Cephalalgia : an international journal of headache
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In 16 patients suffering from migraine without aura, we examined quantitative EEG and steady-state visual evoked potentials (SSVEPs) at 27 Hz stimulation during the critical phase of migraine and in attack-free periods. The main spontaneous EEG abnormalities found during the critical phase were the slowing and asymmetry of the dominant frequency in the alpha range. ⋯ The EEG abnormalities confirm a fluctuating modification of alpha activity during the migraine attack, probably related to a functional disorder. The suppression of visual reactivity during the migraine attack could be related to a phenomenon of neuronal depolarization such as spreading depression, occurring in a situation of central neuronal increased excitability predisposing to migraine attacks.
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We have studied habituation of the P3a component of the passive "oddball" auditory event-related potential which reflects automatic processing of a "novel" stimulus in 24 patients suffering from migraine without aura and in 21 healthy volunteers. Three blocks of responses to 160 standard and to 40 novel tones were sequentially averaged at Cz and analyzed for latencies and peak-to-peak amplitudes. ⋯ The most striking result in migraineurs was a significant potentiation of N2-P3a in successive blocks, contrasting with an habituation in controls. Our previous evoked- and event-related potential studies and the present one suggest that deficient habituation, or even potentiation, represents interictally a fundamental dysfunction of cortical information processing in migraine, which might increase energy demands and play a role in etiopathogenesis.
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Meta Analysis
Consistency of response to sumatriptan nasal spray across patient subgroups and migraine types.
With an onset of headache relief as early as 15 min postdose compared with placebo, sumatriptan nasal spray is an important treatment option for patients who seek rapid headache relief and/or a convenient dosing form, whose migraine-associated nausea and vomiting render the use of an oral medication impractical, and those who prefer not to use an injectable form of migraine medication. Although the efficacy and tolerability of sumatriptan nasal spray are documented, the consistency of response to sumatriptan nasal spray across patient subgroups and migraine subtypes of importance to the prescribing clinician have not been described. To provide this information, data from four randomized, double-blind, parallel-group, placebo-controlled, multicenter studies (Glaxo Wellcome protocol numbers S2B-340, S2B-341, S2B-342, and S2B-T50), conducted between January 1993 and December 1994, were pooled and retrospectively analyzed to determine whether the efficacy and tolerability of sumatriptan nasal spray vary with gender, ethnic origin, age, weight, migraine type, concomitant or prior medication use, or pretreatment headache duration. ⋯ Approximately two-thirds of patients treated with sumatriptan nasal spray 20 mg compared with approximately one-third of placebo-treated patients reported headache relief 2 h postdose regardless of patient or migraine subgroup. The relationship between active treatment and placebo with respect to the overall incidence of adverse events also did not differ between patient or migraine subgroups. There is no evidence based on this analysis that sumatriptan nasal spray dosage should be adjusted in any of the subgroups examined.
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Case Reports
Orbital pain as an isolated sign of internal carotid artery dissection. A diagnostic pitfall.
Head pain is one of the main presenting symptoms of internal carotid artery (ICA) dissection, usually in association with ischemic and/or local signs such as Horner's syndrome, lower cranial nerve palsies, or tinnitus. In rare cases, head pain remains isolated and mimics other conditions. We report a patient who suffered isolated prolonged orbital pain as the only sign of intrapetrous ICA dissection. Early recognition of such unusual facial pain may be crucial in decreasing the risk of secondary cerebral or retinal ischemia.