Headache
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OnabotulinumtoxinA has recently been approved by regulatory agencies in the UK and United States for treatment of chronic migraine based on data generated from the PREEMPT studies. As such, onabotulinumtoxinA is the only prophylactic therapy specifically approved for chronic migraine. Most headache clinicians would agree that acute episodic migraine and chronic migraine differ in their pathophysiology, etiology, diagnosis, and response to pharmacological as well as nonpharmacological therapies. ⋯ In addition to the well-documented myorelaxant effects of this neurotoxin, onabotulinumtoxinA can exert a direct analgesic effect that likely involves inhibition of primary and secondary nociceptive neurons. The inhibitory effects of onabotulinumtoxinA are also likely to involve suppressing the activity of myogenic trigger points and decreasing the persistent nociceptive barrage that promotes and maintains central sensitization. This article describes possible mechanisms to explain how onabotulinumtoxinA functions as a therapy for chronic migraine and considers why treatment with the neurotoxin is not effective in some chronic migraineurs.
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To determine the frequency and risk factors of post-dural puncture headache (PDPH) in research volunteers. ⋯ In this study, where tolerance to risk was low because LPs were done for research rather than clinical purposes and healthy controls were included, adverse effects were mild and self-limited.
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Multicenter Study
Interictal pattern-induced visual discomfort and ictal photophobia in episodic migraineurs: an association of interictal and ictal photophobia.
Pattern-induced visual discomfort and photophobia are frequently observed symptoms in migraineurs. The presumed pathophysiologic mechanisms of pattern glare and photophobia seem to overlap anatomically within the central nervous system. ⋯ We conclude that MwP experienced more severe pattern-induced visual discomfort as compared with the controls and MwoP.
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One goal of the campaign "Lifting the burden: The global campaign against headache" is to highlight existing evidence about headache worldwide. In this context, the aim of our study was to report the migraine-related headache burden in northern Tanzania. ⋯ To our knowledge, this study reports for the first time the burden that arises from migraine headache in a rural population of sub-Sahara Africa (SSA). As the presented migraine-related burden is considerable, we hope that our data will increase the awareness among local decision makers in allocating resources for treatment and research on headache.
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We evaluated the influence of physician-diagnosed migraine on blood pressure levels and the risk of hypertensive disorders of pregnancy in a clinic-based prospective cohort study of 3373 healthy pregnant women. ⋯ Pregnant migraineurs had elevated blood pressures, particularly SBP measured in the third trimester, and a higher risk of preeclampsia than pregnant women without migraine. Observed associations were more pronounced among overweight or obese migraineurs. Our findings add to the accumulating evidence of adverse pregnancy outcomes among migraineurs.