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Acute Migraine

Dalila Masic, Edith Liang, Christina Long, Ethan J Sterk, Brian Barbas, Megan A Rech
The purpose of this systematic review is to evaluate the safety and efficacy of intravenous (IV) lidocaine for the treatment of acute pain in adult patients. The PubMed database was searched for randomized controlled trials, retrospective cohort studies, case series, and case reports evaluating use of IV lidocaine for the treatment of acute pain in adult patients, published between January 1970 and January 2018. The primary outcome was pain reduction via Visual Analog Scale, Verbal Rating Scale, or Numeric Rating Scale among patients treated with IV lidocaine and placebo or active controls...
October 10, 2018: Pharmacotherapy
Caterina Stafuzza, Theodore Landis, Jean-Philippe Guyot
Palinopsia is defined as the persistence or reappearance of images after cessation of the visual stimulus. One patient presented episodes of palinopsia after the functional loss of the 3 semicircular canals of the right ear while the otolithic function was preserved. None of classical causes was identified in this patient, intoxications, brain tumors, migraines, psychiatric disorders, etc. For a movement to be perceived as a single event, central processes of temporal integration are necessary to correct the shift between the rapid vestibular information, and the slow visual information...
2018: Frontiers in Neurology
Angeliki Vgontzas, Rebecca Burch
PURPOSE OF REVIEW: To review the pathophysiologic, epidemiologic, and clinical evidence for similarities and differences between migraine with and without aura. RECENT FINDINGS: The ICHD-3 has recently refined the diagnostic criteria for aura to include positive symptomatology, which better differentiates aura from TIA. Although substantial evidence supports cortical spreading depression as the cause of visual aura, the role (if any) of CSD in headache pain is not well understood...
October 5, 2018: Current Pain and Headache Reports
Krishna Chinthapalli, Anne-Marie Logan, Rohit Raj, Niranjanan Nirmalananthan
Headache is common. Up to 5% of attendances to emergency departments and acute medical units are due to headache. Headache is classified as either primary (eg migraine, cluster headache) or secondary to another cause (eg meningitis, subarachnoid haemorrhage). Even in the acute setting the majority of cases are due to primary causes. The role of the attending physician is to take a comprehensive history to diagnose and treat benign headache syndromes while ruling out sinister aetiologies. This brief article summarises the approach to assessment of headache presenting in acute and emergency care...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Kelsey M Nation, David W Dodick, Edita Navratilova, Frank Porreca
Background Loss of conditioned pain modulation/diffuse noxious inhibitory controls has been demonstrated in patients with migraine and medication overuse headache. We hypothesized that exposure to acute migraine medications may lead to dysregulation of central pain modulatory circuits that could be revealed by evaluating diffuse noxious inhibitory controls and that prior noxious stimulus is required for a loss of the diffuse noxious inhibitory control response in rats exposed to these medications. Methods Rats were "primed" by continuous infusion of morphine or one of two doses of sumatriptan...
October 4, 2018: Cephalalgia: An International Journal of Headache
Duygu Özer, Cem Bölük, Ülkü Türk Börü, Deniz Altun, Mustafa Taşdemir, Cansu Köseoğlu Toksoy
OBJECTIVE: Nerve injections have been used for the acute and preventive treatment of migraine in recent decades. Most of these injections focused on greater occipital nerve (GON) blockade. However, few studies were placebo controlled and only a few of them investigated GON and supraorbital nerve (SON) blockade together. We aimed to evaluate the efficacy of GON and SON blockade with local anaesthetics for the preventive treatment of migraine without aura. METHODS: 87 patients diagnosed with migraine without aura, were included in the study...
October 4, 2018: Current Medical Research and Opinion
Paul Bates
Paul Bates, Senior Lecturer/Advanced Nurse Practitioner, University of Lincoln, , explains the most common symptoms, triggers and treatments of migraine, and the role of the nurse in patient care.
October 4, 2018: British Journal of Nursing: BJN
Vasant Chinnabhandar, Amitabh Singh, Anirban Mandal, B J Parmar
Background: Hemiplegia/hemiparesis denotes the weakness of one side of the body. In contrast to adults, hemiparesis in children occurs secondary to a variety of etiological conditions. Aims: The aim of this study was to assess the clinical, laboratory, and radiological features of children with acquired hemiparesis/hemiplegia of nontraumatic origin and intended to find its underlying etiology in the Indian children. Settings and Design: This prospective, observational study was carried out at a tertiary care hospital in western India...
October 2018: Journal of Neurosciences in Rural Practice
Stewart J Tepper
Objective - To briefly describe the history of and available data on anti-calcitonin gene-related peptide (CGRP) therapies for headache. Background - CGRP was proposed as a target for primary headache therapies. Translational research involved moving from delineating the relationships between CGRP and primary headaches and the clinical development of anti-CGRP treatments. The first anti-CGRP treatment, an intravenous CGRP-receptor antagonist or gepant, olcegepant, was described as effective in terminating migraines in humans in 2004...
September 22, 2018: Headache
Valeria De Giuli, Francesca Graziano, Andrea Zini, Marialuisa Zedde, Rosalba Patella, Corrado Lodigiani, Simona Marcheselli, Maria Luisa DeLodovici, Maurizio Paciaroni, Ilaria Casetta, Elisa Giorli, Alessandro Adami, Massimiliano Braga, Carmela Casella, Alessia Giossi, Giorgio Silvestrelli, Lucia Tancredi, Enrico Maria Lotti, Loris Poli, Filomena Caria, Valeria Piras, Laura Cucurachi, Massimo Gamba, Mario Grassi, Alessandro Padovani, Alessandro Pezzini
OBJECTIVE: Whether migraine modifies after spontaneous cervical artery dissection (sCeAD) more than after other stroke etiologic subtypes has never been adequately investigated. METHODS: In the setting of the Italian Project on Stroke in Young Adults (IPSYS), we compared the course of migraine before and after acute brain infarct in a group of migraine patients with sCeAD and a group of migraine patients whose ischemia was due to a cause other than CeAD (non-CeAD IS), matched by sex, age (± 3 years), and migraine subtype...
September 21, 2018: Neurological Sciences
D García-Azorin, N Yamani, L M Messina, I Peeters, M Ferrili, D Ovchinnikov, M L Speranza, V Marini, A Negro, S Benemei, M Barloese
BACKGROUND: Primary headache are prevalent and debilitating disorders. Acute pain cessation is one of the key points in their treatment. Many drugs have been studied but the design of the trials is not usually homogeneous. Efficacy of the trial is determined depending on the selected primary endpoint and usually other different outcomes are measured. We aim to critically appraise which were the employed outcomes through a systematic review. METHODS: We conducted a systematic review of literature focusing on studies on primary headache evaluating acute relief of pain, following the PRISMA guideline...
September 21, 2018: Journal of Headache and Pain
Hubert de Boysson, Jean-Jacques Parienti, Jérôme Mawet, Caroline Arquizan, Grégoire Boulouis, Cécilia Burcin, Olivier Naggara, Mathieu Zuber, Emmanuel Touzé, Achille Aouba, Marie-Germaine Bousser, Christian Pagnoux, Anne Ducros
OBJECTIVES: To further improve the distinction between primary angiitis of the CNS (PACNS) and reversible cerebral vasoconstriction syndrome (RCVS). METHODS: We compared 2 large French cohorts of patients with PACNS (n = 110, retrospectively and prospectively enrolled) and RCVS (n = 173, prospectively enrolled). RESULTS: Patients with RCVS were predominantly female ( p < 0.0001), with migraines ( p < 0.0001), and were more often exposed to vasoactive substances ( p < 0...
September 19, 2018: Neurology
Michail Vikelis, Andreas A Argyriou, Emmanouil V Dermitzakis, Konstantinos C Spingos, Nikolaos Makris, Evangelia Kararizou
BACKGROUND: Evidence on whether the therapeutic effect and good safety profile of onabotulinumtoxinA (Botox®) in chronic migraine (CM) patients is maintained over long term treatment is still limited. We herein aimed at assessing whether there is a sustained benefit and good safety with repeated onabotulinumtoxinA sessions in CM over more than three years of treatment. METHODS: We prospectively enrolled 65 CM patients, who were classified as responders after three sessions of onabotulinumtoxinA and were eligible to further continue treatment...
September 17, 2018: Journal of Headache and Pain
László Vécsei, Délia Szok, Aliz Nyári, János Tajti
Migraine is a disabling primary headache disorder with unknown exact pathomechanism. Status migrainosus (SM) is a complication of migraine (with or without aura), representing an attack that lasts for more than 72 h. There is a paucity of data published with regard to its pathomechanism and therapeutic options. Areas covered: The authors review the literature on SM from PubMed published between 1999 and January 2018. The authors specifically look at the therapeutic possibilities of SM in the emergency department in patients that have or have not already been treated with serotonergic agents...
September 10, 2018: Expert Opinion on Pharmacotherapy
In-Sik Kang, Jin-Hwa Cho, Maan-Gee Lee, Il-Sung Jang
Migraine is characterized by recurrent and disabling headaches; therefore, several drugs have been widely prescribed to prevent acute migraine attacks. Amitriptyline, a tricyclic antidepressant, is among the most commonly administered. It is poorly known, however, whether amitriptyline modulates the excitability of dural afferent neurons that transmit pain signals from the dura mater. In this study, the effects of amitriptyline on tetrodotoxin-resistant (TTX-R) Na+ channels were examined in acutely isolated rat dural afferent neurons, which were identified by the fluorescent dye DiI...
September 5, 2018: European Journal of Pharmacology
Heidi K Blume
PURPOSE OF REVIEW: Headache following concussion and mild traumatic brain injury is very common in pediatrics. There is significant concern about appropriate management of acute and persistent headache following mild head injuries in children among affected youth, their families and care providers. RECENT FINDINGS: The current article will review definitions and diagnoses of posttraumatic headache (PTHA), recent research regarding risk factors for persistence of postconcussion symptoms and headaches, current recommendations for the evaluation of youth with PTHA, recent data regarding efficacy of treatment options for PTHA, and current recommendations for the treatment of acute and persistent PTHA...
September 3, 2018: Current Opinion in Pediatrics
Marleen L Duizer, Rick Hermsen, Tomas Te Boekhorst, Sven Janssen
BACKGROUND: Crowned dens syndrome (CDS) is a rare cause of acute headache and neck pain, which is accompanied by fever and a stiff neck. It is caused by calcium deposits (pseudogout) around the dens axis (C2). CASE DESCRIPTION: A 61-year-old woman, with a history of migraine and of breast cancer 8 years previously, was referred to the accident and emergency department of our hospital with acute headache and neck pain. She was treated in the department with prednisone, on suspicion of giant-cell arteritis...
July 27, 2018: Nederlands Tijdschrift Voor Geneeskunde
Yuhan Zhu, Yanyan Liu, Jing Zhao, Qingqing Han, Lei Liu, Xiaoxu Shen
OBJECTIVE: This meta-analysis was performed to evaluate the efficacy and safety of monoclonal antibodies against calcitonin gene-related peptide (CGRP) for episodic migraine prevention. METHODS: MEDLINE, EMBASE, Web of Science, and the Cochrane Library were searched from inception to April 2018. Studies considered to be eligible were randomized controlled trials about efficacy and safety of calcitonin gene-related peptide monoclonal antibody for episodic migraine prevention...
September 4, 2018: Neurological Sciences
Vivien Min Er Lee, Lai Lai Ang, Derek Tuck Loong Soon, Jonathan Jia Yuan Ong, Victor Weng Keong Loh
Headaches are common in primary care. For safe assessment and management of the patient with headache, a focused history and physical examination are important to identify secondary headache, and find out whether an immediate referral to the emergency department or a non-emergent referral to the neurologist is warranted. The majority of patients with primary headache may be safely managed in the outpatient setting. Key steps include proper categorisation of the primary headache, attention to lifestyle and psychosocial factors, prescription of analgesics for acute pain relief, and the use of preventive medication when indicated...
August 2018: Singapore Medical Journal
A Zwergal, V Kirsch, J Gerb, J Dlugaiczyk, S Becker-Bense, M Dieterich
Vertigo and dizziness are frequent chief complaints in clinical practice. Symptoms may originate from otological, neurological, medical and psychiatric etiologies, which poses an interdisciplinary challenge. Systematic analysis of case history and clinical examination generally allow classification into peripheral-, central- or non-vestibular disorders. The most important criteria for differentiation are the timeline, quality of symptoms, modulating factors and accompanying symptoms. As concerns the clinical examination, the following tests are relevant: head impulse test, test for spontaneous nystagmus, positional nystagmus, central ocular motor signs and the Romberg test...
August 30, 2018: Der Nervenarzt
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