Headache
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Comparative Study
Spontaneous oscillations in cerebral blood flow velocity give evidence of different autonomic dysfunctions in various types of headache.
Our objectives were to determine if: (1) patients with migraine have B wave abnormalities in comparison to normal controls and patients with chronic tension headache and (2) patients with chronic tension headache have an imbalance in autonomic activity that is reflected in differences in Mayer wave activity in comparison to normal controls. ⋯ Our data support the dysfunction of the brain stem monoaminergic/serotonergic system in migraine. In contrast, patients with chronic tension headache have an autonomic dysfunction of peripheral origin presenting as a decrease of sympathetic activity.
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This study explored the efficacy of a thermal biofeedback treatment package as an intervention with children with tension-type headaches. In a within-subject, time-lagged, multiple baseline design, five children, aged 8 to 14 years, were assigned to baselines of varying lengths prior to receiving treatment. Treatment was introduced sequentially across subjects and involved six thermal biofeedback treatment visits. ⋯ Although the thermal biofeedback treatment package was generally effective for these children with tension-type headaches, the specific type of headache experienced by each child appeared to influence the specific response to treatment. In addition, no single measure of headache activity was the best indicator of response to treatment. The efficacy of the thermal biofeedback treatment package is supported as an alternative treatment for children suffering from tension-type headaches.
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Comparative Study
Recovery cycle of the blink reflex and exteroceptive suppression of temporalis muscle activity in migraine and tension-type headache.
Brain stem interneuronal excitability can be assessed by recording the recovery cycle of the blink reflex and exteroceptive suppression of temporalis muscle activity. Abnormal endogenous pain control mechanisms due to disturbed brain stem interneuronal activity have been implicated in the pathogenesis of tension-type headaches. The blink reflex, exteroceptive suppression of temporalis muscle activity, and the recovery curve of both the R2 component of the blink reflex and the ES2 component of the exteroceptive suppression of the temporalis muscle activity were studied in 20 patients with migraine without aura, 32 patients with tension-type headache, and 20 normal controls. ⋯ The latency of R1, R2, and R2', the amplitude and size of the R2 and R2' components of the blink reflex, the latency and duration of the ES1 and ES2 components, and the recovery curve of the ES2 component of the temporalis muscle activity did not differ between groups. However, the recovery curve of the R2 component of the blink reflex diminished in patients with tension-type headache compared with the other groups. Our findings indicate reduced excitability of the brain stem interneurons in patients with tension-type headache.
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Clinical Trial
Self-reported photophobic symptoms in migraineurs and controls are reliable and predict diagnostic category accurately.
To assess the reliability of self-reported photophobia across different patient populations and to examine how visual stress thresholds and photophobic symptoms may be predictive of diagnosis. ⋯ We suggest that interictal photophobia is common in migraine and similar across different patient populations. One pathophysiological hypothesis is that interictal photophobia is associated with cortical hypersensitivity to stimulation. The predictive validity of interictal photophobic symptoms suggests that clinical diagnosis may be aided by questioning the patient about light sensitivity in the period between attacks.
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To determine the association between childhood history of headache, adolescent stress, and headache syndromes (determined by International Headache Society criteria) in young adulthood. ⋯ Childhood headaches are related to the appraisal of life events reported during mid adolescence. Childhood headaches also appear to confer a specific risk for the development of combined headache. There was little evidence for a prospective relation between stress in mid adolescence and tension-type headache in young adulthood, supporting claims that proximal (rather than distal) stress is associated with this disorder.