Showing papers in "Headache in 1987"

Transformed or Evolutive Migraine

Abstract: SYNOPSIS 630 (39%) of 1600 patients seen in a Headache Clinic over a three year period had chronic daily headaches (CDH). In 78% of these CDH patients, the daily headaches evolved out of a prior history of episodic migraine; these patients we designate as having “transformed” or “evolutive” migraine. The other 12% had migraine headaches which were daily from the start. Patients with transformed migraine, in contrast to those with daily headaches from the start, have a significantly higher incidence of positive family history of migraine, menstrual aggravation of migraine, identifiable trigger factors, associated G.I. and neurological symptoms, and early morning awakening with headache. The CDH group in general over-used symptomatic medication and exhibited abnormalities on behavioral scale testing. Withdrawal of daily symptomatic medication, institution of a low tyramine low caffeine diet, initiation of prophylactic anti-migraine therapy, and biofeedback and behavioral therapy, gave worthwhile improvement in 76% of chronic daily headache patients. Factors which promote “evolution” of migraine from intermittent to chronic daily occurrence are not well-defined but may include medication abuse, medication withdrawal, and psychiatric disturbances.

Headache May Arise From Perturbation of Brain

Abstract: SYNOPSIS Ray and Wolff in a landmark study of human patients under local anesthesia, concluded that the brain was not sensitive to pain; however, at the time of their study, the anatomy and physiology of pain transmission and modulation were largely unknown and their stimulating electrodes were not implanted in the brainstem or thalamic cells or projections now known to be important to pain perception. We now report 15 patients, previously headache-free, who underwent electrode implantation in the periaqueductal gray between 1977 and 1982 who immediately at implantation or in the few days subsequent to implantation reported severe continuous head pain usually with florid “migrainous” feature that persisted for 2 months to 10 years. Ten of these patients were treated with reserpine and all were dramatically responsive to it, but 8 patients rapidly became tolerant. Seven patients who were treated with dihydroergotamine rapidly became headache-free; 2 of the 7 became tolerant quickly. One patient developed the “cough headache” syndrome after implantation, was responsive to indomethacin, the syndrome abating in 6 months. These data suggest that perturbation of brain may generate head pain.

Scalp tenderness and sensitivity to pain in migraine and tension headache.

Abstract: Pressure-pain threshold was assessed in the forehead, temples, occiput and neck of 102 patients with migraine or tension headache, and in 35 nonheadache control subjects of similar age and sex distribution. Pain sensitivity to the application of a weighted blade to the fingers was also assessed. Tenderness was greater in patients than in controls, particularly at the site of migraine or tension headache, and to a lesser extent in other areas of the scalp. Scalp tenderness persisted for several days after headache had subsided. The threshold for pain in the fingers was greater during headache than during the headache-free interval but did not differ from pain threshold in control subjects. Pain in the fingers increased more rapidly in patients with episodically-recurring tension headaches than in other patient categories or control subjects. These findings demonstrate that scalp tenderness is not due to a general increase in sensitivity to pain during migraine. In contrast, diffuse disruption of central pain modulating systems may be involved in the pathophysiology of episodically-recurring tension headaches.

Prior physical and sexual abuse in women with chronic headache: clinical correlates.

Abstract: SYNOPSIS Physical and/or sexual abuse in women with chronic headache has never been addressed. This pilot study addressed differences in women with chronic headache who reported such a history, compared to a control group of women with chronic headache without a traumatic history. Thirty women were divided into two groups, based on self-report of abuse, and all women given an MMPI as part of their assessment. Sixty-six percent of women reported significant traumatic histories, with a mean of 8 years of abuse; headache pain developed after trauma in 100% of these cases. Abused women had shorter chronicity of headache but reported greater psycho-social distress and significantly more headaches. Results lend support to a model of life stress etiologically involved in the development of headache. Variables related to personality prior to headache development may be more important than the chronicity determinant. Assessment and identification of abuse early in the cycle may prevent long-term adjustment problems.

Unmasking latent dysnociception in healthy subjects.

