Search tips
Search criteria

Results 1-5 (5)

Clipboard (0)

Select a Filter Below

Year of Publication
Document Types
1.  Disturbances in ocular sympathetic function and facial blood flow in unilateral migraine headache. 
The relationship between thermographic asymmetry in various parts of the face and indices of ocular sympathetic outflow was examined in 80 patients with unilateral migrainous headache. Both during and between episodes of headache, the pupil on the symptomatic side dilated more slowly and less extensively in darkness than the opposite pupil, indicating that ocular sympathetic outflow was compromised in some patients. In such cases the upper forehead and orbital region were warmer on the symptomatic side during migraine. In contrast to these signs of a reduction in cervical sympathetic outflow, eyelid separation was greater on the symptomatic side in patients with headache on the side that was usually affected. During the headache-free interval no consistent thermographic asymmetry was detected and eyelid separation was similar on both sides. These findings suggest that extracranial vascular changes and ocular sympathetic dysfunction during migraine are secondary to activation of trigeminal-vascular reflexes or to antidromic release of vasoactive substances from trigeminal nerve terminals. A secondary deficit in the sympathetic pathway to the symptomatic pupil could also prevent the expression of an increase in sympathetic outflow during headache.
PMCID: PMC487950  PMID: 2313298
2.  Pupil diameter in migraine and tension headache. 
Pupil diameter was measured in darkness and in dull and bright illumination in 39 migrainous patients and in 15 tension headache sufferers during headache. In 21 migrainous patients, measurements were repeated during the headache-free interval. Mean pupil diameter was smaller in patients with common migraine at the time of examination than in 20 nonheadache control subjects, and smaller on the symptomatic side in migrainous patients with unilateral headache. During the headache-free interval mean pupil diameter did not differ from values in non-headache controls. These findings suggest that migraine is associated with a sympathetic pupillary deficit which is greater on the habitually-affected side.
PMCID: PMC1031498  PMID: 3572438
3.  Harlequin syndrome: the sudden onset of unilateral flushing and sweating. 
Facial flushing and sweating were investigated in five patients who complained of the sudden onset of unilateral facial flushing in hot weather or when exercising vigorously. One patient probably suffered a brainstem infarct at the time that the unilateral flush was first noticed, and was left with a subtle Horner's syndrome on the side opposite to the flush. The other four had no other neurological symptoms and no ocular signs of Horner's syndrome. Thermal and emotional flushing and sweating were found to be impaired on the non-flushing side of the forehead in all five patients whereas gustatory sweating and flushing were increased on that side in four of the five patients, a combination of signs indicating a deficit of the second sympathetic neuron at the level of the third thoracic segment. CT and MRI of this area failed to disclose a structural lesion but latency from stimulation of the motor cortex and thoracic spinal cord to the third intercostal muscle was delayed on the non-flushing side in one patient. The complaint of unilateral flushing and sweating was abolished in one patient by ipsilateral stellate ganglionectomy. The unilateral facial flushing and sweating induced by heat in all five patients was thus a normal or excessive response by an intact sympathetic pathway, the other side failing to respond because of a sympathetic deficit. The onset in the four cases of peripheral origin followed strenuous exertion, which suggested that an anterior radicular artery may have become occluded at the third thoracic segment during torsion of the thoracic spine.
PMCID: PMC1033068  PMID: 3155385
4.  Clinical diagnosis and computer analysis of headache symptoms. 
The headache histories obtained from clinical interviews of 600 patients were analysed by computer to see whether patients could be separated systematically into clinical categories and to see whether sets of symptoms commonly reported together differed in distribution among the categories. The computer classification procedure assigned 537 patients to the same category as their clinical diagnosis, the majority of discrepancies between clinical and computer classifications involving common migraine, tension-vascular and tension headache. Cluster headache emerged as a clearly-definable syndrome, and neurological symptoms during headache were most prevalent in the classical migraine group. However, the classical migraine, common migraine, tension-vascular and tension headache categories differed in terms of the number, rather than the nature, of common migraine features. Whether the two extremes of this migraine-tension headache spectrum are different disorders can be determined only by studies of their pathophysiology.
PMCID: PMC1027680  PMID: 6707652
5.  Facial flushing after thermocoagulation of the Gasserian ganglion. 
The development of a facial flush during thermocoagulation of the Gasserian ganglion was monitored in 16 patients with pulse recording techniques and in a further 17 patients with thermography. There was a close association between the development of the facial flush in the distribution of one or more divisions of the trigeminal nerve and the subsequent demonstration of postoperative analgesia. In regions where significant changes took place, vascular pulsations increased 25-233% (mean 96%) and facial temperature rose 0.5-2.0 degrees C. The response persisted for up to an hour postoperatively, and was not diminished in patients with pre-operative analgesia from a previous procedure. Possible mechanisms for the facial flush, including stimulation of an active vasodilator system, the antidromic release of vasoactive substances from trigeminal nerve terminals and the release of tonic vasoconstriction are discussed. A practical application of the pulse recording technique used in the present investigation would be to monitor the distribution of vasodilatation at operation to avoid unwanted first division sensory loss.
PMCID: PMC1027478  PMID: 6604132

Results 1-5 (5)