Headache
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Randomized Controlled Trial
Long-term migraine prevention with topiramate: open-label extension of pivotal trials.
To demonstrate that topiramate is an effective and generally well-tolerated migraine preventive therapy when used for up to 14 months. ⋯ Patients receiving topiramate experienced a sustained reduction in migraine frequency for up to 14 months. The effectiveness and safety of topiramate was consistent with that observed during 2 26-week pivotal trials.
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To establish if criteria for the diagnosis of migraine change with age and to document the influence of age on the full spectrum of migraine features. Also to define the clinical spectrum and provide a prognostic profile of migraine stratified by age. ⋯ This study highlights specific age differences in migraineurs, in most instances showing an age decline in frequency of variables, such as stress as a trigger, photophobia, phonophobia, dizziness, throbbing, pressure, stabbing, and being forced to sleep or rest with headache. Hormones as a trigger peaked in women in the 30- to 49-year-old age group. Increases with age were seen with alcohol, smoke, and neck pain triggers, neck location, and running of the nose/tearing of the eyes. The 50+ age group showed trends suggesting a "lesser acute migraine attack." These findings support the concept of lessening features of migraine over time resulting in a lower prevalence of migraine in older patients.
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Migrainous vertigo (MV) is increasingly recognized as a common cause of episodic vertigo. MV displays several clinical similarities with familial hemiplegic migraine (FHM) and episodic ataxia type 2 (EA-2), which have been linked to mutations in 3 genes, CACNA1A, encoding a neuronal calcium channel alpha subunit, ATP1A2, encoding a catalytic subunit of a Na(+)/K(+)-ATPase, and most recently the voltage-gated sodium channel SCN1A. The present study explored the hypothesis that mutations in CACNA1A, ATP1A2, SCN1A, and the calcium channel beta(4) subunit CACNB4 confer susceptibility to MV. ⋯ Based on this group of patients there is no evidence that the genes causing FHM and EA-2 represent major susceptibility loci for MV.
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Hemicrania continua is one of the indomethacin-responsive headache syndromes. There are very few effective alternative therapies for hemicrania continua, thus patients may require daily indomethacin for years. ⋯ Recently, melatonin was shown to be effective for primary stabbing headache, another indomethacin-responsive syndrome. Three cases of melatonin responsive hemicrania continua are now reported.