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Migraine treatment emergency

Ying Fan, Min Chen, Jinqiang Zhang, Philippe Maincent, Xuefeng Xia, Wen Wu
Intranasal drug delivery is emerging as a reliable and promising pathway to deliver a wide range of therapeutic agents including small and large molecules, peptides and proteins, genes to the central nervous system for the treatment of brain diseases such as Alzheimer's disease, Parkinson's disease, depression, migraine, schizophrenia, and glioma. This presents noninvasive entry into the brain via direct nose-to-brain and/or indirect nose-to-blood-to-brain routes. Several nanocarrier-based strategies have been developed to transport therapeutic agents to the brain including nanoparticles, liposomes, and exosomes following intranasal delivery...
2018: Critical Reviews in Therapeutic Drug Carrier Systems
Simy K Parikh
PURPOSE OF REVIEW: Migraine is a disabling and prevalent neurological disease, commonly affecting women during their reproductive years. It is crucial for providers to be able to adequately counsel women who are pregnant, planning pregnancy, or nursing, regarding preventive and abortive treatment options for episodic migraine. This review will discuss (1) the expected course of migraine during pregnancy and the post-partum period, (2) recommended preventive therapies for migraine during pregnancy and lactation, and (3) recommended abortive medications for migraine during pregnancy and lactation...
October 5, 2018: Current Pain and Headache Reports
Lisa Gfrerer, Edoardo Raposio, Ricardo Ortiz, William Gerald Austen
Understanding the history and evolution of ideas is key to developing an understanding of complex phenomena and is the foundation for surgical innovation. This historical review on migraine surgery takes us back to the beginnings of interventional management for migraine centuries ago, and reflects on present practices to highlight how far we have come. From Al-Zahrawi and Ambroise Paré to Bahman Guyuron, two common themes of the past and present have emerged in the treatment of migraine headache. Extracranial treatment of both nerves and vessels is being performed and analyzed, with no consensus among current practitioners as to which structure is involved...
October 2018: Plastic and Reconstructive Surgery
Ilana S Lendvai, Ayline Maier, Dirk Scheele, Rene Hurlemann, Thomas M Kinfe
Objectives: Cervical noninvasive vagus nerve stimulation (nVNS) emerged as an adjunctive neuromodulation approach for primary headache disorders with limited responsiveness to pharmacologic and behavioral treatment. This narrative review evaluates the safety and efficacy of invasive and noninvasive peripheral nerve stimulation of the cervical branch of the vagal nerve (afferent properties) for primary headache disorders (episodic/chronic migraine [EM/CM] and cluster headache [ECH/CCH]) and provides a brief summary of the preclinical data on the possible mechanism of action of cervical vagus nerve stimulation (VNS) and trigemino-nociceptive head pain transmission...
2018: Journal of Pain Research
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
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
Michael Ruzek, Peter Richman, Barnet Eskin, John R Allegra
STUDY OBJECTIVES: Numerous studies have shown benefits of nonnarcotic treatments for emergency department (ED) migraine patients. Our goal was to determine if ED treatment of migraine patients and the rate of return within 72 h have changed. METHODS: Design: Multi-hospital retrospective cohort. POPULATION: Consecutive ED patients from 1-1-1999 to 9-31-2014. PROTOCOL: For determining treatments, we examined charts at the beginning (1999-2000) and end (2014) of the time period...
August 20, 2018: American Journal of Emergency Medicine
Kewan Hamid, Neha Dayalani, Muhammad Jabbar, Elna Saah
A 6-year-old female presented with chronic intermittent abdominal pain for 1 year. She underwent extensive investigation, imaging and invasive procedures with multiple emergency room visits. It caused a significant distress to the patient and the family with multiple missing days at school in addition to financial burden and emotional stress the child endured. When clinical picture was combined with laboratory finding of macrocytic anemia, a diagnosis of hypothyroidism was made. Although chronic abdominal pain in pediatric population is usually due to functional causes such as irritable bowel syndrome, abdominal migraine and functional abdominal pain...
2018: Endocrinology, Diabetes & Metabolism Case Reports
Benjamin W Friedman, Sajid Mohamed, Matthew S Robbins, Eddie Irizarry, Valerie Tarsia, Scott Pearlman, E John Gallagher
BACKGROUND: Greater occipital nerve block (GONB) is thought to be an effective treatment for acute migraine, though no randomized efficacy data have been published for this indication. We hypothesized that bilateral GONB with bupivacaine would provide greater rates of headache freedom than a sham injection among a population of emergency department (ED) patients who reported persistence of moderate or severe headache despite standard treatment with intravenous metoclopramide. METHODS: This was a randomized clinical trial conducted in 2 urban EDs...
August 25, 2018: Headache
Welton O'Neal, Elizabeth E Hur, Tesfaye Liranso, Barry Patel
AIM: Examine clinical profile of extended-release topiramate (Trokendi XR® ) and compare treatment-emergent adverse events (TEAEs) associated with Trokendi XR versus previous immediate-release topiramate (TPM-IR) treatment. PATIENTS & METHODS: Pilot retrospective study analyzing data extracted from medical charts of patients ≥6 years of age prescribed Trokendi XR. RESULTS: Trokendi XR was the most commonly used to prevent migraine...
August 23, 2018: Journal of Comparative Effectiveness Research
Chiara Scaratti, Venusia Covelli, Erika Guastafierro, Matilde Leonardi, Licia Grazzi, Paul B Rizzoli, Domenico D'Amico, Alberto Raggi
BACKGROUND: It is common clinical experience that, after structured withdrawal, some patients with chronic migraine and medication overuse headache (CM with MOH) are more prone than others to relapse and to be in need of further structured treatments. Our aim was to explore similarities and differences between frequent relapsers (FRs) and non-frequent relapsers (NFRs) by considering their point of view, perceptions, and perspective of their subjective experience with relapse into CM with MOH...
August 20, 2018: Headache
Stephen Landy, Sagar Munjal, Elimor Brand-Schieber, Alan M Rapoport
BACKGROUND: In a previous randomized, double-blind, proof-of-concept study in rapidly escalating migraine, a 3 mg dose of subcutaneous sumatriptan (DFN-11) was associated with fewer and shorter triptan sensations than a 6 mg dose. The primary objective of the study was to assess the efficacy and safety of acute treatment with DFN-11 compared with placebo in episodic migraine. METHODS: This was a multicenter, randomized, double-blind, placebo-controlled efficacy and safety study of DFN-11 in the acute treatment of adults with episodic migraine (study RESTOR)...
August 15, 2018: Journal of Headache and Pain
Stephen Landy, Sagar Munjal, Elimor Brand-Schieber, Alan M Rapoport
BACKGROUND: DFN-11, a 3 mg sumatriptan subcutaneous (SC) autoinjector for acute treatment of migraine, has not been assessed previously in multiple attacks. The objective of this study was to evaluate the efficacy, tolerability, and safety of DFN-11 in the acute treatment of multiple migraine attacks. METHODS: This was an 8-week open-label extension of multicenter, randomized, double-blind, placebo-controlled US study. Subjects averaging 2 to 6 episodic migraine attacks per month were randomized to DFN-11 or placebo to treat a single attack of moderate-to-severe intensity and then entered the extension study to assess the efficacy, tolerability, and safety of DFN-11 in multiple attacks of any pain intensity...
August 15, 2018: Journal of Headache and Pain
Domenico D'Amico, Emanuela Sansone, Licia Grazzi, Ambra M Giovannetti, Matilde Leonardi, Silvia Schiavolin, Alberto Raggi
OBJECTIVES: Patients with chronic migraine (CM) display a considerable amount of comorbidities, particularly psychiatric and cardiovascular, and the presence of multiple comorbidities, that is, the so-called multimorbidity, is a risk factor for migraine chronification or maintenance of CM. Our aim was to address the rate and impact of multimorbidity in patients with CM and medication overuse headache (MOH). MATERIALS & METHODS: In a sample of patients with CM attending a structured withdrawal for coexisting MOH, we defined multimorbidity as the presence of two or more conditions in addition to CM-MOH...
August 14, 2018: Acta Neurologica Scandinavica
Clément Verkest, Emilie Piquet, Sylvie Diochot, Mélodie Dauvois, Michel Lanteri-Minet, Eric Lingueglia, Anne Baron
BACKGROUND AND PURPOSE: Acid-sensing ion channels (ASICs) are neuronal proton sensors emerging as potential therapeutic targets in pain of the orofacial region. Amiloride, a non-specific ASIC blocker, has been shown to exert beneficial effects in animal models of migraine and in patients. We explored the involvement of the ASIC1-subtype in cutaneous allodynia, a hallmark of migraine affecting cephalic and extra-cephalic regions in about 70% of migrainers. EXPERIMENTAL APPROACH: We investigated the effects of systemic injections of amiloride and mambalgin-1, a specific inhibitor of ASIC1a- and ASIC1b-containing channels, on cephalic and extra-cephalic mechanical sensitivity in a rodent model of acute and chronic migraine induced by i...
November 2018: British Journal of Pharmacology
Matthew S Robbins
PURPOSE OF REVIEW: Headache disorders are extraordinarily common and disproportionately impact women of childbearing age. This article reviews the importance of proper diagnosis, natural history, and management of headache disorders in pregnant and postpartum women. RECENT FINDINGS: Red flags for secondary headache specifically among pregnant women include elevated blood pressure and lack of a previous headache history, as well as a prolonged duration of the headache attack in those with a prior history of migraine...
August 2018: Continuum: Lifelong Learning in Neurology
Michael J Marmura, Aliza S Kumpinsky
Anti-epileptic drugs are among the most effective drugs for migraine prophylaxis, and will likely continue to have a role even as new therapies emerge. Topiramate and valproate are effective for the preventive treatment of migraine, and other medications such as gabapentin or lamotrigine may have a role in the treatment of those with allodynia or frequent aura, respectively. Oxcarbazepine, carbamazepine, phenytoin, gabapentin, and others may alleviate pain in trigeminal neuralgia. While many anti-epileptic drugs can be effective in those with migraine or other headaches, most of these agents can potentially cause serious side effects...
August 2018: CNS Drugs
Calli Cook, Brittany Newberry
The Research to Practice Column is designed to improve translational research critique skills of nurse practitioners (NPs). In this issue, the article "Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine" is discussed in the context of a patient with an acute headache presenting to the emergency department (ED). The study was designed to assess the efficacy of intravenous prochlorperazine and diphenhydramine as compared with intravenous hydromorphone for patients with acute migraine in the ED...
July 2018: Advanced Emergency Nursing Journal
Janet H Ford, Krista Schroeder, Allen W Nyhuis, Shonda A Foster, Sheena K Aurora
BACKGROUND: Migraine is a common and disabling neurological disease associated with substantial economic burden. Among patients with migraine, it is unknown if cost differences exist when preventive migraine medication (PMM) switches occur. OBJECTIVE: To understand the cost burden and health care resource utilization of patients who discontinue or cycle through 1 (PMM1), 2 (PMM2), or ≥ 3 (PMM3) unique PMM drug classes over a 12-month period versus patients who adhere persistently to their initial PMM class...
July 25, 2018: Journal of Managed Care & Specialty Pharmacy
Kate W Grimsrud, Rashmi B Halker Singh
PURPOSE OF REVIEW: The purpose of this review is to evaluate and describe recent and emerging treatment options for episodic migraine. RECENT FINDINGS: Recent advances have been made in better understanding the pathophysiology of migraine, which has led to further investigation of potential new pharmacologic and non-pharmacologic treatment options. A number of new medications are emerging for the acute and preventive treatment of migraine, including CGRP monoclonal antibodies, CGRP receptor antagonists, serotonin 5-HT1F agonists, and PACAP receptor monoclonal antibodies...
July 16, 2018: Current Pain and Headache Reports
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