐type headache, while quite separate mechanisms play a major role in sensitivity to alcoholic drinks in ge

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506355.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Twenty‐five patients with diagnosed migraine headaches were randomly assigned to a biofeedback‐assisted relaxation therapy group or to a group who relaxed on their own. This study confirmed that the biofeedback trained group significantly decreased pain and medication more than the self‐re‐lax group. The best responders were those with the more elevated initial cerebral blood flow values and the changes in cerebral blood flow were specific for the middle cerebral

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506358.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Two female patients, one with chronic paroxysmal hemi‐crania and one with hemicrania continua, had a continuously high requirement of indomethacin, ie,3225 mg per day, for 4 and 7 years, respectively. In the hemicrania continua patient, a right (symptomatic side) C7 root affection due to disc herniation was demonstrated. Removal of the disc relieved the arm pain completely, and reduced the head pain and indomethacin requirement considerably initially. The other patient suffered from theunremittingform of chronic paroxysmal hemicrania with right‐sided attacks from the age of 16. Indomethacin, 200 to 250 mg per day generally kept the headache at bay, but during exacerbations, especially during menstrual periods, the dosage transitorily had to be increased to 250 to 350 mg per day. ACT scan with contrast at aged 18 (1987) was negative. In 1992, she started having new symptoms, including numbness on the ipsilateral side of the face and arm and difficulty swallowing. An MR scan showed a meningioma originating in the roof of the cavernous sinus on the symptomatic side. The meningioma was surgically removed. The postoperative indomethacin requirement was reduced, but only transiently. Patients with chronic paroxysmal hemicrania (CPH) and hemicrania continua (HC) with acontinuouslyhigh indomethacin requirement may have graveadditionaldisorders and should consequently be followed clos

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506363.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

A 30‐year‐old woman with hemiplegic migraine and an elevated CSF protein level with considerable pleocytosis is described. Fourteen other cases of hemiplegic migraine with cerebrospinal fluid abnormalities reported in the literature are revie

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3506368.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY