Why do some dietary migraine patients claim they get headaches from placebos?

Strong FC 3rd.

Departamento de Ciencia de Alimentos, Faculdade de Engenharia de Alimentos, Universidade Estadual de Campinas, SP, Brasil.

BACKGROUND: In six double-blind studies involving 182 tests of dietary migraine patients sensitive to tyramine and beta-phenylethylamine, 18% reported headaches from placebos which were all concealed in gelatin capsules. OBJECTIVE: The purpose of this research was to test a hypothesis: gelatin is partially hydrolysed animal protein; (partially) hydrolysed vegetable protein (PHVP) is known to cause migraine; perhaps the gelatin caused some of the headaches. METHOD: The author tested this hypothesis on himself because he suffers from dietary migraine. He proved this in a double-blind test with tyramine hydrochloride (TYH). The amount required for the test was so small (1 mg) that it was tasteless and capsules were unnecessary. The author then undertook tests with a capsule, PHVP, monosodium glutamate (MSG) aspartame (a dipeptide) and TYH, adjusting quantities to give a moderate headache. Samples were mixed with foods to simulate normal eating: the capsule with potato chips, aspartame with orange juice and the rest with cottage cheese or ricotta cheese. Times were measured from ingestion (1) to start of the headache and (2) to maximum headache intensity. Each experiment was repeated three times. The headaches were relieved with caffeine. RESULTS: Of eight double-blind test samples, the author identified correctly the two placebos and five of the six samples containing tyramine. Quantities giving moderate headaches were: 1 gelatin capsule, 400 mg MSG, 118 mg PHVP, 4.0 mg aspartame and 1.0 mg TYH. Typical times for the three repetitions of the two time periods were 8, 9 and 11 and 17, 19 and 22 min. CONCLUSIONS: Capsules may give headaches to dietary migraine patients that are similar to those from foods. This would explain some of the headaches of patients from placebos. The double-blind test and the repeatability of the time measurements demonstrated the validity of the experiments.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10792367&dopt=Abstract headache medicine




Headache in an emergency room in Brazil.

Bigal M, Bordini CA, Speciali JG.

Department of Neurology, School of Medicine at Ribeirao Preto, Sao Paulo University, Ribeirao Preto, Brazil.

CONTEXT: When experiencing a headache attack, Brazilian patients usually look for a primary care service, where they are seen by general clinicians. In the town of Ribeirao Preto, these clinicians routinely refer patients to the Emergency Room of the University Hospital. OBJECTIVE: The objective of this study was to evaluate the quality of primary care by analyzing retrospectively the medical records of patients with a complaint of headache seen in this emergency room during the year of 1996. DESIGN: retrospective study. SETTIING: Emergency Room of the Universital Hospital, Ribeirao Preto, Sao Paulo, reference unit. PARTICIPANTS:1254 patients. The patients who sought the Emergency Room (ER) of the University Hospital of Ribeirao Preto, during the year of 1996 with a complaint of headache were studied retrospectively. MAIN MEASUREMENTS: Etiology, age, diagnosis, secondary cause, laboratory tests. RESULTS: Of the 1254 patients seen (61% women), 1190 (94.9%) were discharged after the administration of parenteral analgesics before they had spent 12 hours in the room. Only 64 (5.1%) patients remained for more than 12 hours. Of the patients who spent less than 12 hours in the room, 71.5% had migraine or tension type headache and did not require subsidiary exams for diagnosis. Of the patients who spent more than 12 hours in the room, 70.3% had secondary headaches. CONCLUSIONS: We conclude the primary care for headache is unsatisfactory in the Ribeirao Preto region. Many patients with primary headache are referred to tertiary care services, indicating the need for the dissemination of the diagnostic criteria of the International Headache Society to general practitioners.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10810329&dopt=Abstract headache medicine




Comparison of postoperative headache after retrosigmoid approach: vestibular nerve section versus vestibular schwannoma resection.

Jackson CG, McGrew BM, Forest JA, Hampf CR, Glasscock ME 3rd, Brandes JL, Hanson MB.

The Otology Group, Nashville, Tennessee, USA.

