摘要:

SYNOPSISCluster headache sufferers who become candidates for surgical treatment are those relatively rare patients who are refractory to all attempts at pharmacological relief.Ablative surgical procedures have been directed against either the trigeminal nerve or the nervus intermedius/greater superficial petrosal (NI/GSP) pathway. Both carry nociceptive impulses from the head and face, and the NI also carries parasympathetic fibres which appear to be responsible for the autonomic concomitants of cluster headache.Trigeminal operative procedures are not consistently helpful in chronic cluster headache, while NI section has been shown to give potentially long lasting relief but carries the potential risks of cerebellopontine angle surgery.In eight selected cases of chronic cluster headache we have demonstrated a high early success rate for pain relief, with few complications, in the performance of NI section, combined, when indicated, with microvascular decompression of the trigeminal main sensory root. We believe that cochlear nerve monitoring helps prevent postoperative hearing impairment.An intimate relationship between the NI and arterial loops of the anterior inferior cerebellar artery (AICA) or the internal auditory artery has been frequently observed in our chronic cluster headache patients.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3007401.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThis study investigates the use of biofeedback, relaxation and psychotherapy on five patients with severe, vascular headaches that occurred during the course of pregnancy. The subjects received between four and twelve sessions of treatment overall. The subjects all showed a marked reduction or complete cessation of headaches during treatment, the term of pregnancy, and during a follow‐up evaluation months after the birth of the child. Possible alternate explanations for improvement are discussed along with the study's limitations. This preliminary investigation strongly suggests that psychological treatment may be a particularly useful intervention for management of headaches that occur in pregnant wome

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3007407.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISChronic Cluster Headache (CCH) treatment is troublesome; since there are no pain‐free periods, it must be continuous. The most effective CCH prophylactic drug today is lithium carbonate but long‐term use of this drug is limited by the possibility of side effects. Recently, calcium antagonists have been successfully employed to prevent migraine, and preliminary studies also indicate that verapamil in particular is an efficacious treatment for CCH. We have conducted a multicenter trial employing a double‐dummy, double blind, cross‐over protocol, comparing verapamil with the established efficacy of lithium carbonate, inpreventing CCH attacks. Both lithium carbonate and verapamil were effective in preventing CCH butverapamil caused fewer side effects and had a shorter latency period. We did not observe any correlation between plasma levels of the two drugs and their clinical efficacy. Both the drugs tested here may exert their effect by restoring a normal inhibitory tone to the pain modulating pathways from the trigemino‐vascular system, a circuit putatively implicat

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3007411.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThis study investigated whether pain sensitivity of the pericranial musculature remains constant over the course of the day. Changes in the entire, uniformly metrically divided supra‐threshold sensitivity range were measured. In 24 healthy volunteer subjects, pain was induced experimentally at 0200, 0600, 1000,1400, 1800, and 2200 hours in the pericranial musculature. Blood circulation in both superficial temporal and occipital arteries was reduced by applying a cuff to the head pumping up to 200 mmHg during rhythmic chewing on a spring, thereby producing a continuously increasing bilateral, dull, frontal headache. The subjects rated the intensity continuously using a category sub‐dividing procedure ranging from pain threshold to pain tolerance limit. At low levels of headache intensity there were no significant diurnal differences in pain sensitivity. Sensitivity to very intense headache, however, varied significantly over the course of the day: sensitivity was greatest at 0200 hours; it decreased at a constant rate until1400 hours, and increased again continuously until 2200 hours (pó.05). Also the findings showed significant effects of sex on the pain sensitivity of pericranial musculature for all pain intensities: women are approx. twice as sensitive as men (pó.0.05). These results suggest that not only sex, but also time of day, must be taken into consideration in the clinical determination of pain sensitivity of pericranial musculature in the course of headache diagno

