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https://www.readbyqxmd.com/read/29127600/a-review-of-current-and-emerging-approaches-to-pain-management-in-the-emergency-department
#1
REVIEW
Knox H Todd
INTRODUCTION: Pain is the most common symptom prompting an emergency department visit and emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad range of illnesses and injuries. The responsibility to treat must be balanced by the duty to limit harm resulting from analgesics. In recent years, opioid-related adverse effects, including overdose and deaths, have increased dramatically in the USA. In response to the US opioid crisis, emergency physicians have broadened their analgesic armamentarium to include a variety of non-opioid approaches...
November 10, 2017: Pain and Therapy
https://www.readbyqxmd.com/read/29083975/factors-associated-with-direct-health-care-costs-among-patients-with-migraine
#2
Machaon Bonafede, Qian Cai, Katherine Cappell, Gilwan Kim, Sandhya J Sapra, Neel Shah, Katherine Widnell, Paul Winner, Pooja Desai
BACKGROUND: Migraine imposes substantial economic burden on patients and the health care system. Approximately 18% of women and 6% of men suffer from migraine in the United States. This is a heterogeneous group, and little data are available to evaluate factors associated with migraine costs. OBJECTIVE: To evaluate characteristics associated with high costs among commercially insured patients with migraine. METHODS: This retrospective analysis identified patients with migraine in the Truven Health MarketScan Research Databases between January 2008 and June 2013...
November 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29046364/randomized-study-of-iv-prochlorperazine-plus-diphenhydramine-vs-iv-hydromorphone-for-migraine
#3
Benjamin W Friedman, Eddie Irizarry, Clemencia Solorzano, Alexander Latev, Karolyn Rosa, Eleftheria Zias, David R Vinson, Polly E Bijur, E John Gallagher
OBJECTIVE: To determine outcomes among patients with migraine in the emergency department (ED) who receive IV hydromorphone vs IV prochlorperazine + diphenhydramine. METHODS: This study was conducted in 2 EDs in New York City. Patients who met international criteria for migraine were eligible for participation if they had not used an opioid within the previous month. Clinicians, participants, investigators, and research personnel were blinded to treatment. Patients were randomized in blocks of 4...
October 18, 2017: Neurology
https://www.readbyqxmd.com/read/29034453/avp-825-sumatriptan-nasal-powder-reduces-nausea-compared-to-sumatriptan-tablets-results-of-the-compass-randomized-clinical-trial
#4
Richard B Lipton, James S McGinley, Kenneth J Shulman, Stephen D Silberstein, R J Wirth, Dawn C Buse
BACKGROUND: Migraine-related nausea is associated with significant disability, increased burden of disease, and personal distress. Nausea can lead to delays or avoidance of initiating oral migraine treatment, sometimes resulting in treatment failures and poor outcomes. Nausea is often a symptom of migraine, but nausea may also be a consequence of treatment (ie, treatment emergent nausea [TEN]). Relieving nausea and minimizing TEN are important goals in acute migraine therapy. METHODS: We analyzed data from the COMPASS study, a randomized, double blind, double-dummy, comparative efficacy study that contrasted two active treatments, AVP-825 (breath-powered intranasal delivery of powdered sumatriptan 22 mg) and oral sumatriptan tablets (100 mg)...
October 16, 2017: Headache
https://www.readbyqxmd.com/read/28994605/explicit-diagnostic-criteria-for-transient-ischemic-attacks-to-differentiate-it-from-migraine-with-aura
#5
Elena R Lebedeva, Natalia M Gurary, Denis V Gilev, Anne Francke Christensen, Jes Olesen
Background The diagnosis of transient ischemic attacks is fraught with problems. The inter-observer agreement has repeatedly been shown to be low even in a neurological setting, and the specificity of the diagnosis is modest to low, reflected in a poor separation of transient ischemic attacks and mimics, particularly migraine with aura with its varied symptomatology. In other disease areas, explicit diagnostic criteria have improved sensitivity and specificity of diagnoses. We therefore present novel explicit diagnostic criteria for transient ischemic attacks tested for sensitivity and for specificity against migraine with aura...
January 1, 2017: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/28926506/family-perspectives-on-visiting-the-pediatric-emergency-department-for-migraine-a-qualitative-study
#6
Serena Laura Orr, Liam OʼSullivan, Roger Zemek, Natalie M Ward, Hugh J McMillan
OBJECTIVE: The aim of this study was to explore the perspectives of families regarding their expectations and experience of visiting the emergency department (ED) for migraine. METHODS: This was a qualitative study involving the families of 25 patients aged 10 to 18 years receiving ED care for acute migraine. Following their visit, independent semistructured telephone interviews were conducted with both the patient and parent or guardian. Questions were designed to explore factors pertaining to the family's perspective regarding their visit to the ED and expectations for the ED visit...
September 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28918732/acupuncture-for-analgesia-in-the-emergency-department-a-multicentre-randomised-equivalence-and-non-inferiority-trial
#7
RANDOMIZED CONTROLLED TRIAL
Marc M Cohen, De Villiers Smit, Nick Andrianopoulos, Michael Ben-Meir, David McD Taylor, Shefton J Parker, Chalie C Xue, Peter A Cameron
OBJECTIVES: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. DESIGN: A pragmatic, multicentre, randomised, assessor-blinded, equivalence and non-inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department...
June 19, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28862758/fremanezumab-as-add-on-treatment-for-patients-treated-with-other-migraine-preventive-medicines
#8
Joshua M Cohen, David W Dodick, Ronghua Yang, Lawrence C Newman, Thomas Li, Ernesto Aycardi, Marcelo E Bigal
BACKGROUND: Fremanezumab (formerly TEV-48125) is a monoclonal antibody directed against calcitonin-gene-related peptide (CGRP), a validated target for migraine preventive therapy. In two previous phase 2 studies, fremanezumab administered once every 28 days for 12 weeks was found to be effective and safe as a preventive treatment for patients suffering from episodic migraine (EM) and chronic migraine (CM). OBJECTIVE: To evaluate the efficacy and safety of fremanezumab as an add-on preventive therapy in individuals with EM and CM who are on stable doses of preventive migraine medications...
October 2017: Headache
https://www.readbyqxmd.com/read/28757917/intravenous-caffeine-citrate-vs-magnesium-sulfate-for-reducing-pain-in-patients-with-acute-migraine-headache-a-prospective-quasi-experimental-study
#9
Alireza Baratloo, Sahar Mirbaha, Hossein Delavar Kasmaei, Pooya Payandemehr, Ahmed Elmaraezy, Ahmed Negida
BACKGROUND: Current evidence suggests that intravenous magnesium sulfate might be effective for reducing migraine pain. In a recent pilot study, we showed that intravenous caffeine citrate could reduce the severity of migraine headache. The objective of this study is to investigate the efficacy of intravenous caffeine citrate vs. magnesium sulfate for management of acute migraine headache. METHODS: We conducted a prospective quasi-experimental study from January until May 2016 in two educational medical centers of Shahid Beheshti University of Medical Sciences (Shoahadaye Tajrish Hospital and Imam Hossein Hospital), Tehran, Iran...
July 2017: Korean Journal of Pain
https://www.readbyqxmd.com/read/28738690/magnetic-resonance-imaging-in-children-presenting-migraine-with-aura-association-of-hypoperfusion-detected-by-arterial-spin-labelling-and-vasospasm-on-mr-angiography-findings
#10
Domitille Cadiot, Romain Longuet, Bertrand Bruneau, Catherine Treguier, Aline Carsin-Vu, Isabelle Corouge, Constantin Gomes, Maïa Proisy
Objective A child presenting with a first attack of migraine with aura usually undergoes magnetic resonance imaging (MRI) to rule out stroke. The purpose of this study was to report vascular and brain perfusion findings in children suffering from migraine with aura on time-of-flight MR angiography (TOF-MRA) and MR perfusion imaging using arterial spin labelling (ASL). Methods We retrospectively included all children who had undergone an emergency MRI examination with ASL and TOF-MRA sequences for acute neurological deficit and were given a final diagnosis of migraine with aura...
January 1, 2017: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/28678056/enlarged-vestibular-aqueduct-syndrome-sudden-hearing-loss-in-a-child-with-a-cerebral-shunt
#11
Wendi-Jo Wendt, Andrew Hashikawa
Enlarged vestibular aqueduct syndrome (EVAS) is the most common congenital ear anomaly that causes sensorineural hearing loss in children and may predispose a child to sudden hearing loss from sudden pressure changes or minor head trauma. We report a case of a 4-year-old boy with a history of a ventriculoperitoneal shunt and migraines who presented to the emergency department with parental and child care provider reports of acute hearing loss, without a history of trauma, infection, or hardware malfunction, who was diagnosed with bilateral EVAS...
July 4, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28646558/neurology-concepts-young-women-and-ischemic-stroke-evaluation-and-management-in-the-emergency-department
#12
Bernard P Chang, Charles Wira, Joseph Miller, Murtaza Akhter, Bradley E Barth, Joshua Willey, Lauren Nentwich, Tracy Madsen
OBJECTIVE: Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g., premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28645559/multicenter-prevalence-of-opioid-medication-use-as-abortive-therapy-in-the-emergency-department-treatment-of-migraine-headaches
#13
Neil Young, Daniel Silverman, Heather Bradford, Jeffrey Finkelstein
Despite a range of therapeutic options for treating acute migraine headaches, the use of opioids is still reported to be common practice. This study describes treatment practices in regards to migraines in the ED. It characterizes the prevalence of opioid orders during visits in three different settings, an academic medical center, a non-academic urban ED, and a community ED. Fourteen months of consecutive migraine visits were identified. All medications ordered were separated into first-line and rescue medications...
June 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28562545/sumatriptan-induced-angle-closure-glaucoma-a-case-report
#14
Cherng-Ru Hsu, Yi-Hao Chen, Ming-Cheng Tai, Da-Wen Lu
RATIONALE: Drug-induced bilateral angle-closure glaucoma is a rare event and should be treated correctly and promptly to prevent visual loss. PATIENT CONCERNS: We report a rare case of sumatriptan-induced bilateral angle-closure glaucoma in a young woman with migraine, and explore the possible mechanism. DIAGNOSES: We describe the clinical outcome of a patient with sumatriptan-induced bilateral angle-closure glaucoma. The patient presented with bilateral acute elevation of intraocular pressure (IOP) and myopic shift...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28533997/metoclopramide-for-acute-migraine-treatment-in-the-emergency-department-an-effective-alternative-to-opioids
#15
REVIEW
Mejdi Najjar, Tyler Hall, Blanca Estupinan
In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings...
April 20, 2017: Curēus
https://www.readbyqxmd.com/read/28497569/early-onset-of-efficacy-and-consistency-of-response-across-multiple-migraine-attacks-from-the-randomized-compass-study-avp-825-breath-powered-%C3%A2-exhalation-delivery-system-sumatriptan-nasal-powder-vs-oral-sumatriptan
#16
Stephen Silberstein, Paul K Winner, Peter J McAllister, Stewart J Tepper, Rashmi Halker, Ramy A Mahmoud, Joao Siffert
OBJECTIVE: To further characterize the clinical utility of AVP-825 based on additional prespecified outcomes and post hoc analyses of COMPASS, a Phase 3 comparative efficacy trial of AVP-825 vs 100 mg oral sumatriptan (NCT01667679). AVP-825 was approved in January 2016 by the US Food and Drug Administration under the name ONZETRA(®) Xsail(®) (sumatriptan nasal powder) for the acute treatment of migraine with or without aura in adults. BACKGROUND: AVP-825 is a delivery system that uses a patient's own breath to deliver low-dose sumatriptan powder to the upper posterior regions of the nasal cavity beyond the narrow nasal valve, areas lined with vascular mucosa conducive to rapid drug absorption into the systemic circulation...
June 2017: Headache
https://www.readbyqxmd.com/read/28497257/-therapy-of-migranes
#17
D Holle-Lee, S Nägel, C Gaul
In migraine attack treatment analgesics such as nonsteroidal anti-inflammatory drugs and triptans can be utilized. The efficacy of acute attack treatment is relevant to prevent migraine chronification. For prophylactic treatment β‑blockers, tricyclic antidepressants, flunarizine, antiepileptics and onabotulinumtoxin A are available. There is evidence that some other substances (e. g. sartans) are also efficacious in this regard. Furthermore, nondrug approaches are essential in migraine therapy. Early education and prophylactic treatment of patients at risk may prevent from medication overuse headache...
May 11, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28461833/treatment-of-pediatric-migraine-a-review
#18
Raluca Ioana Teleanu, Oana Vladacenco, Daniel Mihai Teleanu, Diana Anamaria Epure
Migraine is a common, but often underdiagnosed complaint in children and the lack of studies regarding its treatment in this particularly population makes it harder to enlarge the choices of treatment. However, recent trials made it easier to utilize newer compounds that improve the outcome of the disease. We reviewed the treatment of pediatric migraine and divided therapeutic methods into two broad areas: treatment of the acute attack - used both in the emergency room and as home options and prophylactic agents...
June 2016: Mædica
https://www.readbyqxmd.com/read/28429801/the-dizzy-patient-don-t-forget-disorders-of-the-central-vestibular-system
#19
REVIEW
Thomas Brandt, Marianne Dieterich
Vertigo and dizziness are among the most common complaints in neurology clinics, and they account for about 13% of the patients entering emergency units. In this Review, we focus on central vestibular disorders, which are mostly attributable to acute unilateral lesions of the bilateral vestibular circuitry in the brain. In a tertiary interdisciplinary outpatient dizziness unit, central vestibular disorders, including vestibular migraine, comprise about 25% of the established diagnoses. The signs and symptoms of these disorders can mimic those of peripheral vestibular disorders with sustained rotational vertigo...
June 2017: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/28336681/accuracy-and-reliability-of-stroke-diagnosis-in-the-pediatric-emergency-department
#20
Mark T Mackay, Adriana Yock-Corrales, Leonid Churilov, Paul Monagle, Geoffrey A Donnan, Franz E Babl
BACKGROUND AND PURPOSE: Access to acute stroke interventions in the emergency department (ED) relies on correct clinical diagnosis. Our aims were to determine the accuracy and reliability of pediatric ED physician diagnosis of childhood stroke and other conditions presenting with brain attack symptoms. METHODS: Prospective study of consecutive children aged 1 month to 18 years presenting to the ED from June 2009 to December 2010 with focal neurological deficits...
May 2017: Stroke; a Journal of Cerebral Circulation
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