Headache
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Migraine or headache is a common problem in the active duty population, in the recently deployed service members, and is a cardinal symptom of traumatic brain injury. While there is increasing appreciation of the clinical burden of post-traumatic headache (PTHA) in the military traumatic brain injury population, there remain significant research gaps related to the epidemiology of PTHA, including lack of understanding of natural history, whether there are predisposing factors that predict the development or prognosis of headache post trauma and, most basically, the features that distinguish PTHA from other forms of chronic headache. Although diagnostic criteria for PTHA are included in the International Classification of Headache Disorders, 2nd edition, revised, these criteria are somewhat arbitrary and were not empirically defined. This lack of precision about the PTHA phenotype limits the rigor of observational studies of PTH but does not appear to significantly hamper treatment, provided the treatment involves a multi-modality approach.
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Randomized Controlled Trial Multicenter Study
Fixed-dose sumatriptan and naproxen in poor responders to triptans with a short half-life.
To evaluate efficacy and tolerability of a single, fixed-dose tablet of sumatriptan 85 mg/naproxen sodium 500 mg (sumatriptan/naproxen sodium) vs placebo in migraineurs who had discontinued treatment with a short-acting triptan because of poor response or intolerance. ⋯ In migraineurs who reported poor response to a short-acting triptan, sumatriptan/naproxen sodium was generally well tolerated and significantly more effective than placebo in conferring initial, intermediate, and sustained efficacy for pain and migraine-associated symptoms of photophobia and phonophobia.
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Clinical Trial
Acute treatment of intractable migraine with sphenopalatine ganglion electrical stimulation.
We report preliminary results of a novel acute treatment for intractable migraine. The sphenopalatine ganglion (SPG) has sensorimotor and autonomic components and is involved in migraine pathophysiology. ⋯ This study suggests a possible role for SPG stimulation in the treatment of refractory migraine headaches.
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To investigate if the effectiveness of a 96-hour multidisciplinary headache treatment program exceeds the effectiveness of a 20-hour program and primary care. ⋯ Intensive multidisciplinary headache treatment is highly effective for patients with chronic headaches. Furthermore, migraine symptomatology responds especially well to this intensive treatment program, whereas effects on tension-type headaches were realized by both multidisciplinary programs. Randomized controlled trials and subgroup analysis are needed to find out if these results can be replicated and which patient characteristics allow for sufficient improvements for headache sufferers even with less complex treatment.
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Pharmacy personnel are supposed to be well informed of recommendations for proper migraine management, but their easy access to medicines may favor self-medication and promote medication overuse for those with frequent migraine attacks. ⋯ Considering their pivotal role in advising migraine patients who seek their help with self-management, migraine education of pharmacy personnel about proper migraine management should be reinforced.