Headache
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Clinical Trial
Nociceptive blink reflex and visual evoked potential habituations are correlated in migraine.
Lack of habituation, as reported in migraine patients between attacks for evoked cortical responses, was also recently found for the nociceptive blink reflex (nBR) mediated by brainstem neurons. It is not known if both brain stem and cortical habituation deficits are correlated in the same patient, which would favor a common underlying mechanism. ⋯ The positive correlation between visual evoked potential and nBR habituations is consistent with the idea that in migraine the same neurobiological dysfunction might be responsible for the habituation deficit both in cortex and brain stem. As nBR habituation increases with attack frequency, its interictal deficit is unlikely to be due to trigeminal sensitization.
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The aim of this study was to assess the prevalence of significant traumatic stressors and post-traumatic stress disorder (PTSD) symptoms in a headache population. ⋯ Exposure to traumatic events in patients with a primary diagnosis of recurrent headaches is similar to that reported for chronic masticatory muscle pain patients or nonpatient populations. However, symptoms consistent with a diagnosis of current PTSD appear to be more frequent in patients with recurrent headaches than reported in the scientific literature printed in English for nonpatient populations. Screening for PTSD symptomatology is recommended as part of the routine clinical evaluation of headache.
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To investigate the habituation response pattern of patients with migraine to a simple standard stressor and to a more complex performance-dependent (achievement) stressor in three peripheral systems (electrodermal, vasomotor, and cardiovascular). We hypothesized that the migraine patients would show abnormal habituation in these peripheral systems, especially in response to achievement stimuli. ⋯ Our results suggest that the mental arithmetic (achievement) habituation paradigm is an important tool for demonstrating reduced habituation in several specific components of the autonomic nervous system. Further research is needed to target the covariance of central and autonomic nervous system habituation phenomena in migraine.
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Case Reports
Recurrent syncope, hypotension, asthma, and migraine with aura: role of metoclopramide.
Migraine associated with asthma or symptomatic orthostatic hypotension is a particularly difficult subgroup to manage. Metoclopramide is a useful pharmacological agent for orthostatic hypotension. I present the case report of a migraine patient with asthma and recurrent hypotensive syncope. ⋯ Metoclopramide has a striking influence on arginine vasopressin (AVP) secretion. AVP promotes antinociception and influences vasomotor and behavior control, which actions possibly keep migraine in remission. Further studies are necessary to confirm the migraine prophylactic value of metoclopramide.