Nitric oxide, endothelin-1, and transcranial Doppler in migraine. Findings in interictal conditions and during migraine attack.

The role of vascular phenomena taking place during an attack of migraine are poorly understood. The aim of this study was to measure systemic levels of nitric oxide and endothelin-1, two of the most potent vasoactive mediators known, and to assess vasomotor responses through transcranial Doppler ultrasound monitoring in patients suffering from migraine without aura, both during the headache event and in headache-free periods as well as after pharmacologically induced pain relief. Seven patients (mean age 31.3 years, range 24 to 49 years), five women and two men, were enrolled in the pilot study. Transcranial Doppler recordings were performed according to conventional procedure. Endothelin-1 concentrations were measured by means of radioimmunoassay, whereas nitric oxide levels were estimated using electron paramagnetic resonance spectroscopy. Ultrasound evaluation did not show significant changes during migraine attacks compared to the interictal condition. Nitric oxide levels showed only slight differences between basal and attack conditions (0.85 +/- 0.46 versus 1.56 +/- 0.88, expressed as arbitrary units), and were raised after pharmacological intervention (2.91 +/- 1.93, P < 0.05). Plasma endothelin-1 concentrations decreased during migraine attacks with respect to interictal conditions (3.99 +/- 1.21 pg/mL versus 4.23 +/- 1.19), and returned to basal values (4.44 +/- 1.08 pg/mL) after relief of pain. Coupling the measurements of systemic levels of nitric oxide and endothelin-1 with transcranial Doppler velocity results will provide useful information on the hemodynamic changes of cerebral blood flow regulation in migraineurs, thereby adding new insights into the mechanisms of the migraine attack.

Outdoor pollution and headache.

The aim of this study was to clarify a possible relationship between pollution and worsening of headache in the industrial city of Turin. From October 1992 to June 1993, we examined a group of 32 patients suffering from various headache types. During these months, they kept a daily record of their headaches and associated disturbances. Changes in pain frequency and severity were recorded every hour of the day and compared hour to hour with the various degrees of pollution recorded in the main streets by a monitoring station. The influence of meteorological parameters was also taken into consideration. During winter, carbon monoxide and nitrogen dioxide showed a simultaneous hyperconcentration on the same days and the same hours. Increased incidence of headache attacks and increase in severity corresponded to the same hours, days, and months. The findings were statistically significant (P = 0.008, Student's t-test). An isolated increase in nitrogen dioxide only (without an increase in carbon monoxide which was only recorded once) induced headache a couple of hours after the peak concentration was reached. Among the meteorological factors, only the highest values in wind velocity were shown to exert a significant influence on worsening headache frequency and severity.

[Hemicrania: primary headache]. / L'emicrania: cefalea primaria.

Migraine is the commonest form among the so-called primary headaches and the description of its clinical picture is lost in the mists of time. On the contrary, headaches of organic origin have only recently received a proper nosological individuation thanks to the modern technological progress achieved in the field of medicine. The migraine crisis, both with and without aura, is so typical in its clinical features that it does not require subtle instrumental methodologies to be diagnosed. In most cases a careful anamnesis provides all the elements necessary to formulate a precise diagnosis: the positive family history, the time and mode of onset of crises, the nature of head pain, the chronological stages are quite constant whatever the trigger factor may be. Some other considerations add further evidence to the primitivity of migraine. First of all, migraine can be relieved by quite structurally different drugs with different mechanisms of action. In addition, no significant relationship has ever been found between migraine and other pathologies.

[Alexithimia: psychosomatic structure or transcultural trait?]. / Alessitimia: struttura psicosomatica o tratto transculturale?

The these put forward by Marty and Sifneos on the one hand and by Cremerius on the other regarding "psichosomatic structure" have been compared in 66 patients suffering from idiopathic cephalea. Of these, 49 were suffering from migraine and 17 from musculotensive cephalea. The conclusion was that the alexithimic trait is related to the sociocultural level of the patients, not to their clinical picture.

[A critical review of the methods used in evaluating the antistreptolysin titre as a diagnostic index]. / Revisione critica della metodologia utilizzata nella valutazione del titolo antistreptolisinico come indice diagnostico.

