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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Serotonin (5-HT) plays a crucial role in mediating the descending pain inhibitory systems and in the pathophysiology of migraine. Previous studies regarding the use of 5-Hydroxytryptophan (5-HTP), the active precursor of 5-HT, in the treatment of Chronic Primary Headache (CPH) have been inconclusive so far. In order to assess the efficacy of the serotonin active precursor in chronic headache prophylaxis, a double-blind cross-over study has been carried out in 31 patients with CPH, comparing L-5-HTP to placebo. Clinical syndromes included: (a) migraine (16 patients); (b) mixed headache (6 patients); (c) psychogenic headache (5 patients); (d) muscle contraction headache (4 patients). L-5-HTP was administered for two months at daily doses of 400 mg p.o. The reduction in severity and frequency of headache in patients taking the active drug and placebo was noted. Mood patterns were also taken into consideration. L-5-HTP proved to be more effective than placebo in reducing both headache frequency and severity, but the difference was not statistically significant. Favourable responses (greater than 50% average reduction in headache symptoms) were obtained in 48% of the cases after the second month of treatment. No significant difference in therapeutic response was observed as related to different clinical syndromes, except for psychogenic headache patients, who responded poorly to the active drug. Side effects, experienced in 19% of the cases, were generally mild and transient. We conclude that L-5-HTP is a medication of moderate efficacy and remarkable safety, providing us with another alternative approach to CPH prophylaxis.
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PMID:Serotonin precursors in chronic primary headache. A double-blind cross-over study with L-5-hydroxytryptophan vs. placebo. 391 52

Headache has been documented as the reason for approximately 18 million office visits per year in the United States, and may be the most prevalent central nervous system condition for which patients consult doctors. The author presents an overview of the literature on classification, causes, and treatment of headache, including uncertainties about diagnostic criteria for migraine and about differentiation of migraine from muscle contraction headache. He discusses treatment of headache in relation to management of the acute attack, avoidance of trigger factors, and pharmacological and nonpharmacological prophylaxis.
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PMID:An overview of the classification, causes, and treatment of headache. 636 59

The speculative efforts of the scientists who research the atavistic enigma of the "spontaneous" aches which affect the head, nuc and neck of a great number of people, seem to be driven by the conviction that they are faced with a systemic autonomic illness rather than a local one. Pain is an obligatory phenomenon which dominates this ailment, and is more or less patently paralleled by a constellation of autonomic functions such as nausea, vomiting, vaso-constrictor dilation and arterial hypotension. An analogous vegetative constellation emerges at "cascades", that is, a stereotypical succession, following upon intense physiological (induced) pain. In a migraine attack, the autonomic hyperfunctions are the same in quality but their chronology is completely disrupted: the usual vegetative "cascade" being deeply perverted. In spite of concentric assaults by clinicians, biologists, rhythmologists and psychologists this species of medical sphynx has remained throughout the centuries. The core of the dilemma is in essence the following: are we dealing with a physiological or a pathological pain? The former (physiological pain) should be symptomatic of vascular (migraine) or psychic (muscle contraction headache) disorder; the latter (pathological) should be symptomatic of a malfunctioning of the nociceptor system.
Cephalalgia 1983 Aug
PMID:Concluding remarks on the Capri symposium: myths, facts and new trends in migraine. 661 7

The epidemiological and clinical profile of Chronic Post-Traumatic Headache (CPTH) has been studied in 57 out of 130 consecutive patients hospitalized, following closed head injuries, at the Institute of Neurosurgery of the University of Milan. The incidence of CPTH has been 44%. Age of the patients ranged between 4 and 69 years. Clinical pictures included closed head injuries of different degree of severity: mild, moderate and severe. Time of onset, headache frequency, character, intensity, duration and associated symptoms showed a great degree of variability. However, chronic muscle contraction headache was the commonest clinical syndrome followed by migraine. Moderate correlations have been found between the severity of CPTH disturbance of consciousness, following the head trauma, and positive findings at CT scan. Moreover the comparison of personality profiles (MMPI) of CPTH (n=26) with a post-traumatic control group, without headache (n=17) showed higher scores on hypocondriasis, depression, hysteria and schizophrenia scales only in the severe CPTH group. Age of the patients, duration of unconsciousness, neurological deficits, course length and pending litigation or compensations were unrelated to the occurrence and outcome of CPTH. These findings suggest the importance of both physical and psychological determinants (social or emotional maladjustment) in the pathogenesis of CPTH.
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PMID:Chronic post-traumatic headache: clinical, psychopathological features and outcome determinants. 666 50

A comparison of hypnotic analgesia, frontalis electromyographic feedback, and frontalis electromyographic feedback in conjunction with Jacobson progressive relaxation for treating chronic prefrontal muscle contraction headache was done. There were four 1-hour treatment sessions for each type, and a follow-up. Measures were the number of headache hours per week, a subjective estimate of pain intensity, and an objective ratio of pain intensity found by using the submaximum tourniquet technique. No significant differences were found between treatments on these dependent measures, although all produced significant change in the desired direction. The current study utilized 48 patients with chronic prefrontal headache, and was performed in a clinical situation. Certain responses to the Headache Questionnaire used in screening were significantly correlated with improvement in headache. The current study controlled for class of medication the patient may have been taking for headache, thereby giving a more realistic assessment of the effectiveness of psychological treatments in a clinic.
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PMID:A comparison of treatments for prefrontal muscle contraction headache. 698 90

