M E Bigal

..In the population where use of specific acute migraine medications is less common, the agreement between ICHD-2R CM and TM may be less robust...

..These findings suggest that early in the process of transformation, migraine is more frequent, and that as CDH evolves, fewer typical attacks of IHS migraine occur...

..To assess the influence of the body mass index (BMI) on the prevalence and severity of chronic daily headache (CDH) and its most frequent subtypes, transformed migraine (TM) and chronic tension-type headache (CTTH)...

..Available data suggest two seemingly opposite trends with regard to the natural history of migraine. Migraine prevalence decreases with age. In some individuals, migraine progresses to chronic daily headache...

..Migraine is a common, chronic, and disabling disorder. The treatment of migraine includes a combination of nonpharmacologic and pharmacologic techniques. Pharmacologic approaches are subdivided in preventive therapies and acute care...

..We summarize the epidemiologic evidence that migraine and epilepsy are associated and discuss specific interrelationships between migraine and epilepsy...

..Probable migraine is a prevalent form of migraine, and like migraine with and without aura it produces decrements in health-related quality of life and increments in disability relative to control subjects...

..Consistently, criteria for CM and CM+ should be revised to require at least 8 days of migraine or probable migraine per month, in individuals with 15 or more days of headache per month...

..Contrary to what we hypothesized, obesity at baseline does not seem to be related to follow-up refractoriness to preventive treatment...

..Data are presented on topiramate, levetiracetam, zonisamide, botulinim toxin, tizanidine, nefazodone, lisinopril, candesartan, carabersat, petasites, and coenzyme Q...

..001). More rigorous prescribing guidelines for patients with frequent headaches are urgently needed. Successful detoxification is necessary to ensure improvement in the headache status when treating patients who overuse acute medications...

..To determine the relative frequency of chronic daily headache (CDH) subtypes in adolescents and to compare the distribution of CDH subtypes in adolescents and adults of various ages...

..To assess the influence of body mass index (BMI) on the prevalence, attack frequency, and clinical features of migraine...

..They are often classified as transformed migraine (TM), a disorder not addressed in the International Headache Society classification...

..A structured approach to the patient and a better comprehension of this variability of presentation should translate into better quality of care and a more specific diagnosis for TTH sufferers...

..The risk factors for migraine progression and the mechanisms for progression will be discussed. This review concludes with the prospects for treating transformed migraine and avoiding migraine progression...

..We then review the potential pathophysiologic mechanisms to support this relationship. We close by briefly discussing clinical interventions related to obesity and migraine...

..Those with high risk of progression will be more aggressively treated, not just to relieve current pain and disability but to prevent progression. Therefore, treatment will focus on decreasing current burden and preventing future burden...

..Clarifying the influence of age on migraine is of importance for clinical diagnosis and treatment. It also may contain clues to evolving disease biology...

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..The clinical approach to diagnosing CDH is the scope of this review...

..The influence of socioeconomic status on the prevalence of migraine is unknown in adolescents. Accordingly, we investigated the prevalence of migraine in a large sample of adolescents by sociodemographic features...

..The aim of this review is to present and discuss the new options for migraine prevention...

..In patients with status migrainous and patients with frequent headache recurrence, ergotamine is still probably useful...

..The clinicians have in their armamentariums an ever-expanding variety of medications. With experience, clinicians can match individual patient needs with the specific characteristics of a drug to optimize therapeutic benefit...

..Dysfunction in the orexins pathways seems to be a risk factor for both conditions. Finally, conditions that are comorbid to both states (e.g., depression, sleep apnea) may also make the relationship between both diseases more complex...

..In many, migraine may have a very benign (complete remission) or relatively benign (partial remission) prognosis. In some, migraine persists and in others, it progresses...

..A large number of headache sufferers with features of migraine fail to meet criteria for strict migraine (SM; migraine with or without aura) but do meet criteria for probable migraine (PM)...

..To evaluate the efficacy and tolerability of zolmitriptan 5 mg and 10 mg nasal spray (ZNS) vs placebo in the acute treatment of cluster headache. Design/..

..They conclude by presenting an approach to headache diagnosis based upon these criteria...

..56 to 3.62) compared with 1.52 (0.99 to 2.34) for less severe pain (p < 0.05). CONCLUSION: Early onset of migraine in the proband as well as the severity of migraines are associated with higher levels of family aggregation...

..We consider clinical trials strategies designed to address the more complex clinical and policy requirements for meeting the needs of those with migraine...

..In this paper we review new treatment options for migraine prevention. We start with an overview about migraine and then briefly discuss current indications for migraine prevention and new and emerging preventive medications...

..To assess patterns of medical consultation, diagnosis, and medication use in representative samples of adults with migraine in England and the United States...

..The authors estimated the prevalence and severity of cutaneous allodynia (CA) in individuals with primary headaches from the general population...

..02), with their level or responsibilities and duties (P = 0.02), and with their ability to perform (P = 0.001). Results from this study show that the impact of migraine extends to household partners and other family members...

..The Silberstein and Lipton system is easier to apply, and more parsimonious. These findings support revision of the IHS classification system to include chronic migraine...

..The headaches were self-limited (69.4% placebo efficacy in 2 hours) and the incidence markedly declined over time. Acetaminophen was no more effective than placebo in the acute and preemptive treatment of these headaches...

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..On most days, they had migraine-associated symptoms (one of nausea, photophobia or phonophobia)). NDPH is common in children and adolescents with CDH. Most subjects do not overuse medication. Migraine features are common...

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..Educational strategies should focus on physician education addressing diagnosing the full spectrum of migraine and physician management of migraine with specific migraine therapy in appropriate patients...

..Persistence in treating these patients can be very rewarding. The authors provide a checklist intended to facilitate the management of refractory patients...

