摘要:

Recently, a new nasal spray formulation of dihydroergotamine was developed which facilitates at‐home treatment of migraine. We studied the efficacy, safety, and tolerability of dihydroergotamine nasal spray as monotherapy in the acute treatment of classic and common migraine in two, identical, double‐blind, randomized, placebo‐controlled trials. Of the 229 patients enrolled, 206 (102 dihydroergotamine nasal spray, 104 placebo) were included in the intent‐to‐treat analyses; 182 treated two headaches and 24 treated one headache. Based on both the patients' and physicians' ratings, dihydroergotamine nasal spray was significantly superior to placebo for reducing the severity of headache pain in both studies, and in relieving nausea in Study 2. The onset of significant efficacy with dihydroergotamine nasal spray compared to that with placebo for both severity of headache pain and relief of nausea occurred at I hour in Study 2 and at 3 hours in Study 1. Dihydroergotamine nasal spray was also significantly superior to placebo for the relief of headache pain in both studies. Based on the physicians' global evaluations of treatment efficacy for headache pain, 71% of the dihydroergotamine‐treated patients in Study 2 and 59% of their counterparts in Study 1 were considered to be responders. The dihydroergotamine‐treated patients had less newly‐occurring vomiting than the placebo‐treated patients. The majority of adverse events reported by the dihydroergotamine‐treated patients were nasopharyngeal. The results demonstrate the efficacy, safety, and tolerability of dihydroergotamine nasal spray as monotherapy in the treatment of acu

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504177.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Headache associated with acute sinusitis is a well‐recognized entity; the diagnosis is easily made due to the associated nasal and sinus symptoms. However, the phenomenon of referred headache from chronic sinusitis or intranasal abnormalities or both without upper respiratory symptoms is not well understood. Only recently have the nasal and sinus cavities been adequately visualized by both the human eye and radiographic techniques; a fact that may account for the historic neglect in considering this region a factor in headache etiology. Modern techniques employed in the workup of sinusitis, namely the use of rigid nasal endoscopes and coronal‐plane CT scanning, have greatly enhanced the clinician's ability to evaluate and diagnose pathology in this area. This report describes a series of patients presenting with various primary headache syndromes without significant nasal or sinus symptoms who failed to respond to conventional antiheadache therapy. On nasal endoscopic and coronal CT examinations, various intranasal and sinus abnormalities were found (either anatomic variations or subclinical inflammation). Medical and/or surgical therapy addressing the sinonasal pathology resulted in improvement in every case, ranging from decreased severity of attacks to total resolution of headaches. A model explaining the possible mechanism of referred vascular‐type headache from sinus and nasal origin is pro

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504185.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Although the primary treatment of chronic cluster headache is medical, surgical treatment is sometimes used. The authors reviewed the charts of seven patients (ages 36 to 68 years) with chronic cluster headache to identify who responded best to percutaneous stereotactic radiofrequency rhizotomy after medical treatment failed. All patients had immediate pain relief after surgery. At follow‐up (median 5 years, range 2 to 20 years), two patients remained pain‐free 7 and 20 years later (excellent results); three patients had mild pain recurrence that was well controlled on medications (good results) 6 to 12 months after surgery; and two patients had major pain recurrence 4 days and 2 months after surgery (poor results). Six patients had relief of vasomotor symptoms. One patient had transient diplopia and keratitis without permanent sequelae. Both patients with excellent results had pre‐operative major pain around the eye; both patients with poor results had major pain around the temple, ear, and cheek; and the three patients with good results had pain equally severe in the eye, temple, and cheek. There was no association between patient age or sex, pain duration, preoperative response to lidocaine blockade, or previous surgery with pain relief. No differences occurred in pain relief between patients with dense hypalgesia and patients with analgesia. The authors conclude that (1) some patients with chronic cluster headache treated by percutaneous stereotactic radiofrequency rhizotomy achieve long‐term pain relief, and (2) surgery on the trigeminovascular system alone may not cure the condition in patients with major pain around the temple, ear, an

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504193.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Oxygen inhalation was early advocated as a treatment for migraine headache. It has been theorized that the efficacy of raising blood oxygen levels in vascular headache is mediated by vasoconstriction and metabolic effects. Hyperbaric oxygen can provide a much greater level of blood oxygenation than normobaric oxygen, and in recent studies it has been used in the treatment of cluster headache. The purpose of this study was to compare the effects of hyperbaric oxygen and normobaric oxygen in migraine. Twenty migraineurs were divided randomly into two groups and studied in a hyperbaric chamber during a typical headache attack. Global headache severity was measured by a verbal descriptor scale before and after exposure to oxygen. One group received 100% oxygen at I atmosphere of pressure (normobaric) while the other received 100% oxygen at 2 atmospheres of pressure (hyper‐baric). One of the 10 patients in the normobaric group achieved significant relief of headache symptoms, while 9 of 10 in the hyperbaric group found relief. Based on a chi‐square test, this difference is significant at theP<.005 level. Those patients who did not find significant relief from normobaric oxygen were given hyperbaric oxygen as above. All nine found significant relief. The results suggest that hyperbaric (but not normobaric) oxygen may be useful in the abortive management of migraine headache. Possibilities for the mechanism of this effect, in addition to vasoconstriction, include an increase in the rate of energy‐producing and neurotransmitter‐related metabolic reactions in the brain which require molecular

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504197.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Problems.‐What is the effect of migraine on health status, defined as the patient's physical, psychological, and social functioning? And, suppose that the health status of migraine sufferers appears to be impaired, to what extent is this a consequence of migraine‐associated comorbidity rather than of migraine itself? Methods.‐A group of 846 migraineurs, selected from the general population following IHS criteria, and a control group were surveyed with the Medical Outcomes Study 36‐item Short‐Form Health Survey, Nottingham Health Profile, EuroQol instrument, end the COOP/WONCA charts. Questions on demographic characteristics and comorbidity were included. Results.‐The health status of migraineurs appeared to be significantly impaired in comparison to the control group. Because statistical significance is distinct from relevance, effect size estimators were employed. Although the direction of the differences indicated consistently a worse health status of the migraineurs, regardless of the instrument used, the sizes of the differences were small to medium. Self‐reported comorbidity, especially depression, was more prevalent in the migraine group. However, this offered only a partial explanation for the impaired health status of the migraine group. Conclusions.‐Migraine has an independent moderately deteriorating effect on the daily functioning

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504200.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

Recurrent abdominal pain in children, frequently diagnosed as “abdominal migraine,” is thought to evolve into more typical migraine headache during the teens and twenties. If this transformation occurred, we would expect some adult migraineurs to retain abdominal pain; but we could not recall this symptom being mentioned by patients. However, without direct questioning the absence cannot be assumed. We, therefore, asked 100 migraineurs about abdominal symptoms during migraine attacks: only one experienced unexplained abdominal pain. We conclude that abdominal pain is not a feature in adult migraineurs, leading us to support the notions that: (1) recurrent abdominal pain of childhood has a number of causes; (2) abdominal migraine may be an incorrect attribution and is liable to be over diagnosed; (3) abdominal migraine requires more precise definition; (4) the transition from childhood abdominal migraine to adult migraine needs precise prospective st

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504207.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

The event‐related potential P300 has been studied in 15 migraine without aura sufferers, and in 15 episodic tension‐type headache sufferers, during pain‐free periods and during spontaneous headache attacks. There were no variations of potential, either of P3latency or N2‐P3amplitude, in either group during the interictal period. Similarly, there were no variations of the P300 parameters in the group of tension‐type headache subjects during headache attacks; by contrast, a significant elongation of latency (P<0.01) and an increment of N2‐P3wave amplitude (P<0.002) was observed in the group of migraineurs. The authors discuss the data in accordance with the etiopathogenic theories of migraine and the hypothesis that acetylcholine and norepinephrine are the neurotransmitters able to affect the event‐related potential P300, which reflects cerebral activity during sensory information processing

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504210.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

We investigated the platelet and plasma levels of serotonin and its metabolite, 5‐hydroxyindoleacetic acid, in patients suffering from episodic tension‐type headache and migraine with and without aura, during headache‐free period. In female subjects, blood samples were drawn during the follicular, ovulatory, and late luteal phases of the menstrual cycle. In tension headache and migraine with aura, the group mean values of serotonin and 5‐hydroxyindoleacetic acid in platelets and plasma were significantly increased, but migraine without aura patients' levels were normal. The pattern of menstrual cycle‐related fluctuations in platelet serotonin levels were similar in female patients with tension headache and in controls, with a maximum value in the follicular phase. In both migraine groups, in contrast, the peak occurred in the ovulatory phase. The results are discussed in view of whether these aberrations in peripheral markers of the metabolism and menstrual cycle‐related rhythmicity of serotonin may reflect similar alterations in the central ner

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504216.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

There is some evidence supporting a potential role of hypersensitivity of the dopaminergic system in the pathogenesis of migraine. In this case report, we describe a syncopal episode in a patient with migraine without aura after the administration of a very low dose of apomorphine, a classical agonist of dopaminergic receptors. The absence of cardiovascular risk factors in this patient suggests that the clinical event might have been caused by hypersensitivity of the dopaminergic system.

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504222.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY

摘要:

The recent publication of drug formularies by third‐party payers has serious implications for the practice of medicine. These formularies list the medications for which the consumer can be reimbursed by the third‐party payer. The most restrictive of the five formularies I have received lists only two agents for the treatment of migraine headaches: Cafergot (at an incorrect dose of 1/100 mg) and Ergotrate which is no longer available. The most liberal of the formularies lists analgesics, Cafergot, Midrin, and Imitrex for the treatment of acute attacks, and as prophylactic agents, Inderal, Sansert, and analgesics (known to cause rebound headaches when used in this fashion in migraine patients). Abortive agents of proven value, such as DHE‐451and NSAIDs,2and preventative medications, such as calcium channel blockers,3tricyclic antidepressants,4serotonin reuptake inhibitors,5methylergonovine,6and divalproex sodium,7are not available. No one could quarrel with a goal of developing a cost‐effective formulary. However, the authors of these formularies have clearly demonstrated their inability to provide even a current, accurate, and adequate formulary by existent standards of care in the treatment of migraine headache. While it is easy to criticize these formularies, it is more difficult to develo a comprehensive list that would satisfy the practitioners' need to provide relief for their patients with a minimum of side effects, and the needs of third‐party payers (presumed) to provide quality care at the most economi

ISSN:0017-8748    

DOI:10.1111/j.1526-4610.1995.hed3504225.x

出版商:Blackwell Science Inc    

年代:1995

数据来源: WILEY