Cephalalgia
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Experimental Pain in Human Temporal Muscle Induced by Hypertonic Saline, Potassium and Acidity The study was aimed at developing a reference model for experimental pain and tenderness in the human temporal muscle by the local injection of hypertonic saline, potassium chloride and acidic phosphate buffer, using isotonic saline as control. The design was randomized and double-blind. Twenty healthy subjects had 0.2 ml test solution injected into one temporal muscle and saline into the other. Following each injection, pain was rated on a 10-point ordinal scale and pressure-pain thresholds were measured every minute for 10 min by a pressure algometer. Hypertonic saline ( n = 11) and potassium chloride ( n = 12) induced significantly more pain than isotonic saline ( ANOVA, p < 0.0001). Compared to control injections, hypertonic saline and potassium chloride induced a significant reduction in pressure-pain threshold (ANOVA, p < 0.0001 and p < 0.05). Forty-eight percent of the injections led to the referral of pain most often to the jaws. A positive correlation between the relative occurrence of referred pain and pain intensity was observed ( p < 0.001) as was a negative correlation between the decrease in pressure-pain threshold and pain intensity ( p < 0.05).
Cephalalgia - Tập 12 Số 2 - Trang 101-106 - 1992
Coat-hanger ache in orthostatic hypotension Background Questionnaires administered to orthostatic hypotension (OH) patients reveal frequent occurrence of coat-hanger ache (CHA), but laboratory-based precipitation of CHA during head-up tilt (HUT) has not been investigated. This study compared the frequency and clinical aspects of CHA in the same group of OH patients during daily activities versus during HUT. Methods Retrospective IRB-approved review of prospectively collected data on 22 dysautonomic patients. Heart rate response to deep breathing, Valsalva manoeuver, HUT and thermoregulatory sweat test evaluated cardiovagal, adrenergic and sudomotor functions. Occurrence and clinical features of CHA during daily activities and during HUT were recorded. Data were analysed with descriptive statistics. Results All patients demonstrated severe adrenergic (OH), cardiovagal and sudomotor impairment. Of 22 patients, 13 (59%) reported CHA within 3–5 minutes of standing or after 10 minutes to 2 hours of sitting that was relieved within 5–20 minutes of recumbency. During HUT, 4 of 13 (18%) patients developed CHA. Clinical features varied. Conclusions CHA was reported by 59% of OH patients during daily activities and by only 18% during HUT. The clinical characteristics of CHA episodes displayed inter-individual and intra-individual variability. These findings militate against direct association between OH and CHA and suggest a complex pathophysiology.
Cephalalgia - Tập 32 Số 10 - Trang 731-737 - 2012
New Appendix Criteria Open for a Broader Concept of Chronic Migraine After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2.
Cephalalgia - Tập 26 Số 6 - Trang 742-746 - 2006
Occipital Nerve Block in the Management of Headache and Cervical Pain The origins of chronic headache and the role of the greater occipital nerve in headache syndromes are reviewed. The anatomical pathways and physiological basis of these headaches are discussed with a view to synthesizing some current concepts of headache generation. Studies of occipital nerve blockade for treatment of headaches of various types are assessed and a retrospective analysis of our own experience is presented.
Cephalalgia - Tập 12 Số 1 - Trang 9-13 - 1992
Greater Occipital Nerve Blockade for Cluster Headache Cluster headache is perhaps the most painful of the primary headache disorders. Its treatment includes acute, transitional, and preventive therapy. Despite the availability of many treatments, cluster headache patients can still be difficult to treat. We treated 14 cluster headache patients with greater occipital nerve block as transitional therapy (treatment initiated at the same time as preventive therapy). The mean number of headache-free days was 13.1+23.6. Four patients (28.5%) had a good response, five (35.7%) a moderate, and five (35.7%) no response. The greater occipital nerve block was well tolerated with no adverse events. Headache intensity, frequency and duration were significantly decreased comparing the week before with the week after the nerve block ( P< 0.003, P = 0.003, P< 0.005, respectively). Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache.
Cephalalgia - Tập 22 Số 7 - Trang 520-522 - 2002
Functional Connectivity between Trigeminal and Occipital Nerves Revealed by Occipital Nerve Blockade and Nociceptive Blink Reflexes Headache syndromes often suggest occipital and neck involvement, although it is still unknown to what extent branches of segment C1-C3 contribute actively to primary headache. Pain within the occipital area may be referred to the trigeminal territory. However, a modulation of trigeminal transmission by affecting cervical input in humans has not been elucidated so far. A convergence of cervical and trigeminal input at the level of the caudal part of the trigeminal nucleus in the brainstem has been suggested due to anatomical and neurophysiological studies in animals. We examined the R2 components of the nociceptive blink reflex responses in 15 healthy subjects before and after unilateral nerve blockade of the greater occipital nerve with 5 ml prilocain (1%). R2 response areas (AUC) decreased and the R2 latencies increased significantly after the nerve blockade only on the side of injection. AUC and latencies on the non-injection side remained stable. Thresholds for sensory or pain perception did not differ significantly between the repeated measurements on both sides. Our findings extend previous results related to anatomical and functional convergence of trigeminal and cervical afferent pathways in animals and suggest that the modulation of this pathway is of potential benefit in primary headache disorders.
