摘要:

SYNOPSISThe traditional approach to classifying headache based on symptoms and assumed mechanisms is criticized as having limited utility when applied to tension‐type headache and migraine. The study reported here was designed to explore an alternative method of conceptualizing chronic headaches based on functional characteristics or controlling variables. One hundred and ninety nine chronic headache sufferers completed questionnaires which enquired about the antecedents and consequences of their headaches. An attempt to build a categorical model driven by functional characteristics using cluster analysis was unsuccessful but a subsequent attempt to construct a dimensional model using factor analysis proved more successful. This approach led to the emergence of five antecedent dimensions and six consequences dimensions (three pertaining to the responses of sufferers and three to the reactions of significant others) which were readily identifiable. The functional dimensions were significantly related to traditional diagnostic categories but at a low level. Three functional dimensions predicted response to psychological treatmen

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309461.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISThe Regional Migraine Field Trial assessed the efficacy and safety of dihydroergotamine mesylate (D.H.E. 45(r)) for migraine in the office setting. Patients were admitted to the study provided they met the International Headache Society definition of migraine with or without aura. Thirty‐eight neurologists enrolled 311 patients (274 women and 37 men) between the ages of 13 and 70 years in this open‐design study. Ninety‐five percent of the patients had moderate or severe headache pain at entry, and 62% had nausea. All patients received a single intramuscular injection of D.H.E. 45(r)1 mg. A second intramuscular injection of 1 mg was given 60 minutes after the first injection, if needed. An antiemetic was administered concomitantly with D.H.E. 45(r), if needed. Rescue therapy was given at the investigators' discretion. Efficacy was judged by the relief of pain, patients' ability to function, need for a second injection, need for rescue medication, and need for an antiemetic. At 30 and 60 minutes, 46% and 72% of patients had only mild or no head pain, respectively. At 24 hours, 77% of all patients had mild or no head pain. D.H.E. 45(r)also improved functional ability. At 30 and 60 minutes, 58% and 75% of patients had only mild or no disability, respectively. At 24 hours, 81% had mild or no impairment. Nausea was present in 62% of patients at the outset, 40% of patients at 30 minutes, and 30% at 60 minutes. An antiemetic was given to 43% of patients at the outset. The presence of nausea was similar whether or not patients received an antiemetic. Rescue medication was needed for 11% of patients, and adverse events were reported by 9%. In conclusion, D.H.E. 45(r)is effective therapy for acute migraine. A second dose provides additional relief, if n

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309471.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISTo determine whether the carotid body plays a pathogenetic role in cluster headache, 20 cluster headache patients have been studied. Of these, 11 patients were in the interparoxysmal cluster phase, and 9 were in remission. Comparison was made with healthy subjects matched for sex, age, and smoking habits. Transient hypoxia was induced by inhalation of 1–8 breaths of 100% nitrogen (N2), until the arterial oxygen saturation (SaO2) decreased to around 80%. Changes in ventilation (tidal volume, inspiratory minute ventilation (VI), and end‐tidal PCO2(PETCO2)), were analyzed breath‐by‐breath.Under basal conditions, cluster headache patients had a slightly higher SaO2and VIwhen compared to controls. PETCO2was significantly lower (P<0.05) during the cluster period as measured by Wilcoxon signed rank test for paired data, and during remission, according to the Student's paired t‐test, in comparison with controls. After exposure to N2, no significant difference was found in the rate of reduction of SaO2between any of the groups. A higher absolute increase in VI, but a relative (%) decrease in VIat moderate hypoxia were measured, the differences between patients and controls being on the border of the level of significance. Chemoreceptor sensitivity of the carotid body, expressed as the slope of a regression curve obtained by plotting the increase in VIagainst the reduction in SaO2, showed no statistical difference between the groups. The results do not support the hypothesis of a pathogenetic role for the carotid body in cluster

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309476.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309483.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISHemicrania continua (HC) is a rare, strictly unilateral, non‐paroxysmal headache disorder characterized by its absolute responsiveness to indomethacin. The pain is usually moderate in intensity and frequently associated with a superimposed“jabs and jolts” headache.We report two cases of HC which presented as chronic daily headache (CDH) with abortive medication overuse.CDH can be due to transformed migraine (TM), new daily persistent headache (NDPH), chronic tension‐type headache, and HC. All can be unilateral, and all can be associated with medication overuse. Our two cases meet the criteria for HC based on indomethacin responsiveness. One meets the criteria for TM, the other NDPH. Is HC a distinct disorder, or a subset of these other disorders? CDH with medication overuse includes in its differential diagn

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309485.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISTranscranial Doppler ultrasound (TCD) investigations have been carried out in cluster headache patients (8 during remission and 6 during bout) and 14 healthy subjects, to assess cerebral vasomotor reactivity (VMR) to hypocapnia induced by voluntary hyperventilation. VMR was expressed as the relative change in blood flow velocity (V) (%) as a function of the reduction in end‐tidal PCO2(PETCO2) (kPa), i.e. V/PETCO2. TCD with simultaneous PETCO2monitoring, was also performed in 5 patients during spontaneous attacks.Prior to hyperventilation, there was bilaterally lower anterior cerebral artery velocity (VACA) during the bout than during remission (P<0.05 on the symptomatic side), and also lower than in the controls. During remission, VACAwas higher on the symptomatic side than on the other side (P<0.05). ACA also showed a lower VMR during the bout than during remission, and it was also lower than in controls (bout vs. remission on the non‐symptomatic side, P0.1). Approximately 30 minutes after the onset of attack, PETCO2started to decrease gradually from 4.65 to 4.10 kPa in one patient with severe attack. The VACAdecreased markedly and bilaterally already at an early stage of the attack, i.e. prior to the hyperventilation. Middle cerebral artery velocity tended to decrease 30 minutes after the onset of attack on the symptomatic side, and 50 minutes after onset on the non‐symptomatic side. It is concluded that the vascular hanges observed most likely are secondary phenomena during the cluster headache a

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309488.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISThree patients with chronic paroxysmal hemicrania (CPH) (1 M, 2 F) and 9 healthy controls (8 M I F) were studied with transcranial Doppler (TCD) sonography. One patient who was studied during the spontaneous attacks hyperventilated markedly. Middle cerebral artery velocity (VMCA) was measured in the first attack, and anterior cerebral artery velocity (VACA) in the second attack, respectively. VMCAand VACAdecreased bi‐laterally during attack. VMCAstarted to decrease at an early stage of the attack, i.e. prior to the major hyperventilation that was observed during the attack. VACAon the symptomatic side decreased less than that on the other side (P0.05) in comparison with controls. These observations may imply an abnormal vascular reactivity in

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309493.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISThe diagnosis of migraine headache in children and adolescents is complex and not well understood. This study was conducted to compare diagnostic rates, using various criteria for pediatric migraine, and specific symptom characteristics in a sample of children referred for care to a specialized pediatric headache clinic. A structured interview was used at the patient's initial assessment visit to elicit symptom patterns and therapies attempted for headache. Clinical diagnoses were based on consensus agreement reached by a multidisciplinary team. Statistically derived diagnostic rates based on International Headache Society (IHS), Prensky, Vahlquist and our own criteria were significantly lower than clinical diagnostic rates. IHS diagnostic rates were differentially distributed as a function of race, but no other effects were found for demographic variables on diagnostic rates. Specific symptom patterns, however, varied as a function of race, gender and age of the child. The results underscore the need for comprehensive, developmentally based models of the evolution of migraine headache as a foundation for future research and the further development of clinically sensitive diagnostic criteria for pediatric migraine.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309497.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309501.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISA patient with a tentorial dural AV fistula causing atypical trigeminal neuralgia (TN) successfully treated by embolization is reported. The patient developed persisting throbbing facial pain in the distribution of the secondand third division of the right trigeminal nerve (V2,V3) after a history of typical neuralgia for one year, preceded by a two month spell of TN 6 years previously and accompanied by right‐sided pulsatile tinnitus for 10 years. The patient's mother, brother and sister were also said to be affected by typical trigeminal neuralgia.A right‐sided dilated vein of Rosenthal due to a dural AV fistula fed by branches of the meningeal, occipital and meningo‐hypophyseal trunk of the internal carotid artery was thought to cause trigeminal nerve compression. Complete resolution of symptoms after partial intra‐arterial embolization of the main feeding arteries with N‐butyroacrylate is

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3309503.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY