Amitriptyline is effective in chronic but not in episodic tension-type headache: pathogenetic implications.

Cerbo R, Barbanti P, Fabbrini G, Pascali MP, Catarci T.

Department of Neurosciences, University La Sapienza, Rome, Italy.

The tricyclic antidepressant, amitriptyline, is an effective drug for the treatment of chronic tension-type headache and for other chronic pain syndromes, but it is also effective in the prophylaxis of an episodic type of headache such as migraine. However, its efficacy in episodic tension-type headache has not yet been clarified. We compared the efficacy of amitriptyline (25 mg/day) in 82 nondepressed patients with either chronic or episodic tension-type headache in an open-label study. Amitriptyline significantly reduced (P < 0.05) frequency and duration of headache as well as analgesic consumption in chronic, but not in episodic, tension-type headache. Further placebo-controlled trials, possibly with higher doses of amitriptyline, might confirm if the different pattern of response to amitriptyline can be explained in terms of different involvement of central nociception and of peripheral myofascial factors in the chronic and in the episodic forms of tension-type headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9664750&dopt=Abstract headache medicine




Hypothalamic activation in cluster headache attacks.

May A, Bahra A, Buchel C, Frackowiak RS, Goadsby PJ.

University Department of Clinical Neurology, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK. amay ion.ucl.ac.uk

BACKGROUND: Cluster headache, one of the most severe pain syndromes in human beings, is usually described as a vascular headache. However, the striking circadian rhythmicity of this strictly half-sided pain syndrome cannot be readily explained by the vascular hypothesis. We aimed to assess changes in regional cerebral blood flow (rCBF) in patients with cluster headache. METHODS: We used positron emission tomography (PET) to assess the changes in rCBF, as an index of synaptic activity, during nitroglycerin-induced cluster headache attacks in nine patients who had chronic cluster headache. Eight patients who had cluster headache but were not in the bout acted as a control group. FINDINGS: In the acute pain state, activation was seen in the ipsilateral inferior hypothalamic grey matter, the contralateral ventroposterior thalamus, the anterior cingulate cortex, and bilaterally in the insulae. Activation in the hypothalamus was seen solely in the pain state and was not seen in patients who have cluster headache but were out of the bout. INTERPRETATION: Our findings establish central nervous system dysfunction in the region of the hypothalamus as the primum movens in the pathophysiology of cluster headache. We suggest that a radical reappraisal of this type of headache is needed and that it should in general terms, be regarded as a neurovascular headache, to give equal weight to the pathological and physiological mechanisms that are at work.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9690407&dopt=Abstract headache medicine




Event-related potentials (P300) in primary headache in childhood and adolescence.

Evers S, Bauer B, Grotemeyer KH, Kurlemann G, Husstedt IW.

Department of Neurology, University of Munster, Germany.

There is strong evidence for a loss of habituation during cognitive processing in migraine as measured by P300 and contingent negative variation in adults. Event-related potentials evoked by an oddball paradigm have not yet been studied in children and adolescents suffering from different primary headache types. We recorded visually evoked event-related potentials (two consecutive trials, 200 stimuli each) in 48 children and adolescents suffering from migraine without or with aura, from episodic tension-type headache, and from ergotamine-induced headache and analyzed the latencies, amplitudes, and reaction times. No statistically significant differences were noted between all headache types and healthy controls analyzing the averaged parameters for the whole measurement. However, a highly significant loss of cortical habituation as measured by P300 amplitude and latency could be observed in migraine without and with aura by analyzing the first and the second trial of measurement separately. This phenomenon increased with age and could not be seen in healthy controls, or patients with tension-type headache or ergotamine-induced headache. Our data suggest a specific cognitive processing in migraine even in children and adolescents. Measurement of the habituation effect in P300 latency and amplitude provides a specific method to differentiate between primary headache types in childhood and adolescence.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9701480&dopt=Abstract headache medicine




Medical treatment of headache after suboccipital acoustic tumor removal.

Hanson MB, Glasscock ME 3rd, Brandes JL, Jackson CG.

Northern Jersey Ear Nose and Throat Associates, Midland Park, New Jersey 07432, USA.

OBJECTIVES: Suboccipital craniotomy is a frequently used surgical approach for removal of cerebellopontine angle (CPA) tumors. A frequently cited consequence, however, is the high incidence of postoperative headaches. Much has been written regarding prevention of these headaches, but little has been written of their treatment. The authors review their extensive experience in suboccipital tumor removal and the medical management of postoperative headache, highlighting the recent use of a regimen of divalproex sodium and verapamil. STUDY DESIGN: Retrospective chart review. METHODS: The charts of a consecutive series of patients having suboccipital craniotomies for CPA tumors were reviewed. Presence, duration, and severity of headache were noted. Medical treatments and their effectiveness were also noted. RESULTS: Between 1980 and 1997, 228 patients underwent suboccipital craniotomy for removal of CPA tumors. Of these patients, 124 (54.4%) complained of headache. For 62 (27.2%) the headaches persisted for more than a year after surgery. Twenty-nine patients (12.7%) received no relief from any medication. Ten of these patients received a regimen of divalproex sodium and verapamil, with all patients obtaining significant relief. CONCLUSION: Headache is a significant problem with the suboccipital approach for acoustic tumor removal. The majority of patients that complain of headache can be adequately treated with nonsteroidal anti-inflammatory drugs (NSAIDs). If pain is unrelieved by NSAIDs, treatment becomes problematic. The authors' early experience with divalproex sodium/verapamil is encouraging and deserves further investigation as a treatment for these refractory cases.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9707226&dopt=Abstract headache medicine




[Comparative study of the analgesic effect of Dikalm and Saridon in headaches of various causes]

[Article in Serbian]

Jovicic A, Raicevic R, Boskovic B.

Headache, as a syndrome, represents large health and wider socio-economic problem in every community for its massive occurrence and frequent absence of therapeutic response to the administered analgesics. That is why the finding, and later production of the drug that would satisfy the criteria of analgesic, efficacious in the treatment of headache, without the entering in etiology of syndrome are presented as the imperative. In connection with that was set the aim of the investigation: to investigate comparative analgesic efficacity of new preparation--Dikalm compared to analgesic that was for a long time present in our pharmaceutic market--Saridon tablets in the patients with different neurologic diseases, where headache represents the leading symptom of their difficulties. The investigation included 30 patients--10 patients were cross-examined with the use of both preparations in the treatment of headache episodes that appeared in separate time interval, and 20 patients received one another preparation. The headache intensity, residual headache, adverse effects and the need for repeating were graded by original standardized scales. The results of investigation revealed significantly better analgesic effect of therapeutic combination contained in Dikalm preparation, as for persistent, residual headache, as for the need of repeating the analgesics administration, what was specially pronounced in the group that cross-received both preparations, or in the whole group compared to the therapeutic combination contained in Saridon tablets. It was concluded that Dikalm represented the drug with efficacious analgesic and with minimal adverse effects.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9720441&dopt=Abstract headache medicine




Photophobia and phonophobia in tension-type and cervicogenic headache.

Vanagaite Vingen J, Stovner LJ.

Department of Neurology, University Hospital of Trondheim, Norway. nevrolog medisin.ntnu.no

Light and sound-induced discomfort and pain thresholds were measured in 26 patients with cervicogenic headache, in 40 patients with tension-type headache, and in 100 headache-free controls. Neither headache group was significantly different as to photophobia and phonophobia, but both were significantly more sensitive to light and sound than controls (p<0.0001), even when patients were tested in the headache-free period (p<0.05). Episodic and chronic tension-type headache had similar photo- and phonophobia thresholds (p> or =0.7). Tension-type headache patients were more photo- and phonophobic during headache than outside attack (p<0.05), but this was not true for cervicogenic headache (p> or =0.56). In cervicogenic headache patients, photophobia (p<0.05) but not phonophobia (p=0.28) was greater on the symptomatic side than on the non-symptomatic side.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9731934&dopt=Abstract headache medicine




Analgesic rebound headache in children and adolescents.

Vasconcellos E, Pina-Garza JE, Millan EJ, Warner JS.

Department of Neurology and the Pediatric Headache Clinic, Vanderbilt University Medical Center, Nashville, TN 37212, USA.

For more than a decade, the frequent use of analgesics has been recognized to lead to daily headaches in adults. To date, no studies on the occurrence of analgesic rebound headache have been done on the pediatric population. We retrospectively reviewed all charts of patients with the diagnosis of headache seen in our pediatric headache clinic between January 1996 and May 1997. Among the 98 patients seen, 46 (47%) suffered from daily or near daily headaches; 30 of them were consuming daily analgesics. Twenty-four patients (mean age 12.1 years, and mean follow-up 6.2 months) successfully discontinued their analgesics. Twenty-two patients were also placed on amitriptyline. A significant reduction in the frequency (80%), severity (47%), and number of school days missed (74%) were seen. In conclusion, this data is comparable to previous observations reported in adults, and suggests that the daily use of analgesics might result in daily or near daily headaches in the pediatric population. Discontinuing daily analgesics, with the concomitant use of amitriptyline, is an effective treatment for analgesic rebound headache in this population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9733291&dopt=Abstract headache medicine




Management of primary headache in emergency services of Santos and surrounding towns.

Fragoso YD, da Fonseca PL, Fortinguerra MB, Cominato L, Matte Gde O, Oliveira CM.

Department of Internal Medicine, Faculdade de Ciencias Medicas de Santos, Sao Paulo, Brazil. yara.fragoso dialdata.com.br

OBJECTIVES: Primary headaches are often seen by Clinicians on duty at Emergency Services. We have investigated the treatment of such patients by 43 medical doctors who have been working at Emergency Services in the city of Santos and surrounding towns for many years. RESULTS: We confirmed the high prevalence of primary headaches in Emergency Services. There seem to be diagnosis difficulties concerning differentiating attacks of migraine and tension type headache. We also observed that IV dipirone was the most frequently prescribed treatment for patients with primary headaches in this study. There is no protocol in the literature which recommends IV dipirone for the treatment of migraine attacks or other primary headaches. CONCLUSION: It would be advisable to perform controlled double blind studies in order to verify the advantages of IV dipirone in the treatment of intense attacks primary headaches. We concluded that headache management recycling programs could be of interest for doctors who regularly work at Emergency Services.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9778883&dopt=Abstract headache medicine