Humoral and hormonal changes in menstrual migraine.
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Biomedical subjects
Publications and source records attributed to G Nattero.
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A biological preparation containing 110a-130a polypeptide fractions with recently discovered antiserotonin and anti-bradykinin activity was employed in the prevention of migraine crises. The overall results were good in trials both versus placebo and using various doses and periods of treatment. Crises were even prevented in a case of cluster headache. Treatment with standard courses giving high doses concentrated in time was apparently successful in antagonising serotonin and bradykinin action on peripheral receptors.
This work is an attempt to find an answer to the question: once arrived at the diagnostic identification of a certain type of idiopathic headache, which treatment should be followed? On the basis of recent researches and experience acquired during ten years' activity of our Headache Unit, a diagnostic identification can be made for migraine (in all its types and evolution stages), cluster headache, tension headache and pure psycogenic headache. Among the most widely used drugs, positive pharmacological results were obtained with: cyproheptadine, pizotifen, cinnarizine, lysergic acid derivatives, histamine, reserpine, clonidine and a barbituric acid derivative. The therapeutic cycles were standardized, for each drug, in the way of administration, dosage and total duration of the treatment. A comparison between the data obtained and the pre-therapeutic situation was made. When repeated, the most efficacious therapeutic cycle was evaluated. According to Pearson's dispersion index, each group of patients improved respresents 16.68% of the expected total results (frequency of attacks reduced to 50%, 25% and 0%): for cyproheptadine, pizotifen, methysergide, histamine, clonidine and allil-propyl-malonylurea, the "p" is less than 0.001; for cinnarizine, less than 0.02. This "a posteriori" analysis does not take into account the placebo control, the "anticipation effect", and the "carry over effect". It cannot therefore be a comparison of efficacy among the various drugs. An evaluation based on "among patients" and "inside patient" method by means of the cross over system, can instead give some useful suggestion about which treatment is to be recommended to patients suffering from recurrent headaches. With regard to migraine sufferers: cinnarizine, cyproheptadine, clonidine, histamine, pizotifen und reserpine. For cluster headaches: cinnarizine, cyproheptadine, clonidine, histamine and reserpine. For tension headaches: cyproheptadine. For pure psychogenic headache: allyl-propyl-malonylurea. For migraine attacks or parossystic crises in the course of ondulating or continuous headaches, positive therapeutic results, statistically significant, were obtained with an association of indomethacin, caffeine and prochlorperazine.
The problem of headache classification is still open. As a mention of all the attempts to classification is not possible, the Author proposes the scheme of work adopted at Turin Headache Unit (referring himself to the best known classifications). The most important idiopathic headaches are described and it is also suggested that they should be kept separated, one from the other, at least up to now. This criterium makes also easier their differential diagnosis from other head pains. Anyway, is has to be emphasized the actual tendency to group together an ever larger amount of headache types.
The results of many researches on migraine pathogenesis and our knowledge of the pharmacological action of reserpine led us to start using it in migraine prophylaxis ten years ago. For this purpose, standardized cycles of twenty administrations--heach dose being of 0.20 mg--were given intravenously; each cycle lasted a period of six to eight weeks. The positive data obtained on 300 patients suffering from severe migraine resulted statistically significant. Then, a double-blind clinical trial was carried out in Turin in agreement with a double-blind biochemical trial carried out in Copenhagen by Fog-Møller, Dalsgaard-Nielsen, Byrndum and Kemp Genefke. The results obtained have confirmed the efficacy of reserpine administered in appropriate doses and enabled the demonstration of its pharmacological mechanism. The results obtained also in "tension-vascular headache" with reserpine treatment were reviewed retrospectively and were highly significant.
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The aim of the present report is to study comparatively the biosynthesis of testosterone in normal and autoimmune rabbit testes, with different degrees of histological lesion, by in vitro double tracer incubation experiments. For this purpose (3H)-pregnenolone and (14C)-progesterone were used as precursors in the presence of testicular homogenates from both groups of animals. In the autoimmune animals, an impairment in the biotransformation of the precursors leading to a lesser synthesis of testosterone was demonstrated. An accumulation of dehydroepiandrosterone, 17 alpha-hydroxyprogesterone and androstenedione was frequently found. It was also shown that the metabolic impairment seemed to be produced at an earlier stage than the histological modifications. On the other hand, a correlation between the degree of testicular damage and the intensity of metabolic impairment could not be demonstrated conclusively.
According to Pearson's method (correlation coefficient) the group of improved patients is 16.88% of the expected total result (frequency of attacks regressed to 50%, 25% or 0%): for cyproheptadine, pizotifene, methysergide, methergoline, histamine, clonidine, allylpropylmalonyl urea 'p' is less than 0.001, for cinnarizine less than 0.02. For hemicrania we used cinnarizine, cyproheptadine, clonidine, histamine, pizotifene and reserpine; for cluster headache, cinnarizine, cyproheptadine, clonidine, histamine and reserpine; for tension headache, cyproheptadine; for psychogenic headache, allylpropylmalonylurea. In attacks of hemicrania or paroxysmal crises with undulant headache or persistent headache, positive statistically significant results were obtained with a combination of indomethacin, prochlorperazine and caffeine.
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