No description available.

Thesis (M.D.)—Boston University

Migraine manifests itself episodically with incidence ranging from one attack in a lifetime to one almost every day. Most migraineurs suffer from typical migraine with or without aura, that is inherited in a complex manner. A small number of migraineurs suffer from FHM, a condition that exhibits Mendelian inheritance. BFNC is another rare episodic disorder that exhibits Mendelian inheritance. In a four generational family the BFNC phenotype was linked to the KCNQ2 gene on chromosome 20q13.3. Blood samples and epidemiological information were collected from 214 migraine probands in the Grampian region. An Access database was created to hold these data which were subsequently input. The database was utilised to extract epidemiological information about the cohort for subsequent analysis. These data were compared to other studies to characterise the severity of the cohort. A total of six polymorphisms were analysed by association analysis for involvement in migraine. The first polymorphism to be analysed was the -141C Ins/Del polymorphism in the DRD2 gene on chromosome 11q22. This polymorphism was analysed by restriction digest. Statistical analysis excluded this polymorphism and the regions encompassed by linkage disequilibrium in the aetiology of migraine. The second and third polymorphisms were located in intron 1 of the ERa gene on chromosome 6q25. These two polymorphisms were identified by restriction digest. Individual and haplotype analysis excluded the involvement of both polymorphisms in the aetiology of migraine. The fourth, fifth and sixth polymorphisms were located in exon 47, exon 23 and exon 8 of the CACNA1A gene on chromosome 19p13. The polymorphisms were analysed by capillary electrophoresis, restriction digest and DASH, respectively. All three polymorphisms were excluded from the aetiology of migraine. A total of 12 hot spot exons were sequenced in the CACNA1A gene in one individual afflicted by FHM and two by HM. No mutations were presented in the exons sequenced.

No description available.

Orientador: Marcos Augusto de Moraes Silva / Resumo: Analisar criticamente os critérios de diagnósticos das cefaléias da Sociedade Internacional de Cefaléia (SIC) 1988 e da SIC 2004. Método: Foram analisados retrospectivamente 496 pacientes atendidos no ambulatório de Cefaléia na Infância e Adolescência do HC Unesp Botucatu no período de 1992 à 2002. Empregou-se critério diagnóstico clínico intuitivo (CDI) como padrão "gold standard". A comparação entre CDI, SIC 88 e Proposta SIC 2002 foi realizada utilizando-se as variáveis: Sensibilidade, Especificidade (E), Valor Preditivo, Positivo (VPP), Valor Preditivo Negativo (VPN); segundo as fórmulas/critérios: CLAP - OPS/OMS, 1988 e de Rouquayrol, 1993. Resultado: Observamos que a proposta SIC 2002 demonstrou maior sensibilidade com relação às migrâneas: a) sem aura, b) com aura, c) com aura típica, d) basilar. A proposta SIC 2002 apresenta alta especificidade. Não houve diferença significativa com as outras variáveis. Conclusões: A proposta SIC 2002 mostrou maior sensibilidade para as migrâneas quando comparada com a SIC 88. Possivelmente o fator tempo de duração das crises de cefaléia,diferentes entre ambas poderiam justificar a relativa baixa sensibilidade quando comparadas ao "gold standard". / Abstract: Critically analyse the diagnostic criteria of headaches from International Classification of Headache Disorders Diagnostic Criteria (ICHD) 1988 and from ICHD 2004. Method: Four hundred ninety-six patients who were attended at the Headache Outpatient Ward for Children and Adolescence of the General Hospital, Medical School of the State University from São Paulo - Unesp- of the city Botucatu from 1992 to 2002 were analyzed. Individuals were classified according three diagnostics groups: Intuitive Clinic Diagnostic (ICD-"gold standard"), ICHD I- 1988 and ICHD II-2004. They were statistically compared using the variables: Sensibility (S), Specificity (Sp), Positive Predictive Value (PPV), Negative Predictive Value (NPV), according to formulas/criteria: CLAP - PAHO/WHO (1988) and of Rouquayrol (1993). Result: It was observed that the ICHD II-2004 presented higher sensibility than ICHD I-1988 concerning migraine with and without aura, there was no significant difference concerning other variables. Conclusions: The ICHD II-2004 showed higher sensibility referring to migraine when compared with ICHD I 1988 without affecting specificity and although it improved migraine diagnosis in children and adolescents, the sensitivity remains poor. / Mestre

Made available in DSpace on 2014-06-11T19:22:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2003Bitstream added on 2014-06-13T18:49:44Z : No. of bitstreams: 1 lima_mmf_me_botfm.pdf: 693398 bytes, checksum: 8736cc7b15cffbd6313959a53f1a78b3 (MD5) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / Analisar criticamente os critérios de diagnósticos das cefaléias da Sociedade Internacional de Cefaléia (SIC) 1988 e da SIC 2004. Método: Foram analisados retrospectivamente 496 pacientes atendidos no ambulatório de Cefaléia na Infância e Adolescência do HC Unesp Botucatu no período de 1992 à 2002. Empregou-se critério diagnóstico clínico intuitivo (CDI) como padrão “gold standard”. A comparação entre CDI, SIC 88 e Proposta SIC 2002 foi realizada utilizando-se as variáveis: Sensibilidade, Especificidade (E), Valor Preditivo, Positivo (VPP), Valor Preditivo Negativo (VPN); segundo as fórmulas/critérios: CLAP – OPS/OMS, 1988 e de Rouquayrol, 1993. Resultado: Observamos que a proposta SIC 2002 demonstrou maior sensibilidade com relação às migrâneas: a) sem aura, b) com aura, c) com aura típica, d) basilar. A proposta SIC 2002 apresenta alta especificidade. Não houve diferença significativa com as outras variáveis. Conclusões: A proposta SIC 2002 mostrou maior sensibilidade para as migrâneas quando comparada com a SIC 88. Possivelmente o fator tempo de duração das crises de cefaléia,diferentes entre ambas poderiam justificar a relativa baixa sensibilidade quando comparadas ao “gold standard”. / Critically analyse the diagnostic criteria of headaches from International Classification of Headache Disorders Diagnostic Criteria (ICHD) 1988 and from ICHD 2004. Method: Four hundred ninety-six patients who were attended at the Headache Outpatient Ward for Children and Adolescence of the General Hospital, Medical School of the State University from São Paulo – Unesp- of the city Botucatu from 1992 to 2002 were analyzed. Individuals were classified according three diagnostics groups: Intuitive Clinic Diagnostic (ICD-“gold standard”), ICHD I- 1988 and ICHD II-2004. They were statistically compared using the variables: Sensibility (S), Specificity (Sp), Positive Predictive Value (PPV), Negative Predictive Value (NPV), according to formulas/criteria: CLAP – PAHO/WHO (1988) and of Rouquayrol (1993). Result: It was observed that the ICHD II-2004 presented higher sensibility than ICHD I-1988 concerning migraine with and without aura, there was no significant difference concerning other variables. Conclusions: The ICHD II-2004 showed higher sensibility referring to migraine when compared with ICHD I 1988 without affecting specificity and although it improved migraine diagnosis in children and adolescents, the sensitivity remains poor.

Migraine headache is a painful and often serious problem in the United States. There are many prophylactic pharmacological and nonpharmacological treatments available for migraine headaches. However, choosing between them can be difficult for individuals and treatment providers alike. The primary literature regarding the effectiveness of pharmacological and nonpharmacological treatments is quite dense. More than 191 primary studies were identified as providing information about the effectiveness of one or more treatments for migraine headaches. Of these, 82 articles were retained for meta-analyses on six prophylactic treatments for migraine: propranolol, flunarizine, divalproex sodium, thermal biofeedback, relaxation treatments, and combined treatments. These results suggest that all of the treatments examined have very similar treatment effect sizes. Effect sizes for the reduction of migraine were found to be between .60 and .75 for all treatments. Results suggest that selection of treatment for migraine must be based on more than treatment effectiveness rates alone.

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No description available.

To aid in understanding headache etiology and symptomatology, psychological and physiological variables were examined in patients with migraine and combination headaches (combined migraine and muscle-contraction headaches). One hundred patients being evaluated for treatment of their headaches at The New England Center for Headache participated in this study. They were assigned to the migraine or combination group, based on diagnoses made by three headache specialists—a psychologist, a psychiatrist, and a nuerologist. Personality data from the MMPI and frontalis electromyographic readings reflecting muscle tensions across three stimulus conditions were compared between the two groups. Subjects were also asked to rate the perceived level of stress elicited by the three conditions.