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Poster Presentations POSTER PRESENTATIONS Scientific Session 1 during the previous year were evaluated using a question- naire. We used logistic regression to analyse age–adjusted Comorbidity associations. P1A1 Results Women complaining of bad sleep, women frequently experiencing difficulties falling asleep or daytime sleepiness, The effect of i.v. L-NG methylarginine hydrochloride (L- and women frequently sleeping less than 5 h per night had an NMMA: 546C88) on basal and acetazolamide (Diamox ®) increase in risk for migraine. Women using sleeping pills and induced changes of blood velocity in cerebral arteries and women experiencing insomnia during the night were not at regional cerebral blood flow in man increased risk for migraine. There was no association between Lisbeth Hjorth Lassen*1, Bjoern Sperling2 & Jes Olesen1 frequent snoring or the self-reported need for sleep, measured 1Danish Headache Center, Department of Neurology, Glostrup Hospital, as the number of hours of sleep per night, and migraine. 2 Denmark, Department of Clin. Phys. and Nuclear Medicine, Bispebjerg However, the larger the discrepancy between the self-reported Hospital need for sleep and length of sleep, the greater the risk for We have previously shown that the nitric oxide synthase migraine. Major depression did not confound the significant inhibitor L-NMMA is effective in the treatment of migraine associations between migraine and sleep patterns. attacks without aura. Here we estimate the effect of L-NMMA Conclusion In this cross-sectional study, women experienc- on the diameter of the middle cerebral artery (MCA) and on ing insomnia and sleep deficit had an increase in risk for regional cerebral blood flow (rCBF). Furthermore, we assess migraine, which was independent of the risk for major the effect of L-NMMA on acetazolamide induced increases in depression. MCA blood velocity and rCBF. In an open crossover design 12 healthy subjects attended P1A3 the laboratory twice. At day one 6 mg/kg L-NMMA i.v. over 15 min preceded 1 g acetazolamide iv over 5 min. At day eight Impact of migraine and concomitant anxiety on economic and quality of life measures only acetazolamide was given. Vmean in MCA was determined with transcranial Doppler (TCD) and rCBF with Xe-133 Robert Shapiro*1, Jacqueline Pesa2, Birgit Eschmann3 & inhalation SPECT at baseline, after L-NMMA, 25 and 55 min Mary Lou Chatterton4 1 after acetazolamide infusion. Department of Neurology, University of Vermont, College of Medicine, Burlington, VT, 2AstraZeneca LP, Wilmintong, DE, 3Consumer Health After L-NMMA the decrease in rCBFMCA was 6.8% (± 7.4)(P Sciences, Princeton, NJ, 4MLG Consulting Services, Inc., Chadds Ford, PA < 0.019,n = 12), whereas Vmean was not affected (P = 0.83,n = 8). The change in MCA diameter was estimated to –1.3% (P = Objectives While it is recognized that migraineurs have more 0.44,n = 8). L-NMMA did not affect acetazolamide increases in anxiety, research has not investigated combined effects of Vmean (P = 0.67,n = 8) nor rCBF (P = 0.29; n = 12). The per- these two conditions on economics and quality of life. centage increase of Vmean was 1.5 times that of rCBF (n = 8). Methods Data were from a representative survey of 22 376 Our data suggests that the basal tone of the cerebral arteri- US adults. Analyses included the 1598 people diagnosed only oles but not of conduit arteries is NO-dependent. The action with migraines, 692 only anxiety, 371 with both, and 2661 of acetazolamide is not NO-dependent. controls with neither. Multivariate models controlled for migraine frequency, severity, demographics, comorbidities, and depression. We modeled mental and physical well-being P1A2 (SF-8), missed days of work and household activities, and Sleep patterns, major depression, and the risk for doctor visits (past six months). migraine Results People with migraines only scored 50.6 for mental well-being, while those who also had anxiety scored lower: 1 Peter Mattsson* 35.2 (P < 0.001). Migraine-anxiety sufferers had more doctor 1Department of Neuroscience, Neurology, University Hospital, Uppsala visits: 9.1 compared to 4.4 for migraine only (P < 0.001). Both Objective Few epidemiological studies have analysed the results held in multivariate analyses (P = 0.007; p = 0.001). associations between sleep patterns and migraine. Having migraines and anxiety alone were each associated Methods A neurologist clinically assessed 728 women aged with lower physical well-being and increased absenteeism, 40–74 years attending a population-based mammography but having both conditions was not worse than the contribu- screening program. The assessment focused on the 1-year tion of each condition separately. prevalence of migraine and major depression using modified Conclusion Additional direct and