OBJECTIVE: To evaluate intradural drilling as a mechanism for the development of postoperative headache after retrosigmoid craniectomy. STUDY DESIGN: A retrospective review of charts was performed on 565 retrosigmoid approaches to the cerebellopontine angle performed between January 1980 and January 1998. Patients treated with retrosigmoid vestibular nerve section without intradural drilling were compared with patients who underwent retrosigmoid removal of vestibular schwannomas in which intradural drilling was performed for exposure of the internal auditory canal. SETTING: Private practice tertiary referral center. PATIENTS: Consecutive patients undergoing retrosigmoid approach between January 1980 and January 1998 were reviewed. MAIN OUTCOME MEASURES: The presence of headache, duration of headache, and severity of headache were noted. RESULTS: In this large series, 54% of patients experienced headaches after vestibular schwannoma removal, and 5% of patients experienced headaches after vestibular nerve section (p < 0.01, chi-square). CONCLUSIONS: Postoperative headache is not a characteristic of retrosigmoid craniectomy in the absence of intradural drilling. Intradural drilling is a probable cause of headache after the retrosigmoid approach. Cranioplasty is not necessary to prevent a high incidence of postoperative headache after retrosigmoid approach.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10821557&dopt=Abstract headache medicine




Cervicogenic headache: prevalence and response to local steroid therapy.

Anthony M.

Department of Neurology, Prince of Wales Hospital, Randwick, NSW, Australia. m.anthony unsw.edu.au

Cervicogenic headache (CEH) has been said to be common among patients with idiopathic headache, but no information exists as to its prevalence among those who have not suffered whiplash or head injury. This study was designed to answer this question and in addition to determine whether headache relief could be achieved by blockade of the occipital nerves (greater and lesser occipital--GON, LON) in the upper neck, on the side habitually affected by the headache. Among 796 patients with idiopathic headache, 128 or 16.1% were found to be suffering from CEH. They were predominantly female, as in the case of migraine, older than the migrainous group (49.5 years as against 34.7 years), respectively, and with a monthly headache frequency of 18, against 6.9 in the case of migraine. Injections of depot methylprednisolone into the region of the GON and LON produced complete relief of headache in 169 out of 180 patients with CEH for a period ranging from 10 to 77 days, the mean duration of relief being 23.5 days. However, similar relief of headache could be achieved in patients with attacks of strictly unilateral migraine or cluster headache, suggesting that local steroid injections by blocking the cervico-trigeminal relay, can arrest other forms of unilateral headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10824289&dopt=Abstract headache medicine




Application of the 1988 International Headache Society diagnostic criteria in nine Italian headache centers using a computerized structured record.

Gallai V, Sarchielli P, Alberti A, Pedini M, Gallai B, Rossi C, Cittadini E; Collaborative group for the application of IHS criteria of the Italian society for the study of headache.

The Neuroscience Department, University of Perugia, Italy. gallai unipg.it

BACKGROUND: The actual application of the current International Headache Society (IHS) diagnostic criteria in clinical practice has not been investigated thoroughly. OBJECTIVES: To develop a computerized, structured, medical record based exclusively on the IHS classification system. DESIGN AND METHOD: We tested the computerized structured record by entering and analyzing data reported on the case sheets of 500 consecutive patients attending nine headache centers in Italy. All clinical diagnoses in the study were made according to current IHS criteria. The rate of concordance between the diagnosis provided by the computerized structured record and that reported by clinicians on the case sheets was calculated, and reasons for any discrepancies between the two diagnoses were analyzed. RESULTS: Concordance between the two diagnoses was found in 345 of 500 cases examined (69%). In the remaining 155 cases, diagnoses reached with the computerized structured record and case sheets were impossible or discordant with respect to the diagnoses made by the clinician. In 144 of these cases (28.8%), this was due to missing information or errors in the diagnosis recorded by the clinicians on the patient case sheet. In particular, the diagnosis could not be reached using the computerized structured record in 105 cases (20.6%) because of a lack of one or more data needed in formulating a correct diagnosis according to the IHS operational criteria for one of the primary headache disorders. In the remaining 41 cases some data were missing, but the data available were sufficient to reach a diagnosis according to the IHS criteria. Moreover, the diagnoses reached using the computerized structured record were not in agreement with those made by the clinicians in another 39 cases (7.9%) due to an incorrect interpretation by the clinicians of the data reported on the patients' case sheets. In only 2.2% of the cases (n = 11) misdiagnoses were due to errors of the program that were promptly corrected. CONCLUSIONS: The present study suggests that incorrect application of IHS criteria for the diagnosis of primary headache may occur in as many as one third of patients attending headache centers and that use of a computerized structured record based exclusively on current IHS criteria may overcome this deficiency.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12453033&dopt=Abstract headache medicine




The influence of a low-fat diet on incidence and severity of migraine headaches.

