Read by QxMD icon Read

Acute Migraine

Joyce H Hurley, Phillip Edward Kunkler, LuJuan Zhang, Kelly L Knopp, Gerry Stephen Oxford
Migraine is triggered by poor air quality and odors through unknown mechanisms. Activation of the trigeminovascular pathway by environmental irritants may occur via activation of TRPA1 receptors on nasal trigeminal neurons, but how that results in peripheral and central sensitization is unclear. The anatomy of the trigeminal ganglion suggests that noxious nasal stimuli are not being transduced to the meninges by axon reflex but likely through intraganglionic transmission. Consistent with this concept, we injected CGRP, ATP or glutamate receptor antagonists or a gap junction channel blocker directly and exclusively into the trigeminal ganglion and blocked meningeal blood flow changes in response to acute nasal TRP agonists...
February 20, 2019: Molecular Pain
Mojtaba Khazaei, Nahid Hosseini Nejad Mir, Fateme Yadranji Aghdam, Mohammad Taheri, Soudeh Ghafouri-Fard
Dexamethasone, metoclopramide, ketorolac, and chlorpromazine have been used for the treatment of migraine headache. However, the effectiveness of these drugs in pain relief and prevention of recurrence and their side effects have not been compared yet. This was a randomized, double-blind clinical trial. Subjects were randomized to four groups; each received one of the following drugs intravenously: dexamethasone 8 mg, ketorolac 30 mg, metoclopramide 10 mg, and chlorpromazine 25 mg. The severity of headache in the two groups was assessed at starting point, 1 h and 24 h after the administration of drug using the visual analogue scale (VAS) on a scale of 0 to 10...
February 19, 2019: Neurological Sciences
Eric R Coon, Ricardo A Quinonez, Daniel J Morgan, Sanket S Dhruva, Timmy Ho, Nathan Money, Alan R Schroeder
Importance: Efforts to combat medical overuse have gained traction in recent years, but success has been intermittent and shortcomings have been recognized. A commitment to a strong evidence base is needed to more broadly engage clinicians and reduce overuse. Observations: A structured MEDLINE search and a manual review of tables of contents from selected high-impact journals was performed to identify original research published in 2017 relevant to pediatric overuse...
February 18, 2019: JAMA Pediatrics
Justin Yanuck, Sagar Shah, Maxwell Jen, Rakhi Dayal
Migraines are consistently among the top 20 primary coded diagnoses in emergency departments, constituting 4.5% of all chief complaints. In a significant subset of these, pain arises from the occipital region innervated by the greater (GON) and lesser occipital nerve. In this case series, we present three patients with occipital migraines who received GON blockade with 1% lidocaine. The blockade was performed only after first-line treatment with metoclopramide and possibly additional medications as ordered by triage physician, failed to adequately alleviate pain by 40 minutes after medication administration...
February 2019: Clinical practice and cases in emergency medicine
Arend M Hamming, Marianne A A van Walderveen, Inge A Mulder, Irene C van der Schaaf, L Jaap Kappelle, Birgitta K Velthuis, Michel D Ferrari, Gisela M Terwindt, Marieke C Visser, Wouter Schonewille, Ale Algra, Marieke J H Wermer
OBJECTIVES: Migraine is a risk factor for stroke, which might be explained by a higher prevalence in anatomical variants in the circle of Willis (CoW). Here, we compared the presence of CoW variants in patients with stroke with and without migraine. MATERIALS AND METHODS: Participants were recruited from the prospective Dutch acute Stroke Study. All participants underwent CT angiography on admission. Lifetime migraine history was assessed with a screening questionnaire and confirmed by an interview based on International Classification of Headache Disorders criteria...
February 16, 2019: Brain and Behavior
Emiko Momoki, Tatsuo Fuchigami, Yuki Kasuga, Kaori Kimura, Wakako Ishii, Ayumi Fukuda, Yukihiko Fujita, Ichiro Morioka
BACKGROUND: Confusional migraine is a rare type of migraine presenting as an acute confusional state. However, the mechanism of this confusional state remains unclear. SUBJECT AND METHODS: We examined an 11-year-old girl with confusional migraine, using electroencephalography, brain magnetic resonance imaging, cerebrovascular magnetic resonance angiography, and single-photon emission computed tomography to investigate cerebral blood flow changes. RESULTS: Our findings revealed vessel narrowing in the left middle and posterior cerebral artery territory, indicating vasospasm and suggesting that the confusion was caused by hypoperfusion...
February 13, 2019: Brain & Development
Michael Seth Smith, Jairo Olivas, Kristy Smith
Manipulative therapies include osteopathic manipulative treatment and many other forms of manual therapies used to manage a variety of conditions in adults and children. Spinal manipulative therapy may provide short-term improvement in patients with acute or chronic low back pain, comparable with other standard treatments. When compared with oral analgesics, cervical manipulation and/or mobilization appears to provide better short-term pain relief and improved function in patients with neck pain. Manipulative therapies may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intensity of pain...
February 15, 2019: American Family Physician
Deborah I Friedman
BACKGROUND: Headache is the most common symptom of idiopathic intracranial hypertension (IIH) and may not resolve with intracranial pressure-lowering treatments. Many patients with IIH have a pre-existing history of migraine. Approximately two-thirds of patients with IIH continue to experience headaches after the other manifestations of the disorder resolve. There are no evidence-based guidelines for treating IIH-related headaches. EVIDENCE ACQUISITION: This review proposes mechanisms by which IIH produces both acute and ongoing headache...
March 2019: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Ankur Sinha, Phone Oo, Muhammad U Asghar, Hira A Cheema, Sanwal S Mehta, Joshua C Leinwand, Kalyana Janga
Topiramate (TMP) is a broad-spectrum anticonvulsant drug used to treat a wide variety of seizure disorders, for migraine prophylaxis, and for many other indications. An important side effect of TMP is metabolic acidosis, which is mediated by renal tubular defects. TMP inhibits carbonic anhydrase, an enzyme that is necessary for acid handling in the proximal renal tubule. Patients can present with asymptomatic serum electrolyte derangements, acute change in mental status, hyperventilation, cardiac arrhythmias, or other sequelae of metabolic acidosis and associated respiratory compensation...
November 26, 2018: Curēus
Minna A Korolainen, Samu Kurki, Mariann I Lassenius, Iiro Toppila, Madlaina Costa-Scharplatz, Timo Purmonen, Markku Nissilä
BACKGROUND: The highest prevalence of migraine is detected among people who are of working age. The aim of this study was to assess the burden of migraine in an occupational health care setting using real world data collected as a part of routine clinical practice. METHODS: This retrospective register study included migraineurs using occupational health care at the private health care provider Terveystalo. An age and gender matched control population was established for comparison...
February 12, 2019: Journal of Headache and Pain
Kiersten L Gurley, Jonathan A Edlow
Dizziness is a common chief complaint with an extensive differential diagnosis that includes both benign and serious conditions. Physicians must distinguish the majority of patients who suffer from self-limiting conditions from those with serious illnesses that require acute treatment. The preferred approach to the diagnosis of an acutely dizzy patient emphasizes different aspects of the history to guide a focused physical examination, with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes...
February 2019: Seminars in Neurology
Pi-Chuan Fan, Ping-Hung Kuo, Ming Tatt Lee, Shu-Hui Chang, Lih-Chu Chiou
Background: Plasma calcitonin gene-related peptide (CGRP) plays a key role in the migraine pathophysiology. This study aimed to investigate its role in predicting diagnosis and outcome of pharmacotherapy in pediatric migraine. Methods: We prospectively recruited 120 subjects, who never took migraine-preventive agents in a pediatric clinic, including 68 patients with migraine, 30 with non-migraine headache (NM), and 22 non-headache (NH) age-matched controls. Short-term therapeutic response was measured for at least 2 weeks after the start of therapy...
2019: Frontiers in Neurology
David W Dodick, Michael L Reed, Kristina M Fanning, Sagar Munjal, Aftab Alam, Dawn C Buse, Todd J Schwedt, Richard B Lipton
BACKGROUND: Cutaneous allodynia is a common clinical feature of migraine that has been associated with reduced efficacy of acute migraine treatments and an increased risk of disease progression. OBJECTIVE: Identify factors associated with allodynia in a sample of adults with migraine. METHODS: An online survey panel was used to identify adults with migraine who averaged at least 1 monthly headache day over the previous 3 months. Data on sociodemographics, headache frequency, headache pain intensity, migraine symptom severity, medication use, depression and anxiety, and cutaneous allodynia (via the Allodynia Symptom Checklist) were obtained...
February 7, 2019: Cephalalgia: An International Journal of Headache
Mia Nielsen, Louise Ninett Carlsen, Signe Bruun Munksgaard, Ida Maria Storm Engelstoft, Rigmor Højland Jensen, Lars Bendtsen
BACKGROUND: Medication-overuse headache leads to high disability and decreased quality of life, and the best approach for withdrawal has been debated. AIM: To compare change in disability and quality of life between two withdrawal programs. METHODS: We randomized medication-overuse headache patients to program A (two months without acute analgesics or migraine medications) or program B (two months with acute medications restricted to two days/week) in a prospective, outpatient study...
February 7, 2019: Cephalalgia: An International Journal of Headache
Lars Edvinsson
Migraine is a common neurological disorder that afflicts up to 15% of the adult population in most countries, with predominance in females. It is characterized by episodic, often disabling headache, photophobia and phonophobia, autonomic symptoms (nausea and vomiting), and in a subgroup an aura in the beginning of the attack. Although still debated, many researchers consider migraine to be a disorder in which CNS dysfunction plays a pivotal role while various parts of the trigeminal system are necessary for the expression of associated symptoms...
February 7, 2019: Handbook of Experimental Pharmacology
Chiari Lupi, Silvia Benemei, Simona Guerzoni, Lanfranco Pellesi, Andrea Negro
Recommended medications for the acute treatment of migraine encompass triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), and analgesics. While it is true that triptans have been the first successful mechanism-driven treatment in the field, recently, new targets involved in migraine pathogenesis have emerged and new drug classes have been studied for migraine attack therapy. Areas covered: Pharmacodynamics and pharmacokinetics of the new acute treatments of migraine (i.e. ditans, gepants, and glutamate receptor antagonists), considering also marketed drugs in new formulations and administration routes...
February 4, 2019: Expert Opinion on Drug Metabolism & Toxicology
Hebun Erdur, Bob Siegerink, Ramanan Ganeshan, Heinrich J Audebert, Matthias Endres, Christian H Nolte, Jan F Scheitz
BACKGROUND: Elevation of cardiac troponin (cTn), a sensitive biomarker of myocardial injury, is observed frequently in severe acute neurological disorders. Case reports suggest that cardiac dysfunction may also occur in patients with transient global amnesia (TGA). Until now, no study has systematically assessed this phenomenon. METHODS: We performed a case-control study using data of consecutive patients presenting with TGA from 2010 to 2015. Multiple logistic regression analysis accounting for age, sex, and cardiovascular risk factors was performed to compare the likelihood of myocardial injury (defined as elevation of cTn>99th percentile, ≥14ng/L; high-sensitivity cTnT assay) in TGA with three reference groups: migraine with aura, vestibular neuritis, transient ischemic attack (TIA)...
January 31, 2019: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Rebecca Burch
Migraine and tension-type headache are highly prevalent. Migraine is associated with significant work- and family-related disability. Migraine is underdiagnosed; it reasonable to err on the side of migraine when choosing between primary headaches. Barriers to appropriate treatment of migraine include lack of access to providers, misdiagnosis, and acute and preventive therapies not being prescribed. Acute, rescue, and preventive treatment options are extensive, and new classes of treatments are either available or in development...
March 2019: Medical Clinics of North America
Reimar Wernich Thomsen, Szimonetta Komjáthiné Szépligeti, Fei Xue, Lars Pedersen, Henrik Toft Sørensen, Vera Ehrenstein
PURPOSE: Population-based data are sparse on utilization of prophylactic versus acute therapies for newly diagnosed migraine. We examined initial migraine treatment patterns and associated patient characteristics in Denmark. METHODS: We used population-based health databases to assemble a nationwide cohort of adult migraine patients in 2005 to 2013. Migraine was defined as a first hospital diagnosis of migraine or a second redeemed outpatient prescription for triptans, ergots, pizotifen, or flunarizine...
January 31, 2019: Pharmacoepidemiology and Drug Safety
Stewart J Tepper, David W Dodick, Peter C Schmidt, Donald J Kellerman
OBJECTIVE: To understand the efficacy of zolmitriptan applied with Adhesive Dermally Applied Microarray (ADAM) in treating types of migraine (those with severe headache pain, the presence of nausea, treatment ≥2 hours after migraine onset, or migraine present upon awakening) that are historically considered to be less responsive to oral medications. BACKGROUND: ADAM is an investigational system for intracutaneous drug administration. In a pivotal Phase 2b/3 study (ZOTRIP, N = 321 in the modified intention-to-treat population), ADAM zolmitriptan 3...
January 30, 2019: Headache
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"