- Email: [email protected]
1-21-15 SUNCT. The first Argentinian case
s34
Headache
In some patients, more than one treatment was necessary. The treatment resulted successful in 11 out of 12 patients, with an average improvement of 4.4 months (range 0.5-12). Conclusions: The using of steroid and anesthetic cervical medial nerve blocks lead to an improvement in those patients with chronic daily headache.
1l-21 -12 1 Tolerability and efficacy of oral naratriptan 2.5 mg in the acute treatment of miaraine over a 12 month period J. Heywood, H. Enahoro ‘, P. Winter ‘, H. Hassani ‘. Austin & Repatriation Medical Centre, Heidelberg Victoria 3084, Australia, ’ Glaxo We//come Research and Development, Greenford, UK
Objectives: To assess the tolerability and efficacy of oral naratriptan 2.5 mg in the acute treatment of migraine attacks over a 12 month period. MethodslDeslgn: IHS diagnosed migraineurs were asked to take one oral naratriptan 2.5 mg tablet at the onset of every moderate or severe migraine experienced throughout the study, and to take a second tablet if they experienced recurrence, four to 24 hours after the first tablet. Patients recorded the occurrence of adverse events for each attack treated, recorded headache severity before treatment of each attack and 120 and 240 minutes after the first dose, and recorded use of the second dose to treat recurrence. Results: Over 12 months, 417 patients treated at least one migraine attack; 253 patients treated attacks with oral naratriptan 2.5 mg for at least 12 month; 185 patients treated ~36 attacks. During the 12 months, 14,953 attacks were treated with oral naratrlptan 2.5 mg. The incidence of adverse events: by attack, was similar with one dose (16%) and two doses (14%); by attack, over the second six month period (15% with one dose, 14% with two doses), was lower than the first six month period (16% with one dose, 15% with two doses); in patients, was similar when ~36 attacks/l2 months (57% with one dose, 49% with two dose) compared to those who treated 536 attacks/i2 months treated (54% with one dose, 41% with two doses). Headache relief at 4 hours occurred in, ‘70% of all attacks treated over 12 months; ‘68% of attacks treated in first six months; ‘72% of attacks treated in second six months; .64%, 536 attacks/l2 months; 72%, z 36 attack/l2 months. Median percentage of attacks per patient treated for headache recurrence was low, 8%. The drug was rated as good or excellent in 64% of all attacks treated. Conclusion: Oral naratriptan 2.5 mg is an effective and well tolerated acute treatment for migraine over a 12 month period.
1 l-21 -13 1 Transcranial Doppler, EEG and SPECT findings of a focal reduction of cerebral blood during the aura phase In migraine I. La Spina, G. Frazzitta, G. Grampa, F. Reverberi, D. Uccellini, Department of Neurolog)! City Hospital, Busto Arsizio, Italy
D. Porazzi.
Background and Objectives: The monitoring of the different phases of the migraine attack with different modalities allows a better interpretation of the pathogenesis of this disease. The possibility of documenting the aura phase in patients with migraine is a rare event. Method: Transcranial Doppler (TCD), Electroencephalography (EEG), single photon emission computed tomography (SPECT) and cerebral magnetic resonance imaging (MRI) or computed tomography (CT) were performed in six cases of migraine with aura during the different phases of the attack from the aura phase (3 cases) or at the beginning (within 2 hours) of the pain (3 cases) to the end. Results: The most important data refer to the earliest phases of the attack: in our six cases TCD studies suggest a decrease of cerebral blood flow (CBF) in the cortical area responsible for the neurological manifestation during the aura phase; in four cases the EEG showed corresponding focal slow abnormalities; in three patients cerebral SPECT revealed an area of relative decreased uptake of the tracer that in one patient persisted when the pain was over. At the end of the attack cranial MRI or CT and follow-up TCD and EEG were normal. Conclusions: The neurological defect during the aura phase corresponds with the evidence of a transient focal reduction in the cerebral blood flow.
1 l-21 -14 1 Thunderclap headache - Results from a prospective study of consecutive patients A.-M. Landtblom I, J. Boivie’ , S. Fridriksson z, J. Hillman *, G. Johansson ‘, I. Johansson 3. ‘Department of Neurolog) University Hospital, Linkdping, Sweden, 2Department of Neurosurgery; University Hospital, Linkiping, Sweden, 3Department of Radiology University Hospita/, LinkSping, Sweden
Aim of investigation: Patients with sudden severe headache, i.e. thunderclap headache (TH), are common in the emergency units. We have performed a prospective study on unselected, consecutive patients in order to investigate the proportion of subarachnoidal hemorrhage (SAH), to find out other causes
of TH, and to see if patients with SAH or other specific causes can be identified clinically. Recurrences and other kinds of headache were monitored. We now report the final result regarding 137 patients. Patients and Methods: A detailed history was recorded in a questionnaire and a neurologic examination was done as well as a CT scan, followed by a spinal tap if the CT did not show SAH. Follow up was done by interviews after 24 davs, 7-9 davs, 1 month, 6 months and 12 months. Re<s: The-mean age of 78 women and 59 men was 44 years (range 16-87). Twenty five patients with a mean age of 56 years (30-87) had SAH, compared with a mean age of 42 years in the non&H group. In.24% of the SAH patients the onset was correlated to exertion or valsalva, compared with 26% in the non-SAH group. Pain location was similar. Very severe headache was more frequent in SAH, than in non-SAH TH, but the headache quality was about the same. Neck stiffnesss and impaired consciousness was more common in the SAH group. Previous migraine was not significantly more common in the non-SAH group. Four nor&AH patients had aseptic meningitis and five patients had cerebral infarction. In the non-SAH group 23% had another TH, but no SAH occurred during follow up. The overall incidence of TH was 33/100 000 inhabitants/year. Conclusions: The proportion of SAH (18% in the whole material, 14% in the incidence material) in the present study is lower than in previous studies of TH, probably because the material is unselected including all patients seeking medical care because of TH in our catchment area. The results support the notion that SAH cannot be identified on clinical grounds. Patients with a first attack of TH should be investigated with a CT scan and a spinal tap to exclude serious conditions like SAH, meningitis or cerebral infarction. It is noteworthy that none of the 112 patients who did not have a SAH at the first TH, were struck by a SAH during the one year follow-up period. This supports the view that angiographies are not indicated in these patients.
I l-21 -15 1 SUNCT. The first Argentinian
case
J. Fernandez Calvo, N. Tinetti, J. Leston. Headache and paint Unif, Division Neurolog)! Hospital de Clinicas J. de San Martin, UBA, Argentina SUNCT is a recently described headache entity.(‘) The episodes may be precipitated by various mechanisms concerning trigeminal inervation as will as the neck. Only few cases have been reported until now. The patients is a 76 years old female. The first paroxysms located in the right supraorbital area lasting seconds during 1 months period, appeared when she was 70 years old. The pain builded up gradually and was precipitated by movement of the neck. She repeated the episode after 1 year without associated autonomic features. The third episode, 4 years ago was precipitated not only by head movement but chewing, talking or even touching the eyelids associated with prominent ipsilateral autonomic symptoms. The pain paroxysms usually lasting seconds to l-2 minutes occurred during 2 months. After a remission of 3 years, she has the more severe attack period, with symptomatic free 2-3 days intervals. Interesting aspects in this case is the beginning of the episodes with only head movement as a trigger factors, and the pain building up gradually without significant autonomic features. Further clinical research and observations are needed to clarify this headache and the variants. [l] Sjaastad 0. Russell D, Horven I, Bunaes U. Multiple neuralgiform, unilateral headache attacks associated with conjunctival injection and appearing in clusters. A nosological problem. Proceedings of the Scandinavian Migraine Society; 197831
I l-21 -16 I Syntomatic treatment of the trigeminai with oxarcabamazepina M.R. Lopez, E.R. Santiago, R.R. Ramos, J.S.V. Zenteno. Neurology; Genera/ Hospital of Mexico, Mexico
neuralgia
Departmenf
of
The trigeminal neuralgia is a suffering that nowadays do not build on a pathological basis defined. During years has been observed to control satisfactory of the paroxism painfull within the drugs phenytoin and carbamazepine. But has seen it to much of the cases resistance to those drugs around from 12 months of established the treatment. The oxcarbazepine it their active metabolith monohydroxi are derivaded from carbamazopine with similar action to it, but with less undesirable effects, theorically would be able to turn out to be effective in patients with this entity. The object of this paper is to appreciate the effectiveness and adverse reactions of the oxcarbamazepine in the trigeminal neuralgia. We selected the patient with clinical trigeminal neuralgia the full of the criterions of Rushton and Olafson, at the ones who realized to TAC and IRM the cranium and reflex of blink. They received oxcarbazepine 300 mg per day, increasing the dose until control of the pain. We were 14 patients, 12 women and 2 mens between 28 and 38 years old, with the illness between 3 weeks to 30 evolution
Headache
In some patients, more than one treatment was necessary. The treatment resulted successful in 11 out of 12 patients, with an average improvement of 4.4 months (range 0.5-12). Conclusions: The using of steroid and anesthetic cervical medial nerve blocks lead to an improvement in those patients with chronic daily headache.
