摘要:

SYNOPSISAutonomic impairment in migraine is wall documented. In order to evaluate the autonomic control in migraine, spectral analysis of heart rate fluctuations was performed on ten migraine patients, drug‐free and during the inter‐headache phase. They were compared to nine healthy controls and eight tension headache patients. A 24h Holter recording of ECG was performed for each subject. Every half hour, a short ECG sub‐trace was digitized and submitted to R wave detection, followed by computation of heart rate power spectrum.The spectral analysis of heart rate fluctuations disclosed significant differences between control subjects and patients with migraine. The migraine patients displayed markedly enhanced low frequency fluctuations (below 0.1 sec‐1), during day hours (p<0.01) and especially at night (p<0.0006). In the respiratory frequency band (between 0.2 and 0.4 sec‐1) no significant change was observed. Tension headache patients however, resembled the controls in that they did not display enhanced low frequency fluctuations.The enhancement at low frequencies fluctuations only, a frequency range known to be related to vasomotor control, suggests that the migraine patients are characterized by a clear sympathetic instability. This finding supports the hypothesis that migraine is of neural origin and is consistent with the observation of large variations in regional cerebral flow. Spectral analysis of heart rate fluctuations allows us to specify and quantitate this autonomic imbalance and may provide a useful tool for the evaluation of drug therapy in

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3201010.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISDuring a six month period, intramuscular dihydroergotamine mesylate (1 mg.) was given to 43 patients (75 headache episodes) who presented to the office after oral medications failed to abort their headaches. Headaches were successfully aborted in 71%, with most responses occurring between 30‐minutes and 4‐hours after injection. Side effects were common (61%) but not serious; sedation developed in 25%, nausea in 24%, transient worsening of headaches in 15%, body aches in 11%, diarrhea in 5%, and in 13%, headaches that were successfully aborted relapsed within 24 hours. Intramuscular dihydroergotamine, although under‐used, is cost effective, practical, and well suited for busy medical offices. Its appropriate use can reduce the need for narcotic analgesics and emergency room v

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3201018.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISThis study examines the practicality and efficacy of dihydroergotamine mesylate (DHE) when self‐administered sub‐cutaneously in a population of refectory headache patients. Forty‐three patients with chronic daily headache or migraine headache without aura, who had been taught self‐injection of DHE either through the Raskin Protocol or in an outpatient headache clinic, were contacted by telephone and administered a questionnaire regarding usage and results from DHE injection. Ninety‐two percent of patients could successfully administer DHE. Forty‐six percent of patients experienced 90% or greater relief of pain and the majority of patients (77%) had greater than 50% relief. Emergency room use was decreased in 83% and 80% preferred DHE to their previous therapy. While side effects were common (79%), only four patients (9%) stopped DHE for this reason. No convincing evidence for the development of rebound headaches due to DHE was found in

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3201021.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISTwo hypotheses have dominated attempts to understand the etiology of migraine with aura or classic migraine; the vascular spasm model proposed by Wolff and colleagues, and the spreading cortical depression hypothesis. Neither can provide a fully satisfactory explanation for the syndrome, however. We propose that classic migraine is both spreading cortical depression and localized ischemia linked in a vicious cycle by potassium induced vasoconstriction. The cycle can be initiated by any event which raises the local cortical ECF potassium concentration to approximately 20 mM. Such an event could be a localized burst of activity of a group of cells, localized metabolic impairment, or a transient reduction in blood flow to a region of the cortex. Once this level of potassium concentration is reached, it may result in localized depolarization of neurons, releasing more potassium into the ECF. Glial siphoning can distribute the potassium preferentially toward the blood vessels in the area, leading to an elevation in potassium concentration in the ECF surrounding the vascular smooth muscle of the arterioles. Above approximately 15 mM, vascular smooth muscle increases its tension in response to elevations in potassium. Therefore, as cortical ECF potassium concentration rises above 15 to 20 mM, localized vasoconstriction occurs, thereby reducing both the supply of oxygen for aerobic metabolism and the removal of potassium in the blood. Under these conditions, the effectiveness of the mechanisms which control potassium concentration is impaired and unable to prevent additional elevations in potassium. As the concentration continues to rise, vasoconstriction becomes more intense, perpetuating the cycle that results in localized depression of cortical neuronal activity and ischemia. The condition is propagated to adjacent regions of the cortex by diffusion and glial‐mediated spread of potassium. In many respects, the hypothesis unites the vascular spasm and spreading depression models. If verified, it may provide insight into the causes of classic migraine as well as give direction toward development of effective therapie

