摘要:

SYNOPSISThe first 100 consecutive patients at our center receiving subcutaneous sumatriptan (6 mg) were evaluated over a total of 455 migraine attacks. Parameters included overall efficacy, average time to relief, recurrence rate, average time to recurrence, adverse events, comparison to previous abortive agents, and subjective global ratings. Overall efficacy (defined as headache severity reduction from severe or moderate to mild or none) was 84%. Average time to relief was 40 minutes. Nine percent failed to respond at all. Recurrence rate was 46.5% with 36% of patients having no recurrence. Fourteen percent of patients reported 100% recurrence (minimum 3 attacks; average 5.4 attacks). Time to recurrence varied widely, but averaged 9.1 hours. Eighty‐one percent rated the drug better or much better than previous abortive medications in terms of sumatriptan's ability to abort the attack. Seventy‐seven percent reported some adverse event (generally mild and transient) with 23% reporting no adverse events, Sixty‐nine percent reported a global rating of Good to Excellent and 31% rated Poor or Fair. The rate of recurrence and average time to recurrence were the most significant factors affecting the global ratings.These parameters were further evaluated with respect to a variety of subgroups: 1) migraine alone 2) migraine with coexistent tension‐type headache 3) drug‐induced headache (analgesic rebound headache) 4) posttraumatic headache 5) preventive versus no preventive medication 6) presence or absence of adverse events 7) presence or absence of recurrence and 8) average duration of migraine with no m

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402067.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISApproximately 10% of adults suffer from severe or disabling headaches. For many patients, headaches are reduced with traditional medical, physical, or psychological therapies. However, a significant minority continue to report debilitating headaches despite the use of these conventional therapies. An integrated, interdisciplinary approach combining these three individual components in a group treatment setting was offered to patients who had failed previous therapy. The interdisciplinary treatment resulted in over 70% of patients experiencing a 50% or better reduction in headaches at follow‐up of an average of 5.8 months. Overall, there was an average reduction in medication use at follow‐up of 71%. The treated group reported significantly greater reduction in headache activity and medication consumption compared to a group that was referred to but did not receive group treatment. The results suggest that an interdisciplinary outpatient group treatment may provide a cost‐effective end time‐efficient treatment option for patients with a variety of recurring headaches, even if they have failed conventional therapies that use medical, physical, and psychological treatments indiv

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402073.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISTo test the influence of arterial O2saturation (SaO2) on heart rate in cluster headache, changes in pulse rate induced by hyperoxia and hypoxia were monitored in 11 cluster headache patients (6 during cluster period, and 5 during remission). The results were compared with those obtained in 11 age and sex matched healthy individuals. The subjects were administered 5 min each of 100% O2and 12% O2in nitrogen in sequence. The aim of the latter procedure was to reduce SaO2to approximately 80%. Pulse rate wasrecorded every minute from a finger pulse oximeter during the whole procedure.Cluster headache patients, in particular during the bout, had a slightly lower basal pulse rate than controls (P>0.5, Student's t‐test).This tendency was maintained throughout the test. Hyperoxia and hypoxia resulted in a marked, significant decrease and increase,respectively, in pulse rate from baseline values within each group. However, the difference between groups was not significant at anystage. Cluster headache patients therefore seem to have the same heart rate response to changes in SaO2as healthy individuals. Themarked heart rate changes which sometimes accompany cluster headache are unlikely to be caused by SaO2change

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402079.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISA single‐breath CO2test was carried out in cluster headache patients both during bout and remission, and in matchedhealthy individuals (n = 10 for each group) to assess peripheral chemosensitivity. The test subjects inhaled one tidal breath of13% CO2in air. The response was expressed as the maximal increase in inspiratory minute ventilation (VI) within 20 secondsfrom the exposure to CO2, divided by the increase in end‐tidal PCO2(PETCO2) (the difference in PCO2between the testbreath and the preceding control breaths): DVI/DPETCO2.Under the initial resting condition, cluster headache patients within the bout showed a slight hyperventilation in that therewas a significantly reduced PETCO2(P<0.05, Student's paired t‐test), and during remission, higher VI, and a lower PETCO2(P<0.05, Wilcoxon signed rank test), in comparison with the controls. There was no statistically significantdifference as regards the peripheral chemosensitivity between cluster headache and control groups. These results indicatethat cluster headache patients have an intact and properly‐functioning carot

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402083.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISFifty patients with migraine were asked about the occurrence of neck symptoms during different phases of their attacks, and if they felt the neck could act as a precipitant. Of the 32 reporting neck pain or stiffness, 10 noted symptoms during the premonitory phase, 30 during the headache phase, and 10 postdromally. In 7 cases the pain radiated into the shoulder and in 1 case into the lumbar region. These findings indicate extracerebral involvement of the migraine process and an overlap between the trigeminal and cervical distribution.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402088.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISPatients with headache represent a common diagnostic and treatment challenge for health care providers in the emergency department. The therapeutic options continue to grow, yet many studies imply that narcotics continue to be a frequently chosen treatment. In this retrospective cross‐sectional survey, the evaluation and treatment patterns of patients presenting to an academic medical center emergency department with a primary diagnosis of headache were analyzed. Headache disorders accounted for 1.7% of all visits to the emergency department. Migraine headache was the most common headache diagnosis representing 60% of headache visits followed by headache of no obvious source at 25%. Narcotics were the most common treatment employed (180 patient‐visits) in all patients and non‐steroidal anti‐inflammatory agents were the second most common agent used (86 patient visits). Narcotics were also the most common therapy in migraine headache patients (152 patient‐visits) while ergotamines were used in less than one‐third of patient‐visits (36 patient‐visits). Therapy of headache patients in the emergency department continues to rely on narcotics. Methods of interrupting the dependence on narcotics need to be explored if newer non‐narcotic therapies are

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402091.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISSixteen patients with chronic periorbital venous vasculitis without nerve involvement and 9 patients with active episodic cluster headache were studied as to cerebrospinal fluid (CSF) pressure. Eighty‐one percent of the patients with chronic and 33% with episodic symptoms had pathologically increased CSF pressure. Magnetic resonance imaging of the brains in the chronic group showed empty sella in 60%, cerebral atrophy in 21% and white matter lesions with high signal intensity on T2 weighted sequences in 29%. Abnormal obesity was found in 31% of the patients with chronic periorbital venous vasculitis under 60 years of age. Venous vasculitis is suggested as a cause of intracranial hypertension, empty sella, and endocrinologic dysfunction

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402095.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISThis study compares the effectiveness of guided imagery, (psychosynthetic approach), and biofeedback in the treatment of migraine headache. Specifically, the volunteer's subjective perception of the efficacy of the treatments is assessed.The subjects were 40 male and female volunteers presenting with migraine headache diagnosis at Sunnybrook Health Sciences Centre in Toronto, Canada. Subjects were randomly assigned to one of the three treatment conditions or to a control group. All subjects attended six sessions of training. Measures were completed pre‐ and post‐treatment.The results did not reveal significant reduction in migraine activity in any of the treatment groups. There were no differences among the groups regarding the intake of medication. Nevertheless the implementation of guided imagery training resulted in subjective reports of improved capacity to cope with the pain and in subjective reports of a reduced perception of the pain itself, although objective measures did not indicate an appreciable change in migraine activity.Findings from the present study do not support either feedback or guided imagery training as more effective in counteracting migraines although subjective reports do favor guided imagery as having a positive influence on the perception of migraine pain.These findings are discussed from the perspective of empowering the sufferers by providing them with a more active role in dealing with the migraine triggering physiology, abandoning the "learned helplessness" typical of chronic pain syndromes.The issue of cost effectiveness is raised and it supports the use of guided imagery versus biofeedback training given the lack of theoretical agreement in the current literat

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402099.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISIn 20 patients with pure menstrual migraine either Estraderm TTS 50° patches (E) or placebo (P) patches were applied during three successive menstrual cycles, randomly allocated to the treatment sequences E‐P‐E or P‐E‐P. Clinical neurophysiological tests, contingent negative variation (CNV) and exteroceptive temporalis muscle suppression test (ETST) were performed before treatment. The predictive value of these tests regarding the efficacy of Estraderm TTS was studied.Neither the number, duration and severity of the migraine attacks, nor the consumption of analgesics and ergotamine differed significantly during Estraderm TTS and placebo treatment.The ETST was consistent with migraine in 35% (95% confidence interval 15.4 to 59.2) of the patients. The CNV in 55% (31.5 to 76.9), and both tests in 25% (8.7 to 49.1%).Regarding the prediction of the Estraderm TTS effect on the migraine attacks, the specificity of the ETST, CNV and the combination of ETST with CNV, calculated for the first two cycles, was respectively 81.8% (48.2 to 97.7), 45.5% (16.8 to 76.6) and 80% (28.4 to 99.5). For the last two cycles these values were respectively 75% (42.8 to 94.5), 50.0% (21.1 to 87.9) and 71.4% (29.0 to 96.3). The sensitivity of the tests was respectively 62.5% (24.5 to 91.5), 62.5% (24.5 to 91.5) and 66.7% (22.3 to 95.7) in the first 2 cycles. In the last 2 cycles 50.0% (15.1 to 84.3), 62.5% (24.5 to 91.5) and 60% (14.7 to 94.7).This study did not demonstrate an effectiveness of Estraderm TTS in perimenstrual migraine, except for the subgroup of perimenstrual migraine patients in whom the ETST test results were consistent with

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402103.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY

摘要:

SYNOPSISThe goal of this study was to evaluate to what extent pregnancy influences headache recurrence in women with · diagnosis of migraine at, or before, their first prenatal visit. Data from the large, prospective Collaborative Perinatal Project of 55,000 pregnancies were reviewed. Less than 2% of women in the sample of first study pregnancies were considered to have migraine at their initial prenatal visit (n=508). Of the 484 women with a complete data set, 17% experienced complete cessation of headache throughout pregnancy and another 62% experienced two or fewer headaches in the third trimester. These observations lead to the conclusion that many migraineurs (79% in this sample) experience improvement in headache recurrence during pregnancy. Only 21% experienced no improvement at all. No demographic or obstetrical factor was associated with headache improvement

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1994.hed3402107.x

出版商:Blackwell Science Inc    

年代:1994

数据来源: WILEY