Cephalalgia - Tập 26 Số 1 - Trang 50-55 - 2006
Neuropeptides in Migraine and Cluster Headache The cerebral circulation is invested by a rich network of neuropeptide Y (NPY) and noradrenaline containing sympathetic nerve fibers in arteries, arterioles and veins. However, the nerve supply of vasoactive intestinal peptide (VIP), substance P (SP) and calcitonin gene-related peptide (CGRP) containing fibers is sparse. While noradrenaline and NPY cause vasoconstriction, VIP, SP and CGRP are potent vasodilators. Stimulation of the trigeminal ganglion in cat and man elicits release of SP and CGRP. Subjects with spontaneous attacks of migraine show release of CGRP in parallel with headache. Cluster headache patients have release of CGRP and VIP during bouts. Treatment with sumatriptan aborts headache in migraine and cluster headache as well as the concomitant peptide release.
Cephalalgia - Tập 14 Số 5 - Trang 320-327 - 1994
Cerebrospinal Fluid Cytokine Levels in Migraine, Tension-Type Headache and Cervicogenic Headache Cytokines have been measured in cerebrospinal fluid (CSF) from headache patients [infrequent episodic tension-type headache (TTH) and migraine with or without aura, all during attack, and cervicogenic headache] and compared with levels in pain-free individuals. Both proinflammatory [interleukin (IL)-1β, tumour necrosis factor-α and monocyte chemoattractant protein-1 (MCP-1)] and anti-inflammatory cytokines IL-1 receptor antagonist (IL-1ra), IL-4, IL-10 and transforming growth factor-β1 (TGF-β1)] were included. There were significant group differences in IL-1ra, TGF-β1 and MCP-1 in episodic TTH and migraine compared with controls, and a significant difference in MCP-1 between cervicogenic headache and migraine with aura. Intrathecal MCP-1 correlated with IL-1ra, IL-10 and TGF-β1 in episodic TTH, and MCP-1 with IL-10 in migraine with aura. Cytokine increases were modest compared with those often accompanying serious neurological conditions, and may represent a mild response to pain. We believe this to be the first comparative study of CSF cytokine levels in connection with headache.
Cephalalgia - Tập 29 Số 3 - Trang 365-372 - 2009
Pain Thresholds and Tenderness in Neck and Head Following Acute Whiplash Injury: A Prospective Study Objective of the investigation: In a 6-month prospective study of 141 consecutive acute whiplash-injured participants, and 40 acute, ankle-injured controls, pain and tenderness in the neck/head, and at a distant control site, were measured. Basic procedures: Muscle palpation and pressure algometry in five head/neck muscle-pairs were performed after 1 week and 1, 3 and 6 months after injury. Algometry was performed at a distant control site. Main findings: Whiplash-injured patients had lowered pressure-pain-detection thresholds and higher palpation-score initially in the neck/head, but the groups were similar after 6 months, and the control site was not sensitized. Principal conclusion: Focal, but not generalized, sensitization to musculoskeletal structure is present until 3 months, but not 6 months, after whiplash injury, and probably does not play a major role in the development of late whiplash syndrome. Pressure algometry and palpation are useful clinical tools in the evaluation of neck and jaw pain in acute whiplash injury.
Cephalalgia - Tập 21 Số 3 - Trang 189-197 - 2001
Post-Lumbar Puncture Headache The aim of the present prospective study was to describe clinical features of post-lumbar puncture headache (PPH), and to test the validity of the diagnostic criteria of the International Headache Society (IHS). Eighty-eight of the 239 included patients (36.8%) experienced PPH. Females were affected more frequently than males (45.2% vs 21.4%; p<0.001) First onset of PPH occurred within the first day in 40 patients (53%), within 2 days in 89%, and never after the fourth day. When PPH occurred for the first time on the day the lumbar puncture was performed, it was usually experienced much later in the day (median 14.00 h) than it first occurred on the second day (median 09.30 h) or later. The median duration of PPH was 6 days (range 1–29 days). Patients with headache performed a “Rising Manoeuvre” twice daily as long as the headache period lasted, and recorded pair and time variables. The severity of PPH was negatively correlated to the time till the headache started or worsened upon rising (T1 and the time from the headache started to increase till it reached its maximum (T2 ) but was not significantly correlated to the time to restitution upon lying down (T3 ). The results are in good accordance with the leakage theory. T1 varied from immediate onset to 265 min (median 20 sec). T2 (median 30 sec, range 0–60 min) and T3 (median 20 sec, range 0–15 min) varied considerably as well. During the course of PPH, 45% of the patients occasionally reported non-postural headache or no headache when the Rising Manoeuvre was performed. It is suggested that PPH should be diagnosed in any patient who experiences postural headache at least once within 4 days of lumbar puncture.
Cephalalgia - Tập 17 Số 7 - Trang 778-784 - 1997
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