摘要:

SYNOPSISWe analyzed retrospectively the data for 300 patients with refractory headache who were treated with dihydroergotamine (DHE) at the Comprehensive Headache Center at German‐town Hospital. The patients had either chronic daily headache (with drug rebound ‐ 216, without rebound ‐ 42), short‐duration headache (18), or cluster headache (24). Treatment consisted of withdrawal of overused medications (usually analgesics and ergots), repetitive IV administration of DHE, and use of metoclopramide and prophylactic medications, together with educational and psychological support. Overall, 91% (range, 86% to 100%) of the patients became headache‐free, usually within 2 to 3 days. The average duration of hospitalization was 7.4 days. Side effects, reported in 157 (52%) of the patients, consisted primarily of nausea (32%), tightness and burning (8%), leg cramps (7%), vomiting (6%), and increased blood pressure (5%). The side effects generally resolved spontaneously or with adjustment of the DHE dose and/or adjunct medication, and necessitated withdrawal of therapy in only 2 patients (1 with drug‐related claudication; 1 with somatic complaints of uncertain origin).We conclude that a regimen of repetitive intravenous DHE and metoclopramide can provide rapid relief of chronic intractable headache, and can ameliorate the effects of analgesic and ergot withdrawal in patients with chronic daily headache and rebound associated with overuse of

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006334.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISWe report the first use of ICI 169,369, a selective S2receptor antagonist, in acute and prophylactic treatment of migraine.Ten selected patients documented their migraine attacks over a 2‐month period of open treatment with ICI 169,369, 30 mg orally, for acute therapy. They compared this treatment with others they had experience of. Four of these patients undertook a pharmacokinetic study comparing drug absorption in an acute attack to that when symptom‐free. Prophylaxis was then commenced with the same drug, 30 mg bd. Patients recorded symptoms in diary cards noting the effects of treatment on the usual frequency and severity of their attacks.The pharmacokinetic study showed that drug absorption could be markedly impaired during an acute attack. Nevertheless, in 35 attacks treated acutely, half the patients reported some efficacy apparent to them. One third of patients considered ICI 169,369 to be better treatment on this one occasion than their own usual medication. Some benefit was also noted during prophylaxis. There was a statistically significant reduction in attack frequency from the baseline observed during acute therapy only, but this was arguably compatible with placebo response.S2receptor antagonism may have some beneficial effect in acute or prophylactic treatment of migraine, but it is not marked and does not support S2receptor activation being important in its pathogene

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006340.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISFor seventeen years, a young man suffered from headaches of one to three days duration occurring once every six or seven days and totally disappearing between episodes. These were strictly unilateral (always on the left side), and were absolutely responsive to indomethacin. They differ clinically from the other two indomethacin‐responsive headaches described up to now: Hemicrania Continua (HC) and Chronic Paroxysmal Hemicrania (CPH). He has a sister suffering from HC.Similar to HC, but unlike CPH, topical tyramine in our patient's eyes resulted in anisocoria before, but not after, indomethacin treatment. Our case differs from HC, however, in its time pattern; it could either be a pre‐chronic stage of HC or a new type of headache. it seems unlikely that a time pattern that has remained unchanged for 17 years will become continuous, as in HC, in the future, and thus it is possible that our patient represents a case of a new type of headache that we propose to name “Hemicrania Episodica.” In any case, it seems probable that this type of headache, although clinically different, may share a common pathogenic basis

