摘要:

We studied transnasal butorphanol (Stadol NS·) for pain relief during acute migraine in a multicenter, randomized, double‐blind, placebo controlled trial using ambulatory patients at 10 geographically diverse headache centers. Patients were volunteer adults diagnosed with migraine with or without aura by International Headache Society criteria. One hundred fifty‐seven patients completed the study. We treated the pain of one headache in each patient with either transnasal butorphanol (n=107) or transnasal placebo (n=50). Pain relief, pain intensity, nausea, vomiting, and effect on function were measured periodically. Adverse experiences were documented. Global assessments were made at follow‐up. With butorphanol, migraine pain was reduced from moderate, severe, or incapacitating to slight or absent for 35 patients (33%) within 30 minutes, for 50 patients (47%) within 1 hour, and for 76 (71%) within 6 hours, compared to 2 (4%) 8 (16%) and 15 (30%) respectively for placebo. Side effects were prominent, though confounded by the migraine. The most common side effects, compared to placebo, were dizziness (58% vs 4%), nausea and/or vomiting (38% vs 18%), and drowsiness (29% vs 0%). We conclude that transnasal butorphanol is a useful analgesic for the pain of acute migraine. Its prominent side effects and low self reinforcement rate may limit its usefulness in some patients, while increasing its appropriateness for

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502065.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

We studied the inheritance of migraine and concomitant symptoms among 2690 monozygotic (1524 female and 1166 male) pairs and 5497 dizygotic (2951 female and 2546 male) twin pairs. Our material consists of a population‐based questionnaire study among Finnish twins in 1981. The definition of migraine is based on a questionnaire method.Concordance was assessed using probandwise concordance rates and tetrachoric correlations for monozygotic (MZ) and dizygotic (DZ) twin pairs. For estimating the contribution of genetic factors to the susceptibility of migraine, a polygenic multifactorial model was used. Structural equation models were applied for estimating variance components and to compare different genetic models.Nearly one‐half (40% to 50%) of the liability to migraine is attributable to genetic factors. In all structural analyses, the model with both additive genetic and unshared environmental component had the best goodness‐of‐fit value. The genetic component varied between 34% to 51% in different migraine types. There were no remarkable differences between sexes except in the effects due to dominance, where the proportion was 26% for men and 14% for women. Concomitant symptoms among subjects within pairs concordant for headache had genetic effects varying from 56% (subjects with unilaterality) and 56% (subjects with visual symptoms) to 45% (persons with nausea and vomiting). The two threshold model of headache points to the continuum model of headache, and the thresholds represent different levels of severity of the pain.Our results emphasize a multifactorial and higher than previously reported genetic pattern in the etiology of migraine. Also unshared environmental factors play an importa

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502070.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

In a noncontrolled study, 23 migraine headache patients were treated with intranasal instillation of 0.4 mL of a 4% lidocaine solution during attacks of varying intensities. Evaluated were pretreatment and posttreatment changes in pain intensity, nausea, and side effects. Posttreatment intensity ratings significantly improved over pretreatment ratings, as determined by a Sandler A analysis (0.077;P<.0005). Migraine attacks were aborted in 12 of 23 patients, of which 8 were completely relieved within 5 minutes. In no case did an aborted attack return to more than a dull level within 24 hours, as determined by follow‐up telephone calls.A successful response of migraine attacks to lidocaine treatment was more apt to occur in patients having migraine solely, when compared to migraine patients who also had daily dull headaches; the difference was not significant. Unilateral attacks, however, were significantly more treatment‐responsive when compared to bilateral attacks (X2=3.85;P=.05). Nausea, associated with migraine attacks in 6 of 12 responders, was similarly aborted by lidocaine in 5 of 6 patients. Other side effects included mild nasal and eye burning of short duration (seconds), and oropharyngeal numbness of approximately 20 minutes' duration. Despite the abrupt and absolute relief of migraine attacks afforded by lidocaine in most of our study patients, its level of efficacy awaits results of double‐blind, placebo‐controlled studies.Our findings raise new questions regarding the differential pathogenesis of migraine and cluster headache attacks. It is suggested here that the rapid effect of lidocaine in aborting migraine attacks, as shown by others in cluster headache, may be due to a conduction‐blocking action on pterygopalatine, internal carotid, and cavernous sinus ganglia. This implies that pain‐evoking mechanisms in migraine and cluster headache may similarly involve parasympathetic activity and calls into question the primacy of the trigeminovascular system to that of vaso‐parasympathe

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502079.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Thirty male patients with cluster headache were given 4% lidocaine solution to use intranasally as an abortive therapy. Four sprays of lidocaine were used ipsilateral to the pain, and two more were used, if necessary. Twenty‐seven percent of the men reported moderate relief, 27% obtained mild relief, and 46% stated that they had no relief from the lidocaine. Side effects were minimal. In this study, intranasal lidocaine was only a marginally helpful therapy for cluster headache. However, because of the ease of administration and lack of side effects, lidocaine may remain worthwhile as an adjunctive medicatio

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502083.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