..This is perhaps as it should be given that the best practice combines knowledge of the evidence with individual clinical experience...

..Specifically, individuals classified with moderate to severe work-related disability had lower HRQoL scores than those classified with low disability...

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..To assess the attitudes, knowledge, and practice patterns of US neurologists regarding migraine management relative to the US Headache Consortium Guidelines (the Guidelines)...

..0 vs. -1.3 mmHg) and high-density lipoprotein cholesterol (-3.7 vs. -0.8 mg/dl). Increased weight during migraine treatment is not associated with poor headache treatment outcomes, but is associated with deterioration of CVD risk markers...

..Ultimately, it will be important to determine whether MA is a modifiable risk factor for CVD and if preventive medications for migraine or antiplatelet therapy might reduce the risk of CVD in patients with MA...

..We aimed to explain the nature of the controversies surrounding the entities of CM and MOH. A clinical case will be used to illustrate some of the problems faced by clinicians in diagnosing patients with chronic daily headache...

..New studies have looked at early treatment paradigms and result in better efficacy data, but are difficult to compare due to different endpoints...

..Future research may focus on how adiponectin levels are potentially altered during migraine attacks, and how that information can be potentially translated into migraine therapy...

..66, and it also correlated well with the three questionnaires (r = 0.33-0.41). The utility of the M-TOQ for assessing treatment benefit in research (M-TOQ-15) and primary care (M-TOQ-5) should be further validated...

..To develop and validate a questionnaire for assessing cutaneous allodynia (CA), and to estimate the prevalence and severity of CA in the migraine population...

..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...

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..To determine the prevalence of chronic pain in elderly people and its relationship with obesity and associated comorbidities and risk factors...

..However, prevalence is high in groups other than these high-risk groups. In a subgroup of patients, migraine may be a progressive disorder...

..the Goadsby and Lipton classification is more clinically useful and should be included in future International Headache Society reclassification...

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..One reported secondary endpoint showed a significant 42% reduction of migraine days, suggesting the need for further randomised, sham-controlled PFO closure studies...

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..Herein we discuss the evidence that migraine may transform and then consider potential mechanisms as well as risk factors. We close with a brief discussion of clinical strategies that arise based on this perspective on migraine...

..Future epidemiologic studies should focus on identifying patients who are at higher risk for progression and on assessing the impact of intervention strategies on disease progression...

..Nevertheless, it is our opinion that nasal preparations increase therapeutic options and may result in faster response times and better efficacy than oral formulations and better patient satisfaction than injectable preparations...

..HC will be addressed in the 2003 revision of the International Headache Society (IHS). In this paper we review the clinical features, classification and treatment of HC...

..6%) for the dipyrone group. Intravenous dipyrone is an effective drug for the relief of pain in tension-type headache and its use is justified in the emergency room setting...

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..A structured approach to the patient and a better comprehension of this variability of presentation, should translate into better quality of care for migraineurs...

..As similar results were obtained when CPTH was used as a control, the correlation is more complex than simple comorbidity...

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..The chronicity and pervasiveness of migraine thus is associated with increased functional impairment as well as increase in headache frequency...

..Use of the methods outlined in this review in choosing a triptan for an individual patient is probably more likely to lead to migraine relief than making an educated guess as to which triptan is most appropriate...

..Research on this issue is in its infancy and cautions are necessary before extrapolating this information into clinical practice...

..05 and P<.01) in pain and all associated symptoms compared with control subjects. CONCLUSIONS: Dipyrone is an effective drug for the relief of acute migraine pain and associated symptoms...

..The epidemiology of these modifiers is discussed...

..CONCLUSIONS: Our findings suggest that studies comparing placebo against an active drug should use stratification according to the presence versus absence of aura...

..Drs. Lipton and Bigal examine the path to acceptance and the impediments that had to be overcome...

..Prospective, controlled studies must be considered for severely disabled, refractory patients...

..To assess this attributes can provide additional information to supplement the traditional tests of efficacy provided by randomized clinical trials...

..These recommendations have not been demonstrated to improve outcomes in longitudinal studies...

..5-mg dose at early time points. The physician can now choose the optimum route of delivery of zolmitriptan to stop the headache, increase the likelihood of reducing disability and restore the patient to complete functionality...

..Migraine is assessed to determine how well it meets criteria for screening and the steps that are necessary before firm public policy recommendations for screening for migraine are possible...

..Herein we briefly discuss reasons for screening migraine in the primary care setting, and focus on the ID-migraine, a validated migraine screening tool...

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..Prospective studies are necessary to confirm our results...

..We hypothesize that the tinnitus intensity increase could be an allodynic symptom related to CS, or alternatively could be associated with cortical hyperexcitability...

..2) From those subjects who did not self-report adverse events after using a triptan, most of them will report positively if presented with a list of side effects...

..iii) About half of the patients with NDPH according to the S-L criteria have too many migraine features to meet ICHD-2 criteria for NDPH...

..Although the cardinal features of HC - continuous, unilateral, indomethacin responsive, remain strongly reliable, a refinement on the clinical characterization is needful and desired...

..CONCLUSIONS: Naratriptan may have a role in the preventive treatment of intractable chronic migraine. Prospective, controlled studies should be considered...

..2) The tolerability of this treatment was excellent. (3) Over a short period of time (3 months), no serious adverse events were reported, nor significant changes were found in the ECG or ophthalmologic evaluation...

..Clinical trials of this entity should therefore be conducted using the S-L criteria. Finally, we propose that in the 3rd edition of the IHS classification, the diagnosis of NDPH be revised so as not to exclude migraine features...

..We present the evidence for each risk factor and discuss possible interventions to address them...