Bic Z, Blix GG, Hopp HP, Leslie FM, Schell MJ.

Division of Hematology/Oncology, The Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange 92868-3298, USA.

Migraine headaches are a common, debilitating syndrome causing untold suffering and loss of productivity. A review of the literature indicates that high levels of blood lipids and high levels of free fatty acids are among the important factors involved in triggering migraine headaches. Under these conditions, platelet aggregability, which is associated with decreased serotonin and heightened prostaglandin levels, is increased. This leads to vasodilation, the immediate precursor of migraine headache. A high-fat diet is one factor that may directly affect this process. This study, undertaken to evaluate the impact of dietary fat intake on incidence and severity of migraine headache, was conducted over a 12-week period on 54 previously diagnosed migraine headache patients. During the first 28 days, the study subjects recorded all food consumption in a diet diary and maintained a headache diary. At the conclusion of this 28-day baseline period, subjects were individually counseled to limit fat intake to no more than 20 g/day. A 28-day run-in period was allowed for adaptation to the low-fat diet. Results are reported on the final 28-day postintervention period. Subjects significantly decreased the ingestion of dietary fat in grams between baseline (mean 65.9 g/day, p < 0.0001) and the postintervention period (mean 27.8 g/day). The decreased dietary fat intervention was associated with statistically significant decreases in headache frequency, intensity, duration, and medication intake (all p < 0.0001). There was a significant positive correlation between baseline dietary fat intake and headache frequency (r = .44, p = 0.02). This study indicates that a low-fat diet can reduce headache frequency, intensity, and duration and medication intake.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10839648&dopt=Abstract headache medicine




Predisposing and provoking factors in childhood headache.

Anttila P, Metsahonkala L, Helenius H, Sillanpaa M.

Department of Child Neurology, University of Turku, Finland.

OBJECTIVE: To study the differences in predisposing and provoking factors between childhood migraine and nonmigrainous headache. BACKGROUND: Information on the predisposing and provoking factors of headache could help to find ways to prevent it. Differences in predisposing and provoking factors between migraine and nonmigrainous headache are largely unknown. METHODS: An unselected, population-based, prospective, follow-up study on the occurrence of headache in schoolchildren was carried out in 1290 children aged from 8 to 9 years. The children who had reported headache during the 6 months prior to the study (n = 725) were sent a more detailed questionnaire about factors that might give rise to headache. Six hundred twenty-two (86%) children returned questionnaires that were completed to an acceptable degree. RESULTS: The occurrence of familial paroxysmal headache and unhappiness in the family independently predicted the occurrence of migraine in children, but this was not the case for nonmigrainous headache. CONCLUSIONS: In particular, the family occurrence of paroxysmal headache increases the risk of migraine in a child. The risk is still greater if their living conditions are experienced as unsatisfactory by the family.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10849028&dopt=Abstract headache medicine




Clinical profile of headache and cranial neuralgias.

Shah PA, Nafee A.

Dept. of Medicine, Govt. Medical College, India.

OBJECTIVES: The present study, first of its kind from Kashmir Valley, was conducted on 2982 patients to depict the pattern of various headache types and cranial neuralgias. Besides demographic parameters, various factors influencing the frequency of headaches and cranial neuralgias were also analysed. METHODS: Patients presenting with the chief complaint of headache and facial pain were included in this study. The diagnosis of different headache types and cranial neuralgias were established after following the criteria as devised by the International Headache Society (1988). RESULTS: Mean age at presentation for all headache types/cranial neuralgias was 24.5 years (range 7-74 years) with a male:female ratio of 2:1. Tension headache and migraine was found in 1988 (66.6%) and 407 (13.6%) cases respectively. Cranial neuralgias were observed in 20 (1%) cases. CONCLUSIONS: Tension headache and migraine were the commonest forms of headache disorders. Militancy related stress and handicrafts profession were the main predisposing factors for tension and cervicogenic headaches respectively. Ramadan fasting was the prime precipitating factor for migraine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10862316&dopt=Abstract headache medicine