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Treatment of migraine: a headache for the emergency department.
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Treatment of migraine: a headache for the emergency department.
Neurology. 2007 Nov 27;69(22):2034-5
migraine therapy Authors: Becker WJ, Kryscio RJ
PMID: 18040009 [PubMed - in process]
Treatment of childhood migraine attacks with oral zolmitriptan and ibuprofen.
Neurology. 2007 Apr 24;68(17):1441
migraine therapy Authors: Kornblau DH
PMID: 17452599 [PubMed - indexed for MEDLINE migraine therapy]
Sumatriptan-naproxen for acute treatment of migraine: a randomized trial.
JAMA. 2007 Apr 4;297(13):1443-54
migraine therapy Authors: Brandes JL, Kudrow D, Stark SR, O'Carroll CP, Adelman JU, O'Donnell FJ, Alexander WJ, Spruill SE, Barrett PS, Lener SE
CONTEXT: Multiple pathogenic mechanisms may be involved in generating the migraine symptom complex, and multimechanism-targeted therapy may confer advantages over monotherapy. OBJECTIVE: To evaluate the efficacy and safety of a fixed-dose tablet containing sumatriptan succinate and naproxen sodium relative to efficacy and safety of each monotherapy and placebo for the acute treatment of migraine. DESIGN, SETTING, AND PARTICIPANTS: Two replicate, randomized, double-blind, single-attack, parallel-group studies conducted among 1461 (study 1) and 1495 (study 2) patients at 118 US clinical centers who were diagnosed as having migraine and received study treatment for a moderate or severe migraine attack. INTERVENTIONS: Patients were randomized in a 1:1:1:1 ratio to receive a single tablet containing sumatriptan, 85 mg, and naproxen sodium, 500 mg; sumatriptan, 85 mg (monotherapy); naproxen sodium, 500 mg (monotherapy); or placebo, to be used after onset of a migraine with moderate to severe pain. MAIN OUTCOME MEASURES: Primary outcome measures included the percentages of patients with headache relief 2 hours after dosing, absence of photophobia, absence of phonophobia, and absence of nausea for the comparison between sumatriptan-naproxen sodium and placebo, and the percentages of patients with sustained pain-free response for the comparison between sumatriptan-naproxen sodium and each monotherapy. RESULTS: Sumatriptan-naproxen sodium was more effective than placebo for headache relief at 2 hours after dosing (study 1, 65% vs 28%; P<.001 and study 2, 57% vs 29%; P<.001), absence of photophobia at 2 hours (58% vs 26%; P<.001 and 50% vs 32%; P<.001), and absence of phonophobia at 2 hours (61% vs 38%; P<.001 and 56% vs 34%; P<.001). The absence of nausea 2 hours after dosing was higher with sumatriptan-naproxen sodium than placebo in study 1 (71% vs 65%; P = .007), but in study 2 rates of absence of nausea did not differ between sumatriptan-naproxen sodium and placebo (65% vs 64%; P = .71). For 2- to 24-hour sustained pain-free response, sumatriptan-naproxen sodium was superior at P<.01 (25% and 23% in studies 1 and 2, respectively) to sumatriptan monotherapy (16% and 14% in studies 1 and 2), naproxen sodium monotherapy (10% and 10% in studies 1 and 2), and placebo (8% and 7% in studies 1 and 2). The incidence of adverse events was similar between sumatriptan-naproxen sodium and sumatriptan monotherapy. CONCLUSION: Sumatriptan, 85 mg, plus naproxen sodium, 500 mg, as a single tablet for acute treatment of migraine resulted in more favorable clinical benefits compared with either monotherapy, with an acceptable and well-tolerated adverse effect profile. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00434083 (study 1); NCT00433732 (study 2).
PMID: 17405970 [PubMed - indexed for MEDLINE migraine therapy]
Twelve-month tolerability and safety of sumatriptan-naproxen sodium for the treatment of acute migraine.
Mayo Clin Proc. 2007 Jan;82(1):61-8
migraine therapy Authors: Winner P, Cady RK, Ruoff GE, Frishberg BM, Alexander WJ, Zhang Y, Kori SH, Lener SE
OBJECTIVES: To evaluate the long-term safety and tolerability of sumatriptan-naproxen sodium for the treatment of moderate to severe acute migraines and to assess the safety of administration of an optional second dose. PATIENTS AND METHODS: A 12-month, multicenter, open-label safety study was conducted in adults treated for migraine attacks of moderate to severe intensity from April 14, 2004, to August 18, 2005. Safety evaluations included adverse events and laboratory tests. RESULTS: Of 600 patients enrolled, 565 (94%) were treated for at least 1 migraine. Of treated patients, 414 (73%) and 362 (64%) completed 6 and 12 months of treatment, respectively. Of the 24,485 attacks treated, 17,144 (70%) were treated with only 1 dose. On average, patients treated 5 migraine attacks per month, with a median of 6 days between attacks. The most common treatment-related adverse events were nausea, muscle tightness, and dizziness. Fourteen patients reported 1 or more serious adverse event with only 1 judged probably related to treatment. No deaths occurred. Eight percent of patients discontinued participation in the study because of adverse events or pregnancy. The rates of adverse events reported were no higher after treatment with 2 tablets (at least 2 hours apart) compared with 1 tablet. CONCLUSIONS: In this 12-month data set of more than 24,000 migraine attacks in 565 patients, sumatriptan-naproxen sodium formulated in a single tablet was well tolerated when used episodically for the treatment of acute migraine. The adverse events did not differ from those expected for the individual components alone, and no new or unexpected findings occurred.
PMID: 17285787 [PubMed - indexed for MEDLINE migraine therapy]
Targeted treatment strategies for menstrual migraine.
J Fam Pract. 2007 Feb;56(2 Suppl Pain):13-22
migraine therapy Authors: Martin V
PMID: 17270114 [PubMed - indexed for MEDLINE migraine therapy]
Propofol: a novel treatment for breaking migraine headache.
Anesthesiology. 2007 Feb;106(2):405-6
migraine therapy Authors: Bloomstone JA
PMID: 17264748 [PubMed - indexed for MEDLINE migraine therapy]
Migraine prevalence, disease burden, and the need for preventive therapy.
Neurology. 2007 Jan 30;68(5):343-9
migraine therapy Authors: Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF,
OBJECTIVES: 1) To reassess the prevalence of migraine in the United States; 2) to assess patterns of migraine treatment in the population; and 3) to contrast current patterns of preventive treatment use with recommendations for use from an expert headache panel. METHODS: A validated self-administered headache questionnaire was mailed to 120,000 US households, representative of the US population. Migraineurs were identified according to the criteria of the second edition of the International Classification of Headache Disorders. Guidelines for preventive medication use were developed by a panel of headache experts. Criteria for consider or offer prevention were based on headache frequency and impairment. RESULTS: We assessed 162,576 individuals aged 12 years or older. The 1-year period prevalence for migraine was 11.7% (17.1% in women and 5.6% in men). Prevalence peaked in middle life and was lower in adolescents and those older than age 60 years. Of all migraineurs, 31.3% had an attack frequency of three or more per month, and 53.7% reported severe impairment or the need for bed rest. In total, 25.7% met criteria for "offer prevention," and in an additional 13.1%, prevention should be considered. Just 13.0% reported current use of daily preventive migraine medication. CONCLUSIONS: Compared with previous studies, the epidemiologic profile of migraine has remained stable in the United States during the past 15 years. More than one in four migraineurs are candidates for preventive therapy, and a substantial proportion of those who might benefit from prevention do not receive it.
PMID: 17261680 [PubMed - indexed for MEDLINE migraine therapy]
Neurology. 2006 Aug 8;67(3):497-9
migraine therapy Authors: Evers S, Rahmann A, Kraemer C, Kurlemann G, Debus O, Husstedt IW, Frese A
The authors conducted a double-blind, placebo-controlled, crossover study to investigate the efficacy of oral zolmitriptan in the treatment of migraine in children and adolescents. Patients (n = 32) received placebo, zolmitriptan 2.5 mg, and ibuprofen 200 to 400 mg to treat three consecutive migraine attacks. Pain relief rates after 2 hours were 28% for placebo, 62% for zolmitriptan, and 69% for ibuprofen (p < 0.05). Both drugs are well tolerated with only mild side effects.
PMID: 16775229 [PubMed - indexed for MEDLINE migraine therapy]
Reversible anorgasmia with topiramate therapy for migraine.
Neurology. 2005 Oct 25;65(8):1333-4
migraine therapy Authors: Newman LC, Broner SW, Lay CL
PMID: 16247079 [PubMed - indexed for MEDLINE migraine therapy]
Symptomatic treatment of migraine in children: a systematic review of medication trials.
Pediatrics. 2005 Aug;116(2):e295-302
migraine therapy Authors: Damen L, Bruijn JK, Verhagen AP, Berger MY, Passchier J, Koes BW
OBJECTIVE: Treatment of pediatric migraine includes an individually tailored regimen of both nonpharmacologic and pharmacologic measures. The mainstay of symptomatic treatment in children with migraine is intermittent oral or suppository analgesics, but there is no coherent body of evidence on symptomatic treatment of childhood migraine available. The objective of this review is to describe and assess the evidence from randomized and clinical controlled trials concerning the efficacy and tolerability of symptomatic treatment of migraine in children. DESIGN: Systematic review according to the standards of the Cochrane Collaboration. METHODS: Databases were searched from inception to June 2004. Additional reference checking was performed. Two authors independently selected randomized and controlled trials evaluating the effects of symptomatic treatment in children (<18 years old) with migraine, using headache (HA) clinical improvement as an outcome measure. Two authors assessed trial quality independently by using the Delphi list, and data were extracted from the original reports by using standardized forms. Quantitative and qualitative analysis was conducted according to type of intervention. RESULTS: A total of 10 trials were included in this review, of which 6 studies were considered to be of high quality. The number of included participants in each trial ranged from 14 to 653, with a total of 1575 patients included in this review. Mean dropout rate was 19.8% (range: 0-39.1%), and the mean age of participants was 11.7 +/- 2.2 years (range: 4-18 years). All studies used HA diaries to assess outcomes. In most studies, a measure of clinical improvement was calculated by using these diaries. Improvement often was regarded as being clinically relevant when the patients' HA declined by > or =50%. Regarding oral analgesic treatment, the effectiveness of acetaminophen, ibuprofen, and nimesulide were evaluated. When compared with placebo, acetaminophen (relative risk [RR]: 1.5; 95% confidence interval [CI]: 1.0-2.1) and ibuprofen (pooled RR: 1.5; 95% CI: 1.2-1.9) significantly reduced HAs. We conclude that there is moderate evidence that both acetaminophen and ibuprofen are more effective in reduction of symptoms 1 and 2 hours after intake than placebo with minor adverse effects. No clear differences in effect were found between acetaminophen and ibuprofen or nimesulide. Regarding the nonanalgesic interventions, nasal-spray sumatriptan, oral sumatriptan, oral rizatriptan, oral dihydroergotamine, intravenous prochlorperazine, and ketorolac were evaluated. When compared with placebo, nasal-spray sumatriptan (pooled RR: 1.4; 95% CI: 1.2-1.7) seemed to significantly reduce HAs. We conclude that there is moderate evidence that nasal-spray sumatriptan is more effective in reduction of symptoms than placebo but with significantly more adverse events. No differences in effect were found between oral triptans and placebo. All medications were well tolerated, but significantly more adverse events were reported for nasal-spray sumatriptan compared with placebo. We also conclude that there is moderate evidence that intravenous prochlorperazine is more effective than intravenous ketorolac in the reduction of symptoms 1 hour after intake. No differences in effect were found between oral dihydroergotamine and placebo. CONCLUSIONS: Acetaminophen, ibuprofen, and nasal-spray sumatriptan are all effective symptomatic pharmacologic treatments for episodes of migraine in children. The new frontier for symptomatic treatment is likely to be the development of triptan agents for use in children. Most treatments have only been evaluated in 1 or 2 studies, which limits the generalizability of the findings. We strongly recommend performing a large, high-quality randomized, controlled trial evaluating different symptomatic medications compared with each other or to placebo treatment. Favorable high-quality studies should be performed and reported according to the CONSORT statement. Clinical improvement of HA should be used as the primary outcome measure, but quality of life, days missed at school, and satisfaction of child or parents should also be used as an outcome measure in future studies.
PMID: 16061583 [PubMed - indexed for MEDLINE migraine therapy]
Targeting therapy for migraine: what to treat?
Neurology. 2005 May 24;64(10 Suppl 2):S4-8
migraine therapy Authors: Ramadan NM
PMID: 15911784 [PubMed - indexed for MEDLINE migraine therapy]
Pharmacokinetic opportunities for combination therapy in migraine.
Neurology. 2005 May 24;64(10 Suppl 2):S21-5
migraine therapy Authors: Fox AW, Kori SH
PMID: 15911783 [PubMed - indexed for MEDLINE migraine therapy]
Initiating and optimizing acute therapy for migraine: the role of patient-centered stratified care.