We have evaluated the specificity and sensitivity of temporalis ES2 measurements for the diagnosis of primary headaches. Ninety‐four outpatients diagnosed according to IHS criteria were prospectively included: 25 had chronic tension‐type headache (code 2.2.), 15 episodic tension‐type headache (code 2.1.), 20 migraine without aura (code 1.1.) and 34 chronic daily headaches with daily analgesics/ergotamine abuse (code 8.2.). In chronic tension‐type, the sensitivity of the ES2 test was 84% at the 0.1 and the 0.5 Hz, but only 56% at the 2Hz stimulation rates. Its specificity was 100% at 0.1Hz, 90% at 0.5Hz and 95% at 2Hz compared to migraine; positive predictive values were at similar levels. Sensitivity of ES2 at 0.1 Hz was 67% in episodic tension‐type headache, but its positive predictive value versus migraine was excellent. Comparing chronic tension‐type headache and analgesic abusers, the specificity and positive predictive value of the ES2 test for diagnosing chronic tension‐type headache were less satisfactory (60%) while the negative predictive values, however, remained good (83% at 0.1Hz).The results confirm that the temporalis ES2 test has a higher diagnostic sensitivity in chronic and episodic tension‐type headache, but that it has a high negative predictive value for both types of tension‐type headache compared to other primary headaches. For diagnostic purposes, the 0.1Hz stimulation rate seems optimal. The 2Hz stimulation rate is the least sensitive, although it may induce total disappearance of ES2 in up to 40% of patients. ES2 is of limited usefulness for separating chronic tension‐type headache and chronic drug‐abuse headache, possibly because the latter group comprises both tension‐type headach

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502085.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Previous studies have not found a significant correlation between location of pain and electromyogram levels in chronic headache patients. However, these studies only examined a limited number of muscle groups and did not assess subjective tension levels. The present study evaluated a group of tension‐type (n = 43) and migraine and tension‐type (n = 30) headache patients. Measures were obtained at five muscle sites (frontalis, temporalis, masseter, splenius capitis, and trapezius) for patient ratings of headache pain, patient ratings of muscle tension, and electromyogram recordings cross‐sectionally. Neither subjective pain nor tension ratings were found to be significantly related to electromyogram levels. The site‐specificity relationship between chronic headache pain, subjective report of muscular tension, and electromyogram levels remains

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502089.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Intractable headaches have been described as the presenting complaint of many patients withT. soliumneurocysticercosis. We conducted a house‐to‐house neuroepidemiological survey of 2,723 residents of an Andean community, known to be endemic for this infection. Migraine headaches were confirmed in 187 cases (68.7 per thousand), and tension headaches were diagnosed in 77 cases (28.3 per thousand). Fifty‐seven migraine sufferers accepted computed tomography examination, and in 19 it revealed neurocysticercosis. In 11 out of 52 migraineurs who had their blood drawn, electron immunotransfer blot testing (EITB) was positive for anticysticercal antibodies. In a computer‐generated random sample of this community, 109 headache‐free individuals were examined by CT, and 87 had EITB. Of the 109 subjects examined by CT, 14 were positive for cysticercosis. Of the 87 individuals tested by EITB, 7 were positive. A statistically significant difference between the symptom‐free general population and the migraine patients was obtained for both CT (odds ratio 3.39, P<0.005) and EITB (odds ratio 3.07, P<0.05) diagnosis of neurocysticercosis. Neurocysticercosis appears to be a significant risk factor for the presentation of migraine‐type headaches in areas endemic forT. so

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502093.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Recently, it has become obvious that disabling postoperative headache is a major problem with acoustic neuroma surgery. A questionnaire was used to retrospectively evaluate the incidence, clinical features, prognosis and possible therapeutic measures of this particular form of headache. Forty‐two percent (42%) of patients had some headache prior to surgery but this was not a major complaint. After surgery, 75% of patients experienced headache. Only 24% had complete relief of headache. A very gradual improvement of the pain occurred in 32%. Pathogenesis remains unclear, but clinical characteristics of the headache suggest a combination of tension‐type, neuralgic and vascular components. Postoperative pain occurs mostly around the surgical site suggesting that this type of headache is the result of surgical trauma. A prospective long‐term study is needed to delineate this condition further. Some therapeutic suggestions are of

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502098.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Pain originating from ophthalmic disease has been well documented. A series of patients presenting with eye or peri‐orbital pain attributed to cervical region dysfunction were diagnosed and treated with injections of subcutaneous lidocaine followed by triamcinolone acetonide. Twelve patients, 11 women and I man, ranging in age from 20 to 82 years had an evaluation including a complete eye examination, and laboratory tests and neuroimaging as dictated by the history to exclude structural abnormalities or systemic disease. All patients had marked focal suboccipital tenderness ipsilateral to the side of their headache and eye pain. A subcutaneous injection with 2% lidocaine followed by triamcinolone acetonide 40 mg was administered directly to the site of focal tenderness. After injection, five patients described total relief of pain, five patients described some degree of pain relief, and two patients had no relief of headache. Duration of pain relief ranged from several hours to 3 months. Patients may present with periorbital or eye pain as a result of disease affecting the cervical sensory roots with subsequent stimulation of the trigeminal apparatus. Subcutaneous injection of lidocaine and triamcinolone acetonide may be of help in the diagnosis of these patients and provide temporary relie

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502101.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Several studies have examined patientsapos; attitudes to a consultation for migraine and other headaches. However, a patient's assessment of the problem for which they seek treatment may differ from that of the referring primary physician which may, in turn, differ from the specialist's. This study set out to examine this triangle.The commonest reason for referral was failure of treatment response. This contrasted with the patient's different perception‐an increase in the frequency of attacks which we saw as headaches additional to migraine, accounting for failed treatment. Similarly, our view of the patient wanting reassurance paralleled their request for further information. These findings confirmed the hypothesis that recognizing and understanding a patient's fears were important factors towards a favorable outcome of a consultatio

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3502104.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY