Headache
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A strong association has been demonstrated between migraine, particularly in the chronic form and with medication overuse, and either major depression or various anxiety disorders. However, there has been less systematic research on the links between migraine with medication-overuse headache (MOH) and obsessive-compulsive disorder (OCD). A drug-seeking behavior shares with OCD the compulsive quality of the behavior. We investigated the relationship between OCD and MOH in migraineurs. ⋯ The excess of psychiatric comorbidity in patients with MOH can be related either to medication overuse or to chronification of headache. Among anxiety disorders, we observed a high rate of subclinical OCD. However, a direct link between compulsive behavior and medication overuse cannot be established yet. OCD in MOH might be underdiagnosed and undertreated.
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Randomized Controlled Trial Multicenter Study
A randomized, double blind, placebo-controlled study of MAP0004 in adult patients with migraine.
Dihydroergotamine mesylate (DHE) is an effective treatment for acute migraine, but its effective use is often limited by the inconvenience and inconsistency of intranasal, intramuscular, or subcutaneous routes of administration. A new formulation of DHE delivered through the lungs by the novel Tempo inhaler is being developed and is designed to offer fast onset, consistent dosing, and sustained response. ⋯ In this study MAP0004 0.5 mg and 1.0 mg were well tolerated and effective at delivering clinically significant, rapid, and sustained pain relief in adult migraine patients. No additional benefit was observed with the higher dose, thus the MAP0004 0.5 mg systemic equivalent dose has been selected as the dose for further clinical study.
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Randomized Controlled Trial Multicenter Study
Acupuncture for treating acute attacks of migraine: a randomized controlled trial.
To discuss the results of a multicenter randomized controlled trial of the efficacy of verum acupuncture in treating acute migraine attacks. ⋯ Verum acupuncture treatment is more effective than sham acupuncture based on either Chinese or Western nonacupoints in reducing the discomfort of acute migraine. Verum acupuncture is also clearly effective in relieving pain and preventing migraine relapse or aggravation. These findings support the contention that there are specific physiological effects that distinguish genuine acupoints from nonacupoints.
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Migraineurs often describe environmental triggers of their headaches, such as barometric pressure change, bright sunlight, flickering lights, air quality, and odors. Environmental aspects of indoor space and workplaces are also implicated in migraine experience. Comprehensive migraine treatment programs emphasize awareness and avoidance of trigger factors as part of the therapeutic regimen. As migraine has a substantial economic impact, remediation of correctable environmental triggers may benefit employee attendance and productivity among migraineurs. Few controlled studies in the literature, however, confirm environmental influences on migraine and headaches. Although some are controversial, migraineurs worldwide consistently report similar environmental triggers. This article addresses commonly mentioned environmental triggers with a discussion of their pathophysiology and proposed preventive measures. ⋯ There are conflicting studies supporting the validity of patient-reported environmental migraine triggers. Prospective studies are needed to determine the extent that external stimuli influence the migraine process. Decreased thresholds for light, noise, olfactory and visual stimuli in migraineurs may be minimized by modifying the work, home and classroom settings.