Soluble interleukin-2 receptors increase during the active periods in cluster headache.

Empl M, Forderreuther S, Schwarz M, Muller N, Straube A.

Department of Neurology, Ludwig-Maximilians University, Munich, Germany.

OBJECTIVE: To investigate whether cytokines are altered during the active period of cluster headache. BACKGROUND: Patients with cluster headache show activation of the hypothalamus in PET studies and via endocrinologic parameters. Data also suggest an inflammatory process occurs in cluster headache. A connection between the presumed inflammatory cause, an immunological activation, and the hypothalamus could be generated by certain cytokines. DESIGN AND METHODS: ELISA was used to determine the serum levels of soluble interleukin-2 receptors, interleukin-1, interleukin-6, and 2 soluble interleukin-6 receptors (sIL-6R and soluble gp130) in 18 patients with cluster headache (6 women and 12 men) during the cluster period and in 17 healthy controls who were headache-free (3 women and 14 men). RESULTS: Patients with cluster headache had significantly increased soluble interleukin-2 receptors (413.6+/-223 U/mL vs. 290.0+/-112 U/mL; P <.05) compared with controls. Serum levels of interleukin-1 (0.29+/-0.30 pg/mL vs. 0.13+/-0.13 pg/mL, n.s.), interleukin-6 (0.87+/-0.6 pg/mL vs. 0.91+/-0.7 pg/ml; n.s.), soluble interleukin-6 receptors (33,131+/-8,349 pg/mL vs. 35,063+/-7,606 pg/mL; n.s.), or soluble gp130 (289+/-59 pg/mL vs. 283+/-20 pg/mL; n.s.) did not differ between the 2 groups, although patients with cluster tended to have higher interleukin-1 values. CONCLUSIONS: Because elevated soluble interleukin-2 receptors indicate T cell activation, our findings suggest immune activation during cluster headache. Because interleukin-2 can activate the hypothalamus and stimulate the release of Corticotropin-releasing Factor (CRF), interleukin-2 could link a putative immunological cause of cluster headache with the observed hypothalamic activation. Systemic changes of interleukin-1 or the interleukin-6 system do not seem to play a role in cluster headache, as no alterations of serum levels were observed. Even so, unchanged serum levels do not exclude limited local production.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12864761&dopt=Abstract headache medicine




Prevalence of headache in Puerto Rico.

Miranda H, Ortiz G, Figueroa S, Pena D, Guzman J.

CEDOC Headache Management Center, San Francisco Hospital, Medical Sciences Campus, University of Puerto Rico, 365 De Diego Avenue, San Juan, Puerto Rico 00923.

BACKGROUND: Headache is one of the most frequently reported disorders in the general adult population. Despite the fact that this disorder is common, no official estimate of the prevalence of headache exists in Puerto Rico. PURPOSE: To examine the prevalence of headache and migraine, specifically, in Puerto Rico. METHODS: A telephone survey of 1610 individuals was conducted. The telephone calls were distributed using the 1990 census adjusted to the population of Puerto Rico in 1998, and according to gender, geographical area, and age. RESULTS: The prevalence of headache in Puerto Rico was 35.9% and migraine, in particular, 13.0%. When prevalence was fractionated by age, gender, and geographical areas, the prevalence of headache was similar for all ages, with females exhibiting a 2:1 preponderance over males. In the younger population (between 20 and 50 years of age), the female-male ratio for migraine was 3:1, and the prevalence for migraine was lower in the Metropolitan area. CONCLUSION: This study, the first of its type in Puerto Rico, demonstrates that headache (and migraine specifically) is a common disorder in this country.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12890132&dopt=Abstract headache medicine




Aspects of referral care for headache associated with improvement.

Salvesen R, Bekkelund SI.

Departments of Neurology, University of Tromso, Nordland Sentralsykehus, 8092 Bodo, Norway.

OBJECTIVE: To assess which aspects of referral care for headache are associated with improvement of pain and subjective quality of life. BACKGROUND: In managed care, referrals to a specialist are sometimes kept to a minimum. It has been questioned whether patients with headache do better after consultation with a specialist. METHODS: We mailed a questionnaire to all patients referred for headache to a neurologic center in northern Norway during a 2-year period (n = 1403). The questionnaire included items concerning diagnosis and treatment, along with simple visual analog scales to assess whether the patient's headache syndrome and self-perceived quality of life had changed after seeing the specialist. RESULTS: There were 1052 responders (75%). Headache generally decreased after consultation with a specialist; it decreased significantly more in the 527 patients who were assigned a diagnosis compared to the 344 patients who claimed they were not. Reduction of headache also was significantly more obvious in the 483 patients who had treatment prescribed, as compared to the 385 patients not receiving any therapeutic measure. Self-perceived quality of life was generally improved, significantly more when the patient was given a diagnosis, and even when the diagnosis did not lead to treatment. CONCLUSIONS: Patients referred to a neurologic center for evaluation of headache generally experience a significantly greater improvement in their headache syndrome and quality of life. This appears particularly so when they receive a diagnosis, even if no treatment is prescribed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12890133&dopt=Abstract headache medicine




Academic headache medicine in America: report of academic membership survey of the American Headache Society special interest section on academic affairs.

Finkel AG.

Department of Neurology, University of North Carolina at Chapel Hill, NC 27599-7025, USA.

BACKGROUND: What constitutes the typical clinical experience of an academic headache specialist in America is unknown. PURPOSE: To clarify this issue, we undertook a survey of academic headache specialists who are members of the American Headache Society. METHODS: In June 2000, 181 surveys including questions regarding academic rank, departmental and institutional affiliation, and time distribution were sent to members drawn from the 1999-2000 Membership Directory of the American Headache Society whose primary addresses were recognized academic institutions or who, by reputation, had extensive academic affiliation. Additional questions about headache teaching, research, and practice were included. RESULTS: Seventy-two (39.7%) of the surveys were returned. Forty-nine (40%) of the 122 American medical schools were represented. The most prevalent academic rank was professor (38%). Included were 2 departmental chairs, 1 division chief, 1 vice dean, and 1 residency training director. The majority (70.8%) were neurologists. Seventy-two percent of respondents spent at least 50% of their time in a clinic, 79% spent 25% or less of their time on research, and 78% spent 25% or less time in teaching. The average number of new patients seen per week was 9.0 +/- 7.6, with each visit lasting 62.4 +/- 20.8 minutes. Clinicians saw 22.7 +/- 14.6 patients for follow-up per week, with the average visit lasting 24.7 +/- 6.8 minutes. Although it appears that at least informal instruction in headache is provided to medical students, interns, and residents, 19.7% (12 of 61) of respondents reported that no formal medical school lecture on the topic of headache was offered at their institutions. CONCLUSION: This preliminary survey offers some insight into the clinical experience of academic headache specialists in the American medical system. Suggestions for future studies are discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12603646&dopt=Abstract headache medicine




Platelet aggregation profiles in cluster headache.

D'Andrea G, Granella F, Cadaldini M.

Headache and Comorbidity Center, Pathology Unit, Este-Monselice Hospital, Este, Italy.

BACKGROUND: Platelets are activated in patients with cluster headache, during both the remission period and the active cycles. OBJECTIVE: To delineate more clearly the origin of platelet activation in cluster headache. Methods.-Platelet aggregation induced by collagen (0.5 micro g/mL and 2 micro g/mL), adenosine diphosphate (10-5 M and 10-6 M), and platelet-activating factor (10-6 M and 10-7 M) was determined by the Born's method in 26 patients with cluster headache and 24 sex- and age-matched controls. RESULTS: The platelets of patients with cluster headache aggregated significantly less to collagen at a concentration of 0.5 micro g/mL compared to those of controls (P =.04). The extent of platelet aggregation obtained with a higher dose of collagen (2 micro g/mL) was in the same range in both groups. Platelet aggregation obtained via adenosine diphosphate at a concentration of 10-6 M was significantly reduced in patients with cluster headache in comparison to controls (P =.002), but no differences were found at a concentration of 10-5 M. In contrast, the platelets of patients with cluster headache aggregated significantly more to platelet-activating factor at both the concentrations of 10-6 M (P =.001) and 10-7 M (P =.00001) compared to those of controls. CONCLUSIONS: This study suggests that platelet aggregation is impaired in patients with cluster headache during the active phase of the disease. We found hypoaggregation in response to low doses of collagen and adenosine diphosphate, and hyperaggregation when platelets were stimulated with platelet-activating factor. Any interpretation of these results can only be speculative. It may be that impairment of platelet aggregation with collagen and adenosine diphosphate may indicate a derangement of nitric oxide function, while the hypersensitivity to platelet-activating factor may be due to fluctuations in its plasma levels.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12603647&dopt=Abstract headache medicine




The cerebral hemodynamics of headache associated with sexual activity.

