摘要:

SYNOPSISSegmental arterial narrowing has rarely been angiographically demonstrated in patients with migraine. One new case is reported and 12 previous cases are reviewed. Though often referred to as vasospasm, arteriographic stenosis may result from edema of the vessel wall, arterial dissection, the effects of puerperium or arteritis.A biphasic course of spasm, similar to the pattern noted with subarachnoid hemorrhage, has been recorded in some migraineurs. The current neurogenic and biochemical concepts of “spasm” developed for subarachnoid hemorrhage are reviewed.Arterial narrowing may be important in several phenomena associated with migraine. It may account for migrainous cerebral infarction or hemorrhage. Vasoconstriction has also been invoked to explain the aura and other features of migraine. But the site of stenosis does not always correlate with the headache or focal neurologic features in location or timing. The angiographic changes are probably an epiphenomena rather than a primary mechanism of migraine. These changes may result from altered sympathetic neuronal activity; factors supporting that concept are revie

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3002052.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISWe report two cases of sleep disturbances and perceptual disorder appearing in close temporal relationship with initiation of flunarizine therapy for migraine prophylaxis: these side effects disappeared after therapy interruption; resumption of the drug in one case was associated with symptom recurrence.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3002062.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISInjury to the right lateral forehead was followed by headaches, and chronic ipsilateral ptosis, miosis, and forehead hyperhidrosis. Episodes of headache were accompanied by an increase in ptosis, miosis and forehead hyperhidrosis. The headaches abated within 6 weeks but the ptosis and miosis, due to postganglionic sympathetic insufficiency, were persistent. Spontaneous forehead hyperhidrosis, was also persistent at the time of last follow‐up, 15 months later. Autonomic assessment of the oculocephalic sympathetic dysfunction, localization of the lesion and possible explanation of the autonomic findings are discusse

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3002064.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThese studies of cluster headache (CH) focus on two key features of pain transmission: a) sensory nerves when stimulated, as well as the expected afferent transmission, also display an efferent function which affects capillaries, glands, and smooth muscle (of the iris in CH); substance P (SP) and allied transmitters such as Vasoactive Intestinal Peptide (VIP) and Calcitonin Gene‐Related Peptide (CGRP) are the main agonists of this dual afferent‐efferent function; b) impaired pain transmission (deafferentation‐like condition) provokes a rostral spread of neuronal irritability and automatic firing (“quasi epileptic foci”) producing a clinical predilection for pain with the generation of “spontaneous” pains along the sensory pathways.The substrates studied in the present experiments are the iris, salivary glands, and nasal mucosa.1) Iris:the conjunctival instillation of SP induces isocoric miosis both in CH sufferers and in normals, thus excluding gross SP receptoral dysfunction of the iris muscle in CH. Electrical stimulation of extraocular (infratrochlear) endings of the first branch of the trigeminal nerve provokes a miosis, which is significantly less in the symptomatic eye than in the contralateral one. This miosis is ascribed to a retrograde release of SP, induced by electrical stimulation of the trigeminal ophthalmic branch. The relatively poor miosis in the painful eye could correlate with a deficient release of SP from the sensory terminals in the iris.2) Salivary glands:an increase of substance P‐like immunoreactivity is found in the saliva taken from the asymptomatic side, but not from the painful side during a cluster headache attack, thus showing at this level also an asymmetry as previously shown in other head structures.3) Nasal mucosa:intranasal application of capsaicin, a powerful releaser of SP from sensory terminals, evokes an immediate burning pain in the ipsilateral nasal, ocular, and temporal areas, as well as lacrimation and rhinorrhea. A gradual decrease (tachyphylaxis) of these phenomena is consistently observed after few days of daily nasal administration of capsaicin. When this treatment is applied to CH patients, a rapid decrease in the number and intensity of attacks, and even disappearance of symptoms accompanies the decline of the capsaicin‐induced manifestations. Local (nasal) capsaicin, in spite of evoking immediately the same vegetative (rhinorrhea, lacrimation, conjunctival congestion) and in part nociceptive (transient nasal, ocular, temporal burning) phenomena of CH, never has been able to provoke delayed spontaneous‐CH like attacks. Such delayed provoked attacks, one of the most pregnant phenomena in CH investigations, are almost constantly evoked by systemic stimuli. Besides stimulating speculation the results from capsaicin desensitization encourages a search for better characterization of this novel p

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3002069.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThe relationship between sleep and headache has been known for over a century. Sleep represents the only well documented behavioral state related to the occurrence of some headache syndrome. Liveing1in 1873, wrote about the effect of sleep in terminating an attack of headache. Bing2also, noted this relationship when he wrote about early morning headaches. Gans3reported a decrease in frequency and severity of migraine attacks following selective ‘deep‐sleep deprivation.’ Dreams4leading to headache have been reported. Quite obviously, headache also finds a place in the classification of sleep disorders.5This very important relationship between sleep and headache is the subject of this clinical r

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3002080.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISChlorpromazine, given intravenously, is a useful agent in the treatment of acute migraine headaches. Patients with more serious conditions, however, may also respond to this medication. In this paper we report two patients who were initially diagnosed as having migraine headaches and treated with chlorpromazine. Both experienced temporary pain relief and it was only after repeated presentations to the emergency department that their conditions‐a subarachnoid hemorrhage and a subdural hematoma‐were accurately diagnosed.Because of this, caution must be exercised before re‐treating within a short period of time, a patient with recurrent headache. Strong consideration must be given to an alternate diagnosis and such a diagnosis should be actively sought should there be any suspicion of a non‐migrainous cause for headache. It is only by doing so that we may avoid missing more serious and life‐threatening conditions such as those with which our patients

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3002085.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISMagnetic resonance imaging (MRI) of the brain was performed in 18 patients with non‐epileptiform basilar artery migraine (BAM). In a few subjects, mild enlargement of the cortical sulci and white matter T2 weighted increased signal intensity were present. Twelve of the patients also underwent computerized tomography (CT) of the head: 6 of the latter individuals had abnormalities on their MRI not detested by CT, but their finding did not modify the pre‐existing diagnosis or influence clinical management. No evidence of biologic markers (i.e. congenital anomalies of the brainstem) was encountered and no signs of prior traumatic lesions, demyelinating disease or complicating stroke. MRI is a useful but limited complementary diagnostic tool in

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3002088.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3002093_a.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY