Elisabet Waldenlind

Shared rearing environment in migraine: results from twins reared apart and twins reared together.

Background.—Studies of twins who are separated from each other early in life and are reared in different environments offer the opportunity to resolve variation in liability to disease.

Prolactin in Cluster Headache: Diurnal Secretion, Response to Thyrotropin-Releasing Hormone, and Relation to Sex Steroids and Gonadotropins:

The diurnal rhythmicity of serum prolactin (PRL) and the PRL and thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) were studied in 31 cluster headache patients (4 chronic cases) and 14 healthy controls. Sixteen of the patients were studied both during clinical remission and headache periods. In males the nocturnal PRL peak was blunted during remissions as compared with that in cluster periods and that in control individuals. The 24-h mean PRL levels were lower during remission and cluster periods than in the controls. There were no significant differences in the PRL levels between female patients and controls. Headache attacks were often associated with increases of serum PRL levels. The PRL reponse to TRH was lower in the female patients but not in the male patients as compared with controls. The maximum testosterone levels were lower during cluster periods than during clinical remission but not when compared with controls. Serum levels of luteinizing hormone, follicle-stimulating hormone, progesterone, estradiol, T3, T4, and TSH did not differ between patients and controls. The results suggest an altered regulation of PRL secretion not only during active cluster periods but also during symptom-free intervals. The possible influence of sleep, estradiol, testosterone, medication, pain, and serotoninergic and dopaminergic mechanisms are discussed.

Lowered circannual urinary melatonin concentrations in episodic cluster headache

The circannual secretion of melatonin in 14 Swedish and 15 Italian patients suffering from episodic cluster headache was compared with 14 Swedish and 15 Italian healthy controls matched for sex and age. Overnight samples of urine were collected once a month from 8 to 14 months and kept at -20° C until analysed with RIA. The melatonin concentrations in nocturnal urine were permanently low in cluster headache and there was no consistent change of the melatonin concentration in relation to cluster periods occurring during the study. There was no definitive circannual or infraannual rhythmicity of melatonin in patients or controls. Multiple analysis of variance with repeated measurements showed a significant effect of disease (p < 0.05), but not of time. Sex, geographical location, age, and smoking also had significant effects (p < 0.001) on the melatonin concentrations. Lower melatonin levels in cluster headache patients than in controls may in part be related to a larger number of smokers in the patient group. The relation between tobacco use and melatonin should be further studied.

Cluster headache in women: evidence of hypofertility(?) Headaches in relation to menstruation and pregnancy.

Two hundred and forty-nine patients with cluster headache have been studied, 215 male and 34 female (ratio 6.3:1). Twenty-five of the 26 fertile female cluster patients stated that their headaches had no relation to menstrual periods. Eight had had 13 pregnancies since the onset of cluster headache. Six of them experienced remission of their headache during pregnancy. Four women with cluster headache had a history of infertility or premature menopause. Parity rate was low in patients who contracted cluster headache as nulliparae; it was lower than in those who contracted the disease after earlier pregnancy or post menopause, and also significantly lower than in 99 consecutive women with migraine. Significant differences were also found when the numbers of childbirths in the cluster patients were compared with total fertility rates up to successive ages for birth cohorts in the general population of Swedish women (p < 0.01).

Sumatriptan in chronic cluster headache: results of continuous treatment for eleven months

A 32-year-old man received a total of 480 injections of subcutaneous sumatriptan 6 mg for the treatment of acute attacks of chronic cluster headache over an eleven-month period. Over 90% of the attacks resolved within 10 min of treatment (average 6.8 ± 3.4). As a comparison, the average duration of 61 attacks occurring over the same period, but not treated with sumatriptan, was 56.1 ± 20.8 min. This difference was highly significant. There was no clinical evidence of tachyphylaxis, and there were no adverse effects. This is the first report of a long-term treatment of cluster headache with sumatriptan. It is concluded that sumatriptan in this case was an effective and well-tolerated treatment for cluster headache.

Lifetime prevalence and concordance risk of cluster headache in the Swedish twin population

Objective: To examine the lifetime prevalence and the concordance risk of cluster headache (CH) in a twin sample representative of the Swedish general population. Methods: The authors assessed CH as defined by the second edition of the International Classification of Headache Disorders in 31,750 registered twins born from 1935 to 1958. Structured lay screening interviews were followed by neurologist interviews of possible cases. Co-twins of affected index twins were follow-up interviewed regardless of their screening outcome. Results: A total of 250 screening-positives (0.8%) were found, of which 218 (88%) were follow-up interviewed. Forty-five (21%) had the CH diagnosis verified. Among screen-negatives, hospitalization records pointed at two more verified cases and index twins at one more verified case. A total of 48 CH cases provided a crude lifetime prevalence of 151 per 100,000 (95% CI: 108, 194). The male-to-female sex ratio corresponded to 4.8 (95% CI: 2.3, 9.9). The crude lifetime prevalence of CH was higher in the twins born from 1945 to 1958 than in the twins born from 1935 to 1944 (190 vs 90/100,000). CH recurred in 2 of 12 co-twins of monozygous index twins (including 1 nonparticipant twin), whereas all co-twins of 25 dizygous index twins proved to be unaffected. Conclusion: As many as 1 per 500 of the general population are affected by cluster headache. Twin concordance seems low, but genetic factors may play a role for familial clustering.

MR-Angiography During Spontaneous Attacks of Cluster Headache: A Case Report

SYNOPSIS

Migraine and Olfactory Stimuli

Migraine patients often report intolerance to odours. Migraineurs report odours may trigger attacks, that they experience osmophobia during attacks, and olfactory hypersensitivity between attacks. In this paper we discuss olfactory mechanisms in migraine. We also present data from a pilot questionnaire study in a group of young women diagnosed with migraine. The study results confirm that hypersensitivity to odour is a common feature in women with migraine. Migraine pathophysiology likely explains this particular vulnerability. We discuss these pathophysiologic mechanisms and hypotheses relating odour intolerances and migraine.

Retro-Gasserian Glycerol Injection in the Treatment of Chronic Cluster Headache

Seven therapy-resistant patients with cluster headache (six of whom were chronic) were treated by percutaneous retro-Gasserian glycerol injections under general anesthesia. In four of the patients immediate and complete relief of attacks was obtained. There was a close correlation between pain relief and the degree of ophthalmic sensory loss. Quantitative estimation of thresholds for thermal perception and pain showed a good correlation to clinically evaluated sensory loss. As the analgesia waned, headaches returned, and the glycerol injections had to be repeated. Two patients were still considerably improved after 5 1/2 and nearly 3 years, respectively. In the other patients the results were less satisfactory at long-term follow-up study. Pure glycerol is highly hypertonic, and the damage of the trigeminal nerve root may be due to this property.

Headache and mood: A time‐series analysis of self‐ratings

Self-ratings with respect to headache and five mood dimensions were obtained twice daily from five patients suffering from migraine and six patients suffering from muscle-contraction headache during a mean period of 47.9 days (range: 38–61). The data were analysed by multiple regression, with the rated headache as dependent variable. Different time intervals between measurement of the independent variables and measurement of the dependent variable were used. A significant time-dependent relation was found between the migraine ratings and the alertness ratings. Significant time-dependent relations were also found between rated muscle-contraction headache and rated anger and alertness, respectively, but the trends were not very pronounced. In the case of no time lag, rated muscle-contraction headache tended to be negatively related to rated alertness, happiness and concentration. Significant periodic trends were found for both the migraine and the muscle-contraction headache. The major findings are discussed in terms of stress and biological rhythms.