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Repiso-Guardeño Á, Moreno-Morales N, Labajos-Manzanares MT, Rodríguez-Martínez MC, Armenta-Peinado JA. Does Tension Headache Have a Central or Peripheral Origin? Current State of Affairs. Curr Pain Headache Rep 2023; 27:801-810. [PMID: 37889466 PMCID: PMC10713699 DOI: 10.1007/s11916-023-01179-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW The aim of this narrative review is to analyze the evidence about a peripheral or central origin of a tension headache attack in order to provide a further clarification for an appropriate approach. RECENT FINDINGS Tension headache is a complex and multifactorial pathology, in which both peripheral and central factors could play an important role in the initiation of an attack. Although the exact origin of a tension headache attack has not been conclusively established, correlations have been identified between certain structural parameters of the craniomandibular region and craniocervical muscle activity. Future research should focus on improving our understanding of the pathology with the ultimate goal of improving diagnosis. The pathogenesis of tension-type headache involves both central and peripheral mechanisms, being the perpetuation over time of the headache attacks what would favor the evolution of an episodic tension-type headache to a chronic tension-type headache. The unresolved question is what factors would be involved in the initial activation in a tension headache attack. The evidence that favors a peripheral origin of the tension headache attacks, that is, the initial events occur outside the brain barrier, which suggests the action of vascular and musculoskeletal factors at the beginning of a tension headache attack, factors that would favor the sensitization of the peripheral nervous system as a result of sustained sensory input.
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Affiliation(s)
- Ángela Repiso-Guardeño
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071, Málaga, Spain
| | - Noelia Moreno-Morales
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071, Málaga, Spain
- Biomedical Research Institute of Malaga-Nanomedicine Platform (IBIMA-BIONAND Platform), 29590, Málaga, Spain
| | - María Teresa Labajos-Manzanares
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071, Málaga, Spain
- Biomedical Research Institute of Malaga-Nanomedicine Platform (IBIMA-BIONAND Platform), 29590, Málaga, Spain
| | - María Carmen Rodríguez-Martínez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071, Málaga, Spain.
- Biomedical Research Institute of Malaga-Nanomedicine Platform (IBIMA-BIONAND Platform), 29590, Málaga, Spain.
| | - Juan Antonio Armenta-Peinado
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071, Málaga, Spain
- Biomedical Research Institute of Malaga-Nanomedicine Platform (IBIMA-BIONAND Platform), 29590, Málaga, Spain
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Doneray H, Tavlas G, Ozden A, Ozturk N. The role of breast milk beta-endorphin and relaxin-2 on infant colic. Pediatr Res 2023; 94:1416-1421. [PMID: 37142649 DOI: 10.1038/s41390-023-02617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/29/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The relationship between infant colic and breast milk beta-endorphin (BE) and relaxin-2 (RLX-2) has not been studied before. METHODS Thirty colic infants and their mothers constituted the study group, and the same sex, similar age and healthy infants and their mothers formed the control group. Maternal predisposing factors were analysed with questionnaires. RESULTS The frequency of headache and myalgia in the mothers was significantly higher in the study group compared to the control group. Sleep quality of mothers in the study group was worse than in the control group (p = 0.028). While breast milk RLX-2 level in the study group was not different from the control group, breast milk BE level in the study group was significantly higher than the control group (p = 0.039). A positive correlation was found between breast milk BE levels and crying times, and between sleep quality scores and crying times. Headache, myalgia, sleep quality and breast milk BE levels were found to have a significant effect on infant colic. CONCLUSIONS Breast milk RLX-2 has no role on infant colic. Breast milk BE may act as a biological mediator in transmitting of maternal predisposing factors such as poor sleep quality, headache and myalgia from mother to infant. IMPACT The relationship between infant colic and breast milk beta-endorphin (BE) and elaxin-2 (RLX-2) has not been studied before. Maternal sleep quality, headache, and myalgia are predisposing factors associated with infant colic. Breast milk RLX-2 has no effect on infant colic. Breast milk BE may play a role as a biological mediator in transmitting the effects of predisposing factors from mother to infant. Breast milk BE may be a mediator in biological communication between mother and infant.
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Affiliation(s)
- Hakan Doneray
- Department of Pediatric Endocrinology, Ataturk University Faculty of Medicine, Erzurum, Türkiye.
- Clinical Research Development and Design Application and Research Center, Ataturk University, Erzurum, Türkiye.
| | - Guzide Tavlas
- Department of Pediatrics, Ataturk University Faculty of Medicine, Erzurum, Türkiye
| | - Ayse Ozden
- Department of Pediatric Endocrinology, Erzurum Regional Training & Research Hospital, Erzurum, Türkiye
| | - Nurinnisa Ozturk
- Department of Medical Biochemistry, Ataturk University Faculty of Medicine, Erzurum, Türkiye
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Is calcitonin gene-related peptide a reliable biochemical marker of migraine? Curr Opin Neurol 2022; 35:343-352. [PMID: 35674078 DOI: 10.1097/wco.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to provide an overview of clinical studies on calcitonin gene-related peptide (CGRP) measurements in body fluids of migraine patients and to discuss the validity of CGRP measurement as a clinical biomarker of migraine. RECENT FINDINGS Several studies have reported increased CGRP levels in venous blood, saliva and tear fluid of migraine patients compared with healthy controls and in migraine patients during attacks compared with the interictal state, suggesting that CGRP may be a feasible biomarker of migraine. However, the findings of studies investigating CGRP levels in migraine patients are generally conflicting and measurements of CGRP levels are challenged by several methodological issues. Reported differences in CGRP levels between patients with chronic migraine relative to episodic migraine have also been inconsistent. There is also a well documented involvement of CGRP in several nonmigraine pain disorders, including cluster headache and common pain conditions such as osteoarthritis. SUMMARY Current evidence does not justify the usage of CGRP levels as a biomarker for diagnosing migraine or for determining the severity of the disease in individual patients. However, CGRP measurements could prove useful in the future as clinically relevant biomarkers for predicting the response to therapy, including anti-CGRP migraine drugs.
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Steel SJ, Robertson CE, Whealy MA. Current Understanding of the Pathophysiology and Approach to Tension-Type Headache. Curr Neurol Neurosci Rep 2021; 21:56. [PMID: 34599406 DOI: 10.1007/s11910-021-01138-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Description of headache dates back thousands of years, and to date, tension-type headache (TTH) remains the most common form of headache. We will review the history and current understanding of the pathophysiology of TTH and discuss the recommended clinical evaluation and management for this syndrome. RECENT FINDINGS Despite being the most prevalent headache disorder, TTH pathophysiology remains poorly understood. Patients with TTH tend to have muscles that are harder, more tender to palpation, and may have more frequent trigger points of tenderness than patients without headache. However, cause and effect of these muscular findings are unclear. Studies support both peripheral and central mechanisms contributing to the pain of TTH. Diagnosis is based on clinical presentation, while the focus of evaluation is to rule out possible secondary causes of headache. Treatment options have remained similar over the course of the past decade, with some additional studies supportive of both pharmacological and non-pharmacological options. An approach to TTH has been outlined including historical context, evolution over time, and the best evidence regarding our current understanding of the complex pathophysiology and treatment of this disease.
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Affiliation(s)
- Stephanie J Steel
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Carrie E Robertson
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mark A Whealy
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Abstract
Tension-type headache (TTH) is the most prevalent neurological disorder worldwide and is characterized by recurrent headaches of mild to moderate intensity, bilateral location, pressing or tightening quality, and no aggravation by routine physical activity. Diagnosis is based on headache history and the exclusion of alternative diagnoses, with clinical criteria provided by the International Classification of Headache Disorders, third edition. Although the biological underpinnings remain unresolved, it seems likely that peripheral mechanisms are responsible for the genesis of pain in TTH, whereas central sensitization may be involved in transformation from episodic to chronic TTH. Pharmacological therapy is the mainstay of clinical management and can be divided into acute and preventive treatments. Simple analgesics have evidence-based effectiveness and are widely regarded as first-line medications for the acute treatment of TTH. Preventive treatment should be considered in individuals with frequent episodic and chronic TTH, and if simple analgesics are ineffective, poorly tolerated or contraindicated. Recommended preventive treatments include amitriptyline, venlafaxine and mirtazapine, as well as some selected non-pharmacological therapies. Despite the widespread prevalence and associated disability of TTH, little progress has been made since the early 2000s owing to a lack of attention and resource allocation by scientists, funding bodies and the pharmaceutical industry.
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Jay GW, Barkin RL. Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache. Dis Mon 2017; 63:342-367. [PMID: 28886861 DOI: 10.1016/j.disamonth.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In Part 2 of Primary Headache disorders, we discuss the fourth Primary Headache Disorder, Tension-Type Headache (TTHA). We are again using the ICHD-III (Beta) definitions of such headaches, taking into consideration episodic and chronic TTHA, as well as the presence or absence of pericranial muscle tenderness. We discuss the pathophysiology and pharmacotherapeutic treatment of TTHA, and the aspects of the Myofascial Pain Syndrome that enhance and help the development of TTHA. We then discuss Medication Overuse Headache (MOH), itself a Secondary headache disorder, but one that is extremely important as it assists with the chronification of both migraine and TTHA. Finally we discuss how to manage and treat those patients with MOH. Chronic migraine, which is TTHA, Migraine as well as, in many patients, MOH, is discussed along with the treatment of this multifaceted disorder.
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Affiliation(s)
- Gary W Jay
- Clinical Professor, Department of Neurology, Headache Division, University of North Carolina, Chapel Hill, NC, USA
| | - Robert L Barkin
- Professor, Department of Anesthesiology, Family Medicine, Pharmacology Rush Medical College Chicago, Clinical Pharmacologist Department of Anesthesiology Pain Center of Skokie and Evanston Hospitals North Shore University Health System Illinois, USA
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Folchini C, Kowacs PA. Neurotrophic factors and tension-type headache: another brick in the wall? ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:377-380. [PMID: 26017200 DOI: 10.1590/0004-282x20150055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/23/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Caroline Folchini
- Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Cefaleia e Dor, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Pedro André Kowacs
- Departamento de Medicina Interna, Serviço de Neurologia, Unidade de Cefaleia e Dor, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Bernstein JA, Fox RW, Martin VT, Lockey RF. Headache and facial pain: differential diagnosis and treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:242-51. [PMID: 24565480 DOI: 10.1016/j.jaip.2013.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/07/2013] [Accepted: 03/08/2013] [Indexed: 11/16/2022]
Abstract
Headaches affect 90% of the population sometime during their life. Most are benign and fleeting, some are serious and life-threatening, and others require ongoing medical consultation and treatment. A careful history and physical is necessary to establish a differential diagnosis and to guide the choice of testing to make an accurate diagnosis. The most common types of headaches are discussed in this review. They are divided into primary and secondary headache disorders as classified by the International Headache Society. Primary headache disorders include migraine without and with aura, cluster and tension-type headaches. Secondary headaches are those that occur as a result of some other disorder and include brain tumors, rhinosinusitis, diseases of intracranial and extracranial vasculature, and temporomandibular joint disease.
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Affiliation(s)
- Jonathan A Bernstein
- Professor of Medicine, Director of Clinical Research, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Roger W Fox
- Professor of Medicine, Pediatrics and Public Health, Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Vincent T Martin
- Professor of Medicine, Department of Internal Medicine, Division of General Internal Medicine, University of Cincinnati, Cincinnati, Ohio; Associate Editor for Headache, American Headache Society, Mount Royal, NJ
| | - Richard F Lockey
- Distinguished University Health Professor, Professor of Medicine, Pediatrics and Public Health, Director, Division of Allergy and Immunology, Joy McCann Culverhouse Chair in Allergy and Immunology, Morsani University of South Florida College of Medicine, Tampa, Fla.
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Abstract
Tension-type headache is the most common headache type worldwide. Chronic tension-type headache (CTTH) affects 2% to 3% of patients, yet it represents the least talked about subtype of chronic daily headache. There is much debate in the headache community on whether CTTH exists as its own entity or is a milder form of chronic migraine (CM), because there are similarities and differences between the two headache forms. This article reviews CTTH, as well as the current pathophysiology and treatment, and discusses controversial issues in the diagnosis of CTTH and CM.
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Affiliation(s)
- Jessica Ailani
- Department of Neurology, Georgetown University Hospital, 3800 Reservoir Road NW, 7-PHC, Washington, DC 20007, USA
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10
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Abstract
OBJECTIVE The object of this review is to examine the published literature for cerebrospinal fluid laboratory measures of primary headache disorders to identify biomarkers and provide recommendations for future biomarker discovery. BACKGROUND Biomarkers may distinguish deviation from a normal state, provide insight into mechanisms of pathophysiology, quantify the degree of change, discriminate what may be clinically overlapping disorders, and allow monitoring and/or selection of specific treatment. High-throughput, discovery technologies fuel the ability to reveal more biomarkers than past hypothesis-driven studies. DESIGN OR METHODS: Publications were identified in PubMed, ISI web of knowledge (both Web of Science and BIOSYS), and SciFinder, using the key words for cerebrospinal fluid (CSF) and migraine, headache, or biomarkers. Additional references were sought from the papers identified in these searches. Data were assessed relating to all primary headache types for clinical and scientific methods and results. RESULTS Fifty-five out of 82 biomarkers were found from 55 publications, though none have been validated for clinical utility. Data for site (ventricular, cervical, lumbar) and timing of CSF collection, headache state, and diagnostic description were patchy, and controls were often poorly defined. Most routinely performed CSF measurements were within normal limits. Most levels of pain-related molecules were reduced, and concentrations of most neurotransmitters, neuropeptides, proteins, and small molecules were increased. Though few studies assessed the specificity of biomarkers for primary headaches, it is clear that there are differences in CSF biomarkers between migraine, cluster headache, tension-type headache, and trigeminal neuralgia. CONCLUSIONS The high proportion (67%) of biomarkers identified from laboratory measures tested thus far predicts that many more biomarkers will be identified for primary headaches when more candidates are evaluated. In order to discover and evaluate more biomarkers, especially those that may have clinical application for headache management, 3 recommendations are encouraged: prospective design of care-independent studies; evaluation of more clinical variables; and evaluation of substantially more candidates by using discovery-based research methods. Outlines of approaches to pursue these aims are proposed.
