Hemicrania continua is not a rare disorder. All cases of chronic unilateral daily headaches should receive an indomethacin trial early if not first in treatment.

Objective-To study the clinical characteristics of cluster headache in women. Cluster headache is a disorder of men (male to female ratio 6-7:1). Methods-Retrospective chart review to identify all women diagnosed with cluster headache at an academic headache centre from January 1995 through July 1998. Results-Thirty two women and 69 men were identified. The mean age of onset of cluster headache was 29.4 years in women versus 31.3 years in men. Two peaks of onset in women (2nd and 5th decade) were identified compared with one in men (3rd decade). Episodic cluster headache was present in 75% of women and 77% of men. Women and men had on average 3 attacks a day, but attack duration was shorter in women (67.2 minutes v 88.2 minutes). Cluster headache period duration (11.1 weeks v 10 weeks) and remission periods (21.1 months v 23.1 months) were similar in women and men. Miosis and ptosis seemed to be less common in women (miosis 13.3% v 24.6%, ptosis 41.9% v 58.1%) whereas lacrimation and nasal congestion/rhinorrhoea were almost equally prevalent in women and men. Women had more nausea than men (62.5% v 43.5%, p=0.09) and significantly more vomiting (46.9% v 17.4%, p=0.003). Photophobia occurred in 75% of women and 81.2% of men, and phonophobia occurred in 50% of women and 47.8% of men. Conclusions-The clinical characteristics of cluster headache in women are very similar to those in men. Women develop the disorder at an earlier age of onset and experience more "migrainous symptoms" with cluster headache, especially vomiting. Both men and women have frequent photophobia and phonophobia with cluster headache attacks. These symptoms are not included in the International Headache Society cluster headache criteria, suggesting the need for possible criteria revision. (J Neurol Neurosurg Psychiatry 2001;70:613-617) Keywords: cluster headache; women; sex; autonomic symptoms Cluster headache is a stereotypic headache disorder characterised by short lasting attacks of severe unilateral head pain with associated autonomic symptoms. Cluster headache has always been identified as a disorder of men, with a male to female ratio of 6-7:1.1 Most of the accepted clinical characteristics of cluster headache have been established through observation of men with this disorder. Very few studies have been dedicated to describing the disorder in women because of its rarity. Manzoni 1 has suggested that the sex ratio for cluster headache is decreasing and that more women are developing or being diagnosed with cluster headache. We attempted to better define the clinical characteristics of cluster headache in women and compare and contrast these manifestations with those in men. Patients and methodsWe carried out a retrospective chart review at the JeVerson Headache Center (a university based academic headache clinic) to identify all women diagnosed with cluster headache from January 1995 to the end of July 1998. Each patient had to satisfy the International Headache Society (IHS) criteria for cluster headache 2 : at least five att...

The objective was to assess the efficacy of coenzyme Q10 as a preventive treatment for migraine headaches. Thirty-two patients (26 women, 6 men) with a history of episodic migraine with or without aura were treated with coenzyme Q10 at a dose of 150 mg per day. Thirty-one of 32 patients completed the study; 61.3% of patients had a greater than 50% reduction in number of days with migraine headache. The average number of days with migraine during the baseline period was 7.34 and this decreased to 2.95 after 3 months of therapy, which was a statistically significant response (P < 0.0001). Mean reduction in migraine frequency after 1 month of treatment was 13.1% and this increased to 55.3% by the end of 3 months. Mean migraine attack frequency was 4.85 during the baseline period and this decreased to 2.81 attacks by the end of the study period, which was a statistically significant response (P < 0.001). There were no side-effects noted with coenzyme Q10. From this open label investigation coenzyme Q10 appears to be a good migraine preventive. Placebo-controlled trials are now necessary to determine the true efficacy of coenzyme Q10 in migraine prevention.

We reviewed the electronic records of 74 migraine patients treated with topiramate for more than 6 weeks. Twenty-four patients had episodic migraine and 50 had chronic (transformed) migraine. Most (81%) started treatment at 25 mg per day and reached a dose of 100 mg twice a day (mean dose on the last follow-up visit was 208 mg). The mean headache frequency decreased from 20.6 days to 13.6 days per month (P<0.0001) for all headaches (9.9-5.1 (P<0.0001) and 25.7-17.7 (P<0.001) for episodic migraine and chronic migraine, respectively). The percentage of patients whose headache frequency was reduced by > or =50% was 44.6% for all patients; 58.3 for episodic migraine and 38.0 for chronic migraine. For all patients mean headache severity (10-point scale) was reduced from 6.2 to 4.8 (P<0.0001). Patients on monotherapy (20%) and polytherapy (80%) had similar reductions in headache frequency. Adverse events were usually mild to moderate and were seen in 58.1% (paresthesias in 25%, cognitive difficulties 14.9%). Mean weight loss was 3.1 +/- 4 kg (3.8% of total body weight).

We evaluated the reproducibility of brainstem auditory evoked responses (BAERs) in 87 normal individuals in a longitudinal study by estimating the correlation coefficients and variability of the interpeak intervals and the V/I amplitude ratio between trials on the same day and between sessions spaced 2 years apart. The highest correlation coefficients occur for the I-V interpeak interval between trials on the same day. The coefficients for the I-III and III-V intervals are lower, due to the variability of wave III. The correlations between ears done on the same day are lower still and are similar to measures obtained from the same ear at a 2-year interval. BAERs are more variable than previously believed between ears and over time, but not in a manner that is clinically significant and can be used longitudinally as a measure of neurologic disease. Finally, we provide the sample size required to detect a significant change in interpeak intervals.