Headache
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The relationship between pain and autonomic disturbances in cluster headache was studied in 54 patients whose attack always recurred on the same side, and in 7 others whose attack had affected either side on different occasions. In one of these seven patients, facial flushing and ocular sympathetic deficit was observed on the original side of headaches. In most patients, the orbital region was warmer on the painful side but in three cases this region was cooler during and between attacks. ⋯ These findings support the view that certain autonomic disturbances in cluster headache are provoked by pain. Residual autonomic dysfunction could influence autonomic activity during cluster headache. If so, residual dysfunction on the pain-free side could explain the dissociation between autonomic disturbances and pain observed in a few cases.
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This study investigated whether pain sensitivity of the pericranial musculature remains constant over the course of the day. Changes in the entire, uniformly metrically divided suprathreshold sensitivity range were measured. In 24 healthy volunteer subjects, pain was induced experimentally at 0200, 0600, 1000, 1400, 1800, and 2200 hours in the pericranial musculature. ⋯ Sensitivity to very intense headache, however, varied significantly over the course of the day: sensitivity was greatest at 0200 hours; it decreased at a constant rate until 1400 hours, and increased again continuously until 2200 hours (p less than or equal to .05). Also the findings showed significant effects of sex on the pain sensitivity of pericranial musculature for all pain intensities: women are approx. twice as sensitive as men (p less than or equal to 0.05). These results suggest that not only sex, but also time of day, must be taken into consideration in the clinical determination of pain sensitivity of pericranial musculature in the course of headache diagnostics.
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The topics of interest in this study are whether migraine patients exhibit a stereotypic reaction to a stressful stimulus which is different from the reaction of nonheadache controls and whether it is possible to predict headache activity within the migraine population. Our study population comprised 37 female migraine patients and 34 matched controls. Heart rate, skin conductance, pulse amplitude of the temporal artery and an EMG of the temporal muscle were registered during a baseline situation and during a mental stressor. ⋯ Linear combinations of psychological and psychophysiological data sets did not show an acceptable degree of accuracy in the classification of individual response profiles into groups. Within the migraine group, 54% of the average duration of migraine attacks and 33% of the variation in average maximum headache intensity could be explained by a combination of psychological, psychophysiological and socio-demographic variables. It is concluded that measures from both the psychological and the physiological domain should be included when studying the effects of stress in migraine.
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Nuchal symptoms were found in the majority of 100 consecutive patients with cluster headache. In 10%, pain was experienced in the neck with the initial typical orbitotemporal pain; in 37%, pain radiated from the orbit or temple to the ipsilateral side of the neck. Sometimes, neck pain heralded the onset of the attack by a few minutes. ⋯ Neck movement aggravated the headache in 16 of 100 patients and an equal number reported amelioration of pain by neck movement, especially extension. The nuchal features did not necessarily accompany every attack and were usually overshadowed by the severity of the typical headache. Nevertheless, symptoms referable to the neck occur more commonly than is generally appreciated.
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In 50 patients, aged 16 to 58, an autologous blood patch was injected into the epidural space immediately after diagnostic lumbar puncture. The incidence of postpuncture headache was 22%, which was significantly lower than in a control group (40 patients, aged 17 to 54), where it amounted to 45%. ⋯ Lower back pain as the only side effect was experienced by 30 to 40% of the patients in each of the 2 groups. We conclude that the epidural blood patch is practicable and effective in the prophylaxis of postpuncture headache, but cannot prevent its occurrence in all cases.