Biofeedback has proven effective in treatment of vascular and muscle contraction headache. However, many factors have not yet been explored. Research into personality and psychologic aspects that can predict success or failure with biofeedback is necessary, as is research into the applicability of skills learned in the laboratory to nonlaboratory situations. The possibility of symptom substitution should be investigated, and the problem of using study volunteers who do not adequately represent the headache population must be dealt with. Biofeedback represents a significant step forward in control of migraine and muscle contraction headache. Further experience with biofeedback techniques is necessary, but the future seems to promise continued success with this new method of treatment.
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PMID:Biofeedback for headache. 704 36

Oral function was evaluated in a group of 13 patients with muscle contraction headache (MCH), 7 patients with common migraine (CM) and 18 patients with 'combination headache' (CM + MCH) and in a control group of 25 normal persons who had never had a headache. Malocclusion and loss of molars were rare in both groups. Impaired denture function and joint disturbances were more frequent in the headache patients but not significantly so. Clenching and grinding teeth and tongue pressure were all significantly more common in headache patients. Tenderness of pericranial muscles was present in all headache patients with severity increasing in the order CM, MCH, CM + MCH; it was absent in all the controls. On the average 9 tender spots were found per patient. Pressure on tender spots evoked pain in other areas (referred pain) in 29 of 38 headache patients. The abnormal tonic hyperactivity in the masticatory muscles and the neck may be the cause of tenderness which again may be an important source of pain in these patients.
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PMID:Evaluation of pericranial tenderness and oral function in patients with common migraine, muscle contraction headache and 'combination headache'. 704 8

This study investigated the effects of three types of laboratory stressors (stressful imagery, mental arithmetic, pain) on temporal artery, skeletal muscle, general autonomic [digital blood volume pulse (DBVP), spontaneous resistance responses (SRR's)] and self-report measures of distress in chronic migraine, mixed, muscle contraction and non-headache controls. All subjects were female, free of medication at time of testing and equated for age. Headache subjects reported a 19 year history of headache. Results revealed a pattern of digital BVP (constriction), SSR's (increase) and frontal EMG (increase) indicative of a general autonomic-skeletal muscle arousal response to all three stressors in all groups, while the temporal artery response to the pain stimulus was vasodilation. Distress ratings were elevated during the stress periods for all four group. Pain threshold and tolerance and the tendency to utilize cognitive coping strategies during exposure to pain did not differ across the four groups. The results do not support the general autonomic dysfunction theory of migraine or the specificity hypothesis implicating an overreactive temporal artery or skeletal muscle response to stress in migraine and muscle contraction headache, respectively. Despite epidemiological research supporting the stress-headache relationship, the present results indicate that the psychophysiological mechanism underlying this relationship does not appear to involve abnormal tonic levels or phasic response to stress. It is argued that the temporal artery dilation response to pain questions the role of stress in triggering the two stage vasoconstriction-dilation mechanism of migraine and suggests the need to evaluate a four stage model as a potential psychophysiological mechanism underlying the stress-headache relationship.
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PMID:Stress and chronic headache: a psychophysiological analysis of mechanisms. 707 48

Long-term follow-up evidence for biofeedback treatment of headaches, Raynaud's disease, essential hypertension, and the irritable bowel syndrome was reviewed. Acknowledging the difficulties with cross-study comparisons, the following general success rate were determined: primary idiopathic Raynaud's disease--70%, or better; vascular headache--70%, or better; mixed headache--about 60%; and muscle contraction headache--50%, or less. With relatively fewer patients, successful outcomes with the irritable bowel syndrome and secondary Raynaud's phenomenon were roughly 60% and 40%, respectively. Few cases of clinically significant long-term decreases in diastolic blood pressure were demonstrated; however, the need for medication was reduced or eliminated in some patients. There were indications that biofeedback combined with psychotherapy resulted in highest success rates. No differences were found in effectiveness between biofeedback, other relaxation techniques, and biofeedback in combination with relaxation techniques--all had essentially comparable rates of success. No correlations between physiological and psychological measures of condition at follow-up were reported. Implications and interpretations of these findings are discussed.
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PMID:Biofeedback treatment for headaches, Raynaud's disease, essential hypertension, and irritable bowel syndrome: a review of the long-term follow-up literature. 716 83

Histamine, 0.16, 0.33 and 0.66 microgram/kg/min, was infused intravenously to 13 normal non-headache-prone volunteers, 10 patients with chronic muscle contraction headache and 25 patients with common migraine. In the normal group no patients developed pulsating headache. In the migraine group 13 patients developed severe, 9 patients moderate and 2 patients mild pulsating headache, and only 1 patient failed to develop headache at all. The muscle contraction headache patients responded intermediately. At each infusion rate the headache was of constant quality and severity as long as the infusion continued, but disappeared shortly after its termination. Injection of an H1 blocking agent, mepyramine, almost immediately abolished the headache. The H2 blocker cimetidine was much less effective, but still significantly better than placebo. The i.v. histamine infusion test is a useful model for the study of experimental vascular headache.
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PMID:Headache provocation by continuous intravenous infusion of histamine. Clinical results and receptor mechanisms. 740 88


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