indirect costs accrue for IHS and DSM-III-R criteria. The participants’ sleep patterns migraineurs who also have anxiety. Further research is neces- © Blackwell Publishing Ltd Cephalalgia, 2003, 23, 581–762 581 582 Poster presentations sary to assess whether disorders concomitant with migraine, bral ischemia is still unclear. The accumulation of Notch3 such as anxiety or depression, contribute predominantly addi- ectodomain within vessels wall seems to be the leading mech- tive or synergistic effects on quality of life. anism of vascular impairment. The aim of this study is to eval- uate hemodynamic reserve and its relationship with clinical features. P1A4 Materials and methods We investigated the reactivity of mean cerebral arteries to hypercapnia by breath-holding Sleep disorders in primary nocturnal headaches: index (BHI) in 11 CADASIL patients (5 men and 6 women, epidemiological data mean age 35,28 ± 2.8) vs. age and sex matched controls. 4 Grazia Sances*1, Natascia Ghiotto1, Marianna Loi1, patients (2 men and 2 women) suffered from migraine with Michele Terzaghi2, Alberto Proietti Cecchini1, Raffaele Manni2 & aura, stroke and dementia with wide distribution of lacunar 3,1 Giuseppe Nappi infarcts at MRI. The other subjects (3 man and 4 women) 1Headache Diagnosis and Treatment Centre, University Centre for referred only migraine with aura and have few neuroradio- Adaptive Disorders and Headache (UCADH), Pavia, Italy, 2Unit of Sleep Medicine and Epilepsy, IRCCS C. Modino Institute of Neurology, Pavia, logical features. Italy, 3Department of Neurology and ORL, University of Rome ‘La Results Mean flow velocities on middle cerebral arteries Sapienza’, Rome, Italy were lower in patients with strokes/dementia/migraine than The relationship between primary headache and sleep is well in those with migraine only. BHI was lower in CADASIL recognized but the exact nature of this association remains patients than in controls without differences between fully unclear. Our study was based on three stages: 1. Prospective symptomatic and migraineurs only subjects. epidemiological evaluation of headache outpatients to estab- Discussion These results suggest an early dysfunction of lish presence of nocturnal headache; 2. Patients with a high cerebrovascular vasodilator stimuli response in CADASIL. frequency of episodes during sleep underwent clinical evalu- The homogeneous impairment of hemodynamic reserve may ation of their headache according to the International account for the importance of vascular mechanisms in Headache Society (HIS) classification. Moreover, we also stroke/migraine comorbidity of CADASIL. included patients with hypnic headache, a new clinical entity that is to be included in the Second Edition of the IHS classi- fication; 3. Investigation of the coexistence with sleep disor- P1A6 ders by means of questionnaire and polysomnographic study in patients in whom there was a clinical suspicion of sleep dis- Development of time-efficient procedures for assessing order. 596 consecutive headache outpatients were screened psychopathological aspects of medication overuse and 65 (10.9%) of them found have nocturnal attacks with a headache frequency ≥50%. Thirty-nine patients (24 males; 15 female; Monica Silvia Verticale*1, Alberto Proietti Cecchini1, mean age 54.51 years, range 19–85) agreed to participate in the Natascia Ghiotto1, Silvano Cristina1, Caterina Biancardi1, 1,2 1 study. Thirty-six patients were diagnosed with headache: 22 Giuseppe Nappi & Grazia Sances 1Headache Diagnosis and Treatment Centre, University Centre for (61%) migraine without aura; 8 (22%) hypnic headache; and Adaptive Disorders and Headache (UCADH), IRCCS C. Mondino 6 (17%) cluster headache. Institute of Neurology, Pavia, 2Department of Neurology and ORL, Sleep disorders were sleep apnoea, snoring, insomnia, rest- University of Rome ‘La Sapienza’, Rome, Italy less legs syndrome, periodic limb movement disorder. DSM-IV/SCID-I substance dependence criteria do not Polysomnography was recorded in 16 patients and showed entirely fit chronic headache with analgesic overuse and need obstructive sleep apnoea in all of them. Our data suggest that to be adapted to cater for this condition. The aim of this study nocturnal recurrence of headache may correlate with sleep was: (a) to develop a new assessment tool for investigating disorders. this type of disorder (Interview for Medication Overuse and This study was supported by a grant from the Italian Min- Dependence in Headache – IMODH); (b) to look for psy- istry of Health (RF 2001/151). chopathological aspects, other than neuroticism. Over 16 months we investigated 369 patients (293 females, 76 males), admitted for analgesic overuse headache and P1A5 detoxification treatment, using the SCID-I (clinical version). Impairment
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