Am J Med. 2005 Mar;118 Suppl 1:18S-27S
migraine therapy Authors: Diamond M, Cady R
Migraine is a chronic, intermittently disabling condition that affects physical, mental, and social aspects of health-related quality of life. Because patients seeking assistance with migraine most often present to primary care providers, these healthcare professionals play critical roles in the diagnosis and treatment process. A comprehensive migraine management plan involves a partnership between the patient and healthcare professional where treatment goals and strategies are established. Elements of such a plan should include preventive strategies to reduce the frequency and effects of future attacks as well as the use of acute treatments to address the immediate need for relief during an attack. Approaches to prevention include education, lifestyle modification, and, often, appropriate medication. Many medications have been used for acute treatment. Nonspecific agents include nonsteroidal anti-inflammatory drugs (NSAIDs), single or combination analgesics (sometimes including antiemetics or caffeine), and narcotics. Migraine-specific medications include ergot alkaloids and triptans (5-hydroxytryptamine(1B/1D) agonists). Various professional organizations have created guidelines to help providers in choosing appropriate management interventions. Clinical approaches to the patient with migraine include step care, whereby all patients begin on a simple or nonspecific treatment, stepping up to the next level of therapy if treatment is unsuccessful; or stratified care, whereby first-line therapy is tailored to the severity of the patient's pattern of headache. Studies have demonstrated that for more disabled headache patients, the stratified-care approach results in more robust headache response with less disability and greater cost-effectiveness than step care. Patient satisfaction studies demonstrate that the use of migraine-specific abortive medications (triptans) is associated with a higher satisfaction rate than over-the-counter preparations, NSAIDs, and analgesic combinations. Patients who initially reported satisfaction with the latter medications also reported a preference for triptan therapy. Healthcare professionals can assist patients, not only by choosing the most appropriate medication but also by assessing whether the level of benefit the patient is currently receiving could be improved.
PMID: 15841884 [PubMed - indexed for MEDLINE migraine therapy]
Migraine: primary care challenges in diagnosis and treatment. Introduction.
Am J Med. 2005 Mar;118 Suppl 1:1S-2S
migraine therapy Authors: Lipton RB, Loder EW
PMID: 15841881 [PubMed - indexed for MEDLINE migraine therapy]
Petasites hybridus root (butterbur) is an effective preventive treatment for migraine.
Neurology. 2004 Dec 28;63(12):2240-4
migraine therapy Authors: Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A
OBJECTIVE: To evaluate the clinical efficacy of a standardized special root extract from the plant Petasites hybridus as a preventive therapy for migraine. METHODS: This is a three-arm, parallel-group, randomized trial comparing Petasites extract 75 mg bid, Petasites extract 50 mg bid, or placebo bid in 245 patients with migraine. Eligible patients met International Headache Society criteria for migraine, were ages 18 to 65, and had at least two to six attacks per month over the preceding 3 months. The main outcome measure was the decrease in migraine attack frequency per month calculated as percentage change from baseline over a 4-month treatment period. RESULTS: Over 4 months of treatment, in the per-protocol analysis, migraine attack frequency was reduced by 48% for Petasites extract 75 mg bid (p = 0.0012 vs placebo), 36% for Petasites extract 50 mg bid (p = 0.127 vs placebo), and 26% for the placebo group. The proportion of patients with a > or =50% reduction in attack frequency after 4 months was 68% for patients in the Petasites extract 75-mg arm and 49% for the placebo arm (p < 0.05). Results were also significant in favor of Petasites 75 mg at 1, 2, and 3 months based on this endpoint. The most frequently reported adverse reactions considered possibly related to treatment were mild gastrointestinal events, predominantly burping. CONCLUSIONS: Petasites extract 75 mg bid is more effective than placebo and is well tolerated as a preventive therapy for migraine. Petasites 50 mg PO bid was not significantly more effective than placebo on the primary study endpoints.
PMID: 15623680 [PubMed - indexed for MEDLINE migraine therapy]
Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society.
Neurology. 2004 Dec 28;63(12):2215-24
migraine therapy Authors: Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S, ,
OBJECTIVE: To review evidence on the pharmacologic treatment of the child with migraine headache. METHODS: The authors reviewed, abstracted, and classified relevant literature. Recommendations were based on a four-tiered scheme of evidence classification. Treatment options were separated into medications for acute headache and preventive medications. RESULTS: The authors identified and reviewed 166 articles. For acute treatment, five agents were reviewed. Sumatriptan nasal spray and ibuprofen are effective and are well tolerated vs placebo. Acetaminophen is probably effective and is well tolerated vs placebo. Rizatriptan and zolmitriptan were safe and well tolerated but were not superior to placebo. For preventive therapy, 12 agents were evaluated. Flunarizine is probably effective. The data concerning cyproheptadine, amitriptyline, divalproex sodium, topiramate, and levetiracetam were insufficient. Conflicting data were found concerning propranolol and trazodone. Pizotifen, nimodipine, and clonidine did not show efficacy. CONCLUSIONS: For children (>age 6 years), ibuprofen is effective and acetaminophen is probably effective and either can be considered for the acute treatment of migraine. For adolescents (>12 years of age), sumatriptan nasal spray is effective and should be considered for the acute treatment of migraine. For preventive therapy, flunarizine is probably effective and can be considered, but is not available in the United States. There are conflicting or insufficient data to make any other recommendations for the preventive therapy of migraine in children and adolescents. For a clinical problem so prevalent in children and adolescents, there is a disappointing lack of evidence from controlled, randomized, and masked trials.
PMID: 15623677 [PubMed - indexed for MEDLINE migraine therapy]
Comprehensive surgical treatment of migraine headaches.
Plast Reconstr Surg. 2005 Jan;115(1):1-9
migraine therapy Authors: Guyuron B, Kriegler JS, Davis J, Amini SB
The purpose of this study was to investigate the efficacy of surgical deactivation of migraine headache trigger sites. Of 125 patients diagnosed with migraine headaches, 100 were randomly assigned to the treatment group and 25 served as controls, with 4:1 allocation. Patients in the treatment group were injected with botulinum toxin A for identification of trigger sites. Eighty-nine patients who noted improvement in their migraine headaches for 4 weeks underwent surgery. Eighty-two of the 89 patients (92 percent) in the treatment group who completed the study demonstrated at least 50 percent reduction in migraine headache frequency, duration, or intensity compared with the baseline data; 31 (35 percent) reported elimination and 51 (57 percent) experienced improvement over a mean follow-up period of 396 days. In comparison, three of 19 control patients (15.8 percent) recorded reduction in migraine headaches during the 1-year follow-up (p < 0.001), and no patients observed elimination. All variables for the treatment group improved significantly when compared with the baseline data and the control group, including the Migraine-Specific Questionnaire, the Migraine Disability Assessment score, and the Short Form-36 Health Survey. The mean annualized cost of migraine care for the treatment group (925 dollars) was reduced significantly compared with the baseline expense (7612 dollars) and the control group (5530 dollars) (p < 0.001). The mean monthly number of days lost from work for the treatment group (1.2) was reduced significantly compared with the baseline data (4.41) and the control group (4.4) (p = 0.003). The common adverse effects related to injection of botulinum toxin A included discomfort at the injection site in 27 patients after 227 injections (12 percent), temple hollowing in 19 of 82 patients (23 percent), neck weakness in 15 of 55 patients (27 percent), and eyelid ptosis in nine patients (10 percent). The common complications of surgical treatment were temporary dryness of the nose in 12 of 62 patients who underwent septum and turbinate surgery (19.4 percent), rhinorrhea in 11 (17.7 percent), intense scalp itching in seven of 80 patients who underwent forehead surgery (8.8 percent), and minor hair loss in five (6.3 percent). Surgical deactivation of migraine trigger sites can eliminate or significantly reduce migraine symptoms. Additional studies are necessary to clarify the mechanism of action and to determine the long-term results.
