[Female hormones and migraine]. / Hormones féminines et migraine.

All the hormonal events of the female life may modify the course of the migrainous disease. Their influence is slightly different on migraine with and without aura. Development of migraine at menarche and menstrually-related migraine attacks are principally observed in migraine without aura. Percutaneous estradiol is often effective for the prevention of pure menstrual migraine. Migraine usually improves during pregnancy; a worsening or a first development of attacks may nevertheless occur during this period, especially for migraine with aura. Oral contraception is not contraindicated in most migraine sufferers; it may worsen, improve or leave unchanged their disease. Migraine represents a risk factor of ischaemic stroke in young women; though a low one, some caution is necessary: tobacco should be forbidden, and the use of low-dose estrogen pills is recommended. Oral contraceptives should be interrupted in case of worsening of migraine, especially with aura. Estrogen replacement therapy is allowed after menopause in migraine sufferers; it may sometimes exacerbate migraine, which is in most cases controlled by therapeutic adjustment.

Head pain in non-traumatic carotid artery dissection: a series of 65 patients.

In order to assess the prevalence and characteristics of cephalic pain in internal carotid artery (ICA) dissection, and to compare clinical and angiographic features of patients with painful and non-painful dissections, we observed 65 patients with angiographically diagnosed extracranial ICA dissection from 1972 to 1990. Forty-eight patients (74%) complained of a cephalic pain which was inaugural in 38 (58.5%). It was homolateral to the dissection in 79% of cases and lasted from 1 h to 30 days, with a median of 5 days. Signs of cerebral or retinal ischemia were observed in 79% of patients, often delayed and occurring up to 29 days after the onset of pain. A painful Horner's syndrome was present in 31% of patients, and was the only manifestation of dissection in 16%. The clinical presentation of the dissections and angiographic findings were similar in patients with and without pain except for a past history of migraine which was more frequent in patients with painful dissections. Cephalic pain is frequent and often inaugural in carotid dissection. Its recognition is important for early diagnosis and treatment.

[What is new in the treatment of migraine?]. / Quoi de neuf dans le traitement de la migraine?

No miracle treatment has occurred which would cure the migraineur, but treatments able to improve him are more numerous and better defined. Conditions are now achieved for significant progress in the field of migraine treatment: better knowledge of the pathophysiology progress in the field of migraine treatment: better knowledge of the pathophysiology of the attack, definition of diagnostic criteria unanimously accepted and of rigorous and specific methodologic rules for therapeutic trials in migraine, discovery of new drugs such as more and more specific agonists or antagonists of serotonin-receptors subtypes.

[Motor neglect of thalamic origin: report on two cases (author's transl)]. / La négligence motrice d'origine thalamique. A propos de deux cas.

Two cases of thalamic lesions with motor neglect are presented. The syndrome of motor neglect was complete in those cases with a) underutilization of left limbs, but good utilization upon verbal orders, b) loss of placement reaction, c) weakness of movement when hand was approaching the target, d) weakness of motor reaction to nociceptive stimuli. Those cases confirm that motor neglect exists after thalamic lesions and bring pathologic clues for topographic discussion. Motor neglect seems to be a particular case of partial unilateral neglect throwing some doubt on the hypothesis of a global trouble of hemispheric activation. Prevalence of left motor neglects suggests some linkage between propositional motility and language. One may suppose that in the right hemisphere language is able to have a vicarious action when spontaneous activation is lost; at the opposite, in the left hemisphere language and motility would be too linked to let this dissociation be generally possible.