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J Neural Transm. 2008;115(1):91-5. Epub 2007 Aug 10.
Family-based association analysis of functional VNTR polymorphisms in the
dopamine transporter gene in migraine with and without aura.
Karwautz A, Campos de Sousa S, Konrad A, Zesch HE, Wagner G, Zormann A,
Wanner C, Breen G, Ray M, Kienbacher C, Natriashvili S, Collier DA,
Wöber C, Wöber-Bingöl C.
Because of the role of dopamine in triggering migraine attacks, genes of the
dopamine system are candidates for involvement in migraine. We examined three
VNTR polymorphisms in the dopamine transporter, the 5'UTR VNTR, the intron 8
VNTR and the intron 14 VNTR, in a sample of 205 family trios. We used the
transmission disequilibirium test (TDT) to examine the transmission of these
three markers and their haplotypes to offspring affected by migraine. We found
no significant transmission distortion of any marker. Likewise haplotypes of the
three markers did not show significant overall or individual association with
migraine. Finally we examined migraine with and without aura, and likewise found
no association between dopamine transporter VNTRs or their haplotypes and either
classification of the disease. We conclude that functional genetic variation in
the dopamine transporter does not act as a significant risk factor for migraine.
Cephalalgia 27 (7), 773–780.
Family-based analysis of serotonin transporter gene polymorphisms in migraine with and without aura
A Karwautz, S Campos de Sousa, C Wöber, G Wagner, T Li, A Konrad, HE Zesch, A Zormann, G Berger, C Wanner, Ç Wöber-Bingöl, DA Collier
epidemiological twin studies have demonstrated a significant
heritability for migraine, with > 60% of liability to migraine
either with or without aura coming from additive genetic factors.
Because of the essential role of serotonin in the
pathophysiology and treatment of migraine, genes of the
serotonin system are candidates for involvement in migraine.
Consequently, we examined two functional VNTR polymorphisms in
the serotonin transporter gene, the 5-HTTLPR and the intron 2
VNTR, in a sample of 212 family trios each with a proband with
childhood migraine, 153 with migraine without aura (MoA) and 59
with migraine with aura (MA). For the first time, we used
transmission disequilibrium test analysis with the program
TDTPHASE to examine the transmission of these two markers and
their haplotypes to offspring affected by migraine. We found no
significant transmission distortion of any marker, with the
common L allele of the 5-HTTLPR transmitted 170 times and not
transmitted 178 times, and the S allele 130 vs. 122 times.
Likewise, the common 12 allele of the intron 2 VNTR was
transmitted 201 times and not transmitted 188 times, and the 10
allele 107 vs. 120 times. The markers were not associated with
MoA and MA and none of the haplotypes was associated with
overall migraine, MoA or MA. The 5-HTTLPR and the intron 2 VNTRs
do not play a major role in susceptibility to migraine.
Ann Neurol, 2007,
A dopamine D4 receptor exon 3 VNTR allele protecting against migraine without
S. C. de Sousa, A. Karwautz, C. Wober, G. Wagner, G. Breen, H. E.
Zesch, A. Konrad, A. Zormann, C. Wanner, C. Kienbacher, D. A. Collier
and C. Wober-Bingol
dopamine plays an important role in the pathophysiology of migraine and
antimigraine drugs have an effect on the dopamine system, the objective of this
study was to examine the dopamine D4 receptor gene for involvement in the cause
METHODS: We tested a VNTR-polymorphism in the dopamine D4 receptor
gene, the exon 3 VNTR, in a sample of 190 family trios each with a proband with
childhood migraine by using transmission disequilibrium test tests.
found a trend for transmission distortion of this marker in migraine, with the
common seven-repeat allele of the VNTR transmitted 58 times and not transmitted
82 times (global likelihood ratio score (LRS) = 12.27, degress of freedom (DF) =
6, p = 0.06; for the 7-repeat allele: chi(2) = 5.1, p = 0.02). This effect came
only from migraine without aura (145 trios), with the common 7-repeat allele
transmitted 45 times and not transmitted 69 times (global LRS = 15.18; DF = 6, p
= 0.019; for the 7-repeat allele: chi(2) = 6.4, p = 0.01; odds ratio, 0.47),
whereas in migraine with aura (45 trios) there was no transmission distortion of
the 7-repeat allele.