Abstract: SYNOPSIS Headache is the most common side effect of nitroglycerin, administered for angina pectoris. Two phases can be distinguished in nitroglycerin-induced headache: the first phase (immediate headache), a mild sensation of temporal pulsating pain, can be due, at least in part, to the vasodilation provoked by nitroglycerin; the second phase (delayed headache), an increasing pain, possibly with nausea and vomiting, lasting even for a number of hours, is independent from the vasomotility, since it arises and persists when all vasomotor and metabolic nitroglycerin-induced changes are over. The present investigation demonstrates that healthy subjects, neither suffering from idiopathic headache nor with a family headache history, never complain of delayed headache after nitroglycerin; healthy subjects not suffering from headache but who have one or both parents suffering from migraine, exhibit the delayed long-lasting headache in 28.6% of cases; finally, 66.7% of their migrainous parents complain of the delayed long-lasting headache after nitroglycerin. The following conclusions can be drawn: nitroglycerin-induced delayed headache 1) is not a true side effect of nitroglycerin, since it is never present in healthy subjects; 2) is peculiar to migraine sufferers: or 3) is an index of migraine predisposition, as it may be present in healthy subjects, but only if they have one or two migrainous parents. The features of nitroglycerin-induced delayed headache suggest an analogy with the phenomenon of overreaction, a painful and exaggerated response (in latency, intensity and duration) to a stimulus, that is the most typical aspect of central pain. In nitroglycerin-induced delayed headache, which shows close similarities to the spontaneous attack of migraine, the trigger stimulus could be the moderate immediate headache which is probably correlated with the vasodilation provoked by nitroglycerin.

Trigger factors in migraine: a study conducted by the Belgian Migraine Society.

Abstract: SYNOPSIS Information on trigger factors provoking a migraine attack, was collected in 217 migraineurs (176 women, 41 men). In this selected group of patients, most patients were spontaneously aware of one or more trigger factors; 184 (85%) of the patients reported trigger factors with a median number of 3 different trigger factors. The main trigger factors were menstruation (48%) or ovulation (8.5%) in women, certain food (44.7%), alcoholic beverages (51.6%) and stress 148.8%). After excluding the menstrual cycle as a trigger factor, trigger factors were more frequent in women, in older patients and in patients with a longer duration of disease. Women with a menstrual cycle-related migraine reported more trigger factors, other than the menstrual cycle itself, than women in whom the menstrual cycle had no influence on this migraine: this was especially so for food and beverages. The number and type of trigger factors in the women in whom the migraine was not menstrual cycle-related, were fully comparable with those in men. Patients in whom alcohol acts as a trigger factor had also significantly more other trigger factors, especially food. The same holds true for patients reporting stress as a trigger factor, but the latter difference is not significant when the different subgroups of trigger factors (food, beverages, other)are considered. Certain trigger factors may be mutually related.

Cervicogenic Headache ‐ The Clinical Picture, Radiological Findings and Hypotheses on Its Pathophysiology

Abstract: SYNOPSIS The clinical picture of 15 patients with “cervicogenic headache” is presented The patients suffered from constant one-sided headaches, upon which were superimposed acute attacks The pain could be precipitated and intensified mechanically It was accompanied in one third of the patients by ipsilateral lacrimation, conjunctival injection, lid edema and visual blurring Other concomitant symptoms were phono- and photophobia, nausea and vomiting A C2 blockade always led to temporary pain reliefRoutine X-rays of the cervical spine and functional radio-graphs in flexion and extension did not reveal any findings specific for cervicogenic headache when compared to 18 control subjects Hypotheses on the pathophysiology of cervicogenic headache are presented

Ergotamine dependency--a review.

Abstract: SYNOPSIS Ergotamine tartrate has been recognized as the drug of first choice for the treatment of acute attacks of migraine. This paper draws attention to a common but poorly delineated state of addiction that can develop when ergotamine tartrate usage exceeds two or three days per week. This syndrome is characterized by a self-sustaining, rhythmic headache/medication cycle, with daily or almost daily migraine headaches and the irresistible and predictable use of ergotamine tartrate as the only means of alleviating the headache attacks. This report further delineates the clinical features, criteria for recognition, and treatment alternatives for this syndrome. In order to avoid this condition, usage should be restricted to 2 days per week.

Personality and Behavioural Characteristics in Pediatric Migraine

Abstract: SYNOPSIS Personality and behavioural features in pediatric migraine were investigated in a comparison study of 20boys and girls with migraine, matched for age and sex with a “pain” control group of 20 children withmusculoskeletal pain, and with a “no-pain” control group of 20 children. When the amount of pain experiencedby children was controlled, the only discriminating variable was that of somatic complaints which includedvomiting, nausea, and perceptual disturbances, all migraine-related phenomena. The inclusion of the “pain” control group in this investigation yielded results which indicated that the behavioural and personality featuresthought to be characteristic of childhood migraine are common to a chronic pain disorder and in fact, themanifestation of many of these features correlate directly with the amount of pain experienced. It is suggestedthat the personality and behavioural characteristics evident in many children with migraine may result from therecurrent chronic pain episodes rather than in some way being causative of the pain.

Management of Chronic Head and Neck Pain: Effectiveness of Altering Factors Perpetuating Myofascial Pain

Abstract: SYNOPSIS The response of 25 chronic myofascial head and neck pain patients to a systematic musculoskeletal rehabilitation program was examined. The program emphasized the acquisition of self-management skills through a highly structured interdisciplinary format. Physical and cognitive behavioral therapies were aimed at reducing factors which perpetuate myofascial pain. Results immediately following treatment, and at three, six and twelvemonths post-treatment when compared to pretreatment scores, showed highly reliable reductions in self-reports of pain and medication intake.

Amelioration of ergotamine withdrawal symptoms with naproxen.

Abstract: SYNOPSIS The effect of concomitant use of Naproxen in the amelioration of symptoms of ergotamine withdrawal was studied in a series of 22 patients. Withdrawal symptoms were characterized by increased headache, nausea and vomiting, increased use of analgesics and antiemetics and restlessness. Those patients treated with Naproxen during the withdrawal had significantly less headache, nausea, vomiting and restlessness, and consumed a smaller quantity of analgesic tablets and anti-emetics. Naproxen is recommended as a useful medication for amelioration of symptoms of ergotamine withdrawal.

Sustained Headache Syndrome Associated with Tender Occipital Nerve Zones

Abstract: SYNOPSIS A sustained headache syndrome can develop from headaches of diverse etiologies. Over seven years,112 patients with such a syndrome received 188 sets of injections in the occipital nerve regions andtwo-thirds had prolonged relief. In such headaches, interrupting the pain cycle with occipital injectionscontaining 1% lidocaine plus betamethasone may be a useful adjunct to other preventive and abortivemedical therapies.

A Comparison of Naproxen Sodium, Acetaminophen and Placebo in the Treatment of Muscle Contraction Headache

Abstract: SYNOPSIS The purpose of the present study was to compare the efficacy and safety of naproxen sodium (550 mg), acetaminophen (650 mg) and placebo in the treatment of muscle-contraction, or tension headache. Six investigators participated in this randomized, double-blind, 3-way parallel study, in which 149 patients were entered. Each patient treated one episode of moderate-to-severe headache with the test medication. The intensity of the headache pain was recorded on 10 cm visual analogue scales (VASs) by patients for up to 12 hours after treatment with the study medication. In addition, the degree of pain relief (PR) was recorded in a similar manner. Mean pain intensities (Pls), percentage changes in mean pain intensities, pain intensity differences (PIDs) and the sum of these differences (SPIDs) were calculated. From the data collected in 124 patients eligible for efficacy analysis, naproxen sodium was shown to provide a significantly greater percentage change in mean PI compared to acetaminophen (p<0.01) or placebo (p<0.001). Mean PID and SPID scores also showed naproxen sodium to be significantly more effective in relieving pain compared to acetaminophen (p<0.02) or placebo (p<0.001). Mean pain relief scores and calculated total pain relief (TOTPAR) scores correlated well with the reduction in pain intensity. During the trial 13 patients reported side effects including nausea, dizziness and drowsiness. None of the side effects were considered clinically significant. The results from this study demonstrated naproxen sodium to be a well tolerated analgesic, which provided statistically significantly superior analgesia compared to acetaminophen or placebo in the treatment of muscle-contraction or tension headaches.

Five year prospective follow-up on the treatment of chronic headache with biofeedback and/or relaxation.

Abstract: SYNOPSIS We have followed-up, by means of 4 weeks of headache diary, 21 chronic headache patients (9 tension, 12 vascular) annually for 5 years after the successful completion of biofeedback and/or relaxation training. Results show 78% tension headache patients and 91% of vascular headache patients are still significantly improved.

Headache in the elderly: an evaluation of risk factors.

