Four men and two women were treated for refractory cluster headache by gamma knife radiosurgery of the trigeminal nerve root entry zone. The maximum dose of radiation was 70 Gy to the isocenter. Of five patients treated who had refractory chronic cluster headache and one with refractory episodic cluster headache, four had relief judged excellent. Of the two remaining patients with refractory chronic cluster headache, one had relief judged good and the other fair. Five of the six patients treated had relief within a few days to a week following gamma knife radiosurgery. Three with chronic cluster headache had remissions allowing cessation of all preventive and abortive medication. Although one patient experienced complete relief of chronic cluster headache, he continued to have migraine requiring medication. None of the patients treated developed significant postradiation side effects during a follow-up period of 8 to 14 months. The authors conclude that gamma knife radiosurgery of the trigeminal nerve affords great promise in the management of chronic and refractory cluster headache. The technique seemingly carries negligible short- and long- term risk.

We reviewed data on 171 patients with refractory headache treated by continuous intravenous dihydroergotamine mesylate (i.v. DHE 45) and repetitive i.v. DHE and compared the efficacy of continuous i.v. DHE to repetitive i.v. DHE. One hundred (58.5%) patients had refractory chronic daily headache. Seventy-one (42%) had drug rebound headache. One hundred thirty-eight (81%) had refractory migraine without aura, and 28 (16%) had migraine with aura. Treatment consisted of either continuous i.v. DHE by infusion pump or repetitive i.v. DHE and withdrawal of excessively used analgesics, analgesic narcotics, ergotamines, or benzodiazepines. Eighty-nine (92.5%) patients treated with continuous i.v. DHE became headache-free; the majority, 62 (64.5%), within 3 days. Sixty-five (86.5%) patients treated by repetitive i.v. DHE became headache-free, 50 (66.5%) within three days. The average hospital stay for both treatment groups was 4 days. Twelve (12.5%) of the continuous group and 12 (16%) of the repetitive group were headache-free within 24 hours. The average length of time to become headache-free was similar for the two groups, 3.06 days for continuous i.v. DHE and 2.94 days for repetitive i.v. DHE. The most common side effect was nausea, followed by diarrhea, vomiting, and leg cramps. We conclude that DHE can be accurately and easily administered by continuous i.v. infusion pump, and that continuous i.v. DHE is a safe and efficacious mode of treatment producing results similar to repetitive i.v. DHE.

We reviewed thermograms of 993 suitable patients with migraine with and without aura, chronic daily headache, cluster headache, posttraumatic headache, and a variety of other headache types. Eight hundred fifty-five (86.1%) had abnormal thermograms usually characterized by decreased supraorbital thermal emission. Six hundred ninety-four (69.9%) of 993 had migraine without aura of whom 593 (85.4%) had abnormal thermograms. Two hundred two (20.3%) of 993 had migraine with aura, of whom 180 (89.1%) had abnormal thermograms. Thirty of 35 (85.7%) patients with cluster headache, and 28 of 33 (84.8%) with posttraumatic headache had abnormal thermograms. Twenty-four of 29 (82.8%) of patients with various less common headaches and head pain syndromes had abnormal thermography. Previous studies have indicated that about 67 to 84% of patients with migraine have abnormal thermograms. Some reports have indicated fewer have thermal asymmetries in migraine without aura, and even fewer with "mixed or muscle contraction" headaches. Our study indicates a somewhat greater number of headache patients have abnormal thermograms than has generally been reported. We conclude digital infrared thermography is a useful diagnostic test in the management of headaches.

Rutherford scattering experiments are traditionally performed in the college physics laboratory with an alpha source and some suitable scattering foil. Simple calculations based on reasonable source strengths, geometry, and cross section show that it is very difficult to measure the complete Rutherford angular distribution by this method. The reason for this difficulty is, of course, that the cross section can decrease by a factor of 105 from the forward to the back angles. The purpose of this paper is to show that the Rutherford angular distribution can be measured in a reasonable laboratory period with a low-energy Cockcroft-Walton accelerator. Many universities have these accelerators or plan to add them to their lists of capital equipment. To date, these machines are used almost exclusively as neutron generators with the T(d,n)4He or D(d,n)3He reactions. These accelerators can easily be modified to include charged-particle experiments. In this report, the general format is given for measuring the Rutherford angular distributions for 150-keV protons for the following reactions: C12(p,p)12C, Ni58(p,p)58Ni, , B11(p,p)11B, and Au197(p,p)197Au. At Oak Ridge Associated Universities, we have performed charged-particle experiments similar to those outlined with many undergraduate physics students, as well as their professors. The results have been most gratifying.

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