Chronic Paroxysmal Hemicrania: The First Possible Bilateral Case

There are three headaches syndromes that are typically characterized by strictly unilateral and always same-sided attacks: cluster headache, “cervicogenic” headache, and chronic paroxysmal hemicrania (CPH). In rare cases, cluster headache also occurs bilaterally; “cervicogenic” headaches probably as well. We present a patient with a probable bilateral CPH. To our knowledge no such case has previously been described

The Price of Gold and the Exchange Rates: Once Again

This paper examines the theoretical and empirical relationships between the major exchange rates and the price of gold using forecast error data. Among other things, it is found that, since the dissolution of the Bretton Woods international monetary system, floating exchange rates among the major currencies have been a major source of price instability in the world gold market and, as the world gold market now seems to be dominated by the U.S. dollar bloc, appreciations or depreciations of that dollar would have strong effects on the price of gold in other currencies. The results of this study are rather different from those obtained in an earlier study of the same subject.

Import Protection, Capital Inflows, and Real Exchange Rate Dynamics

This paper focuses on the effect of import protection on the response of the real exchange rate to capital flows. The central hypothesis is that barriers to imports blunt the expenditure and production shifting effects of changes in relative prices, and hence the ability of the real exchange rate to equilibrate the economy in response to international capital flows. Employing a cross-section approach, the study focuses on three broadly similar countries but with very different levels of protection: Argentina, Australia, and Canada. The empirical results are consistent with the central hypothesis.import protection; real exchange rate

Long- term poverty and child development in the United States: Results from the NLSY

The authors describe developmental deficits in early childhood associated with long-term poverty in the National Longitudinal Survey of Youth (NLSY). They compare estimates of the effects of long-term poverty (based on a thirteen-year average of income) to estimates of the effects of poverty based on a single year of income (at the time of developmental assessment). They find substantial developmental deficits among children who, on average, are poor over a number of years relative to those who are not. These deficits are approximately twice as large according to the long-term income measure as compared to those based on the single- year measure, and are not explained by differences in maternal education, family structure, maternal behaviors during pregnancy, infant health, nutritional status, or age of mother at first birth. However, an index of the home environment accounts for one-third to one-half of the developmental disadvantages (net of other factors) of children who experience long-term poverty.

SUNCT syndrome: The materialization of a headache syndrome

Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is a rare headache, described by our group in 1989. This overview presents our early studies of SUNCT pathogenesis. Due to the conspicuous ictal, ocular phenomena, ie, conjunctival injection and tearing, our studies started out with ocular parameters: intraocular pressure and corneal indentation pulse amplitudes, both of which showed clear ictal increments, symptomatic side. Beat-to-beat, noninvasive blood pressure measurements during attack showed instant, systolic blood pressure rise and corresponding pulse rate decrease. Carotid body, the principal peripheral chemoreceptor, seemed to function normally. The middle cerebral artery was dilated during attacks, particularly on the symptomatic side. Finally, some viewpoints are added regarding terminology. SUNCT is a workable and accepted term. There does not seem to be any need for another, fictitious term to describe the same clinical picture

Epilepsy prevalence by individual interview in a Norwegian community

SummaryIncomplete case finding is a problem in epidemiological studies of epilepsy. We tried to optimize case ascertainment by combining information from individual interviews and medical records. During 2 years, 1838 inhabitants of Vågå, Norway, aged 18–65 (88.6% of the target population) were interviewed as part of an epidemiological study of headache. Individuals with learning disability, mental disorders and dementia were excluded. One question concerning epilepsy was presented to 1793 consecutive cases (mean age 35, males 49%): “Have you ever had convulsions, epileptic fits or other epileptic symptoms?” The medical records of the 133 subjects who acknowledged this possibility were reviewed, and telephone interviews were performed when needed. A diagnosis of epilepsy had been made in 41 subjects. Twenty-one were treated with antiepileptic drugs, of whom 12 had had seizures within the last 5 years. By this unique method of case ascertainment, the prevalence of epilepsy in adults (cases under treatment) was 1.2%, and of active cases 0.7%, despite the fact that high-risk groups for epilepsy, such as elderly people and individuals with cognitive deficits, were excluded. Although these findings were derived from a small population in a circumscribed rural area, they suggest that the true prevalence of epilepsy may be higher than reflected in many previous studies

Chronic paroxismal hemicrania (CPH): a review of the clinical manifestations.

On a world-wide basis, 84 cases of CPH were found, 59 females and 25 males: i.e., a F:M ratio of 2.36. Forty-nine cases never exhibited a remitting stage, whereas in 35 cases a history of a remitting stage was obtained, 17 cases still remaining in the remitting stage. In other words, the ratio between the chronic and the remitting stage as of today is 67:17 = 3.94. Accordingly, there seems to be a reverse relationship of the chronic versus the remitting stage, when compared to cluster headache. A maximum attack frequency even of 5-6 attacks per 24 hours seems to be consistent with a diagnosis of CPH. Nocturnal attacks occurred in 55 out of 58 cases where such information was available. An unchanging unilaterality was the rule, in that only 3 exceptions have been reported

Incidence and influence on referral of primary stabbing headache in an outpatient headache clinic

Primary stabbing headache (PSH) is a pain, as brief, sharp, jabbing stabs, predominantly felt in the first division of trigeminal nerve. Population studies have shown that PSH is a common headache. However, most people suffer attacks of low frequency or intensity and seldom seek for medical assistance. There are few clinic-based studies of PSH, and its real influence as a primary cause for referral to neurology outpatient offices is to be determined. We aim to investigate the burden of PSH as main complaint in an outpatient headache clinic. We reviewed all patients with PSH (ICHD-II criteria), attended in an outpatient headache clinic in a tertiary hospital during a 2.5-year period (January 2008–June 2010). We considered demographic and nosological characteristics and if PSH was main cause of submission. 36 patients (26 females, 10 males) out of 725 (5%) were diagnosed of PSH. Mean age at onset 34.1 ± 2.9 years (range 10–72). Mean time from onset to diagnosis 68.8 ± 18.3 months. Twenty-four patients fulfilled ICHD-II criteria for other headaches (14 migraine, 6 tension-type headache, 2 hemicrania continua, 1 primary cough headache and 1 primary exertional headache). 77.7% of patients were submitted from primary care. In 14 patients (39%), PSH was main reason for submission, its intensity or frequency in 5 (35.7%) and fear of malignancy in 9 (74.3%). Only two patients of those who associated other headaches were submitted due to PSH. In conclusion, PSH is not an uncommon diagnosis in an outpatient headache office. However, and according to our data, it is not usually the main cause of submission to a headache clinic

A CPH-Like Picture in Two Patients with an Orbitocavernous Sinus Syndrome

Two patients with retroorbital pain syndromes with or without paresis of cranial nerves developed weeks after ipsilateral headache resembling chronic paroxysmal hemicrania (CPH) but without autonomic features. These findings might support the hypothesis that CPH may be caused by a pathological process in the region of the cavernous sinus, as has been proposed for the Tolosa-Hunt syndrome (THS)