<b>Objective:</b> To explore meanings, perspectives and points of view of the subjective experience of paediatric patients with headache (PPwH) and create a first-person narrative for clinical practice. &l...<b>Objective:</b> To explore meanings, perspectives and points of view of the subjective experience of paediatric patients with headache (PPwH) and create a first-person narrative for clinical practice. <b>Methods:</b> We conducted a qualitative, narrative research study with PPwH, 11 - 17 years old. Data were collected through narratives interviews and a twofold narrative analysis was performed: a narrative and a thematic analysis. <b>Results:</b> Twenty-three patients (14 girls;mean age 14.5;median duration of illness of 5.8 years) were recruited. Through narrative analysis and close reading, narratives revealed different ways to organize illness experience: PPwH can use 1) narrative sequences of recurrent events in order a) to describe the continuing living-through of the experience of headache, b) to define operative script or c) to characterize the illness experience generally as a “controlled” routine;or 2) a storied account of events, with well-defined characters, plot and evaluation of contingency and correlation between events to express a personal point of view and a moral standpoint about the illness experience. Through thematic analysis 5 main themes and 22 subthemes about the significance of being a PPwH emerged: a) disease dimension (description of pain), b) illness dimension, c) sickness, d) causality, e) coping and f) future perception. Then, a first-person narrative story was created as a tool enabling reflection and conversation during clinical consultation. <b>Conclusions:</b> Results suggest that promoting narrative dialogue can be an opportunity for the neurologist: the prototypical narrative developed from story analysis might be a tool to apply for the narrative-based medicine in the clinical setting.展开更多
Alzheimer’s disease is a prevalent and debilitating neurodegenerative condition that profoundly affects a patient’s daily functioning with progressive cognitive decline,which can be partly attributed to impaired hip...Alzheimer’s disease is a prevalent and debilitating neurodegenerative condition that profoundly affects a patient’s daily functioning with progressive cognitive decline,which can be partly attributed to impaired hippocampal neurogenesis.Neurogenesis in the hippocampal dentate gyrus is likely to persist throughout life but declines with aging,especially in Alzheimer’s disease.Recent evidence indicated that RNA-binding protein 8A(Rbm8a)promotes the proliferation of neural progenitor cells,with lower expression levels observed in Alzheimer’s disease patients compared with healthy people.This study investigated the hypothesis that Rbm8a overexpression may enhance neurogenesis by promoting the proliferation of neural progenitor cells to improve memory impairment in Alzheimer’s disease.Therefore,Rbm8a overexpression was induced in the dentate gyrus of 5×FAD mice to validate this hypothesis.Elevated Rbm8a levels in the dentate gyrus triggered neurogenesis and abated pathological phenotypes(such as plaque formation,gliosis reaction,and dystrophic neurites),leading to ameliorated memory performance in 5×FAD mice.RNA sequencing data further substantiated these findings,showing the enrichment of differentially expressed genes involved in biological processes including neurogenesis,cell proliferation,and amyloid protein formation.In conclusion,overexpressing Rbm8a in the dentate gyrus of 5×FAD mouse brains improved cognitive function by ameliorating amyloid-beta-associated pathological phenotypes and enhancing neurogenesis.展开更多
Objectives. -This study characterized sleep parameters and complaints in a large clinical sample of migraineurs and examined sleep complaints in relation to headache frequency and severity. Background. -The relationsh...Objectives. -This study characterized sleep parameters and complaints in a large clinical sample of migraineurs and examined sleep complaints in relation to headache frequency and severity. Background. -The relationship between headache and sleep has been documented at least anecdotally in medical literature for well over a century and clinical texts allude to the importance of sleep as a headache precipitant. A small number of empirical studies have emerged, but the precise nature and magnitude of the headache/sleep association and underlying mechanisms remain poorly understood. Methods. -In this investigation, 1283 migraineurs were drawn from 1480 consecutive headache sufferers presenting for evaluation to a tertiary headache clinic. Patients underwent a physical examination and structured interview assessing a variety of sleep, headache, and demographic variables. Migraine was diagnosed according the IHS criteria (1.1 to 1.6 diagnostic codes). Migraineurs were 84%female, with a mean age of 37.4 years. Groups were formed based on patient’s average nocturnal sleep patterns, including short, normal, and long sleep groups, and were compared on headache variables. Results. -Sleep complaints were common and associated with headache in a sizeable proportion of patients. Over half of migraineurs reported difficulty initiating and maintaining sleep at least occasionally. Many in this sample reported chronically shortened sleep patterns similar to that observed in persons with insomnia, with 38%of patients sleeping on average 6 hours per night. Migraines were triggered by sleep disturbance in 50%of patients. “Awakening headaches”or headaches awakening them from sleep were reported by 71%of patients. Interestingly, sleep was also a common palliative agent for headache; 85%of migraineurs indicated that they chose to sleep or rest because of headache and 75%were forced to sleep or rest because of headache. Patients with chronic migraine reported shorter nightly sleep times than those with episodic migraine, and were more likely to exhibit trouble falling asleep, staying asleep, sleep triggering headache, and choosing to sleep because of headache. Short sleepers (ie, average sleep period 6 hours) exhibited significantly more frequent and more severe headaches than individuals who slept longer and were more likely to exhibit morning headaches on awakening. Conclusions. -These data support earlier research and anecdotal observations of a substantial sleep/migraine relationship, and implicate sleep disturbance in specific headache patterns and severity. The short sleep group, who routinely slept 6 hours per night, exhibited the more severe headache patterns and more sleep-related headache. Sleep complaints occurred with greater frequency among chronic than episodic migraineurs. Future research may identify possible mediating factors such as primary sleep and mood disorders. Prospective studies are needed to determine if normalizing sleep times in the short sleeps would impact headache threshold.展开更多
Anticonvulsant and antidepressant medications have demonstrated efficacy in migraine treatment. Vagus nerve stimulation (VNS) is an effective treatment for drug- refractory epilepsy and possibly depression and it also...Anticonvulsant and antidepressant medications have demonstrated efficacy in migraine treatment. Vagus nerve stimulation (VNS) is an effective treatment for drug- refractory epilepsy and possibly depression and it also has documented analgesic effects. These observations suggested a possible role for VNS in treating severe refractory headaches, and led to a trial of VNS in patients with such headaches. VNS was implanted in four men and two women with disabling chronic cluster and migraine headaches. In one man and one woman with chronic migraines VNS produced dramatic improvement with restoration of ability to work. Two patients with chronic cluster headaches had significant improvement of their headaches. VNS was well tolerated in five patients, while one developed nausea even at the lowest current strength. In conclusion, VNS may be an effective therapy for intractable chronic migraine and cluster headaches and deserves further trials.展开更多
Background: Menstrually associated migraine (MAM) is often prolonged and difficult to manage with conventional therapies. Frovatriptan is a new selective 5HTlB/1D receptor agonist indicated for short term management o...Background: Menstrually associated migraine (MAM) is often prolonged and difficult to manage with conventional therapies. Frovatriptan is a new selective 5HTlB/1D receptor agonist indicated for short term management of migraine. It has a long half life and good tolerability. These characteristics suggest that frovatriptan may be useful for the intermittent prevention of MAM. Methods: The study was a randomized, double blind, placebo controlled, three way crossover design. Patients treated each of three perimenstrual periods (PMPs) with placebo, frovatriptan 2.5 mg QD, and frovatriptan 2.5 mg BID. The 6 day treatment started 2 days before the anticipated start of MAM headache. The primary efficacy endpoint was incidence of MAM headache during the 6 day PMP. Results: The population comprised 546 women (mean age, 37.6 years). Use of frovatriptan reduced the occurrence of MAM headache. The incidence of MAM headache during the 6 day PMP was 67% for placebo, 52% for frovatriptan 2.5 mg QD, and 41% for frovatriptan 2.5mg BID. Both frovatriptan regimenswere superior to placebo (p < 0.0001), and the BID regimen was superior to theQD regimen (p < 0.001). Both frovatriptan regimens also reduced MAM severity (p < 0.0001),duration (p < 0.0001),and the use of rescue medication (p < 0.01 QD; p < 0.0001 BID) in a dose dependent manner. The incidence and type of adverse events for both regimens were similar to placebo and consistent with those reported for short term migraine management. Conclusion: Frovatriptan given prophylactically for 6 days was effective in reducing the incidence of menstrually associated migraine. More than half of patients who used frovatriptan 2.5 mg BID had no menstrually associated migraine headache during the 6 day perimenstrual period. The findings are consistent with the long duration of action and good tolerability of frovatriptan observed in short term migraine management.展开更多
Objectives. This study of premonitory symptoms in migraine was performed to document the frequency, duration, and types of symptoms in a large group of migr aine patients. Background. Prodrome importance continues to ...Objectives. This study of premonitory symptoms in migraine was performed to document the frequency, duration, and types of symptoms in a large group of migr aine patients. Background. Prodrome importance continues to be debated. Interv ention early in the migraine attack is assuming more importance and necessitates better knowledge of the prodrome. Methods. A total of 893 migraine patients ( IHS 1.1-1.7) were evaluated at first visit. Prodrome frequency, duration, and c haracteristics were analyzed in the total migraine population IHS 1.1-1.7 and I HS 1.1-1.6 migraine. Results. A total of 32.9%of IHS migraine 1.1 1.6 patie nts reported prodrome symptoms with an average of 9.42 hours. IHS 1.1-1.7 migra ine reported 29.7%and 6.8 hours, respectively. The most commonest symptoms were tiredness, mood change, and gastrointestinal symptoms; all three of these sympt oms were present together in 17%of the patients with prodrome. The duration of prodrome was less than 1 hour in 45.1%, 1-2 hours in 13.6%, 2-4 hours in 15. 0%, 4-12 hours in 13.1%, and greater than 12 hours in 13.2%. IHS 1.1-1.7 pa tients showed similar findings. IHS 1.1-1.6 patients with prodrome differed fro m patients without prodrome in having more triggers as a whole (P <..01), more i ndividual triggers including alcohol (P <..01), hormones (P <..01), light (P <.. 001), not eating (P <..05), perfume (P <..01), stress (P <..01), and weather cha nges (P <.05), a longer duration of aura (P <.05), longer time between aura and headache (P <.05), more aura with no headache (P <..05), longer time to peak of headache (P <..05), longer time to respond to triptan (P <.05), longer maximum d uration of headache (P <.05), and more headache associated nausea (P <..05), mor e headache associated running of the nose or tearing of (the eyes (P <.05), more postdrome syndrome (P <..05), and longer duration of postdrome syndrome (P <..0 01). Conclusions. This study provides a portrait of prodrome in a large cohort of patients. It highlights differences between patients with prodrome and patie nts not having prodrome, and it draws attention to the potential of preventing t he headache phase of the acute migraine attack.展开更多
The aim of this study was to document the frequency and types of aura symptoms , to define the relationship between aura symptoms and to define the aura freque ncy in different migraine types. In 952 migraine patients...The aim of this study was to document the frequency and types of aura symptoms , to define the relationship between aura symptoms and to define the aura freque ncy in different migraine types. In 952 migraine patients, aura frequency, durat ion, time to headache, characteristics and percentage of headaches with aura wer e analysed. Thirty eight percent of IHS 1.1-1.5 patients reported aura, 38.1% of females and 33.0%of males. Average percentage of aura occurrence with headac he was 19.7%of headaches, average aura duration 27.3 min and aura was followed by headache in 10.4 min on average. Visual disturbances occurred in 92.1%and au ra without visual aura was rare. Aura frequency was headache type dependent. Th e highest frequency of aura was seen in the more full blownmigraine attack. Visual aura is the overwhelming aura symptom. Even in patients with aura the pe rcentage of aura with migraine attacks is limited.展开更多
Objective. -To identify variables predictive of a negative response to prophylactic therapy with topiramate in patients with chronic migraine. Background. -While certain of the newer antiepileptic drugs (AEDs) have em...Objective. -To identify variables predictive of a negative response to prophylactic therapy with topiramate in patients with chronic migraine. Background. -While certain of the newer antiepileptic drugs (AEDs) have emerged as promising or definitely effective therapies for migraine prevention, we continue to lack biologic or clinical variables predictive of treatment response to these or other widely used prophylactic therapies. Methods. -A consecutive series of 170 patients with IHS defined migraine who were experiencing 15 or more days of headache per month were treated with topiramate according to a uniform dosing protocol. Variables examined for their potential value in predicting treatment response included age, gender, prior experience with prophylactic therapy, prior experience with divalproex sodium specifically, headache frequency and, if present, duration of chronic daily headache (CDH). A positive treatment response was defined as a 50%or greater reduction in headache days during the second treatment month relative to the patient’s pretopiramate baseline. Only patients who completed the treatment phase and achieved the 50 mg BID target dose were analyzed (efficacy analysis). Each variable prospectively selected was evaluated in regards to treatment outcome via a paired Mest, and a multiple regression analysis of all variables subsequently was performed. Results. -A total of 116 patients completed at least 60 days of treatment and consequently were available for analysis. In the efficacy analysis, 45 (38.8%) of the 116 responded positively to topiramate. Neither age nor gender influenced treatment response. Those patients with CDH of more than 6 months duration, patients who previously had tried and failed more than three prophylactic agents and patients who previously had failed to respond to divalproex sodium were more likely to be nonresponders, but after multiple regression analysis the only statistically significant predictor of a negative treatment response was CDH of more than 6 months duration (P < .001). Conclusions. -Patients with chronic migraine who are treated with topiramate may respond positively at a rate approaching that reported from placebo-controlled trials involving topiramate or other AEDs administered to less severely afflicted migraineurs. Our analysis suggests that patients with chronic migraine least likely to respond to topiramate would be those with extensive and negative previous experience with prophylactic therapy, previous failure to respond to divalproex sodium, CDH, and, most notably, CDH of more than 6 months duration.展开更多
Objective. - To examine the occurrence of dynamic mechanical (brush) allodynia (BA) in patients with cluster headache (CH). Background. - Cutaneous allodynia was described in migraine. It was related to sensitization ...Objective. - To examine the occurrence of dynamic mechanical (brush) allodynia (BA) in patients with cluster headache (CH). Background. - Cutaneous allodynia was described in migraine. It was related to sensitization of neurons in the trigeminal nucleus caudalis (TNC). This phenomenon has not been previously described in cluster headache. Methods. - We examined adult patients with episodic or chronic CH for the presence of BA. Demographic data and the characteristics of CH were obtained through a questionnaire. Allodynia testing was performed by repetitively applying a 4 x 4- inch gauze pad to skin areas in the trigeminal and cervical dermatomes. Degree of allodynia was measured on a 100- mm visual analog scale (VAS). The relations between the location and severity of headache and allodynia were assessed. Results. - Ten patients (all male, mean age 39.3) were included in the study. Seven had episodic CH (ECH) and 3 had chronic CH (CCH). Two patients were in acute attack when tested for BA. In total, 4 (40% ) of the 10 patients had BA (2 [28.6% ] of the 7 with ECH and 2 [66.7% ] of the 3 with CCH). Median disease duration was 22 years for patients with BA and 12 years for patients without BA. Of the two patients in acute attack, one had BA, ipsilateral to the headache, which was reduced 20 minutes after treatment, along with reduced headache severity. Conclusios. - This is the first report on the occurrence of cutaneous allodynia in CH. The presence of BA in CH may be related to CH type (episodic vs. chronic) and to the duration of disease. These results support the concept that allodynia in CH may result from a time- dependent process of neuronal sensitization.展开更多
Objective. -To compare the efficacy and tolerability of sumatriptan nasal spray (NS) (5, 20 mg) versus placebo in the acute treatment of migraine in adolescent subjects. Background. -Currently, no triptan is approved ...Objective. -To compare the efficacy and tolerability of sumatriptan nasal spray (NS) (5, 20 mg) versus placebo in the acute treatment of migraine in adolescent subjects. Background. -Currently, no triptan is approved in the United States for the treatment of migraine in adolescent subjects (12 to 17 years). In a previous randomized, placebo-controlled study of 510 adolescent subjects, sumatriptan NS at 5, 10, and 20 mg doses was well tolerated. However, the primary efficacy analysis for headache relief with 20 mg at 2 hours did not demonstrate statistical significance (P= .059). A second study was initiated to evaluate the efficacy of sumatriptan NS in this population. Methods. -This was a randomized (1:1:1), placebo-controlled, doubleblind, parallel-group study. Overall, 738 adolescent subjects (mean age: 14 years) with ≥6-month history of migraine (with or without aura) self-treated a single attack of moderate or severe migraine. The primary endpoints were headache relief at 1 hour and sustained relief from 1 to 24 hours. Pain-free rates, presence/absence of associated symptoms, headache recurrence, and use of rescue medications were also assessed. Tolerability was based on adverse events (AEs) and vital signs. Results. -Sumatriptan NS 20 mg provided greater headache relief than placebo at 30 minutes (42%vs. 33%, respectively; P= .046) and 2 hours (68%vs. 58%; P= .025) postdose, but did not reach statistical significance at 1 hour (61%vs. 52%; P= .087) or for sustained headache relief from 1 to 24 hours (P= .061). Significant differences (P < .05) in favor of sumatriptan NS 20 mg over placebo were observed for several secondary efficacy endpoints including sustained relief from 2 to 24 hours. In general, sumatriptan NS 5 mg percentages were slightly higher than placebo but the differences did not reach statistical significance. Both doses of sumatriptan NS were well tolerated. No AEs were serious or led to study withdrawal. The most common event was taste disturbance (2%, placebo; 19%, sumatriptan NS 5 mg; 25%, sumatriptan NS 20 mg). Conclusions. -This study suggests that sumatriptan may be beneficial to some adolescents and is generally well tolerated in the acute treatment of migraine in this population.展开更多
Cutaneous allodynia has been described in migraine. We report on a 39- year- old woman with migraine with aura who had cutaneous allodynia to both dynamic (brush) and static (pressure) mechanical stimulation between a...Cutaneous allodynia has been described in migraine. We report on a 39- year- old woman with migraine with aura who had cutaneous allodynia to both dynamic (brush) and static (pressure) mechanical stimulation between attacks. For both sensory modalities, the evoked pain on allodynia testing was located to the right frontal area (the location of her usual migraine headache), contralaterally to the stimulated skin area. There was no allodynia when the right frontal area was stimulated directly. We suggest the term ’ referred allodynia’ for this phenomenon and discuss possible mechanisms for its occurrence.展开更多
Objectives. - This study assesses osmophobia and taste abnormality for the first time in a large sample of migraine patients. Methods. - Seven hundred and twenty seven migraineurs were evaluated. Osmophobia, taste abn...Objectives. - This study assesses osmophobia and taste abnormality for the first time in a large sample of migraine patients. Methods. - Seven hundred and twenty seven migraineurs were evaluated. Osmophobia, taste abnormality, and perfume or odor trigger were graded from 0 to 3. Results. - In patients with data, 24.7% of 673 patients complained of osmophobia (12.5% occasional, 7% frequent, and 5.2% very frequent) and 24.6% of 505 of taste abnormality (13.5% occasional, 6.1% frequent, and 5.0% very frequent). Perfume or odor trigger of acute migraine occurred in 45.5% of 724 patients (22.7% occasional, 10.2% frequent, and 12.6% very frequent). Perfume or odor trigger was associated with osmophobia in 61.5% and taste abnormality 62.1% . Osmophobia without taste abnormality occurred in 28.3% and taste abnormality without osmophobia in 40.3% . A greater percentage of females than males had osmophobia (25.7 vs. 17.5), taste abnormality (25.4 vs. 17.9), and perfume or odor trigger (49.3 vs. 22.1), all P < .0001. Conclusions. - Osmophobia and taste abnormality occur in about one quarter of migraineurs during an acute migraine attack while perfume or odor trigger migraine in almost 50% of patients. Osmophobia and taste abnormality in the acute migraine attack, as well as perfumes or odor as a migraine trigger, are more common in females than in males.展开更多
A patient is described who developed recurrent headaches following a traumatic injury in the vicinity of the right greater occipital nerve (GON) that fulfill IHS criteria for migraine with aura. Both aura and headache...A patient is described who developed recurrent headaches following a traumatic injury in the vicinity of the right greater occipital nerve (GON) that fulfill IHS criteria for migraine with aura. Both aura and headache can be triggered by pressure over the GON and relieved by local anesthetic blockade.展开更多
Six migraine patients experienced significant topiramate-related cognitive and language dysfunction that improved with donepezil treatment and allowed uninterrupted topiramate use. These patients represent the first r...Six migraine patients experienced significant topiramate-related cognitive and language dysfunction that improved with donepezil treatment and allowed uninterrupted topiramate use. These patients represent the first report of topiramate-related cognitive and language dysfunction that improved with a cholinesterase inhibitor. Although, the mechanism responsible for this effect is uncertain, cholinesterase inhibition resulting in cholinergic augmentation and enhanced cognition probably account for some if not most of the improvement.展开更多
A 36-year-old woman has had repeated episodes of concurrent hemifacial spasm and migraine for 8 years. Her history is summarized and possible pathophysiolog ic links are discussed.
Cluster headaches both episodic and chronic are some of the most challenging headaches to treat. Although effective treatments are now available, some patients continue to be unresponsive to standard therapy. We prese...Cluster headaches both episodic and chronic are some of the most challenging headaches to treat. Although effective treatments are now available, some patients continue to be unresponsive to standard therapy. We present 17 patients from our practice whom we treated preventively with frovatriptan, a new triptan with a long half- life. The promising results suggest that this medication may be an useful addition to our ammaterium against this painful disorder.展开更多
文摘<b>Objective:</b> To explore meanings, perspectives and points of view of the subjective experience of paediatric patients with headache (PPwH) and create a first-person narrative for clinical practice. <b>Methods:</b> We conducted a qualitative, narrative research study with PPwH, 11 - 17 years old. Data were collected through narratives interviews and a twofold narrative analysis was performed: a narrative and a thematic analysis. <b>Results:</b> Twenty-three patients (14 girls;mean age 14.5;median duration of illness of 5.8 years) were recruited. Through narrative analysis and close reading, narratives revealed different ways to organize illness experience: PPwH can use 1) narrative sequences of recurrent events in order a) to describe the continuing living-through of the experience of headache, b) to define operative script or c) to characterize the illness experience generally as a “controlled” routine;or 2) a storied account of events, with well-defined characters, plot and evaluation of contingency and correlation between events to express a personal point of view and a moral standpoint about the illness experience. Through thematic analysis 5 main themes and 22 subthemes about the significance of being a PPwH emerged: a) disease dimension (description of pain), b) illness dimension, c) sickness, d) causality, e) coping and f) future perception. Then, a first-person narrative story was created as a tool enabling reflection and conversation during clinical consultation. <b>Conclusions:</b> Results suggest that promoting narrative dialogue can be an opportunity for the neurologist: the prototypical narrative developed from story analysis might be a tool to apply for the narrative-based medicine in the clinical setting.
基金supported by the National Natural Science Foundation of China,No.91849104(to YW)。
文摘Alzheimer’s disease is a prevalent and debilitating neurodegenerative condition that profoundly affects a patient’s daily functioning with progressive cognitive decline,which can be partly attributed to impaired hippocampal neurogenesis.Neurogenesis in the hippocampal dentate gyrus is likely to persist throughout life but declines with aging,especially in Alzheimer’s disease.Recent evidence indicated that RNA-binding protein 8A(Rbm8a)promotes the proliferation of neural progenitor cells,with lower expression levels observed in Alzheimer’s disease patients compared with healthy people.This study investigated the hypothesis that Rbm8a overexpression may enhance neurogenesis by promoting the proliferation of neural progenitor cells to improve memory impairment in Alzheimer’s disease.Therefore,Rbm8a overexpression was induced in the dentate gyrus of 5×FAD mice to validate this hypothesis.Elevated Rbm8a levels in the dentate gyrus triggered neurogenesis and abated pathological phenotypes(such as plaque formation,gliosis reaction,and dystrophic neurites),leading to ameliorated memory performance in 5×FAD mice.RNA sequencing data further substantiated these findings,showing the enrichment of differentially expressed genes involved in biological processes including neurogenesis,cell proliferation,and amyloid protein formation.In conclusion,overexpressing Rbm8a in the dentate gyrus of 5×FAD mouse brains improved cognitive function by ameliorating amyloid-beta-associated pathological phenotypes and enhancing neurogenesis.
文摘Objectives. -This study characterized sleep parameters and complaints in a large clinical sample of migraineurs and examined sleep complaints in relation to headache frequency and severity. Background. -The relationship between headache and sleep has been documented at least anecdotally in medical literature for well over a century and clinical texts allude to the importance of sleep as a headache precipitant. A small number of empirical studies have emerged, but the precise nature and magnitude of the headache/sleep association and underlying mechanisms remain poorly understood. Methods. -In this investigation, 1283 migraineurs were drawn from 1480 consecutive headache sufferers presenting for evaluation to a tertiary headache clinic. Patients underwent a physical examination and structured interview assessing a variety of sleep, headache, and demographic variables. Migraine was diagnosed according the IHS criteria (1.1 to 1.6 diagnostic codes). Migraineurs were 84%female, with a mean age of 37.4 years. Groups were formed based on patient’s average nocturnal sleep patterns, including short, normal, and long sleep groups, and were compared on headache variables. Results. -Sleep complaints were common and associated with headache in a sizeable proportion of patients. Over half of migraineurs reported difficulty initiating and maintaining sleep at least occasionally. Many in this sample reported chronically shortened sleep patterns similar to that observed in persons with insomnia, with 38%of patients sleeping on average 6 hours per night. Migraines were triggered by sleep disturbance in 50%of patients. “Awakening headaches”or headaches awakening them from sleep were reported by 71%of patients. Interestingly, sleep was also a common palliative agent for headache; 85%of migraineurs indicated that they chose to sleep or rest because of headache and 75%were forced to sleep or rest because of headache. Patients with chronic migraine reported shorter nightly sleep times than those with episodic migraine, and were more likely to exhibit trouble falling asleep, staying asleep, sleep triggering headache, and choosing to sleep because of headache. Short sleepers (ie, average sleep period 6 hours) exhibited significantly more frequent and more severe headaches than individuals who slept longer and were more likely to exhibit morning headaches on awakening. Conclusions. -These data support earlier research and anecdotal observations of a substantial sleep/migraine relationship, and implicate sleep disturbance in specific headache patterns and severity. The short sleep group, who routinely slept 6 hours per night, exhibited the more severe headache patterns and more sleep-related headache. Sleep complaints occurred with greater frequency among chronic than episodic migraineurs. Future research may identify possible mediating factors such as primary sleep and mood disorders. Prospective studies are needed to determine if normalizing sleep times in the short sleeps would impact headache threshold.
文摘Anticonvulsant and antidepressant medications have demonstrated efficacy in migraine treatment. Vagus nerve stimulation (VNS) is an effective treatment for drug- refractory epilepsy and possibly depression and it also has documented analgesic effects. These observations suggested a possible role for VNS in treating severe refractory headaches, and led to a trial of VNS in patients with such headaches. VNS was implanted in four men and two women with disabling chronic cluster and migraine headaches. In one man and one woman with chronic migraines VNS produced dramatic improvement with restoration of ability to work. Two patients with chronic cluster headaches had significant improvement of their headaches. VNS was well tolerated in five patients, while one developed nausea even at the lowest current strength. In conclusion, VNS may be an effective therapy for intractable chronic migraine and cluster headaches and deserves further trials.
文摘Background: Menstrually associated migraine (MAM) is often prolonged and difficult to manage with conventional therapies. Frovatriptan is a new selective 5HTlB/1D receptor agonist indicated for short term management of migraine. It has a long half life and good tolerability. These characteristics suggest that frovatriptan may be useful for the intermittent prevention of MAM. Methods: The study was a randomized, double blind, placebo controlled, three way crossover design. Patients treated each of three perimenstrual periods (PMPs) with placebo, frovatriptan 2.5 mg QD, and frovatriptan 2.5 mg BID. The 6 day treatment started 2 days before the anticipated start of MAM headache. The primary efficacy endpoint was incidence of MAM headache during the 6 day PMP. Results: The population comprised 546 women (mean age, 37.6 years). Use of frovatriptan reduced the occurrence of MAM headache. The incidence of MAM headache during the 6 day PMP was 67% for placebo, 52% for frovatriptan 2.5 mg QD, and 41% for frovatriptan 2.5mg BID. Both frovatriptan regimenswere superior to placebo (p < 0.0001), and the BID regimen was superior to theQD regimen (p < 0.001). Both frovatriptan regimens also reduced MAM severity (p < 0.0001),duration (p < 0.0001),and the use of rescue medication (p < 0.01 QD; p < 0.0001 BID) in a dose dependent manner. The incidence and type of adverse events for both regimens were similar to placebo and consistent with those reported for short term migraine management. Conclusion: Frovatriptan given prophylactically for 6 days was effective in reducing the incidence of menstrually associated migraine. More than half of patients who used frovatriptan 2.5 mg BID had no menstrually associated migraine headache during the 6 day perimenstrual period. The findings are consistent with the long duration of action and good tolerability of frovatriptan observed in short term migraine management.
文摘Objectives. This study of premonitory symptoms in migraine was performed to document the frequency, duration, and types of symptoms in a large group of migr aine patients. Background. Prodrome importance continues to be debated. Interv ention early in the migraine attack is assuming more importance and necessitates better knowledge of the prodrome. Methods. A total of 893 migraine patients ( IHS 1.1-1.7) were evaluated at first visit. Prodrome frequency, duration, and c haracteristics were analyzed in the total migraine population IHS 1.1-1.7 and I HS 1.1-1.6 migraine. Results. A total of 32.9%of IHS migraine 1.1 1.6 patie nts reported prodrome symptoms with an average of 9.42 hours. IHS 1.1-1.7 migra ine reported 29.7%and 6.8 hours, respectively. The most commonest symptoms were tiredness, mood change, and gastrointestinal symptoms; all three of these sympt oms were present together in 17%of the patients with prodrome. The duration of prodrome was less than 1 hour in 45.1%, 1-2 hours in 13.6%, 2-4 hours in 15. 0%, 4-12 hours in 13.1%, and greater than 12 hours in 13.2%. IHS 1.1-1.7 pa tients showed similar findings. IHS 1.1-1.6 patients with prodrome differed fro m patients without prodrome in having more triggers as a whole (P <..01), more i ndividual triggers including alcohol (P <..01), hormones (P <..01), light (P <.. 001), not eating (P <..05), perfume (P <..01), stress (P <..01), and weather cha nges (P <.05), a longer duration of aura (P <.05), longer time between aura and headache (P <.05), more aura with no headache (P <..05), longer time to peak of headache (P <..05), longer time to respond to triptan (P <.05), longer maximum d uration of headache (P <.05), and more headache associated nausea (P <..05), mor e headache associated running of the nose or tearing of (the eyes (P <.05), more postdrome syndrome (P <..05), and longer duration of postdrome syndrome (P <..0 01). Conclusions. This study provides a portrait of prodrome in a large cohort of patients. It highlights differences between patients with prodrome and patie nts not having prodrome, and it draws attention to the potential of preventing t he headache phase of the acute migraine attack.
文摘The aim of this study was to document the frequency and types of aura symptoms , to define the relationship between aura symptoms and to define the aura freque ncy in different migraine types. In 952 migraine patients, aura frequency, durat ion, time to headache, characteristics and percentage of headaches with aura wer e analysed. Thirty eight percent of IHS 1.1-1.5 patients reported aura, 38.1% of females and 33.0%of males. Average percentage of aura occurrence with headac he was 19.7%of headaches, average aura duration 27.3 min and aura was followed by headache in 10.4 min on average. Visual disturbances occurred in 92.1%and au ra without visual aura was rare. Aura frequency was headache type dependent. Th e highest frequency of aura was seen in the more full blownmigraine attack. Visual aura is the overwhelming aura symptom. Even in patients with aura the pe rcentage of aura with migraine attacks is limited.
文摘Objective. -To identify variables predictive of a negative response to prophylactic therapy with topiramate in patients with chronic migraine. Background. -While certain of the newer antiepileptic drugs (AEDs) have emerged as promising or definitely effective therapies for migraine prevention, we continue to lack biologic or clinical variables predictive of treatment response to these or other widely used prophylactic therapies. Methods. -A consecutive series of 170 patients with IHS defined migraine who were experiencing 15 or more days of headache per month were treated with topiramate according to a uniform dosing protocol. Variables examined for their potential value in predicting treatment response included age, gender, prior experience with prophylactic therapy, prior experience with divalproex sodium specifically, headache frequency and, if present, duration of chronic daily headache (CDH). A positive treatment response was defined as a 50%or greater reduction in headache days during the second treatment month relative to the patient’s pretopiramate baseline. Only patients who completed the treatment phase and achieved the 50 mg BID target dose were analyzed (efficacy analysis). Each variable prospectively selected was evaluated in regards to treatment outcome via a paired Mest, and a multiple regression analysis of all variables subsequently was performed. Results. -A total of 116 patients completed at least 60 days of treatment and consequently were available for analysis. In the efficacy analysis, 45 (38.8%) of the 116 responded positively to topiramate. Neither age nor gender influenced treatment response. Those patients with CDH of more than 6 months duration, patients who previously had tried and failed more than three prophylactic agents and patients who previously had failed to respond to divalproex sodium were more likely to be nonresponders, but after multiple regression analysis the only statistically significant predictor of a negative treatment response was CDH of more than 6 months duration (P < .001). Conclusions. -Patients with chronic migraine who are treated with topiramate may respond positively at a rate approaching that reported from placebo-controlled trials involving topiramate or other AEDs administered to less severely afflicted migraineurs. Our analysis suggests that patients with chronic migraine least likely to respond to topiramate would be those with extensive and negative previous experience with prophylactic therapy, previous failure to respond to divalproex sodium, CDH, and, most notably, CDH of more than 6 months duration.
文摘Objective. - To examine the occurrence of dynamic mechanical (brush) allodynia (BA) in patients with cluster headache (CH). Background. - Cutaneous allodynia was described in migraine. It was related to sensitization of neurons in the trigeminal nucleus caudalis (TNC). This phenomenon has not been previously described in cluster headache. Methods. - We examined adult patients with episodic or chronic CH for the presence of BA. Demographic data and the characteristics of CH were obtained through a questionnaire. Allodynia testing was performed by repetitively applying a 4 x 4- inch gauze pad to skin areas in the trigeminal and cervical dermatomes. Degree of allodynia was measured on a 100- mm visual analog scale (VAS). The relations between the location and severity of headache and allodynia were assessed. Results. - Ten patients (all male, mean age 39.3) were included in the study. Seven had episodic CH (ECH) and 3 had chronic CH (CCH). Two patients were in acute attack when tested for BA. In total, 4 (40% ) of the 10 patients had BA (2 [28.6% ] of the 7 with ECH and 2 [66.7% ] of the 3 with CCH). Median disease duration was 22 years for patients with BA and 12 years for patients without BA. Of the two patients in acute attack, one had BA, ipsilateral to the headache, which was reduced 20 minutes after treatment, along with reduced headache severity. Conclusios. - This is the first report on the occurrence of cutaneous allodynia in CH. The presence of BA in CH may be related to CH type (episodic vs. chronic) and to the duration of disease. These results support the concept that allodynia in CH may result from a time- dependent process of neuronal sensitization.
文摘Objective. -To compare the efficacy and tolerability of sumatriptan nasal spray (NS) (5, 20 mg) versus placebo in the acute treatment of migraine in adolescent subjects. Background. -Currently, no triptan is approved in the United States for the treatment of migraine in adolescent subjects (12 to 17 years). In a previous randomized, placebo-controlled study of 510 adolescent subjects, sumatriptan NS at 5, 10, and 20 mg doses was well tolerated. However, the primary efficacy analysis for headache relief with 20 mg at 2 hours did not demonstrate statistical significance (P= .059). A second study was initiated to evaluate the efficacy of sumatriptan NS in this population. Methods. -This was a randomized (1:1:1), placebo-controlled, doubleblind, parallel-group study. Overall, 738 adolescent subjects (mean age: 14 years) with ≥6-month history of migraine (with or without aura) self-treated a single attack of moderate or severe migraine. The primary endpoints were headache relief at 1 hour and sustained relief from 1 to 24 hours. Pain-free rates, presence/absence of associated symptoms, headache recurrence, and use of rescue medications were also assessed. Tolerability was based on adverse events (AEs) and vital signs. Results. -Sumatriptan NS 20 mg provided greater headache relief than placebo at 30 minutes (42%vs. 33%, respectively; P= .046) and 2 hours (68%vs. 58%; P= .025) postdose, but did not reach statistical significance at 1 hour (61%vs. 52%; P= .087) or for sustained headache relief from 1 to 24 hours (P= .061). Significant differences (P < .05) in favor of sumatriptan NS 20 mg over placebo were observed for several secondary efficacy endpoints including sustained relief from 2 to 24 hours. In general, sumatriptan NS 5 mg percentages were slightly higher than placebo but the differences did not reach statistical significance. Both doses of sumatriptan NS were well tolerated. No AEs were serious or led to study withdrawal. The most common event was taste disturbance (2%, placebo; 19%, sumatriptan NS 5 mg; 25%, sumatriptan NS 20 mg). Conclusions. -This study suggests that sumatriptan may be beneficial to some adolescents and is generally well tolerated in the acute treatment of migraine in this population.
文摘Cutaneous allodynia has been described in migraine. We report on a 39- year- old woman with migraine with aura who had cutaneous allodynia to both dynamic (brush) and static (pressure) mechanical stimulation between attacks. For both sensory modalities, the evoked pain on allodynia testing was located to the right frontal area (the location of her usual migraine headache), contralaterally to the stimulated skin area. There was no allodynia when the right frontal area was stimulated directly. We suggest the term ’ referred allodynia’ for this phenomenon and discuss possible mechanisms for its occurrence.
文摘Objectives. - This study assesses osmophobia and taste abnormality for the first time in a large sample of migraine patients. Methods. - Seven hundred and twenty seven migraineurs were evaluated. Osmophobia, taste abnormality, and perfume or odor trigger were graded from 0 to 3. Results. - In patients with data, 24.7% of 673 patients complained of osmophobia (12.5% occasional, 7% frequent, and 5.2% very frequent) and 24.6% of 505 of taste abnormality (13.5% occasional, 6.1% frequent, and 5.0% very frequent). Perfume or odor trigger of acute migraine occurred in 45.5% of 724 patients (22.7% occasional, 10.2% frequent, and 12.6% very frequent). Perfume or odor trigger was associated with osmophobia in 61.5% and taste abnormality 62.1% . Osmophobia without taste abnormality occurred in 28.3% and taste abnormality without osmophobia in 40.3% . A greater percentage of females than males had osmophobia (25.7 vs. 17.5), taste abnormality (25.4 vs. 17.9), and perfume or odor trigger (49.3 vs. 22.1), all P < .0001. Conclusions. - Osmophobia and taste abnormality occur in about one quarter of migraineurs during an acute migraine attack while perfume or odor trigger migraine in almost 50% of patients. Osmophobia and taste abnormality in the acute migraine attack, as well as perfumes or odor as a migraine trigger, are more common in females than in males.
文摘A patient is described who developed recurrent headaches following a traumatic injury in the vicinity of the right greater occipital nerve (GON) that fulfill IHS criteria for migraine with aura. Both aura and headache can be triggered by pressure over the GON and relieved by local anesthetic blockade.
文摘Six migraine patients experienced significant topiramate-related cognitive and language dysfunction that improved with donepezil treatment and allowed uninterrupted topiramate use. These patients represent the first report of topiramate-related cognitive and language dysfunction that improved with a cholinesterase inhibitor. Although, the mechanism responsible for this effect is uncertain, cholinesterase inhibition resulting in cholinergic augmentation and enhanced cognition probably account for some if not most of the improvement.
文摘A 36-year-old woman has had repeated episodes of concurrent hemifacial spasm and migraine for 8 years. Her history is summarized and possible pathophysiolog ic links are discussed.
文摘Cluster headaches both episodic and chronic are some of the most challenging headaches to treat. Although effective treatments are now available, some patients continue to be unresponsive to standard therapy. We present 17 patients from our practice whom we treated preventively with frovatriptan, a new triptan with a long half- life. The promising results suggest that this medication may be an useful addition to our ammaterium against this painful disorder.
