摘要:

SYNOPSISStimulation of the locus ceruleus produces vasoconstriction in the intracerebral circulation and vasodilatation in the extracerebral circulation. The latter is mediated by the seventh cranial nerve, involving a non‐cholinergic transmitter. These vascular changes are reminiscent of those occurring in migraine. Stimulation of the trigeminal ganglion or of the trigeminal divisions produces a reflex dilatation in the external carotid territory also mediated by non‐cholinergic fibers in the seventh nerve.It is postulated that, in migraine, activation of the locus ceruleus would produce vasoconstriction in the cerebral circulation and dilatation extracerebrally. Such an effect would account for both the neurological symptoms of migraine and the observed changes in blood flow and vascular reactivity. Dilatation in the external carotid territory could lead to further reflex changes by activation of the central pathways described. Changes in locus ceruleus activity could be responsible for the pain of the headache phase of migraine, by disrupting a descending pain control sys

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1983.hed2306258.x

出版商:Blackwell Science Inc    

年代:1983

数据来源: WILEY

摘要:

SYNOPSISSince Wolff's original proposal regarding the vascular etiology of cyclic head pain, evidence has accumulated that the prodromes of migraine are due to cerebral vasoconstriction and headaches of both cluster and migraine are due to painful dilatation. Theories regarding their pathogenesis include cyclic release of vasoactive substances from platelets and/or other sources (such as serotonin, catecholamines, histamine, acetyl choline, prostaglandins, substance P, endogenous opiates). These substances influence vasomotor receptors bringing about abnormal constriction and/or dilatation. Drugs which modify receptors (such as methysergide, alpha and beta blockers, antihistaminics, anticholinergics, steroids and non‐steriodal anti‐inflammatory agents) have had some therapeutic success in migraine but provide little benefit for cluster patients. Ca2+entry blockers (including nimodipine, nifedipine, verapamil) theoretically should diminish cephalic vasoconstriction and ‐dilatation no matter what their cause. To test this, 35 headache patients with classic (N = 13), common (N = 14) migraine or cluster (N=8) were evaluated by double‐blind, cross‐over, randomized assignment to high or low dose nimodipine therapy. Within 10 days migraine prodromes became infrequent and after 2–4 weeks headache frequency was significantly reduced for migraine and within 4–6 weeks for cluster. CBF measurements during oxygen inhalation showed reduced cerebral vasoconstrictive responses after high dose nimodipine. Associated muscular contraction headaches were not altered. Nifedipine and verapamil provided equivalent relief for cluster but produced more side effects, and were less effective, than nimodipine in contro

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1983.hed2306266.x

出版商:Blackwell Science Inc    

年代:1983

数据来源: WILEY

摘要:

SYNOPSIS,The calcium channel antagonists are a recently developed class of vasodilators that prevent the influx of calcium into vascular smooth muscle. The unique pharmacologic effects of these agents provide a theoretical basis for their use in the treatment of migraine. First, the calcium channel antagonists inhibit the actions of all vasoactive substances on intracerebral smooth muscle via a blockade of the "final common pathway" of cellular contraction. Secondly, the vascular effects of the calcium channel antagonists are selective for intracerebral versus peripheral vessels. Clinically, two specific calcium antagonists (flunarizine, cinnarizine) and two non‐specific antagonists (cyproheptadine, amitriptyline) are effective in the treatment of migraine. Further studies will determine whether the calcium channel antagonists, as a class of agents, are effective in the treatment of migraine and other forms of vascular headache. This novel class of vasodilators also provides a powerful tool for the critical evaluation of the vascular theory of migrain

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1983.hed2306278.x

出版商:Blackwell Science Inc    

年代:1983

数据来源: WILEY

摘要:

