[Use of mental tests at a headache center].
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Headache↗
Biomedical subjects
F Antonaci
Publications and source records attributed to F Antonaci.
"H response" to photic stimulation in migraine: study with the EEG spectral analysis.
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Electroencephalography↗
The sweating anomaly in cluster headache. Further observations on the underlying mechanism.
We describe a patient with a typical history of cluster headache for more than 18 years. During the first approximately 10 years of his disease, the pain was right-sided, and pupillometric and evaporimetric measurements indicated a sympathetic deficiency on this same side. However, for the next greater than 6 years, his pain was consistently left-sided, although the signs of sympathetic dysfunction still were more marked on the right side. This was also true for the findings obtained during the interictal period and for the heating test performed within an attack. The implications of this interesting case are discussed. The view that two separate lines of symptom production lead to the pain and the autonomic phenomena seems to be supported by this case history. The cluster headache syndrome may also be a bilateral disorder, with only the weight of balance pointing one way or the other. Finally, the autonomic test results of this patient could reflect an autonomic "scar" in the previous headache side.
Aged↗
Chronic paroxysmal hemicrania: a case report. Long-lasting remission in the chronic stage.
In a 38-year-old woman who had had CPH since the middle 1960s and had been successfully treated with indomethacin (dosage usually within the limits of 50-175 mg/day) for approximately 10 years, the requirement for indomethacin was gradually reduced to nought in the spring of 1985. She was then pain-free without indomethacin for almost 1 1/2 years. In the late fall of 1986 she had a 3-week exacerbation. In recent months, she again seems to have a slowly increasing, although clearly fluctuating, indomethacin requirement. Long-lasting remissions may thus appear even in the chronic stage. The remission could be a spontaneous one or it could in some way be related to the protracted indomethacin treatment; the authors favour the former possibility. The recurrence of symptoms after a while shows that the attack-generating potential has not been permanently extinguished by indomethacin.
Adult↗
Cluster headache pathogenesis: a pupillometric study.
Thirty-two cluster headache patients and healthy controls (n = 16-20 for the various tests) were examined by means of a Whitaker pupillometer during pain-free intervals. Eye drops of the sympathomimetic agents tyramine, hydroxyamphetamine, and phenylephrine were instilled into the conjunctival sacs on separate occasions, and pupillary diameters recorded at standard time intervals. The mydriatic responses of the two pupils were compared. A moderate, but statistically significant, basal relative miosis was found on the pain side in cluster headache. The symptomatic-side pupils were less responsive than their counterparts when stimulated with tyramine and hydroxyamphetamine, the difference being statistically significant for the OH-amphetamine test. With the phenylephrine test, however, the mydriasis on the symptomatic side significantly exceeded that of the contralateral pupil. This pattern of reactions does not quite correspond to those of "ordinary" Horner's syndrome (1st, 2nd, and 3rd neuron lesion). There are, however, gross similarities with the recently reported pattern in central sympathetic neuron dysfunction. In cluster headache there is probably a "Horner-like picture" rather than a proper Horner's syndrome.
Adult↗
[Analysis of the EEG spectrum in attacks of classical migraine].
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Adolescent↗
Erythrocyte deformability changes in headache patients under flunarizine treatment.
Changes in erythrocyte deformability (ED) parameters have been investigated in 36 patients suffering from different forms of headache (classic and common migraine; migraine with interval headache; chronic tension headache) and treated with flunarizine (10 mg/day at bedtime). Patients were carefully selected in order to avoid any possible interference with the parameters under study, and smoke and drug use in particular (symptomatics included) were considered as criteria for exclusion from the trial. Controls of ED parameters were planned before treatment and after 20 and 35 days. Baseline ED alterations were present only among patients with chronic tension headache, but flunarizine treatment was able to positively modify ED parameters in these patients, as well as in migraine cases that showed normal baseline ED values. No correlation was found between patients' characteristics and baseline ED values, nor between ED changes under treatment and therapeutic effects of flunarizine.
Adult↗
Pain, affective life and memory impairment: study on 26 headache patients.
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Adult↗
Chronic paroxysmal hemicrania (CPH) and hemicrania continua: transition from one stage to another.
Two female patients, one suffering from CPH in non-remitting form, and the other from hemicrania continua, in the pre-chronic (non-continuous) stage are described. Both were followed through transitions to other stages: the CPH patient was followed from the non-remitting stage to a longlasting remission, and lastly back to another chronic stage. Indomethacin was effective in all the symptomatic stages. The hemicrania continua patient was followed from the non-continuous to the continuous stage. Indomethacin was effective in both stages. These observations provide further evidence that the non-chronic and chronic ("remitting" and "non-remitting") stages of CPH belong together. The same seems to apply to the two stages of hemicrania continua, the "continuous" and the "non-continuous" stages.
