摘要:

SYNOPSISTen episodic cluster headache patients in their active cluster period, ten patients in remission and five control subjects were monitored for minute to minute changes in oxygen saturation (SaO2) and pulse rate before and after nitroglycerin (NTG) administration.A transient but significant decrease in SaO2 and increase in pulse rate of 25 minutes duration occurred following NTG in all groups. These changes may reflect physiologic hemodynamic effects of NTG as a smooth muscle relaxant. Subsequently, SaO2 levels and pulse rate recovered to baseline values in remission and control groups. In contrast, SaO2 values in the active cluster group decreased further and after an extended period culminated in cluster headache attacks in 10/10 patients.Three major changes, therefore, distinguished active cluster patients from remission and control groups. First, the magnitude of oxygen desaturation increased after the physiological effects of NTG ceased. Second, oxygen desaturation was sustained for an additional 9 to 30 minutes duration. Third, the hypoxemic state culminated in attacks in all cases.Our findings suggest that the active cluster period may be characterized by an impaired mechanism to autoregulate, and thus compensate, for hypoxemia. It is further proposed that persistence of hypoxemia and the cluster attack onset may share a common mechanism, coupling the two events. We suggest that abnormal central and/or peripheral chemoreceptor activity may be responsible for these events.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008474.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISData are scant concerning some epidemiological aspects of those severe headaches which cause serious personal and economic morbidity. Our purpose was to study the incidence and other epidemiological features of patients suffering from severe migraine exacerbations, in an unselected population. The 64 patients who suffered from severe migraine bouts represented 10.5% of all the new walk‐in neurological consultations in the area covered in this study. 70% of these patients were between 10 and 39 years old. Although females clearly predominated in all ages after fifteen, below this age there was a slight male predominance. The calculated incidence of serious migraine exacerbations was 90 per 100,000 people per year, the corrected incidence for females being 143/100,000 and for males 37/100,000. The highest incidence for females was in 15–19 year‐olds (377/100,000) and for males in 10–14 year‐olds (166/100,000). Our data seem to confirm the periodic nature of this condition since in 80% of patients the migraine bouts (ie: groups of attacks) lasted between two and nine months. Also they support the reported existence of genetic and hormonal factors in the susceptibility to migraine exacerbations. Our results may help in planning the public health aspect of migraine and add some light to the natural history of this common

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008481.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThree cases of sudden, severe headache occurring during swimming are described. A 51‐year‐old female had been engaging in a swimming exercise for about 20 minutes when she suddenly experienced a pulsating headache in the parietotemporal region, accompanied by nausea. A few days later, she experienced a similar episode, again during swimming practice. A 45‐year‐old male developed a pulsating headache with nausea immediately after diving into a swimming pool, and had a similar attack during diving practice 1 week later. A 32‐year‐old male developed a pulsating headache accompanied by nausea while swimming in the sea. In all three cases, blood pressure, pulse rate, neurological findings, cervical spinal x‐rays, brain CT scans, and hematological findings were normal and the outcome was good. Although these patients' headaches were diagnosed as benign exertional headache, pathophysiologically they appeared to resemble the headache associated with se

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008485.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SUMMARYPlatelet monoamine oxidase activity (MAO) in a group (n = 17) of white, female migraineurs during an acute migraine attack was similar to both the values obtained for the same group of patients two to three weeks after the headache episode (pain‐free period) and to the results obtained for a group (n = 18) of sex and race‐matched, age‐comparable, drug‐free healthy volunteers (blind study; substrate p‐tyramine, 38.7 ± 5.7, 41.9 ± 8.8 and 43.0 ± 3.4 or p‐methoxybenzylamine, 178.9 ± 11.3, 177.2 ± 6.9 and 181.0 ± 9.7 nmole/hr/10 9 platelets ± SD, respectively). With each patient serving as its own control, MAO activity during the migraine episode and when pain‐free failed to show a significant trend. Neither a number of other medical conditions nor the use of several medications appeared to significantly influence our results. The present work, while dealing only with a small but well defined patient population, argues against the possible usefulness of platelet MAO activity as a biological marker fo

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008488.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThe abuse of the combination drug containing butalbital 50 mg, aspirin 325 mg and caffeine 40 mg (or BAC), is commonly recognized by headache specialists as causing headaches. Despite this widespread problem, there is not a published treatment regimen for the BAC detoxification of patients. I describe such a protocol which was used four times in three patients. These patients fulfilled the diagnostic criteria of the IHS Headache Classification for headaches induced by chronic substance abuse (8.2) and analgesics abuse headache (8.2.2). These patients took between 150 and 420 BAC/month for 2–15 years. Two patients had previously undergone inpatient detoxification. One patient unsuccessfully tried detoxification twice as an outpatient.All patients were required to have psychological support prior to hospitalization for this protocol. BAC was discontinued. A pentobarbital challenge test corroborated butalbital dosage. The patients were given phenobarbital and caffeine which were tapered over several days. Dihydroergotamine (DHE) with metoclopramide was used (Raskin). Propranolol 60 mg bid was started. No narcotics were permitted. After hospital discharge, patients were allowed to continue subcutaneous DHE, as needed. One patient restarted BAC use after 8 months without it. The other two patients were still BAC free 18 and 14 months after detoxificatio

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008491.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThis work assesses the differences in the thermographic findings in the craniofacial and neck areas between normal individuals and patients with craniofacial pain or headache, and investigates the influence of muscle contraction on such findings. Thermographic records were taken in 10 healthy subjects and 47 patients suffering from craniofacial pain or headache of different kinds. In the patients with painful episodes the record was taken between attacks. In all the normal subjects and in 19 patients lateral thermograms were also taken during and after maximal tooth clenching for three minutes. The majority of the patients, as compared to the normal group, showed some thermal alterations and asymmetry. Such alterations seem to be due both to vascular instability and muscle contraction: these two factors may be variably superimposed in the different conditions. In patients with cluster headache or chronic paroxysmal hemicrania the presence on the symptomatic side of a cold spot along the supraorbital area and/or the inner orbital canthus, was a constant finding. We conclude that thermography is useful as an additional diagnostic means in patients with head and face pain, and that the clenching test may increase the amount of information provided.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008497.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThe relationship between pain and autonomic disturbances in cluster headache was studied in 54 patients whose attack always recurred on the same side, and in 7 others whose attack had affected either side on different occasions. In one of these seven patients, facial flushing and ocular sympathetic deficit was observed on the original side of headaches. In most patients, the orbital region was warmer on the painful side but in three cases this region was cooler during and between attacks. Lacrimation and rhinorrhoea were more common in severe attacks, and the temperature difference between the orbits increased with increasing severity of pain. These findings support the view that certain autonomic disturbances in cluster headache are provoked by pain. Residual autonomic dysfunction could influence autonomic activity during cluster headache. If so, residual dysfunction on the pain‐free side could explain the dissociation between autonomic disturbances and pain observed in a few case

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008505.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISWe have observed in a patient, during four subsequent spontaneous attacks of cluster headache, recurrence of marked bradycardia and junctional rhythm constantly associated with systolic and diastolic blood pressure increase.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008509.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISAvailable evidence supports the contention that migraine involves a disturbance in serotonin function.Several parameters of serotonin function in humans have been found to vary seasonally and may underliethe seasonal fluctuations observed in many clinical neuropsychiatric phenomena that are thought toinvolve serotonin dysfunction. We therefore postulated that migraine headaches might also varyseasonally and examined the admissions to our hospital over a 20‐year period with a primary diagnosis ofmigraine. Peak admissions were found to occur most frequently in the spring for females in comparison tomales (p£0.04, chi‐square). The implications of these findings are discu

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008511.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISEighty‐one patients were diagnosed as having migraine, tension headache or both according to previously used criteria. Then we performed a standardized interview to determine the frequency and severity of headache characteristics used in the new operational diagnostic criteria of the International Headache Society (IHS). In every patient the original diagnosis fulfilled also the IHS criteria, but in 9 patients the criteria were only fulfilled in half or less of the attacks, and applying the IHS criteria they also achieved an additional diagnosis. In one patient these attacks did not fulfill the pain criteria and in 8 (4 migraine, 4 tension headache) they did not fulfill the criteria for accompanying symptoms. Overall the HIS criteria are sensitive and specific, but they may possibly be improved with regard to accompanying symptoms. The present study suggests that recording of frequency and graded severity of characteristics using a headache diary may further improve the distinction between the different types of headach

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3008514.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY