摘要:

SYNOPSISRecent epidemiologic studies have reported an association between migraine and major depression. Little is known about the mechanisms that link the two disorders, or the natural history of their co‐occurrence. We examined the association between migraine and major depression in a sample of young adults, using longitudinal data.Method: A random sample of 1,007 young adults (21–30 years of age) members of a large HMO in Southeast Michigan was interviewed in 1989; 97% of the sample were reinter‐viewed 3.5 years later, in 1992. A structured diagnostic interview was used to elicit information on DSM‐III‐R major depression and IHS migraine in lifetime (in the 1989 interview) and during the 3.5 year follow‐up interval (in the 1992 interview). Using Cox‐proportional hazards models with time‐dependent covariates, we estimated the relative risk for major depression associated with prior migraine and the relative risk for migraine associated with prior major depression.Results: In this sample of young adults, the incidence of migraine per 1,000 person years, based on the prospectively gathered data, was 5.0 in males and 22.0 in females. The estimated relative risk for major depression associated with prior migraine, adjusted for sex and education, was 3.2 (95% CI 2.3–4.6). The adjusted relative risk for migraine associated with prior major depression was 3.1 (95% CI 2.0–5.0).Conclusions: The study provides the first body of evidence that the previously observed cross‐sectional association between migraine and major depression can result from bidirectional influences, with each disorder increasing the risk for first onset of the other. The explanation that major depression in persons with migraine represents a psychologic response to migraine attacks would have been more plausible had we found an influence only from migraine to depression. By diminishing the plausibility of a simple causal explanation for the migraine‐depression comorbidity, the findings favor the shared

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407387.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISMigraine headache involves the activation of trigeminal afterents that are predominantly found in the first or ophthalmic division of the nerve. The headache is often pounding and the connections of the trigeminal nerve, the trigeminovascular system, have therefore been implicated in the pathophysiology of migraine and studied extensively. Considerable attention has been given to the peripheral ramifications of the system as a possible locus of action for anti‐migraine drugs while little attention has been focused upon possible central sites of action. It has been shown that certain peptides can act as markers for the trigeminal system, in particular calcitonin gene‐related peptide (CGRP), and that CGRP is elevated in migraine. We have employed an animal model for activation of the trigeminovascular system to evaluate a new anti‐migraine compound, 311C90, that may have central and as well as peripheral trigeminal actions. Cats were anesthetized by halothane induction and alpha‐chloralose maintenance (60 mg/kg, intraperitoneal), intubated, paralyzed and ventilated. Biparietal craniotomies were carried out to measure cerebral blood flow using laser Doppler flowmetry (CBFLDF). The external jugular vein was cannulated and blood drawn, centrifuged and frozen until processing. Stimulation of the trigeminal ganglion resulted in a mean maximum increase in CBFLDFOf 39 ± 5% at 20/s. The 5HT1agonist 311C90 was administered intravenously in two doses (30 and 100 μg/kg) to cover the range of doses likely to be effective clinically. At each dose the CBF LDF effect of trigeminal ganglion stimulation was inhibited. Stimulation of the trigeminal ganglion led to increases in both calcitonin gene‐related peptide and vasoactive intestinal polypeptide (VIP) levels in the external jugular vein. These were both attenuated markedly by administration of 311C90 in a dose of 100 μg/kg. No change in either neuropeptide Y or ß‐endorphin were seen during the study. These data demonstrate that trigeminal ganglion stimulation results in a brisk change in CBF LDF that can be modulated by 311C90. Furthermore the inhibition of VIP release indicates an action of the drug at the synapse in the trigeminal nucleus caudalis suggesting that this central site may have important advantages for the action of 311

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407394.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISWe evaluated the possibility that cluster headache may be a transmitted disorder, influenced by migraine genetics. In the first part of a two part study, 24 female cluster headache probands having at least one first degree relative with cluster headache were evaluated for familial histories of cluster and migraine headache. Headache histories of most parents, sib‐lings and children were satisfactorily documented by either direct interview or by information provided by knowledgeable relatives. In approximately a third of relatives, the headache history could not be properly ascertained. The second part of the study evaluated occurrence rates of cluster and migraine headaches among first degree relatives of 200 female and 100 male cluster headache patients, and the proportion of affected relatives. These data were compared to those of 200 women and 100 men with migraine headache; family history data were, for the most part, provided by headache patients.Twenty‐four of two hundred cluster headache women (12%) had at least one first degree relative with cluster headache. Three generations of cluster headache were found in 7/ 24 kindreds (29.17%). Parental cluster headache was found in 19 of the 24 probands (79.17%); in 14/19 (73.68%), transmission was from father to proband. Fifty percent of cluster pro‐bands also had migraine headaches, and almost 50% had a family history of migraine. Similarly, of the larger population of 300 cluster patients, approximately 45% had a positive family history of migraine. Of 1652 relatives of all cluster patients, 3.45% had cluster headache (thirteen times the expected frequency of cluster headache in the general population) and 17.55% had migraine headaches.The combined occurrence rate of cluster and migraine headaches among mothers or fathers of cluster patients differed little from the parents of migraine patients (X2= 3.16,P<.10; X2= 0.28,P<0.70, respectively). Migraine was significantly more common, however, among some relatives of migraineurs compared to combined frequencies of migraine and cluster headache among relatives of cluster patients. Finally, the migraine population of Goodell et al.28was compared to our cluster headache population for occurrence of either headache type among children where neither, one or both parents had headaches. The results for our cluster population was 36.33%, 48.07% and 71.43%, respectively; this distribution was not significantly different from the migraine group of Goodell et al. (28.6%, 44.2% and 69.2%),28and conformed to a Mendelian pattern of transmission (X2= 37.55,P<0.001).Results of this study provided evidence suggesting a genetic basis for cluster headache. Equally compellingwere findings suggesting a genetic link between migraine and cluster headaches. The authors have speculatedthat migraine and cluster headache may be the same disorder, genotypically, but expression of the latter mayinvolve a more complex process requiring, as yet unknown, extrinsic or intrinsic influ

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407400.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISSerotonin, or 5‐hydroxytryptamine [5‐HT], is a biogenic amine implicated in controlling feeding behavior, thermoregulation, sexual behavior, and sleep. 5‐HT receptors recognize at least three types of molecular structures: G protein coupled receptors, ligand gated ion channels, and transporters. It is now believed that there are at least seven different families of receptors, many of which have subtypes. The nervous system can be compared to a group of well‐modulated neural networks functioning in parallel. The serotonergic system may modulate these networks rather than actually mediate individual responses. Circumstantial evidence suggests a link between 5‐HT and migraine. Platelet HT decreases during an attack, and in some cases increased levels of metabolites are found. Many antimigraine drugs interact with 5‐HT and it

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407408.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISA link between headache and depression has been noted in the literature for over 30 years. To date, however, studies investigating this relationshiphaveignored the potential impact transdiagnostic symptoms (i.e., symptoms indicative of both depression and headache) may have on correlations between measures of depression and measures of headache activity. The present study examined this issue using the Beck Depression Inventory in a large sample of recurrent headache sufferers who had presented for treatment at one of two university‐based clinics. Factor analysis identified two distinct, albeit correlated, factors reflecting cognitive/affective symptoms and somatic symptoms. Correlational analyses found consistent relationships between the somatic symptom factor and measures of headache activity, but not between the cognitive/affective factor and headache activity. We suggest that the BDI items comprising the somatic factor identified in this study may not be appropriate indicators of depression in recurrent headache sample

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407418.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISTwenty‐three patients with diagnosed migraine headaches were randomly assigned to a biofeedback‐assisted relaxation therapy group or to a group who relaxed on their own. The biofeedback trained group decreased pain and medication more than the self relax group. Cerebral blood flow velocity was measured in the middle cerebral artery with transcranial doppler (TCD). The trained group significantly reduced systolic and mean cerebral blood flow velocity on the side with the highest veloc

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407424.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISSubject samples used in research on recurrent headache disorders typically are composed of individuals who are seeking or receiving treatment. To the extent such subjects are unrepresentative of the larger population of recurrent headache sufferers, the external validity of findings may be jeopardized. We examined young recurrent (tension‐type or migraine) headache sufferers and compared individuals who had sought treatment (N=81) and individuals who had not sought treatment (N=109) for their headache problem. Subjects who did not experience headaches (N=129) served as a comparison group. Recurrent headache sufferers who had sought treatment reported more frequent headaches and experienced problem headaches for a longer period of time than recurrent headache sufferers who had not sought treatment for their headaches. However, the two treatment‐seeking groups did not differ on measures of psychological symptoms, coping strategies, or beliefs about their headache disorder. Irrespective of whether they had sought treatment or not sought treatment for their headache problems, recurrent headache sufferers reported higher levels of depression and physical symptoms than comparison subjects. These results provide no support for the hypothesis that psychological symptoms or neuroticism are associated with treatment‐seeking behavior in recurrent headache suff

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407429.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISHeadache is one of the cardinal features of intracranial neoplasm. However, there is little published information on the prevalence and clinical profiles of headache in patients with brain tumor. This cross‐sectional study recruited 171 cases of brain tumor. The average age was 39 years (range from 4 to 75 years). The female to male ratio was 1.2:1. The prevalence of headache was 71%. The duration of headache ranged from 3 days to 10 years with an average of 15.7 months. Most prominent headache profiles in this series were intermittent, nocturnal and early morning headache as well as headache upon arising. Most of the patients had mild to moderately severe headache. Headache is more common with tumors below the tentorium cerebelli. It is more prevalent in primary and intracerebral tumor than in metastatic and extracerebral tumor. Headache has lateralizing value, especially in patients with supratentorial lesions who have no obvious increased intracranial pressur

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407435.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISThe 5‐HT3antagonism property of metoclopramide, acting on receptors presumably located in the trigeminovascular system, is the theoretical basis of its remarkable success, as a single intravenous agent, in the treatment of migraine attacks. The specific anti‐migraine activity of oral metoclopramide is, most probably, applicable only when its plasma level is equivalent to 10 mg injected intravenously. The clinical effective dose of ergotamine, beginning from the minimal dose of 1 mg, correlates well with its affinity for 5‐HT18and 5‐HT1Dreceptors, and the rank order of clinical potency of ergotamine is superior to sumatriptan. The presumed synergic power of drugs that interact with both 5‐HT1and 5‐HT3receptors is examined, in order to formulate a highly potent, low headache recurrence, oral

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407439.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISA case of lithium neurotoxicity in a patient with cluster headache, resulting from coadministration of ketorolac is reported. While lithium interaction with many other NSAIDs is well‐known, ketorolac has not been incriminate

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3407442.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY