Marcelo Bigal

..We follow by addressing new barriers to migraine care that have emerged as a function of the knowledge gained in this process...

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..While we await randomized trials, these findings should inform the choice of acute migraine treatments with the goal of reducing the risk of migraine progression to chronic migraine...

..In addition, we discuss the importance of metabolic syndrome and autonomic dysfunction in modulating the obesity/migraine progression relationship...

..We then review the class of the triptans--mechanism of action and clinical evidence. We close by briefly discussing the class of CGRP receptor antagonists, which is currently being developed for the acute treatment of migraine...

..Accordingly, specific classes of medications are associated with migraine progression, and high frequency of headaches seems to be a risk factor for chronic migraine regardless of medication exposure...

..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...

..For CM, > 34% use opiates or barbiturates. Accordingly, a sizable proportion use medications that are not firstline according to the US Headache Consortium Guidelines...

..For some such as depression, the association has been well described, but for others, the relationship has been recently suggested, such as in the case of clinical and subclinical vascular brain lesions and coronary heart disease...

..We close with our view of the future and hopes for the next generation of antimigraine therapies...

..The second part of this presentation will address the most important MCD. Finally, the last part of this presentation will address the correlation between MCD and epilepsy...

..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...

..Because migraine worsens in a sizeable subgroup of sufferers, but not in most, identifying factors that predict the change from episodic into chronic migraine is of extreme interest and should be seen as a priority in headache research...

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

..For each headache type, we discuss the clinical features and diagnosis, as well as therapeutic strategies...

..The concept of critical dose of exposure for different classes is presented and biological plausibility and putative mechanisms are reviewed...

..We follow by summarizing the evidence on the topic. We then briefly present the results of a recent meta-analysis. We close by highlighting results of a large epidemiological study conducted after the publication of the meta-analysis...

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..To evaluate the disability profile and patterns of treatment and health care use for chronic migraine (CM) in the general population, in contrast to episodic migraine...

..We close by discussing potential future therapies, including calcitonin gene-related peptide receptor antagonism, as well as substance P and the nitric oxide pathways...

..Herein we contrast the rate of diagnosed CVD as well as of risk factors for CVD in individuals with migraine with and without aura (MA and MO) and in controls...

..To assess the efficacy and tolerability of rizatriptan (RI), dexamethasone (DE), and RI combined with DE (RI+DE) in the acute treatment of menstrually related migraine (MRM)...

..To define yet more clearly the utility of topiramate in the treatment of chronic migraine, we evaluated prespecified secondary endpoints from a recent randomized, double-blind, placebo-controlled, multicenter clinical trial...

..To understand migraine postdrome by directly interviewing migraine patients with postdrome symptoms. To document these symptoms, as well as impacts, as a prelude to developing a postdrome migraine questionnaire...

..Rizatriptan and almotriptan are effective and well-tolerated triptans that have not been compared directly...

..To assess the efficacy and tolerability of memantine(MEM)in the preventive treatment of refractory 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...

..To assess the level of satisfaction and determinants of satisfaction or dissatisfaction of patients presenting in tertiary care, in regard to their usual care (UC) for the acute treatment of migraine...

..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...

..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)...

..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...

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

..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...

..Our data support the idea that magnesium sulphate can be used for the treatment of all symptoms in migraine with aura, or as an adjuvant therapy for associated symptoms in patients with migraine without aura...

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

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

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

..In contrast to migraine, which is less prevalent in African-Americans than in Whites, PM is more prevalent in African-Americans than in Whites. In the USA, many with PM do not receive adequate treatment...

..The mean of this relief, evaluated by the numerical pain scale, was 41.6%, 23.1% and 36%, respectively. Use of placebo is essential in evaluating the therapeutic role of drugs used in the treatment of acute headache...

..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/..

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..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...

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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)...

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

..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...

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

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

..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...

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

..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...

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

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

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

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

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

..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...

..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...

..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...

..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...

..Nauseas and/or vomiting were the most frequent associated symptoms. Finally, we found, among the menstrual headaches, 9 cases of tension type headache, 2 cases of cervicogenic headache and 1 case of stabbing headache...

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

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

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

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..CONCLUSIONS: Headache is common in patients undergoing hemodialysis. Classification of such headaches according to the International Headache society criteria may be difficult...

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

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

..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 identification of possible triggering factors and further evaluations of the treatment might increase our knowledge and contribute to reduce the burden of the headaches in patients with chronic renal failure...

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

..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...

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

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

..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)...

..Educational initiatives should emphasize that the newer specific acute migraine medications (triptans) may also be associated with PMOH...

..After 5 months she developed orbital and eyelid edema, with painful restrictions to eye movement. Orbital MRI and pathological exam demonstrated inflammatory orbital pseudotumor (myositic form)...

..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...

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

..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...

..Thus, estimates of the burden of migraine often include the costs of conditions comorbid with it...

..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...

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

..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...

..Our findings make possible some speculations about the pathophysiology of migraine, as well as about the therapeutic approach of patients presenting migrainous aura...