Der Schmerz
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Sixty-five patients (51 women, 14 men), who were 41.9 years on average, suffered from combination headache (migraine and tension headache) and were under therapy with propranolol and amitriptyline-N-oxide. The following predictive factors were tested with regard to the success of therapy: age, sex, duration of the migraine and tension headache illness, and frequency of use of analgesic and ergotamine preparations. ⋯ Both the migraine treatment and the tension headache were standardized and headache records were kept. The statistical procedure used permitted clear differentiation between responders and non-responders, but these predictive factors did not make it possible to distinguish a subgroup of potential responders.
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Migraine is more than the pain involved in the "migraine attack." Before the onset of pain many clinical symptoms can be observed. These symptoms may be classified as vegetative, affective, and vascular. Brain perfusion is altered during migraine attacks as well as during the intervals between attacks. ⋯ It may be assumed that platelet serotonin is a potent vasoregulating substance that may interact in the brain vessels with the neurotransmission controlled perfusion. The hypothesis of an (inborn) instability of the interaction of cerebral neurotransmission systems in patients suffering from migraine is in accordance with the vegetative and affective symptoms in migraine, the observed imbalance of neurotransmission mediated cerebrovascular autoregulation and the irritation of platelets in migraine attacks, as well as in the interval between attacks. The "modern" treatments of migraine with acetylsalicylic acid, ergotamin and/or beta blockers are discussed in relation to this proposed hypothesis of a migraine pathophysiology.
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Pathophysiological models of migraine describe stress as a potential activator of migraine. Clinical observations have shown that stress over prolonged periods leads to migraine, particularly in the relaxation period (e.g. sleep) that follows the stress situations. However, psychophysiological investigations have not been able to prove a direct correlation between stress and the reaction of peripheral and central vascular mechanisms. ⋯ The peripheral resistance was measured by Doppler ultrasonography. The results showed a significant response specificity in migraine patients with respect to peripheral resistance. The results are discussed using a diathesis-stress model of migraine.
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During a semi-structured interview 82 migraine patients were asked biographical and illnessrelated questions. They completed psychological instruments on coping behavior (Stressverarbeitungsfragebogen), self-concept (Frankfurter Selbstkonzeptskalen), attributional style (IE-SV-F), illness behavior, and illness-related attributions (Tübinger Attributions-fragebogen). The theoretical background of this research is a cognitive model of coping with stress and illness. ⋯ Some of the pain behavior strategies could be identified as being focused on illness (guarding behavior, avoidance and social withdrawal, resignation and complaint); only the attempt to relax is regarded as being focused on health. Migraine patients show a preference neither for medical nor psychological causal attributions of their illness but score significantly higher on medical than psychological control attributions. The results have implications for psychological therapy.