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Headache Clinical diagnosis and computer analysis of headache symptoms
205
HEADACHE
Clinical diagnosis and computer analysis of headache symptonis. - P.D. Drummond and J.W. Lance, J. Neurol. Neurosurg. Psychiat., 47 (1984) 128-133. Six hundred case histories from patients with a clinical diagnosis of classic migraine, common migraine, tension-vascular headache, tension headache and cluster headache were subjected to computer analysis. In 537 patients the computer arrived at the same category as the clinical diagnosis. Major discrepancies were between common migraine, tension-vascular headache and tension headache. Cluster headache and classic migraine emerged as clearly definable syndromes. It is suggested that the difference between common migraine, tension-vascular headache and tension headache is more quantitative than qualitative and that in fact they may be part of a continuum. This problem can only be solved by further pathophysiological studies.
Erythrocyte choline concentrations and cluster headache. - J. de Belleroche, GE. Cook, I. Das, R. Joseph, I. Tresidder, S. Rouse, R. Petty and F. Clifford Rose, Brit. med. J., 288 (1984) 268-270. Erythrocyte choline concentrations were low in patients with cluster headache compared to age-related control subjects. This was true during cluster periods as well as outside of cluster periods. During lithium treatment choline levels rose 78 times. It is suggested that low choline in the erythrocytes may be an important pa~ogenetic factor in cluster headache. Together with some u~no~ trigger factor, it may be responsible for the attacks.
Is migraine food allergy? A double-blind controlled trial of oligo-antigenic diet treatment. - J. Egger, J. Wilson, C.M. Carter, M.W. Turner and J.F. Soothill, Lancet, ii (1983) 865-869. O~g~~tige~c diets resulted in dramatic improvement of classic or common migraine in 82 of 88 children. Sequential reintroduction identified causative foods which varied from child to child. Most patients responded to several foods. In a double-blind trial 40 patients received an oligo-antigenic diet with added placebo or provoking substance. Significantly more children had recurrence of headache during intake of challenging substances than during placebo intake (P -c0.001). There was no relationship between positive prick tests, IgE levels and response to oligo-antigenie diet. The authors conclude that the mechanism for ~o~-~duc~ migraine is probably allergic rather than idiosyncrasic and of a slow type, since median reaction time for recurrence of symptoms was two days. The study is the first double-blind study of food allergy in migraine and it is very extensive, elegant and cautious in its conclusions. It should stimulate to similar work in adults with migraine.
HEADACHE
Clinical diagnosis and computer analysis of headache symptonis. - P.D. Drummond and J.W. Lance, J. Neurol. Neurosurg. Psychiat., 47 (1984) 128-133. Six hundred case histories from patients with a clinical diagnosis of classic migraine, common migraine, tension-vascular headache, tension headache and cluster headache were subjected to computer analysis. In 537 patients the computer arrived at the same category as the clinical diagnosis. Major discrepancies were between common migraine, tension-vascular headache and tension headache. Cluster headache and classic migraine emerged as clearly definable syndromes. It is suggested that the difference between common migraine, tension-vascular headache and tension headache is more quantitative than qualitative and that in fact they may be part of a continuum. This problem can only be solved by further pathophysiological studies.
Erythrocyte choline concentrations and cluster headache. - J. de Belleroche, GE. Cook, I. Das, R. Joseph, I. Tresidder, S. Rouse, R. Petty and F. Clifford Rose, Brit. med. J., 288 (1984) 268-270. Erythrocyte choline concentrations were low in patients with cluster headache compared to age-related control subjects. This was true during cluster periods as well as outside of cluster periods. During lithium treatment choline levels rose 78 times. It is suggested that low choline in the erythrocytes may be an important pa~ogenetic factor in cluster headache. Together with some u~no~ trigger factor, it may be responsible for the attacks.
Is migraine food allergy? A double-blind controlled trial of oligo-antigenic diet treatment. - J. Egger, J. Wilson, C.M. Carter, M.W. Turner and J.F. Soothill, Lancet, ii (1983) 865-869. O~g~~tige~c diets resulted in dramatic improvement of classic or common migraine in 82 of 88 children. Sequential reintroduction identified causative foods which varied from child to child. Most patients responded to several foods. In a double-blind trial 40 patients received an oligo-antigenic diet with added placebo or provoking substance. Significantly more children had recurrence of headache during intake of challenging substances than during placebo intake (P -c0.001). There was no relationship between positive prick tests, IgE levels and response to oligo-antigenie diet. The authors conclude that the mechanism for ~o~-~duc~ migraine is probably allergic rather than idiosyncrasic and of a slow type, since median reaction time for recurrence of symptoms was two days. The study is the first double-blind study of food allergy in migraine and it is very extensive, elegant and cautious in its conclusions. It should stimulate to similar work in adults with migraine.