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Migraine prevalence is increased in high-altitude populations and symptoms of acute mountain sickness mimic migraine symptoms. Here we tested whether normobaric hypoxia may trigger migraine attacks. As positive control we used nitrolgycerin (NTG), which has been shown to induce migraine attacks in up to 80% of migraineurs. Sixteen patients (12 females, mean age 28.9 +/- 7.2 years) suffering from migraine with (n = 8) and without aura (n = 8) underwent three different provocations (normobaric hypoxia, NTG and placebo) in a randomized, cross-over, double dummy design. Each provocation was performed on a separate day. The primary outcome measure was the proportion of patients developing a migraine attack according to the criteria of the International Headache Society within 8 h after provocation onset. Fourteen patients completed all three provocations. Migraine was provoked in six (42%) patients by hypoxia, in three (21%) by NTG and in two (14%) by placebo. The differences among groups were not significant (P = 0.197). The median time to attacks was 5 h. In conclusion, the (remarkably) low response rate to NTG is surprising in view of previous data. Further studies are required to establish fully the potency of hypoxia in triggering migraine attacks.

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Migraine pathophysiology possibly involves deficient mitochondrial energy reserve and diminished cortical habituation. Using functional magnetic resonance spectroscopic imaging (fMRSI), we studied cortical lactate changes during prolonged visual stimulation to search for different pathophysiological mechanisms in clinically distinct subgroups of migraine with aura. Eleven healthy volunteers (HV) and 10 migraine patients were investigated interictally: five with visual aura (MA) and five with visual symptoms and at least one of the following: paraesthesia, paresis or dysphasia (MAplus). Using MRSI (Philips, 1.5 T) (1)H-spectra were repeatedly obtained from a 25 mm-thick slice covering visual and non-visual cortex, with the first and fifth measurements in darkness and the second to fourth with 8-Hz checkerboard stimulation. In MAplus lactate increased only during stimulation, only in visual cortex; in MA resting lactate was high in visual cortex, without further increase during stimulation. This is compatible with an abnormal metabolic strain during stimulation in MAplus, possibly due to dishabituation, and a predominant mitochondrial dysfunction in MA.

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Riboflavin, which improves energy metabolism similarly to coenzyme Q10 (CoQ10), is effective in migraine prophylaxis. We compared CoQ10 (3 x 100 mg/day) and placebo in 42 migraine patients in a double-blind, randomized, placebo-controlled trial. CoQ10 was superior to placebo for attack-frequency, headache-days and days-with-nausea in the third treatment month and well tolerated; 50%-responder-rate for attack frequency was 14.4% for placebo and 47.6% for CoQ10 (number-needed-to-treat: 3). CoQ10 is efficacious and well tolerated.

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OBJECTIVE: This study examined lexical emotional perception in patients with unilateral brain damage. BACKGROUND: Hypotheses pertaining to laterality and emotion were tested. More specifically, we were interested in whether the right hemisphere is dominant for verbally-presented emotion. In addition, we examined whether emotional content improves the performance of patients with left brain damage (LBD) and language deficits. METHOD: Subjects were 11 patients with right brain damage (RBD), 10 patients with LBD, and 15 normal control adults. The subject groups did not differ significantly on demographic or basic cognitive variables; the patient groups were similar on neurologic variables. Parallel emotional experimental and nonemotional control tasks included word identification (or recognition), sentence identification, and word discrimination. There were eight emotional categories (e.g., happiness) and eight nonemotional categories (e.g., vision). RESULTS: A significant interaction among Group, Condition, and Task revealed that patients with RBD were significantly impaired relative to patients with LBD and normals within the emotional condition, particularly for the identification tasks. Furthermore, the performance of patients with LBD and language deficits was improved by emotional content for the sentence identification task. CONCLUSIONS: These findings suggest that the right hemisphere has a unique contribution in the identification of lexical emotional stimuli. Implications for rehabilitation of patients with LBD and language deficits and patients with RBD by means of emotion-based strategies are discussed.

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Emotional perception was examined in stroke patients across 3 communication channels: facial, prosodic, and lexical. Hemispheric specialization for emotion was tested via right-hemisphere (RH) and valence hypotheses, and relationships among channels were determined. Participants were 11 right-brain-damaged (RBD), 10 left-brain-damaged (LBD), and 15 demographically matched normal control (NC) adults. Experimental measures, with analogous psychometric properties, were identification and discrimination tasks, including a range of positive and negative emotions. Nonemotional control tasks were used for each channel. For identification, RBDs were significantly impaired relative to LBDs and NCs across channels and valences, supporting the RH hypothesis. No group differences emerged for discrimination. Findings were not influenced by demographic, clinical, or control variables. Correlations among the channels were more prominent for normal than for brain-damaged groups.

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Epidermal growth factor and its receptor (EGFR) constitute an important and well-characterized mitogenic system in various ectodermal tissues including glial cells. Over-expression of the EGFR due to gene amplification has been reported in primary brain tumours of glial origin. Using a monoclonal antibody to the EGFR and immunohistochemical analysis, we examined the expression and distribution of EGFR in 103 astrocytic tumours. In addition, selected tumours were studied by Western blotting using a polyclonal antibody to EGFR and by Southern blot analysis. Glioblastomas (WHO grade IV) showed EGFR expression in 37% of cases, whereas pilocytic (WHO grade I), low-grade (WHO grade II) or anaplastic astrocytoma (WHO grade III) were invariably EGFR negative. Generally, there was a close correlation between the presence of EGFR gene amplification and over-expression of receptor protein. Different patterns of immunoreactive cells and significant intratumour heterogeneity of EGFR expression were observed in glioblastomas. The specific association of EGFR over-expression with glioblastoma may provide a useful diagnostic tool for distinguishing anaplastic astrocytoma (WHO grade III) and glioblastoma multiforme (WHO grade IV).

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