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Biomedical subjects

F Sicuteri

Publications and source records attributed to F Sicuteri.

At least 91 records · Page 5Linked to original sources
PubMed1982

Intermittent hypoendorphinaemia in migraine attack.

Beta-endorphin (RIA method, previous chromatographic extraction) was evaluated in plasma of migraine sufferers in free periods and during attacks. Decreased levels of the endogenous opioid peptide were found in plasma sampled during the attacks but not in free periods. Even chronic headache sufferers exhibited significantly lowered levels of beta-endorphin, when compared with control subjects with a negative personal and family history of head pains. The mechanism of the hypoendorphinaemia is unknown: lowered levels of the neuropeptide, which controls nociception, vegetative functions and hedonia, could be important in a syndrome such as migraine, characterized by pain, dysautonomia and anhedonia. The impairment of monoaminergic synapses ("empty neuron" condition) constantly present in sufferers from serious headaches, could be due to the fact that opioid neuropeptides, because of a receptoral or metabolic impairment, poorly modulate the respective monoaminergic neurons, resulting in imbalance of synaptic neurotransmission.

Adult↗
PubMed1982

Latent dysautonomic pupillary lateralization in cluster headache. A pupillometric study.

Forty-five patients with cluster headache in the asymptomatic phase were studied by electronic pupillography, testing autonomic function of both pupils pharmacologically. Topical sympathetically-acting mydriatics, tyramine and cocaine and the cholinoceptor blocker, homatropine, induced defective mydriatic responses on the symptomatic side, indicating latent impairment of sympathetic function. The abnormality was found in interattack intervals of the cluster period or during intercluster phases. The tyramine test can be proposed for objective diagnosis of cluster headache. We postulate that cluster attacks are triggered and lateralized by a permanent latent unilateral sympathetic dysfunction. Lithium reduced the mydriatic response to tyramine of the pupil contralateral to the pain, thus restoring the equilibrium between both pupils; this therapy may correct the asymmetric sympathetic function by attenuating the activity in the asymptomatic side.

Adolescent↗
PubMed1982

Possible lateralization of the cardiac sympathetic function in cluster headache.

In cluster headache an adrenergic dysfunction of the pupillary sympathetic system can be demonstrated even during pain-free periods by instillation of tyramine in the conjunctival sac. In this study 10 patients with typical cluster headache syndrome exhibited a positive tyramine conjunctival test (minor mydriatic response in the pain side). As the adrenergic dysfunction may also involve the heart, possible neurogenic changes in ventricular repolarization were investigated in a group of patients with cluster headache by means of a hyperventilation test. When compared to controls, an increase of the QTc interval, a faster heart rate and a minor shortening of the QT interval, were observed. In all cases except one the T waves became bifid or inverted, sometimes showing a pseudoischemic aspect. Since the positive response to hyperventilation seems to depend on an asynchronous repolarization which can, in turn, be related to asymmetric sympathetic function, the present results seem to suggest the presence of a possible lateralization of the cardiac sympathetic function, in cluster headache patients.

Adolescent↗
PubMed1982

Monoamine sensitivity of smooth muscle in vivo in nociception disorders.

A significant degree of supersensitivity to 5-HT and DA was detected when carrying out the computerized venotest on migraine patients during an attack. A similar supersensitivity was observed during morphine abstinence and naloxone-precipitated withdrawal in addicts. Mild abstinence after slight and short morphine treatment provoked monoamine supersensitivity in volunteers. In these conditions, the administration of morphine inhibited the 5-HT and DA supersensitivity. In spontaneous central panalgesia, monoamine supersensitivity is detectable, as well as in panalgesia induced in headache sufferers by means of PCPA 5-HT deprivation. By means of the venotest, the ergot derivatives were confirmed as being partial 5-HT agonists. These drugs can also carry out their therapeutic activity by potentiating 5-HT at a central level in 5-HT-deficient neurons. The presence of opiate receptors in the human vein is stressed. The high supersensitivity of the venous smooth muscle to 5-HT and DA both in headache and systemic pain sufferers and during morphine withdrawal suggests a pathophysiological analogy between these conditions.

Dopamine↗
PubMed1982

A new nonvascular interpretation of syncopal migraine.

Migraine suffers who experience spontaneous syncopes (syncopal migraine) during attacks exhibit a dramatic intolerance to bromocriptine, a dopamine agonist. An oral dose of this drug renders these patients unable to stand, even for some hours, because of precipitously falling of arterial blood pressure. Treatment with domperidone, a specific dopamine receptor antagonist, abolishes the syncopal effect of bromocriptine. This evidence is compatible with a supersensitivity of those dopamine receptors, which exert an inhibiting activity and are located on blood pressure regulating centers as well as on cardiovascular sympathergic neurons.

Adolescent↗
PubMed1982

Sexuality and headache.

