1/32. Can migraine damage the inner ear?BACKGROUND: Auditory and vestibular symptoms and signs are common in patients with migraine, yet little is known about the pathogenesis of these symptoms and signs. OBJECTIVE: To perform clinicopathological correlation in a patient with migraine, sudden deafness, and delayed endolymphatic hydrops. methods: A patient with long-standing migraine with aura developed sudden hearing loss in the left ear at the age of 50 years and meniere disease on the right side at age 73. At age 76, he had a flurry of sudden drop attacks typical of otolithic crisis. He died of unrelated causes at age 81. The brain and temporal bones were removed approximately 24 hours after death. The cochlea and vestibular end organs were dissected after the surrounding bone was carefully removed. RESULTS: The brain and cerebrovasculature were normal. The left cochlea showed prominent fibrosis consistent with an old infarction. The right inner ear showed hydrops, with relatively good preservation of the hair cells in the cochlea, saccular macule, and cristae of the semicircular canals. However, the utricular macule was denuded of hair cells. CONCLUSIONS: The sudden left-sided deafness likely resulted from ischemia, possibly due to migraine-associated vasospasm. Presumably, the right ear suffered only minimal damage when the patient was 50 years old, but this damage later led to the development of delayed endolymphatic hydrops on the right. Otolithic crises are thought to result from pressure changes across the utricular macule. We speculate that loss of hair cells in the utricular macule resulted from a collapse of the utricular membrane onto the macule.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/32. Successful use of propranolol in migraine associated with electroconvulsive therapy.To date, there have been no reports on the use of propranolol in electroconvulsive therapy (ECT)-induced migraine; we describe a 32-year-old woman who was successfully treated with propranolol for this condition. Over a course of ECT, the patient developed increasingly severe migraine which was refractory to treatment with acetaminophen, codeine, and naproxen. sumatriptan did not relieve the headache and aggravated the nausea. Successful migraine relief was achieved with a combination of propranolol and naproxen, administered before and after ECT. propranolol reduced blood pressure and decreased the heart rate, measured before and immediately after ECT. propranolol, possibly in combination with naproxen, may be useful in both acute and prophylactic treatment of post-ECT migraine.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/32. Fatal cardiac arrhythmia after oral sumatriptan.Typically, 3% to 5% of patients experience sensations of heaviness, pressure, and tightness in the chest after administration of sumatriptan, but there is little ECG evidence of ischemia. The serious cardiovascular incidents after consuming sumatriptan have been associated mostly with the subcutaneous dosage form of this drug and with patients with underlying cardiovascular risk factors. We report a case of fatal cardiac arrhythmia in an otherwise perfectly healthy patient with migraine after consuming a single 100-mg dose of oral sumatriptan.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/32. Computerized tomography-guided epidural blood patch in the treatment of spontaneous low cerebrospinal fluid pressure headache.A 54-year-old woman suffering from migraine for 35 years was referred to the pain clinic with a changed pattern of headache that had developed over the last 6 weeks. The pain was located in the central forehead region; aggravation in the prone and immediate relief in the supine position led to the hypothesis of a spontaneous low cerebrospinal fluid (CSF) pressure headache. Cisternography revealed a cyst-like formation in the cervico-thoracic region, indicating cerebrospinal fluid leakage. magnetic resonance imaging (MRI) myelography confirmed ventral leakage but failed to locate the exact site. Computerized tomography (CT)-guided epidural blood patching between T1 and T2 completely relieved the headache.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
5/32. A spectrum of exertional headaches.Headaches that have an explosive onset with exercise, including sexual activity, generally are benign in origin. A subarachnoid hemorrhage, a mass lesion in the brain, or an anomaly of the posterior fossa must be considered, however. The mechanisms that produce sexually induced or cough headaches of abrupt onset are unknown. It is known, however, that a rapid increase in intrathoracic pressure suddenly reduces right atrial pressure and presumably decreases venous sinus drainage from the brain. This situation results in a transient increase in intracranial pressure. jaw pain that occurs with chewing often is considered to be TMJ dysfunction when arthritic in quality and if subluxations of the jaw can be shown on the physical examination. giant cell arteritis and common or external carotid artery occlusive disease should be considered when the pain is ischemic in quality. An anginal equivalent is another possibility. Headaches that worsen with vigorous exercise are commonly migrainous. When their onset is apoplectic with exertion (particularly exertion against a closed glottis), the most likely diagnoses are increased intracranial pressure, a posterior fossa abnormality, or benign exertional headaches. Most cardiac induced headaches, but not all, are of a more gradual onset. If there are significant risk factors for coronary artery disease, an exercise stress test is appropriate. A therapeutic trial of nitroglycerin may help to establish a diagnosis if it improves the headache. Using antimigraine drugs as a diagnostic test is inappropriate because triptans and ergots are contraindicated in the presence of coronary artery disease, and a positive response is not diagnostic of migraine.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