INTERPRETATION: We conclude that seven-repeat allele of the
dopamine D4 receptor VNTR is a protective factor for migraine without aura.
Because migraine is a common disorder, this protective effect may have
contributed to the positive selection acting on the dopamine D4 receptor exon 3
VNTR seven-repeat allele in recent human history. We speculate that dopamine
function in the lateral parabrachial nucleus is involved in migraine without
aura. Ann Neurol 2007.
Cephalalgia, 2006, 26(7): 820-30
Clinical features, classification and prognosis of migraine and tension-type
headache in children and adolescents: a long-term follow-up study
C. Kienbacher, C. Wober, H. E. Zesch, A. Hafferl-Gattermayer, M.
Posch, A. Karwautz, A. Zormann, G. Berger, K. Zebenholzer, A.
Konrad and C. Wober-Bingol
We performed a long-term follow-up examination in children and
adolescents with migraine and tension-type headache (TTH) in order to
investigate the evolution of clinical features and headache diagnoses, to
compare International Classification of Headache Disorders (ICHD)-I and ICHD-II
criteria and to identify prognostic factors. We re-examined 227 patients (52.4%
female, age 17.6 +/- 3.1 years) 6.6 +/- 1.6 years after their first presentation
to a headache centre using identical semistructured questionnaires. Of 140
patients initially diagnosed with migraine, 25.7% were headache free, 48.6%
still had migraine and 25.7% had TTH at follow-up. Of 87 patients with TTH,
37.9% were headache free, 41.4% still had TTH and 20.7% had migraine. The number
of subjects with definite migraine was higher in ICHD-II than in ICHD-I at
baseline and at follow-up. The likelihood of a decrease in headache frequency
decreased with a changing headache location at baseline (P < 0.0001), with the
time between baseline and follow-up (P = 0.0019), and with an initial diagnosis
of migraine (P = 0.014). Female gender and a longer time between headache onset
and first examination tended to have an unfavourable impact. In conclusion, 30%
of the children and adolescents presenting to a headache centre because of
migraine or TTH become headache-free in the long-term. Another 20-25% shift from
migraine to TTH or vice versa. ICHD-II criteria are superior to those of ICHD-I
in identifying definite migraine in children and adolescents presenting to a
headache centre. The prognosis is adversely affected by an initial diagnosis of
migraine and by changing headache location, and it tends to be affected by an
increasing time between headache onset and first presentation.
Headache. 2006 Feb;46(2):259-63.
Facial pain and the second edition of the international classification of
Zebenholzer K, Wober C, Vigl M, Wessely P, Wober-Bingol C.
BACKGROUND: Recurrent or
chronic facial pain may be a diagnostic challenge.
Applying the diagnostic criteria of the second edition of the International
Classification of Headache Disorders (ICHD-II) leaves a considerable number of
OBJECTIVE: The aim of this study was to establish and evaluate revised criteria
of trigeminal neuralgia and persistent idiopathic facial pain. METHODS: Based on
the diagnostic value of 12 clinical features of trigeminal neuralgia and 15
features of persistent idiopathic facial in 97 patients referred for facial pain
to a neurological tertiary care centre we established revised criteria for
persistent idiopathic facial pain and additional criteria for probable
trigeminal neuralgia and probable idiopathic facial pain.
RESULTS: Applying the newly proposed criteria reduced the number of patients
with facial pain not classifiable by more than 50%. The new criteria improved
the sensitivity, particularly in idiopathic facial pain and did not cause a
relevant decrease in specificity compared to ICHD-II.
CONCLUSION: This study suggests that amendments to the ICHD-II criteria improve
the diagnostic classification of facial pain.
Cephalalgia 2004, 24: 12-17
Wöber-Bingöl C, Wöber C, Karwautz A,
Auterith A, Serim M, Zebenholzer K, Aydinkoc K, Kienbacher C, Wanner
C, Wessely P
Clinical features of migraine: a cross-sectional study in patients aged three to
We investigated 260 consecutive patients
classified as migraine cases aged 3-69 at two tertiary headache centres, one for
children and adolescents and the other for adults to evaluate the relationship
between age and clinical features of migraine cross-sectionally. We only
included subjects with definite migraine without or with aura and we excluded
subjects with coexisting tension-type headache, medication overuse and/or other
clinically relevant disorders. The percentage of males decreased markedly from
childhood to adulthood and this affected the evaluation of age-related changes
in male patients, as only large differences reached the level of statistical
significance. In females, the headache duration and the prevalence of
unilateral, pulsating pain, photophobia and phonophobia increased, whereas the
prevalence of aggravation by physical activity decreased with age. In conclusion,
this cross-sectional, clinic-based study on a strictly defined sample of 260
consecutive patients with definite migraine covering a wide range of age from
the very young to the old suggests marked age-related differences of the
clinical features of migraine in females and failed to demonstrate similar
differences in males due to the small number of adult male migraineurs.
Funct Neurol 2000;15 Suppl 3:89-105
Clinical management of young patients presenting with headache.
Wober C, Wober-Bingol C.
Headache is a common symptom in young patients and requires a clearly
structured, individual approach. The history and the clinical examination are
prerequisites for planning further management of the condition. The IHS
classification is particularly useful in the differential diagnosis of
idiopathic headache. Additional diagnostic testing should not be performed
routinely, but on an individual basis depending on the patient's history and
neurological findings. The acute therapy of idiopathic headache in young
patients has been evaluated in few studies only. However, there is general
agreement that (in subjects requiring medication) paracetamol, acetylsalicylic
acid and ibuprofen are most useful for treating migraine attacks, whereas
analgesics should widely be avoided in tension-type headache. For the
prophylaxis of migraine and tension-type headache, non-pharmacological measures
such as regulation of lifestyle, relaxation training and psychological or
psychotherapeutic interventions are much more important than pharmacotherapy,
which is required in a small number of patients only.
Cephalalgia 2000 Sep;20(7):611-6
Migrainous disorder and headache of the tension-type not fulfilling the
criteria: a follow-up study in children and adolescents.
Zebenholzer K, Wober C, Kienbacher C, Wober-Bingol C.
In this follow-up study in children and adolescents with recurrent headaches
classified as migrainous disorder (IHS 1.7) and headache of the tension-type not
fulfilling the criteria (IHS 2.3), 28.6% were headache-free and 71.4% still had
headaches 2-5 years after the first examination. The majority remained in the
same one-digit IHS diagnosis, whereas 20% changed from migraine to tension-type
headache or vice versa. The number of IHS criteria fulfilled increased
significantly from the first to the second examination. The reason for
diagnosing IHS 1.7 and IHS 2.3 most often was a short headache duration or
headache characteristics not meeting the criteria. By reducing the minimum
headache duration to 1 h, 11 of 58 patients could be diagnosed as migraine
without aura. There was a remarkable overlap in the diagnostic criteria for
migraine without aura and tension-type headache. In IHS 1.7 and IHS 2.3 this
overlap exceeded 80%, with a trend to decrease at the second examination.
Neurology 2000 Mar 14;54(5):1209-10
Comment on: Neurology. 1999 Apr 22;52(7):1507-10.
Intranasal sumatriptan for the acute treatment of migraine in children.
Wober C, Wober-Bingol C.
Neuroradiology 1999 Apr;41(4):283-7
Virchow-Robin spaces in childhood migraine.
Schick S, Gahleitner A, Wober-Bingol C, Wober C, Ba-Ssalamah A, Schoder M,
Schindler E, Prayer D.
Virchow-Robin spaces (VRS) are pia-lined extensions of the subarachnoid space
which surround penetrating arteries as they enter the brain on its surface.
Using high-resolution MRI, which shows small penetrating arteries, we studied a
possible association of accentuated VRS in children with tension-type headache
(TTH) or migraine. We studied 58 children aged 3-14 years (mean 10.8 years) with
a clinical diagnosis of migraine (31) or TTH (27), who underwent cerebral MRI,
and 30 headache-free patients of the same age (mean 10.2 years) and 30 adult
migraineurs with postpubertal onset of symptoms, who served as controls. The
images were reviewed for structural abnormalities in the regions of the small
penetrating arteries. Accentuated VRS were found in 61% of the children with
migrainous headaches and in 22% of children of those with TTH. Prominent VRS
were seen in 27% of the control children and in only 13% of the adults. Small
infarcts and gliosis were rare in children with or without headache, but were
seen in 30% of the adult migraineurs. Our findings show that accentuated VRS are
significantly more common in children with migraine than in those with TTH or
headache-free controls. Detection of accentuated VRS may therefore enhance
differential diagnosis of primary headaches in children, contributing to an
improvement in management.
Cephalalgia 1999 Jan;19(1):32-43
Psychosocial factors in children and adolescents with migraine and tension-type
headache: a controlled study and review of the literature.
Karwautz A, Wober C, Lang T, Bock A, Wagner-Ennsgraber C, Vesely C, Kienbacher C, Wober-Bingol C.
We investigated 341 children and adolescents to evaluate the relevance of
psychosocial factors in idiopathic headache. According to the criteria of the
International Headache Society, 151 subjects had migraine and 94 had
tension-type headache (TTH). Ninety-six subjects were headache-free controls.
Psychosocial factors covered family and housing conditions, school problems,
relations in the peer group, and several other items. We found that migraine
patients did not differ from headache-free controls. Patients with TTH more
often had divorced parents than the headache-free controls, and they had fewer
peer relations than migraineurs and controls. In addition, migraine patients
were significantly more often absent from school due to headache. All other
psychosocial factors failed to discriminate between the three study groups. In
conclusion, this controlled study in children and adolescents suggests that
migraine is not related to family and housing conditions, school situation, or
peer relations, whereas TTH is associated with a higher rate of divorced parents
and fewer peer relations.
Cephalalgia 1998 Jul-Aug;18(6):304-5
Migraine in childhood and adolescence.
Neurology 1998 Mar;50(3):831-2
Comment on: Neurology. 1997 Mar;48(3):602-7.
Pediatric migraine and the International Headache Society criteria.
Wober C, Wober-Bingol C.
Pain 1996 Sep;67(1):53-8
Tension-type headache in different age groups at two headache centers.
Wober-Bingol C, Wober C, Karwautz A, Schnider P, Vesely C, Wagner-Ennsgraber C,
Zebenholzer K, Wessely P.
At two headache centers, one for children and adolescents and the other for
adults, we investigated patients aged 5-80 years with episodic or chronic
tension-type headache to evaluate the relation between age and headache
characteristics as well as analgesics intake. We found an increasing headache
frequency and duration, an increasing variability of the headache location, and
an increasing frequency of nausea with increasing age. All other headache
features did not depend on age. Additionally, our study revealed a marked
increase of analgesics use in adults compared to children and adolescents. In
conclusion, children, adolescents, and adults referred for tension-type headache
show minor differences in some headache features, but a marked change of
analgesics intake. The different headache symptoms may be causally related to
age, but an influence of medication or other factors must also be considered.
Headache 1996 Apr;36(4):231-8
IHS criteria for migraine and tension-type headache in children and adolescents.
Wober-Bingol C, Wober C, Wagner-Ennsgraber C, Karwautz A, Vesely C, Zebenhoizer
K, Geldner J.
We investigated the influence of age on the IHS criteria for migraine and
tension-type headache in 437 consecutive children and adolescents and found the
following age-associated statistically significant differences: migraine
duration, occurrence of migraine aura, and bilateral location of tension-type
headache were more often fulfilled by adolescents, whereas aggravation of
headache by physical activity (in migrainous disorder) and photophobia (in
migraine with aura) were more often fulfilled by children. Accordingly, there
are only a few differences concerning the fulfillment of the IHS criteria for
migraine and tension-type headache in children and adolescents. Independent of
age, the intensity of headache and the presence or absence of nausea are most
important for differentiating the two major types of idiopathic headache. The
sensitivity of the IHS criteria for migraine could be increased by reducing the
minimum duration of migraine and by allowing the diagnosis of migraine when
severe headache is associated with nausea, even though the criteria of location,
quality, and aggravation by physical activity are not fulfilled.
Cephalalgia 1996 Apr;16(2):107-12
Comment in: Cephalalgia. 1996 Apr;16(2):78.
IHS criteria and gender: a study on migraine and tension-type headache in
children and adolescents.
Wober-Bingol C, Wober C, Wagner-Ennsgraber C, Zebenholzer K, Vesely C, Geldner J, Karwautz A.
The aim of this study was to investigate whether the IHS criteria for migraine
and tension-type headache depend on gender. Among 409 children and adolescents
with recurrent idiopathic headache seen at a university outpatient clinic, girls
had significantly more often migraine with aura. Also, there was a trend towards
a higher frequency of tension-type headache in girls. In migraine, aggravation
of headache by physical activity and occurrence of aura symptoms were more
common in females, whereas vomiting and phonophobia occurred more often in
males. In tension-type headache, females more often reported mild intensity of
headache. All other criteria were similar in both sexes. Age influenced the
expression of some of the accompanying symptoms in the various types of
migraine, but had only minimal influence on other diagnostic criteria of
migraine and tension-type headache in females as well as in males. Our study
suggests that the frequency of migraine (except that of migraine with aura) is
similar among girls and boys, that tension-type headache may occur more often in
girls, and that gender has some influence on the IHS criteria for migraine, but
almost no influence on those of tension-type headache.
Cephalalgia 1996 Feb;16(1):22-6
Freud and migraine: the beginning of a psychodynamically oriented view of
headache a hundred years ago.
Karwautz A, Wober-Bingol C, Wober C.
Sigmund Freud, the famous Viennese founder of psychoanalysis, suffered from
recurrent episodes of severe headache. Autobiographic and biographic data make
it evident that he had migraine. Freud's theoretical approaches to pain in
general and to migraine in particular are discussed. Initially, Freud's theories
on the etiopathogenesis of pain and migraine focused on neurophysiological
hypotheses which are of historical interest. They were replaced by psychodynamic
hypotheses which are still important for our current understanding of pain and
headache. These psychodynamic pain theories are reviewed and their importance
for headache research is discussed.
Headache 1996 Feb;36(2):83-90
Magnetic resonance imaging for recurrent headache in childhood and adolescence.
Wober-Bingol C, Wober C, Prayer D, Wagner-Ennsgraber C, Karwautz A, Vesely C,
Zebenholzer K, Feucht M.
We investigated 429 consecutive patients, aged 5 to 18 (mean: 11.0 +/- 3.1)
years, diagnosed with migraine or tension-type headache. The patients underwent
either MRI or exclusively clinical follow-up examinations. Magnetic resonance
imaging revealed normal findings in 82.3% and structural changes in 17.7%.
However, the vast majority of these changes had minimal or no pathological
relevance, and a causal relationship to the patient's headache could not be
proven in any case. In the non-MRI group, clinical follow-up examinations
confirmed the initial diagnosis in all patients and MRI was not required in any
of these subjects. In conclusion, our study shows a poor relation between
recurrent headache fulfilling the criteria of migraine and tension-type headache
and structural changes incidentally detected by MRI. In addition, it suggests
that clinical follow-up examinations are reliable. Accordingly, MRI is not
required for routine examination of recurrent headache in children and
adolescents, but it should be performed in patients with abnormal neurological
findings, atypical headache pattern, or significant change of preexisting
Cephalalgia 1995 Oct;15(5):335-6
Comment on: Cephalalgia. 1995 Oct;15(5):404-9.
Children and criteria for migraine.
Cephalalgia 1995 Feb;15(1):26-30
Migraine and stroke in childhood and adolescence.
Wober-Bingol C, Wober C, Karwautz A, Feucht M, Brandtner S, Scheidinger H.
Over 3 years we evaluated two patients, an adolescent and a child, with
migraine-like headache and ischemic stroke. Based on our clinical observations
and on literature review of migraine and stroke in the pediatric age group, we
believe that the criteria of migrainous infarction outlined by the International
Headache Society (IHS) could be occasionally too restrictive. Therefore, we
suggest subclassifying migrainous infarction into: (i) "definite", referring to
the patients whose ischemic stroke fulfills all the IHS criteria, (ii)
"possible", referring to ischemic strokes which fulfill some, but not all,
criteria. This subclassification of migrainous infarction may be relevant in
clinical practice and in human research studies.
Cephalalgia 1995 Feb;15(1):13-21
Diagnosis of headache in childhood and adolescence: a study in 437 patients.
Wober-Bingol C, Wober C, Karwautz A, Vesely C, Wagner-Ennsgraber C, Amminger GP,
Zebenholzer K, Geldner J, Baischer W, Schuch B.
We investigated whether the criteria for idiopathic headache published by the
International Headache Society (IHS) are useful in childhood and adolescence and
compared the diagnoses according to this classification with those of Vahlquist.
We used a semi-structured questionnaire to examine a total of 437 children and
adolescents referred consecutively to a headache outpatient clinic. Twenty-eight
of 437 patients were excluded because of symptomatic or unclassifiable headache.
Of 409 patients with idiopathic headache, 70.4% had definite migraine or
tension-type headache (IHS 1.1, 1.2, 2.1, 2.2), 20.5% had a migrainous disorder
(IHS 1.7) and 9.1% had headache of the tension-type not fulfilling the criteria
(IHS 2.3). In the differential diagnosis of migraine and tension-type headache
the intensity of pain, aggravation of headache by physical activity, nausea and
vomiting were the most important features. The quality of pain, photo- and
phonophobia were less helpful and location least important. The duration of
migraine attacks was less than 2 h in 19.0% of the migraine patients. In
general, the diagnostic criteria of migraine were highly specific but less
sensitive, and those of tension-type headache highly sensitive but less
specific. The agreement between IHS criteria and those of Vahlquist was marked
(kappa = 0.57). We conclude that the IHS criteria are useful for classifying
headache in children and adolescents referred to a headache outpatient clinic. A
forthcoming modification of the IHS criteria should consider a reduction of the
minimum duration of migraine attacks from 2 h to 1 h and should try to increase
the sensitivity of the criteria for migraine and the specificity of the criteria
for tension-type headache.
Cephalalgia 1994 Jun;14(3):235-40
Dopamine D2 receptor blockade and antimigraine action of flunarizine.
Wober C, Brucke T, Wober-Bingol C, Asenbaum S, Wessely P, Podreka I.
We studied in vivo the influence of flunarizine on dopamine D2 receptors and
investigated whether dopamine D2 receptor blockade is involved in its
antimigraine action. Eleven migraine patients, treated with flunarizine, 10 mg
per day, underwent single photon emission computer tomography (SPECT) using
[123I] labeled iodobenzamide, a ligand with high affinity and high specificity
for D2 receptors. There was a reduction of the dopamine D2 receptor binding
potential in all patients compared to age-matched controls. The efficacy of
flunarizine in migraine prophylaxis failed to correlate with the degree of the
dopamine D2 receptor blockade. The antimigraine action of flunarizine may not
involve antidopaminergic mechanisms.
Cephalalgia 1994 Apr;14(2):162-7
Use and abuse of analgesics in tension-type headache.
Schnider P, Aull S, Feucht M, Mraz M, Travniczek A, Zeiler K, Wessely P.
Eighty patients suffering from tension-type headache for an average of 21 years
were asked to report on all drugs they had ever taken (type, dosage, duration of
intake, efficacy) or were taking currently. The patients had consumed on average
6.3 different drugs. The cumulative doses of derivatives of para-aminophenol,
pyrazolone, and salicylic acid in some cases reached a maximum of several
kilograms. Most drugs were classified by the patients as "moderately effective".