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3201024.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISObjective ‐ To examine the characteristics of cold‐induced headaches in a group of migraine patients, to compare these with their usual migraine headache and with cold‐induced headache in s control population.Design ‐ Subjects completed a structured questionnaire recording previous headache history along with the characteristics of any headache produced during supervised palatal and pharyngeal application of ice cream.Subjects ‐ 70 consecutive patients attending the City of London Migraine Clinic, and 50 pre‐clinical medical and dental student volunteers from Queen Mary and Westfield College.Results ‐ 27% of the migraine patients and 40% of the students reported previous ice cream headaches. 17% of the migraine patients and 46% of the students developed headache following palatal application or a swallow of ice cream.Typically the headache was of early onset (x = 12.5s) and short duration (x = 21s), with a tendency for anterior headache on the same side as a palatal stimulus, and bilateral headache following an ice cream swallow. However, a significant minority experienced a previously unreported headache of late onset (x = 102s) and long duration (x = 236s) which tended to occur particularly after swallowing ice cream and to be less wall localised to the side of the cold stimulus.Ice cream appeared not to be a common trigger for migraine, and there was no significant correlation between site of ice cream headache and usual site of migraine.Conclusions ‐ These findings confirm that cold stimulation of the palate or pharynx commonly produces a headache. In contrast to previous studies, our results suggest that the 'ice cream headache' is less common in migraine patients than the general population. A similar pattern of headache was produced in both migraine patients and controls, and apart from the few for whom an ice cream headache may trigger a migraine, the ice cream headache seems not to have any special significance for mi

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3201035.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISThe case of a 53‐year‐old woman is described, who since the age of 38 years had been suffering from a unilateral headache that was at first remitting, but then evolved into an unremitting course. The headache was burning in quality, located in the left forehead and face, and was accompanied by mild ipsilateral autonomic symptoms. The clinical picture, as well as the absolute response to indomethacin, suggested a diagnosis of hemicrania continua. The presence of mild gastric discomfort on continuous indomethacin administration made us transfer the patient to another NSAID (piroxicam‐beta‐cycIodextrin). With this drug, complete relief and good tolerability was o

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3201039.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISExteroceptive suppression (ES) of temporalis muscle activity, particularly the multisynaptic ES2, has been reported to be significantly reduced in tension type headache, but not in migraine. We re‐evaluated the methods of optimally analysing the single shock technique and its intra‐ and inter‐individual variability in 26 normal subjects. These data were compared with the results in patients with migraine, post‐lumbar puncture headache, headache due to meningitis, tension‐type headaches in HIV infection and patients with symptomatic headache of various etiologies. ES2 was absent in about 50% of tension‐type headache patients, but only in one normal subject. With the methods used here and when patients with absent ES2 were excluded, mean duration of ES2 was not significantly different between the various groups. It seems therefore necessary, in spite of increased discomfort for patients, to use complementary methods, such as averaging 16‐32 responses and applying various stimulation sets, if one wants to increase the potency of temporalis ES2 as a diagnostic and pathophysiologic too

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3201041.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISWe established the occurrence of headache in a group of 20 patients with traumatic transections of the cervical spinal cord. All but two patients had complete sensory lesions at levels varying from C2‐3to C7‐8. Only three patients claimed to have no headaches at all although one of them had nuchal pains with fever. Twelve patients had “bladder” or “bowel headaches” or had had them in the past. These headaches were mostly generalized, throbbing or pounding in nature and severe in intensity. They were caused by obstruction of urinary flow and fecal impaction, respectively, and were associated with autonomic dysreflexia. Otherwise the headaches reported by the patients were mild although frequent in four, i.e. once per week or more. These headaches were also mostly bilateral and lasted a relatively short time, i.e. less than one or two hours. The causes of these headaches were nonspecific for the group studied except for stimulation of the body which, however, probably depended on a mechanism similar to that of the bladder and bowel headaches. Migraine, either classic or common, was not reported by any of t

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3201045.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY

摘要:

SYNOPSISA six‐week cardiovascular exercise program was provided to 11 subjects classified as experiencing classical migraines, while 9 similarly‐classified subjects served as waiting‐list controls. Measures included the Canadian Aerobic Fitness test, a headache diary to record the Frequency, Intensity, and Duration of migraine episodes and the Pain‐Severity, Affective‐Distress, and Support scales of the West Haven‐Yale Multidimensional Pain Inventory (MPI). Measures were taken on both treatment and control subjects before, mid‐way through, and upon termination of the first aerobic program, as well as after a two week follow‐up. The aerobic classes were effective in significantly improving cardiovascular fitness. Pain Severity decreased significantly for those receiving aerobic training, who also showed (nonsignificant) trends, over the measurement periods, toward reductions in Affective Distress as well as the Frequency, Intensity and Duration of migraines, but these trends failed to reach statistical significance. Control subjects demonstrated no systematic changes in any of the dependent measures. These results suggest possible long‐term benefits of aerobic fitness in the management of cl

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1992.hed3201050.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.hed3201055_1.x

出版商:Blackwell Science Inc    

年代:1992

数据来源: WILEY