Ten percent of 362 headache sufferers reported sexual arousal during migraine attack. Clinical investigations on sexuality in 16 headache sufferers, according to some studies showing correlations between idiopathic headache and sexual behavior, were performed. Patients responding by questionnaire listed each sexual experience, headache attack, and number of sleeping hours every day for 1 month. In both men and women, the number of coiti, erotic dreams, and sleeping hours were similar in headache sufferers and controls, while the frequency of masturbation was significantly reduced in the former. Sexual excitement and fantasies appeared more often in female headache sufferers than in controls, while the opposite occurred in the male group. Among the clinical analogies between the crises of migraine and morphine abstinence, sexual arousal may be included.

Adult↗
PubMed1982

A putative 5-HT central feedback in migraine and cluster headache attacks.

5-HT is considered to play a role in the migraine mechanism; its decrease in the midbrain during migraine attacks has been postulated. CSF TP and plasma and platelet 5-HT levels in migraine and cluster headache sufferers have been evaluated; the values registered were compared to those of neurological and carcinoid patients, respectively. The following results were obtained: (a) no significant difference in the time course of free and total TP after l-TP intravenous loading, (b) increased levels of CSF TP during migraine and cluster headache attacks, (c) impressively increased levels of plasma 5-HT only in carcinoid patients. These findings suggest the existence of a positive 5-HT central feedback mechanism during attacks of migraine and cluster headache and thus exclude peripheral 5-HT effects in the generation of pain.

Adolescent↗
PubMed1981

Enkephalinase inhibition relieves pain syndromes of central dysnociception (migraine and related headache).

Normotensive and hypertensive headache sufferers were treated with D-phenylalanine, aprotinin or captopril--all inhibitors of endogenous opioid degradation. Inconsistent results were obtained using D-phenylalanine and aprotinin (acute administration at the start of a migraine attack). Satisfactory results were obtained by prophylactic treatment with captopril (an inhibitor of the angiotensin converting enzyme and of the dipeptidyl carboxypeptidase--an enkephalin inactivating enzyme) compared with conventional drugs such as methysergide, lisuride, pizotifen, clonidine and beta-blocking agents. Excellent results were obtained with captopril on patients suffering from headache and arterial hypertension who had experienced no relief from beta-blocking agents and clonidine. Captopril could thus be a drug of choice in the therapy of headache associated with essential hypertension.

Acute Disease↗
PubMed1981

Opioid receptor impairment--underlying mechanism in "pain diseases"?

The scarce or absent analgesic effect exhibited by morphine on pain from migraine attack and the poor inhibition of the spasmogenic effect of 5-HT (tested on the hand dorsal vein, computerized venotest) suggest the hypothesis of an opioid receptor deficiency in headache sufferers. Since endogenous opioids control the nociception, the sense of well being, and the vegetative balance, an opioid receptoral hypofunction could be the background of the headache and central panalgia, where the trinity pain, anhedonia, and dysautonomia are the characteristic features.

Animals↗
PubMed1980

Dopamine and 5-HT supersensitivity in nonorganic central pain and in morphine abstinence: fortuitous or renal analogy?

Unexplained pain, such as central panalgesia, might be the most common clinical expression of a deficiency, central in nature, of the endorphin system. Acute natural opioid deficiency is comparable to morphine withdrawal in addicts characterized by vegetative, psychic disorder and the appearance of pain. An impressive supersensitivity (up to 1000 fold) to dopamine and 5-HT of the smooth muscle (hand dorsal vein: venotest) is detected both in central panalgesia sufferers and in addicts during spontaneous (withdrawal) or pharmacological (naloxone) abstinence. A 5-HT and dopamine supersensitivity, of less intensity, however, (10-30 fold), is found during migraine attacks: on these occasions, morphine-like factors in CSF appear reduced or undetectable, reinforcing the chemical analogy between morphine abstinence and migraine attacks. In the present study, evidence of opiate receptors in the human vein is also provided: 5-HT venospasms, inhibited by morphine, promptly emerge when naloxone is inoculated locally.

Dopamine↗
PubMed1979

Morphine abstinence and serotonin supersensitivity in man: analogies with the mechanism of migraine?

Supersensitivity to serotonin during migraine attack has been previously observed. Since the attack has been attributed to a critical lowering of morphine-like factors, we can expect serotonin supersensitivity during morphine abstinence. Slight signs of morphine abstinence have also been induced in volunteers after mild (10-24 mg/day) and limited (3 days) treatment. To evaluate the sensitivity to serotonin, dopamine, noradrenaline, and tyramine in the smooth muscle of the hand dorsal vein, in vivo, the computerized venotest was applied before, during, and 24 h after withdrawal of morphine. Venous sensitivity to serotonin and dopamine (but not to noradrenaline and tyramine) increased 10- to 20-fold after morphine withdrawal. Venous monoamine supersensitivity in morphine abstinence, similar to that observed during migraine attacks, could be indirect evidence of an analogous mechanism in both conditions.

Adult↗