Evers S, Schmidt O, Frese A, Husstedt IW, Ringelstein EB.

Department of Neurology, University of Munster, Albert-Schweitzer-Strasse 33, 48129 Munster, Germany. everss uni-muenster.de

Headache associated with sexual activity is an idiopathic headache disorder and regarded to be a vascular headache but no pathophysiological studies have been performed to date to elucidate the underlying mechanisms. We investigated 12 patients with the explosive type of sexual headache according to the criteria of the International Headache Society during a headache-free state by means of acetazolamide test and of stress Doppler sonography. Twelve age-matched migraine patients and 14 healthy subjects served as control groups. Changes of blood pressure, cerebral blood flow velocity (CBFV), and pulsatility index (PI) were evaluated. Patients with sexual headache showed a significantly higher increase of blood pressure during standardized physical exercise as compared to healthy subjects and migraine patients. Changes of CBFV by physical exercise were not different between the three examination groups. After 1g acetazolamide, CBFV showed a significantly higher increase in patients with sexual headache (plus 66%+/-16%) than in healthy subjects (plus 46%+/-18%), and PI showed a significantly lower decrease as compared to healthy subjects and migraine patients. These data suggest that in patients with sexual headache the metabolic rather than the myogenic component of the cerebral vasoneuronal coupling is impaired.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12620598&dopt=Abstract headache medicine




Relationship between postconcussion headache and neuropsychological test performance in high school athletes.

Collins MW, Field M, Lovell MR, Iverson G, Johnston KM, Maroon J, Fu FH.

Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15203, USA.

BACKGROUND: The relevance of headache to outcome after sports-related concussion is poorly understood. HYPOTHESES: High school athletes reporting headache approximately 1 week after injury will have significantly more other concussion symptoms and will perform more poorly on neuropsychological tests than athletes not experiencing headache. STUDY DESIGN: Prospective cohort study. METHODS: Study participants included 109 high school athletes who had sustained concussion and who were divided into two groups: those reporting headache 7 days after injury and those reporting no headaches. The two groups were compared regarding on-field markers of concussion severity at the time of injury and symptoms and neurocognitive test results collected via ImPACT, a computerized neuropsychological test battery and postconcussion symptom scale, at a mean of 6.8 days after injury. RESULTS: Athletes reporting posttraumatic headache demonstrated significantly worse performance on reaction time and memory ImPACT neurocognitive composite scores. These athletes also reported significantly more symptoms other than headache and were more likely to have demonstrated on-field anterograde amnesia. CONCLUSIONS: Findings suggest that any degree of postconcussion headache in high school athletes 7 days after injury is likely associated with an incomplete recovery after concussion. Copyright 2003 American Orthopaedic Society for Sports Medicine

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12642248&dopt=Abstract headache medicine




Self-reported headache during saturation diving.

Englund M, Risberg J.

Norwegian Underwater Intervention (NUI) A/S, Bergen, Norway. martin.englund ort.lu.se

INTRODUCTION: Some commercial divers have claimed that headache is a frequent symptom related to decompression following a saturation dive, but due to lack of systematic reporting there is limited knowledge of the incidence and clinical characteristics of such headaches. METHODS: During 2001, a questionnaire was distributed to divers participating in offshore saturation diving operations on the Norwegian continental shelf. Two major diving contractors participated. The survey allowed anonymous self-reporting of past and present problems with headache; pain intensity was indicated daily on a visual analog scale (VAS) from 0 to 10. Of 95 divers, 56 participated and 67 saturations were registered. RESULTS: The divers estimated a higher frequency of headaches in connection to saturation diving than in everyday life (p < 0.001). One third of the divers reported experiencing headache after they finished decompression. There was a significant increase in reports of headache on the last day of decompression (p = 0.03) and on the first day post-saturation (p < 0.001) compared with the start of decompression. Median headache duration was 6 h (range 1-84 h) and median pain score estimated on a VAS was 2.5 (range 0.1-7.8), equivalent to moderate intensity. CONCLUSIONS: Headache incidence is greater in divers during saturation diving than in everyday life. The increase is correlated to the last phase of decompression and the post-saturation period. No specific cause(s) of the headache could be identified, but we discuss possible explanations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12650270&dopt=Abstract headache medicine