IGRAINE IS A COMMON AND disabling condition that typically manifests as attacks of severe, pulsating, 1-sided headaches, often accompanied by nausea, phonophobiaor or photophobia. Population-based studies suggest that 6% to 7% of men and 15% to 18% of women experience migraine headaches. 1,2 Although in most cases it is sufficient to treat acute headaches, many patients require interval treatment as attacks occur often or are insufficiently controlled. Drug treatment with ␤-blockers, calcium antagonists, or other agents has been shown to reduce the frequency of migraine attacks; however, the success of treatment is usually modest and tolerability often suboptimal. 3 Acupuncture is widely used for preventing migraine attacks although its effectiveness has not yet been fully established. 4 Since 2001, German social health insurance companies have reimbursed accredited physicians who provide acupuncture treatment for chronic pain. By December 2004 more than 2 million patients had been treated with acupuncture , about a third of these had migraine or tension-type headaches. In this study, the Acupuncture Randomized Trial (ART-Migraine), we investigated whether acupuncture reduced headache frequency more effectively than sham acupuncture or no acupuncture in patients with migraines.

ISRCTN9737659.

Due to missing the recruitment target (480 patients) and the high drop-out in the metoprolol group the results must be interpreted with caution. Still, they suggest that acupuncture might be an effective and safe treatment option for patients unwilling or unable to use drug prophylaxis.

We report headache induced BOLD changes in an atypical case of trigeminal autonomic cephalgia (TAC). A 68-year-old patient was imaged using fMRI during three attacks of a periorbital head-pain with a average duration of 3 min. During the attacks, left sided conjunctival injection, rhinorrhea, lacrimation, facial sweating and hypersalivation were apparent. These attacks were usually partly responsive to oxygen administration but otherwise refractory to any drug. The patient described either attacks with a duration of one minute or less or longer attacks persisting for maximum of 20 min with headaches occurring up to 100 times a day. When considering the symptoms, frequency, duration and therapeutic response of the patient's headache, no clear-cut classification to one of the subtypes of trigeminal autonomic cephalgias (cluster headache, paroxysmal hemicrania, SUNCT) or trigeminal neuralgia was possible. The cerebral activation pattern was similar but not identical to those previously observed in cluster headache and SUNCT with a prominent activation in the hypothalamic grey matter. This case study underlines the conceptual value of the term TAC for the group of headaches focusing around the trigeminal-autonomic reflex. Our results emphasize the importance of the hypothalamus as key region in the pathophysiology of this entity.