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Migraine treatment emergency

Laura S Moye, Alycia F Tipton, Isaac Dripps, Zoie Sheets, Aimee Crombie, Jonathan D Violin, Amynah A Pradhan
Headaches are highly disabling and are among the most common neurological disorders worldwide. Despite the high prevalence of headache, therapeutic options are limited. We recently identified the delta opioid receptor (DOR) as an emerging therapeutic target for migraine. In this study, we examined the effectiveness of a hallmark DOR agonist, SNC80, in disease models reflecting diverse headache disorders including: chronic migraine, post-traumatic headache (PTH), medication overuse headache by triptans (MOH), and opioid-induced hyperalgesia (OIH)...
December 13, 2018: Neuropharmacology
(no author information available yet)
OBJECTIVE: To provide healthcare professionals with updated guidance in the use of novel preventive and acute treatments for migraine in adults. BACKGROUND: The principles of preventive and acute pharmacotherapy for patients with migraine have been outlined previously, but the emergence of new technologies and treatments, as well as new formulations of previously established treatments, has created a need for an updated guidance on the preventive and acute treatment of migraine...
December 10, 2018: Headache
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
Tad Seifert
Concussion and migraine share many similar pathophysiologic mechanisms, including cortical spreading depression and failure in brain ion homeostasis. Migraine may predispose to concussion, and migraine and posttraumatic headache are common following concussion. This overlap may interfere with proper diagnosis following sport injury, thereby delaying either appropriate treatment or return-to-play. Posttraumatic headache is the most common symptom following concussion, and although symptoms are indistinguishable from migraine, persistent posttraumatic headache may be a unique entity that is more refractory to traditional headache management...
2018: Handbook of Clinical Neurology
Paolo Martelletti, Todd J Schwedt, Michel Lanteri-Minet, Rebeca Quintana, Veruska Carboni, Hans-Christoph Diener, Elena Ruiz de la Torre, Audrey Craven, Annette Vangaa Rasmussen, Simon Evans, Annik K Laflamme, Rachel Fink, Donna Walsh, Paula Dumas, Pamela Vo
BACKGROUND: Migraine is associated with many debilitating symptoms that affect daily functioning. My Migraine Voice is a large global cross-sectional study aimed at understanding the full burden and impact of migraine directly from patients suffering from ≥4 monthly migraine days (MMDs) with a history of prophylactic treatment failure. METHODS: This study was conducted worldwide (31 countries across North and South Americas, Europe, the Middle East and Northern Africa, and the Asia-Pacific region) using an online survey administered to adults with migraine who reported ≥4 MMDs in the 3 months preceding survey administration, with pre-specified criteria of 90% having used preventive migraine treatment (80% with history of ≥1 treatment failure)...
November 27, 2018: Journal of Headache and Pain
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
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
Holland C Detke, Peter J Goadsby, Shufang Wang, Deborah I Friedman, Katherine J Selzler, Sheena K Aurora
OBJECTIVE: To evaluate the efficacy and safety of galcanezumab, a humanized monoclonal antibody that selectively binds to calcitonin gene-related peptide, in the preventive treatment of chronic migraine. METHODS: A phase 3, randomized, double-blind, placebo-controlled study of LY2951742 in patients with chronic migraine (Evaluation of Galcanezumab in the Prevention of Chronic Migraine [REGAIN]) was a phase 3 study with a 3-month double-blind, placebo-controlled treatment phase and a 9-month open-label extension...
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
Uwe Reuter, Peter J Goadsby, Michel Lanteri-Minet, Shihua Wen, Peggy Hours-Zesiger, Michel D Ferrari, Jan Klatt
BACKGROUND: A substantial proportion of patients with migraine does not respond to, or cannot tolerate, oral preventive treatments. Erenumab is a novel CGRP-receptor antibody with preventive efficacy in migraine. We assessed its efficacy and tolerability in patients with episodic migraine in whom previous treatment with two-to-four migraine preventives had been unsuccessful. METHODS: LIBERTY was a 12-week, double-blind, placebo-controlled randomised study at 59 sites in 16 countries...
November 24, 2018: Lancet
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...
October 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...
October 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
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