Cephalalgia : an international journal of headache
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Migraine headaches usually decrease in frequency and severity and often cease during advancing age. Occasionally, migraineurs report late-life migrainous accompaniments, i.e., auras without headache, particularly when typical migraine attacks terminate or diminish following major or minor strokes, at which time the auras may become atypical. Clinical observations such as these suggest that degenerative cerebrovascular changes accompanying aging may modify the course of migraine headaches particularly those with aura. ⋯ Global CBF increases after Diamox in Group B (with persistent and severe migraine), were significantly greater compared with normals without headache, and with Group C consisting of migraineurs whose headaches had decreased, subsided, or become replaced by late-life migrainous accompaniments (Group C). Results establish that cerebrovasodilator capacitance declines with advancing age, probably due to progressive cerebral atherosclerosis, since these declines were accentuated by risk factors for stroke, particularly TIAs or documented lacunar infarcts by CT. Progressive impairments of cerebral vasodilator capacitance among migraineurs were associated with: (i) reductions in frequency and severity of migrainous cephalalgia and (ii) appearance of late-life migrainous accompaniments.
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This community-based telephone survey determined medication patterns of 274 frequent headache sufferers who reported 12 or more headaches a year. Headaches were classified using the International Headache Society's (IHS) criteria. Participants reported on 465 types of headaches: 129 tension headaches, 158 migraine headaches, 8 chronic tension headaches, and 148 headaches which were unclassifiable using IHS criteria. ⋯ Both tension-headache and migraine-headache sufferers waited about 1 h before taking any medication. Tension-headache sufferers waited until the headache was above 5 on a 0 to 10 scale (4.6 for migraine). It is possible that more aggressive use of medication might improve headache management.
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Transcranial Doppler sonography (TCD) studies may help to elucidate the nature and role of vascular abnormalities in migraine. Our aim in this study was to evaluate cerebrovascular autoregulative response in migraine patients with and without aura to blood pressure increase using stress TCD. ⋯ Differences exist in cerebrovascular reactivity in migraine patients with aura that may contribute to the neurologic disturbances in these patients during attack. We propose that there is disorder of myogenic cerebrovascular autoregulation in migraine patients with aura during headache-free intervals.
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Headache is one of the most prevalent neurological disorders diagnosed by practising neurologists. It is a public health problem of major concern in all countries, and it represents a drain on a country's productivity, its health systems, society, individuals, and families. The economic costs involved (direct and indirect) and the psychosocial and human costs are enormous burdens on society in general. While health status assessments that rely on traditional morbidity and mortality rates are of limited use in the evaluation of headache patients, it is important to create awareness and acceptance of these disorders that cause so much personal suffering and enormous public expense.
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Previous studies suggest that nitric oxide (NO) is involved in headaches induced by i.v. infusion of the vasodilator and NO donor glyceryl trinitrate (GTN) in healthy subjects. Extending these studies to sufferers of migraine without aura, it was found that migraineurs experienced a stronger headache than non-migraineurs. In addition, most migraineurs experienced a delayed migraine attack at variable times (mean 5.5 h) after GTN provocation. ⋯ No definite effects of GTN were demonstrated. The precise mechanisms involved in NO-triggered migraines and which part of the NO-activated cascade that is involved remain to be determined. The possibilities for pharmacological stimulation and/or inhibition of several steps of the NO-activated cascade increase rapidly and soon may be available for human studies.