SynopsisSystematic ultrasonic Doppler flow examinations of 98 migraine patients during a headache free interval revealed a highly significant reduction of blood flow in the A. supratrochlearis, an endbranch of the A. ophthalmica, compared with a control group (n=55). 34 migraineurs with invariable hemicrania showed a significant reduction of ophthalmica‐blood‐flow on the affected side, compared with the painfree side. Doppler flow examinations during spontaneous migraine attacks revealed a characteristical increase of the flow velocity in Aa. carotides communes, internae, externae and Aa. vertebrales, whereas the A. ophthalmica showed a flow reduction during the attack. Of 6 patients suffering from cluster headache, there was a marked flow acceleration in the A. ophthalmica during spontaneous or nitrolingual provoked attacks. The results indicate that the noninvasive transcutaneous Doppler sonography is of value in the differential diagnosis of migraine patients and cluster headache. The implications of the results are discussed with respect to the hemodynamics of migraine and cluster heada

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1983.hed2306284.x

出版商:Blackwell Science Inc    

年代:1983

数据来源: WILEY

摘要:

SYNOPSISThis article reports the results of 61 procedures performed on 20 patients and reviews the literature. The procedures consisted of 27 radiofrequency lesions, nine V root sections, five injections of local anaesthetic into the Gasserian ganglion, four greater superficial petrosal neurectomies, seven superficial temporal artery sections, six nerve avulsions and three alcohol injections. The authors conclude that:1) No one procedure gives consistent longlasting relief.2) Patients must have a full trial of medical therapy before considered for surgery.3) Radiofrequency lesions and nerve avulsion are reasonable first stage procedures.4) Both V root section and petrosal neurectomy appear to be useful as second stage procedures.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1983.hed2306289.x

出版商:Blackwell Science Inc    

年代:1983

数据来源: WILEY

摘要:

SYNOPSISTemporal artery, frontal EMG, systemic blood pressure, peripheral temperature, heart rate, and anxiety levels were monitored daily four days preceding a typical migraine attack and during the headache in twelve female migraine cases. The specific relationship between temporal artery activity and anxiety and temporal artery activity and pain was also determined. The results indicated the presence of an increased variability in the right temporal artery three days preceding the migraine with the absence of changes in the general autonomic and skeletal muscle measures. Considerable individual differences in temporal artery amplitude were observed necessitating an analysis of individual patients which revealed a general pattern of dilation three days prior to the attack and constriction the day preceding the attack. Increased anxiety was noted only on the headache day. Elevations in anxiety four days prior to the migraine were associated with the increased temporal artery variability observed three days prior to the attack. Anxiety experienced on the headache day was not related to changes in temporal artery amplitude variability or pain. Temporal artery dilation was not consistently associated with the site of pain. The results provide support for a disregulation theory of migraine relating anxiety to temporal artery change across days preceding the attack but question major assumptions regarding anxiety, temporal artery activity and pain during the headache itself.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1983.hed2306296.x

出版商:Blackwell Science Inc    

年代:1983

数据来源: WILEY

摘要:

SYNOPSISA patient developed cluster headache after exenteration of the ipsilateral orbit. This case illustrates that the prominent eye findings in cluster headache are epiphenomena, and not critical to the development of the pain itself.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1983.hed2306305.x

出版商:Blackwell Science Inc    

年代:1983

数据来源: WILEY

摘要:

SYNOPSISA 23‐year‐old male presented with features of vascular headache (unilateral throbbing pain of brief duration and ocular site). Ipsilateral tingling and hypalgesia were noted over part of the face during the headache. Papilledema was prominent. Increased intracranial pressure (ICP) and hydrocephalus were caused by aqueductal stenosis as noted in the computerized tomograms. Asymmetrical herniation of a cerebellar tonsil was noted in the angiograms. The patient's symptoms were relieved by a ventriculo‐peritoneal shunt. Although intraventricular pressure was not monitored, the brief duration of the headache and its associated symptoms are best explained by the effect of plateau waves of extreme intracranial hypertension. Asymmetrical tonsillar herniation causing traction of nociceptive vascular structures of the tentorium cerebelli and on cervical nerve roots can account for the focal nature of the headache and associated symptoms. The clinical features and theories of mechanisms of plateau waves are disc

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1983.hed2306307.x

出版商:Blackwell Science Inc    

年代:1983

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1983.hed2306315.x

出版商:Blackwell Science Inc    

年代:1983

数据来源: WILEY