摘要:

SYNOPSISA large body of evidence points to an inflammatory process in the cavernous sinus and tributary veins as being primarily responsible for cluster headaches. The inflammation obliterates the venous outflow from the cavernous sinus on one side and injures the through‐running sympathetic fibers to the eye, upper eye lid, forehead skin, and the intracranial internal carotid artery and its branches. The active period ends when the inflammation is suppressed and the sympathetic fibers partially or fully recover. Evidence is presented that the symptoms suggestive of an enhanced parasympathetic activity during attacks may alternatively be explained as local pain fiber activation or a stasis in the outflow from the cavernous sinus. Vasodilator agents like nitroglycerin induce an attack by enhancing the venous load on the cavernous sinus. Constriction of the proximal intracranial internal carotid artery, spontaneously induced by tressful pain activation of the perivascular sympathetic nerves, or by exogenous administration of serotonin 1 D‐like receptor agonists or oxygen, terminates the venous load and thus the pain and associated sympt

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403125.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISCapsaicin, when repeatedly applied to the nasal mucosa of cluster headache patients, has been shown to prevent the occurrence of pain attacks. In order to investigate the mechanism of the drug's action, we evaluated the effect of repeated nasal application of capsaicin on the contents of sensory fibres immunoreactive to substance P and CGRP in the rat nasal mucosa. Further, considering the possible involvement of the cerebral circulation, we verified the effect of a single application of capsaicin on the blood flow velocity of the internal carotid and middle cerebral arteries (of both sides) and the basilar artery, in a group of healthy humans. The measurements were taken using Doppler devices. In order to verify the reproducibility of therapeutic effect of capsaicin, we carried out a 2‐year follow‐up study on patients affected by cluster headache (17 by episodic form, 8 by chronic form) who responded positively to the first treatment with capsaicin. During this period they were treated again with capsaicin in case of re‐occurrence of symptoms. Capsaicin depletes the fibers immunoreactive to substance P and CGRP in the rat nasal mucosa. In the healthy controls, a single application induced vasodilation in the internal carotid, whereas middle cerebral arteries and basilar artery were narrowed. The results of the follow‐up study, demonstrates that in 65% of the patients, the beneficial effect of capsaicin was again present when the treatment was repeated. In the chronic patients the therapeutic effect was always transitory (lasting, at maximum one month). The present findings indicate that a specific effect on the nociceptive fibers and perhaps the consequential reflex modifications in the cerebral circulation, could play a role in the therapeutic effect of capsaicin. This effect has been shown to be repeatable. The present results, apart from indicating future therapeutic strategies, also offered interesting clues for the interpretation of the pathophysiology of the s

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403132.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISObjective: Comparison of clinical headache diagnoses in primary care to algorithm diagnoses from a standardized headache interview.Design: A sample of consecutive primary care headache patients (n=779) at the Group Health Cooperative of Puget Sound were interviewed and medical records abstracted.Measurements: The medical record provided ‘chart’ diagnoses while a structured interview and diagnostic algorithm yielded the ‘algorithm diagnosis’. The patients were also administered the depression sub‐scale from the SCL 90‐R, in addition to answering questions about pain intensity and disability used to rade the severity of chronic pain.Results: Among persons diagnosed by the primary care physician as having migraine, 78% received an algorithm diagnosis of migraine. However, study patients were more likely to receive a diagnosis of migraine by algorithm (57%) than by clinical diagnosis (33%). While clinicians infrequently recorded a diagnosis of migraine and tension‐type headache in the same patients, tension‐type headache was identified among half of the algorithm diagnosed migraineurs. Among patients with algorithm‐diagnosed migraine, female gender, increased isability, and the presence of aura increased the likelihood that the clinician would also diagnose migraine, Conversely, the presence of tension‐type headache features, high levels of depression, high number of headache days and age over 65 years reduced the likelihood of the clinician diagnosing migraine among algorithm‐diagnosed cases.Conclusions: The co‐occurrence of migraine and tension‐type headache symptoms are commonly reported by patients, however, primary care physicians usually recorded a single diagnosis of either migraine or tension headache. Among patients reporting migrainous features, the presence of chronic headache, emotional distress and the absence of disability reduced the likelihood that the clinician would assign a diagnosis of migraine. These results suggest the need for diagnostic and management strategies appropriate for patients whose headaches combine tension‐t

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403138.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISBackground: To analyze the differences in quality of life associated with headache diagnoses using the Medical Outcomes Study Short Form Health Survey (SF‐20).Methods: A patient interview survey using the SF‐20 Short Form Health Survey was conducted in a headache clinic within a multi‐specialty group practice. All six health components of the SF‐20 were included in the study, Headache diagnoses were made using IHS criteria.Results: 208 consecutive headache patients were studied. Patients with cluster headache had a significantly higher (worse) pain score (P<0.018) and higher percentage of patients with poor health due to pain (P<0.005) than patients with migraine headache. There were fewer cluster patients with poor health associated with physical functioning than tension‐type (P<0.020) or mixed headache (P<0.022) patients. Poor health associated with social functioning was greater for cluster (P<0.011) and tension‐type headache (P<0.015) than for migraine. There was a significantly higher percentage of tension‐type headache patients with poor health associated with mental health (P<0.002) than patients with migraine.Conclusions: The SF‐20 is a reliable and valid measure of quality of life for patients with different headache diagnoses. Distinct headache diagnoses are marked by unique patterns of impairment and

