Impact of Skull Thickness on Cerebral NIRS Oximetry in Neonates: An in silico Study.

Monitoring of cerebral tissue oxygen saturation (StO2) by near-infrared spectroscopy (NIRS oximetry) has great potential to reduce the incidence of hypoxic and hyperoxic events and thus prevent long-term disabilities in preterm neonates. Since the light has to penetrate superficial layers (bone, skin and cerebrospinal fluid) before it reaches the brain, the question arises whether these layers influence cerebral StO2 measurement. We assessed this influence on the accuracy of cerebral StO2 values. For that purpose, we simulated light propagation with 'N-layered medium' software. It was found that with a superficial layer thickness of ≤6 mm, typical for term and preterm neonates, StO2 accurately reflects cerebral tissue oxygenation.

Comparison of tissue oximeters on a liquid phantom with adjustable optical properties: an extension.

Cerebral near-infrared spectroscopy (NIRS) oximetry may help clinicians to improve patient treatment. However, the application of NIRS oximeters is increasingly causing confusion to the users due to the inconsistency of tissue oxygen haemoglobin saturation (StO2) readings provided by different oximeters. To establish a comparability of oximeters, in our study we performed simultaneous measurements on the liquid phantom mimicking properties of neonatal heads and compared the tested device to a reference NIRS oximeter (OxiplexTS). We evaluated the NIRS oximeters FORE-SIGHT, NIRO and SenSmart, and reproduced previous results with the INVOS and OxyPrem v1.3 oximeters. In general, linear relationships of the StO2 values with respect to the reference were obtained. Device specific hypoxic and hyperoxic thresholds (as used in the SafeBoosC study, www.safeboosc.eu) and a table allowing for conversion of StO2 values are provided.

Headache patients in primary care and a tertiary care unit in Zürich, Switzerland.

The Headache and Pain Clinic (HPC) is a unit of the Zürich Neurology Department, established in 1966. In the present study demographic features, clinical characteristics and medical management of primary and tertiary care patients were compared in two groups of 181 patients each, seen by general practitioners (GPs) or the HPC, respectively, for primary headaches in 1998. There was a preponderance of women and the socially underprivileged in both samples. Chronic headache was overrepresented in the HPC (44.7%). Loss of work for >2 months was found exclusively in the HPC (9.9%). Of the GP patients, 40% were using triptans and 26.5% in the HPC. One-third of both groups had had complementary and alternative medical treatment. Differences in management strategies reflected differences in headache severity and chronicity. Results indicated that remaining shortcomings of diagnosis and treatment of headache in primary care could be minimized by involving GPs in similar non-commercial studies.

The early use of ergotamine in migraine. Edward Woakes' report of 1868, its theoretical and practical background and its international reception.

Although ergot had been used in obstetrics for several centuries, it was proposed for the treatment of migraine only in the 19th century. The British ENT-surgeon Edward Woakes (1837-1912) recommended ergot as a vasoconstricting agent for migraine and other neurogenic conditions associated with vasodilatation in 1868. He subscribed to the theory of vasodilatation by sympathetic deficit, presented in the early 1850s by Brown-Séquard and Claude Bernard. Du Bois-Reymond proposed vasoconstriction by sympathetic overactivity as the cause of migraine in 1860; Brown-Séquard opposed this in favour of vasodilatation. Vasodilatation due to sympathetic deficit in migraine was again supported by Möllendorf, with clinical evidence, in 1867. Woakes' paper of 1868 introduced ergot as a vasoconstrictor for the same condition. Reception abroad was prompt. A German version appeared in 1869, and Eulenburg cited Woakes in his textbook of 1871. Eulenburg presented the use of ergot for migraine as a routine measure in the second edition of his textbook in 1878, and in a paper published in 1883. The method was internationally accepted, but it became really popular only after the isolation of pure ergotamine in 1918, resulting in the first reliable compounds with stable properties and predictable effects. Contrary to Woakes' theory, in the early 20th century ergot was used for migraine because of its well-documented adrenolytic properties, as migraine was by then again believed to be a sympathotonic and vasospastic condition.

The pioneer woman's view of migraine: Elizabeth Garrett Anderson's thesis "Sur la migraine".

This is a presentation of a doctoral thesis of 1870. The author was English but the thesis and the examinations were in French. Elizabeth Garrett Anderson, usually referred to as E.G.A., was the first woman in Britain to obtain the title of M.D., but not the first in Europe. Nadeshda Prokofevna Suslova, a Russian, received her M.D. in 1867 in Zurich, the most liberal university at that time, soon to be flooded by female students from Russia. E.G.A. had been applying to the few possible European universities but she settled for Paris after the Empress Eugenie had decided that she should be accepted there. This meant that she could succeed without having to be a Paris resident, just by writing a thesis and passing a series of examinations presided over by Paul Broca. This was important as she was already conducting private and dispensary practice, and could not find a locum (she insisted on a woman). E.G.A. had suffered many setbacks, for being a woman, as such being unacceptable in dissection rooms and operating theatres, and generally in a professional career where women were unheard of. She was finally permitted to receive her medical diploma from the Worshipful Society of Apothecaries of London. She wrote about her thesis: "I have chosen Headache as its subject. I had to find a subject which could be well studied without post-mortem observations, of which I can have but very few in either private or dispensary practice; and I wished also to take a large subject, one that demanded some insight into the harmony that exists between the main physiological functions." Marcia Wilkinson (M.W.), who worked in the Elizabeth Garrett Anderson Hospital in London for 35 years, heard there of E.G.A.'s thesis on migraine and sent for it from Paris. In 1966 she translated it into English from the original French, being interested both in the subject and in the person of this resolute and lucid woman. When H. Isler found the French thesis in the British Library he intended to translate it but, after discussion, we decided on a joint effort (95% of the translation is by M.W.; very few details were changed, and some footnotes added for better understanding). We think that E.G.A.'s text is a classic, showing profound understanding, sound practical advice, and also, in its theoretical part, the limits of neurophysiological knowledge in Paris when Brown-Sequard was "charge des cours" there. We may add that in her various examinations she had to answer questions, in French, on the use of footprints by the police, the general nature of fishes, toxic fishes, electric fishes, cod liver oil, and the secretion of tears. She earned much applause from the public, which consisted of male French students, and the overt appreciation of Paul Broca, head examiner, and Dr Wurtz, the Dean of the Faculte de Médecine. The impact of her thesis in the 19th century was modest. It appears to be rather marginal in the German literature of the early 20th century, but it has imprinted the management of migraine at the City of London Migraine Clinic in the last thirty years. The importance of nutrition, regular meals, regular habits, the need to supplement analgesics with antiemetics, and the treatment of the attack with rest, and great quantities of hot tea, were certainly related to E.G.A.'s doctrine. The internationally prevailing recommendation to give antiemetics, and then only analgesics, as well as the combination of both in one tablet, may thus be traced back to E.G.A. via the teachings of M.W. and Nat Blau.

A sixth-century Irish headache cure and its use in a south German monastery.

Medieval headache treatment is largely unknown. Medieval incantations against headache enumerate bodily organs to be protected. One 8th-century Latin hymn from Lake Constance using this device is addressed to St. Aid "mechprech", who has been identified as Aed Mac Bricc, Bishop of Killare, 6th century. This Irish Saint inspired unusual legends by some rather unorthodox activities: He abducted a young girl as hostage while his inheritance was withheld, but at the same time was seen surrounded by angels. He prayed for a nun who was pregnant and made the pregnancy vanish by a miracle, and he replaced the severed heads of maids, men and horses, creating a new spring as a by-product of this operation. Already at his birth his head had hit a stone, leaving a hole in the stone which collected rainwater that cured all ailments. In our own time, such "bullaun stones" are still believed to cure headache in Ireland. According to the legends collected by Plummer and Colgan, St. Aed Mac Bricc was well known for his power to cure headaches. He relieved St. Brigid's headache when she was suffering many miles away, but his most impressive cure was in convincing a headache sufferer that the patient's headache could actually be transferred own head. The headache hymn or incantation is intended to repeat Aed's unique miracle.

Magnesium in the prophylaxis of migraine--a double-blind placebo-controlled study.

The migraine prophylactic effect of 10 mmol magnesium twice-daily has been evaluated in a multicentre, prospective, randomized, double-blind, placebo-controlled study. Patients with two to six migraine attacks per month without aura, and history of migraine of at least 2 years, were included. A 4-week baseline period without medication was followed by 12 weeks of treatment with magnesium or placebo. The primary efficacy end-point was a reduction of at least 50% in intensity or duration of migraine attacks in hours at the end of the 12 weeks of treatment compared to baseline. With a calculated total sample size of 150 patients, an interim analysis was planned after completing treatment of at least 60 patients, which in fact was performed with 69 patients (64F, 5M), aged 18-64 years. Of these, 35 had received magnesium and 34 placebo. The number of responders was 10 in each group (28.6% under magnesium and 29.4% under placebo). As determined in the study protocol, this was a major reason to discontinue the trial. With regard to the number of migraine days or migraine attacks there was no benefit with magnesium compared to placebo. There were no centre-specific differences, and the final assessments of treatment efficacy by the doctor and patient were largely equivocal. With respect to tolerability and safety, 45.7% of patients in the magnesium group reported primarily mild adverse events like soft stool and diarrhoea in contrast to 23.5% in the placebo group.