1l-21 -12 1 Tolerability and efficacy of oral naratriptan 2.5 mg in the acute treatment of miaraine over a 12 month period J. Heywood, H. Enahoro ‘, P. Winter ‘, H. Hassani ‘. Austin & Repatriation Medical Centre, Heidelberg Victoria 3084, Australia, ’ Glaxo We//come Research and Development, Greenford, UK
Objectives: To assess the tolerability and efficacy of oral naratriptan 2.5 mg in the acute treatment of migraine attacks over a 12 month period. MethodslDeslgn: IHS diagnosed migraineurs were asked to take one oral naratriptan 2.5 mg tablet at the onset of every moderate or severe migraine experienced throughout the study, and to take a second tablet if they experienced recurrence, four to 24 hours after the first tablet. Patients recorded the occurrence of adverse events for each attack treated, recorded headache severity before treatment of each attack and 120 and 240 minutes after the first dose, and recorded use of the second dose to treat recurrence. Results: Over 12 months, 417 patients treated at least one migraine attack; 253 patients treated attacks with oral naratriptan 2.5 mg for at least 12 month; 185 patients treated ~36 attacks. During the 12 months, 14,953 attacks were treated with oral naratrlptan 2.5 mg. The incidence of adverse events: by attack, was similar with one dose (16%) and two doses (14%); by attack, over the second six month period (15% with one dose, 14% with two doses), was lower than the first six month period (16% with one dose, 15% with two doses); in patients, was similar when ~36 attacks/l2 months (57% with one dose, 49% with two dose) compared to those who treated 536 attacks/i2 months treated (54% with one dose, 41% with two doses). Headache relief at 4 hours occurred in, ‘70% of all attacks treated over 12 months; ‘68% of attacks treated in first six months; ‘72% of attacks treated in second six months; .64%, 536 attacks/l2 months; 72%, z 36 attack/l2 months. Median percentage of attacks per patient treated for headache recurrence was low, 8%. The drug was rated as good or excellent in 64% of all attacks treated. Conclusion: Oral naratriptan 2.5 mg is an effective and well tolerated acute treatment for migraine over a 12 month period.
1 l-21 -13 1 Transcranial Doppler, EEG and SPECT findings of a focal reduction of cerebral blood during the aura phase In migraine I. La Spina, G. Frazzitta, G. Grampa, F. Reverberi, D. Uccellini, Department of Neurolog)! City Hospital, Busto Arsizio, Italy
D. Porazzi.
Background and Objectives: The monitoring of the different phases of the migraine attack with different modalities allows a better interpretation of the pathogenesis of this disease. The possibility of documenting the aura phase in patients with migraine is a rare event. Method: Transcranial Doppler (TCD), Electroencephalography (EEG), single photon emission computed tomography (SPECT) and cerebral magnetic resonance imaging (MRI) or computed tomography (CT) were performed in six cases of migraine with aura during the different phases of the attack from the aura phase (3 cases) or at the beginning (within 2 hours) of the pain (3 cases) to the end. Results: The most important data refer to the earliest phases of the attack: in our six cases TCD studies suggest a decrease of cerebral blood flow (CBF) in the cortical area responsible for the neurological manifestation during the aura phase; in four cases the EEG showed corresponding focal slow abnormalities; in three patients cerebral SPECT revealed an area of relative decreased uptake of the tracer that in one patient persisted when the pain was over. At the end of the attack cranial MRI or CT and follow-up TCD and EEG were normal. Conclusions: The neurological defect during the aura phase corresponds with the evidence of a transient focal reduction in the cerebral blood flow.
1 l-21 -14 1 Thunderclap headache - Results from a prospective study of consecutive patients A.-M. Landtblom I, J. Boivie’ , S. Fridriksson z, J. Hillman *, G. Johansson ‘, I. Johansson 3. ‘Department of Neurolog) University Hospital, Linkdping, Sweden, 2Department of Neurosurgery; University Hospital, Linkiping, Sweden, 3Department of Radiology University Hospita/, LinkSping, Sweden
Aim of investigation: Patients with sudden severe headache, i.e. thunderclap headache (TH), are common in the emergency units. We have performed a prospective study on unselected, consecutive patients in order to investigate the proportion of subarachnoidal hemorrhage (SAH), to find out other causes
of TH, and to see if patients with SAH or other specific causes can be identified clinically. Recurrences and other kinds of headache were monitored. We now report the final result regarding 137 patients. Patients and Methods: A detailed history was recorded in a questionnaire and a neurologic examination was done as well as a CT scan, followed by a spinal tap if the CT did not show SAH. Follow up was done by interviews after 24 davs, 7-9 davs, 1 month, 6 months and 12 months. Re<s: The-mean age of 78 women and 59 men was 44 years (range 16-87). Twenty five patients with a mean age of 56 years (30-87) had SAH, compared with a mean age of 42 years in the non&H group. In.24% of the SAH patients the onset was correlated to exertion or valsalva, compared with 26% in the non-SAH group. Pain location was similar. Very severe headache was more frequent in SAH, than in non-SAH TH, but the headache quality was about the same. Neck stiffnesss and impaired consciousness was more common in the SAH group. Previous migraine was not significantly more common in the non-SAH group. Four nor&AH patients had aseptic meningitis and five patients had cerebral infarction. In the non-SAH group 23% had another TH, but no SAH occurred during follow up. The overall incidence of TH was 33/100 000 inhabitants/year. Conclusions: The proportion of SAH (18% in the whole material, 14% in the incidence material) in the present study is lower than in previous studies of TH, probably because the material is unselected including all patients seeking medical care because of TH in our catchment area. The results support the notion that SAH cannot be identified on clinical grounds. Patients with a first attack of TH should be investigated with a CT scan and a spinal tap to exclude serious conditions like SAH, meningitis or cerebral infarction. It is noteworthy that none of the 112 patients who did not have a SAH at the first TH, were struck by a SAH during the one year follow-up period. This supports the view that angiographies are not indicated in these patients.
I l-21 -15 1 SUNCT. The first Argentinian
case
J. Fernandez Calvo, N. Tinetti, J. Leston. Headache and paint Unif, Division Neurolog)! Hospital de Clinicas J. de San Martin, UBA, Argentina SUNCT is a recently described headache entity.(‘) The episodes may be precipitated by various mechanisms concerning trigeminal inervation as will as the neck. Only few cases have been reported until now. The patients is a 76 years old female. The first paroxysms located in the right supraorbital area lasting seconds during 1 months period, appeared when she was 70 years old. The pain builded up gradually and was precipitated by movement of the neck. She repeated the episode after 1 year without associated autonomic features. The third episode, 4 years ago was precipitated not only by head movement but chewing, talking or even touching the eyelids associated with prominent ipsilateral autonomic symptoms. The pain paroxysms usually lasting seconds to l-2 minutes occurred during 2 months. After a remission of 3 years, she has the more severe attack period, with symptomatic free 2-3 days intervals. Interesting aspects in this case is the beginning of the episodes with only head movement as a trigger factors, and the pain building up gradually without significant autonomic features. Further clinical research and observations are needed to clarify this headache and the variants. [l] Sjaastad 0. Russell D, Horven I, Bunaes U. Multiple neuralgiform, unilateral headache attacks associated with conjunctival injection and appearing in clusters. A nosological problem. Proceedings of the Scandinavian Migraine Society; 197831
I l-21 -16 I Syntomatic treatment of the trigeminai with oxarcabamazepina M.R. Lopez, E.R. Santiago, R.R. Ramos, J.S.V. Zenteno. Neurology; Genera/ Hospital of Mexico, Mexico
neuralgia
Departmenf
of
The trigeminal neuralgia is a suffering that nowadays do not build on a pathological basis defined. During years has been observed to control satisfactory of the paroxism painfull within the drugs phenytoin and carbamazepine. But has seen it to much of the cases resistance to those drugs around from 12 months of established the treatment. The oxcarbazepine it their active metabolith monohydroxi are derivaded from carbamazopine with similar action to it, but with less undesirable effects, theorically would be able to turn out to be effective in patients with this entity. The object of this paper is to appreciate the effectiveness and adverse reactions of the oxcarbamazepine in the trigeminal neuralgia. We selected the patient with clinical trigeminal neuralgia the full of the criterions of Rushton and Olafson, at the ones who realized to TAC and IRM the cranium and reflex of blink. They received oxcarbazepine 300 mg per day, increasing the dose until control of the pain. We were 14 patients, 12 women and 2 mens between 28 and 38 years old, with the illness between 3 weeks to 30 evolution