Migraine recurrence is not associated with depressive or anxiety symptoms. Results of a randomized controlled trial.

In order to investigate the plausible association of migraine recurrence with anxiety and depressive symptoms, a multicentre, randomized, double-blind, placebo-controlled, crossover clinical trial was conducted using sumatriptan as a vehicle drug. Migraineurs were randomly assigned to receive either 50 mg sumatriptan or placebo for three consecutive migraine attacks, and then cross over to the other treatment for three more migraine attacks. The primary measurements were the observed rate of migraine recurrence in relation to (i) patient's mood condition, measured by the Hamilton rating scales for depression and anxiety and (ii) patient's general health and functioning measured by the Symptom Checklist (SCL)-90-R. Migraine recurrence was defined as any migrainous headache that occurred within 24 h post treatment, only when pain free at 2 h was achieved. The analysis of efficacy was performed on 376 migraine attacks treated with sumatriptan and 373 attacks treated with placebo. Recurrence ratio was 14.1% and 5.1%, respectively (P = 0.045). The number needed to treat for pain free at 2 h post dose was 5.4. Recurrence was not affected by Hamilton scores for depression or anxiety, SCL-90-R scores or treatment. Apparently, depressive or anxiety symptoms do not influence headache recurrence in acute pharmaceutical migraine treatment, but further investigation is required.

Apraxia related with subcortical lesions due to cerebrovascular disease.

OBJECTIVES: To examine whether ideomotor apraxia exists in patients with subcortical ischemic lesions. PATIENTS AND METHODS: A matched-control, prospective and multi-centered research design was used. Ideomotor apraxia, anxiety and depression were assessed by the Movement Imitation Test and the Hamilton scales, respectively. RESULTS: Forty two consecutive patients with subcortical ischemic stroke and an equal number of healthy participants, matched in age and sex were included. Paired-sample t-tests showed that patients had significantly more apractic elements in their movements (t = 5.03, P < 0.01), higher anxiety (t = -2.55, P = 0.0014) and depression levels (t = -2.61, P = 0.012) than their healthy matched participants. Participants with higher anxiety and depression scores performed worse on the Movement Imitation Test. CONCLUSIONS: Ischemic damage of subcortical modular systems may affect praxis.

Usefulness of inflammatory and haemostatic markers to predict short-term risk for death in middle-aged ischaemic stroke patients.

OBJECTIVES: There is increasing evidence that inflammation and hypercoagulability play an important role in the pathophysiology of acute ischaemic stroke. We examined the in-hospital prognostic value on mortality of C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-alpha), fibrinogen and D-dimer in middle-aged ischaemic stroke patients. MATERIALS AND METHODS: We recruited 231 consecutive patients <66 years with acute ischaemic stroke. CRP, TNF-alpha, fibrinogen and D-dimer levels were determined within 12 h from admission. RESULTS: Fifteen (6.5%) patients died during hospitalization. CRP, fibrinogen and D-dimer levels were significantly higher in patients who died compared with those who survived but only CRP and fibrinogen were independently associated with death, after adjusting for various confounding factors. For 1 mg/l increase in CRP there was a 20% higher risk of dying while for 10 mg/dl increase in fibrinogen the additive risk was 18%. CRP levels >18 mg/l and fibrinogen levels >490 mg/dl were the optimal points that discriminated those who died from the rest. CONCLUSIONS: CRP and fibrinogen levels can predict independently the risk of early death in middle-aged ischaemic stroke patients emphasizing the role of inflammation and coagulation in the evolution of ischaemic stroke.

Refractory chronic headache associated with obstructive sleep apnoea syndrome.

The aim was to investigate the comorbidity of chronic refractory headache with obstructive sleep apnoea syndrome (OSAs). Seventy-two patients (51 women and 21 men) with chronic and refractory headaches, whose headache occurred during sleep or whose sleep was accompanied by snoring, were submitted to polysomnography. Patients diagnosed with OSAs (respiratory disturbance index > 10) began continuous positive airway pressure (C-PAP) treatment and were followed up for >or= 6 months. Twenty-one cases of OSAs were identified (29.2% of the total investigated, 13.7% of the women and 66.6% of the men). Headaches were classified into several headache disorders, medication overuse headache and cluster headache being the most prevalent (nine and six of the 21 cases, respectively). In one case (1.4% of the total sample, 4.7% of all the men), the criteria for hypnic headache were fulfilled. Multivariate regression analysis revealed that age, male gender and body mass index were associated with OSAs. C-PAP treatment improved both sleep apnoea and headache in only a third of the cases. Patients suffering from chronic refractory headache associated with sleep or snoring, in particular those who are also middle-aged, overweight men, should be considered for polysomnography. C-PAP treatment alone does not seem to improve headache, but further investigation is needed.