Biomedical subjects
Publications and source records attributed to G Nattero.
Flunarizine was given in daily doses of 10 mg for periods of two to four months to 176 patients suffering from various types of headache. The symptoms were improved in 82% of the cases treated. No differences emerged among the various types of headache reported by the patients or in relation to the presence or absence of neurological involvement or its type.
Ipsilateral carotid and vertebral vasomotor phenomena are marked components of a unilateral cluster headache crisis. Investigation of lateralisation at the height of a crisis has shown that Doppler findings supplement Heick's observation of the reversible opening of both intra and extracranial arteriovenous shunts. This observation is in line with personal thermographic evidence and that of Lance indicating local hypothermia, and with Wolff's demonstration of dilatation and congestion associated with the superficial temporal artery. Personal dynamographic findings now point to a local extra-intracranial artery pressure gradient as the cause of the peripheral component of lateralisation in cluster headache.
Research has already been conducted into complement, immunoglobulin, and immune complexes with regard to analogies with allergy mechanisms (in the case of dietary headaches) or with vasculitic alterations. The results showed no complement activation or variation in the immunoglobulin of migraine sufferers during healthy intervals and migraine attacks that in any way support an involvement of the immune system in the pathogenesis of common migraine.
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Headache of muscle tension origin and/or with a muscle tension component is underlain by a high degree of head, neck, and face muscle contraction. Biofeedback EMG enables patients to check their muscle tension, and thus achieve complete decontraction. Reference is made to a series of 59 subjects divided in 4 groups in accordance with the number of sessions needed to obtain decontraction. It was found that no relation exists between such number and the degree of improvement obtained. On the other hand, it was not possible to determine whether a relation exists between the moment in which decontraction is achieved and the commencement of an improvement in the symptomatology.
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"In vitro" experiments carried out by us and partially published have resulted in significant data concerning the contracting activity of migraineurs sera on extracranial animal arteries. In the present study, human and animal arteries (superficial temporal) were tested by means of blood samples taken under identical conditions. No contracting activity from sera taken both in the headache-free period and during the migraine crisis was observed in animal arteries. By contrast, sera obtained in the pre-attack and post-onset stages showed a synergistic effect not only on the action of serotonin and histamine but also on that of norepinephrine. This synergism increases with the worsening of the migraine attack while it decreases as soon as the attack wears off. Other experiments on human specimens provided data which cannot be evaluated yet. There is evidence that, on the occasion of the migraine attack, vasoactive substances which enable isolated organs to contract "in vitro" are released or activated. Moreover, an activity raises in sera which interferes with the other mediators on extracranial arteries.
Six children who had benign cutaneous vascular lesions characterized by papillary or solid proliferation of the endothelial cells were seen in a 16-year period. In five of them, the lesions had the histologic features of the entity originally described by Masson and recently reported by Clearkin and Enzinger as intravascular papillary endothelial hyperplasia. In one of the five, the lesion appeared in the pure form within large vascular spaces, whereas in the remaining four it appeared as a very limited focal change in a hematoma. The authors agree with others that this lesion represents a peculiar variant of an organizing thrombus. The histologic features of the lesion in the sixth patient were compatible with the so-called "intravenous atypical vascular proliferation," another pseudomalignant vascular disorder recently described by Rosai and Akerman.
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The best results in the prevention of migraine have so far been obtained with tricyclic antihistamine, anti-5HT drugs. Experimentation of dimethothiazine--already widely employed in the management of essential headache--in this field is reported. Results obtained in a double-blind trial with a placebo on randomised levels and on a large series evaluated with Pearson's scatter index showed that the drug was effective, especially in the prevention of classic migraine. It was also usuable during attacks and in the prevention of cluster headache. Good tolerance and the absence of side-effects suggest the adoption of a standard course of 60 mg/day for not less than 2 to 3-4 months. Other therapeutic courses may be alternated during the year.