cluster, Goadsby and the M word (read past the M-word)

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Posted by dougW ( on April 07, 2001 at 23:37:30:

Hot off the press, published in Lancet, reported by reuter's health news......

PET Imaging Shows Distinct Pathogenicity of Migraine

WESTPORT, CT (Reuters Health) Apr 04 - The results of positron emission tomography (PET) conducted in a patient with a history of both migraine without aura and cluster headaches demonstrate that the two disorders are pathogenically distinct.

Dr. P. J. Goadsby and associates of the Institute of Neurology in London administered 1.2 g glyceryl trinitrate, which is known to induce migraine and cluster headaches, to the 43-year old man. The patient subsequently developed symptoms typical of migraine without aura. PET scans were obtained before drug administration, during the headache, and after the patient was given 6 mg subcutaneous sumatriptan.

As reported in March 31st issue of The Lancet, activation in the rostral brainstem, previously shown to be associated with migraine, persisted after treatment with sumatriptan. The investigators also observed activation in areas corresponding to the intracranial and extracranial blood vessels and in regions associated with pain processing.

However, there was no activation of the hypothalamus, which has been associated with cluster headache. Dr. Goadsby told Reuters Health this case was significant because the patient was known to have distinct attacks of the two types of headache.

"The question arises, are there areas of brain activation specific to each condition?" he queried. "When this chap came along, the change in his brain was that seen in migraine, not in cluster headache."

PET scanning is not yet practical for differentiating between migraine and cluster headaches in clinical practice, Dr. Goadsby added, because it is not sufficiently reproducible.

However, he believes that with "a bit of time and a little more development," PET scanning will be useful in clinical practice. "It holds enormous promise."

Lancet 2001;357:1016-1017.


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