PMID: 15622223 [PubMed - indexed for MEDLINE migraine therapy]
Surgical treatment of migraine headaches by corrugator muscle resection.
Plast Reconstr Surg. 2004 Sep 1;114(3):652-7; discussion 658-9
migraine therapy Authors: Dirnberger F, Becker K
The authors, a plastic surgeon (Dirnberger) and a neurologist (Becker), conducted this study after reading the article by of Bahman Guyuron et al. in the August 2000 issue of Plastic and Reconstructive Surgery (106: 429, 2000). Sixty patients were operated on between June of 2001 and June of 2002; postoperative follow-up ranged between 6 and 18 months. Patients' charts were reviewed to confirm the diagnosis of migraine headache according to the criteria of the International Headache Society. Sixty patients (13 men and 47 women) from Austria and four neighboring countries took part in the study. The patients were divided into three groups, based on the severity of their migraines: group A comprised patients with up to 4 days of migraine per month; group B included patients with 5 to 14 days of migraine per month; and group C was composed of patients with more than 15 days of headache per month ("permanent headache") or evidence of drug abuse and drug-related headaches. The effectiveness of the operation was evaluated using the following factors: percentage reduction of headache days; percentage reduction of drugs; percentage reduction of side effects, severity of headaches, and response to drugs; and patient grade of personal satisfaction, using a scale from 1 to 5 [1 = excellent (total elimination of migraine headache) to 5 = insufficient or no improvement]. From the entire group of 60 patients, 17 (28.3 percent) reported a total relief from migraine, 24 (40 percent) reported an essential improvement, and 19 (31.7 percent) reported minimal or no change. Patients with a rather mild form of migraine headache had a much better chance (almost 90 percent in group A and 75 percent in group B) to experience an improvement or total elimination of migraine than those patients (n = 27) from group C with severe migraine, "permanent headaches," and drug-induced headaches. Contrary to the reports by Guyuron, 11 patients who had a very favorable response immediately and in the first weeks after the operation experienced a gradual return of their headaches to preoperative intensity after about 4 postoperative weeks. After 3 months, the results in all patients could be declared permanent. All side effects, such as paraesthesia in the frontal region, disappeared in all patients within 3 to 9 months.
PMID: 15318040 [PubMed - indexed for MEDLINE migraine therapy]
Migraine prevalence in male to female transsexuals on hormone therapy.
Neurology. 2004 Aug 10;63(3):593-4
migraine therapy Authors: Pringsheim T, Gooren L
PMID: 15304612 [PubMed - indexed for MEDLINE migraine therapy]
Use of narcotic analgesics in the emergency department treatment of migraine headache.
Neurology. 2004 May 25;62(10):1695-700
migraine therapy Authors: Colman I, Rothney A, Wright SC, Zilkalns B, Rowe BH
OBJECTIVE: Treatment of acute migraine headache with narcotics is potentially ineffective and may lead to abuse. The authors examined the treatment practice variation across five linked EDs in one Canadian center, focusing on the use of narcotic analgesics and factors associated with their use. METHODS: Five hundred acute migraine headache patient charts were randomly selected from five Canadian EDs. Charts underwent a structured review to determine medication use. Data were analyzed, comparing those who received narcotics as first-line treatment with those who did not, using chi(2) and t-tests and logistic regression. RESULTS: The majority of patients (59.6%) received narcotics as first-line treatment. Numerous factors were associated with first-line narcotic treatment. Having taken antiheadache medications prior to ED presentation (odds ratio [OR]: 2.63; 95% CI: 1.53, 4.51) and hospital of presentation being other than Hospital A (e.g., Hospital D, OR: 6.32; 95% CI: 2.76, 14.46) increased the odds of receiving first-line narcotics. Having received a more urgent triage score (OR: 0.4; 95% CI: 0.24, 0.65) or having a longer duration of headache (OR: 0.994; 95% CI: 0.99, 0.99) decreased the odds of receiving first-line narcotics. CONCLUSIONS: Acute migraine management in these EDs does not meet current consensus guidelines. Factors associated with narcotic use are predictable, and a concerted effort to replace narcotics with more evidence-based first-line treatments is needed.
PMID: 15159464 [PubMed - indexed for MEDLINE migraine therapy]
Randomized, placebo-controlled trial of rofecoxib in the acute treatment of migraine.
Neurology. 2004 May 11;62(9):1552-7
migraine therapy Authors: Silberstein S, Tepper S, Brandes J, Diamond M, Goldstein J, Winner P, Venkatraman S, Vrijens F, Malbecq W, Lines C, Visser WH, Reines S, Yuen E
OBJECTIVE: To investigate the clinical profile of rofecoxib, a long-acting (approximately 17-hour half-life) selective cyclo-oxygenase-2 inhibitor, for the acute treatment of migraine. METHODS: A randomized, double-blind, placebo-controlled, parallel-group study was conducted. Patients age > or =18 treated a moderate or severe migraine headache with placebo (n = 182), rofecoxib 25 mg (n = 183), or rofecoxib 50 mg (n = 192). The primary efficacy measure was headache relief (mild or no pain) 2 hours after dose. RESULTS: The proportions of patients with migraine headache relief at 2 hours after dose were 34.3% for placebo, 54.0% for rofecoxib 25 mg (p < 0.001 vs placebo), and 56.7% for rofecoxib 50 mg (p < 0.001 vs placebo). Rofecoxib 25 and 50 mg were superior to placebo in providing pain freedom at 2 hours, 24-hour sustained headache relief, and 24-hour sustained pain freedom; in reducing photophobia, phonophobia, nausea (50 mg only), and functional disability at 2 hours after dose; and in improving some quality-of-life scores over 24 hours. More patients on rofecoxib 50 mg reported adverse events (39.6%) than patients on rofecoxib 25 mg (26.8%) or placebo (23.6%) regardless of drug relatedness; however, the incidences of drug-related adverse events were similar between treatment groups. These adverse events were generally mild or moderate in severity. The most commonly reported adverse events were dry mouth, dizziness, somnolence, nausea, dyspepsia, paresthesia, and asthenia, with similar incidences between treatment groups. CONCLUSION: Rofecoxib 25 and 50 mg were effective and generally well tolerated for the acute treatment of migraine attacks.
PMID: 15136680 [PubMed - indexed for MEDLINE migraine therapy]
Migraine in special populations. Treatment strategies for children and adolescents, pregnant women, and the elderly.
Postgrad Med. 2004 Apr;115(4):39-44, 47-50
migraine therapy Authors: Gladstone JP, Eross EJ, Dodick DW
Although migraine is a common occurrence in children and adolescents, its diagnosis and treatment present unique challenges. Migraine management in pregnant women and the elderly can also be difficult and requires selection of appropriate and safe medications for patients in these special circumstances. In this article, Drs Gladstone, Eross, and Dodick provide pearls for both abortive and prophylactic treatments for migraine in these populations.
PMID: 15095535 [PubMed - indexed for MEDLINE migraine therapy]
Effective treatment of migraine. Terminating acute attacks, reducing their frequency.
Postgrad Med. 2004 Apr;115(4):28-30, 33-4, 38 passim
migraine therapy Authors: Pringsheim T, Edmeads J
Migraine is the headache most commonly encountered in primary care practice. In one US population survey, 17.6% of women and 6% of men reported migraine. Specific, effective treatment options for migraine are increasingly available, helping to reinforce how important it is that this common and sometimes disabling condition be recognized by primary care physicians.
PMID: 15095534 [PubMed - indexed for MEDLINE migraine therapy]
Nasal sumatriptan is effective in treatment of migraine attacks in children: A randomized trial.
Neurology. 2004 Mar 23;62(6):883-7
migraine therapy Authors: Ahonen K, Hämäläinen ML, Rantala H, Hoppu K
OBJECTIVE: To investigate the efficacy of nasal sumatriptan in migraine attacks of children and adolescents. METHODS: A double-blind, placebo-controlled, two-way crossover trial was conducted in three hospital outpatient departments, with 8 to 17 year olds diagnosed with migraine serving as subjects (International Headache Society 1988). A single dose of sumatriptan nasal spray and a matching placebo were administered at home during two attacks. The sumatriptan dose was 10 mg for a body weight of 20 to 39 kg and 20 mg for those with a body weight of >/==" BORDER="0">40 kg. The primary efficacy endpoint was headache relief by two grades on a 5-grade face scale at 2 hours. RESULTS: Eighty-three patients used both treatments and 11 only the first. At 2 hours, the primary endpoint was reached nearly twice as often after sumatriptan (n = 53/83; 64%) as after placebo (n = 32/83; 39%) (p = 0.003). Already at 1 hour, headache relief was seen more often after sumatriptan (n = 42/83; 51%) than after placebo (n = 24/83; 29%) (p = 0.014). The difference was even more obvious in patients who received the 20-mg dose as well as in the intention-to-treat analyses (n = 94). Other endpoints, including child's preference and using rescue medication, also favored sumatriptan. The most common adverse effect was a bad taste after sumatriptan, reported in 29% (n = 26/90) of the attacks. No serious adverse effects were observed. CONCLUSION: Nasal sumatriptan is an effective and well-tolerated treatment for migraine attacks in children over 8 years of age.
PMID: 15037686 [PubMed - indexed for MEDLINE migraine therapy]
Calcitonin gene-related peptide receptor antagonist BIBN 4096 BS for the acute treatment of migraine.
N Engl J Med. 2004 Mar 11;350(11):1104-10
migraine therapy Authors: Olesen J, Diener HC, Husstedt IW, Goadsby PJ, Hall D, Meier U, Pollentier S, Lesko LM,
BACKGROUND: Calcitonin gene-related peptide (CGRP) may have a causative role in migraine. We therefore hypothesized that a CGRP-receptor antagonist might be effective in the treatment of migraine attacks. METHODS: In an international, multicenter, double-blind, randomized clinical trial of BIBN 4096 BS, a highly specific and potent nonpeptide CGRP-receptor antagonist, 126 patients with migraine received one of the following: placebo or 0.25, 0.5, 1, 2.5, 5, or 10 mg of BIBN 4096 BS intravenously over a period of 10 minutes. A group-sequential adaptive treatment-assignment design was used to minimize the number of patients exposed. RESULTS: The 2.5-mg dose was selected, with a response rate of 66 percent, as compared with 27 percent for placebo (P=0.001). The BIBN 4096 BS group as a whole had a response rate of 60 percent. Significant superiority over placebo was also observed with respect to most secondary end points: the pain-free rate at 2 hours; the rate of sustained response over a period of 24 hours; the rate of recurrence of headache; improvement in nausea, photophobia, phonophobia, and functional capacity; and the time to meaningful relief. An effect was apparent after 30 minutes and increased over the next few hours. The overall rate of adverse events was 25 percent after the 2.5-mg dose of the drug and 20 percent for the BIBN 4096 BS group as a whole, as compared with 12 percent for placebo. The most frequent side effect was paresthesia. There were no serious adverse events. CONCLUSIONS: The CGRP antagonist BIBN 4096 BS was effective in treating acute attacks of migraine.
PMID: 15014183 [PubMed - indexed for MEDLINE migraine therapy]
CGRP-receptor antagonists--a fresh approach to migraine therapy?
N Engl J Med. 2004 Mar 11;350(11):1073-5
migraine therapy Authors: Durham PL
PMID: 15014178 [PubMed - indexed for MEDLINE migraine therapy]
Migraine throughout the life cycle: treatment through the ages.
Neurology. 2004 Mar 9;62(5 Suppl 2):S2-8
migraine therapy Authors: Landy S
Migraine seriously impairs the quality of life in those who suffer from it and exacts a high socioeconomic cost in lost productivity. About half of all persons with migraine go undiagnosed. To avoid misdiagnosis of migraine, clinicians must be prepared to recognize atypical presentations, including tension headache-like and "sinus" symptoms. Nonpharmacologic treatments, including relaxation training and thermal or EMG biofeedback training, may be appropriate for some patients. Pharmacotherapy for migraine may be acute or preventive. In prescribing treatment, the clinician should consider the characteristics of the patient's headaches, the patient's medication history and preferences, and co-morbidities. For acute treatment in patients with more severe migraine and those whose headaches respond poorly to nonsteroidal anti-inflammatory drugs or combination analgesics, migraine-specific agents, such as triptans, dihydroergotamine, and ergotamine, are recommended. Early intervention--identifying and treating the headache during the mild phase--is often a key to successful management. Preventive treatment of migraine may be appropriate to reduce the frequency, severity, and duration of migraine attacks, to improve the response to acute treatment, and to reduce disability. Clinicians who treat migraine must be aware of considerations specific to children, women, and the elderly.
PMID: 15007158 [PubMed - indexed for MEDLINE migraine therapy]
Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac.