Adult↗
Unilateral headaches and their relationship with cervicogenic headache.
The concept of headache originating/starting in the neck is revised and considered in the light of previous descriptions of syndromes and entities and with reference to the current diagnostic systems for the classification of headache and other head pain. Cervicogenic headache (CEH), a clinical picture recently described by Sjaastad and coworkers and listed in the International Association for the Study of Pain (IASP) Classification, is analyzed, also taking into consideration its diagnostic criteria in terms of sensitivity and specificity. The problem of a differential diagnosis with migraine, tension headache and other well defined forms of unilateral headaches is discussed with reference to a case series of 114 patients who were selected based on their adherence to two fundamental criteria: (i) side-locked unilaterality of pain; and (ii) pain starting in the neck and spreading to the fronto-orbital area. Based on the results, these simple criteria can contribute to a preliminary identification of possible CEH cases that may then undergo a sequence of clinical and instrumental procedures in order to confirm the diagnosis and, possibly, to localize the level(s) of dysfunction in the cervical spine which may be the target for therapeutic investigations, whether invasive or non-invasive.
Diagnosis, Differential↗
Whiplash injuries: clinical picture and diagnostic work-up.
The term "whiplash" commonly refers to symptoms and signs associated with a mechanical event such as a sudden acceleration and deceleration of the neck (due, in the majority of cases, to a road accident), instead of to the mechanism itself. The recent Quebec Classification of Whiplash Associated Disorders (WAD) contributed to define nosographically all the clinical manifestations usually grouped under the terms acute/post-traumatic and late "syndrome". In the late phase of WAD, neck pain and neck muscle contraction have been reported in all cases, together with headache in over 50%. "Headache stemming from the neck", despite numerous attempts to classify this entity (i.e. cervicogenic headache) according to the IASP classification (headache associated with neck disorders), is still a subject of debate. An adequate multiparametric procedure is required to study WAD, which takes into account: the patient's principal details; an exact reconstruction of the event; description and analysis of the signs and symptoms, with various complications and correlated dysfunctions; an objective neurological and neck-shoulder examination; and a battery of complementary instrumental tests which are described in this study. These investigations include evaluation of muscle tension (manual palpation, algometry, EMG recording), kinematic analysis of the cervical spine, neuropsychological and psychological evaluation, and evaluation of disability. In order to assess cervical spine mobility in WAD patients, a 3D kinematic analysis by means of the ELITE system and clinical evaluation were performed in our setting. Seventy patients with whiplash injury and 46 healthy volunteers were enrolled in the study. Patients were tested at the time of first consultation and again 6 months and 12 months later. Clinical evaluation of the range of motion was performed both in patients and in 41 healthy volunteers. Furthermore, patients diagnosed according to the WAD Classification as grade 2 (n = 68) or grade 3 (16) underwent a Quality of life (QoL) evaluation, measured using the short form (36-item) Health Survey (SF36) and the migraine-specific questionnaire (MSQ). According to our data, whiplash patients showed an impairment of cervical spine mobility, as well as a poor QoL, compared to a control group population, even though we observed a trend towards improvement over time in cervical ROM.
Biomechanical Phenomena↗
Current methods for cervical spine movement evaluation: a review.
Cervical spine mobility is difficult to investigate accurately because of its anatomic structure and the compensatory movements. Different methods have been conceived in order to obtain a reliable measurement of cervical range of movement (ROM). We reviewed different instruments described in the literature: x-rays, CT and MRI, goniometer, inclinometer, cybex and related devices, and opto-electronic scanners. Cybex and 3D kinematic analysis by means of opto-electronic scanners (Elite system) seemed to be the most reliable and reproducible methods. Cybex equipment is relatively inexpensive and easy to use in a clinical setting, while the Elite system is expensive and requires special training of the personnel. However, the choice of method depends primarily on whether the physician's goal is a clinical screening or a thorough investigation of neck function (e.g., post-traumatic cervical spine disorders). For the first purpose, certain types of goniometers (gravity goniometer, ad modum Myrin), as well as the cybex, show good reproducibility and reliability in evaluating maximal cervical ROM (flexion-extension, rotation, lateral bending), while x-rays and, above all, 3D kinematic analysis (using opto-electronic scanners) are more suitable for diagnostic and follow-up evaluation of neck disorders.
Biomechanical Phenomena↗
Hemicrania continua and chronic paroxysmal hemicrania: a comparison of pupillometric findings.
