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Acute Migraine

Nicolas Legris, Olivier Chassin, Ghaidaa Nasser, Florence Riant, Elisabeth Tournier-Lasserve, Christian Denier
PRRT2 gene mutations cause paroxysmal kinesigenic dyskinesia (PKD), infantile convulsions, hemiplegic migraine, and episodic ataxia. A 21-year-old woman reported an episode of dizziness and ataxic gait occurring after swimming. Brain MRI showed a hyperintense cerebellar lesion on diffusion-weighted imaging (DWI) with decreased apparent diffusion coefficient. The clinical course was favorable. Both clinical and MRI abnormalities regressed. Her brother had presented PKD since adulthood. A C.649dupC PRRT2 truncating mutation was identified in both patients...
November 28, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Mathieu Schertz, Benzakoun Joseph, Pyatigorskaya Nadya, Samia Belkacem, Sahli-Amor Melika, Navarro Vincent, Cholet Clément, Leclercq Delphine, Dormont Didier, Law-Ye Bruno
PURPOSE: Arterial spin labeling (ASL) is a noninvasive tool measuring cerebral blood flow (CBF) and is useful to assess acute neurological deficit. While acute stroke presents as hypoperfused vascular territory, epileptic activity causes cortical hyperperfusion. Other neurological conditions exhibit hyperperfusion, like migraine or secondary "luxury perfusion" in strokes. Our objectives were to evaluate the usefulness and potential specificities of ASL in acute seizure and correlate it with electroencephalogram...
November 27, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Giorgio Lambru, Anna P Andreou, Martina Guglielmetti, Paolo Martelletti
Migraine is a very frequent and disabling neurological disorder. The current treatment options are old, generally poorly tolerated and not migraine-specific, reflecting the low priority of migraine research and highlighting the vast unmet need in its management. Areas covered: Advancement in the understanding of migraine pathophysiological mechanisms and identification of novel potentially meaningful targets have resulted in a multitude of emerging acute and preventive treatments. Here we review the known putative migraine pathophysiological mechanisms in order to understand the rationale of the most promising novel treatments targeting the Calcitonin-Gene-Related Peptide (CGRP) receptor and ligand and the 5 hydroxytryptamine (5-HT)1F receptor...
November 28, 2018: Expert Opinion on Emerging Drugs
Allison S Young, Sally M Rosengren, Miriam S Welgampola
Disorders of the inner-ear balance organs can be grouped by their manner of presentation into acute, episodic, or chronic vestibular syndromes. A sudden unilateral vestibular injury produces severe vertigo, nausea, and imbalance lasting days, known as the acute vestibular syndrome (AVS). A bedside head impulse and oculomotor examination helps separate vestibular neuritis, the more common and innocuous cause of AVS, from stroke. Benign positional vertigo, a common cause of episodic positional vertigo, occurs when otoconia overlying the otolith membrane falls into the semicircular canals, producing brief spells of spinning vertigo triggered by head movement...
2018: Handbook of Clinical Neurology
Paolo Martelletti, Maria Adele Giamberardino
Migraine is a common and highly disabling neurological disorder whose acute treatment remains problematic and unsatisfactory in a high percentage of cases. Consequently, there remains a need for new symptomatic therapies that can be easily handled by patients (i.e. by oral administration). Area covered: This review reports on compounds currently under development for the oral treatment of acute migraine attacks, focusing on Calcitonin-Gene-Related-Peptide receptor antagonists, specifically ubrogepant and rimegepant...
November 26, 2018: Expert Opinion on Pharmacotherapy
Anna Luisa Di Stefano, Giulia Berzero, François Ducray, Marica Eoli, Anna Pichiecchio, Lisa Maria Farina, Valeria Cuccarini, Marta Claudia Brunelli, Luca Diamanti, Stéphanie Condette Auliac, Andrea Salmaggi, Antonio Silvani, Bruno Giometto, Andrea Pace, Antonello Vidiri, Frederic Bourdain, Stefano Bastianello, Mauro Ceroni, Enrico Marchioni
BACKGROUND: Patients with history of brain radiotherapy can experience acute "stroke-like" syndromes related to the delayed effects of brain radiation, including "Stroke-like Migraine Attacks after Radiation Therapy (SMART)", "Peri-Ictal Pseudoprogression (PIPG)", and "Acute Late-onset Encephalopathy after Radiation Therapy (ALERT)" syndrome. The aim of this study is to collect evidence on the long-term outcome and treatment of these conditions, whose knowledge is undermined by their rarity and fragmented description...
November 24, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Rebecca Burch
Migraine is the most common cause of headache during pregnancy. Pregnancy increases risk for many causes of headache, including pathologic vascular processes. Headache associated with neurologic signs or symptoms or that is progressive and refractory to treatment; acute in onset; and severe, postural, or different from typical headaches should be evaluated. Work-up should include cerebral and cerebrovascular imaging and monitoring for hypertension. Acetaminophen is first-line symptomatic treatment during pregnancy, and evidence supports triptans rather than butalbital combination analgesics as second-line treatment...
February 2019: Neurologic Clinics
Bjørn Bjorvatn, Ståle Pallesen, Bente E Moen, Siri Waage, Espen Saxhaug Kristoffersen
OBJECTIVES: To investigate associations between different types of headaches and shift work. DESIGN, PARTICIPANTS AND OUTCOME MEASURES: Nurses with different work schedules (day work, two-shift rotation, night work, three-shift rotation) participated in a cohort study with annual surveys that started in 2008/2009. In 2014 (wave 6), a comprehensive headache instrument was included in the survey, in which 1585 nurses participated. Headaches were assessed according to the International Classification of Headache Disorders IIIb...
November 18, 2018: BMJ Open
Stephen D Silberstein, Alan M Rapoport, Pippa S Loupe, Ernesto Aycardi, Mirna McDonald, Ronghua Yang, Marcelo E Bigal
BACKGROUND: Migraine has a substantial impact on daily living, affecting productivity and quality of life for patients and their families. Patients frequently discontinue preventive medications in part because of a delay in headache and symptom relief due to the long dose titration procedures necessary for some migraine preventives. OBJECTIVE: To evaluate the efficacy of fremanezumab, a selective monoclonal CGRP ligand antibody, during the first 3 weeks of therapy in patients with high-frequency episodic migraine (HFEM) to relieve migraine headaches and associated symptoms and to reduce use of acute migraine medications...
November 18, 2018: Headache
Alexander Latev, Benjamin W Friedman, Eddie Irizarry, Clemencia Solorzano, Andrew Restivo, Andrew Chertoff, Eleftheria Zias, E John Gallagher
STUDY OBJECTIVE: Migraine patients continue to report headache during the days and weeks after emergency department (ED) discharge. Dexamethasone is an evidence-based treatment of acute migraine that decreases the frequency of moderate or severe headache within 72 hours of ED discharge. We hypothesize that intramuscular methylprednisolone acetate, a long-acting steroid that remains biologically active for 14 days, will decrease the number of days with headache during the week after ED discharge by at least 1 day compared with intramuscular dexamethasone...
November 15, 2018: Annals of Emergency Medicine
Denise E Chou, Marianna Shnayderman Yugrakh, Dana Winegarner, Vernon Rowe, Deena Kuruvilla, Jean Schoenen
OBJECTIVE: To assess the safety and efficacy of external trigeminal nerve stimulation for acute pain relief during migraine attacks with or without aura via a sham-controlled trial. METHODS: This was a double-blind, randomized, sham-controlled study conducted across three headache centers in the United States. Adult patients who were experiencing an acute migraine attack with or without aura were recruited on site and randomly assigned 1:1 to receive either verum or sham external trigeminal nerve stimulation treatment (CEFALY Technology) for 1 hour...
November 17, 2018: Cephalalgia: An International Journal of Headache
Nazia Karsan, Peter J Goadsby
Migraine is a common neurological disorder with a diverse clinical phenotype that comprises more than just head pain. Premonitory (prodromal) symptoms can start hours to days before the onset of a migraine headache and can predict its onset in some individuals. Such symptomatology can include lethargy, yawning, light and sound sensitivity, thirst and cravings. This earliest phase of the migraine attack provides valuable insights into the neurobiology of the disorder, furthering our understanding of how and why these phenotypically heterogeneous symptoms are mediated...
December 2018: Nature Reviews. Neurology
Marika Heblinski, Christopher Bladen, Mark Connor
BACKGROUND AND PURPOSE: Serotonin 5-HT1B receptors are widely expressed G protein-coupled receptors and a target of triptans, the most commonly prescribed anti-migraine drugs. There is very limited information about the acute, agonist-induced regulation of 5-HT1B receptor signalling and so we sought to characterize this in a neuron-like system. EXPERIMENTAL APPROACH: Epitope-tagged human 5-HT1B receptors were expressed in mouse AtT20 cells. 5-HT1B receptor signalling was assessed using whole-cell patch-clamp recordings of endogenous G protein-gated inwardly rectified K channels (GIRK), and receptor localization measured using immunofluorescence...
November 16, 2018: British Journal of Pharmacology
Bernice Kuca, Stephen D Silberstein, Linda Wietecha, Paul H Berg, Gregory Dozier, Richard B Lipton
OBJECTIVE: To assess the efficacy and safety of lasmiditan in the acute treatment of migraine. METHODS: Adult patients with migraine were randomized (1:1:1) to a double-blind dose of oral lasmiditan 200 mg, lasmiditan 100 mg, or placebo and were asked to treat their next migraine attack within 4 hours of onset. Over 48 hours after dosing, patients used an electronic diary to record headache pain and the presence of nausea, phonophobia, and photophobia, one of which was designated their most bothersome symptom (MBS)...
November 16, 2018: Neurology
Ashley R Etchison, Lia Bos, Meredith Ray, Kelly B McAllister, Moiz Mohammed, Barrett Park, Allen Vu Phan, Corey Heitz
Introduction: Patients frequently present to the emergency department (ED) with migraine headaches. Although low-dose ketamine demonstrates analgesic efficacy for acute pain complaints in the ED, headaches have historically been excluded from these trials. This study evaluates the efficacy and safety of low-dose ketamine for treatment of acute migraine in the ED. Methods: This randomized, double-blinded, placebo-controlled trial evaluated adults 18 to 65 years of age with acute migraine at a single academic ED...
November 2018: Western Journal of Emergency Medicine
Luana Mazzacoratti Loeb, Rebeca Padrão Amorim, Maria da Graça Naffah Mazzacoratti, Fulvio Alexandre Scorza, Mario Fernando Prieto Peres
OBJECTIVE: The aim of this work was to evaluate patients with chronic migraine treated with botulinum toxin A (BT-A) and compare this with low level laser therapy (LLLT), referencing: pain days, pain intensity, intake of drugs/self-medication, anxiety and sleep disorders. METHODS: Patients were randomized into two groups: BT-A group (n = 18) and LLLT group (n = 18). Each patient kept three pain diaries: one before (baseline) (30 days), one during treatment (30 days) and one after the post-treatment phase (30 days)...
October 2018: Arquivos de Neuro-psiquiatria
Hulya Karatas, Muge Yemisci, Emine Eren-Kocak, Turgay Dalkara
The realization of the importance of growth factors in adult CNS led to several studies investigating their roles in neuropsychiatric disorders. Based on the observations that chronic stress decreases brain-derived neurotrophic factor (BDNF) and antidepressant treatments reverse BDNF to normal levels, "neurotrophic hypothesis of depression" was proposed. Subsequent studies found that several other growth factors, including fibroblast growth factor (FGF), vascular endothelial growth factor, nerve growth factor were also decreased by chronic stress...
November 11, 2018: Current Pharmaceutical Design
Chia-Cheng Hsu, Shih-Hung Tsai, Jen-Chun Wang, Hung-Wen Kao, Chin-Wang Hsu, Wei-Hsiu Liu, Sy-Jou Chen
A ruptured cavernous carotid aneurysm (CCA) with carotid cavernous fistula can appear as a benign headache but progress to a swollen and bloodshot eye overnight. A 66-year-old woman visited emergency department with sudden onset of pain behind her left forehead and vomiting. She was treated for a migraine-like headache and discharged. She presented again on the next day with a persistent headache and a swollen left eye with blurred vision. An ophthalmologic examination revealed erythema of the left lid and chemosis at the temporal and lower bulbar conjunctiva...
November 7, 2018: American Journal of Emergency Medicine
Sheridan M Hoy
Fremanezumab-vfrm (hereafter referred to as fremanezumab) [AJOVY™] is a fully humanized monoclonal antibody (IgG2Δa) developed by Teva Pharmaceuticals to selectively target calcitonin gene-related peptide (a vasodilatory neuropeptide involved in the pathophysiology of migraine). Its use has been associated with significant reductions in migraine frequency, the requirement for acute headache medication use and headache-related disability compared with placebo in multinational, phase III studies, and in September 2018 fremanezumab was approved by the US FDA for the preventive treatment of migraine in adults...
November 8, 2018: Drugs
Mahtab Ramezani, Zahra Sahraei, Leila Simani, Kamran Heydari, Farzad Shahidi
BACKGROUNDS AND AIMS: Clinical studies demonstrated that the efficacy of Coenzyme Q10 (CoQ10) as an adjuvant therapeutic agent in several neurological diseases such as Parkinson disease (PD), Huntington disease (HD), and migraine. The purpose of this study is to investigate oxidative stress effects, antioxidant enzymes activity, neuroinflammatory markers levels, and neurological outcome in acute ischemic stroke (AIS) patients following administration of CoQ10 (300 mg/day). METHODS: Patients with AIS (n = 60) were randomly assigned to a placebo group (wheat starch, n = 30) or CoQ10-supplemented group (300 mg/day, n = 30)...
November 7, 2018: Nutritional Neuroscience
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