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The aim of the research was to study the interrelationship between the primary neurovascular headaches, the various levels dimension of nasal pyramid and the rapid palatal expansion. Twenty-five patients, of both sexes and on developmental age, were studied before and after the rapid palatal expansion. All patients showed palatal hypoplasia and were suffering from primary neurovascular headache. The research was based on the cephalometric and rhinomanometric data. The radiographic documentation of each patient consisted of three postero-anterior teleradiographic projection; the first before application of the disjunction device, the second immediately after disjunction and the third at the end of the contention period. The rhinomanometric evaluation studied the reduction of nasal resistance values before and after palatal expansion. In all patients a constant increase in the values relating both skeletal and dental structures was observed. The nasal septum, if deviated, appeared straightend. The nasal resistances were decreased. The concomitant headache symptomatology presented resolution or recovery in the 98% of treated patients. The results should confirm the hypothesis of the central-peripheral theory of "primary headaches" and the possibility to treat the primary headaches by rapid palatal disjunction in eliminating the stenosis at various levels of nasal pyramid.

The therapeutical results such as recoveries or substantial improvements obtained by neurovascular decompressive functional morpho-corrective rhino-skull base surgery on 2124 cases of primary headaches (migraine with aura, migraine without aura, cluster headache, chronic paroxysmal hemicrania, tension-type headache) obliges a thorough review of the classical chapter on "rhinogenous headaches" (Bonaccorsi, Novak, Blondiau, Bisschop, Hoover, Clerico). In fact all those headaches seemingly "primary", but having a "central-peripheral" etiopathogenesis proved by a well documented (CT) volumetric reduction of "ethmoidosphenoidal subcribriform chamber" according to hemoangiokinetics purposes of endo-exocranial anastomotic circulation of this area, should be included in the chapter of "rhinogenous headaches". This endo-exocranial anastomotic circulation is considered a "functional unit" owing to the continuity of rhino-ophthalmic-encephalic trigeminal-vegetative and vascular circuits (Hannerz, Hardebo, Moskowitz). These morphological abnormalities of the rhino-skull base osteo-vascular-mucous structures acquire physio-pathological significance only in patients with "low pain threshold and elevated central integrative capability", modulated and timed by the neurogenic biorhythms. It is described the surgery of rhino-skull base by "neurovascular decompressive septo-ethmoidosphenoidectomy" procedure, either conservative or radical till the III grade monolateral with trigeminal and vegetative selective neurotomy that permits to save olfaction and to remove even the controlateral pain decompressing the circulation and eliminating stasis even on the opposite side. Further, it is emphasized that the neurological deficit or central irritative symptomatology (visual aura, sensory-motor paresis, epilepsy) disappears after surgical removal of the "peripheral rhinogenous trigger". It demonstrates a cause and effect relationship that is the central peripheral functional interdependence, even if it's included in the neuro-transmissive, biochemical, neuro-endocrine, constitutional background which is controlled by the psychical, vegetative and dysnociceptive biorhythms.

Chronic Cluster Headache (CCH) treatment is troublesome; since there are no pain-free periods, it must be continuous. The most effective CCH prophylactic drug today is lithium carbonate but long-term use of this drug is limited by the possibility of side effects. Recently, calcium antagonists have been successfully employed to prevent migraine, and preliminary studies also indicate that verapamil in particular is an efficacious treatment for CCH. We have conducted a multicenter trial employing a double-dummy, double blind, cross-over protocol, comparing verapamil with the established efficacy of lithium carbonate, in preventing CCH attacks. Both lithium carbonate and verapamil were effective in preventing CCH but verapamil caused fewer side effects and had a shorter latency period. We did not observe any correlation between plasma levels of the two drugs and their clinical efficacy. Both the drugs tested here may exert their effect by restoring a normal inhibitory tone to the pain modulating pathways from the trigemino-vascular system, a circuit putatively implicated in CCH.

The efficacy of propranolol used for prophylactic treatment of 122 patients with migraine is evaluated. Of the 122 patients 51 were suffering from simple or ophthalmic migraine, 43 from vasomotor cephalgia, and 28 from cervical migraine. On the basis of the data obtained the authors come to a conclusion that propranolol is an effective remedy for prevention of migraine and other headaches. According to the authors' data the optimal daily dose of the drug is 120 ml, and the treatment is to be given for not less than 12 weeks. The drug is well tolerated, and the side effects are negligible.

A daily dose of papaverine (5--10 mg per kg body weight) was administered on a double-blind basis for two months to 42 successive child patients suffering from migraine or other vascular headache attacks not less than twice a month. Thirty-seven patients received the drug for the whole period of two months and 31 of these could be followed for a period of one to 10 months (mean 4.5 months) after the cessation of the treatment. Nineteen received papaverine and 18 placebo. Six out of 19 papaverine patients and none of 18 placebo patients were completely free from attacks during the treatment. Altogether 11 patients in the papaverine group and 5 in the placebo group experienced a 75--100% reduction in attack frequency which was accompanied by lower intensity and shorter duration of attacks. The results were best in cases with classical migraine. An "excellent" or "good" drug effect was experienced by 58% of papaverine patients and 17% of placebo patients.

Flunarizine was given in daily doses of 10 mg for periods of two to four months to 176 patients suffering from various types of headache. The symptoms were improved in 82% of the cases treated. No differences emerged among the various types of headache reported by the patients or in relation to the presence or absence of neurological involvement or its type.

Methylergometrine, the main metabolite of methysergide, has 40-times greater 5 HT antagonistic potency than methysergide in isolated segments of human temporal artery. It is suggested that methylergometrine is the "active" drug when methysergide is used in migraine prophylaxis, and that the two compounds should be compared in prophylactic trials in migraine.