Ann Emerg Med. 2004 Feb;43(2):256-62
migraine therapy Authors: Brousseau DC, Duffy SJ, Anderson AC, Linakis JG
STUDY OBJECTIVE: We compare the effectiveness of intravenous ketorolac and intravenous prochlorperazine in the treatment of pediatric migraine headaches. METHODS: We performed a prospective, randomized, double-blind clinical trial in 2 pediatric emergency departments (EDs) within children's hospitals. Children aged 5 to 18 years presenting to the ED with migraine headaches were eligible for the study. Contraindications to either medication or the inability to complete the pain score resulted in exclusion. Children were randomized to receive intravenous ketorolac (0.5 mg/kg; maximum 30 mg) or intravenous prochlorperazine (0.15 mg/kg; maximum 10 mg). All children also received a normal saline solution bolus. Successful treatment was defined as a 50% or greater reduction in the Nine Faces Pain Scale score at 60 minutes. If a less than 50% improvement occurred by 60 minutes, the child received the other medication. Forty-eight-hour follow-up telephone calls were made to each family to assess recurrence and late side effects. RESULTS: Sixty-two children were enrolled: 33 initially received prochlorperazine, and 29 initially received ketorolac. By 60 minutes, 16 (55.2%) of 29 of those who received ketorolac and 28 (84.8%) of 33 of those who received prochlorperazine were successfully treated (difference=30%; 95% confidence interval [CI] 8% to 52%). Fifty-six (93.3%) of the 60 children who completed the study were successfully treated by the study's conclusion. Approximately 30% of each group had a recurrence of some headache symptoms. Only 2 children reported side effects, both mild and self-limited. CONCLUSION: In children, intravenous prochlorperazine is superior to intravenous ketorolac in the acute treatment of migraine headaches.
PMID: 14747817 [PubMed - indexed for MEDLINE migraine therapy]
Acute migraine treatment with droperidol.
Neurology. 2003 Dec 23;61(12):1826; author reply 1826
migraine therapy Authors: Ehrenberg BL
PMID: 14694067 [PubMed - indexed for MEDLINE migraine therapy]
Brain imaging and prophylactic therapy in children with migraine: recommendations versus reality.
J Pediatr. 2003 Dec;143(6):776-9
migraine therapy Authors: Schor NF
OBJECTIVES: To determine the concordance between referring physician behavior and published criteria for performance of imaging studies and institution of prophylactic therapy, respectively, in children referred to an academic children's hospital headache clinic.Study design A retrospective review of the records of 106 consecutive patients referred to an academic children's hospital headache clinic. RESULTS: Approximately half of patients referred to the clinic had already had head computed tomography or magnetic resonance imaging ordered by the referring doctor and performed before their clinic appointment. However, using published criteria, only 10% of patients seen in the clinic would have required an imaging procedure before institution of therapy. The referring physician had initiated treatment with daily prophylactic medications for headache in more than 30% of patients before their clinic appointments, of whom 89% were on appropriate medications at age-appropriate and weight-appropriate doses. Half of these children exhibited a positive response to this medication before being seen by the consulting neurologist. However, more than 60% of the children actually met the criteria for recommending prophylactic therapy. CONCLUSIONS: Imaging is more frequently obtained and prophylactic therapy less frequently implemented by the referring physician than would be indicated by published recommendations.
PMID: 14657827 [PubMed - indexed for MEDLINE migraine therapy]
Zolmitriptan nasal spray: advances in migraine treatment.
Neurology. 2003 Oct 28;61(8 Suppl 4):S27-30
migraine therapy Authors: Syrett N, Abu-Shakra S, Yates R
Zolmitriptan nasal spray was developed specifically to achieve fast, high effectiveness and to overcome many of the limitations associated with oral and sc migraine therapies. Pharmacokinetic studies have demonstrated a very rapid appearance of zolmitriptan in plasma as early as 5 minutes after intranasal dosing, with about 40% of peak plasma concentration (C(max)) being achieved within 10 to 15 minutes of dosing. Comparison of plasma concentration-time profiles of zolmitriptan and its active metabolite after oral and intranasal administration, together with PET scanning, clearly indicate direct absorption of zolmitriptan across the nasal mucosa after intranasal administration. The remainder of the dose is then swallowed and is absorbed through the gastrointestinal tract. In one blinded, randomized, placebo-controlled, multiple-attack study of zolmitriptan nasal spray, headache response was superior to placebo as early as 15 minutes after dosing (p < 0.05). In the zolmitriptan 5 mg treatment group, the primary end point of 2-hour headache response was achieved in 70% (300/427) of attacks versus 31% of attacks (119/389 attacks) in the placebo group (p < 0.001). Patients achieved a 2-hour headache response, had no recurrence, and used no additional or escape medications for up to 24 hours in 49% of attacks versus 14% of attacks in the placebo group (p < 0.001). Zolmitriptan 5 mg nasal spray was well tolerated. These data and those from other similar studies demonstrate that zolmitriptan nasal spray combines early, sustained efficacy and good tolerability, making it an optimal acute treatment for migraine.
PMID: 14581655 [PubMed - indexed for MEDLINE migraine therapy]
Treatment approaches to maximizing therapeutic response in migraine.
Neurology. 2003 Oct 28;61(8 Suppl 4):S21-6
migraine therapy Authors: Brandes JL
Migraine is a chronic condition that presents with episodic disabling attacks, which can respond unpredictably to therapies. Studies support early treatment intervention strategies as part of the routine clinical care of migraine patients. Identifying illness severity and stratifying treatment accordingly (as in other diseases such as asthma, diabetes, or hypertension) improves patient outcome. Assessing the presence of any coexisting conditions, such as depression or anxiety, is another essential part of managing migraine.
PMID: 14581654 [PubMed - indexed for MEDLINE migraine therapy]
Pain-free efficacy after treatment with sumatriptan in the mild pain phase of menstrually associated migraine.
Obstet Gynecol. 2003 Oct;102(4):835-42
migraine therapy Authors: Nett R, Landy S, Shackelford S, Richardson MS, Ames M, Lener M
OBJECTIVE: To estimate the efficacy of sumatriptan 50-mg and 100-mg tablets in menstrually associated migraine when treatment is administered during the mild pain phase. METHODS: A randomized, double-blind, placebo-controlled, single-attack study was conducted. Menstrually associated migraine was defined as any migraine beginning on or between day -2 and day 4, with day 1 = first day of flow. Patients had at least a 1-year history of migraine as defined by International Headache Society criteria and reported regularly occurring menstrually associated migraines typically having a mild pain phase. Patients treated attacks within 1 hour of the onset of pain but only if the pain was mild at onset and while the pain was still mild. RESULTS: In the 349 women with menstrually associated migraine, sumatriptan was significantly more effective than placebo: 61% and 51% of patients who used sumatriptan 100 mg and 50 mg, respectively, were pain-free 2 hours after treatment compared with 29% of patients who used placebo (P <.001 for both comparisons). At 2 hours, 51% and 45% of patients who used sumatriptan 100 mg and 50 mg were free of pain and associated symptoms (photophobia, phonophobia, nausea, vomiting) compared with 25% of placebo patients (P <.001 for both comparisons). Adverse events were low for sumatriptan 100 and 50 mg, and both doses were generally well tolerated. CONCLUSION: Sumatriptan 50-mg and 100-mg tablets are generally well tolerated and effective in providing pain-free relief and relief of the associated symptoms of menstrually associated migraine when administered in the mild pain phase.
PMID: 14551015 [PubMed - indexed for MEDLINE migraine therapy]
Acute migraine treatment guideline.
Ann Intern Med. 2003 Oct 7;139(7):603; author reply 603-4
migraine therapy Authors: Marino C
PMID: 14530242 [PubMed - indexed for MEDLINE migraine therapy]
Treatment of sporadic hemiplegic migraine with calcium-channel blocker verapamil.
Neurology. 2003 Sep 9;61(5):721-2; author reply 722
migraine therapy Authors: Lastimosa AC
PMID: 12963781 [PubMed - indexed for MEDLINE migraine therapy]
Intravenous sodium valproate versus prochlorperazine for the emergency department treatment of acute migraine headaches: a prospective, randomized, double-blind trial.
Ann Emerg Med. 2003 Jun;41(6):847-53
migraine therapy Authors: Tanen DA, Miller S, French T, Riffenburgh RH
STUDY OBJECTIVE: We compare the efficacy of intravenous sodium valproate versus prochlorperazine for the emergency department treatment of acute migraine headache. METHODS: We performed a randomized, prospective, double-blind trial performed at a tertiary care military ED. Forty patients, aged 18 to 65 years, presenting with typical migraine symptoms were enrolled. Patients were randomized to receive either 10 mg of prochlorperazine or 500 mg of valproate intravenously over 2 minutes. Pain, nausea, and sedation were assessed by using a standard visual analog scale (VAS). Changes in VAS scores were compared between groups from baseline to end point by using a rank sum test, over time by using 2-way repeated-measures analysis of variance, and by requirement for rescue at 60 minutes by using the Fisher exact test. RESULTS: Comparison of the change in median VAS scores over 60 minutes revealed that sodium valproate was significantly less effective than prochlorperazine in reducing pain or nausea (P <.001). Median improvements in VAS pain scores (binomial confidence intervals) were as follows: 64.5 mm (48.1 to 75.6 mm) for prochlorperazine versus 9 mm (-3 to 39.6 mm) for sodium valproate. Median improvements in VAS nausea scores were as follows: 35.5 mm (13.2 to 47.9 mm) for prochlorperazine versus 2 mm (-1.3 to 11 mm) for sodium valproate. There was no significant difference (P =.603) detected in the median changes in VAS scores for sedation: -4 mm (-29.9 to 8.6 mm) for prochlorperazine versus 0 mm (-6.6 to 6 mm) for sodium valproate. Comparison of the mean VAS time curves for pain and nausea also demonstrated a significant difference (both P <.001) but not for sedation (P =.232). In post hoc analysis, valproate failed to elicit significant improvement in pain or nausea scores over time, whereas prochlorperazine improved pain by 30 minutes (P <.001) and nausea by 15 minutes (P =.002). At the conclusion of the study, 15 (79%) of 19 patients receiving valproate required rescue treatment compared with 5 (25%) of 20 patients receiving prochlorperazine (P <.001). CONCLUSION: Prochlorperazine was statistically and clinically superior to sodium valproate for the treatment of the pain and nausea associated with acute migraine headaches.
PMID: 12764341 [PubMed - indexed for MEDLINE migraine therapy]
Acute migraine treatment with droperidol: A randomized, double-blind, placebo-controlled trial.
Neurology. 2003 Jan 28;60(2):315-21
migraine therapy Authors: Silberstein SD, Young WB, Mendizabal JE, Rothrock JF, Alam AS
BACKGROUND: The treatment of a migraine attack can be difficult when first-line medication is unsuccessful and options for parenteral "rescue" therapy are limited. METHODS: A randomized, double-blind, placebo-controlled, dose-ranging, multicenter study was conducted to assess the efficacy and tolerability of droperidol 0.1 mg, 2.75 mg, 5.5 mg, and 8.25 mg for the acute treatment of moderate to severe migraine headache in adults. RESULTS: A total of 331 patients were enrolled; 305 were treated. Headache response at 2 hours was better (p < 0.002) in the treatment groups receiving droperidol IM at doses of 2.75 mg (87%), 5.5 mg (81%), and 8.25 mg (85%) compared with placebo (57%). The percent of patients achieving a pain-free response at 2 hours after treatment was significantly greater than placebo for the droperidol 2.75-mg, 5.5-mg, and 8.25-mg dose groups. The frequency of headache recurrence (within 24 hours) for patients initially responding by 2 hours was lower in patients treated with droperidol than placebo, but differences failed to reach significance. A significantly greater percentage of patients receiving droperidol 2.75 mg reported the elimination of migraine-associated symptoms (nausea, vomiting, photophobia, and phonophobia) than those who received placebo. Although most adverse events were of mild or moderate intensity, anxiety, akathisia, and somnolence were rated as severe in 30% of patients who experienced those symptoms. Hypotension was uncommon. No patient had QT prolongation.
PMID: 12552051 [PubMed - indexed for MEDLINE migraine therapy]
Neurology. 2003 Jan 14;60(1):120-1
migraine therapy Authors: Yu W, Horowitz SH
Gene mutations within the P/Q type neuronal calcium channel in familial hemiplegic migraine (FHM) suggest a therapeutic role for calcium-channel blockade. The authors have previously reported abortive therapy of FHM with IV verapamil. Here the authors describe four cases of sporadic hemiplegic migraine (SHM) responsive to verapamil, administered either orally or IV. The findings indicate that verapamil is effective therapy for both SHM and FHM.
PMID: 12525732 [PubMed - indexed for MEDLINE migraine therapy]
Prophylactic treatment of migraine with an angiotensin II receptor blocker: a randomized controlled trial.
JAMA. 2003 Jan 1;289(1):65-9
migraine therapy Authors: Tronvik E, Stovner LJ, Helde G, Sand T, Bovim G
CONTEXT: There is a paucity of effective, well-tolerated drugs available for migraine prophylaxis. OBJECTIVE: To determine whether treatment with the angiotensin II receptor blocker candesartan is effective as a migraine-prophylactic drug. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled crossover study performed in a Norwegian neurological outpatient clinic from January 2001 to February 2002. PATIENTS: Sixty patients aged 18 to 65 years with 2 to 6 migraine attacks per month were recruited mainly from newspaper advertisements. INTERVENTIONS: A placebo run-in period of 4 weeks was followed by two 12-week treatment periods separated by 4 weeks of placebo washout. Thirty patients were randomly assigned to receive one 16-mg candesartan cilexetil tablet daily in the first treatment period followed by 1 placebo tablet daily in the second period. The remaining 30 received placebo followed by candesartan. MAIN OUTCOME MEASURES: The primary end point was number of days with headache; secondary end points included hours with headache, days with migraine, hours with migraine, headache severity index, level of disability, doses of triptans, doses of analgesics, acceptability of treatment, days of sick leave, and quality-of-life variables on the Short Form 36 questionnaire. RESULTS: In a period of 12 weeks, the mean number of days with headache was 18.5 with placebo vs 13.6 with candesartan (P =.001) in the intention-to-treat analysis (n = 57). Some secondary end points also favored candesartan, including hours with headache (139 vs 95; P<.001), days with migraine (12.6 vs 9.0; P<.001), hours with migraine (92.2 vs 59.4; P<.001), headache severity index (293 vs 191; P<.001), level of disability (20.6 vs 14.1; P<.001) and days of sick leave (3.9 vs 1.4; P =.01), although there were no significant differences in health-related quality of life. The number of candesartan responders (reduction of > or =50% compared with placebo) was 18 (31.6%) of 57 for days with headache and 23 (40.4%) of 57 for days with migraine. Adverse events were similar in the 2 periods. CONCLUSION: In this study, the angiotensin II receptor blocker candesartan provided effective migraine prophylaxis, with a tolerability profile comparable with that of placebo.
PMID: 12503978 [PubMed - indexed for MEDLINE migraine therapy]
Summaries for patients. Guidelines for the treatment and prevention of migraine headaches.
Ann Intern Med. 2002 Nov 19;137(10):I50
migraine therapy Authors:
PMID: 12435232 [PubMed - indexed for MEDLINE migraine therapy]
Treatment of migraine.
N Engl J Med. 2002 Sep 5;347(10):764-6; author reply 764-6
migraine therapy Authors: Klein AW
PMID: 12214628 [PubMed - indexed for MEDLINE migraine therapy]
migraine therapy Authors: Ewart RM
PMID: 12214627 [PubMed - indexed for MEDLINE migraine therapy]
migraine therapy Authors: Barker JN
PMID: 12214626 [PubMed - indexed for MEDLINE migraine therapy]
migraine therapy Authors: Samuels N
PMID: 12214625 [PubMed - indexed for MEDLINE migraine therapy]
migraine therapy Authors: Wyderski RJ
PMID: 12214624 [PubMed - indexed for MEDLINE migraine therapy]
migraine therapy Authors: Werner A
PMID: 12213953 [PubMed - indexed for MEDLINE migraine therapy]
Botulinum toxin type A (BOTOX) for treatment of migraine.
Dis Mon. 2002 May;48(5):323-35
migraine therapy Authors: Binder WJ, Brin MF, Blitzer A, Pogoda JM
An open-label study and 2 double-blind, placebo-controlled studies have provided supporting evidence of botulinum toxin type A (BTX-A) as an effective, well-tolerated treatment for migraine. Observed durations of benefit were consistent with known properties of BTX-A. Findings suggest that response may vary by features of preinjection headaches, such as migraine frequency. The precise mechanism by which BTX-A provides pain relief is hypothesized to be related not only to acetylcholine inhibition but also to a blocking action on the parasympathetic nervous system. Additional studies that control factors likely to be related to response may lead to better understanding of the BTX-A effect on migraine and an optimal treatment protocol.
PMID: 12195263 [PubMed - indexed for MEDLINE migraine therapy]
Strategies in the treatment of migraine.
Mayo Clin Proc. 2002 Aug;77(8):876; author reply 876-7
migraine therapy Authors: Gupta R, Gupta S
PMID: 12173725 [PubMed - indexed for MEDLINE migraine therapy]
Surgical treatment of migraine headaches.
Plast Reconstr Surg. 2002 Jun;109(7):2183-9
migraine therapy Authors: Guyuron B, Tucker T, Davis J
This prospective study was conducted to investigate the role of removal of corrugator supercilii muscles, transection of the zygomaticotemporal branch of the trigeminal nerve, and temple soft-tissue repositioning in the treatment of migraine headaches. Using the criteria set forth by the International Headache Society, the research team's neurologist evaluated patients with moderate to severe migraine headaches, to confirm the diagnosis. Subsequently, the patients completed a comprehensive migraine headaches questionnaire and the team's plastic surgeon injected 25 units of botulinum toxin type A (Botox) into each corrugator supercilii muscle. The patients were asked to maintain an accurate diary of their migraine headaches and to complete a monthly questionnaire documenting pertinent information related to their headaches. Patients in whom the injection of Botox resulted in complete elimination of the migraine headaches then underwent resection of the corrugator supercilii muscles. Those who experienced only significant improvement underwent transection of the zygomaticotemporal branch of the trigeminal nerve with repositioning of the temple soft tissues, in addition to removal of the corrugator supercilii muscles. Once again, patients kept a detailed postoperative record of their headaches. Of the 29 patients included in the study, 24 were women and five were men, with an average age of 44.9 years (range, 24 to 63 years). Twenty-four of 29 patients (82.8 percent, p < 0.001) reported a positive response to the injection of Botox, 16 (55.2 percent, p < 0.001) observed complete elimination, eight (27.6 percent, p < 0.04) experienced significant improvement (at least 50 percent reduction in intensity or severity), and five (17.2 percent, not significant) did not notice a change in their migraine headaches. Twenty-two of the 24 patients who had a favorable response to the injection of Botox underwent surgery, and 21 (95.5 percent, p < 0.001) observed a postoperative improvement. Ten patients (45.5 percent, p < 0.01) reported elimination of migraine headaches and 11 patients (50.0 percent, p < 0.004) noted a considerable improvement. For the entire surgical group, the average intensity of the migraine headaches reduced from 8.9 to 4.1 on an analogue scale of 1 to 10, and the frequency of migraine headaches changed from an average of 5.2 per month to an average of 0.8 per month. For the group who only experienced an improvement, the intensity fell from 9.0 to 7.5 and the frequency was reduced from 5.6 to 1.0 per month. Only one patient (4.5 percent, not significant) did not notice any change. The follow-up ranged from 222 to 494 days, the average being 347 days. In conclusion, this study confirms the value of surgical treatment of migraine headaches, inasmuch as 21 of 22 patients benefited significantly from the surgery. It is also evident that injection of Botox is an extremely reliable predictor of surgical outcome.
PMID: 12045534 [PubMed - indexed for MEDLINE migraine therapy]
Which oral triptans are effective for the treatment of acute migraine?
J Fam Pract. 2002 Feb;51(2):176
migraine therapy Authors: Chang L, Henley E
PMID: 11978220 [PubMed - indexed for MEDLINE migraine therapy]
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