Cephalalgia : an international journal of headache
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A dysbalance of the cerebrovascular response during functional activation of the brain has been postulated as a factor in the pathophysiology of migraine. To determine the dynamic pattern of the cerebrovascular response in migraineurs compared with a control group, changes of the cerebral perfusion during cerebral activation were studied with high temporal resolution by functional transcranial Doppler sonography (fTCD). The cerebral blood flow velocity (CBFV) in the right posterior cerebral artery (PCA) and the left middle cerebral artery (MCA) was measured simultaneously during visual stimulation in 19 interictal migraineurs and in 19 age- and sex-matched control subjects. ⋯ In the PCA, compared with normal subjects, migraineurs showed significantly (P < or = 0.05) stronger CBFV changes at the beginning and after the end of stimulation, with a slower decline to baseline. Data are in accordance with electrophysiological findings in migraineurs. It is assumed that a lack of habituation of the cerebrovascular response in migraineurs might contribute to a disturbance of the metabolic homeostasis of the brain that might induce migraine attacks.
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Headache is one of the most commonly encountered neurologically related complaints in HIV patients. The authors review the relationship between HIV infection and headache and discuss the role of neuroimaging in this select patient group.
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Comparative Study
Pain thresholds and tenderness in neck and head following acute whiplash injury: a prospective study.
OBJECTIVE OF THE INVESTIGATION: In a 6-month prospective study of 141 consecutive acute whiplash-injured participants, and 40 acute, ankle-injured controls, pain and tenderness in the neck/head, and at a distant control site, were measured. ⋯ Focal, but not generalized, sensitization to musculoskeletal structure is present until 3 months, but not 6 months, after whiplash injury, and probably does not play a major role in the development of late whiplash syndrome. Pressure algometry and palpation are useful clinical tools in the evaluation of neck and jaw pain in acute whiplash injury.
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In a large-scale study of headache epidemiology in Vågå, Norway, 1838 adult parishioners(18--65 years of age) were examined, and this represents 88.6% of the target group. Jabs and jolts syndrome/idiopathic stabbing headache (ISH) was verified in 35.2% of the questioned parishioners. This prevalence is much higher than previously observed ones. ⋯ The ratio, 1.49, also differs clearly from a previously observed one: 6.6 (P-value = 0.0003, Fisher's exact test). Control studies included blinded re-check of 100 work-ups, with complete concurrence (kappa-value of 1.00 and blinded re-check of 41 individuals (kapp value of 0.841). Jabs and jolts/ISH are frequent and almost the sole shortlasting (generally < 3 s duration) cephalic paroxysms.
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We conducted a population-based headache questionnaire survey including questions on physician consultation for headache in Taipei, Taiwan from August 1997 to June 1998. The participants comprised 3377 subjects aged > or = 15 years, of whom 328 (9.7%) had a diagnosis of migraine and 1754 (52%) had a diagnosis of non-migraine headache. Migraineurs had a higher physician consultation rate (once or more in the past year) than the subjects with non-migraine headache (54% vs. 31%, P < 0.0001). ⋯ In addition to old age, low education levels, living in a rural area, migrainous features (nausea and photophobia), and work day loss, predictors of physician consultations also included 'having been troubled with headache' (odds ratio (OR) = 1.7) and co-morbidity with hypertension (OR = 1.8) or heart disease (OR = 2.2). Low copayment and unrestricted access to medical care, as well as cultural factors played an important role in the high consultation rates in our headache subjects. Moreover, this study found self-perception of headache impact and co-morbid illnesses were important factors affecting the decision to consult physicians about headache.