Robert S. Kunkel

Migraine Medication Attributes Important for Patient Compliance: Concerns About Side Effects May Delay Treatment

Objectives.—To determine the level of concern among migraineurs about migraine prescription medication tolerability and adverse effects and the impact of these concerns on their self‐management of migraine.

Demographics of Headache in Elderly Patients

SYNOPSIS

Diagnosis and Treatment of Muscle Contraction (Tension-Type) Headaches

Acute tension-type headache is a very common condition that rarely is a problem in treatment. Chronic tension-type headache, however, is often a difficult therapeutic problem. The pathogenesis is not well understood, but both peripheral muscle contraction and central pain-modulating systems are probably involved. Therapy usually works best when multiple techniques are used, including pharmacologic, psychological, and physiologic modalities.

Trigeminal cisternal injection of glycerol for treatment of chronic intractable cluster headaches.

Medical treatment of chronic cluster headaches (cluster headaches that occur frequently without remission) can be very difficult. In many patients, the pain remains severe despite all medication trials. For these patients, previous reports recommend radiofrequency trigeminal rhizotomy, which risks corneal anesthesia and subsequent corneal decompensation. As a safer, yet effective, treatment, retro-Gasserian injections of glycerol were given to eight patients having intractable chronic cluster headaches. Needle penetration into the trigeminal cistern, glycerol amount (0.55 ml), and length of patient elevation after the procedure (80-90 degrees upright for 10 h) were modified for maximal exposure of the V1 division. Three patients required one additional injection, and one patient required two additional injections. Verbal pain scales (means +/- 1 standard error of the mean) were: 9.1 +/- 0.30 (preoperative), 2.6 +/- 1.10 (1 mo postoperative), and 2.1 +/- 0.64 (1 yr postoperative). Daily headache frequency decreased from 6.0 +/- 2.0 (preoperative) to 0.2 +/- 0.09 (i.e., one headache every 5 days) (1 yr postoperative). Three of the eight patients had no headaches after 1 year. There were no instances of corneal or facial anesthesia. One year postoperatively, five patients required no medication, and three remained on low doses of medication for headache treatment. In contrast to previous limited reports of glycerol injections for cluster headaches, results with these patients having chronic cluster headaches support the use of glycerol injections as a viable treatment alternative, with significant pain relief and corneal safety.

Impact of headache education program in the workplace.

Article abstract We evaluated the impact of a headache education program in a workplace setting. A 45-minute standardized educational program was delivered to 492 participants at eight companies. Participants completed questionnaires regarding their headaches and headache management techniques, the Short Form (SF)-36, and the Headache Disability Inventory (HDI) before and 1 month after the presentation. The intervention significantly improved health-related quality of life, decreased headache-related disability, and promoted the use of self-management techniques.

Hypersensitivity to substance P in the etiology of postlumbar puncture headache.

Objective.‐Postlumbar puncture headache may represent a model which could be used to test the hypothesis that headache pain is caused by the release of substance P in patients who are predisposed to headache due to hypersensitivity to substance P.

PRES Following Administration of DHE in a Patient With Unsuspected Pheochromocytoma

We describe neurological complications which manifested after a patient with unsuspected pheochromocytoma was administered dihydroergotamine. Following administration of dihydroergotamine, the patient developed Balint syndrome, with the appearance of symmetric, bilateral occipital signal change on magnetic resonance imaging suggestive of posterior reversible encephalopathy syndrome.

Clinical manifestations of migraine.

Migraine is a disorder with many clinical manifestations that vary from person to person and often from headache to headache in the same person. Several body organ systems are involved in a migraine attack. It is a condition that is underdiagnosed by physicians and misidentified by persons suffering with headaches. Many individuals with migraine self-diagnose as having sinus headaches or tension headaches. This article discusses the many symptoms of migraine and will help the busy practitioner to better recognize and diagnose this common disorder.

Clinical Trials in Migraine: Parallel versus Crossover Studies

Most prophylactic drug studies for migraine utilize parallel or crossover formats. Both study designs have disadvantages and advantages. The pros and contras of each study are discussed. The majority of headache investigators seem to favor the parallel study and reasons for this preference are discussed.

The American Headache Society: Looking Back

Dr. Kunkel, a former president and member of the American Headache Society from its most formative days, shares some personal recollections about the emergence of the society from a small group of like‐minded individuals through to its period of rapid growth in the late 1970s and 1980s.