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403143.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISThe experience with 34 patients who came to the Shreveport Headache Clinic for treatment of postconcussion headache is reviewed. All had been suffering from postconcussion (posttraumatic) syndrome for periods ranging from one day to more than three years, and all displayed, in addition to headache, at least three other symptoms characteristic of the syndrome, eg, memory problems, impaired concentration, sleep problems, dizziness, and anxiety. After initial evaluation at the clinic, the patients were admitted to Willis Knighton Medical Center and treated with repetitive administration of intravenous dihydroergotamine (DHE) and metoclopramide. A good to excellent overall response to DHE therapy was achieved by 88% (29) of the patients. The percentages and numbers of patients obtaining good to excellent relief of selected key symptoms were: 85% (28) ‐ headache, 91% (30) ‐ memory problems, 94% (31) ‐ sleep problems, and 88% (29) ‐ dizziness. DHE was well‐tolerated, and no serious or unexpected adverse reactions were reported. The most frequently reported adverse reactions were mild nausea and brief worsening of

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403148.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISThe investigations of personality traits have been the issue of many studies on patients with headache. Minnesota Multiphasic Personality Inventory (MMPI) is the most popular assessment instrument used in these studies. MMPI responses of 36 cases (14 male, 22 female) with tension headache and 44 cases (11 male, 33 female) with migraine headache had been compared with 36 nonheadache controls (12 male, 24 female). Because of the inadequate number of male subjects, the statistical analyses were made between female groups. The results obtained revealed that subjects in the tension‐type headache group got significantly higher scores on neurotic subtests (hypochondriasis, depression, hysteria) than subjects in the control group. Likewise, migraine subjects got significantly higher scores on hysteria subtest than control subjects. No significant differences were noted between migraine and tension groups. However, none of the headache groups could be characterized by marked elevations on any of the validity and clinical scales. These results, support the finding that neurotic symptoms occur with a higher frequency in headache sufferer

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403152.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISWhile headache is a documented side effect of electroconvulsive therapy (ECT), there is little information on this phenomenon. Studies of the mechanisms of ECT as a treatment for depression indicate that alterations in serotonergic neurotransmission appear to be related to its efficacy. While ECT and many of the antidepressant drugs have similar effects on serotonergic transmission, they are notably different in the changes they induce in type 2 receptors for 5‐hydroxytryptamine (5‐HT). ECT upregulates 5‐HT2, and antidepressants down regulate the receptor's expression. 5‐HT2receptor sensitization has been associated previously with headache genesis, which may explain why ECT induces headache, and amitriptyline relieves headache.In our study we surveyed 98 patients retrospectively about their experiences with headache prior to and following ECT. Of the 54 patients who submitted properly completed questionnaires, five reported new onset of headaches following ECT, four reported exacerbation of a previous headache problem, and two reported their headaches improved. The patients experienced changes in the character or location of pain, with a tendency to progress from tension‐type to migrainous headache. In all but two cases these developments persisted at least eight months after ECT. We discuss the possible reasons and significance of our

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403155.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISRecent research has shown that magnesium levels in serum, salivary secretions and red blood cells are reduced in migraine patients with and without aura, both ictally and interictally. This suggests that lower magnesium levels can contribute to the etiopathogenetic mechanisms underlying migraine attacks. It has been suggested that mononuclear magnesium content is a reliable index of magnesium nutritional status, as it is more closely related to the total body stores than other biochemical indices. Therefore we determined mononuclear magnesium content in adult migraine patients with and without aura, in headache‐free periods and, in a number of patients, during attacks. Migraine patients with and without aura, assessed in interictal periods, had a reduced mononuclear magnesium content compared to age‐matched healthy control subjects. No significant variations were observed between ictal and interictal periods in migraine patients with aura and without aura. The lower magnesium content in mononuclear cells could indirectly indicate the reduction of brain magnesium concentration, which has recently been demonstrated in the course of migra

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403160.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISThis study initiated by a self‐help migraine group investigated disability caused by visual environmental stimuli, e.g. glare, flicker, pattern and color. One thousand forty‐four women with migraine completed the self‐report questionnaire on visual environmental stimuli reported in earlier studies to precipitate or aggravate migraine. One hundred twenty‐one female controls were obtained from general practice and hospital out‐patients. The responses of the classical, common and non‐migraine groups were compared. Women with classical migraine expressed greater disability than those with common migraine or controls both in respect of number of visual sensitivities reported (P<0.0001 ) and severity of consequences of such stimuli (P<0.0001). This study indicated differences between classical and common migraine outside of the attack phase apart from aura. Reported range of sensitivities for the migraineurs peaked between the ages of 46–60 years. A high level of unrealized disability caused by visual environmental stimuli was thus identified in hitherto unexplored sel

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403166.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISThe occurrence of limb pain in close temporal relationship with headache was sought in 245 (185 women and 60 men) patients. Eleven patients (4.4% three men and eight women) had referred pain at least once, in one or more limbs in close temporal relationship with headache. Usually the pain was located in the upper limbs, was concomitant with the headache but could precede or follow it. The severity and length varied between patients but was relatively stable in the same subject. It is possible that this symptom is more frequent than believed so far and that many patients are misdiagnosed.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3403169.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY