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https://read.qxmd.com/read/30893102/emerging-treatments-for-cluster-headache-hopes-and-disappointments
#1
Delphine Magis
PURPOSE OF REVIEW: Cluster headache stands among the worst debilitating pain conditions. Available treatments for cluster headache have often disabling side effects, are not tolerated, or are ineffective. The management of drug-refractory chronic forms is challenging. New treatments are warranted and reported here. RECENT FINDINGS: In cluster headache acute treatment, delivery systems like Demand Valve Oxygen or nonrebreather-type masks could enhance the effectiveness of inhaled oxygen therapy...
March 19, 2019: Current Opinion in Neurology
https://read.qxmd.com/read/30891372/a-case-of-ophthalmic-branch-trigeminal-neuralgia-in-the-emergency-department
#2
Sebastian R Copp, Constance LeBlanc
This case report describes a middle-aged patient with a past history of migraine headaches, who presented to the emergency department with a new onset of headaches around his left eye that were different from the pattern and character of his usual migraine headaches. The pain was severe, brief, and stabbing in nature, lasting only seconds, and occurring over intervals of a few minutes. His vital signs, including glucose, were normal. He had no constitutional symptoms, a normal neurological examination, and a normal head, eyes, ears, nose, and throat examination...
January 6, 2019: Curēus
https://read.qxmd.com/read/30803806/successful-treatment-of-a-child-with-definite-meniere-s-disease-with-the-migraine-regimen
#3
Mehdi Abouzari, Arash Abiri, Hamid R Djalilian
Emerging evidence suggests substantial overlap between the symptoms of Meniere's disease (MD) and migraine-related cochlear/vestibular disorders. We report a 5-year-old girl with a 6-month history of left-sided hearing loss followed by daily episodes of vertigo, headache, and vomiting who met the criteria for definite MD. The patient became symptom-free and gained near normal hearing levels after starting on a 6-week migraine diet/lifestyle regimen with riboflavin and magnesium. We believe that the symptoms of MD may be primarily due to a vestibular migraine phenomenon...
February 18, 2019: American Journal of Otolaryngology
https://read.qxmd.com/read/30795781/saliva-molecular-inflammatory-profiling-in-female-migraine-patients-responsive-to-adjunctive-cervical-non-invasive-vagus-nerve-stimulation-the-moxy-study
#4
Azize Boström, Dirk Scheele, Birgit Stoffel-Wagner, Frigga Hönig, Shafqat R Chaudhry, Sajjad Muhammad, Rene Hurlemann, Joachim K Krauss, Ilana S Lendvai, Krishnan V Chakravarthy, Thomas M Kinfe
BACKGROUND: Rising evidence indicate that oxytocin and IL-1β impact trigemino-nociceptive signaling. Current perspectives on migraine physiopathology emphasize a cytokine bias towards a pro-inflammatory status. The anti-nociceptive impact of oxytocin has been reported in preclinical and human trials. Cervical non-invasive vagus nerve stimulation (nVNS) emerges as an add-on treatment for the preventive and abortive use in migraine. Less is known about its potential to modulate saliva inflammatory signaling in migraine patients...
February 22, 2019: Journal of Translational Medicine
https://read.qxmd.com/read/30786733/assessing-evidence-based-medicine-and-opioid-barbiturate-as-first-line-acute-treatment-of-pediatric-migraine-and-primary-headache-a-retrospective-observational-study-of-health-systems-data
#5
Elizabeth K Seng, Amy A Gelfand, Robert A Nicholson
OBJECTIVES: To evaluate providers' use and predictors of evidence-based medicine or opioid/barbiturate as first-line acute treatment for children's initial presentation of acute migraine or primary headache. METHODS: This retrospective, observational study utilized patient (children ages 6-17) and provider/encounter characteristics extracted from the patient's Electronic Health Record from 2008-2014 during an initial encounter for migraine or primary headache. The primary outcome was provider evidence-based medicine utilization; overall prescriptions and opioid/barbiturate prescriptions were also evaluated...
February 20, 2019: Cephalalgia: An International Journal of Headache
https://read.qxmd.com/read/30784040/cross-sectional-evaluation-of-the-psychometric-properties-of-the-headache-specific-locus-of-control-scale-in-people-with-migraine
#6
Amy S Grinberg, Elizabeth K Seng
OBJECTIVE: This study aims to investigate the psychometric properties (component structure, reliability, and construct validity) of the Headache-Specific Locus of Control scale in several clinical migraine populations. BACKGROUND: Headache-specific locus of control beliefs may impact a person's behavioral decisions that affect the likelihood of migraine attack onset, emotional responses to migraine attacks, coping strategies used, and treatment adherence. The 33-item Headache-Specific Locus of Control scale is the most widely used measure of locus of control specific to headache yet psychometric evaluations remain limited...
February 19, 2019: Headache
https://read.qxmd.com/read/30775654/occipital-nerve-blocks-in-the-emergency-department-for-initial-medication-refractory-acute-occipital-migraines
#7
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
https://read.qxmd.com/read/30747510/neurologic-conditions-dizziness-and-vertigo
#8
James E McKinley, Allen Perkins
Dizziness is seen frequently in patients in the family medicine and emergency department settings. The differential diagnosis of dizziness can be expansive but with a targeted history and physical examination, a correct diagnosis often can be established and appropriate treatment offered. Common etiologies of dizziness include hypotension, benign paroxysmal positional vertigo (BPPV), and Meniere disease. Strokes and malignancies also can cause this symptom. Imaging is indicated if intracranial pathology is suspected...
February 2019: FP Essentials
https://read.qxmd.com/read/30714429/pharmacokinetics-and-pharmacodynamics-of-new-acute-treatments-for-migraine
#9
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
https://read.qxmd.com/read/30714426/development-and-in-vitro-in-vivo-evaluation-of-dihydroergotamine-mesylate-loaded-maltodextrin-pullulan-sublingual-films
#10
Ozgur Esim, Cansel K Ozkan, Sevinc Kurbanoglu, Alper Arslan, Cetin Tas, Ayhan Savaser, Sibel A Ozkan, Yalcin Ozkan
Dihydroergotamine mesylate (DHE), ergotamine derivative, has been offered for clinical use to stop or treat symptoms of an emerging migraine as injection for more than a half century. It is shown that bioavailability of DHE greatly changes between the subjects and up to 99% of the orally absorbed dose may be cleared by first pass metabolism. The aim of this study was to design and optimize DHE fast-dissolving sublingual films for migraine treatment. For this purpose pullulan and maltodextrin was chosen as film forming polymers and propylene glycol as plasticizer...
February 4, 2019: Drug Development and Industrial Pharmacy
https://read.qxmd.com/read/30707533/points-pearls-evaluation-and-management-of-life-threatening-headaches-in-the-emergency-department
#11
David Zodda, Gabrielle Procopio, Amit Gupta, Nachi Gupta, Jeffrey Nusbaum
Headache is the fourth most common reason for emergency department encounters, accounting for 3% of all visits in the United States. Though troublesome, 90% are relatively benign primary headaches --migraine, tension, and cluster headaches. The other 10% are secondary headaches, caused by separate underlying processes, with vascular, infectious, or traumatic etiologies, and they are potentially life-threatening. This issue details the important pathophysiologic features of the most common types of life-threatening headaches, the key historical and physical examination information emergency clinicians must obtain, the red flags that cannot be missed, and the current evidence for best-practice testing, imaging, treatment, and disposition...
February 1, 2019: Emergency Medicine Practice
https://read.qxmd.com/read/30707118/pharmacokinetics-and-pharmacodynamics-of-immediate-release-versus-extended-release-guanfacine-in-adult-daily-smokers
#12
Terril L Verplaetse, Walter Roberts, Kelly E Moore, MacKenzie R Peltier, Lindsay M Oberleitner, Sherry A McKee
BACKGROUND: Guanfacine is Food and Drug Administration approved for hypertension and attention-deficit hyperactivity disorder and has been used off-label for migraine prophylaxis, heroin withdrawal, and more recently smoking cessation. Previous studies have shown positive effects of 3 mg/d of immediate-release (IR) guanfacine on smoking outcomes, but the dose equivalency of the IR and extended-release (ER) formulations is unknown. PROCEDURES: A within-subject design was used to compare the pharmacokinetics and pharmacodynamics of 3 mg/d of IR, 4 mg/d of ER, and 6 mg/d of ER guanfacine in adult daily smokers (n = 5)...
January 30, 2019: Journal of Clinical Psychopharmacology
https://read.qxmd.com/read/30698925/migraine-headache-diagnosis-and-current-and-emerging-preventive-treatments
#13
Richard B Lipton, Stephen Silberstein
Migraine is associated with considerable pain and disability. Accurate diagnosis that differentiates migraine from other primary and secondary headache disorders is needed, and clinicians should assess the patient's risk of progressing to chronic migraine. Many patients will benefit from preventive treatment. Clinicians must know how to identify these patients and be familiar with the numerous preventive treatments. Finally, clinicians must select the safest, most effective treatment while keeping in mind individual characteristics such as coexisting conditions and patient preferences...
December 27, 2018: Primary Care Companion to CNS Disorders
https://read.qxmd.com/read/30681821/migraine-overview-and-summary-of-current-and-emerging-treatment-options
#14
Golden L Peters
Migraine is a leading cause of disability worldwide. Approximately 15% of Americans experience migraines. Most people who have migraines feel that people who do not have them often underestimate their condition. Migraines affect people's quality of life and ability to participate in work, family, and social events. A new class of medication, calcitonin gene-related peptide (CGRP) antagonists, has been approved for migraine prevention in adults. The newly approved CGRP antagonists are erenumab, fremanezumab, and galcanezumab, while eptinezumab looks to 2020 for approval...
January 2019: American Journal of Managed Care
https://read.qxmd.com/read/30676714/evaluation-and-management-of-life-threatening-headaches-in-the-emergency-department
#15
David Zodda, Gabrielle Procopio, Amit Gupta
Headache is the fourth most common reason for emergency department encounters, accounting for 3% of all visits in the United States. Though troublesome, 90% are relatively benign primary headaches --migraine, tension, and cluster headaches. The other 10% are secondary headaches, caused by separate underlying processes, with vascular, infectious, or traumatic etiologies, and they are potentially life-threatening. This issue details the important pathophysiologic features of the most common types of life-threatening headaches, the key historical and physical examination information emergency clinicians must obtain, the red flags that cannot be missed, and the current evidence for best-practice testing, imaging, treatment, and disposition...
February 2019: Emergency Medicine Practice
https://read.qxmd.com/read/30665504/intravenous-fluid-for-the-treatment-of-emergency-department-patients-with-migraine-headache-a-randomized-controlled-trial
#16
Christopher W Jones, Lauren B Remboski, Brian Freeze, Valerie A Braz, John P Gaughan, Samuel A McLean
STUDY OBJECTIVE: The objective of this pilot study is to assess the feasibility and necessity of performing a large-scale trial to measure the effect of intravenous fluid therapy on migraine headache pain. METHODS: This was a single-center, pilot randomized controlled trial. We randomized adult emergency department migraine headache patients to receive 1 L of normal saline solution during 1 hour (fluid group) or saline solution at 10 mL/hour for 1 hour (control group)...
February 2019: Annals of Emergency Medicine
https://read.qxmd.com/read/30661365/cgrp-ligand-and-receptor-monoclonal-antibodies-for-migraine-prevention-evidence-review-and-clinical-implications
#17
David W Dodick
BACKGROUND: Monoclonal antibodies that target calcitonin gene-related peptide or the canonical calcitonin gene-related peptide receptor have emerged as effective and well tolerated for the preventive treatment of migraine. These large molecules appear ideally suited for migraine prevention. They have an extended biological half-life, are administered either monthly or quarterly either by subcutaneous injection or intravenous infusion, require minimal or no dose-titration and have the potential for a rapid onset of effect compared to conventional oral preventive drugs...
January 19, 2019: Cephalalgia: An International Journal of Headache
https://read.qxmd.com/read/30659611/stop-101-a-phase-1-randomized-open-label-comparative-bioavailability-study-of-inp104-dihydroergotamine-mesylate-dhe-administered-intranasally-by-a-i123-precision-olfactory-delivery-pod-%C3%A2-device-in-healthy-adult-subjects
#18
Stephen B Shrewsbury, Maria Jeleva, Kelsey H Satterly, Jason Lickliter, John Hoekman
OBJECTIVE: Investigate the safety and pharmacokinetics (PK) of INP104, intranasal dihydroergotamine mesylate (DHE) administered via a Precision Olfactory Delivery (POD® ) device, (Impel NeuroPharma, Seattle, WA) vs intravenous (IV) DHE and DHE nasal spray (Migranal® ) in healthy adult subjects. METHODS: This was a Phase 1, open-label, randomized, single-dose, 3-period, 3-way crossover study. Subjects received a single dose of A) INP104 1.45 mg (a drug-device combination product composed of DHE and the I123 POD device); B) DHE 45® Injection (IV) 1...
January 19, 2019: Headache
https://read.qxmd.com/read/30634909/novel-hypotheses-emerging-from-gwas-in-migraine
#19
REVIEW
Arn M J M van den Maagdenberg, Dale R Nyholt, Verneri Anttila
Recent technical advances in genetics made large-scale genome-wide association studies (GWAS) in migraine feasible and have identified over 40 common DNA sequence variants that affect risk for migraine types. Most of the variants, which are all single nucleotide polymorphisms (SNPs), show robust association with migraine as evidenced by the fact that the vast majority replicate in subsequent independent studies. However, despite thorough bioinformatic efforts aimed at linking the migraine risk SNPs with genes and their molecular pathways, there remains quite some discussion as to how successful this endeavour has been, and their current practical use for the diagnosis and treatment of migraine patients...
January 11, 2019: Journal of Headache and Pain
https://read.qxmd.com/read/30629285/intravenous-metoclopramide-in-the-treatment-of-acute-migraines-a-randomized-placebo-controlled-trial
#20
Nurettin Özgür Doğan, Murat Pekdemir, Serkan Yilmaz, Elif Yaka, Adnan Karadaş, Uğur Durmuş, Nazire Avcu, Esra Koçkan
OBJECTIVES: The present study aimed to evaluate the efficacy and safety of intravenous metoclopramide for acute migraine treatment. MATERIALS & METHODS: A double-blind, randomized, parallel-group, placebo-controlled trial was carried out in an academic emergency department. After the patients were assessed for eligibility via the International Headache Society criteria for migraines, they were randomized into 10 mg intravenous metoclopramide and normal saline groups...
January 10, 2019: Acta Neurologica Scandinavica
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