P C Tfelt-Hansen

..The place of triptans compared with non-triptan drugs in migraine therapy remains to be established and further RCTs are required...

..Head-to-head comparisons should remain the 'gold standard' and meta-analyses are a useful supplement in cases when comparative trials are relatively small and when no comparative trials exist...

..003) and most AEs were mild or moderate. In this migraine population with infrequent attacks, sumatriptan was superior to placebo and was generally well tolerated...

..The attack can be treated with oxygen or subcutaneous sumatriptan, and verapamil, ergotamine and prednisolone can be successfully used for prophylaxis. Early diagnosis and specific treatment are emphazised...

..Only 17-32% become pain free after these drugs. For attacks of cluster headache oxygen and subcutaneous sumatriptan can be used. Intranasal triptans can be an alternative...

..In theory, there should probably be a 10-fold variation in doses available, but in clinical practice a fourfold difference in doses will probably cover the needs of most patients...

..We welcome this development, but recognise that advice at the point of sale is crucial for effective and safe use of these drugs...

..This most likely due to a quicker rise in blood concentrations after subcutaneous injections.. In designing new therapies for migraine one should aim at a quick absorption of the drug, which will probably result in an increased efficacy...

..Pharmacogenomics will most likely in the future be one part of our therapeutic armamentarium and will provide a stronger scientific basis for optimizing drug therapy on the basis of each patient's genetic constitution...

..In an American review of 2003 it was suggested that ergotamine may be considered in the treatment of selected patients with moderate to severe migraine...

..These results indicate that subcutaneous naratriptan in a high dose can overcome central sensitization that occurs in migraine attacks...

..Relationship between meta-analyses and head-to-head comparative trials is reviewed; and it is concluded that head-to-head comparisons remain the "golden standard" with meta-analyses as a useful supplement...

..The intranasal dose of DHE , between 1 and 2 mg, should also be tailored to the individual patient. In order to avoid drug-induced headache ergotamine and DHE should not be used daily...

..From the middle of the 1980s the pathophysiology of tension-type headache has been investigated and recent results indicate central sensitization in patients with chronic tension-type headache...

..To compare the peripheral vasoconstrictor effects of ergotamine, rizatriptan, and their combination, in normal subjects...

..In assessing treatment response (rizatriptan and sumatriptan versus placebo, rizatriptan versus sumatriptan, within-treatment dose effects), SPID usually yielded similar results to the more easily understood pain-free measure...

..They moved attention from ischaemia to CSD and thereby to the brain itself, and paved the way for subsequent discoveries of brainstem mechanisms...

..6 +/- 8.6% (P < 0.001 vs. baseline). Adverse events, especially headache, were common. The findings suggest that cilostazol is an interesting candidate for future clinical trials of delayed cerebral vasospasm...

..She was operated for a localised thyroid cancer. At follow-up, 6 years later, she was in good health without any symptoms apart from numbness of the chin...

..The contractions were typically slow in on and off set (about 30-60 min). The long duration of ergots should be investigated further in an attempt to design drugs with less recurrence...

..It is suggested that based on current evidence, effervescent aspirin should be the first-line drug for the treatment of migraine. Aspirin is also much cheaper than the triptans...

..The difference in observations between the experimental models may be related to the maintenance of shear stress in the arteriograph...

..5) It is unclear whether triptans offer clinically relevant benefits over aspirin or NSAIDs in migraine patients. Thus NSAIDs, particularly effervescent aspirin, should be considered the first-line treatment of migraine attacks...

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..No unusual or unexpected safety risks emerged. These findings demonstrate that TPM 100 mg/d is effective in migraine prophylaxis. TPM 100 mg/d and PROP 160 mg/d exhibited similar efficacy profiles...

..1%, n.s.). In the extension phase, treatment groups had similar adverse event rates. CONCLUSIONS: Rofecoxib 25 and 50 mg and ibuprofen 400 mg were effective and generally well tolerated in the acute treatment of migraine...

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