Pupillometric studies were carried out in 9 patients with chronic paroxysmal hemicrania (CPH), in 10 patients with hemicrania continua (HC) and in age- and sex-matched controls (n = 12-17). Studies were carried out in the basal condition and after instillation of 2% tyramine, 1% OH-amphetamine, or 1% phenylephrine. The pupillary response to tyramine in HC was more marked than in controls on a percentage increase basis, but not so much when the increment is calculated in absolute values. In this series, there was no asymmetrical response (relative miosis on the symptomatic side) like in previous case reports. The pupil reaction was less in HC than in CPH after hydroxyamphetamine instillation and without any marked asymmetry. There was no definite evidence of supersensitivity to a directly acting sympathicomimetic agent, phenylephrine. No gross abnormalities as regard the sympathetic function in HC was thus observed. The asymmetry on tyramine testing differed in CPH and HC (most marked in HC). No major emphasis should probably be attached to this finding, since on testing with OH-amphetamine, a similar substance, this finding was not reproduced.
Adult↗
Hemicrania continua: a possible symptomatic case, due to mesenchymal tumor.
The case of a 28-year old woman with headache resembling hemicrania continua (HC) is described. Since her childhood she had a history of right-sided, side-locked, painful headache attacks, with increasing attack frequency during the last two years, each attack lasting around 24 hours. There were only a few "migrainous" symptoms and signs, thus no photo- and phono-phobia and no vomiting. Only occasionally did she have slight nausea. The clinical picture as well as the complete indomethacin effect suggested a case of HC. However, the indomethacin effect faded away after > 2 months. At that time, a CT scan revealed a tumor in the right sphenoidal bone involving the clinoid process and the base of the skull. A biopsy of the tumor during craniectomy showed a mesenchymal tumor, and the patient was considered inoperable (April, 1989). After cytostatic treatment, she is back in full time work; the headache disappeared and it still has not recurred after approximately 2 years of observation. Neuroradiological investigation should, therefore, be included in the work-up of patients with HC. At the present stage of knowledge, neuroradiological investigations should probably also be included when faced with a typical clinical picture.
Adult↗
Pain threshold in humans. A study with the pressure algometer.
Pain perception threshold (PPT) in the head was assessed with a pressure algometer in 40 control individuals (24 females and 16 males). Threshold was assessed at 11 symmetrical points on each side. The average threshold for each side was calculated, and differences between two sides were evaluated with an asymmetry index. Subjects were studied in relation to age and sex, and any difference in the symmetrical perception of pain on the head was registered. The deltoid muscle was chosen as a reference point, since it is rarely a site of trigger points. The reproducibility of the method was satisfactory. A significantly positive correlation was found between PPT value of the head and the deltoid muscle. There was no tendency to rise or fall in PPT during the same "session", which consisted of 3 separate complete measurements. The mean of mean values showed that there was little asymmetry as for the thresholds pertaining to the head in the total material. Age and sex apparently played little role as for the outcome of the test. The assessment of PPT in the head might be a useful tool in the study of lateralization of pain in unilateral headache syndromes.
Adult↗
Pupillary response to topical naloxone in cluster headache.
Eye drops of naloxone were applied and pupillary diameters recorded at standard time intervals in 18 healthy controls and in 20 patients with episodic cluster headache during pain free intervals by means of a pupillometer. In the basal condition, the mean symptomatic side pupil in the cluster headache group was significantly smaller than the pupil of controls. Patients in the cluster period had a significantly smaller symptomatic-side pupil when compared to patients outside the bout. After naloxone, the pupils on the symptomatic as well as on the non-symptomatic side were significantly smaller than those in controls when expressed in mm. The difference between patients and controls persisted, and was, grossly speaking, of a not widely varying magnitude during the drug test. This study thus does not render any definite evidence for a role of opioids in the mechanism underlying the miosis of cluster headache.
Adult↗
Sympathetic functions in parkinsonism treated with stereotactic surgery: observations in ten patients.
Ipsilateral sympathetic deficits, that is symptoms and signs consistent with a diagnosis of Horner's syndrome, have been described in patients who have undergone thalamotomy for dyskinesia as well as for parkinsonism. The present patient material consists of 10 patients with parkinsonism who had undergone stereotactic surgery. Since anhidrosis and miosis are two integral components of Horner's syndrome, forehead sweating and pupillometric response to sympathicomimetic agents have been investigated in this preliminary work. The tests were carried out a considerable time postoperatively. Sweating was stimulated in two different ways: by body heating and by parenterally administered pilocarpine. OH-amphetamine and phenylephrine (an indirectly and a directly acting sympathicomimetic agent) were used in the pupillometric tests. The results were compared with those obtained in a healthy control group. With the OH-amphetamine test, there were some indications of a changed sympathetic activity on the surgical side. However, when comparing these results with those obtained by the phenylephrine test, the inference seems to be allowable that parkinsonian patients operated in this way (target area: ventro-oral thalamic nuclei (Voa and Vop) and the reticular thalamic nucleus) show no definite sympathetic supersensitivity at the late postoperative stage. Our data suggest that the response pattern of the pupils and the sweat glands may be related to the surgical method used and/or to the interval from operation to investigation.
Aged↗