CM, Langston JW (1998a) Absence of mutations in the coding region of the alpha-synuclein gene in pathologically proven Parkinson's disease. Neurology 50:1136-1137 Chan P, Tanner CM, Jiang X, Langston JW (1998b) Failure to find the alpha-synuclein gene missense mutation (G209A) in 100 patients with younger onset Parkinson's disease. Neurology 50:513-514 Letters to the Editor

The Monks of Athos in Greece constitute a particular group with unusual sleep schedule and specific diet. In order to study the frequency of headache among them, a special questionnaire was designed. Four hundred forty-nine monks below the age of 50 were approached, 39 of whom suffered from frequent (more than one episode per month, in the last 6 months) headaches (8.68%). The prevalence of migraine was 1.78% (0.66% with aura and 1.11% without) and of tension-type headache 3.34% (1.33% chronic and 2% episodic). Furthermore, 1.87% of monks suffered from mixed headaches (tension-type and migraine attacks as well). Cluster headache was not traced.

Objectives ‐ The aim of this study was to explore the efficacy of buspirone (BSR), in comparison with amitriptyline (AML) in the prophylactic treatment of chronic tension‐type headache (CTH), in an open and randomized clinical trial. Material and methods ‐ Twenty‐six CTH patients (10 men and 16 women) were treated with BSR (30 mg daily) for 12 weeks. A parallel group of 32 CTH patients (12 men and 20 women) was treated with AML (50 mg daily). The major clinical parameters evaluated were the headache index (days with headache per month), the frequency of drug use for the acute management of headaches, the patients' opinion for the treatment and the Hamilton anxiety and depression rating scales.Results ‐ During the study 9 patients dropped out (4 from the BSR group and 5 from the AML group). Twelve (54.5%) patients from the BSR group responded to treatment (&50% reduction in the headache index), compared to 17 (60.7%) from the AML group. In the BSR group, 14 (53.8%) patients reported various mild side effects (nausea most frequently), vs 21 (65.6%) of the AML group (mouth dryness more frequently). Patients treated with AML had better opinion and used less drugs for the acute treatment of headaches than the BSR treated patients.Conclusion ‐ These results suggest that BSR may be effective in the prophylactic treatment of CTH, and that further investigation in a placebo controlled study, is needed.

Two patients with headaches meeting the criteria of chronic paroxysmal hemicrania, as defined by the International Headache Society classification, are presented. Further investigations revealed parasellar pituitary microadenoma in the first patient and a maxillary cyst in the second. Surgical removal of the lesions resulted in complete relief from headaches. The clinical features of this rare syndrome are discussed and suggest that a more detailed laboratory study and clinical follow-up is necessary in patients with chronic paroxysmal hemicrania.Key words: chronic paroxysmal hemicrania, secondary headache, headache diagnosis Abbreviations: CPH chronic paroxysmal hemicrania (Headache 1996;36:511-513) Chronic paroxysmal hemicrania (CPH) is a rare disorder which resembles cluster headache and is characterized by short attacks, lasting from 2 to 45 minutes. It is associated with autonomic nervous system changes and responds to treatment with indomethacin (150 mg/day or less). 1 It is considered a variant form of cluster headache but with differences in duration and frequency of attacks, sex distribution, and therapeutic response to indomethacin. 2,3 Recently, a number of reports have described the coexistence of CPH and intracranial lesions or vascular disorders. [3][4][5] Two patients with CPH are presented. Laboratory examination revealed a tumor in the right parasellar area of the first patient, and physical examination of the second patient revealed a maxillary cyst. CASE HISTORIESPatient 1.-A 20-year-old man, with no family history of headache, was seen for the first time in our department in March 1994. His symptoms had started 1 year previously and consisted of attacks of severe throbbing and pulsating pain located in the right supraorbital area. The headache, lasting 10 to 20 minutes occurred 5 to 10 times a day; pain was associated with lacrimation, nasal congestion, rhinorrhea, ptosis, and severe unilateral eyelid edema. Many of the attacks occurred during sleep. At times, ptosis and eyelid edema persisted between attacks. Physical and neurological examinations did not reveal any abnormalities. A brain CT scan taken at this time was normal. Cluster headache was diagnosed and treatment with carbamazepine (400 mg daily) and amitriptyline (25 mg daily) produced a significant decrease both in frequency and intensity of the attacks. Six months later, however, the attacks occurred with greater intensity and higher frequency, and the patient was totally incapacitated. At this time, he was admitted to our department. Physical and neurological examinations yielded normal results, except for right eyelid edema. Routine hematology and biochemical screening were normal. Indomethacin (75 mg per day) was prescribed, and the intensity and frequency of attacks markedly decreased. Nevertheless, a repeat brain CT scan demonstrated a right parasellar hypodense area; coronal MRI with intravenous Gd-DPTA showed a signal intensity slightly less than that of the normal pituitary gland. On the basis of these findings, the dia...