Authors review the most common laboratory tests showing an immunologic response caused by group A beta-hemolytic streptococcus infections. After a preliminary evaluation on characteristics and peculiarities of different methods the results obtained are compared with the usually employed systems. The survey of most common analytical methods and personal experience lead to confirm and emphasize the laboratory results supporting and confirming, without substituting, the clinical data.

Relevance of prostaglandins in true menstrual migraine.

Eighteen patients suffering from true menstrual migraine and 12 control subjects were studied. We evaluated in different phases of the menstrual cycle and during the migraine crisis the peripheral plasma concentrations of 6-keto-PGF1 alpha (the stable metabolite of PGI2), thromboxane B2 (the stable metabolite of thromboxane A2), PGF2 alpha and PGE2. The mean values of 6-keto-PGF1 alpha in menstrual migraine sufferers are lower than in normal women throughout the whole cycle. The difference between the trends observed in the two groups is statistically significant (p less than 0.05). The plasma levels of TXB2 and of PGF2 alpha are similar in the two groups investigated, both in basal conditions and during the attack. The plasma concentrations of PGE2 are slightly lower in migraineurs in basal conditions than in normals. However, during the crisis they increase significantly (p less than 0.05). In conclusion, among all the parameters considered, PGE2 seems to play the most important role during the pain phase of the attack. The results of the present study suggest that a deficit of PGI2, one of the most important protecting agents against ischemia, might be a typical feature of menstrual migraine and might cause in these patients a vascular hypersensitivity to different ischemic stimuli.

Psychological aspects of weekend headache sufferers in comparison with migraine patients.

Sometimes the relaxation after stress may trigger a migraine attack. This is the principle that underlies that particular variant of migraine called "weekend headache". We hypothesize the presence in weekend headache prone subjects of a particular psychological background, different from that of common migraine sufferers. In order to detect possible differences supporting our hypothesis, we studied 104 new outpatients: 46 patients suffering from headache only on weekends (23 males and 23 females) and 58 matched common migraineurs (26 males and 32 females) with no weekend predilection. The psychological assessment was performed using the following psychometric tools: MMPI, BDI, STAIX1-X2. A clinical assessment of each patient was also carried out. Significant differences were found after statistically analyzing the test results. Most of the MMPI scales were found to be more elevated in both male and female weekend headache sufferers. From a clinical point of view, the weekend headache attacks proved to be similar to those of common migraine, but with a significantly higher incidence of concomitant symptoms. Our study confirms the important role that psychological factors play in the pathogenesis and clinical development of migraine and leads us to conclude that a psychic tension component is associated with the vascular one in weekend headache.

Classification and diagnostic criteria for primary headache disorders (Ad Hoc Committee IHS, 1988).

Clinical features and pathophysiological mechanisms of primary (idiopathic) headaches are revisited in the light of the new classification of headache, recently proposed by the Ad Hoc Committee of the International Headache Society. This computer-based classification is hierarchically constructed and offers operational diagnostic criteria for all headache disorders. However, further investigations are required in some cases (e.g. in case of tension-type headache) to better define the clinical form.

Antitrombina III y heparinemia en pacientes en hemodialisis / Antithrombin III and heparinemia in patients in hemodialysis

