IntroductionMultimodal approaches in behavioral treatment have gained recent interest, with proven efficacy for migraine. The utility of the Internet has been demonstrated for behavioral treatment of headache disorders, but not specifically for migraine. The aim of the study was to develop and evaluate an Internet-based multimodal behavior treatment (MBT) program for migraine and to test hand massage treatment as an adjunct.MethodsEighty-three adults, 58 women and 25 men, with at least two migraine attacks a month were recruited via advertisements. An MBT program aiming at improvements in life-style and stress coping was developed for this study and, together with a diary, adapted for use over the Internet. Participants were randomized to MBT with and without hand massage and to a control group, and were followed for 11 months. Questionnaires addressing issues of quality of life (PQ23) and depressive symptoms (MADRS-S) were used.ResultsA 50%, or greater, reduction in migraine frequency was found in 40% and 42% of participants of the two groups receiving MBT (with and without hand massage, respectively), who statistically were significantly more improved than participants in the control group. No effect of hand massage was detected, and gender did not show any independent contribution to the effect in a multivariate analysis.ConclusionsMBT administered over the Internet appears feasible and effective in the treatment of migraine, but no effect of hand massage was found. For increased knowledge on long-term effects and the modes of action of the present MBT program, further studies are needed.

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Background: Positron emission tomography (PET) is a well-recognized technique used in research, especially for intracranial studies, as well as for clinical practice, and has contributed to the fast development in neuroscience during the last decades. Procedures: We have used PET in pituitary tumors for in vivo characterization with respect to metabolism, ¹¹C-L-methionine and ¹⁸F-fluorodeoxyglucose, receptor properties, ¹¹C-N-methylspiperone and ¹¹C-raclopride, and monoamine oxidase B enzyme content, ¹¹C-L-deprenyl; further, for diagnosing and outlining the tumors in differential diagnostic perspectives and in the follow-up of treatment. Observations:¹¹C-raclopride, a specific dopamine antagonist, demonstrated high amounts of dopamine D₂ binding in prolactinomas and some growth hormone-secreting adenomas. There was a significant correlation between high amounts of D₂ receptors and the positive treatment effect of dopamine agonist therapy. When ¹¹C-L-methionine and ¹⁸F-fluorodeoxyglucose were used for metabolic mapping, the highest metabolic activity was found in the prolactinomas, which correlated well with the serum prolactin levels. The growth hormone adenomas also showed high metabolic rates. At treatment follow-up, a considerable decrease in ¹¹C-L-methionine uptake was observed in all tumors that responded positively to the treatment and thus foretold that the medical treatment, both concerning dopamine agonist and somatostatin analogue, was effective. In this respect, PET was valuable to monitor treatment. PET was also shown valuable in differential diagnosing between pituitary adenomas, meningiomas and skull base neuromas. Conclusion: We have found PET to be highly valuable in the research and clinical handling of patients with a pituitary adenoma for in vivo tumor characterization.

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Eleven cases of migraine with and without aura were investigated with positron emission tomography (PET). Regional cerebral blood flow (rCBF), oxygen metabolism (rCMRO2) and oxygen extraction (rOER) were measured during baseline (n = 11), aura (n = 6), headache (n = 10) and after treatment with sumatriptan (n = 4). Data were analysed using an ROI-based approach from 26 different anatomically defined regions, and also an exploratory approach whereby all subjects were normalized to a stereotactic brain atlas; t-maps were constructed by depicting significant changes between states. The exploratory approach revealed a region corresponding to the primary visual cortex with significant reductions in rCBF (23.1%) and rCMRO2 (22.5%), but no change in rOER during the headache phase compared to baseline. These data suggest that cerebral ischemia was not the primary cause of the attacks in these cases.