Cyclandelate in the prophylaxis of migraine: a randomized, parallel, double-blind study in comparison with placebo and propranolol. The Study group.

Cyclandelate inhibits calcium-induced contraction of vascular smooth muscle cells, platelet aggregation induced by thrombin, platelet-activating-factor and adenosine, and also suppresses a provoked 5HT release from platelets. This pharmacological profile suggests that cyclandelate may have a potential prophylactic effect in migraine. To test this hypothesis, a double-blind multicentre study was performed in 214 patients to investigate the efficacy and tolerability of cyclandelate compared to placebo and propranolol. After a 4-week baseline period, eligible patients (randomization 3:2:3) were treated for 12 weeks with daily doses of 1.200 mg cyclandelate (n = 81), placebo (n = 55) or 120 mg propranolol (n = 78). The number of migraine attacks (> or = 50% responders) and the migraine duration/month were compared based on the difference between baseline and the last 4 weeks of prophylactic treatment. The percentage of patients with a reduction in migraine attacks of > or = 50% treated with cyclandelate (37.0%) or propranolol (42.3%) was not significantly superior to placebo (30.9%; p > 0.025). The mean duration of migraine in hours (h) per month decreased in both active treatment groups (cyclandelate: 36.8 h, p = 0.046; propranolol: 34.4 h, p = 0.039) compared to placebo (13.7 h) without reaching statistical significance (alpha/2 = 0.025). The clinical efficacy of cyclandelate and propranolol was comparable. Adverse experiences were reported by 13 patients (16.0%) treated with cyclandelate, by 5 patients (9.1%) treated with placebo and by 19 patients (24.4%) treated with propranolol. These were drug-related in 7.1% (n = 6) of patients treated with cyclandelate and in 9% (n = 7) of patients treated with propranolol. In summary, cyclandelate has a comparable efficacy to that of propranolol, an established drug of first choice in the prophylaxis of migraine. Both drugs were better than placebo, but not significantly so. Both active treatments were well tolerated.

Headache as an occupational illness in the treatise "De morbis artificum diatriba" of Bernardino Ramazzini.

The treatise "De morbis artificum diatriba" (Modena, 1700) is considered to be the first text to specifically deal with occupational illnesses. It was also the last for over 150 years. Written by Bernardino Ramazzini (Carpi, 1633-Padua, 1714), a professor at the University of Padua from 1700 to 1714, the book highlights the importance given at the time to headache as an occupational symptom. Among the 69 professions described, accounting for the majority of the occupations of the period, 12 were found to lead to headache as an important symptom caused by work. Ramazzini appears to have paid more attention to this than we do today. Ramazzini's work opens up a wide view on social conditions in the 18th century, as his sensitivity for occupational hazards was exceptional. His remarks on headache are typical of his way of collecting first-hand experience of working conditions, and they underline the importance of occupational hazards in the assessment of headache, today just as in 1710.

[Neuropsychiatry and neuropsychology]. / Neuropsychiatrie und Neuropsychologie.

The 17th centurys origins of neuropsychiatry are found in the works of Thomas Willis, who introduced the terms 'psychologia' and 'neurologia' and developed a complete neuropsychiatric concept. His views were revived by 18th-century animists and vitalists who were able to accept body-mind interactions, unlike the followers of Leibniz (e.g. Haller) who stuck to his psychophysical parallelism without possible interaction. This was also the creed of John Hughlings Jackson, whose influence on the development of neuropsychiatry and neuropsychology in the first decades of the 20th century was second to none. Neuropsychiatry, a Germanic specialty, was able to germinate in 1845 in Griesinger's 'Pathology and therapy of mental diseases', after Gall, Mesmer, Johannes Müller and many others had reformed and expanded the concept of mind-body interaction. In the second half of the 19th century, in the German-speaking countries progress in both neurology and psychiatry was usually achieved by neuro-psychiatrists. Neuropsychology (Lashley, 1913) was a product of both Jacksonian and Germanic neuropsychiatric ideas. During the 20th century neurology was separated from psychiatry, but new trends and their names such as 'psychobiology' and 'biological psychiatry', although quite old, are suggestive of a new kind of neuropsychiatry.

Headache classification and the Bible: Was St Paul's thorn in the flesh migraine?

