[Ultrasound studies of blood flow velocity in main cranial arteries in idiopathic headaches]

The published results of transcranial Doppler (TCD) studies of main cerebral arteries, performed in the patients with idiopathic headaches, especially with migraine, are controversial. Some authors could not find any changes, others observed increased blood flow. These results were, however, based on single examination, and the comparison on mean velocities calculated for the whole groups. In the present study the authors decided to perform a series of TCD studies in each patient and to analyse the individual cases. It was found that blood flow velocity in the main cerebral arteries in chronic tension-type headache (8 cases) and cluster headache (7 cases) showed normal values, established for 35 healthy subjects. In migraine without aura (20 cases) and with aura (11 cases) a considerable increase (above 30%) in cerebral blood flow was found in some studies. In around 50% of the cases increased blood flow in anterior and middle cerebral arteries was found unilaterally. The authors believe that the above findings might be specific for migraine and reflect transient vasoconstriction of the vessels that, on the other head, may be the premonitory laboratory sign of the attack.

[Sodium valproate versus propranolol in the prophylactic treatment of migraine]

In the recent years sodium valproate (SV) has been proposed as a prophylactic drug in migraine. Several reports documented a positive effect of SV in migrainous patients. The authors present the results of the open study in 35 women with migraine without aura treated with the daily dose of 1000-1500 mg of SV, during 10 weeks. The results were compared with the effect of propranolol administered to the same patients, in daily dose of 120-160 mg during 10 weeks. The effects were similar: in both methods more than 50% reduction of frequency and severity of attacks was obtained. The side effects were generally mild; in no case the treatment was stopped. The authors conclude that in the future SV might be administered in migraine prophylaxis as the first choice drug.

[Automatic regulation of sinus rhythm in patients with migraine]

The clinical symptoms of migraine point to autonomic disturbances, especially to disrupted regulation of the circulatory system and autonomic balance. Searching for more accurate autonomic system studies we turned to the spectral analysis of cardiac rhythm changes, that allows to estimate the autonomic balance in sinus node. 44 patients with migraine were studied and the results were compared with those obtained in 74 healthy subjects. The reduced influence of both sympathetic and parasympathetic part of autonomic system on the sinus rhythm in migraine patients was found. The autonomic balance is shifted to the parasympathetic innervation side in patients with migraine.

[The number and affinity of fibrinogen receptors in blood platelets of patients with ischemic stroke]

Parameters of fibrinogen binding with blood platelets (number of receptors and their affinity) have been studied in patients with ischemic stroke. Due to the increased platelet ability to aggregate in the ischemic diseases such studies seem helpful. The studies involved 13 patients with ischemic stroke. Blood platelets collected from younger patients (under 50 years) possessed significantly higher number of receptors binding fibrinogen than blood platelets of healthy individuals (p less than 0.02). These receptors significantly more strongly bound ligand than those in the control group (p less than 0.05), and in the group of older patients with stroke (less than 0.05). Fibrinogen binding to blood platelets in patients over 50 years of age did not differ significantly from that in the control group. These results may indicate, that the increased platelet aggregation might be a significant pathogenic factor of the stroke in younger patients.

Expression of fibrinogen receptors in platelets of migraine patients--correlation with platelet GPIIb content and plasma cholesterol

Binding of fibrinogen to platelets washed from blood of migraine patients (n = 30) and control donors (n = 24) was compared. In addition, contents of platelet glycoprotein IIb and platelet fibrinogen were determined in both groups by radioimmunoassay. The receptor capacity for fibrinogen in platelets activated by ADP was significantly higher (p less than 0.01) in migraine patients (52,505 +/- 4,925) than in controls (33,881 +/- 3,965). The mean contents of GPIIb (3.51 +/- 0.34 micrograms/10(8) platelets) and fibrinogen (37.26 +/- 4.05 micrograms/10(8) platelets) in migraine platelets were also markedly increased (p less than 0.01 and p less than 0.001, respectively) when compared to controls (2.21 +/- 0.18 micrograms of GPIIb and 18.75 +/- 2.29 micrograms of fibrinogen per 10(8) platelets, respectively). There was a high correlation between the number of fibrinogen receptors exposed by ADP and the total amount of platelet GPIIb both in migraine patients (R = 0.69, p less than 0.01) and controls (R = 0.62 p less than 0.01), as well as plasma cholesterol in the case of migraine patients (R = 0.82, p less than 0.001).

[Effect of total cholesterol level on platelet aggregation in patients with migraine]

In 34 women with simple migraine the total cholesterol concentration in the serum and the platelet aggregation index according to Wu and Hoak were determined. The blood cholesterol levels differed in them. Two groups of patients were isolated: group I with cholesterol level above the upper normal range and group II with cholesterol within this range. The mean concentration of this lipid differed significantly between these groups (p less than 0.001). The platelet aggregation index in group I was significantly lower than in the group with normal cholesterol level (p less than 0.05). During migraine attack a further fall was observed in the platelet aggregation index in the group with high cholesterol level (p less than 0.01). The authors suppose that cholesterol concentration may be one of the factors determining differences in platelet behaviour in migraine patients.

[Pathomechanisms of pain attacks in Horton's headache (cluster headache)]

In view of the still unexplained pathomechanism of Horton's cluster headaches 9 patients were given a challenge test with nitroglycerin while at the same time the attacks were blocked with indomethacin. The attacks were provoked with one dose (1 mg) of nitroglycerin. Then during 3 days the patients took 75-100 mg indomethacin which dose was quite sufficient for inhibition of the activity of arachidonic acid cyclooxygenase. On the fourth day another nitroglycerine provocation was done. No inhibitory effect of indomethacin on the attack was observed. It seems doubtful that products of arachidonic acid cyclooxygenation play any role in the pathomechanism of this headache.

[Platelet aggregation in patients with migraine during the pain attack and in the pain-free period]

In 31 women with a history of migraine platelet aggregation was studied between migrainous attacks, and in 14 of them during an attack of migraine. The method of Born and Cross was used. The rates of the first and second phases of aggregation were calculated and the quantitative index of aggregation curve according to Cavallero was calculated. Adrenaline in concentrations of 2 and 4 micron M was used as the aggregating factor. No differences were found in the mean rates of the first phase of aggregation between the patients and the controls. The rate of the second phase in the time between migraine attacks was significantly higher in patients with migraine (p less than 0.001) than in healthy subjects. During migraine attack the mean rate of the second phase decreased significantly (p less than 0.02 and p less than 0.001). These changes of the rate of the second phase may be explained as due to disturbances in the release of the aggregating substances from platelets and accumulation of platelet-activating substances.