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5-21-16 Chronic daily headache: Validity of proposed revisions to the IHS criteria
Headache 5-21-13
The effect of acupuncture in migraineurs
treatment
on endothelins
C. irkeq, M. Amy, B. Nazhel. Gezi UniversiM Medical School, Departments of Neuroiqy and Anesthesiolog)! Ankara, Turkey Pharmacotherapy of migraine characterized with frequent attacks, is still under discussion. Recently, acupuncture, transcutaneous electrical stimulation, thenal stimulation and thennal biofeedback have been tried on migraineurs. Acupuncture is thought to decrease pain in migraine by mobilizing enkephalins and endorphins. Serum endothelins (ETl) increases during acute attacks in migraineurs. In this study to find the effect of acupuncture on ET1 levels, we measured ET1 in 30 migraineurs before and after acupuncture treatment, in 20 migraineurs before and after plasebo treatment and in 20 normal controls by using radioimmunoassay technique. ET1 levels were found to be significantly high in both groups when compared with controls and was shown to decrease in the first 12 hours after acupuncture treatment while there was not any significant change in the plasebo group. These findings suggest that besides effecting enkephalin and endorphins, acupuncture in migraine treatment also effects endothelins.
5-21-l 4
A case of ophthaimoptegic migraine; Reversible ischemia demonstrated by brain SPECT
HwanMo Jeong, KyungSik Ha, DongJin Shin. Department Chung-Ang Gil General Hospital, Inch&t, Korea
of Neurology;
Ophthalmoplegic migraine is a syndrome characterized by the typical history of migrainous headache followed by opthalmoplegia in the absence of demonstrable intracranial lesion. Until now, investigations of regional cerebral blood flow (CBF) in patients with migraine have been performed during prodrornal and/or headache phases by brain SPECT with Tc-99m HMPAO. However, no such paper has described patients with ophthalmoplegic migraine. We present a 1 Cyear-old girl with 4 episodes of paroxysmal migrainous headache on the right fro&-orbital area without aura followed by ptosis and diplopia, which were always gradually resolved without aberrant regeneration over 2 or 3 weeks period. Neurologic examination showed the right internal and external ophthalmoplegia. Diagnostic studies (including laboratoty tests, tensilon test, brain MRI, and cerebral angiography) were normal. Serial brain SPECT studies with Tc-99m HMPAO showed the presence of reversible ischemia in the branches of the posterior cerebral artery.
5-21-l 5
Citric fruits as a dietary trigger of migraine
A.V. Ktyrnchantowski, Rio de Janeiro, Brazil
M.E.N.M.
Costa.
Headache
Center of Rio de Janeiro,
Many dietary factors have been described as possible trigger factors of primary headaches, among them citric fruits. Our study aims to analyse the frequency of this factor in patients diagnosed as having migraine. We reviewed the records of 318 patients (247 females and 71 males), ranging from 10 to 88 years of age. In this universe, we related the diagnosis, according to the International Headache Society, with the report of citric fruits as a trigger factor by the patient. Also, we studied the sex and age distribution of patients with migraine comparing with the group of migrainous patients having citric fruits as a trigger factor. Df the total of patients, 271 (85%) had migraine and 47 (15%) had other types of primary headache. Df the patients with migraine, 65 (24%) referred citric fruits precipitating headache attacks, while patients with non-migraine type of headache did not refer citric fruits at all. Patients with migraine were distributed according to sex and age as follows: 81% were female and 19% were male; 23% had less than 30 years of age and 77% had more than 30 years of age. Patients with migraine attacks precipitated by citric fruits had the following distribution: 88% were female and 12% were male; 9% had less than 30 years of age and 91% had more than 30 years of age. We conclude that citric fruits probably are an important dietary trigger factor in migraine headache. Besides, there was no significant difference in sex and age distribution comparing all migrainous patients with migrainous patients referring citric fruits as a precipitating factor.
5-21 1_1
16
paroxysmal hemicrania were excluded. The diagnosis of CDH included transformed migraine (TM), chronic tension-type headache (CTTH) and new daily persistent headache (NDPH). Female: Male ratio was 4.8:1; mean age 40 (range 18 to 65). With the IHS criteria we were unable to classify 36% of the patients. Using the proposed revisions to the IHS classification, 77.3% of the patients had TM, 18.5% had ClTH, and 4.2% had NDPH. The IHS classification does not adequately deal with CDH. The new proposed criteria (1995) are more comprehensive because they had excluded the time criteria in the moment of transformation of migraine. We think that time criteria should be changed in the same way in the other CDM types.
5-21-I 7
Migraine-associated anterior ischemic optic neuropathy in sicki+celi trait
M.A. Lana-Peixoto, A. Barbosa. Departments of Neurology and Ophrhalmology, Federal University of Minas Gemis Medical School, Belo Horizonte, Stazii Objective: To describe the development of anterior ischemic optic neuropathy (AION) during a migraine attack in a patient with sicklecell trait. Cew Report: An ll-year-old black boy with a long-standing history of migraine with visual aura had a migraine attack with persistent decreased sight in his left eye. He also had a histoty of recurring transient loss of vision in the left eye with no headache during intensive physical exercises. Ophthalmic examination revealed visual acuity 20/20 in the right and 20160 in left eye. He could read none of the lshihara plates with the left eye, had a dense cecccentral scotoma, and a pale optic disc in this eye. Routine laboratory work-up including imaging studies were negative. Hemoglobin electrophoresis revealed a double band of A and S mobility. The S hemoglobin was 38%, A hemoglobin 62% and the red cells sickled under classical conditions. Conclusions: This case suggests that sickle-cell trait is not a benign condition when associated with migraine. Vasospasm may precipitate sickling and AION in patients with AS hernoglobinopathy.
5-21-l 8 u
“Pseudotumor patients
Cerebrl”
C. Ferreira, M. Veloso, M. Correia. Santa Antdnio, Rzto, Portugal
Neurology
long term prognosis Department,
Comparison propranoloi,
Spain
Geral de
of the prophyiactk effects of fiunarizin, and amitrlptyline on migraine
2. Odaba#, 2. Gak$l, E. $ener, 0. Vural, M. Yardim. Giilhane Medics/ School, Ankara, Turkey
Many chronic daily headache (CDH) patients couldn’t be appropriately classified within the International Headache Society (IHS) system. We tested the Silberstein’s et al proposed revisions to the IHS criteria in 97 consecutive outpatients with CDH. Patients with symptomatic headache, chronic cluster headache or chronic
Hospital
of 22
Background and objectfvee: Pseudotumor Cerebri (PTC). or Benign Intracranial Hypertension, is a syndrome associated with multiple clinical conditions. Our objective was to determine the number of patients who’s follow up changed the diagnosis, and the prognosis in terms of neurdogical sequella. Methods: Between 1986 and 1996 we identified patients with this diagnosis at release from hospital. PTC was defined as stated by the International Headache Society. From clinical records were obtained demographic and clinical data. Current complaints and functional status were assessed by a postal ou telephonic inquiry. Results: We found 22 patients, 12 female, median age 32 years (6-63). Prediswng factors were: obesity (8 female); head trauma (1); use of hormonal anticonceptional (7) steroids (2), tetracycline (1). Neurdogical examination: papilledema (22); enlargement of the blind spot (22); VI nerve palsy (7). CTscan was normal in all patients (22/22), MRI (12/12); angiography (3/3). Treatment: steroids (12), acetazolamide (ll), furosemide (5). Median follow up 5.7 years (OS-1 0.5 y). 8 patients were readmitted. Diagnosis was changed in 2 patients: dural fistula diagnosed by MRI and angiography 7 years later; an arteriovenous malformation (AVM) diagnosed by angiography 1 year later. Postal (11) or telephone (11) inquiry found all patients alive and independent. 16 considered complete recovery, 6 have chronic tension headache (all have normal MRI). Conotuefon: These PTC patients follow up revealed an AVM and a dural fistula diagnosed by MRI and or angiography (2/22; 9.1%). We suggest that diagnostic criteria should include the nomality of these exams. Definitive PTC has a good prognosis with 72.7% completely recovered and 27.3% with chronic tension headache. No patient showed ophthalmological sequella.
5-21-l 9
Chronic dally headache: Validity of proposed revisions to the IHS criteria
M.J. Mom&. J.M. Lainez, J.M. Santonja, A. Pareja, J. Parra, C. Peir6, J. Sancho. Neurofogy Service, Hospiral Genera/ Universiario, Valencia,
s305
Dep. of Neurology;
In this study, we investigated the prophylactic effects of flunartzine (cerebrcselective calcium-channel antagonist) propranolol (beta-blocker agent) and amitriptyline (tricycle antidepressant) on classic and common migraine in 190 patients. 120 patients had common and 70 had classic migraine. All patients received the only one drug during four months period followed by a month drug holiday.
The effect of acupuncture in migraineurs
treatment
on endothelins
C. irkeq, M. Amy, B. Nazhel. Gezi UniversiM Medical School, Departments of Neuroiqy and Anesthesiolog)! Ankara, Turkey Pharmacotherapy of migraine characterized with frequent attacks, is still under discussion. Recently, acupuncture, transcutaneous electrical stimulation, thenal stimulation and thennal biofeedback have been tried on migraineurs. Acupuncture is thought to decrease pain in migraine by mobilizing enkephalins and endorphins. Serum endothelins (ETl) increases during acute attacks in migraineurs. In this study to find the effect of acupuncture on ET1 levels, we measured ET1 in 30 migraineurs before and after acupuncture treatment, in 20 migraineurs before and after plasebo treatment and in 20 normal controls by using radioimmunoassay technique. ET1 levels were found to be significantly high in both groups when compared with controls and was shown to decrease in the first 12 hours after acupuncture treatment while there was not any significant change in the plasebo group. These findings suggest that besides effecting enkephalin and endorphins, acupuncture in migraine treatment also effects endothelins.
5-21-l 4
A case of ophthaimoptegic migraine; Reversible ischemia demonstrated by brain SPECT
HwanMo Jeong, KyungSik Ha, DongJin Shin. Department Chung-Ang Gil General Hospital, Inch&t, Korea
of Neurology;
Ophthalmoplegic migraine is a syndrome characterized by the typical history of migrainous headache followed by opthalmoplegia in the absence of demonstrable intracranial lesion. Until now, investigations of regional cerebral blood flow (CBF) in patients with migraine have been performed during prodrornal and/or headache phases by brain SPECT with Tc-99m HMPAO. However, no such paper has described patients with ophthalmoplegic migraine. We present a 1 Cyear-old girl with 4 episodes of paroxysmal migrainous headache on the right fro&-orbital area without aura followed by ptosis and diplopia, which were always gradually resolved without aberrant regeneration over 2 or 3 weeks period. Neurologic examination showed the right internal and external ophthalmoplegia. Diagnostic studies (including laboratoty tests, tensilon test, brain MRI, and cerebral angiography) were normal. Serial brain SPECT studies with Tc-99m HMPAO showed the presence of reversible ischemia in the branches of the posterior cerebral artery.
5-21-l 5
Citric fruits as a dietary trigger of migraine
A.V. Ktyrnchantowski, Rio de Janeiro, Brazil
M.E.N.M.
Costa.
Headache
Center of Rio de Janeiro,
Many dietary factors have been described as possible trigger factors of primary headaches, among them citric fruits. Our study aims to analyse the frequency of this factor in patients diagnosed as having migraine. We reviewed the records of 318 patients (247 females and 71 males), ranging from 10 to 88 years of age. In this universe, we related the diagnosis, according to the International Headache Society, with the report of citric fruits as a trigger factor by the patient. Also, we studied the sex and age distribution of patients with migraine comparing with the group of migrainous patients having citric fruits as a trigger factor. Df the total of patients, 271 (85%) had migraine and 47 (15%) had other types of primary headache. Df the patients with migraine, 65 (24%) referred citric fruits precipitating headache attacks, while patients with non-migraine type of headache did not refer citric fruits at all. Patients with migraine were distributed according to sex and age as follows: 81% were female and 19% were male; 23% had less than 30 years of age and 77% had more than 30 years of age. Patients with migraine attacks precipitated by citric fruits had the following distribution: 88% were female and 12% were male; 9% had less than 30 years of age and 91% had more than 30 years of age. We conclude that citric fruits probably are an important dietary trigger factor in migraine headache. Besides, there was no significant difference in sex and age distribution comparing all migrainous patients with migrainous patients referring citric fruits as a precipitating factor.
5-21 1_1
16
paroxysmal hemicrania were excluded. The diagnosis of CDH included transformed migraine (TM), chronic tension-type headache (CTTH) and new daily persistent headache (NDPH). Female: Male ratio was 4.8:1; mean age 40 (range 18 to 65). With the IHS criteria we were unable to classify 36% of the patients. Using the proposed revisions to the IHS classification, 77.3% of the patients had TM, 18.5% had ClTH, and 4.2% had NDPH. The IHS classification does not adequately deal with CDH. The new proposed criteria (1995) are more comprehensive because they had excluded the time criteria in the moment of transformation of migraine. We think that time criteria should be changed in the same way in the other CDM types.
5-21-I 7
Migraine-associated anterior ischemic optic neuropathy in sicki+celi trait
M.A. Lana-Peixoto, A. Barbosa. Departments of Neurology and Ophrhalmology, Federal University of Minas Gemis Medical School, Belo Horizonte, Stazii Objective: To describe the development of anterior ischemic optic neuropathy (AION) during a migraine attack in a patient with sicklecell trait. Cew Report: An ll-year-old black boy with a long-standing history of migraine with visual aura had a migraine attack with persistent decreased sight in his left eye. He also had a histoty of recurring transient loss of vision in the left eye with no headache during intensive physical exercises. Ophthalmic examination revealed visual acuity 20/20 in the right and 20160 in left eye. He could read none of the lshihara plates with the left eye, had a dense cecccentral scotoma, and a pale optic disc in this eye. Routine laboratory work-up including imaging studies were negative. Hemoglobin electrophoresis revealed a double band of A and S mobility. The S hemoglobin was 38%, A hemoglobin 62% and the red cells sickled under classical conditions. Conclusions: This case suggests that sickle-cell trait is not a benign condition when associated with migraine. Vasospasm may precipitate sickling and AION in patients with AS hernoglobinopathy.
5-21-l 8 u
“Pseudotumor patients
Cerebrl”
C. Ferreira, M. Veloso, M. Correia. Santa Antdnio, Rzto, Portugal
Neurology
long term prognosis Department,
Comparison propranoloi,
Spain
Geral de
of the prophyiactk effects of fiunarizin, and amitrlptyline on migraine
2. Odaba#, 2. Gak$l, E. $ener, 0. Vural, M. Yardim. Giilhane Medics/ School, Ankara, Turkey
Many chronic daily headache (CDH) patients couldn’t be appropriately classified within the International Headache Society (IHS) system. We tested the Silberstein’s et al proposed revisions to the IHS criteria in 97 consecutive outpatients with CDH. Patients with symptomatic headache, chronic cluster headache or chronic
Hospital
of 22
Background and objectfvee: Pseudotumor Cerebri (PTC). or Benign Intracranial Hypertension, is a syndrome associated with multiple clinical conditions. Our objective was to determine the number of patients who’s follow up changed the diagnosis, and the prognosis in terms of neurdogical sequella. Methods: Between 1986 and 1996 we identified patients with this diagnosis at release from hospital. PTC was defined as stated by the International Headache Society. From clinical records were obtained demographic and clinical data. Current complaints and functional status were assessed by a postal ou telephonic inquiry. Results: We found 22 patients, 12 female, median age 32 years (6-63). Prediswng factors were: obesity (8 female); head trauma (1); use of hormonal anticonceptional (7) steroids (2), tetracycline (1). Neurdogical examination: papilledema (22); enlargement of the blind spot (22); VI nerve palsy (7). CTscan was normal in all patients (22/22), MRI (12/12); angiography (3/3). Treatment: steroids (12), acetazolamide (ll), furosemide (5). Median follow up 5.7 years (OS-1 0.5 y). 8 patients were readmitted. Diagnosis was changed in 2 patients: dural fistula diagnosed by MRI and angiography 7 years later; an arteriovenous malformation (AVM) diagnosed by angiography 1 year later. Postal (11) or telephone (11) inquiry found all patients alive and independent. 16 considered complete recovery, 6 have chronic tension headache (all have normal MRI). Conotuefon: These PTC patients follow up revealed an AVM and a dural fistula diagnosed by MRI and or angiography (2/22; 9.1%). We suggest that diagnostic criteria should include the nomality of these exams. Definitive PTC has a good prognosis with 72.7% completely recovered and 27.3% with chronic tension headache. No patient showed ophthalmological sequella.
5-21-l 9
Chronic dally headache: Validity of proposed revisions to the IHS criteria
M.J. Mom&. J.M. Lainez, J.M. Santonja, A. Pareja, J. Parra, C. Peir6, J. Sancho. Neurofogy Service, Hospiral Genera/ Universiario, Valencia,
s305
Dep. of Neurology;
In this study, we investigated the prophylactic effects of flunartzine (cerebrcselective calcium-channel antagonist) propranolol (beta-blocker agent) and amitriptyline (tricycle antidepressant) on classic and common migraine in 190 patients. 120 patients had common and 70 had classic migraine. All patients received the only one drug during four months period followed by a month drug holiday.