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The responses to work-test in ischemia (tourniquet technique), before and after I.V. injection of naloxone (2 mg) or saline, were investigated in healthy volunteers and patients suffering from various types of headache. The patients were examined during both painful and painless periods. We found that only the subjects suffering from migraine showed a significantly shortened pain tolerance at work-test in ischemia, after injection of naloxone, and only during painful periods. Psychogenic headache patients and migraine patients in painless periods showed responses during work-test similar to those in healthy volunteers, even after injection of naloxone. We believe that hyperalgesic effect of naloxone is due to involvement of beta-endorphin systems only during organic pain.

A pharmacological trial has been carried out on 41 out-patients suffering from mixed headache. The prophylactic effect of a timed-release dihydroergotamine formulation was tested versus amitriptyline. Patients reported daily, on appropriate cards, the hours of headache and the degree of pain during the month before therapy and on the following two months of treatment. Whereas amitriptyline was found to be more effective than dihydroergotamine in reducing headache intensity, timed-release dihydroergotamine was found significantly more effective than amitriptyline in reducing attacks of "migraine" type.

The effect of the ergot derivative bromocriptine (5 mg orally) on blood pressure and plasma catecholamine concentrations was explored in normal volunteers. A significant decrease of plasma noradrenaline was found, while dopamine and adrenaline concentrations did not change significantly. Systolic and diastolic blood pressures were significantly lowered at 150 min after administration. The hypotensive effect of bromocriptine seems to be mediated by a lowered release of noradrenaline from sympathetic nerve endings. It may be hypothesized that the drug stimulates presynaptic dopamine receptors located on postganglionic sympathetic nerves, thus inhibiting noradrenaline discharge.

Prophylactic use of Lithium salts in patient suffering from cluster headaches has been evaluated looking at the mean number of headache attacks in one critical period and the mean weekly duration of the period itself. These two elements have been compared to those observed on other drugs treatments. Plasma Lithium monitoring has been performed weekly during the trial. Authors discuss the results reported and the hypothetic basis of them.

Twenty common migraine patients received a one sided frontotemporal application of nitroglycerin (10 patients) or placebo ointment (10 patients) in a double blind study. Early onset migraine attacks were induced by nitroglycerin in seven out of 10 patients versus no patient in the placebo group. Subsequently 20 migraine patients, who developed an early onset attack with frontotemporal nitroglycerin, received the drug in a second induction test at other body areas. No early onset migraine was observed. Thus the migraine-inducing effect of nitroglycerin seems to depend on direct stimulation of the habitual site of pain, suggesting that the frontotemporal region is of crucial importance in the development of a migraine crisis. This is not consistent with a CNS origin of migraine attack.