Headache
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We report a case of reversible cerebral vasoconstriction, possibly secondary to the use of indomethacin to relieve pain during a migraine with aura attack. Non-steroidal anti-inflammatory drugs are not reported among substances precipitating secondary forms of reversible cerebral vasoconstriction. A transcranial Doppler sonography study, performed during the phase with headache and the other neurological deficits, suggested the presence of distal cerebral vasospasm, which normalized when all symptoms regressed completely (<24 hours). We speculated that indomethacin might represent the trigger factor of these particular phenomena, by acting either directly on distal cerebral vessels, or under certain predisposing conditions, such as migraine with aura attacks.
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The objectives of this study were to develop a preclinical rodent model that produces migraine-like behaviors based on International Headache Society diagnostic criteria, to determine whether sex differences are present, and to determine whether expression of calcitonin gene-related peptide (CGRP) and the genes encoding its receptor in trigeminal ganglion or medulla correlates with those behaviors. ⋯ This study demonstrates significant changes in locomotor activity and facial allodynia associated with application of IS to the dura as well as significant sex differences, demonstrating that International Headache Society diagnostic criteria can be used to design a rodent behavioral model of migraine. In addition, there were prominent baseline sex differences in expression of CGRP and its receptor in both the trigeminal ganglion and medulla, but the majority of changes in expression of CGRP and its receptor were present in both the IS and PBS treated rats. This suggests that the CGRP pathway responds to changes in intracranial pressure or meningeal stretch, while migraine-like behaviors occur after meningeal inflammation.
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Randomized Controlled Trial Multicenter Study Comparative Study
Randomized controlled study of telcagepant plus ibuprofen or acetaminophen in migraine.
To evaluate the efficacy and tolerability of telcagepant when co-administered with ibuprofen or acetaminophen for the acute treatment of migraine. ⋯ The combination of telcagepant 280 mg with either ibuprofen 400 mg or acetaminophen 1000 mg did not show a statistically significant difference from telcagepant alone. Numerically greater treatment effects in the combination treatment groups over the telcagepant 280 mg monotherapy suggest that telcagepant combination treatments may merit further evaluation in studies powered to detect smaller additive benefits. (Clinicaltrials.gov; NCT00758836).
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Randomized Controlled Trial Multicenter Study
MAP0004, orally inhaled DHE: a randomized, controlled study in the acute treatment of migraine.
To evaluate the efficacy and tolerability of MAP0004 compared with placebo for a single migraine in adult migraineurs: The FREEDOM-301 Study. ⋯ In this study, MAP0004 was effective and well tolerated for the acute treatment of migraine with or without aura, providing statistically significant pain relief and freedom from photophobia, phonophobia, and nausea in adults with migraine compared with placebo.
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Few prospective studies have evaluated the relationship between insomnia and headache. We aimed to analyze the influence of insomnia at baseline on the risk for headache 11 years later. ⋯ In headache-free subjects, insomnia was associated with an increased risk of headache 11 years later. The association was particularly strong for chronic headache.