Iris Adrenergic Impairment in Idiopathic Headache

Fanciullacci, M

doi:10.1111/j.1526-4610.1979.hed1901008.x

Cited by 80 publications

(88 citation statements)

References 15 publications

(17 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Between successive attacks of migraine and during an attack, a smaller pupil diameter and a higher degree of anisocoria with smaller pupil size on the symptomatic side has been observed [4,8]. After local bilateral direct sympathetic activation by application of drugs such as cocaine and phenylephrine, pupillary dilatation was more pronounced in migraine sufferers than in controls [4,12,17], suggesting central sympathetic dysfunction [12]. Furthermore, following indirect activation of the sympathetic innervation, the pupillary dilatation was less marked compared with controls, suggesting a dysfunction of the tertiary sympathetic neuron [7].…”

Section: Introductionmentioning

confidence: 95%

Dysfunction of the pupillary light reflex following migraine headache

Mylius¹,

Braune²,

Schepelmann³

2003

Clinical Autonomic Research

View full text Add to dashboard Cite

Using pupillometry and sympathetic skin responses we compared the changes in local and systemic autonomic function within one week of a migraine attack. We investigated whether the measurement of the pupillary light reflex provides further information on the pathophysiology of migraine.Forty-two migraine patients and forty-two healthy age-matched controls were included. The parameters that were measured were the amplitude of the pupillary light reflex, the pupil size at the beginning of the measurement, the latency, the velocity of constriction and the velocity at the end of the dilatation. The average pupil size was 6.43 mm in the migraine group and 6.7 mm in the control group (p < 0.01). Reduced velocity of constriction and smaller amplitude of constriction in migraine patients within two days of an attack were signs of a parasympathetic dysfunction (p < 0.05). The sympathetic skin response did not differ significantly between migraine sufferers and controls. These findings indicate that both parasympathetic and sympathetic nerves supplying the eye are involved in migraine headache presumably due to effects on the pericarotid sympathetic fibers and involvement of trigeminal-parasympathetic reflexes.

show abstract

Section: Introductionmentioning

confidence: 95%

Dysfunction of the pupillary light reflex following migraine headache

Mylius¹,

Braune²,

Schepelmann³

2003

Clinical Autonomic Research

View full text Add to dashboard Cite

show abstract

“…However, he exhibited manifestations of transient sympathicoparesis, typical of acute attacks of cluster headache. [26][27][28][29] Recently, a patient was reported who, after 20 years of freedom from chronic cluster headache, had a relapse after a carotid thrombendarterectomy. It was concluded that the relapse might possibly be secondary to peroperative damage of the carotic sympathetic plexus.…”

Section: Clinical Features Of Sellar/suprasellar and Parasellar Pathomentioning

confidence: 99%

Clusterlike Headache in a Patient With a Pituitary Adenoma. With a Review of Literature

1996

View full text Add to dashboard Cite

A man had left-sided atypical clusterlike headache for II years before he developed symptoms and signs consistent with acromegaly. Preoperative evaluation revealed raised levels of somatomedin C and growth hormone. An MR indicated a left-sided intrasellar mass measuring 8 x 7.5 x 10 mm. He underwent surgery and microscopy confirmed the diagnosis of a benign hypophyseal adenoma. Postoperatively, the acromegalic features regressed, and for the last 4 years the patient has been completely free from headache attacks. On pharmacological testing of the pupillary response to 19 and 5% phenylephrine and 2% tyramine solutions, there was no convincing evidence of persistent sympathetic dysfunction on the earlier symptomatic side.Key words: acromegaly, clusterlike headache, phenylephrine pituitary adenoma, pupil, tyramine Abbreviations: GH growth hormone (Headache 1996;36:184-188) The pathophysiology of cluster headache remains unclear. In most instances, every extensive neurological and neuroradiological examinations will be normal. 1 However. symptomatic clusterlike headache has been reported in a variety of pathological conditions with varying locations. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Recently, pathophysiological interest has been focused on basal midline structures and in particular, the cavernous sinus. [17][18][19][20][21][22][23] We report a case of clusterlike headache associated with an intrasellar pituitary adenoma causing acromegaly. The relevance of the tumor location and its possible implications for the symptomatology, particularly with respect to sympathetic dysfunction, are discussed. CASE HISTORYA 37-year-old man had suffered from left-sided headache attacks for 4 years before he sough medical advice at the Department of Neurology Malmö University Hospital in 1985. His previous history was unremarkable. The headache was strictly left-sided and located behind the eye; radiating towards the left ear, the occiput, and the neck. Because the pain also involved the teeth in the left upper jaw, he had undergone dental treatments, including correction of bite, all of which had been in vain.The attacks occurred with varying intervals of weeks or months. The pain was excruciating, with a stinging and pulsating character. It always started at about the same time in the afternoon and lasted for up to 7 or 8 hours. The patient could only get some relief by a high intake of phenacetin and acetylsalicylic acid. However, by pouring hot water over the neck or by massaging the occipital region on the left side, he could also obtain considerable relief. The pain never sub sided completely before he went to bed. Initially, when the headache attacks started, he thought that attacks could be provoked by intense sunlight, shimmering waves, but also by a cold wind blowing in the face. Whenever he suffered an attack, his left eye was reddened with markedly increased lacrimation. The left nostril was blocked and there was rhinorrhea. During an attack, he did not experience nausea, nor did he ever vomit. Som...

show abstract

“…Tyramine eyedrops have been used successevoked mydriasis in healthy subjects. We used methoxamine-evoked mydriasis as a control: methoxamine is a fully in ophthalmic pharmacology as a diagnostic tool in Horner's syndrome [2 ] and in cluster headache directly acting a 1 -adrenoceptor agonist whose effect is not dependent on the size of the presynaptic noradrenaline patients [ 3,4]. In both clinical syndromes, indirectly acting sympathomimetic amines such as tyramine and store [17 ].…”

Section: Introductionmentioning

confidence: 99%

“…hydroxyamphetamine may have a reduced effectiveness in evoking mydriasis. The reduced effectiveness of the indirectly acting sympathomimetic amines is attributed to an impairment of the uptake and/or noradrenaline storage mechanisms in the terminals of the peripheral Methods sympathetic neurones innervating the dilator muscle of the iris [2,3,5]. Furthermore, in Horner's syndrome the Ethical considerations reduced effectiveness of tyramine is regarded as evidence for a postganglionic lesion.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effects of clonidine on tyramine‐ and methoxamine‐evoked mydriasis in man

Bitsios

Langley

Szabadi

et al. 1996

Brit J Clinical Pharma

View full text Add to dashboard Cite

1 It has been reported previously that clonidine can potentiate tyramine‐evoked mydriasis on the pain‐free side of cluster headache patients. We examined whether a single oral dose of clonidine (200 μg) can also potentiate tyramine‐evoked mydriasis in healthy subjects, using mydriasis to methoxamine, a directly acting sympathomimetic amine, as a control. 2 Eight healthy male volunteers participated in four weekly sessions. In the first two sessions (Experiment 1) the effect of clonidine or placebo on the mydriasis to tyramine hydrochloride eyedrops (75 mm; 2×10 μl), and in the last two sessions (Experiment 2) the effect of clonidine or placebo on the mydriasis to methoxamine hydrochloride eyedrops (20 mm; 2×10 μl) was examined. In both experiments subjects were allocated to drugs and sessions according to a double‐blind balanced design. In both experiments, pupil diameter of both the treated and the untreated eyes was recorded in standard ambient light and in the dark, before, and 2 h after clonidine/placebo, via binocular infrared television pupillometry. Salivation (dental roll technique), systolic and diastolic blood pressure (sitting), heart rate, and self‐ratings of mood and feelings (visual analogue scales), were also measured before, and 2 h after the ingestion of clonidine or placebo. 3 Both tyramine and methoxamine produced a significant mydriasis, which was more prominent in the light condition (change in resting pupil size; mm±s.e.mean: tyramine/light 1.05±0.28; tyramine/dark: 0.73±0.15; methoxamine/light: 1.65±0.28; methoxamine/dark: 0.85±0.15). Clonidine produced a significant miosis in the untreated eye which was more prominent in the light condition (change in resting pupil size; mm±s.e.mean: Experiment 1, light: −1.34±0.19; Experiment 1, dark: −0.46±0.1; Experiment 2, light −0.97±0.18; Experiment 2, dark: −0.29±0.17). Clonidine had no significant effect on either tyramine‐ or methoxamine‐evoked mydriasis. 4 In agreement with previous reports, clonidine significantly reduced salivation (g, mean±s.e.mean; Experiment 1: −0.84±0.22; Experiment 2: −0.55±0.11), systolic blood pressure (mm Hg; Experiment 1: −17.5±3.76; Experiment 2: −23.38±4.67), diastolic blood pressure (mm Hg; Experiment 2: −12.38±2.05), alertness (mm; Experiment 2: −24.19±5.40), and anxiety (mm; Experiment 1: −13.82±4.60), indicating the presence of pharmacodynamically effective tissue levels of the drug. 5 These results show that a single oral dose (200 μg) of clonidine causes significant miosis in human subjects, and fails to potentiate tyramine‐evoked mydriasis. This indicates that the pupil on the asymptomatic side of cluster headache patients is affected differently from the pupils of healthy volunteers by tyramine and/or clonidine.

show abstract

Iris Adrenergic Impairment in Idiopathic Headache

Cited by 80 publications

References 15 publications

Dysfunction of the pupillary light reflex following migraine headache

Dysfunction of the pupillary light reflex following migraine headache

Clusterlike Headache in a Patient With a Pituitary Adenoma. With a Review of Literature

Comparison of the effects of clonidine on tyramine‐ and methoxamine‐evoked mydriasis in man

Contact Info

Product

Resources

About