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Professional Abstracts
This page contains abstracts of technical articles, and is intended for physicians and other medical professionals.
Table of Contents
Migraine: current therapeutic targets and future avenues
Motion sickness in migraine sufferers
Migraine and stroke--why do we talk about it?
Epilepsy and migraine headache: is there a connection?
The pharmacological treatment options for pediatric migraine: an evidence-based appraisal
Migraine headache prophylaxis: current options and advances on the horizon
Prodromes and predictors of migraine attack
Chronic disorders with episodic manifestations: focus on epilepsy and migraine
Infrequent or non-response to oral sumatriptan does not predict response to other triptans--review of four trials
Symptoms of premenstrual syndrome and their association with migraine headache
What are effective medical treatments for adults with acute migraine?
Effects of a Website designed to improve the management of migraines
Migraine: current therapeutic targets and future avenues
Arulmozhi DK, Veeranjaneyulu A, Bodhankar SL.
New Chemical Entity Research, Lupin Research Park, Village Nande, Taluk Mulshi, Pune, Maharashtra, India. adk_bits@yahoo.com
Migraine is characterized by attacks of intense pulsatile and throbbing headache, typically unilateral in nature with or without aura. Migraine affects a substantial fraction (10-20 %) of the world population (more women than men). With regard to the pathophysiology of migraine, several theories have been proposed; the major three are vascular (due to cerebral vasodilatation), neurological (abnormal neurological firing) and neurogenic dural inflammation (release of inflammatory neuropeptides). The drugs used to treat migraine can be divided into two groups: agents that abolish the acute migraine headache and agents aimed at prevention. The acutely acting antimigraine agents (5-HT(1B/1D) receptor agonists) stimulated research interest in the field of migraine. Currently prophylactic treatments for migraine include calcium channel blockers, 5-HT(2) receptor antagonists, beta-adrenoceptor blockers and gamma-amino butyric acid (GABA) agonists. Unfortunately, many of these treatments are non-specific and not always effective. Despite progress, the complex etiology of migraine requires further research, the condition often remains undiagnosed and available therapies are underused. In this review, the evidence that linked the different theories of migraine with its pathophysiology is considered. Furthermore, the present therapeutic targets and future approaches for the acute and prophylactic treatment of migraine are critically evaluated.
Publication Types:
• Review
PMID: 16611154 [PubMed - indexed for MEDLINE]
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Motion sickness in migraine sufferers
Marcus DA, Furman JM, Balaban CD.
Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15206, USA. MarcusD@anes.upmc.edu
Motion sickness commonly occurs after exposure to actual motion, such as car or amusement park rides, or virtual motion, such as panoramic movies. Motion sickness symptoms may be disabling, significantly limiting business, travel and leisure activities. Motion sickness occurs in approximately 50% of migraine sufferers. Understanding motion sickness in migraine patients may improve understanding of the physiology of both conditions. Recent literature suggests important relationships between the trigeminal system and vestibular nuclei that may have implications for both motion sickness and migraine. Studies demonstrating an important relationship between serotonin receptors and motion sickness susceptibility in both rodents and humans suggest possible new motion sickness prevention therapies.
PMID: 16316307 [PubMed - in process]
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Migraine and stroke--why do we talk about it?
Lampl C, Marecek S.
Department of Neurology and Psychiatry, Pain and Headache Center, Linz General Hospital, Linz, Austria. christian.lampl@akh.linz.at
Data from observational studies suggest that migraine may be a risk factor for stroke. Furthermore, a significant association between migraine and ischemic stroke (IS) has been demonstrated in population and case-control studies. The risk of IS appears to be higher for migraine with aura than for migraine without aura. The pathogenesis is not known but several studies report some common biochemical mechanisms in the two diseases. Meta-analysis also demonstrates that subjects with migraine are at higher risk of showing white matter abnormalities on magnetic resonance images than are those without migraine.
Publication Types:
* Review
PMID: 16618335 [PubMed - indexed for MEDLINE]
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Epilepsy and migraine headache: is there a connection?
Stevenson SB.
Arkansas Children's Hospital, 800
Marshall St, Slot #512-15, Little Rock, AR 72202, USA.
stevensonsharon@uams.edu
INTRODUCTION: This study investigated the prevalence of migraine headache in pediatric patients with epilepsy and the incidence of these two disorders in the family history. METHOD: A retrospective chart review was conducted on 475 patients with a primary diagnosis of epilepsy between January 2003 and June 2004. The patients were managed in a pediatric neurology outpatient clinic at a major teaching hospital. Cases were selected using the ICD-9-CM definition for epilepsy. Data collected included age, sex, headache, migraine, and family history. RESULTS: The study revealed a higher prevalence of migraine in epilepsy patients (14.7%) than in the general population (2.7% to 11%). Only 4.7% had a family history of migraine, but 20.6% had a positive family history of epilepsy, supporting current ideas of the genetic etiology of some epilepsies. DISCUSSION: This study specifically addressed epilepsy and migraine in children, but whenever a primary diagnosis is made, the potential for a coexisting disorder should be investigated.
PMID: 16675377 [PubMed - in process]
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The pharmacological treatment options for pediatric migraine: an evidence-based appraisal
Lewis DW, Winner P.
Division of Pediatric Neurology,
Children's Hospital of the King's Daughters,
Eastern Virginia Medical School, Norfolk, 23501, USA.
dlewis@chkd.com
The treatment of children and adolescents who suffer from migraine headaches must be individually tailored, flexible, and balanced with a blend of bio-behavioral measures, agents for acute treatment and, if needed, daily preventive medicines. While controlled data is limited, there is now enough evidence available to provide a rational framework to build treatment plans appropriate for the pediatric population. Essentially, the pharmacological management of pediatric migraine divides into agents for the acute attacks and agents used daily to prevent or reduce the frequency of attacks. For the acute treatment, the most rigorously studied agents are ibuprofen, acetaminophen, and the nasal spray forms of sumatriptan and zolmitriptan, all of which have shown both safety and efficacy in controlled trials. For preventive treatment the calcium channel blocker flunarezine has the best efficacy profile in controlled trials, but is not available in the U.S. A growing body of data, mostly uncontrolled, is emerging regarding the use of several anti-epileptic agents (e.g. topiramate, disodium valproate, levateracetam), as well as the antihistamine cyproheptadine and the anti-depressant amitriptyline.
Publication Types:
* Review
PMID: 16554256 [PubMed - indexed for MEDLINE]
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Migraine headache prophylaxis: current options and advances on the horizon
Ramadan NM.
Rosalind Franklin University of Medicine and Science,
3333 Green Bay Road, North Chicago, Il 60064, USA.
nabih.ramadan@rosalindfranklin.edu
Migraine is increasingly recognized as a disorder of altered neuronal excitability, in part based on genetically mediated and environmentally modified aberrations of ionic exchange across the brain neuronal membrane. To this end, migraine pharmacotherapy aids in restoring the abnormally low threshold for neuronal excitation. Indeed, modulation of neuronal excitability is a common property of several established migraine preventive drugs such as propranolol, valproate, amitriptyline, and topiramate. Future migraine preventive pharmacologic therapies likely will aim at restoring the neuronal threshold for excitation by targeting such processes as cortical spreading depression and intracellular calcium influx. Also, strategies aimed at enhancing descending antinociceptive inhibition will yield effective antimigraine drugs.
Publication Types:
* Review
PMID: 16522261 [PubMed - indexed for MEDLINE]
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Prodromes and predictors of migraine attack
Rossi P, Ambrosini A, Buzzi MG.
Headache Clinic,
INI Grottaferrata, Rome, Italy.
paolo.rossi90@tin.it
Premonitory symptoms of migraine include a wide and heterogeneous collection of cognitive, psychic and physical changes preceding and forewarning of an attack by a few hours to 2-3 days. To date, premonitory symptoms have received little attention in the literature, being treated more as a curiosity than as a primary feature of migraine. This paper provides an extensive critical review of this neglected area of migraine research in the light of the recent advances in our understanding of the pathogenetic mechanisms of migraine. Epidemiological and clinical studies that have investigated the premonitory symptoms of migraine lack scientific rigour, producing conflicting results, whilst genetic and pathophysiological investigations are still in their very early stages. There is evidence supporting the idea that premonitory symptoms could be used as a phenotypical marker to identify subgroups of migraineurs which could show correlations with specific clinical expressions of the disease, genotypes, or responses to treatments. Future studies are needed to clarify the clinical, pathophysiological and therapeutic significance of premonitory symptoms.
Publication Types:
* Review
PMID: 16483459 [PubMed - indexed for MEDLINE] 1818
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Chronic disorders with episodic manifestations: focus on epilepsy and migraine
Haut SR, Bigal ME, Lipton RB.
Comprehensive Epilepsy Management Center,
Montefiore Medical Center and the Albert Einstein College of Medicine,
Bronx, NY 10467-2490, USA.
haut@aecom.yu.edu
Epilepsy and migraine are chronic neurological disorders with episodic manifestations that are commonly treated in neurological practice and frequently occur together. In this review we examine similarities and contrasts between these disorders, with focus on epidemiology and classification, temporal coincidence, triggers, and mechanistically based therapeutic overlap. This investigation draws attention to unique aspects of both epilepsy and migraine, while identifying areas of crossover in which each specialty could benefit from the experience of the other.
Publication Types:
* Review
PMID: 16426991 [PubMed - indexed for MEDLINE]
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Infrequent or non-response to oral sumatriptan does not predict response to other triptans--review of four trials
Dahlof CG.
Gothenburg Migraine Clinic, Gothenburg, Sweden.
carl.dahlof@migraineclinic.se
A migraineur can claim to be an infrequent responder ('non-responder') to an oral triptan independent of which triptan he or she is presently using. Four trials of an alternative triptan (zolmitriptan/rizatriptan; eletriptan; naratriptan; almotriptan) in patients with a history of infrequent response to oral sumatriptan were compared and contrasted in terms of study design, patient characteristics, and efficacy and tolerability of the triptan under investigation. Unfortunately, none of the reported studies used an appropriate parallel design, which would have had the non-responding triptan (oral sumatriptan) in one arm and without encapsulation. While the four trials differed in terms of study design (open-label vs. placebo-controlled), definition of sumatriptan 'non-responder' (retrospective vs. prospective) and pain intensity at baseline (30% severe to 70% severe), all four demonstrated that lack of response to sumatriptan did not predict lack of response to an alternative triptan. Changing triptans resulted in 2-h pain-relief rates of 25-81% in patients with a history of poor response to sumatriptan. It can be concluded that migraine patients who respond infrequently to sumatriptan should be switched to a different triptan, as lack of response to one triptan does not predict likelihood of responsiveness to another. A review of the available evidence suggests that almotriptan may be one of the most appropriate choices for an alternative triptan.
Publication Types:
* Meta-Analysis
* Review
PMID: 16426262 [PubMed - indexed for MEDLINE]
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Symptoms of premenstrual syndrome and their association with migraine headache
Martin VT, Wernke S, Mandell K, Ramadan N, Kao L, Bean J, Liu J, Zoma W, Rebar R.
Departmentof Internal Medicine,
University of Cincinnati, Cincinnati, OH 45267-4217, USA.
OBJECTIVES: To determine the association between the severity of premenstrual (PMS) symptoms and headache outcome measures during natural menstrual cycles and after medical oophorectomy. BACKGROUND: Premenstrual syndrome may occur in 64% of those with pure menstrual migraine and 33% of those with menstrually related migraine. Few past studies have examined the relationship between the severity of PMS symptoms and migraine headache. METHODS: Data were obtained from a 6.5-month randomized-controlled trial examining the role of medical oophorectomy in the prevention of migraine headache and later divided into two data sets for analysis purposes. The menstrual cycle data set was composed of data from three natural menstrual cycles obtained from 21 participants during lead-in and placebo run-in phases. Each menstrual cycle was subdivided into seven 3-day intervals based on urine hormone metabolites. The medical oophorectomy data set included data from a 2-month treatment period in which a medical oophorectomy was induced by gonadotropin-releasing hormone agonists (GnRHa) and participants were randomized to transdermal estradiol or a matching placebo (GnRHa/estradiol and GnRHa/placebo groups, respectively). All participants completed a daily diary recording the severity of PMS symptoms and headache outcome measures. The primary outcome measures were the PMS index (mean of the daily PMS severity scores) and the headache index (mean of the headache severity scores). Pearson correlation coefficients were used to assess the degree of association between the outcome measures. RESULTS: Menstrual Cycle Data Set.-The PMS index was significantly correlated with the headache index during native menstrual cycles (correlation coefficient of 0.47; P < .05) and during all seven intervals of the menstrual cycle (correlation coefficients of 0.39 to 0.65; all P values < .05). Medical Oophorectomy Data Set.-Correlation coefficients between the PMS and headache indices were 0.58 and 0.47 for the GnRHa/estradiol (n = 9) and GnRHa/placebo groups, respectively (P-values of <.05). CONCLUSIONS: Moderate correlations exist within female migraineurs between the severity of PMS symptoms and headache outcome measures throughout natural menstrual cycles as well as after medical oophorectomy. Our data would suggest that the presence and severity of headache might modulate PMS symptoms in female migraineurs.
Publication Types:
* Randomized Controlled Trial
PMID: 16412160 [PubMed - indexed for MEDLINE]
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What are effective medical treatments for adults with acute migraine?
Church CR, Kesler E, Sheeler R.
Wake Forest University School of Medicine,
Winston-Salem, NC USA.
Medications collectively referred to as "triptans" (eg, sumatriptan, naratriptan, etc) have been shown to be effective for acute migraine (strength of recommendation [SOR]: A). Nonsteroidal anti-inflammatory drugs (NSAIDs)--including aspirin, ibuprofen, naproxen sodium, diclofenac potassium, ketoprofen, tolfenamic acid, and ketorolac--are also effective (SOR: A). The combination of acetaminophen/aspirin/caffeine is effective (SOR: B). Parenteral dihydroergotamine (DHE), when administered with an antiemetic, is as effective as, or more effective than meperidine, valproate, or ketorolac (SOR: B). Prochlorperazine is more effective than metoclopramide in headache pain reduction (SOR: A). Isometheptene mucate/dichloralphenazone/acetaminophen is as effective as low-dose oral sumatriptan (SOR: B).
PMID: 16750070 [PubMed - in process]
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Effects of a Website designed to improve the management of migraines
Sciamanna CN, Nicholson RA, Lofland JH, Manocchia M, Mui S, Hartman CW.
Jefferson Medical College,
Philadelphia, PA 19107, USA.
OBJECTIVE: The aim was to examine the effect of using a Web-based computer program that provides personalized feedback to migraine patients, on the interactions of patients and providers. Background.-Despite the widespread availability of evidence-based migraine treatment guidelines, patients often do not receive optimal treatment to reduce migraine pain and disability. METHODS: To address these quality gaps in migraine care, we developed a Web-based computer program, to be used by migraine patients before doctor visits. The feedback is designed to prompt patients to ask questions that lead to higher quality of care. This study was conducted to examine the effect of using the program on migraine-specific doctor-patient communications. Patients were randomized to use the Website before (intervention) or after (control) a visit with their provider. The outcome measures were the migraine-specific topics discussed during the visit, measured by an exit survey after the visit. RESULTS: Fifty of 53 subjects randomized completed the postvisit measures (94%). Overall, the mean age was 42.0 years, most patients were female (86.5%), all were white, and 58.5% saw a headache specialist during their visit. Most (75.0%) reported having headaches at least once per week and 48.1% rated their headaches as "severe." Intervention patients were significantly more likely to "discuss whether you had migraine headaches or some other type of headache?" (89.3% vs 54.5%; P < .01) and to "discuss whether or not there may be a more serious cause of your headaches?" (50.0% vs 13.6%; P < .01). Intervention patients were more likely to report discussing 8 of 12 migraine-related topics more frequently and a greater overall number of topics (5.5 vs 4.3) than control patients. This difference was not statistically significant. CONCLUSIONS: These results suggest that the Website may have a positive impact on migraine-specific doctor-patient communications. A larger study, including important quality of life and utilization outcomes, is warranted.
Publication Types:
* Randomized Controlled Trial
PMID: 16412156 [PubMed - indexed for MEDLINE]
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