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ON SOME OF THE LATEST
RESEARCH Crying
as a precipitating factor for migraine and tension-type headache. The
physiology of crying is not well documented or understood. Scarcely
reported in the literature, crying seems to be an important precipitating
factor for both migraine and tension-type headache in daily practice. A
Brazilian study evaluated the role of crying as a precipitating factor for
migraine and tension-type headache.
From the total group of 163 individuals, 90 (55.2%) considered
crying to be a potential factor for triggering headache attacks. . Only
stress, anxiety and menstrual periods rated higher or equal to crying as
triggering factors for both types of headache. Drug
overuse and rebound headache. The
overuse of acute medications in patients who are headache-prone poses a
great challenge to headache management. Medication overuse-induced
headache represents one of the most common iatrogenic disorders. It is the
reason that most patients visit headache subspecialty clinics worldwide
and often is the cause of an intractable or worsening headache in primary
headache sufferers. The recent development of acute headache medications,
especially the triptans, has provided increased migraine relief; however,
the incidence of triptan-overuse headache has also increased. Awareness of
medication overuse-induced headache and familiarity with the diagnosis and
the treatment of this disorder are important to physicians who treat
patients with headache. Comment: Medication overuse headache is the
bugaboo of most neurologists and headache specialists, and this review is
by a master of that topic who provides clinical guidance for the
condition's recognition and treatment. SJT I would agree with Dr. Tepper.
We need to scrutinize closely this group of patients to avoid replacing
the "ergot abusers" of the past with the triptan overusers.
Diener et al has proposed that patients should restrict triptan use to
<12 attacks per month. DSM Overuse
of symptomatic medications among chronic (transformed) migraine patients:
profile of drug consumption. Chronic
daily headache and chronic (transformed) migraine (TM) patients represent
more than one third of the subjects seen in specialized headache centers.
Most of these patients may overuse symptomatic medications (SM) taken on a
daily basis to relieve headache and associated symptoms. The conversion to
the daily or near-daily pattern of headache presentation is thought to be
related to the medication overuse. The categories of overused symptomatic
medications varied from simple analgesics to narcotics, triptans and
combinations of ergot derivatives and caffeine and of analgesics and
caffeine. The average intake per patient per day was of 3 to 4 tablets and
mostly of the patients overused simple analgesics (isolated or in
combination with other substances) (75.2%), caffeine containing drugs
(71.4%), drugs containing ergotamine derivatives (26.1%), triptans (alone
or combined) (15.5%), drugs with narcotics or ansiolitics (13%) and
anti-inflammatory drugs (3.7%). The mechanisms by which the overuse of
symptomatic medications may play a role in this transformation are
uncertain but despite of the necessity of controlled trials to demonstrate
the real role of such compounds in the development of transformed
migraine, this study emphasizes the necessity for more rigorous
prescribing guidelines for patients with frequent headaches. Peripheral
neurostimulation for the treatment of chronic, disabling transformed
migraine. A
study undertaken by Fort Bend Neurology, PA, Sugar Land, Texas,
analyzed clinical responses of transformed migraine to cervical
peripheral nerve stimulation. Headache frequency, severity, and disability
(Migraine Disability Assessment [MIDAS] scores) were
measured pre and post treatment with
C1 through C3 peripheral nerve stimulation. Prior to stimulation,
all patients experienced severe disability (grade IV on the MIDAS) with
75.56 headache days (average severity, 9.32; average MIDAS score, 121)
over a 3-month period. Following stimulation, 15 patients reported little
or no disability (grade I), 1 reported mild disability (grade II), 4
reported moderate disability (grade III), and 5 continued with severe
disability (grade IV), with 37.45 headache days (average severity, 5.72;
average MIDAS score, 15). The average improvement in the MIDAS score was
88.7%, with all patients reporting their headaches well controlled after
stimulation. These results raise the possibility that C1 through C3
peripheral nerve stimulation can help improve transformed migraine
symptoms and disability. A controlled study is required to confirm these
results. (Headache 2003 Apr;43(4):369-75)(Aurora SK, Welch KM, Al-Sayed
F.) and
in a related study The
threshold for phosphenes is lower in migraine. The
Headache Research Center at Henry Ford Health Sciences Center, Detroit
have reported a preliminary study confirming hyperexicitability of
occipital cortex in migraine with aura (MwA) using transcranial magnetic
stimulation (TMS). They have now completed a blinded study to investigate
the occipital cortex in MwA and without aura (MwoA) compared with normal
controls (NC) using TMS. There is a difference in threshold for
excitability of occipital cortex in MwA and MwoA compared to NC. This is a
direct neurophysiological correlate for clinical observations, which have
inferred hyperexicitability of the occipital cortex in migraineurs. Migraine
during pregnancy and postpartum An
Italian
study has investigated the
course of migraine during pregnancy and postpartum.
49 migraine sufferers--two were affected by migraine with aura (MA)
and 47 by migraine without aura (MO)--who had experienced at least one
attack during the 3 months preceding pregnancy were identified, enrolled
in the study and given a headache diary. Migraine was seen to improve in
46.8% of the 47 MO sufferers during the first trimester, in 83.0% during
the second and in 87.2% during the third, while complete remission was
attained by 10.6%, 53.2%, and 78.7% of the women, respectively. Migraine
recurred during the first week after childbirth in 34.0% of the women and
during the first month in 55.3%. Certain risk factors for lack of
improvement of migraine during pregnancy were identified: the presence of
menstrually related migraine before pregnancy was associated with a lack
of headache improvement in the first and third trimesters, while
second-trimester hyperemesis, and a pathological pregnancy course were
associated with a lack of headache improvement in the second trimester.
Breast feeding seemed to protect from migraine recurrence during
postpartum.(Cephalalgia
2003 Apr;23(3):197-205)(Sances G, Granella F, Nappi RE, Fignon A,
Ghiotto N, Polatti F, Nappi G.) Migraine
headaches and sleep disturbances in children. A
study by Case Western Reserve University, Ohio.has
investigated the prevalence and nature of sleep disturbances in
children with migraine headaches. A relationship between migraine
headaches and sleep disturbances has been suggested in both children and
adults, but there is a lack of research examining the relationship between
specific headache features and the range of sleep behaviors in
children.The study
found that the frequency and duration of migraine headaches
predicted specific sleep disturbances, including sleep anxiety,
parasomnias, and bedtime resistance, and that children with migraine
headaches have a high prevalence of sleep disturbances. The direction of
the relationship between headaches and sleep is unknown. Regardless,
interventions targeting sleep habits may improve headache symptoms, and
effective treatment of headaches in children may positively impact sleep. Emergency
department treatment of acute migraine headaches A
study undertaken by the Department of Emergency Medicine
and the Clinical Investigation Department , Naval Medical Center
San Diego, CA, and the Department of Emergency Medicine, Naval Hospital
Jacksonville, Jacksonville,FL,
compared the efficacy of intravenous sodium valproate versus
prochlorperazine for the emergency department treatment of acute migraine
headache.The study concluded that Prochlorperazine was statistically and
clinically superior to sodium valproate for the treatment of the pain and
nausea associated with acute migraine headaches. (Ann Emerg Med 2003
Jun;41(6):847-853) (Tanen DA, Miller S, French T, Riffenburgh RH.)
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