SYNOPSIS An experiment is described which compared visual evoked potential (VEP) amplitudes and latencies in normal subjects and migraine patients. Several VEP abnormalities were found: at vertex and to a lesser extent at temporal sites, P100‐N120 amplitudes were larger in patients; at vertex and temporal sites N120 amplitudes were larger in patients; at temporal sites patients had larger N120‐P200 amplitudes but smaller P100 amplitudes. Peak latencies of the VEP were also found to be abnormal in patients. At vertex, patients had delayed N120 peak latencies while at temporal sites delays were found in the P200 latencies. Patients were subdivided according to side of headache. Right‐sided headache patients showed larger temporal P100 amplitudes and larger left temporal P100‐N120 amplitudes than bilateral headache patients.

SYNOPSIS 88 patients in need of prophylactic treatment for classical, common or mixed migraine of at least 2years' duration were admitted to a double‐blind placebo‐controlled trial of the beta1‐selective adrenoceptorblocker, metoprolol. All patients initially took placebo for 1 month, during which 29 were excludedprincipally because of failure to reattend or placebo‐response making active treatment unnecessary. Theremaining 59 patients were randomised to continued placebo or metoprolol 50 mg b.i.d. for 2 months.Patients after this time subjectively categorizing their responses as less than optimal changed,double‐blindly, from placebo to metoprolol 50 mg b.i.d., or from metoprolol 50 mg b.i.d. to 100 mg b.i.d., fora further follow‐up period of up to 3 months. Placebo response was 40% overall, and often occurred after the first month. In the first double‐blindcomparative period metoprolol reduced attack frequency significantly, and more than placebo. Severity ofattacks still occurring was not altered by either treatment. Other measures of illness were alteredconsistently with these principal findings. Consistent improvements also were seen in patients switchingfrom initial placebo therapy to metoprolol 50 mg b.i.d. for the further follow‐up period, and those changingto the higher dose of metoprolol showed statistically significant further improvements, and clinicallyimportant improvements overall. Side‐effects were minor and reversible. This study gives supportive evidence of the value of metoprolol in preventing migraine attacks andsuggests that individual dosage titration can substantially enhance its efficacy. Side‐effects do notsignificantly impede its use and other evidence suggests that beta1‐selective blockers are to be preferredover non‐selective in migraine therapy.

In a questionnaire-based study we compared the clinical features of migraine with aura (classical migraine) and migraine without aura (common migraine) in 354 and 397 patients, respectively, attending The Princess Margaret Migraine Clinic. Other than those related to the aura, no significant differences were seen in any clinical features of the attack (e.g. frequency or duration of attacks, time of day at onset, location of headache at onset, severity of headache, or nausea and vomiting). Common migraine attacks were significantly more likely to occur at weekends (p = 0.002). Dietary triggers tended to be more troublesome in classical migraineurs while pregnancy and the menstrual cycle affected both migraine types equally. Classical migraine patients were twice as likely to have a history of hypertension (p less than 0.05) and showed a slightly but not significantly greater tendency to depression. Family histories of migraine were similar in each migraine type. We conclude that classical and common migraine are fundamentally similar in their clinical characteristics and that the occurrence of focal neurological symptoms during a migraine attack has little influence on the rest of the attack.

SummaryThe effect of graded exercise on the secretion of cortisol, testosterone, prolactin, growth hormone, thyroid stimulating hormone (TSH), luteinizing hormone and follicle stimulating hormone (FSH) is reported. While cortisol, prolactin, growth hormone and testosterone rise during the period of exercise, a rise in luteinizing hormone becomes evident only after rest. Levels of FSH and TSH remained unchanged.