Combination monoamine oxidase inhibitor and beta-blocker treatment of migraine, with anxiety and depression.

This paper presents the results of a study comparing the effectiveness of a beta-adrenergic blocking agent, atenolol, a monoamine oxidase inhibitor (MAO-I), phenelzine, and the combination in treatment of 61 adults with migraine headache. The goals of the study are (1) to investigate the safety of concomitant treatment of migraine with beta-blockers and phenelzine, (2) to assess whether orthostatic hypertension and other side effects would be relieved, and (3) to compare the results of this open trial of phenelzine to those of a previous study using similar methods. Phenelzine was associated with a large decrease in the frequency and severity of migraine attacks. Anxiety and depression were also reduced by phenelzine both alone, and in combination with a beta-blocker. The results show that the combination of MAO-I's and beta-blockers can be administered safely, and can lead to the reduction in the side effects with either drug alone.

Tyramine conjugation deficit in migraine, tension-type headache, and depression.

This study was designed to investigate tyramine sulfate conjugation in patients with migraine or tension-type headache, as defined by the newly introduced International Headache Society (IHS) criteria and to examine whether this relationship is mediated by major depression. A total of 62 subjects completed the study: 38 with migraine (22 with aura and 16 without aura), 12 with tension-type headache, and 12 controls. Patients with migraine had significantly lower urinary tyramine sulfate excretion following oral tyramine challenge than normal control. Tension-type headache was also associated with low tyramine conjugation, but only when comorbid with depression. Although mean tyramine sulfate output was lower among subjects with major depression within each of the subtypes of headache, no significant main effect emerged for depression or major subtype thereof. The lower tyramine sulfate excretion values among patients with both migraine and depression compared to those of migraine alone or depression alone in our data and those of others suggests that comorbid migraine with depression may represent a more severe form of migraine than migraine alone. The findings underscore the importance of comorbidity in clinical and epidemiological studies of migraine.

Headache syndromes and psychiatric disorders: association and familial transmission.

This paper examines the association between psychiatric disorders and headache syndromes in a longitudinal epidemiologic sample of young adults who were selected from the general population of Zurich, Switzerland. Headache syndromes were defined according to the newly introduced diagnostic criteria of the International Headache Society in 1988. The prevalence rates of psychiatric disorders, according to specific headache subtypes, were examined both cross-sectionally and longitudinally. In the cross-sectional data, migraine with aura was associated with hypomania, recurrent brief depression, and all of the anxiety disorders, whereas only the phobic disorders and panic were elevated among subjects with migraine without aura. Similar findings emerged for the longitudinal data, with the exception that major depression was associated with both subtypes of migraine. Subjects with tension-type headaches did not differ from controls with respect to any of the effective or anxiety disorders in both the cross-sectional and longitudinal data. Prospective study data indicated that the age of onset of anxiety disorders generally preceded that of migraine and that the onset of affective disorders in the majority of comorbid subjects followed that of the onset of migraine. In order to investigate the mechanism for the associations between anxiety/depression syndromes and migraine, patterns of co-transmission of migraine and anxiety/depression were examined in data from a controlled family history study of migraine. The results were consistent with a syndromic relationship between migraine and anxiety/depression, rather than their representing discrete manifestations of shared underlying etiology. The implications of these data for research and clinical work are discussed.

Migraine and depression: association and familial transmission.

We have studied the association between migraine and major depression in a group of 133 probands with major depression, a group of 82 normal community controls and 400 interviewed first-degree relatives of the probands and controls. There was a significant association between depression and migraine among both the probands and the relatives. We also found that concomitant symptoms of anxiety were prominent among the depressed persons with migraine. Both depression and migraine were strongly familial but their association did not appear to be highly transmissible. Rather, our data suggested that depression may either be a sequela of migraine or the diathesis which results in both migraine and depression.

Common neurologic syndromes in medical practice.

The cases presented here are intended to illustrate an approach to the patient with complaints which may be vague, evanescent, or related to emotional factors. A scheme to analyze only five factors, mood, movement, sensation, cognition, and consciousness is presented to simplify the complexity of human behavior in order to arrive at correct diagnoses. The importance of a complete medical evaluation is stressed. Psychosis and other major psychiatric illness have been alluded to, but space does not permit discussion of the very important issues of the genetics, the neurochemistry, and the differential diagnosis of schizophrenia, mood disorders, and the organic brain syndromes. Some of the many manifestations of epilepsy have been presented, and the importance of electroencephalography and computed axial tomography is stressed. The references have been chosen for their general utility to practicing clinicians, especially the works of Pincus, Glaser and Tumulty.

Ocular myasthenia gravis after D-penicillamine administration.

A 68-year-old black woman who was put on D-penicillamine therapy (250-500 mg per day, total dose 15 g) for rheumatoid arthritis developed ocular myasthenia gravis. Two weeks after she discontinued D-penicillamine her signs and symptoms cleared with no other treatment. Review of previous cases and possible immunological mechanisms are discussed.

Chromosome banding study of the Cornelia De Lange syndrome.

Chromosome studies were performed on 13 patients with the Cornelia de Lange syndrome. With the technique of chromosome banding analysis, no chromosomal abnormalities were found.

Visually evoked potentials from occipital and precentral cortex in visually deprived humans.

The visually evoked potential (VEP) was recorded from the scalp overlying precentral and occipital cortex in three monocularly deprived humans. The subjects had defects of the globe from birth that effectively created a condition of diffuse light rearing in one eye. In subject, BER, a 19-year-old with a recently removed congenital cataract, the occipital response evoked from the deprived eye was reduced by 53% compared with the response evoked from the good eye. In subject GUZ, age 20 with a congenital cataract, the occipital response evoked from the deprived eye was actually larger by 20% than was the response evoked from the good eye. For UTZ, age 5 with whitish cellular debri in the anterior vitreous of the eye, the occipital response evoked from the deprived eye was only 4% smaller than the response evoked from his good eye. In all three subjects, the precentral response evoked from the deprived eye was reduced in amplitude compared with the precentral response evoked from the good eye. In terms of relative effect of the deprivation upon the VEP from the two recording sites, the precentral VEP was altered to a greater extent than was the occipital VEP. These findings indicate that diffuse light rearing can affect the pathways projecting to precentral cortex independently of the specific visual pathways.

Blood choline and response to clonazepam and haloperidol in Tourette's syndrome.

This paper reports the results of a single blind clinical study of drug treatment response of 20 patients with Tourette's syndrome to haloperidol and clonazepam. Because patients with Tourette's syndrome have been reported to have increased red blood cell choline levels, choline levels were examined in relation to treatment response. Differential drug treatment response was found among patients with high versus low red blood cell-to-plasma choline ratios. Patients with high red blood cell-to-plasma choline ratios responded better to clonazepam than to haloperidol. This suggests that there may be two distinct subtypes of patients with Tourette's syndrome.