摘要:

SYNOPSISExteroceptive suppression of temporalis muscle activity was studied in patients with chronic headache and in healthy controls. Among different methods of recording, averaging 10 full‐wave rectified EMG responses produces results withacceptablevariability and discomfort. The late temporalis exteroceptive suppression period (ES2) is reduced on average in patients with chronic tension‐type headache; this finding has been reproduced by several independent laboratories. Mean duration of temporalis ES2 is also diminished, but to a lesser degree, in daily drug abuse headache and, as shown by others, in episodic tension‐type headache. It is normal in migraine between attacks, cluster headache and various types of symptomatic headaches. Temporalis ES2 may be decreased in untreated patients with major depression.In healthy volunteers, temporalis ES2 duration is reduced by a short‐lasting painful stimulus to peripheral limbs after a delay of 50 to 60 ms, and by a sub‐motor threshold electromagnetic stimulation to the contralateral cerebral cortex after a delay of 20 to 30 ms. In contrast, long‐lasting trains of peripheral painful stimuli have no effect. Various pharmacological agents are able to modify temporalis ES2. Its duration is increased by 5‐HT antagonists, but decreased by 5‐HT uptake blockers. Pharmacological effects may differ between controls and patients. Considering these results and available data on the anatomo‐functional organization of masticatory reflexes, we postulate that temporalis ES2 is a marker of the excitability of interneuronal nets in the ponto‐medullary reticular formation. In chronic tension‐type headache, excitability of these interneurons is decreased because of inadequate control by the serotonergic raphe magnusnucleusand the periaqueductal gray matter. Dysfunctioning of the latter structures might be caused by abnormal limbic inputs to the brain stem. Some steps of this pathophysiological hypothesis can be verified by modern neurophy

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301003.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISA subcutaneous injection of 6 mg sumatriptan rapidly and effectively stopped attacks of cluster headache. After a time lag of 4–14 minutes (mean 7 minutes) pain dramatically dropped to zero within seconds to single minutes (mean 56 seconds). This rapid effect may indicate that mere vasoconstriction is the mechanism behind the beneficial effect of sumatriptan in cluster pain. The findings support a scenario in cluster headache where an inflammation in the cavernous sinus affects the sympathetic fibers traversing the cavernous region. This leads to the miosis, ptosis and forehead anhidrosis but also to a dilated internal carotid arterial tree distal to the lesion. The dilatation, in combination with an obliterated drainage of the cavernous sinus by the inflammatory process, leads to progressive stasis in the sinus, to cause the painful attack. The attack terminates when the enhanced load on the sinus is reduced by constriction of vessels supplying the sinus, as is achieved by administration of sumatriptan. The present observation that other accompanying symptoms during attacks (nasal congestion, rhinorrhea, lacrimation and swelling of eyelids) disappeared in parallel with the pain points to the possibility that these symptoms may be directly related to venous stasis or activation of pain fibers, rather than resulting from a primary parasympathetic activatio

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301018.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISTwenty patients were enrolled in a double‐blind, placebo‐controlledcrossover study of meclofenomate sodium in headache and craniofacial pain. There were four observation periods of 15 days each: Period I was a wash‐out period. In period 2, subjects were randomly assigned to a 15‐day regimen of taking two capsules a day of 100mg meclofenamate sodium (group 1) or placebo (group 2). In period 3, group I was switched to placebo and group 2 to meclofenamate sodium for the next 15 days. Lastly, the patients took no medication for a further 15 days (period 4). A thermographic record of the craniofacial and neck areas was taken at the end of periods 1 and 4. A record of the pressure threshold and tissue compliance at different sites of the craniofacial, neck and shoulder areas was taken at the end of each period. During the trial, number and duration of painful events were recorded daily by the patients, and the level of pain evaluated on a visual analog scale. Mean data were analyzed for significant difference by ANOVA and paired t‐test. During the meclofenamate sodium period, there was a significant decrease of days with painful events compared to the wash‐out period in group I and compared to the placebo period in group 2. In the majority of patients, the meclofenamate sodium period scored lowest or second‐lowest after the follow‐up period in mean pain intensity. Data for pressure threshold, although not significant, were indicative of a possible increase during and after intake of meclofenamate sodium. An improvement of thermal symmetry was recorded at the second thermogram in a majority of patients. It is concluded that meclofenamate sodium showed a consistent analgesic effect in our patients, compared

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301022.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISData from the 1989 National Health Interview Survey concerning migraine occurrence and impairment were analyzed to assess the impact of migraine on the US population. About four of every one hundred persons in the United States were found to have migraine, accounting for nearly 10 million individuals. Migraine was most prevalent in those aged 25 to 44 years and was about 2.5 times more frequent in females than males. Migraine was most common in whites (85%) and those with low household income. In women, migraine prevalence increased with the level of education. About 10% of migrainous children missed at least one day of school over a two‐week period due to migraine; nearly 1% missed four days. Migraineurs were bedridden for about three million days per month and had an estimated 74.2 million days per year of restricted activity due to migraine. The potential cost of lost productivity was estimated at $1.4 billion per year for the estimated 6,196,378 migraineurs who worked outside the home. It is difficult to derive similar estimates for costs of lost productivity in housewives; however, housewives experienced an estimated 38 million days per year of restricted activity. Eighty‐five percent of females and 77% of males reported a physician visit at some point for their migraine. Migraine is a relatively common disease whose social and financial impact has been poorly underst

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301029.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISAn 8‐month, double‐blind, placebo‐controlled cross‐over trial was carried out on the use of trazodone in pediatric migraine prophylaxis. It involved 40 patients aged 7 to 18 years old and suffering from migraine without aura, randomly divided into 2 groups.After a 4‐week run‐in period, Group A received oral trazodone (1 mg/kg a day divided into 3 doses) for 12 weeks, while Group B received a placebo. After a further 4‐week washout period, Group A was given the placebo and Group B was treated with trazodone for a further 12 weeks. The trial was completed by 35 patients, the number of drop‐outs being comparable in the two groups.During the first treatment period, both the frequency and the duration of the migraine episodes were significantly reduced in both groups. During the second, a significant further improvement in both parameters was only observed in Group B. No side‐effects were observed at any time. Our results showed that, like other antidepressants, trazodone is a valid prophylactic agent for

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301036.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

摘要:

SYNOPSISApplication of an ice pack and local scalp pressure are the most commonly used non‐pharmacological methods for temporary relief of migraine headache pain. An elastic band secured around the head with Velcro(r)and firm rubber discs inserted under the band was used to apply local pressure over the area of maximum pain in 25 patients with migraine headache. Three headaches were studied in each patient. Two patients dropped out because of local tenderness which prevented them from using the band. The 23 remaining patients used the band in a total of 69 headaches. Pain relief was monitored for 30 minutes at 10 minute intervals. Sixty headaches (87%) were relieved. Nine headaches (13%) were not improved. Sixty‐seven percent of those who improved (40 headaches) had relief of over 80%, twenty‐five percent (15 headaches) improved between 50–60% and eight percent (5 headaches) had less than 50% improvement. Pain severity steadily increased when the band was released. Temporary relief of pain from mechanical compression of the scalp supports the possibility that at least part of the pain in migraine headache originates from dilated blood vessels in th

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301040.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301043_1.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301043_2.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301043_3.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1993.hed3301046_a.x

出版商:Blackwell Science Inc    

年代:1993

数据来源: WILEY