The conversion of Saul to Paul was a major event in the history of Western culture. Compared with its impact, any medical comments may seem redundant, but they have kept their place in the literature for many centuries. The flashing light that caused Saul to fall is often explained as solar retinopathy or keratitis, a seizure, or even a hysterical fit. These interpretations propose either a trivial injury or disease that would interfere with mental health. Neither version is quite compatible with the dramatic dimension of the event and with Paul's later achievements and sufferings. In later years, Paul became a great manager, preacher and writer who was able to carry on under any kind of duress, though not without very painful reactions. He was suffering from bouts of unilateral headache, and also from a chronic eye condition which gave great trouble to his followers but did not cause lasting damage; the descriptions fulfil the criteria for migraine without aura of the 1988 Headache Classification. If the flashing light that caused Paul to fall down is interpreted as a visual migraine aura, with the additional symptoms of "not seeing" or photophobia and anorexia, it falls into place with his later history of migraine.

Efficacy and tolerability of amitriptylinoxide in the treatment of chronic tension-type headache: a multi-centre controlled study.

Amitriptyline is the medication of first choice in the treatment of chronic tension-type headache. In 197 patients with chronic tension-type headache (87M and 110F with a mean age of 38 +/- 13 (18-68)) efficacy and tolerability of 60-90 mg amitriptylinoxide (AO) were compared with 50-75 mg amitriptyline (AM) and placebo (PL) in a double-blind, parallel-group trial consisting of a four weeks' baseline phase and 12 weeks of treatment. The primary study endpoint was a reduction of at least 50% of the product of headache duration and frequency and a reduction of at least 50% in headache intensity. Statistics used were Fisher's exact test and analysis of variance. No significant difference emerged between AO, AM and PL with respect to the primary study endpoint. Treatment response occurred in 30.3% of the AO, 22.4% of the AM and 21.9% of the PL group. A reduction in headache duration and frequency of at least 50% was found in 39.4% on AO, in 25.4% on AM and in 26.6% on PL (PAO-PL = .1384, PAM-PL = 1.000, PAO-AM = .0973). A reduction in headache intensity of at least 50% was found in 31.8% on AO, in 26.9% on AM and in 26.6% on PL (PAO-PL = .5657, PAM-PL = 1.000, PAO-AM = .5715). Trend analysis with respect to a significant reduction of headache intensity (p < 0.05) and the product of headache duration and frequency revealed a superior effect of AO.(ABSTRACT TRUNCATED AT 250 WORDS)

The Zurich Study: XXIII. Epidemiology of headache syndromes in the Zurich cohort study of young adults.

This study examines the 1 year prevalence rates of headache syndromes in an epidemiologic cohort study of young adults ages 29-30 in Zurich, Switzerland. The 1 year prevalence rates of headache subtypes were 3.3% for migraine with aura and 21.3% of migraine without aura as defined by the International Headache Society (IHS) criteria. The demographic distribution, clinical features, sequelae, and treatment patterns of subjects with specific headache subtypes are described. The rates of migraine are compared to those of other community samples that have employed the IHS criteria for headache subtypes. Subjects with migraine reported pervasive impairment in nearly every life role including occupation, leisure, and social relationships. Despite the substantial degree of impairment in occupational and social functioning that was associated with migraine, an extremely low proportion of subjects had received professional treatment for headache. These results suggest that a concerted effort should be directed towards education regarding the classification of headache and the availability of efficacious treatment for migraine.

Episodic cluster headache from a textbook of 1745: van Swieten's classic description.

The first description of cluster headache is usually attributed to authors who published between 1867 and 1939, but lately several researchers have found accounts dating back to the 18th or even the 17th century which are incomplete or do not account for cluster headache in the strict sense. However, Gerhard van Swieten gave a full description of a case of episodic cluster headache meeting the IHS criteria in 1745, in his textbook of clinical medicine, the mainstream textbook of Continental medicine in those years, since van Swieten was the founder of the then leading medical centre, the Vienna School. That the case was found again only in 1992 is due to the circumstance that it was published in Latin. It is presented here in an English translation facing the original Latin text.

Evaluation of the nosology of chronic tension-type headache.

Tension-type headache is one of the problematic classes of the IHS classification of headache. Based on the data of 211 cases of chronic tension-type headache modified criteria are proposed for the diagnosis of chronic tension-type headache. In order to provide optimal discrimination between migraine and tension-type headache it is recommended that the severity of characteristic migraine symptoms, which also frequently occur at a mild level of intensity among patients with tension-type headache, be incorporated into the diagnostic criteria for this headache. Specifically, mild photophobia and phonophobia, and headache aggravation by physical activity should not be used as exclusion criteria for tension-type headache.