Endogenous Opioids in Cerebrospinal Fluid and Blood in Idiopathic Headache Sufferers

Anselmi, B; Baldi, Elisabetta; Casacci, F; Salmon, S

doi:10.1111/j.1526-4610.1980.hed2006294.x

Cited by 99 publications

(50 citation statements)

References 14 publications

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“…Why are migraineurs prone to frequent or daily headaches as the time evolved? Is this due to a depletion of central antinocioceptive neuro-chemical factors [13][14][15] or is it an abnormal sensitivity of the peripheral vascular receptors? What is the role of daily symptomatic medication in the perpetuation of the daily headache?…”

Section: Discussionmentioning

confidence: 99%

Transformed or Evolutive Migraine

Mathew¹,

Reuveni²,

Pérez³

1987

Headache

373

350

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SYNOPSIS630 (39%) of 1600 patients seen in a Headache Clinic over a three year period had chronic daily headaches (CDH). In 78% of these CDH patients, the daily headaches evolved out of a prior history of episodic migraine; these patients we designate as having "transformed" or "evolutive" migraine. The other 12% had migraine headaches which were daily from the start.Patients with transformed migraine, in contrast to those with daily headaches from the start, have a significantly higher incidence of positive family history of migraine, menstrual aggravation of migraine, identifiable trigger factors, associated G.I. and neurological symptoms, and early morning awakening with headache.The CDH group in general over-used symptomatic medication and exhibited abnormalities on behavioral scale testing. Withdrawal of daily symptomatic medication, institution of a low tyramine low caffeine diet, initiation of prophylactic anti-migraine therapy, and biofeedback and behavioral therapy, gave worthwhile improvement in 76% of chronic daily headache patients.Factors which promote "evolution" of migraine from intermittent to chronic daily occurrence are not well-defined but may include medication abuse, medication withdrawal, and psychiatric disturbances. (Headache 27:102-106, 1987) The traditional teaching considers migraine as a purely episodic phenomena, and daily headaches are categorized as muscle contraction or tension headache. Clinical observation of Dalsgaard-Neilsen 1 indicated that 73% of patients with migraine get frequent low grade headaches between their attacks. He concluded that headache is not just an episodic phenomena, but a permanent deviation from normal, because their biologic threshold for headache is lower than in the normal population.Discussing the natural history of migraine, Graham 2 observed that in some individuals headache may show an increasing frequency of attack until they become daily in occurrence. In 1982, Mathew et al 3 reported a series of patients who had a clear-cut history of episodic migraine in the past, whose headaches, over the years transformed into a daily or near daily headache. This communication is an extension of that paper with additional observations and a larger number of patients. MATERIALS AND METHODSThe history and clinical features of 630 chronic daily headache patients were analyzed in detail. These 630 patients were selected from a series of 1600 patients seen in a headache clinic population between the years 1982 and 1985. The diagnostic breakdown of the 1600 patients in a headache clinic population is given in Table 1. Chronic daily headaches formed 39% of the patients seen.The diagnostic criteria for migraine is shown in Table 2, where certain points are allocated for individual clinical features of migraine. A minimum of 5 points out of 10 was considered essential to meet the diagnostic criteria for migraine. Chronic daily headaches were divided into three types: Type I: starts as daily or near daily headache with no change in the severity and lacks migrainous ...

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Section: Discussionmentioning

confidence: 99%

Transformed or Evolutive Migraine

Mathew¹,

Reuveni²,

Pérez³

1987

Headache

373

350

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“…There is little experimental evidence relating migraine headaches to a disorder of endogenous opiates (27)(28)(29)(30)(31). A reasonable postulation suggests that "vascular" headaches might in part reflect a decrease in normal mechanisms of opiate-induced presynaptic inhibition at the peripheral and central terminals of primary sensory neurons, perhaps as the result of a decrease in dynorphin release or receptor interaction.…”

Section: Discussionmentioning

confidence: 99%

Dynorphin B-Containing Perivascular Axons and Sensory Neurotransmitter Mechanisms in Brain Blood Vessels

1986

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This is the first report demonstrating the existence of opiate-containing nerve fibers surrounding brain blood vessels. Dynorphin B, a tridecapeptide and potent opiate analgesic, was visualized by immunohistochemistry in guinea pig cerebral arteries comprising the circle of Willis and was measured by radioimmunoassay in canine middle cerebral arteries. This peptide, reportedly present in dorsal root ganglion cells, was observed by others to decrease the depolarization-induced release of substance P from primary sensory axons and, by so doing, to retard the development of neurogenic inflammation in target tissues. Consistent with an indirect action of dynorphin B, this peptide did not relax precontracted canine middle cerebral or basilar artery segments when added in vitro, nor did it modulate receptor-mediated relaxation on the addition of substance P. The presence of opiate-containing axons in or near trigeminovascular nerve fibers suggests novel mechanisms related to the modulation of pain possibly emanating from cerebral vessels.

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“…So far, it is difficult to decide whether the gastrin level decrease is a result of alimentary canal disturbances or is this relation at the CNS level, because the inter dependences of the gastrin level in brain and at the periphery are not yet fully evaluated. Similar distribution of gastrin and cholecystokinin in the brain [3,5] allows to suppose that gastrin can also take part in pain sensa tion modulation similarly to other neuropep tides [1,6]. This could correspond with the low level of this hormone in migraine and cluster headache sufferers.…”

Section: Resultsmentioning

confidence: 99%

Gastrin Levels in Patients with Migraine and Cluster Headache

Klimek¹

1982

Eur Neurol

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Idiopathic headaches (migraine, cluster headache) are very often accompanied by alimentary canal disturbances. In view of a suspected relation of gastrin to these symptoms the author decided to test its level in connection with these diseases. It was found that the level of gastrin in 23 women with migraine and 23 men with cluster headache was significantly lower in comparison with the control group of 26 healthy volunteers. The author discusses the possible reasons for such results obtained in patients with idiopathic headaches.

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Endogenous Opioids in Cerebrospinal Fluid and Blood in Idiopathic Headache Sufferers

Cited by 99 publications

References 14 publications

Transformed or Evolutive Migraine

Transformed or Evolutive Migraine

Dynorphin B-Containing Perivascular Axons and Sensory Neurotransmitter Mechanisms in Brain Blood Vessels

Gastrin Levels in Patients with Migraine and Cluster Headache

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