Poster Abstracts Friday, November 11, 2005 $491

treatment has a better tolerability profile than DVPX in patients with episodic migraine. These results need to be verified in large controlled trials.

1536 Headache clinic a study of 300 cases pattern, social awareness, the role of education

Pazhan[, R ~. 1Apollo Hospitals, Chennai, bzdia

Background: 1 ) To asses the usefulness of tiffs special cliuic 2) To find out the pattern of headache in the studied population 3) To asses how nmch patients aware about different types of headache 4) To reassess the impact of education Methods: Three hundred patients who attended the headache clinic in the past one year was taken for the study. Patients were asked about the following details duration, site, nature, frequency, intensity, treatment, fmnily history, educational background and awareness about the disease. Results: Two hundred patients were women, hundred were men. The age range was 8-55. Sixty percent is migraine, 30% tension headache and 10% remaining headache (medication overuse headache, cluster headache, temporal arteritis, other atypical headache and structural cause). Among the migrainers 80"/0 had migraine without aura, 8% migraine with aura, 10% chronic migraine and 2',/0 other atypical migraine including migrainous aura with out headache. Ten percentage of the patients heard about migraine and only 3% aware about preventive measures with positive attitude. The quality of lives of patients were affected in 93',/0 of the population studied. With adequate time spent with answering all the questions 95% of the patients felt positive about the outcome. The remaining 5% under- stood well about their disease, but could not think positively during first consultation, as there was significant anxiety/depression. Conclusion: This study reveals the importance of specialist run clinic on headache, the role of educating the patients especially in developing countries. It is important to prevent and treat the headache actively especially in developing countries, as it is one of the common causes of men working hour 's loss.

1537 Wide clillieaI ~pe~Ll'ltlII1 of Pseudomigraine with Lylnphoeyiie Pleocylosis in a young man

Rodriguez-Vieo, jz, Catalina, 11, Martin-Moro, M 1. 2University General Hospital "Gregorio Mara~rn", Neurology department, Madrid, Spain.

We report an uncomon case of Pseudomigraine with lymphocytic pleocytosis (PLP) with severe and variable clinical features. The long evolution and the particularity of symptoms make tiffs patient unusual. Backgrouml: PLP, also referred to as headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL), is characterized by episodic transient neurologic dysfunction associated with moderate to severe throbbing headache and cerebrospinal fluid lymphodtic pleocytosis. Episodes are recurrent and self-limited. Methods: Prospective clinical follow up of a patient with clinical features of PLP admitted in to our Hospital, from October 2003 to April 2005. Results: A long term follow up, showed a 4 month clinical history of transient episodes of severe headache, confusion with delirium, aphasia, alucinations, weakness and sensory symptoms lasting from minutes up to 8-9 hours. The most conmn presentation was severe headache, alone or associated to sensory symptoms afecting a limb or generalized. Cerebrospinal fluid showed high presure and lymphocytic pleocytosis of up to 900 cells during the first three weeks. Differencial diagnosis was made for over six months. Conclusions: Clinical suggested criteria fitted with our patient with the particularity of been of very long evolution and with almost all the described posible symptoms in tiffs pathology. No other patient has

been reported with 900 lymphocytic cells in cerebrospinal fluid and this long evolution.

We should be sometimes cautious to call tiffs, a "benign" headache syndrome.

1538 Botulinmn toxin type A reduces frequency of headache-days in migraine patients with 15 or more headache days and frequent headache

Sflberstein, S ~, Dodick, D a, DeGryse, R 3, Turkel, C 3. 1Jefferson Headache Center, Philadelphia, PA, USA," 2Mayo Clinic, Scottsdale, AZ, U&4," 3Allergan, Inc., Irvine, CA, U&4

Background: Botulinum toxin type A (BoNTA, BOTOX~): Allergan, Inc, Irvine, CA) has been suggested as an effective treatment for headaches. Method: A subgroup analysis of 168/355 patients from a 2-arm, randomized, double-blind, placebo-controlled study was performed. Patients had >15 headache days (i>50°,5 of which were migraine/ probable migraine days), at least 4 headaches, each _>4 hours, and no concurrent headache prophylmxis. Patients received 110-260 U of BoNTA or placebo for 3 treatment cycles using a modified follow the pain injection paradigm. Results: Both treatment groups had 22.1 headache days at baseline (p - 0.961). Over 90"/0 of the headache-days were migraine/probable migraine days (BoNTA -- 20.5 days, placebo -- 20.3 days). A reduction in headache days favoring BoNTA at all time points was observed, with a mmximum difference between treatment groups of 4.9 days (BoNTA: 11.2, placebo: 6.3, P -- 0.012) at day 180. Only 3 BoNTA patients discontinued due to adverse events. Condusiom BoNTA was safe, well-tolerated and effective in reducing headache days in patients with 15 or more headache days per month.

1539 Occipitofrontalis Contraction Headaches, secondary to Proses - an Undassitied Headache

I~ I Sng, G Varughese. Gleneagles Intan Medical Centre, Kuala Lumpur, Malaysia

Background: Prolonged occJpitofrontalis muscular contraction, which is secondary to ptosis and results in headaches in majority of cases, is a true nmscular contraction headache, which is yet unclassified or listed in the 1-nteruational Classification of Headache Disorders [updated 2004].

Headaches can be severe and disabling. Reconstructive surgery with reattachment of levator palpebrae superioris with or without brow lift results in remarkable cure of headaches. Method: Patients who present with chronic daily headaches are routinely exmnined for ptosis, which may or may not be apparent. Often, ptosis is corrected with occipitofrontalis contraction resulting in obvious frontal creases especially in adults and elderly patients. Younger patients may not demonstrate frontal creases even with very strong occipitofrontalis contraction. Two signs, invariably present are elicited to confimt the diagnosis of Occipitofrontalis Contraction Headaches, secondary to ptosis. The patient is told to relax and close the eyes. The occipitofrontalis nmscle is then firmly but gently fixed and neutralised in its action. The patient is then asked to open his/her eyes. Patient is unable to open eyes adequately for vision in all cases, while simultaneously, there is a very strong attempt by the occipitofrontalis muscle to assist in palpebral elevation. In a few patients, there is total inability to open eyelids. Tiffs test is repeatedly demonstrated and viewed also by patient using a mirror, with patient in the upright sitting position. The test is then repeated with the patient in a horizontal lying position. Ptosis is demonstrably absent in the lying position and occipitofrontalis action not necessary, with gravity eliminated. Results: Ten patients are described from ages 26-86. All patients were offered surgery. Five patients who underwent surgery showed