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Biomedical subjects

V Pfaffenrath

Publications and source records attributed to V Pfaffenrath.

At least 73 records · Page 4Linked to original sources
PubMed1988

[Drug therapy of migraine].

Out of the knowledge of various headache syndromes the physician has to develop a clear diagnostical and therapeutical concept. This is especially true for migraine. Relevant pathophysiological hypotheses are presented e.g. the neurogenic-vascular model of migraine. Metoclopramide and domperidone in combination with mono-analgesics, ergotamine and nonsteroidal-antiinflammatory drugs are favoured in the treatment of the acute migraine attack. 2 to 4 mg ergotamine for the attack, respectively 16 to 20 mg per month should not be exceeded. Mixed compounds, containing ergots, analgesics, codeine, caffeine, tranquilizers and barbiturates should be avoided as these drugs may induce rebound-headache. A prophylaxis of migraine is indicated if a migraineur suffers from at least 2 attacks per month or if a migraine attack lasts longer than 4 days. In the first place, beta-blockers and flunarizine, in some cases verapamil or naproxen, should be used; the effect of dihydroergotamine is questionable. Because of its severe side effects, methysergide should only be given if all other prophylactic drugs fail. Naproxen is standard medication in the short time prophylaxis of menstrual migraine.

Adrenergic beta-Antagonists↗
PubMed1988

Cervicogenic headache: results of computer-based measurements of cervical spine mobility in 15 patients.

Head and neck pain are often attributed to impaired mobility of the cervical spine. No established methods exist to examine such an impaired mobility objectively in patients with cervicogenic headache. Therefore, functional roentgenograms of the cervical spine in maximum ventral and dorsal flexion were analyzed in 15 patients with cervicogenic headache and in 18 controls. Qualitative radiologic evaluation showed no significant differences in either group. A computer-based technique to assess the mobility of the cervical spine demonstrated a statistically pronounced hypomobility of the craniocervical joints C0/C2 and an impaired overall mobility of the upper cervical spine (C0-C5) in the cervicogenic headache group. The most evident hypomotility was found in segment C0/C1. Interesting was, furthermore, a probably compensatory hypermotility in segment C6/C7. These findings did not correlate with the results of the qualitative radiologic evaluation.

Adult↗
PubMed1988

[Tension headache--a review].

Tension headache (TH) is an ill-defined headache syndrome, characterized by bilateral, daily headaches with fronto-occipital localisation. TH is often accompanied by a migraine and an abuse of analgesics and/or ergotamine. In the etiology of TH vascular, muscular and psychogenic factors are assumed. Floating transitions to common migraine are discussed. The increased muscle tension is not specific for TH, but more probably a consequence of TH. In addition a decrease of the pain threshold with a deficiency of the antinociceptive system is supposed. The efficacy of tricyclic antidepressives in TH is based on potentiation of serotonergic and noradrenergic mechanisms and - besides their analgetic potencies - upon an increase of the pain threshold. TH prophylaxis is indicated if patients suffer from TH more than ten times per month. Medication are tricyclic antidepressives of the amitriptyline-type. Prophylaxis of TH can only be successful if a simultaneous abuse of analgesics and/or ergotamine is discontinued. In addition, EMG-biofeedback, as well as relaxation - and vasoconstriction training might be helpful in specific cases.

Diagnosis, Differential↗
PubMed1987

Mitral valve prolapse and platelet aggregation in patients with hemiplegic and non-hemiplegic migraine.

Migraine and mitral valve prolapse (MVP) share a number of features. Both migraine and MVP show platelet dysfunctions and an increased risk of transient ischemic attacks (TIA) and stroke. There is a strikingly high incidence of migraine among MVP patients. The focal neurological deficits associated with hemiplegic migraine resemble TIA symptoms which may occur in MVP patients. Furthermore, the risk of cerebral infarction in migraineurs is reported to be higher than in the general population. The results of our study with 43 patients suffering from non-hemiplegic migraine (common and classical migraine) and 19 migraineurs with a hemiplegic migraine indicate that hemiplegic migraine is not associated with MVP and increased platelet aggregation more frequently than other migraine forms. Independent of migraine type, there is no difference between patients with and without mitral valve prolapse with respect to platelet dysfunction.

Adolescent↗
PubMed1986

Chronic paroxysmal hemicrania: the first possible bilateral case.

There are three headaches syndromes that are typically characterized by strictly unilateral and always same-sided attacks: cluster headache, "cervicogenic" headache, and chronic paroxysmal hemicrania (CPH). In rare cases, cluster headache also occurs bilaterally; "cervicogenic" headaches probably as well. We present a patient with a probable bilateral CPH. To our knowledge no such case has previously been described.

Aged↗
PubMed1986

Onset of nocturnal attacks of chronic cluster headache in relation to sleep stages.

Nocturnal attacks are symptomatic of numerous primary headache syndromes. It has proven possible to verify, with polygraphic sleep recordings, a strict correlation between the onset of headache attacks and the rapid eye movements (REM) stage for migraineurs, patients with chronic paroxysmal hemicrania and cluster headache (CH). The purpose of this study was to investigate the correlation between attack onset of chronic CH and sleep stages, the REM stage in particular. Nine patients from our headache outpatient service with a diagnosis of CH were examined in this study. All medication was discontinued at least one week prior to sleep polygraphias, which were conducted in a sleep laboratory on two consecutive nights. Any attacks were treated with oxygen inhalation during the drug-free period. EEG, EMG, and EOG were continuously monitored during the sleep polygraphias. Eight patients had 25 CH attacks during 12 of the 17 nights recorded. Only three of these patients had arousals with attacks in the REM stage and these amounted to five of the 25 recorded attacks. Eleven attacks were in stage 2, four in stage 1 and two in stage 3. These results correlate with recent findings according to which headache attacks were often related to REM in episodic CH, but rarely in the chronic type. Whether or not different pathogenic mechanisms are involved in the episodic and the chronic type of CH is a matter for further discussion.

