Our pilot studies (PS) show that high adrenergic neurovascular tone (ANVT) with high vagal tone (VT) occurs with basilar artery migraine (BAM). PS show that systolic time intervals (STI = PEP/LVET × 100%) can be used to measure ANVT levels that correlate with the severity of symptom levels (SL) of BAM and its hemodynamic findings (HF). Gastroesophageal reflux (GERD) was also found in all of the BAM PS patients. Prospective studies (ProS) were done to test PS findings and treatment. A random sample of the general population, with the clinical complaints typical of BAM, were studied. These include occipital headaches, scotomata, visual disturbances, near-syncope, and paresthesias. Serial measurements were made of: systolic time intervals (STI), systolic blood pressure (SBP), cardiac output (CO) by 2D echo, systemic vascular resistance (SVR), and symptom levels (SL) and heart rate (HR at 12 noon, peak high VT) at Time (T) l before therapy (Rx) (1 year) and at T2 during Rx (1 year). The patients were 18-70 years of age, 3/1 female/male, all Caucasian. Exclusions were fibromyalgia, diabetes, hypertension, and on other drugs. Controls (C) were normal age/sex/race matched. PS criteria of STI ranges were used to predict the degree of hemodynamic abnormalities and the severity of SL of BAM and GERD (both 1-100 scale). The Rx was diltiazem CD 240-360 mg/day, methyldopa 125-500 mg/day, and amitriptyline 10-100 mg/day. All data were placed into a blind matrix for later analysis. Data were grouped by PS STI criteria (mean ± range [R]) in a double blind crossover design. ProS results: Group (G) means shown:
The severity of BAM (mild, moderate, severe) was found to correlate with the severity of STI levels (G 3, 2, 1), with an underlying high VT as shown by the heart rate of 60 ± 5. The severity of GERD was found to parallel the severity of BAM at the same levels of STI. Characteristic HF were present in BAM and GERD, consisting of high ANVT, VT, and SVR with low CO. Low blood flow (CO) with high SVR was found to be associated with high SL. Thus, Rx changed HF to C levels with a significant reduction in SL.
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