In the present study, 23 patients with migraine without aura were monitored during a migraine attack. Plasma levels of interleukin (IL)-4, IL-5, IL-10, and interferon-gamma were measured by enzyme-linked immunosorbent assay techniques. Interestingly, we observed low to undetectable IL-5 and IL-4 levels, whereas high IL-10 levels were seen in 52.2% of the patients. Interferon-gamma plasma levels were undetectable in all patients. After treatment with sumatriptan, 10 patients showed a subsequent decrease in IL-10 and an increase in both IL-4 and IL-5 plasma levels. Although these findings are derived from a limited number of patients, the apparent return to the IL-4 and IL-5 cytokine profile observed during the interictal period leads us to speculate that a preferential enhancement of TH2-type cytokine production may contribute to the pathogenesis of migraine.

Thirty-two patients suffering from migraine without aura were assessed during in interictal period to evaluate the contribution of cytokines to the pathophysiology of migraine. To this end, plasma levels of IFN-gamma, IL-4, IL-5, and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA) techniques. Plasma levels of both IFN-gamma and IL-10 were not increased in the patients and did not differ significantly from healthy controls. Of interest, we observed a strong increase of IL-5 levels in 84.3% as well as increased IL-4 levels in 37.5% of patients with migraine without aura. These results suggests a preferential enhancement of some Th2-type cytokines, and may support the growing arguments of an immunoallergic mechanism in the pathophysiology of migraine.

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A 42-year-old man came to our headache unit in October 1995 complaining of recurrent attacks of headache, which had begun in February 1991. Chronic cluster headache was diagnosed, and he was given verapamil, 360 mg per day. The attacks ceased in the following months and verapamil was stopped in March 1996. In May 1997, a recurrence of the attacks required the readministration of verapamil, 360 mg per day. The attacks decreased (one to three per week), but after 2 months the patient reported a worsening in his condition due to the appearance of shorter attacks, which were diagnosed as chronic paroxysmal hemicrania. The administration of indomethacin, 225 mg per day, resulted in the disappearance of the short attacks.The concomitant occurrence of attacks of cluster headache and chronic paroxysmal hemicrania suggests the presence of shared factors in the pathophysiology of the two forms of headache. This hypothesis is supported by previous reports in the literature. Key words: chronic cluster headache, chronic paroxysmal hemicrania, verapamil, indomethacinAbbreviations: CH cluster headache, CPH chronic paroxysmal hemicrania ( Headache 2000;40:54-56) The coexistence of cluster headache (CH) and chronic paroxysmal hemicrania (CPH) in the same patient has been previously reported in four published cases. 1-3 The two varieties of headache occurred in different periods in three of the four patients, whereas their simultaneous occurrence was reported in one patient. Here, we report the case of a patient with concomitant attacks of CH and ipsilateral CPH in the same period. Our experience adds data to support the likelihood of the concomitant presence of attacks of CH and ipsilateral CPH. CASE REPORTA 42-year-old policeman, who was married with three children, came to our Headache Unit in October 1995 complaining of recurrent attacks of headache. These attacks had started suddenly and without any particular reason for the first time in February 1991, when he was 37 years old. He had two to three attacks per day, each lasting 30 minutes to 2 hours; the timetable was unpredictable, although the most critical times were after lunch and during the night. The pain was extremely severe and located around the left temple, eye, and forehead, without radiation. The pain was throbbing and was associated with ipsilateral lacrimation and conjunctival injection, ptosis, rhinorrhea, photophobia, and phonophobia. The patient did not report a family history of headache. He smoked 20 cigarettes per day and drank four to five cups of coffee per day, but no alcoholic beverages. He weighed 87 kg and was 188 cm in height.The results of routine blood tests, an EEG, skull x-ray, and a cranial CT scan were normal. Nonsteroidal anti-inflammatory drugs, decreasing dosages of cortisone, lithium salts, and amitriptyline gave almost no benefit, whereas since 1994 he had been responsive to sumatriptan, 6 mg subcutaneous (SQ), for the treatment of the attacks.

The authors, in order to evaluate the important role of gastrointestinal dysfunction during the migraine attack, have studied 53 patients with migraine without aura during the asymptomatic stage between attacks. Patients were examined functionally with a pH meter test of the gastroesophageal tract over 24 hours and morphologically with esophagogastroduodenoscopy. The results of this study point out that in a high percentage of patients with migraine, both evaluations are normal. The authors suggest the possibility of detecting, even hypothetically, an alteration of the common neurotransmitter substrate in the origin of migraine attacks and accompanying symptoms.