Para disminuir el riesgo de coagulación en el dializador, la heparina ha sido ampliamente usada en pacientes sometidos a hemodiálisis (HD). El efecto anticoagulante de la heparina depende de los niveles de antirombina III (AT III) de la sangre. La heparina acelera la reacción entre la AT III y las enzimas que participan en la coagulación sanguínea formando complejos inactivos equimolares. En trabajos recientes se muestran que los niveles de ATIII son contradictorios en HD. Los objetivos de este trabajo son: 1) evaluar los niveles de AT III en pacientes con insuficiencia renal crónica (IRC) en HD); 2) valorar las variaciones de AT III durante y después de la HD; 3) medir la heparinemia durante y después del tratamiento idalítico; 4) encontrar una prueba de laboratorio simple, pero sensible para medir el nivel de anticoagulación. Se estudian 20 pacientes (7 mujeres y 134 varones) con una edad promedio de 30 años (18 a 55 años) portadores de IRC terminan en plan de HD intermitente, con un filtrado glomerular inferior a 5 ml/min.; 11 pacientes fueron estudiados en 2 oportunidades lo que hace un total de 31 determinaciones. La forma de administración de la heparina fue por vía EV intermitente. La AT III, heparinemia y KPTT, son dosados a partir de muestras sanguíneas antes, durante y luego de cada sesión de HD; además en 12 pacientes se tomaron muestras 24 horas después de la HDEl nivel de AT III en pacientes con IRC se encontró dentro de límites normales. No se encontraron variaciones entre los valores iniciales y durante la HD, lo que podría deberse a que el aumento de la heparinemia es transitorio. El perfil de variación de la heparinemia es similar al observado con el KPTT. En nuestros resultados encontramos que la profilaxis de heparina durante la diálisis en pacientes urémicos pueden ser dadas en una dosis suficiente para prolongar el KPTT a 5 ó 6 veces el valor inicial, sin ningún riesgo de coagulación en el dializador y sin ningún riesgo de inducir una pérdida o consumo de AT III

Antitrombina III y heparinemia en pacientes en hemodialisis / Antithrombin III and heparinemia in patients in hemodialysis

Para disminuir el riesgo de coagulación en el dializador, la heparina ha sido ampliamente usada en pacientes sometidos a hemodiálisis (HD). El efecto anticoagulante de la heparina depende de los niveles de antirombina III (AT III) de la sangre. La heparina acelera la reacción entre la AT III y las enzimas que participan en la coagulación sanguínea formando complejos inactivos equimolares. En trabajos recientes se muestran que los niveles de ATIII son contradictorios en HD. Los objetivos de este trabajo son: 1) evaluar los niveles de AT III en pacientes con insuficiencia renal crónica (IRC) en HD); 2) valorar las variaciones de AT III durante y después de la HD; 3) medir la heparinemia durante y después del tratamiento idalítico; 4) encontrar una prueba de laboratorio simple, pero sensible para medir el nivel de anticoagulación. Se estudian 20 pacientes (7 mujeres y 134 varones) con una edad promedio de 30 años (18 a 55 años) portadores de IRC terminan en plan de HD intermitente, con un filtrado glomerular inferior a 5 ml/min.; 11 pacientes fueron estudiados en 2 oportunidades lo que hace un total de 31 determinaciones. La forma de administración de la heparina fue por vía EV intermitente. La AT III, heparinemia y KPTT, son dosados a partir de muestras sanguíneas antes, durante y luego de cada sesión de HD; además en 12 pacientes se tomaron muestras 24 horas después de la HDEl nivel de AT III en pacientes con IRC se encontró dentro de límites normales. No se encontraron variaciones entre los valores iniciales y durante la HD, lo que podría deberse a que el aumento de la heparinemia es transitorio. El perfil de variación de la heparinemia es similar al observado con el KPTT. En nuestros resultados encontramos que la profilaxis de heparina durante la diálisis en pacientes urémicos pueden ser dadas en una dosis suficiente para prolongar el KPTT a 5 ó 6 veces el valor inicial, sin ningún riesgo de coagulación en el dializador y sin ningún riesgo de inducir una pérdida o consumo de AT III (AU)

Menstrual migraine: a possible pathogenic implication of platelet function.

It has been suggested that migraine is a blood disorder caused by a primary abnormality of platelet behaviour. We have studied in different phases of the cycle of 11 healthy normal women and 13 patients suffering from menstrual migraine: 1. The platelet aggregation induced in vitro by ADP, collagen and ristocetin; 2. The platelet sensitivity to prostacyclin (PSP); 3. The platelet content of 5-hydroxytryptimine (5-HT); 4. The possible correlation between these parameters and the plasma concentration of progesterone. The results demonstrate that in patients with menstrual migraine the platelet response to various aggregating agents is not modified compared to the controls, whereas there is a different response of the PSP to the modulating effect of plasma progesterone. Moreover, in the same patients the platelets have an increased capability of accumulating 5-HT during the perimenstrual phase of the cycle. This suggests that platelet dysfunction may play a role in the pathogenesis of menstrual migraine.