摘要:

SYNOPSISMigraine patients seem to suffer from a continuous autonomic imbalance. Sympathetic instability, expressed by enhancedlow frequency fluctuations, which exists during the headache free intervals, was observed in our previous study by spectral analysis of heart rate (HR) fluctuations. Propranolol ‐ a beta adrenoceptor antagonist, is widely used in migraine prophylaxis.In order to specify and quantitate propranolol efficacy in migraine, spectral analysis of heart rate fluctuations was performedon 10 migraine patients before and during the treatment with propranolol. They were compared to 10 healthy control patientsand 6 migraine patients who Were treated for several months with propranolol and then discontinued the medication. The analysis was carried out on a 24h Holter ECG recording, which was performed for each subject during a headache freeinterval. Short 256 sec subtraces, taken every 30 min from the 24h ECG signal, were submitted to A/D conversion, R wavedetection and computation of heart rate power spectrum.Propranolol achieved a marked effect, when comparing the power spectra of HR fluctuations in treated versus untreatedmigraine patients. A strong reduction (to normal level) in the low frequency HR fluctuations in the range below 0.1 Hz., wasapparent in patients treated with propranolol. Subjects who had received propranolol in the past and discontinued the drug,displayed a carry‐over effect of reduced fluctuations even 2‐3 months after its discontinuation. it seems that the propranololefficacy in migraine is associated with the mechanism of stabilizing the fluctuations within the frequency band related to sympathetic activity, hereby moderating the vascular instability in mig

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3204169.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISEntrapment of the greater occipital nerve (GON) in its peripheral course has been thought to be of possible pathogenic significance in cervicogenic headache. We have performed a “liberation” operation (“neurolysis”) of the nerve in the nuchalmusculature, with special attention to the trapezius insertion, and the follow‐up results in 50 patients are presented. Theimmediate effect of the operation was quite good, but the pain gradually recurred in the majority (46/50) of the patients.Eventually, all operated patients will probably have recurrence of pain episodes. Nevertheless, most patients claim that theoverall disability is less after the operation, and 40% actually want to undergo a new, identical procedure. The justification for doing a second “liberation” operation is clearly less than for a first operation. In our opinion, this operation should not be performed in patients with cervicogenic headache in general. The present study shows that other therapeutic approache sshould be searched for in cervicog

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3204175.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISTwenty patients disabled for work because of chronic post‐traumatic headaches were treated: 13 men, and seven women.Their ages ranged between 26 and 69 years (mean = 40.3). Their accidents occurred three months to eight years prior to theinitial visit (mean = 1.5 yrs.). Thirteen patients had concurrent spinal injuries.They were assigned to an individualized program with emphasis on doctor‐patient relationship.All patients received medications, biofeedback, and educational sessions. Thirteen patients with concurrent spinal injuriesreceived additionally therapeutic exercises and transcutaneous nerve stimulation. Five patients needed neuromuscularre‐education, and three, stress management. All sessions were individualized.Patients attended the Center one to three times a week for three to 12 weeks (average = 9 weeks). The number oftreatment days ranged from six to 37 (average = 18.8 days). The average cost of the program for patients with headachealone was $3849.00; and for those with additional spinal injuries, $7030.00.All patients improved: markedly, 14; moderately, four; end slightly, two patients. The improvement occurred within sevento 150 days (average = 48.7 days). Seventeen out of the 20 patients, (85%) returned to work within 21ndash;224 days (average = 111days).An individualized outpatient program is very successful in the treatment of post‐traumatic h

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3204180.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISForty‐nine out of 51 consecutive male patients with episodic cluster headache were studied with regard to their smoking and drinking habits in general and in relation to cluster headache periods. Questionnaires were constructed for data regarding tobacco intake. Situation‐related smoking behavior was registered according toFrith (1971). Screening for alcohol over‐consumption was made using the Malmö modification of the brief Michigan Alcoholism Screening Test (Mm‐MAST).Eighty‐three percent of the patients used tobacco on a regular basis at the time of the study, with an average consumption of 20 cigarettes per day. Only 3% had never used tobacco regularly. The smoking‐related desire to smoke in different situations was consistent with what is found in a general population of smokers.Sixty‐seven percent of the patients had scores on the Mm‐MAST indicative of alcohol over‐consumption (i.e.heavy social drinking or alcoholism). During active headache periods 79% decreased their alcohol intake, whereas no consistent change in tobacco consumption was reported for the group as a whole. These findings were furthercorroborated by the fact that alcohol, but not tobacco intake, was reported by the majority of patients to elicit headache attacks during periods.Thus, our study showed high alcohol and tobacco consumption to be prominent feature in male patients with episodic cluster headache. Since neither alcohol nor tobacco appear to have properties of ameliorating headache periods or attacks, the addictive behavior in our patients more likely reflects certain personali

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3204184.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3204188.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISPeople with a wide variety of problems use support groups. We describe the development, structure and current functioning of a support group organization for headache sufferers, which has grown from ten members to 300 in four years. About one‐half of the members participate in ten currently functioning support groups. In addition to these support groups, the organizationplays an active role in the community by sponsoring public awareness seminars, publishing a quarterly newsletter, providing emergency treatment cards, and making knowledgeable speakers available to local business groups.The membership has been described by means of a questionnaire. Information regarding medical history, impact of headaches on everyday functioning, and involvement with the organization is presented. Future directions of the organization are discusse

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3204193.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISIn order to evaluate the effect of non‐pharmacological treatment on menstrual and non‐menstrual migraine headache (HA), 2 studies have been conducted. In Study I which was a retrospective examination of between group reactions to non‐drug treatments, 37 self‐defined menstrual migraineurs and 62 non‐menstrual migraineurs showed comparable overall Improvement (reduction in HA activity) after treatment, but menstrual migraineurs maintained larger usage of medication across time than non‐menstrual migraineurs. In Study 2 which was aprospective examination of within subject reactions to non‐drug treatments, 15 carefully documented menstrual migraineurs again showed comparable levels of overall improvement but also showed that level of menstrual headache activity remained higher across time then non‐menstrual migraine HA. Because there were no interactions of time and type of migraine in either study, these results raise some questions about the existence of differential effectiveness of non‐pharmacological treatment of menstrual vs non

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3204197.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISEleven patients with refractory chronic daily headache, associated depression, and generalized anxiety were treated with phenelzine. Ten patients (91%) had a greater than or equal to 50% improvement in headache frequency, seven (64%) had a similar degree of improvement in mood and headache intensity or activity level.Orthostatic hypotension was the most common side effect and necessitated discontinuation of therapy in two patients. One patient suffered a hypertensive crisis which was easily managed and caused no permanent sequelae. Based on these preliminary results, we conclude that phenelzine is effective in the treatment of chronicdaily headache with associated depression and anxiety, but further investigations are needed to determine if thereis selective efficacy of phenelzine for this subgroup of patients.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3204203.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3204209.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY