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Biomedical subjects

A A Krabbe

Publications and source records attributed to A A Krabbe.

8 recordsLinked to original sources

Cluster headache: a review.

Cluster headache is a rare headache entity that predominantly occurs in younger males. The clinical features are characterized by sudden attacks of unilateral excruciating pain localized periorbitally, associated with ipsilateral autonomic symptoms. The attacks occur in periods: clusters. The pathophysiology is still unknown. Such vasodilating substances as histamine, nitroglycerin and alcohol may provoke attacks. These substances may be used as diagnostic tests, but the interpretation of a negative result must be careful, as the attacks can not be induced in a refractory period after spontaneous occurrence, or at the beginning and end of cluster periods. As symptomatic treatment, ergotamine is the drug of first choice. High attack frequency may lead to overconsumption with ergotisme and further increased frequency. In such cases and for nocturnal attacks, oxygen inhalations represent an alternative. As prophylactic treatment ergotamine, methysergide, lithium and prednisone have proved efficacious. Most patients benefit from such treatment and may become virtually free from attacks. It is, therefore, important to differentiate this headache entity from classical migraine, common migraine and trigeminal neuralgia.

Cluster Headache↗

Tomographic determination of cerebral blood flow during attacks of cluster headache.

A rapidly rotating single-photon emission tomograph was used to study regional cerebral blood flow (rCBF) by 133-Xenon inhalation in 18 patients with cluster headache. Measurements were performed in all patients in the resting state. The patients were given alcohol and/or nitroglycerin to provoke an attack of cluster headache. In eight patients it was possible to obtain satisfactory measurements during their cluster headache attack. All patients had a normal resting CBF with a normal age regression. During the headache phase, no significant changes of mean CBF from baseline occurred. There were no focal changes in the individual patient, but the mean rCBF in all eight patients showed significantly increased rCBF in the central, basal region and a small part of the right parietotemporal region. These changes we interpret as pain activation. It may be concluded that changes in rCBF are not likely to play a pathophysiological role in the development of cluster headache attacks.

Adult↗

Effect of histamine on regional cerebral blood flow in man.

Regional cerebral blood flow (rCBF) was measured using the intra-arterial 133Xe technique in 35 or 256 areas of a hemisphere. In seven patients rCBF was measured in the resting state and following intracarotid (i.c.) infusion of histamine 10-50 microgram/min. In four patients histamine was infused intravenously in a dose of 25-40 microgram/min. Histamine caused no significant change in mean arterial blood pressure or arterial PCO2. There was no significant change in mean hemispheric blood flow during i.v. or i.c. histamine infusion. No change in the regional distribution of hemispheric blood flow was observed. Experimental histamine headache is most likely of extracranial origin.

Blood Pressure↗

Methodological aspects of prophylactic drug trials in migraine.

The purpose of this paper is to analyse methodological aspects of prophylactic drug trials in migraine. A study of ferrum quartz in 33 patients provided the necessary data base. Migraine definitions, relation between interval headache and migraine, and a number of other clinical problems are discussed. A headache diary is presented which to a certain extent allows a separation of internal headache and migraine attacks. Virtually all patients with frequent migraine attacks have interval headaches. A statistical model which allows a separation of time effects and treatment effects is presented. The inter-patient variability was much greater than intra-patient variability. This indicates that it will be difficult to obtain sufficient power with a non-crossover design. The relation between duration of treatment periods and the necessary number of patients is shown to be inversely related.

Adult↗