The rating "very effective" was assigned primarily to barbiturates; however,
barbiturates are no longer used as components of compound analgesic drugs in
Austria. At the time of investigation, patients consumed 2.5 (mean) different
drugs, primarily as compound preparations. Seventeen patients (21%) showed signs
of possible analgesics- or ergotamine-induced headache and were therefore
advised to undergo withdrawal therapy. Our results show that patients with
tension-type headache are at considerable risk of becoming drug-dependent and of
acquiring analgesics-induced headache.
Nervenarzt 1993 Dec;64(12):753-65
Idiopathic headache in childhood and adolescence
Karwautz A, Wober-Bingol C, Wober C.
This review of the literature covers classification, epidemiology and clinical
aspects of idiopathic headache in childhood and adolescence. In addition,
pathogenetic models taking into account the complex involvement of organic,
psychological and psychosocial factors are critically reviewed. A general
pathogenetic model of migraine may be characterized by a given predisposition,
various co-factors which enhance the tendency, and finally, trigger mechanisms
which induce an attack. No generally accepted model exists for tension-type
headache. In assessing the importance of various factors thought to be related
to idiopathic headache, it is necessary to differentiate between causal
relation, unspecific association, and coincidence. The aim of this review is to
present potential factors influencing headache in childhood and adolescence and
to discuss these factors critically with regard to their etiopathogenetic
importance. Organic factors seem to be most important in migraine, whereas
psychological and (psycho)social factors may influence any type of headache.
Briefly, migraine in childhood and adolescence seems to be definitively
associated with vegetative dysfunction, abdominal symptoms and hormonal factors
and possibly with allergic reactions, whereas a relation to epilepsy can be
excluded. There is absolutely no evidence for a typical personality of migraine
patients. Various psychic reactions, however, are important in all types of
headache. Depression and anxiety in young headache patients seem to be related
generally to pain, but not specifically to headache. However, school problems,
learning disabilities and stress coping behaviour seem to be related directly to
recurrent headache. Additionally, there is evidence that the prevalence of
headache is associated with low economic status.
Fortschr Neurol Psychiatr 1993 Nov;61(11):378-82
SUNCT syndrome--case report and review of the literature
Wober C, Wober-Bingol C, Wessely P.
The SUNCT syndrome is a recently described headache disorder characterised by
shortlasting, unilateral headache attacks with conjunctival injection and
tearing. Our report presents a further case and compares the findings in our
patient with those in the cases described earlier. In addition, we review the
literature and discuss possible aetiological and pathogenetic factors as well as
the differential diagnosis of SUNCT syndrome, trigeminal neuralgia and cluster
Wien Med Wochenschr 1993;143(19-20):514-8
Calcium channel blockers in therapy of neurologic diseases
Wessely P, Wober-Bingol C.
The clinical use of calcium antagonists (Ca-antagonists) in neurological
diseases focuses on 2 main therapeutic fields: (a) For the therapy of migraine
flunarizine is the first choice therapy and nimodipine is a second line
treatment. With verapamil cluster headache can be treated successfully,
flunarizine shows less impressive clinical efficacy. The therapy with
flunarizine may be restricted due to the incidence of extrapyramidal
disturbances and depressions as known side effects. (b) The therapy of clinical
conditions after subarachnoidal bleeding with nimodipine is well established. In
the therapy of acute cerebral ischemia the therapeutic efficacy of nimodipine
administered orally is not therapeutically proved until now; the intravenous
administration of nimodipine offers the risk of acute hypotensive reactions. At
present the usefulness of the administration of ca-antagonists in the so-called
cerebrovascular insufficiency or dementia and various others cerebral disorders
with vertigo could not be demonstrated.
Wien Klin Wochenschr 1993;105(2):42-52
Tension headache--new evaluation of symptomatology based on International
Headache Society diagnostic criteria
Mraz M, Aull S, Feucht M, Ilieva D, Schnider P, Travniczek A, Zeiler K, Wessely
This study presents the history and clinical findings in 80 patients suffering
from tension-type headache diagnosed according to the criteria (group 2)
proposed in 1988 by the Headache Classification Committee of the International
Headache Society (IHS). The aim of this investigation was to evaluate the extent
to which the symptomatology in our cases still corresponds with the clinical
picture of tension headache described in the older literature. A positive family
history of headache was obtained in 59% of the patients; mothers of headache
patients were affected five times more often than fathers; a history of migraine
was reported as frequently as tension-type headache in the families of the
investigated patients. The first manifestation of headaches arose almost
exclusively in the first four decades of life, whereby two peaks (15-20 and
35-40 years) were observed in patients with the episodic form. Headache in
younger patients showed no distinct diurnal pattern; headache in older patients,
however, predominantly occurred immediately after awakening from sleep or in the
morning. Changes of weather and psychosocial stress were the most frequent
precipitating factors; additionally, the premenstrual period, occupational
stress, and sleep deprivation were precipitating factors in female patients.
Bilateral pain was most often located in the occipital/nuchal, in the frontal,
and the periorbital regions. Headache was usually described as
pressing/tightening in quality. Difficulties in concentration and the need of
rest were the most important associated symptoms. Photophobia, phonophobia and
autonomic symptoms were less frequent and are probably partially drug-related
and may also be due to the fact that the selected group of patients suffered
from severe forms of headache. 33 of our 80 patients belonged to the subgroup
"with disorders of pericranial muscles" (IHS criteria: groups 2.1.1., 2.2.1). A
remarkable low percentage of patients, especially of the male sufferers,
reported regular smoking and/or drinking habits. Oral contraceptives influenced
neither frequency nor intensity of headache attacks. Signs of depressive
disorders were present in 28% of the female patients. The differences in
symptomatology of tension-type headache between patients with episodic and
chronic forms, between female and male patients, and also between younger and
elderly patients are documented and have to be taken into account in the
diagnostik evaluation of this condition.
Cephalalgia 1992 Jun;12(3):152-4
Tension headache and the cervical spine--plain X-ray findings.
Wober-Bingol C, Wober C, Zeiler K, Heimberger K, Baumgartner C, Samec P, Wessely
The aim of the present study was to investigate if there is any causal
connection between plain X-ray findings of the cervical spine and tension
headache. We evaluated the X-rays of the cervical spine of 243 patients, in 91
of which the diagnosis was "tension headache", in 102 "headache not fulfilling
the criteria of tension headache" and in 50 "spondylogenic complaints without
headache". We compared these three groups with regard to frequency and severity
of radiologically assessable changes of the cervical spine and found that
patients with tension headache had normal findings significantly more often and
significantly less often functional or organic changes or both than patients of
the other two groups. The radiologically assessable changes of the cervical
spine are unlikely to have an essential role in the cause or mechanism of
Cephalalgia 1991 Dec;11(6):251-6
Long-term results of migraine prophylaxis with flunarizine and beta-blockers.
Wober C, Wober-Bingol C, Koch G, Wessely P.
We followed-up 64 migraine patients after discontinuation of successful interval
prophylaxis with flunarizine, propranolol or metoprolol, to investigate how long
the therapeutic success would last, if further prophylaxis would be successful
again, and what factors would influence the prognosis. We found that 16 out of
64 patients experienced a lasting reduction of migraine frequency, whereas 48
patients did improve initially, but later experienced a relapse. Further
prophylaxis was effective in 29, poorly effective in 11, and ineffective in 8 of
these patients; in 7 of the 8 non-responders prophylaxis was not changed.
Negative prognostic factors were frequent attacks, a history of analgesic abuse
and/or analgesic withdrawal therapy and ineffective previous prophylaxis. In
conclusion, the therapeutic success decreases dramatically in the majority of
patients several months after discontinuation of prophylaxis; further
prophylaxis is more effective if the substance class is changed; increased
analgesic intake is the most important prognostic factor. As a strategy for
migraine prophylaxis we propose sequential changing of interval prophylaxis
or--in patients with negative prognostic factors--long-term prophylaxis.