Adult↗
PubMed1986

Combination headache: practical experience with a combination of a beta-blocker and an antidepressive.

In the prophylaxis of migraine beta-blockers are commonly used. In the therapy of tension headache (TH) the use of tricyclic antidepressives is widespread. Therefore, from a rational point of view, one should combine an antidepressive and a beta-blocker in the treatment of combination headache (CH), in which patients have both migraine and TH. In an open uncontrolled study, 61 patients with CH received a combination of an antidepressive (amitriptyline) or amitriptyline-N-oxide and a beta-blocker (propranolol or metoprolol) for at least 3 months. The 61 patients kept a diary in which they recorded frequency and duration of migraine attacks and tension headaches. The median migraine attack frequency decreased in the 3 months from four to two and the mean attack duration per month from 2 to 0.7 days. TH frequency was reduced from a median of 21 days to 6 days; TH duration fell from a median of 21 days to 2.7 days. At first sight, this treatment appears to be highly effective, at least when judged by the results at the group level. Nevertheless, in an open uncontrolled study like this, one must be aware of many problems, which are discussed in detail.

Adult↗
PubMed1985

Functional radiographs of the craniocervical region and the cervical spine. A new computer-aided technique.

Disabilities of the articulations of the head and cervical spine can often be detected only by exact measurement of functional radiographs. From two radiographs, one in flexion and one in extension, not only can the total mobility of the head be measured, but also the mobility of the individual articulations can be evaluated by taking exact measurements of the position of each vertebra. A method for semi-automatic measuring of such pairs of radiographs is presented. Edges and structures of the bones that are clearly visible in both radiographs are digitized on a graphics tablet. Then, by computer program, each vertebra of the first radiograph is shifted and rotated until it fits best to the respective vertebra of the second radiograph. Thus, for each articulation, the mobility angle and the location of the mobility axis relative to the adjacent vertebra, can be computed. First experiences with this method are presented.

Adult↗
PubMed1985

[Migraine and beta blocker. An overview].

Migraine is considered to be a primarily neurogenic disease. In this common headache syndrome beta-blockers are widely used as prophylactic drugs. In the meantime there is evidence for central beta-receptors. The effect of beta-blockers is considered to be based on a reduction of the increased sympathetic tonus and its influence on the intracerebral vessels. Beta-blockers--such as Atenolol, Metoprolol, Nadolol, Pindolol, Propranolol and Timolol which differ according to their intrinsic activity, their selectiv cardiac effects, their membran stabilizing ability, their hydro- or lipophily as well as according to their plasmaprotein binding capacity are used. Therefore, it is more likely that beta-blockers develop their effect through a stabilisation of the intrasynaptic serotonin-level in the serotonergic neurons of the brainstem.

Adrenergic beta-Antagonists↗
PubMed1984

[Chronic paroxysmal hemicrania. A review based on personal cases].

Chronic paroxysmal Hemicrania (CPH) is a headache syndrome first described in 1974. Since then about 60 cases have been reported in the world literature. CPH is characterised by headache attacks occurring daily and always strictly unilaterally. The frequency of the attacks varies from 5 to 30 per 24 hours, the single attack having an usual length of 2 to 30 minutes. The prompt response to indomethacin is the decisive diagnostic criterion of this headache syndrome. The clinical picture, the treatment, some aspects of the pathogenesis and the differential diagnosis of CPH are described by means of case reports. To our knowledge these are the first four cases reported in West Germany.

Adult↗
PubMed1982

[Cluster headache].

Cluster headache is a defined disorder which is often mistaken in spite of its characteristic picture. The different types of cluster headache and their clinical symptoms are reviewed in detail. Predisposing factors, frequency of other medical disorders as well as personal and psychological characteristics are described. The treatment of the attack and the prophylaxis includes ergot alkaloids, methysergide, cortisone, lithium and oxygen. Some aspects of etiology and pathogenesis are discussed.

Adult↗
PubMed1982

Platelet aggregation and multiple sclerosis.

Measurements of blood platelet aggregation were carried out in 30 patients suffering from multiple sclerosis (MS) and in 15 healthy individuals. Compared with the control group, the MS patients showed an increase in both spontaneous and induced (ADP and serotonin) platelet aggregation. The possible pathogenetic significance of these results is discussed.

Adenosine Diphosphate↗
PubMed1981

[Cerebrospinal fluid passage of therapeutic immunoglobulins of the IgG class in infectious inflammatory disease of the CNS].

Immunoglobulins are often used as an optimizing therapy in cases of infectious diseases of the central nervous system. To clarify the question of whether or not an intravenously administered compound of the IgG class is able to penetrate the cerebrospinal fluid barrier despite its high molecular weight, 12 anti-HBs negative patients received 20 ml each of a beta-Propiolacton treated IgG compound with a high anti-HBs titre (1 : 115 000) used as a marker. Four patients having an inconspicuous fluid condition were consulted for control. Five patients were suffering from slight disturbances and three other patients had severe disorders of the blood-cerebrospinal fluid barrier function resulting from inflammatory diseases of the central nervous systems. Cerebrospinal fluid was produced by way of lumbar puncture resp. drainage for the determination of anti-HBs. Simultaneously, the concentration of antibodies in serum was determined. In all patients having barrier disturbances, anti-HBs was evident in the cerebrospinal fluid, the transfer of intravenously administered immunoglobulins to cerebrospinal fluid increasing in correlation with the degree of the barrier disorder. The therapeutical importance of immunoglobulin therapy in treating infections of the central nervous system is pointed out.

Adult↗