6/32. Hemicrania continua in african americans.OBJECTIVE: The first six cases of hemicrania continua and episodica in african americans are reported, differences from previous accounts noted, and important diagnostic features described. BACKGROUND: Hemicrania continua is an indomethacin responsive chronic daily headache. Mild to moderate daily headache is strictly unilateral, constant but fluctuating. Superimposed severe headache attacks occur, last seconds to days, and are associated with ipsilateral orbital-nasal autonomic dysfunction. RESULTS: Severe headache attacks are usually pulsatile, occur one to four times daily, and last 40 minutes to three days. Daily unilateral background headache was typically of a pressure, sharp, dull or pulling quality. Ipsilateral orbital-nasal autonomic symptoms were noted in all. Serious concomitant medical illnesses, e.g. coronary artery disease, diabetes, and hypertension, were frequent in this population. CONCLUSIONS: This is the first report of hemicrania continua and episodica in african americans and the second in persons of African descent in the world's literature. Late age of onset, frequent serious medical illnesses, and family history of migraine differentiate this series from previous reports. The lack of reports in african americans most likely reflects misdiagnosis rather than true prevalence. Thus, whenever any patient presents with chronic daily unilateral headache, ipsilateral autonomic symptoms should be assessed during severe headache attacks, and an indomethacin trial considered.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/32. Reversible conduction block in human ischemic neuropathy after ergotamine abuse.Conduction block [a significant reduction in compound muscle action potential (CMAP) amplitude after proximal compared to distal stimulation] is often found in demyelinating neuropathies, including inflammatory neuropathies and degenerative neuropathies, such as "liability to pressure neuropathy." There is experimental evidence that a transient conduction block can occur in rats after ischemic lesions of peripheral nerves are induced either by ligation of arterial vessels supplying nerve trunks, or by injection of arachidonic acid into peripheral arterial vessels. Conduction block has also recently been described in cases with necrotizing vasculitis. To date, however, no example of a reversible conduction block has been reported in human ischemic neuropathy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/32. Efficacy of candesartan in the treatment of migraine in hypertensive patients.Triptans are usually administered for migraine, but cannot be given to patients with malfunctioning cardiac or cerebral vascular systems, which commonly accompany hypertension. This article focuses on 8 cases in which treatment with candesartan was successful in reducing both the incidence and severity of headache in hypertensive patients with migraine. The cases reported in this article showed a mean improvement in Migraine Disability Assessment score from 29.4 to 9 points and in blood pressure from 154.9/90.4 to 129.5/81.9mmHg, suggesting that candesartan is an extremely attractive option for the treatment of migraine. Although recent studies have reported the efficacy of candesartan for treating migraine, there has been no description of its potential advantages over other prophylactic drugs. The present study included patients who could not tolerate triptans for whom triptans were contraindicated, several patients for whom other migraine prophylactic drugs showed little or no effect, and one patient for whom candesartan was prescribed initially for hypertension, but was also found to be therapeutic for migraines. Thus candesartan is considered to be a unique, attractive choice of prophylactic agent for migraine complicated by hypertension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/32. Referred cutaneous allodynia in a migraine patient without simultaneous headache.Cutaneous allodynia has been described in migraine. We report on a 39-year-old woman with migraine with aura who had cutaneous allodynia to both dynamic (brush) and static (pressure) mechanical stimulation between attacks. For both sensory modalities, the evoked pain on allodynia testing was located to the right frontal area (the location of her usual migraine headache), contralaterally to the stimulated skin area. There was no allodynia when the right frontal area was stimulated directly. We suggest the term 'referred allodynia' for this phenomenon and discuss possible mechanisms for its occurrence.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/32. Ear acupuncture in the control of migraine pain: selecting the right acupoints by the "needle-contact test".There is increasing evidence that somatic acupuncture can be helpful in migraine treatment, but substantial data on ear acupuncture (EAP) are still lacking. EAP can be useful both in the diagnosis and in the treatment of many medical conditions. As regards the control of migrainous pain, we present a case report in which a procedure called the "needle-contact test" is described in detail. During a migraine attack, the patient undergoes an accurate search for tender points of the outer ear by means of a specific pressure algometer. Once the most sensitive point has been identified, an acupuncture needle is placed in contact with it for about 10 s, without skin penetration. The expected effect is a quick and evident reduction of acute pain. If no appreciable variation in pain intensity occurs within the following 60 s, a second or third attempt is made on other previously identified tender points, until the point at which the patient notices a clear remission of pain is found. In this positive case, the same testing needle can be immediately used for therapy, completely penetrating the skin, and then extracted after about 30 min. Alternatively, a temporary needle can be implanted and left in situ for a variable period of time (1-15 days). This innovative technique allows the identification, with maximum accuracy, of the most effective ear acupoints on migraine pain during acute attacks.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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