SYNOPSIS
Nine patients with migraine (5 with migraineous stroke) were investigated for defects of mitochondrial energy metabolism. During effort, blood lactate rose significantly higher in migraineurs. Muscle biopsy showed ragged‐red fibres deficient in cytochrome‐c‐oxidase activity in one case. On muscle biochemistry, depression of some respiratory chain enzymes was found for the whole group of patients, and especially in 2 for cytochrome‐c‐oxidase, succinate‐cytochrome‐c‐reductase and NADH‐cytochrome‐c‐reductase.
Our findings are still preliminary, but they suggest impaired mitochondrial energy metabolism in migraine.
The aim of this double-blind crossover study was to compare the prophylactic effect of acetylsalicylic acid (ASA) with that of propranolol (PRP) in the treatment of migraine. Plasma concentrations of the two drugs were measured in order to investigate a possible relationship to the clinical effect. Compared to the pretreatment period, PRP and ASA reduced migraine index, frequency, duration, severity of attacks and headache days. Due to the limited number of patients, our results should be cautiously interpreted, however relevant the clinical improvement seemed. Improvement of migraine index was not related to different plasma levels of the two drugs.
Long-term migraine evolution is still undefined. The poorest outcome is the transformation from episodic attacks to a pattern of daily attacks or continuous headache with intermittent attacks. We called these cases "chronic migraine". The aim of our study was to investigate whether some clinical variables contributed to migraine chronicity. We interviewed 50 patients with chronic migraine from 2 to 15 years and 90 patients with episodic migraine matched for sex and age as a control group. Univariate analysis revealed two correlations with a chronic outcome: (1) In the control group a significantly higher number of women took oral contraceptives. (2) In the group who developed chronic migraine, there were a greater number of smokers, without reaching statistical significance. The stepwise multiple logistic regression method showed that these two variables influence the prognosis with a maximum likelihood estimate of 65%, hence not much higher than random probability.
SYNOPSIS
Five patients suffering from cluster headache underwent simultaneous recordings of the pneumogram, ECG, and systemic arterial pressure before and during attacks.
The polygraphic investigations showed the following: systolic and diastolic blood pressure increased during attacks; mean heart rate decreased or increased; mean respiratory rate decreased or remained unchanged. Standard deviations and coefficients of variation of all three measures calculated during attacks were higher than those recorded before attacks. The polygraphic recordings showed that during attacks there were phasic cardiovascular changes characterized by an increase and subsequent decrease in arterial pressure and heart rate, synchronous with the respiratory movements.
Cardiovascular reflex function was assessed in two patients prior to and during attacks: Valsalva maneuver was normal be fore and during attacks; beat‐to‐beat variation of heart rate and heart rate variability during deep breathing showed higher values during attacks compared with values beforehand.
The findings of this study suggest a central disturbance of vagus‐sympathetic equilibrium.
The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.
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