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Migraine and lateral asymmetry of experimental pain sensitivity
124 type headache is not known, and individually reliable objective, apparature parameters are not available, the exact registration of the anamnesis and headache symptomatology is decisive. The PC programme facilitates an objective and completely automatic description of the headache phenomena. The structure of the programme, and first experiences of the application, are presented. (The programme is available free of charge from Glaxo GmbH, Alsterufer 1, W-2000 H a m b u r g 36)
M I G R A I N E A N D L A T E R A L A S Y M M E T R Y OF E X P E R I M E N T A L PAIN SENSITIVITY H. G6bel, K. R a u t m a n n and P. Kropp Neurological Clinic, Christian-Albrechts-University, Germany
Kiel,
The unilaterality of the pain is one of the most typical features of migraine. The pathophysiology is still unclear. A functional failure of the antinociceptive brain stem system with paroxysmal e n h a n c e m e n t of pain sensitivity during the migraine attack has been suggested. The bilaterally localised brain stem nuclei might inhibit each other reciprocally, causing the transformation of the headache into an unilateral or alternating symptomatology. We investigated the symmetry of experimental pain sensitivity in migraine patients, compared to control groups, during the migraine interval. 26 migraine patients without aura, 15 patients with chronic pain disorders other than migraine and 25 healthy subjects were examined. The experimental pain sensitivity of the right and left hand were determind using randomized local pressure on the middle phalanges of the fingers I I - I V and an modified submaximal effort tourniquet test. There were no significant differences in absolute pain sensitivity using the various methods between the three groups. In contrast, we found a significant lateralisation of pain sensitivity in migraine patients compared to the control groups ( P _< 0.05). We conclude that a marked asymmetry of vascular pain sensitivity might be one condition for the unilaterality of headache pain in migraine patients.
M I G R A I N E PAIN A N D A S Y M M E T R Y OF C E R E B R A L BLOOD FLOW VELOCITY H. G6bel, K. R a u t m a n n and P. Kropp Neurological Clinic, Christian-Albrechts-University, Kiel, Germany A hereditary instability of the cerebral haemodynamics is presumed by the pathogenesis of migraine. We used transcranial doppler sonography to investigate the correlations of asymmetries of the cerebral blood flow velocity in the middle cerebral arteries to headache phenoma.
The blood flow velocities of the middle cerebral arteries were determined in 26 patients suffering from migraine without aura during the headache interval. The two control groups consisted of 15 patients with chronic pain disorders others than migraine and 26 healthy volunteers. We found no significant asymmetries of the parameters of cerebral blood flow velocity in migraine patients compared to the control groups. Within the group of migraine patients we found differences in the asymmetries of the blood flow velocity between the subgroup of patients with a mean duration of the migraine attacks of more than 12 h and those with mean attack durations less than ( P < 0.05). The asymmetries of the blood flow velocity were markedly significant in the group of patients with a duration of the attacks of more than 12 h. We conclude that the duration of the attack might be related to the extent of the asymmetry of cerebral haemodynamics. The distinct asymmetry may be an expression of a hereditary instability of the cerebral perfusion.
I N T E R O C E P T I V E S U P P R E S S I O N P E R I O D S O F TEMP O R A L I S M U S C L E ACTIVITY P R O D U C E D BY C O R T I C A L M A G N E T I C A L S T I M U L A T I O N IN H E A D A C H E It. G6bel, M. Dworschak, P. Kropp and D. Soyka Neurological Clinic, Christian-Albrechts-Universityl Germany
Kiel,
Using transcranial electromagnetic cortex stimulation it is possible to measure a interoceptive suppression period (IS) of temporal muscle activity during voluntary contraction. In this study, we evaluate the pattern of interoceptive suppression periods of temporalis muscle activity in patients with chronic tension-type headache and healthy subjects. 10 patients with chronic tension-type headache (1.H.S. headache criteria) and 10 age- and sex-matched healthy control subjects were examined. Electromyogram signals were recorded from surface electrodes placed over the temporalis muscle. During maximum voluntary contraction of the jaw muscles, the contralateral cortex was stimulated electromagnetically over F8 (Novametrix Magstim 200; stimulus intensity 60%). The suppression periods were defined as 80% of baseline E M G activity. The latency of interoceptive suppression in patients with chronic tension-type headache was 49.7_+ 10.5 ms, in healthy subjects 46.33+7.2 ms. This difference was statistically not significant. In contrast, the duration of interoceptive suppression periods in patients with chronic tension-type headache (11.83+12.1 ms) was significantly shorter than in healthy subjects (35.6_+6.2 ms; P _< 0.01). Electromagnetical stimulation of the cortex produces interoceptive suppression periods which show comparable latencies of late exteroceptive suppression periods (ES2) produced by electrical trigeminal stimulation. A suppression period comparable to early exteroceptive suppression period (ESI) is absent. The results provide evidence that cortical mechanisms
