"Cervicogenic" headache. An hypothesis.
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Biomedical subjects
Publications and source records attributed to C Saunte.
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In four of the approximately 40 cases of chronic paroxysmal hemicrania (CPH) that are known so far, attacks that are similar to the spontaneous ones may be precipitated by head movements or pressure against certain points in the neck. Head flexion was used as the precipitation procedure in a 34-year-old female who was studied several times in the course of five years. Attacks occur within 5-40 sec, and the pain is preceded by tearing and conjunctival injection. External rubbing or external compression of the common and internal carotid arteries on the symptomatic side did not produce attacks. The combination of head flexion and external compression of the common or internal carotid arteries on the symptomatic side invariably produced an attack of usual severity and within the usual time. This investigation would seem to render unlikely the possibility of a primary vascular mediation of the signal from the neck to the ocular region. Sympathetic fibres are the likely mediators of the impulses from the neck to the ocular area.
Sweating in the forehead, on the eyelids, in the face and on the trunk was measured with the Evaporimeter during 31 spontaneous cluster headache attacks of varying severity in 18 patients. The evaporimeter measures evaporative water loss (sweating + transepidermal water loss) rapidly and accurately as g/m2/h. The patients themselves acted as controls. Sweating was also estimated in 25 healthy individuals at a temperature of 27 +/- 1 degree C, and a mean relative humidity of 19%. During eight severe attacks, sweating in the medial part of the forehead on the symptomatic side was invariably increased. In moderate attacks the increment was less pronounced and in the inter-cycle period, no definite increase was found. The cause of increased sweating during cluster headache attacks remains enigmatic.
A double-blind comparison between a combined antihistaminc and vasoconstricting preparation (Lunerin Mixture, Lunerin Mite) and placebo was performed in children with secretory otitis media. It was shown that the children given the active drug reacted more favourably on every investigated parameter (hearing threshold, appearance and mobility of the ear drum, number of myringotomies and observation time) than the patients who were given placebo. The incidence of side-effects was low.
The unilateral headache in patients with cluster headache syndrome is associated with a number of autonomic accompanying phenomena. Investigation of sweating of the forehead, salivation, nasal secretion and tearing is described and sympathetic parasympathetic firing in connection with headache attacks is discussed.
Tyramine pupillometry was performed in 27 cluster headache patients and in 45 healthy controls. Asymmetry variables, i.e. symptomatic(S)-nonsymptomatic(NS) side diameter difference and the ratios (S/NS, log NS/S or S/S+NS) displayed higher sensitivities than variables which express the function of the symptomatic and the nonsymptomatic side pupil separately. Thirty percent of patients had abnormal S-NS values at maximal pupillary dilatation. The statistical properties of different ratio variables are discussed and it is concluded that the transformed ratio (log(NS/S], anisocoria (S-NS) and the anisocoria index (S/S+NS) may be superior to the conventional S/NS ratio.