References1. Picard N, Strick PL. Motor areas of the medial wall: a review of their location and functional activation. Cereb Cortex 1996;6:342-353. 2. Rizzolatti G, Luppino G, Matelli M. The organization of the cortical motor system: new concepts. Electroencephalogr Clin Neurophysiol 1998; 106:283-296. 3. Laplane D, Talairach J, Meininger V, Bancaud J, Orgogozo JM. Clinical consequences of corticectomies involving the supplementary motor area in man. J Neurol Sci 1977;34:301-314. 4. Morecraft RJ, Louie JL, Herrick JL, Stilwell-Morecraft KS. Cortical innervation of the facial nucleus in the non-human primate: a new interpretation of the effects of stroke and related subtotal brain trauma on the muscles of facial expression.There is increasing evidence that melatonin secretion and pineal function are related to headache disorders. Altered melatonin levels have been found in cluster headache, migraine with and without aura, 1 menstrual migraine, 2 and chronic migraine. 3 A great variety of melatonin mechanisms may be linked to headache pathophysiology. 3 Melatonin may have antiinflammatory effect, it scavenges toxic free radicals, reduces the up-regulation of proinflammatory cytokines, and inhibits nitric oxide synthase activity and dopamine release. It also interferes with membrane stabilization, ␥-aminobutyric acid and opioid analgesia potentiation, protection from glutamate neurotoxicity, neurovascular regulation, and serotonin modulation. Melatonin and indomethacin share similar chemical structure. 4 Melatonin is then a possible candidate for migraine prevention. We tested the hypothesis of the potential effectiveness of melatonin for migraine prophylaxis.Methods.We performed an open-label trial of melatonin, 3 mg, for migraine prevention. Forty patients with episodic migraine with or without aura according to the International Headache Society (IHS) diagnostic criteria were screened for the baseline period. Three patients did not have headaches during the baseline period; three patients were lost to follow-up evaluation. Thirty-four patients (29 women, 5 men) started prophylactic treatment with melatonin, 3 mg, 30 minutes before bedtime. Thirtytwo patients completed the study. All patients signed an informed consent form. The local and federal ethics committees approved the study.Study participants experienced between two and eight migraine attacks per month. Chronic daily headache patients were excluded. Patients on preventive therapy 3 months before recruitment for the trial were excluded. Patients were examined, and an adequate headache history was ascertained. Patients with insomnia or considerable sleep hygiene problems were excluded. The total study length was 4 months, with a 1-month baseline period and 3-month therapy phase. A study diary was provided to each study participant.The primary endpoint was the percentage of patients with Ͼ50% reduction in headache frequency comparing baseline vs month 3 after treatment. Headache intensity, duration, and analgesic consumption were also ascertained. Analgesic...

As cefaléias de curta duração dividem-se entre aquelas com pouca ativação; autonômica e aquelas com importante ativação, este grupo inclui a cefaléia em salvas. Este trabalho tem por objetivo discutir a fisiopatologia da cefaléia em salvas, com maior enfoque nos fenômenos autonômicos, como injeção conjuntival, lacrimejamento, congestão nasal, rinorréia, semiptose e edema palpebral, mostrando o nítido envolvimento do núcleo salivatório superior com a propagação do estímulo doloroso, originado no nervo trigêmeo. As alterações autonômicas foram estudadas em 28 pacientes com cefaléia em salvas e as prevalentes foram o lacrimejamento e a hiperemia conjuntival.

Introduction: CGRP, a neuropeptide synthetized and released in the central nervous system and potent vasodilator, has been implicated in migraine physiopathology. Because of that, there are CGRP targeted therapies that decrease CGRP levels. Melatonin, a pineal gland secretion, has already proved its analgesic effect. We aimed to study CGRP expression in an animal model comparing capsaicin, CGRP and melatonin. Methods: We used in our study male animal rats and separated them into groups based in the kind of received solution (control group, capsaicin only and melatonin plus capsaicin). It was prepared brain stem slices and measured the CGRP levels in the trigemino nucleus caudalis (TNC). Results: Capsaicin group (N = 5) presented low intensity of GCRP expression and animals that received capsaicin plus melatonin (N = 5) showed high intensity of CGRP expression compared to capsaicin group. Conclusion: Melatonin decreases CGRP in an experimental model in rats induced by capsaicin, reducing its inflammatory action in cerebral vessels.

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