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3007418.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISCognitive processes and cognitive styles of persistent headache sufferers were examined in relation to indices of intensity and duration of head pain. One hundred and eight persistent headache patients, referred for cognitive‐behavioral management of their disorder, completed questionnaires designed to assess: distressing thoughts and feelings experienced during headache attacks, evaluation of the experienced pain, perceived influence of stress and worry on headaches, and capacity to verbally express emotions.The results showed that the intensity of head pain correlated with measures of headache‐related distress and‐with the proportion of headache‐related distress to situation‐related distress. Duration of head pain was also associated with the proportion of headache‐related distress to situation‐related distress, and additionally with a tendency to deny the influence of stress and worry on headaches and with difficulty in expressing emotions.These findings were taken as support of our previously stated hypothesis that head pain of increased severity is associated with a cognitive shift whereby the patient's primary concern moves from situational and interpersonal distress to distress associated with the disorder itself.1 In addition, these findings point to affective distress and lack of emotional expressiveness as correlating differentially with the headache dimensions of intensity

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3007423.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISWe report for the first time the detection by magneto‐encephalography (MEG) of signals observable inmigraine patients during headache, but not in controls. These signals consisted of three features: suppression of spontaneous cortical activity, long duration field changes, and large amplitude waves(LAW) of several seconds duration. LAW were also seen during the interictal period. We discuss the possible relationship of these signals to spreading depression (SD), and why the LAW have not been observed in previous studies of S

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3007428.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISTwenty patients with migraine with visual aura, aged 19 to 55 years (2 men and 18 women) were studied by the method of Visual Evoked Potentials (VEP). The control group consisted of an equal number of healthy subjects, comparable for age and sex. The most important finding in our study is that migraine patients with visual prodromata have a significantly longer P100 latency than the subjects of control group. These modifications of the VEP‐PR could indicate, as other investigators have pointed out, that there are some special metabolic conditions and abnormalities of neuromediators during and between attack

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3007435.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThe exact relationship between depression and chronic headache remains unclear. Considerable clinical and pharmacological evidence suggests the existence of a common biological terrain. Many antidepressant drugs are effective in the treatment of migraine and chronic headache disorders.Ritanserin, a new very selective serotonin‐2 (5‐HT2) antagonist, has recently shown both analgesic and antidepressant properties. The present study compares in a double‐blind design, the effectiveness of ritanserin and amitriptyline, a well‐known antidepressant extensively used in migraine prophylaxis.Thirty‐eight patients (30 females and 8 males ranging in age from 20 to 50 yrs) were classified according to the International Headache Society criteria as: patients with chronic tension‐type headache (CTH) (11 cases) and patients with coexisting migraine and CTH (MCTH) (27 cases).Only patients with a score equal to or higher than 18 on the Hamilton Rating Scale for Depression (HRSD) were included.Ritanserin was highly effective in reducing Pain Total Index and analgesic consumption in chronic headache, and its activity was similar to that observed during amitriptyline treatment. A significant improvement of HRSD and HRSA(Hamilton Rating Scale for Anxiety) scores was observed during both treatments. The main results of our study concern the demonstration of antiheadache and antidepressive properties of ritanserin.To better define the profile of the patients and their clinical responsiveness to the treatment, dexamethasone suppression test, clonidine test and nociceptive flexion reflex were investigated in our patients.Our data confirm the usefulness of these methods as markers of chronic headache with

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3007439.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY

摘要:

SYNOPSISThe topics of interest in this study are whether migraine patients exhibit a stereotypic reaction to a stressful stimulus which is different from the reaction of non headache controls and whether it is possible to predict headache activity within the migraine population.Our study population comprised 37 female migraine patients and 34 matched controls. Heart rate, skin conductance, pulse amplitude of the temporal artery and an EMG of the temporal muscle were registered during a baseline situation and during a mental stressor. In addition, state anxiety, trait anxiety, facilitating anxiety and stress tolerance were assessed.Migraine patients reported higher levels of trait anxiety, greater fear of failure, lower stress tolerance and higher levels of state anxiety than non headache controls. Physiological baseline levels and stress reactions did not differbetween migraine patients and controls.Linear combinations of psychological and psychophysiological data sets did not show an acceptable degree of accuracy in the classification of individual response profiles into groups.Within the migraine group, 54% of the average duration of migraine attacks and 33% of the variation in average maximum headache intensity could be explained by a combination of psychological, psychophysiological and socio‐demographic variables.It is concluded that measures from both the psychological and the physiological domain should be included when studying the effects of stress in migrain

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1990.hed3007445.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.hed3007458_a.x

出版商:Blackwell Science Inc    

年代:1990

数据来源: WILEY