M I G R A I N E A N D L A T E R A L A S Y M M E T R Y OF E X P E R I M E N T A L PAIN SENSITIVITY H. G6bel, K. R a u t m a n n and P. Kropp Neurological Clinic, Christian-Albrechts-University, Germany
Kiel,
The unilaterality of the pain is one of the most typical features of migraine. The pathophysiology is still unclear. A functional failure of the antinociceptive brain stem system with paroxysmal e n h a n c e m e n t of pain sensitivity during the migraine attack has been suggested. The bilaterally localised brain stem nuclei might inhibit each other reciprocally, causing the transformation of the headache into an unilateral or alternating symptomatology. We investigated the symmetry of experimental pain sensitivity in migraine patients, compared to control groups, during the migraine interval. 26 migraine patients without aura, 15 patients with chronic pain disorders other than migraine and 25 healthy subjects were examined. The experimental pain sensitivity of the right and left hand were determind using randomized local pressure on the middle phalanges of the fingers I I - I V and an modified submaximal effort tourniquet test. There were no significant differences in absolute pain sensitivity using the various methods between the three groups. In contrast, we found a significant lateralisation of pain sensitivity in migraine patients compared to the control groups ( P _< 0.05). We conclude that a marked asymmetry of vascular pain sensitivity might be one condition for the unilaterality of headache pain in migraine patients.
M I G R A I N E PAIN A N D A S Y M M E T R Y OF C E R E B R A L BLOOD FLOW VELOCITY H. G6bel, K. R a u t m a n n and P. Kropp Neurological Clinic, Christian-Albrechts-University, Kiel, Germany A hereditary instability of the cerebral haemodynamics is presumed by the pathogenesis of migraine. We used transcranial doppler sonography to investigate the correlations of asymmetries of the cerebral blood flow velocity in the middle cerebral arteries to headache phenoma.
The blood flow velocities of the middle cerebral arteries were determined in 26 patients suffering from migraine without aura during the headache interval. The two control groups consisted of 15 patients with chronic pain disorders others than migraine and 26 healthy volunteers. We found no significant asymmetries of the parameters of cerebral blood flow velocity in migraine patients compared to the control groups. Within the group of migraine patients we found differences in the asymmetries of the blood flow velocity between the subgroup of patients with a mean duration of the migraine attacks of more than 12 h and those with mean attack durations less than ( P < 0.05). The asymmetries of the blood flow velocity were markedly significant in the group of patients with a duration of the attacks of more than 12 h. We conclude that the duration of the attack might be related to the extent of the asymmetry of cerebral haemodynamics. The distinct asymmetry may be an expression of a hereditary instability of the cerebral perfusion.
I N T E R O C E P T I V E S U P P R E S S I O N P E R I O D S O F TEMP O R A L I S M U S C L E ACTIVITY P R O D U C E D BY C O R T I C A L M A G N E T I C A L S T I M U L A T I O N IN H E A D A C H E It. G6bel, M. Dworschak, P. Kropp and D. Soyka Neurological Clinic, Christian-Albrechts-Universityl Germany
Kiel,
Using transcranial electromagnetic cortex stimulation it is possible to measure a interoceptive suppression period (IS) of temporal muscle activity during voluntary contraction. In this study, we evaluate the pattern of interoceptive suppression periods of temporalis muscle activity in patients with chronic tension-type headache and healthy subjects. 10 patients with chronic tension-type headache (1.H.S. headache criteria) and 10 age- and sex-matched healthy control subjects were examined. Electromyogram signals were recorded from surface electrodes placed over the temporalis muscle. During maximum voluntary contraction of the jaw muscles, the contralateral cortex was stimulated electromagnetically over F8 (Novametrix Magstim 200; stimulus intensity 60%). The suppression periods were defined as 80% of baseline E M G activity. The latency of interoceptive suppression in patients with chronic tension-type headache was 49.7_+ 10.5 ms, in healthy subjects 46.33+7.2 ms. This difference was statistically not significant. In contrast, the duration of interoceptive suppression periods in patients with chronic tension-type headache (11.83+12.1 ms) was significantly shorter than in healthy subjects (35.6_+6.2 ms; P _< 0.01). Electromagnetical stimulation of the cortex produces interoceptive suppression periods which show comparable latencies of late exteroceptive suppression periods (ES2) produced by electrical trigeminal stimulation. A suppression period comparable to early exteroceptive suppression period (ESI) is absent. The results provide evidence that cortical mechanisms