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006344.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISNuchal symptoms were found in the majority of 100 consecutive patients with cluster headache. In 10%, pain was experienced in the neck with the initial typical orbitotemporal pain; in 37%, pain radiated from the orbit or temple to the ipsilateral side of the neck. Sometimes, neck pain heralded the onset of the attack by a few minutes. During an attack, neck stiffness was reported in 40% and tenderness in 29%. Movement of the neck, especially flexion, precipitated cluster headache in 9% of patients. This was particularly true of patients with chronic cluster headache. Neck movement aggravated the headache in 16 of 100 patients and an equal number reported amelioration of pain by neck movement, especially extension.The nuchal features did not necessarily accompany every attack and were usually overshadowed by the severity of the typical headache. Nevertheless, symptoms referable to the neck occur more commonly than is generally appreciated.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006347.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISFourteen patients with cluster headache (13 with the episodic and I with the chronic form; 11 males and 3 females) were studied. One patient was in remission at the time of investigation; no one was studied during an ongoing attack. The cavernous sinus and its immediate surroundings were studied at 0.5 Tesla (n=7) and 1.5 Tesla (n=7). No definite pathological changes were found in the area of particular interest. Since the evidence implicating the cavernous sinus in cluster headache pathogenesis is rather strong, the search for abnormalities in this area should continue.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006350.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISIn order to investigate the hypothesis that migraine has a detrimental effect on cognitive functioning, 37 female migraine patients and 34 nonheadache female controls underwent a battery of neuropsychologic tests. No significant difference in test performance between groups was found. There was no relation between the length of migraine history or medication use and the level of impairment of cognitive abilities. The patient and control groups differed significantly on several self‐report measures known to interfere with performance. Patients reported higher trait and state anxiety levels, higher debilitating anxiety and state depression, and less vigor. Statistical correction for these variables, however, did not result in significant group differences of cognitive performance. The results suggest that the general population of female migraine patients show no indication of cognitive impairmen

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006352.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThe pattern of headache syndromes in 222 subjects (142 Saudi nationals, 80 non‐Saudis) seen at AI‐Khobar, Saudi Arabia is presented. Headaches were common, and accounted for 13% of all neurological outpatients. They affected mainly young adults, with a peak frequency in the third decade for Saudis and the fourth for non‐Saudis. They were rare in those under 10 and above 50 years old. Among Saudis, females outnumbered males especially in the second and fifth decades, while non‐Saudi males were more frequent than females in all age groups except the second decade.The main types were tension headache (66%) and migraine (22%). Acute/chronic sinusitis was an uncommon cause of headache. Tension headache affected mainly individuals between 21 and 40 years of age (69%). It showed a female preponderance in Saudis aged 11‐20 and above 40 years, unlike the male predilection in non‐Saudis. Migraine showed a definite female predilection only in Saudis in the fourth decade (female to male ratio of 4:1 ). A positive family history for headache was present in 10% of the cases.The major precipitating factor for headaches was stress related to family or working conditions. Other triggers included hunger and prolonged exposure to excessive heat or sunlight.The pattern of headaches in Saudi nationals may be related to the prevalent sociocultural factors, and the differences observed between them and non‐Saudis probably reflect the demographic status of non‐Saudis in the Kingdom as a consequence of governmental rec

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006359.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISNimodipine is one of the most discussed calcium antagonists used in cerebrovascular diseases and, recently, in migraine prophylaxis. Its specificity in preventing cerebral arterial constriction has been invoked to explain nimodipine's efficacy in migraine. The discovery of neuronal receptors specific for dihydropyridines, however, favours a mechanism of action for nimodipine that is not exclusively vascular. This is in accordance with a view of migraine pathogenesis which implicates a primary neuronal event as the basis of the vascular changes observed in migraine patients.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006363.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISMigraine is a common clinical diagnosis, occurring in 4–10% of school age children. Migraine in the infant and preschool child has been infrequently described in retrospective studies. We report the prospective evaluation and therapy of six children (5–42 months) with migraine. In four of the children, Prensky's criteria were used for diagnosis, while the two youngest children presented with ophthalmoplegic migraine. All children had a strong family history of migraine and presented with headache and prominent features including facial pallor, irritability, sleep disturbance or mood changes. The oldest four children were successfully treated with either amitriptyline or imipramine in low doses. Theinfants with ophthalmoplegic migraine failed to completely respond to any therapy. At followup 2 to 18 months later, all children were well and without toxicity. The pediatrician should be aware that migraine may begin in infancy and can be effectively and safely trea

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006366.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISFlunarizine plasma concentrations and side effects were evaluated in migraine patients during a 3 month course of prophylactic treatment. Plasma concentrations did not correlate with daily dose (in mg/kg). Mean flunarizine levels were higher in patients showing sleepiness or sedation. Weight gain was independent of plasma concentrations. Future clinical trials of flunarizine should be supported by drug monitoring in order to clarify the relationship between plasma levels and drug effects.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3006369.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY