Salvatore Bonuso

Trigeminal Stimulation Elicits a Peripheral Vestibular Imbalance in Migraine Patients

Objective.—The study explored the hypothesis that spontaneous nystagmus (Ny) in migraine patients can be triggered or modulated by painful trigeminal stimulation, providing evidence of a functional connection between vestibular and trigeminal systems.

Acetazolamide efficacy and tolerability in migraine with aura : A pilot study

The study was an open uncontrolled pilot trial to test the efficacy and the tolerability of acetazolamide in a group of 22 outpatients suffering from migraine with aura (MA) with at least one aura episode in the last 2 months.

A cluster headache family with possible autosomal recessive inheritance

Until the early 1990s, cluster headache (CH) was considered a sporadic disorder, with a prevalence of 69 per 100,000.1 The presence of CH in monozygotic twins2 and in first- and second-degree relatives3 suggested that genetic factors might be involved. Based on a mailed questionnaire, the prevalence of familial CH was 7%, and based on personal examination of alleged familial cases, it was 30%.3 A large epidemiologic study suggested autosomal dominant inheritance can be involved in some families.4 The current study describes a large kindred in which an autosomal recessive model could be involved. The pedigree (figure) includes four related families from the Naples area (southern Italy). The proband (IV-1), diagnosed in March 2000, referred other relatives possibly affected. All living members were interviewed by telephone, and all possibly affected members were evaluated by a neurologist experienced in CH. Clinical information about deceased individuals, obtained from their descendants, allowed us to exclude CH. Figure. Pedigree of a large kindred of four related families in which eight members …

Source of pain and primitive dysfunction in migraine: an identical site?

Twenty common migraine patients received a one sided frontotemporal application of nitroglycerin (10 patients) or placebo ointment (10 patients) in a double blind study. Early onset migraine attacks were induced by nitroglycerin in seven out of 10 patients versus no patient in the placebo group. Subsequently 20 migraine patients, who developed an early onset attack with frontotemporal nitroglycerin, received the drug in a second induction test at other body areas. No early onset migraine was observed. Thus the migraine-inducing effect of nitroglycerin seems to depend on direct stimulation of the habitual site of pain, suggesting that the frontotemporal region is of crucial importance in the development of a migraine crisis. This is not consistent with a CNS origin of migraine attack.

The frontotemporal region plays a role in the genesis of migraine without aura.

We have compared the migraine‐inducing effect of nitroglycerin ointment applied to the frontotemporal region of the head, which is innervated by the ophthalmic and maxillary divisions of the trigeminal nerve, with that of nitroglycerin applied to the chin (innervated by the mandibular division), the posterolateral region of the neck (innervated by the second and third cervical roots), the lateral surface of the proximal third of the forearm (innervated by the sixth cervical root), and the medial surface of the upper‐arm region (second dorsal root). One hundred patients suffering from migraine without aura were randomly divided into five equal groups. Each group received an application of 5 mg nitroglycerin in 2% ointment on a preselected body area for 2 hours. Frontotemporal nitroglycerin induced a significantly greater number of early onset migraine attacks with respect to the arm and forearm regions. In all cases, nitroglycerin applied to the frontotemporal region resulted in subsequent migraine, whereas there was a significant number of negative trials with nitroglycerin applied to the neck, arm, and forearm vs the frontotemporal area. It, therefore, appears that the trigeminal nerve endings in the affected frontotemporal region are particularly sensitive to the migraine‐inducing effect of the nitrate. This suggests a peripheral neurogenic hypothesis of migraine genesis.

The effect of bromocriptine on plasma catecholamine concentrations in normal volunteers

SummaryThe effect of the ergot derivative bromocriptine (5 mg orally) on blood pressure and plasma catecholamine concentrations was explored in normal volunteers. A significant decrease of plasma noradrenaline was found, while dopamine and adrenaline concentrations did not change significantly. Systolic and diastolic blood pressures were significantly lowered at 150 min after administration. The hypotensive effect of bromocriptine seems to be mediated by a lowered release of noradrenaline from sympathetic nerve endings. It may be hypothesized that the drug stimulates presynaptic dopamine receptors located on postganglionic sympathetic nerves, thus inhibiting noradrenaline discharge.

Headache Patients: Different Responses Induced by Naloxone During Work-Test

The responses to work-test in ischemia (tourniquet technique), before and after I.V. injection of naloxone (2 mg) or saline, were investigated in healthy volunteers and patients suffering from various types of headache. The patients were examined during both painful and painless periods. We found that only the subjects suffering from migraine showed a significantly shortened pain tolerance at work-test in ischemia, after injection of naloxone, and only during painful periods. Psychogenic headache patients and migraine patients in painless periods showed responses during work-test similar to those in healthy volunteers, even after injection of naloxone. We believe that hyperalgesic effect of naloxone is due to involvement of b-endorphin systems only during organic pain.

Long-term outcome of migraine therapy Predictive value of the frontotemporal nitroglycerin test

We evaluated whether type of response to the migraine-induction test with a nitroglycerin ointment applied to the frontotemporal head region could predict the efficacy of antimigraine therapy. Forty-two patients with migraine without aura underwent the test before and 2 months after antimigraine therapy. Two and 4 months after treatment withdrawal, most subjects with a negative response to the post-treatment test maintained treatment benefit, whereas benefit was lost in patients with an early onset migraine response.