[Endogenous potentials evoked by acoustic stimulus in children with idiopathic headache--preliminary report]

[Article in Polish]

Steczkowska-Klucznik M, Kroczka S, Domaradzka E, Kacinski M.

Klinika Neurologii Dzieciecej i Pracownia, Neurofizjologii Kliniki Neurologii Dzieciecej, Collegium Medicum, Uniwersytetu Jagiellonskiego, Krakow. neupedkr cm-uj.krakow.pl

PURPOSE: Endogenous evoked potentials (P300) are elicited by several stimuli, and are electrophysiological consequence of cognitive processing. Abnormalities have often been reported in dementive syndromes, demyelinating diseases, metabolic disorders, CNS tumors, phacomatoses, neuroinfections, attention deficit hyperactivity disorder and epilepsy. The role of this element of neurophysiological characteristics is debated in migraine, pato-genetically undefined, and other primary headaches. THE AIM: The aim of this research was to determine whether the parameters of endogenous responses to the transient auditory stimulation in children with migraine differ from parameters obtained from children with tension-type headache, and whether the results are different in children with primary headaches compared with headache-free controls. SUBJECTS AND METHODS: 56 patients, 27 girls and 29 boys aged from 10 to 18 years, recruited from the Department of Pediatric Neurology and Headache Outpatient Clinic of University Children's Hospital of Cracow were studied between 1.04.2004 and 31.08.2004. 21 children affected with migraine, 17 with aura, 4 without aura, and 15 children with frequent episodic tension-type headache (ETTH) were diagnosed according to IHS criteria, and compared with 20 sex- and age-matched headache-free controls. Endogenous evoked potentials P300 were performed in all children using auditory oddball paradigm, averaging 60 responses to stimuli different from the background activity. Responses were recorded using superficial electrodes placed on the frontal (Fz), middle (Cz) and parietal (Pz) region, while reference electrodes on the ear lobes. The procedure of average out of target and non target stimuli was repeated three times in each patient. RESULTS: The parameters of latency and amplitude of P300 were not significantly different between children with migraine, without aura and ETTH, and healthy controls. On the contrary, the amplitude of responses was lower in children with ETTH than in controls. However the latency was shortened in children with migraine compared with children with other primary headaches and with headache-free controls. There was no significant correlation between parameters. CONCLUSION: The findings of shortened latency of P300 potentials in children with migraine, esp. migraine with aura may contribute to migraine pathogenesis. There were no significant differences in the latency and amplitude of P300 potentials in children with migraine without aura compared with the frequent ETTH. This finding does not add further information to the differentiation of both types of primary headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15727024&dopt=Abstract headache medicine




[Hypnic headache as a primary short-lasting night headache: a report of two cases.]

[Article in Polish]

Domitrz I.

Katedra i Klinika Neurologii, Akademia Medyczna w Warszawie.

Hypnic headache is a rare type of primary short-lasting headache related to sleep. The pathogenesis of hypnic headache still remains unknown, but it may be a chronobiological disturbance or a response to a pineal circadian irregularity in which melatonin may play a role in resynchronizing biological rhythms to lifestyle. It is a moderate headache that appears during sleep with almost an alarm clock regularity and lasts up to 60 minutes. The headache is boring, unilateral or with diffuse location. Lithium carbonate and flunarizine show the best efficacy, caffeine and melatonin may also be useful. The author describes two cases of hypnic headache, which were effectively treated. A 45-year-old woman was treated with flunarizine and melatonin and a 65-year-old man was treated with flunarizine. The efficacy of flunarizine may be associated with the activation of D2 receptor and the added treatment with melatonin may hasten the good effect similar to that seen in our patient.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15735995&dopt=Abstract headache medicine




Cluster headache: diagnosis and treatment.

Rozen TD.

Michigan Head-Pain and Neurological Institute, 3120 Professional Drive, Ann Arbor, MI 48104, USA. trozen mhni.com.

Cluster headache is a primary headache syndrome that is under-diagnosed and in many instances under-treated. The pain produced during a cluster headache is more severe than that generated by any other primary headache. Cluster headache is very stereotyped in its presentation and fairly easy to diagnose with an in-depth headache history. Cluster headache is easy to treat in most individuals if the correct medications are used and the correct dosages are given. The following manuscript presents information on the clinical presentation of cluster headache and both medicinal and surgical interventions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15743546&dopt=Abstract headache medicine




Cluster headache: diagnosis and treatment.

Rozen TD.

Michigan Head-Pain and Neurological Institute, 3120 Professional Drive, Ann Arbor, MI 48104, USA. trozen mhni.com.

Cluster headache is a primary headache syndrome that is underdiagnosed and in many instances undertreated. The pain produced during a cluster headache is more severe than that generated by any other primary headache. Cluster headache is very stereotyped in its presentation and fairly easy to diagnose with an in depth headache history. Cluster headache is easy to treat in most individuals if the correct medications are used and the correct dosages are given. The following manuscript presents information on the clinical presentation of cluster headache and both medicinal and surgical interventions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15745625&dopt=Abstract headache medicine




A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report.

McDonnell MK, Sahrmann SA, Van Dillen L.

Washington University School of Medicine, St Louis, MO 63110, USA. mcdonnellm wustl.edu

STUDY DESIGN: Case report. OBJECTIVE: To describe an intervention approach consisting of a specific active-exercise program and modification of postural alignment for an individual with cervicogenic headache. BACKGROUND: The patient was a 46-year-old male with a 7-year history of cervicogenic headache. He reported constant symptoms with an average intensity of 5/10 on a visual analogue scale where 0 indicated no pain and 10 the worst pain imaginable. Average pain intensity in the week prior to the initial evaluation was 3/10 secondary to trigger point injections. The patient's headache symptoms worsened with activities that involved use of his arms and prolonged sitting. METHODS AND MEASURES: The patient was treated 7 times over a 3-month period. Impairments of alignment, muscle function, and movement of the cervical, scapulothoracic, and lumbar regions were identified. Outcome measurements included headache frequency, intensity, and the Neck Disability Index (NDI) questionnaire. Intervention included modification of alignment and movement during active cervical and upper extremity movements. The patient also received functional instructions focused on diminishing the effect of the weight of the upper extremities on the cervical spine. RESULTS: The patient reported a decrease in headache frequency and intensity (1 headache in 3 weeks, intensity 1/10) and a decrease in his NDI score from 31 (severe disability) to 11 (mild disability). The patient also demonstrated improvement in upper cervical joint mobility, cervical range of motion, scapular alignment, and scapulothoracic muscle strength. CONCLUSION: Interventions that included modification of alignment in the cervical, scapulothoracic, and lumbar region, along with instruction in a specific active-exercise program to address movement impairments in these 3 regions, appeared to have been successful in relieving headaches and improving function in this patient.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15754599&dopt=Abstract headache medicine




Prevalence, clinical features and accompanying signs of post-traumatic headache in children.

[Article in English, Lithuanian]

Necajauskaite O, Endziniene M, Jurieniene K.

Center of Pediatric Surgery, Vilnius University Children's Hospital, Santariskiu 7, 08406 Vilnius, Lithuania. olgutene takas.lt.

The aim of the study was to investigate the prevalence and clinical features of headaches and their accompanying signs in children with mild traumatic brain injury, as well as to evaluate their changes over time. MATERIAL AND METHODS. The research involved two groups of 4-16 year-old children: the case group of 301 children who had experienced a single mild traumatic brain injury, and the control group - 301 children who had suffered from any other mild body injury without head trauma. Groups were matched according to gender, age, date of admission to hospital. The period between the date of trauma and examination was at least one year (median 7 months). Standardized questionnaires were sent by post to parents from both groups. Parents were asked about character, frequency, dizziness and concomitant symptoms. In total, 102 matched pairs were analyzed. RESULTS. During the year before the filling in the questionnaires 114 (57.3%) parents indicated headaches: 64 (62.7%) in the case, and 50 (49%) in control group. Frequent (>/=8 days per month) headaches prevailed in children with mild traumatic brain injury (p=0.039); however, their prevalence decreased from 43.8% to 12.5% (p=0.01) with increasing time interval between the date of trauma and the inquiry. By the character, duration, intensity of the headaches, none of the features (except dizziness) showed any difference between the groups. Thirty-three (51.6%) parents from the case and 16 (32%) from the control group indicated that dizziness accompanied headaches (p=0.036). Forty-five (44.1%) parents from the case group and 28 (27.5%) parents from the control group indicated that dizziness appeared separately from headaches (p=0.013). According to the data for the last month before the inquiry, there was no statistically significant difference between both groups when estimating the dynamics in time. CONCLUSIONS. Headaches are not more prevalent in children with mild traumatic brain injury, compared to children with other mild body injuries. The frequency of headaches, as well as the prevalence of dizziness in children with mild traumatic brain injury decreases with time.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15758575&dopt=Abstract headache medicine




The association between calcitonin gene-related peptide (CGRP), substance P and headache in pituitary tumours.

Levy MJ, Classey JD, Maneesri S, Meeran K, Powell M, Goadsby PJ.

Headache Group, Institute of Neurology, Queen Square, London, UK.

OBJECTIVES: To determine if the differential expression of calcitonin gene-related peptide (CGRP) or substance P (SP) in a range of pituitary tumours was related to the presence or absence of headache. METHODS: Using recognised immunohistochemical techniques we examined twenty-six consecutive pituitary adenoma specimens for the presence of CGRP and SP. We included one normal post mortem pituitary specimen for comparison. A separate observer divided the patients into two groups: headache and non-headache. The association between the presence of CGRP, SP and headache was observed. RESULTS: We observed CGRP in seven specimens (27%) and SP in six tumour specimens (23%), with cytoplasmic staining being the predominant morphological picture. CGRP and SP were co-expressed in the same tumour specimen in five cases. There was no significant association between the presence of CGRP and headache (chi(2) 0.86; P = 0.35). We did not observe CGRP or SP in the control specimen. There was no correlation between tumour subtype and the presence of CGRP or SP. CONCLUSIONS: The mechanism of pituitary tumour-associated headache remains undetermined. The significance of the presence of CGRP and SP in pituitary tumours is unknown but does not appear to be related to headache or endocrine activity of the tumour.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15761654&dopt=Abstract headache medicine




[Prevalence of headache in an emergency department in Colombia.]

[Article in Spanish]

Rueda-Sanchez M, Mantilla-McCormick FJ, Solano MN, Ortiz CJ.

Universidad Autonoma de Bucaramanga. Facultad de Medicina, Bucaramanga, Colombia.

OBJECTIVE. To determine the headache prevalence like main reason of consultation, primary and secondary headaches and alarm signs in Emergency Service. PATIENTS AND METHODS. It was carried out a serial sampling in the Emergency Service of the Clinica Los Comuneros in Bucaramanga, since the 6th to 15th December of 2002, including all patients older than 18 years old, were excluded pregnant women and patient with mental retardation, psychotic disorders or dementia. RESULTS. 100 patients out of 1,054 consulted for headache (9.49%); 25% corresponded to primary and 75% to secondary headaches. Thirty four patients had fever, headache began after the 50 years in 7, signs and focal symptoms in 4, cancer antecedent in 4, mental changes in 3, antecedent of trauma cranial in 2, thunderclap headache, headache persistently unilateral, antecedent of AIDS and signs meningeal in a patient respectively. CONCLUSIONS. The headache is a reason of frequent consultation in the Service of Emergency; the proportion of secondary headaches is high.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15765314&dopt=Abstract headache medicine