Cephalalgia : an international journal of headache
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Levels of beta-endorphin in peripheral blood mononuclear cells have been studied as a new approach to investigating opioid tone in migraine and tension-type headache. Sixty-one patients with migraine without aura, 39 with migraine with aura and 23 with episodic tension-type headache were compared with 37 healthy controls. ⋯ A significant reduction in peripheral blood mononuclear cell beta-endorphin concentrations was observed in migraine patients with and without aura, but not in tension-type headache patients. Altered transmitter modulation to peripheral blood mononuclear cells may be the cause of this alteration, which could be part of a more diffuse opioid system derangement in migraine subjects.
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Randomized Controlled Trial Clinical Trial
Experimental pain in human temporal muscle induced by hypertonic saline, potassium and acidity.
The study was aimed at developing a reference model for experimental pain and tenderness in the human temporal muscle by the local injection of hypertonic saline, potassium chloride and acidic phosphate buffer, using isotonic saline as control. The design was randomized and double-blind. Twenty healthy subjects had 0.2 ml test solution injected into one temporal muscle and saline into the other. ⋯ Compared to control injections, hypertonic saline and potassium chloride induced a significant reduction in pressure-pain threshold (ANOVA, p less than 0.0001 and p less than 0.05). Forty-eight percent of the injections led to the referral of pain most often to the jaws. A positive correlation between the relative occurrence of referred pain and pain intensity was observed (p less than 0.001) as was a negative correlation between the decrease in pressure-pain threshold and pain intensity (p less than 0.05).
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Pressure pain detection threshold and pressure pain tolerance threshold were measured in the temples and on the fingers in 40 healthy volunteers, equally distributed as to sex and handedness. Lower pressure pain thresholds were found over the temporal muscle than in a neighbouring temporal location without interposed myofascial tissue (p less than 0.001), indicating that nociception from myofascial tissue contributes to the pressure pain threshold. ⋯ Finally, pressure pain thresholds were lateralized in dextrals but not in sinistrals. The information that can be obtained from pressure pain detection and tolerance thresholds is discussed and examination of both threshold types is recommended in future studies.
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A 34-year-old woman developed severe and incapacitating positional headaches two weeks following a minor head trauma. Lumbar punctures demonstrated unmeasurable or very low CSF pressures. Gadolinium-enhanced cranial MRI showed diffuse enhancement of thickened meninges, suggesting inflammation. One year later, MRI was normal.
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The role of cerebrovascular risk factors such as mitral valve prolapse, platelet aggregation, platelet activation and cardiac arrythmias in migraine was investigated in a total of 44 migraineurs (32 migraineurs without aura and 12 with prolonged aura) and 32 controls. Comparing the total of migraineurs and the two subgroups with controls, mitral valve prolapse, a raised thromboxane B2 level, at least one platelet aggregation dysfunction or an abnormality in 24-h ECG was statistically seen no more often than in the control group. ⋯ Altogether, this study showed no increased coincidence of migraine with prolonged aura and migraine without aura with the above parameters. The absence of cardiac and haematological abnormalities in migraine with prolonged aura focuses attention on the control of the cortical microcirculation.