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Affiliation(s)
- Michael G Harrington
- Molecular Neurology Program, Huntington Medical Research Institutes, 99 North El Molino Avenue, Pasadena, CA 91101, USA
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Loder E, Harrington MG, Cutrer M, Sandor P, De Vries B. Selected Confirmed, Probable, and Exploratory Migraine Biomarkers. Headache 2006; 46:1108-27. [PMID: 16866715 DOI: 10.1111/j.1526-4610.2006.00525.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Elizabeth Loder
- Harvard Medical School and the John R. Graham Headache Centre, Department of Neurology, Brigham and Women's/Faulkner Hospital, Boston, MA, USA
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12
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Abstract
Tension-type headache is one of the most common primary headache disorders. Advances in basic pain and clinical research have improved our understanding of pathophysiologic mechanisms of tension-type headache. Increased excitability of the central nervous system generated by repetitive and sustained pericranial myofascial input may be responsible for the transformation of episodic tension-type headache into the chronic form. Studies of nitric oxide (NO) mechanisms suggest that NO may play a key role in the pathophysiology of tension-type headache and that the antinociceptive effect of nitric oxide synthase inhibitors may become a novel principle in the future treatment of chronic headache. Future studies should focus on investigation of the source of peripheral nociception, the role of descending pain modulation, and the development of an animal model of tension-type headache to support the pathophysiologic importance of central sensitization in tension-type headache.
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Affiliation(s)
- Sait Ashina
- Danish Headache Center and Department of Neurology, Glostrup Hospital, University of Copenhagen, DK-2600 Glostrup, Copenhagen, Denmark.
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13
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Edvinsson L, Uddman R. Neurobiology in primary headaches. ACTA ACUST UNITED AC 2004; 48:438-56. [PMID: 15914251 DOI: 10.1016/j.brainresrev.2004.09.007] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Revised: 08/17/2004] [Accepted: 09/08/2004] [Indexed: 11/23/2022]
Abstract
Primary headaches such as migraine and cluster headache are neurovascular disorders. Migraine is a painful, incapacitating disease that affects a large portion of the adult population with a substantial economic burden on society. The disorder is characterised by recurrent unilateral headaches, usually accompanied by nausea, vomiting, photophobia and/or phonophobia. A number of hypothesis have emerged to explain the specific causes of migraine. Current theories suggest that the initiation of a migraine attack involves a primary central nervous system (CNS) event. It has been suggested that a mutation in a calcium gene channel renders the individual more sensitive to environmental factors, resulting in a wave of cortical spreading depression when the attack is initiated. Genetically, migraine is a complex familial disorder in which the severity and the susceptibility of individuals are most likely governed by several genes that vary between families. Genom wide scans have been performed in migraine with susceptibility regions on several chromosomes some are associated with altered calcium channel function. With positron emission tomography (PET), a migraine active region has been pointed out in the brainstem. In cluster headache, PET studies have implicated a specific active locus in the posterior hypothalamus. Both migraine and cluster headache involve activation of the trigeminovascular system. In support, there is a clear association between the head pain and the release of the neuropeptide calcitonin gene-related peptide (CGRP) from the trigeminovascular system. In cluster headache there is, in addition, release of the parasympathetic neuropeptide vasoactive intestinal peptide (VIP) that is coupled to facial vasomotor symptoms. Triptan administration, activating the 5-HT(1B/1D) receptors, causes the headache to subside and the levels of neuropeptides to normalise, in part through presynaptic inhibition of the cranial sensory nerves. These data suggest a central role for sensory and parasympathetic mechanisms in the pathophysiology of primary headaches. The positive clinical trial with a CGRP receptor antagonist offers a new promising way of treatment.
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Affiliation(s)
- Lars Edvinsson
- Department of Internal Medicine, University Hospital, S-221 85 Lund, Sweden.
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14
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Affiliation(s)
- M Ashina
- Department of Neurology and Danish Headache Center, Glostrup Hospital, University of Copenhagen, Glostrup, Copenhagen, Denmark.
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15
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Ashina M, Bendtsen L, Jensen R, Schifter S, Olesen J. Calcitonin gene-related peptide levels during nitric oxide-induced headache in patients with chronic tension-type headache. Eur J Neurol 2001; 8:173-8. [PMID: 11284996 DOI: 10.1046/j.1468-1331.2001.00191.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It has been proposed that nitric oxide (NO) induced headache in primary headaches may be associated with release of calcitonin gene-related peptide (CGRP). In the present study we aimed to investigate plasma levels of CGRP during headache induced by the NO donor glyceryl trinitrate (GTN) in 16 patients with chronic tension-type headache and 16 healthy controls. The subjects were randomly allocated to receive 0.5 microg/kg/min GTN or placebo over 20 min on two headache-free days. Blood samples were collected at baseline, 10, 20 and 60 min after start of infusion. Both patients and controls developed significantly stronger immediate headache on the GTN day than on the placebo day and the headache was significantly more pronounced in patients than in controls. There was no difference between the area under the CGRP curve (AUCCGRP) on GTN vs. placebo day in either patients (P=0.65) or controls (P=0.48). The AUCCGRP recorded on the GTN day did not differ between patients and controls (P=0.36). Both in patients and controls, CGRP levels changed significantly over time, on both the GTN and placebo days (P < 0.05). The present study indicates that NO-induced immediate headache is not associated with release of CGRP.
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Affiliation(s)
- M Ashina
- Department of Neurology, Glostrup Hospital, University of Copenhagen, DK-2600 Glostrup, Copenhagen, Denmark.
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Abstract
Long-term administration of typical and atypical antipsychotic drugs (AP) induces excessive weight gain which afflicts up to 50% of patients, impairs health and interferes with treatment compliance. Basic and clinical research has shown that AP may affect body weight through diverse mechanisms. Increased appetite is probably related to the interaction of AP with neuronal receptors to dopamine, serotonin and histamine. Additional metabolic-endocrine disruption of weight regulation may be related to the effects of AP-induced hyperprolactinaemia on gonadal-adrenal steroids and insulin sensitivity. In humans, programmed physical activity, dietary restriction, anorectic agents, and drugs that counteract hyperprolactinaemia have been shown to be successful in a limited number of studies. Two novel strategies could expand the available therapeutic options. First, in preclinical experiments in female rats the estradiol antagonist/agonist drug tamoxifen or estradiol itself have been shown to completely prevent the obesity provoked by the AP sulpiride, and to induce an endocrine-metabolic milieu that seems to counteract AP-induced obesity. Secondly, it has also been shown that oral antihyperglycaemic agents such as metformin may decrease body weight and counteract insulin resistance and hyperinsulinaemia which is correlated with several metabolic abnormalities in obese subjects. Lastly, estradiol replacement, tamoxifen and/or antihyperglycaemic agents are not devoid of significant side-effects, and these drugs have not been tested in obese psychiatric patients. Therefore, further research is needed before their clinical use may be recommended.
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Affiliation(s)
- T Baptista
- Department of Physiology, Medical School, Universidad de Los Andes, Mérida, Venezuela
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Abstract
This paper endeavours to provide a critical clinical review of the use of selective serotonin reuptake inhibitors (SSRIs) in the management of pain. Case reports, placebo-controlled trials and trials comparing SSRIs with tricyclic antidepressants (TCAs) are considered. The analgesic effects of TCAs are well known and this review suggests that there is little evidence for their replacement by SSRIs in pain management. There are, at present, too few comparative drug trials to make a definitive statement, although the trend is clearly against SSRIs.
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Affiliation(s)
- A J Smith
- Liaison Psychiatry Department, Addenbrooke's Hospital, Cambridge, UK.
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Abstract
This article is the 17th installment of our annual review of research concerning the opiate system. It includes papers published during 1994 involving the behavioral, nonanalgesic, effects of the endogenous opiate peptides. The specific topics covered this year include stress; tolerance and dependence; eating; drinking; gastrointestinal, renal, and hepatic function; mental illness and mood; learning, memory, and reward; cardiovascular responses; respiration and thermoregulation; seizures and other neurological disorders; electrical-related activity; general activity and locomotion; sex, pregnancy, and development; immunological responses; and other behaviors.
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Affiliation(s)
- G A Olson
- Department of Psychology, University of New Orleans, LA 70148, USA
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