Headache
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To investigate the habituation response pattern of patients with migraine to a simple standard stressor and to a more complex performance-dependent (achievement) stressor in three peripheral systems (electrodermal, vasomotor, and cardiovascular). We hypothesized that the migraine patients would show abnormal habituation in these peripheral systems, especially in response to achievement stimuli. ⋯ Our results suggest that the mental arithmetic (achievement) habituation paradigm is an important tool for demonstrating reduced habituation in several specific components of the autonomic nervous system. Further research is needed to target the covariance of central and autonomic nervous system habituation phenomena in migraine.
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Case Reports
Recurrent syncope, hypotension, asthma, and migraine with aura: role of metoclopramide.
Migraine associated with asthma or symptomatic orthostatic hypotension is a particularly difficult subgroup to manage. Metoclopramide is a useful pharmacological agent for orthostatic hypotension. I present the case report of a migraine patient with asthma and recurrent hypotensive syncope. ⋯ Metoclopramide has a striking influence on arginine vasopressin (AVP) secretion. AVP promotes antinociception and influences vasomotor and behavior control, which actions possibly keep migraine in remission. Further studies are necessary to confirm the migraine prophylactic value of metoclopramide.
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The aim of this study was to assess the prevalence of significant traumatic stressors and post-traumatic stress disorder (PTSD) symptoms in a headache population. ⋯ Exposure to traumatic events in patients with a primary diagnosis of recurrent headaches is similar to that reported for chronic masticatory muscle pain patients or nonpatient populations. However, symptoms consistent with a diagnosis of current PTSD appear to be more frequent in patients with recurrent headaches than reported in the scientific literature printed in English for nonpatient populations. Screening for PTSD symptomatology is recommended as part of the routine clinical evaluation of headache.
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This study attempts to validate the alternative criteria for classification of migraine without aura (International Headache Society [IHS] A1.1) proposed in the appendix of The International Classification of Headache Disorders, 2nd edition. This method uses at least two of the associated symptoms (nausea, vomiting, photophobia, phonophobia, and osmophobia) in category D of the IHS classification. ⋯ This classification of migraine in a headache center population shows that the proposed use of any two of nausea, vomiting, photophobia, phonophobia, and osmophobia in category D of the classification may be a valid alternative method of classification. This study also demonstrates that the standard IHS methodology includes a very small group of patients who appear to be different from other migraine patients.