Abstract: SYNOPSIS Information on the prevalence of headache in an ambulatory elderly population was collected from 1,284 participants in a health screening program in Dunedin, Florida Association between headache and possible risk factors including age, sex, reported symptoms and diseases, drug use, physical characteristics, and sleep patterns were studied Eleven percent of women and 5 percent of men reported frequent headaches There was no relationship between age and reported headache in this elderly population The most commonly reported positions for headache were frontal (352 percent) and all over (297 percent) In women there was a significant correlation between headache and the total number of other diseases and symptoms reported (p<00001) However, in men, there was no such correlation Numerous specific symptoms were found to be associated with headache in women including: temporary loss of vision, expressive aphasia, and feeling that others do not care In men, headache was significantly correlated only with paroxysmal nocturnal dyspnea, feeling lonely, and feeling depressed, Subjects who slept less than seven hours a day reported a greater prevalence of headache (135 percent) than those who slept more than seven hours (81 percent) (p<001) There was no correlation of headache with systolic or diastolic blood pressure, coffee, alcohol or tobacco use, or the amount of time spent watching television Elderly headache sufferers, in summary, often have other conditions coexisting with and/or contributing to the headaches Some of these conditions may respond to psychological or medical intervention

Efficacy, side effects and tolerance compared during headache treatment with three different calcium blockers.

Abstract: SYNOPSIS Experiences gained in this laboratory during long-term, separate prophylactic trials utilizing three different calcium channel blockers among patients with common migraine, classic migraine, mixed and chronic cluster headaches are reviewed. Nifedipine provided symptomatic improvement among 65% of patients with common migraine and among 77% of patients with classic migraine. Forty-one percent of patients with mixed headache reported some relief of head pain. Sixty percent of patients with chronic cluster reported improved control of their headaches. Verapamil produced improved control of symptoms in 81% of patients with common migraine, 72% of those with classic, 67% of those with mixed and 79% of those with cluster. Nimodipine was reported to be beneficial among 84% of patients with common migraine, among 73% of those with classic migraine and among 53% with chronic cluster. Only 33% of patients treated with nimodipine for mixed headache reported improvement. Side effects were more common with nifedipine (71%) than with verapamil (41%) and were least common with nimodipine (20%). Tolerance developed in 42% of those treated with nifedipine and in 49% of those treated with verapamil. Development of tolerance with nimodipine was rare (4%). Each of these three calcium channel blockers showed different and specific therapeutic efficacies which differed according to the clinical classification of the different types of vascular head pain undergoing treatment.

Somnambulism, migraine and propranolol.

Abstract: SYNOPSIS 150 migraine patients and 150 healthy subjects without headache were questioned about previous or current somnambulism. Previous or current somnambulism was found in 21.9% of the migraine group and in 6.6% of the control group; this difference is significant (p<0.001). Of the 25 migraine patients who had childhood or adult somnambulism, 16 had common migraine and 9 had classical migraine; classical migraine is over-represented in patients with somnambulism. Three patients treated with propranolol described aggravation of current somnambulism or re-appearance of previous somnambulism with the beginning of this drug treatment.

Nerves and vessels in the pterygopalatine fossa and symptoms of cluster headache.

Abstract: SYNOPSIS The study evaluates the contribution of activated parasympathetic and sensory nerve fibres in the sphenopalatine ganglion area, and of vasodilation in surrounding vessels in this narrow region (pterygopalatine fossa), to the pain and signs of autonomic dysfunction seen during attacks of cluster headache. Agents with anesthetic and vasoconstrictor effects were applied nasally to reach this area. It was found that the anesthetic effect is the most important, both regarding pain and autonomic symptoms. The effectiveness was also evaluated: this treatment is useful to stop attacks of cluster headache, but the beneficial effect is less than that reported in previous studies.

Atenolol in Migraine Prophylaxis a Double-blind Cross-over Multicentre Study

Abstract: SYNOPSIS The prophylactic anti-migraine effect of atenolol was compared to placebo in a multicentre study on 63 patients with classical and/or common migraine. The study design was double-blind cross-over and patients were given atenolol 100 mg o.d. or matching placebo during a study treatment period of 24 weeks. The effect of atenolol was significantly better than that of placebo: integrated headache values were reduced in 70% of the patients (p = 0.004) and the proportion of days with headache was reduced in 59% of the patients (p = 0.010). Few side effects were reported with both atenolol and placebo. This study shows atenolol to be safe and effective in the prophylactic treatment of migraine.

Effervescent ASA Versus Solid ASA in the Treatment of Tension Headache. A Double-Blind, Placebo Controlled Study

Abstract: SYNOPSIS This study aimed at comparing the time courses of pain relief in tension headache after taking 648 mg solid ASA and after taking 648 mg effervescent ASA (acetyl salicylic acid). A modified double dummy technique with both solid and effervescent placebo was used. 47 patients entered, and 33 patients took all four trial drugs. No statistically significant difference between solid and effervescent ASA could be demonstrated. ASA was significantly better than placebo although the median rating of ASA in this study was unexpectedly poor - as was the placebo response. This fact might have reflected the severely afflicted nature of a headache clinic's population. Different pain rating scales are compared, and it is concluded that the overall (GLOBAL) rating is sensitive, but should not be used alone, since it may sometimes reflect less relevant factors. The power of the trial was good, but reflects the comparatively poor responsiveness to ASA (low variance) in this particular patient population. An advantage of the effervescent preparation in more ASA-responsive patients cannot be ruled out. It is advised for future studies to recruit patients from general practice rather than from a headache-clinic population.

Cognitive Therapy and Relaxation Training in Muscle Contraction Headache: Efficacy and Cost-Effectiveness

Abstract: SYNOPSIS The purpose of this study was first, to examine the efficacy of adding a cognitive therapy component to traditional relaxation training; and second, to examine the feasibility and cost-effectiveness of administering these treatments in a largely self-ad-ministered format for headache patients. Twenty-five muscle contraction headache sufferers were assigned to one of three treatment conditions, which provided either relaxation training alone or relaxation training in combination with cognitive therapy. Procedures were delivered utilizing either a therapist-ad-ministered office-based format, or a largely self-administered format designed to provide significantly less therapist contact than the office-based procedure. At one-month post-treatment, patients in all 3 conditions exhibited significant decreases in headache activity, with no significant differences between the groups, although then appeared to be a slight advantage for the cognitive groups and for groups with increased therapist contact. Patients in all 3 groups evidenced significantly greater use of relaxation and cognitive strategies at post-treatment, with the combined treatment groups showing slightly greater use of the latter. Additionally, all 3 groups decreased their use of traditional medical strategies. There were no significant differences in cost-effectiveness among the 3 groups. However, overall this study suggests that largely self-administered treatments can result in significant improvements in headache, while substantially reducing the total amount of therapist contact.

Cluster headache after head injury.

Abstract: SYNOPSIS Four patients developed cluster headaches after minor head injuries that caused no permanent neurologic or CT abnormalities. None had had headaches previously. The headaches of the three whose histories were known in detail either corresponded to the injury site or evolved from an earlier headache that did. Nerve injury is suggested as the mechanism by which trauma could initiate cluster headache.

Comparative Efficacy of Nadolol and Propranolol in the Management of Migraine

Abstract: SYNOPSIS A multicenter randomized double-blind study was conducted on 140 patients with classic and/or common migraine who received either nadolol (80 mg or 160 mg OD) or propranolol (80 mg bid). Admission into the 12-week active treatment period required at least 3 attacks per month during a placebo lead-in period. Abortive headache therapy was allowed at the patients' discretion, each keeping a diary of migraine attacks and use of medications. Clinical assessments were performed monthly. Data from 42 patients were excluded from the evaluation of efficacy, mainly because of non-adherence to protocol requirements. Drug efficacy evaluation in the remaining 98 patients was based on 4 separate migraine indices: frequency of attacks, intensity of attacks, days of pain, and need for relief medication, with success being defined as a reduction in an index of at least 50% relative to baseline. A successful response in at least I index was found in 48% of patients on nadolol 80 mg (p=NS vs propranolol 160 mg) and in 69% of the patients on nadolol 160 mg compared with 54% on propranolol 160 mg (p<0.05). Success in all 4 indices was found in 21% of patients on nadolol 80 mg (p=NS vs propranolol 160 mg) and in 41% of patients on 160 mg nadolol as compared to 15% on propranolol 160 mg (p<0.05). Adverse reactions required discontinuation from therapy in 2 of 48 patients on nadolol 80 mg (4.1%), 2 of 47 patients on nadolol 160 mg (4.3%), and 4 of 44 patients on propranolol 160 mg (9.1%). This study indicates that, in the prophylaxis of migraine, 80 mg of nadolol administered once daily is equivalent in efficacy and safety to propranolol 80 mg administered twice daily. Furthermore, nadolol given as a single daily dose of 160 mg is superior to an equal total daily dose of propranolol administered twice daily.

Stroke in Migraine as a Consequence of Propranolol

Abstract: SYNOPSIS There have been two previous case reports of complicated migraine headaches associated with the use of beta blockers. In this article we report a third case of complicated migraine in a patient with longstanding migraine headaches taking propranolol for hypertension. Visual field testing demonstrated a left homonymous hemianopsia and CT scan revealed a low density defect in the left posterior parietal-occipital area without enhancement. A review of the literature on stroke in migraine and the mechanism of action of beta-blockers are included. We question the appropriateness of the use of beta-blocking agents for prophylaxis of migraines associated with or preceded by conspicuous sensory or motor deficits.

Benign recurrent transient monocular blindness: a possible variant of acephalgic migraine.

Abstract: SYNOPSIS Twenty-four patients with benign recurrent transient monocular blindness of possible migrainous etiology are presented. The visual loss was predominantly one-sided and stereotyped in character. Postural change or exercise was a provocative factor in half the cases. Other neurologic symptoms were not present and only one patient developed permanent visual loss during an attack. Evaluation by CT scanning, angiography, echocardiography, and ophthalmodynamometry, when performed, was uniformly normal.

Hypothesis: Chronic Benign Daily Headache is an Immune Disorder with a Viral Trigger

Abstract: SYNOPSIS The persistence and reactivation of classic viruses may be responsible for some chronic headache syndromes and their exacerbations. Persistent infections may selectively decrease neurotransmitter output. Alternatively, headache may be due to the viral-induced immune response. Lymphocytes secrete substances with CNS activity. Continuous antigenic stimulation may result in immune complexes, anti-idiotype antibodies, and autoimmunity. Our studies show an increased incidence of raised thyroid microsomal antibodies in patients with chronic benign daily headache or benign paroxysmal vertigo (a syndrome closely related to idiopathic headache syndrome). We detected oropharyngeal secretion of Epstein-Barr Virus by nucleic acid hybridization in 20 of 32 patients with the recently-defined syndrome of new, daily persistent headache and in only 4 of 32 age and sex-matched control patients. Based on these studies, we propose that chronic benign daily headache may be an auto-immune disorder with a persistent viral trigger.

Whiplash and its relationship to migraine.

Abstract: SYNOPSIS Five patients with severely symptomatic cervical injury of the type commonly referred to as ‘whiplash’ were discovered to also have many migrainous features and all were successfully managed with medications. The relationship of whiplash to migraine is discussed and the argument made that whiplash is trauma-precipitated cervical migraine.

What can precipitating factors teach us about the pathogenesis of migraine

Abstract: SYNOPSIS Relationships between precipitating factors in the pathogenesis of migraine were studied in a sample of 217 migraineurs. The most frequently cited triggers were the menstrual cycle (51.5% of the women), alcoholic beverages (51.6%) and emotional or psychic stress (48.8%). Analysis of 4 subgroups of patients, i.e. those with only one of these 3 triggers or with none of these (controls), showed that alcohol-susceptible patients reported significantly (p<0.001) more alimentary triggers than the controls. A similar phenomenon was found in patients with menstrual-cycle related migraine, but in this group the difference with the controls fell short of reaching statistical significance. A further analysis showed that menstrual migraine attacks are more frequently preceded by depressive symptoms than other migraine attacks. It is suggested that the gut of certain migraineurs may be unduly permeable, either intrinsically or extrinsically (e.g. under the influence of alcohol). In addition, in some patients with menstrual migraine, a depressive episode, associated with the menstrual period, may facilitate the development of a migraine attack.

Auditory Brainstem Evoked Potentials in Patients with Migraine

Abstract: SYNOPSIS Auditory brainstem evoked potentials (ABEP's) using the routine 10 per second click rate, and also a 55 persecond stimulus rate, were studied in 17 migraine patients between and during attacks, and in 20 normal subjects.Only in the "migraine during attack" group did the increased stimulus rate change the ABEP's. Similar changeswith increased stimulus rates may be seen in situations of ischemic synaptic dysfunction. Thus, our data supporta vascular pathogenesis of migraine.

Greater Occipital Neuralgia: An Unusual Presenting Feature of Neurosyphilis

Abstract: SYNOPSIS The syndrome of greater occipital neuralgia (GON) is a cause of chronic unilateral or bilateral headaches. It occurs when the greater occipital nerve is compressed, irritated or inflamed. We describe a case of neurosyphilis in which GON was the presenting manifestation. We discuss this previously unreported early presenting feature of neurosyphilis and its implication.