Headache
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In the current literature, there is neither a reported systematic review comparing the efficacy of triptans at 30 minutes and 1 hour after the migraine treatment, nor data related to efficacy of new marketed triptans. ⋯ This analysis updates the comparative data available for the 7 currently marketed oral triptans and clearly demonstrates their efficacy when compared to placebo, even with stricter endpoints, such as efficacy at 30 minutes. No triptan exhibited better tolerability than placebo. Results are diverse, depending on the triptan, which probably is a reflection of heterogeneous pharmacokinetics.
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Cortical spreading depression (CSD) is an electrophysiological phenomenon characterized by a wave of excitation followed by inhibition. The aura phase that precedes migraine headache in about 20-30% of migraineurs shares overlapping characteristics with CSD. Studies of rare autosomal-dominant forms of migraine with aura provide strong evidence that the threshold for evoking CSD and aura are related to neuronal excitability. Although the relationship between CSD and migraine without aura is not completely understood, the molecular abnormalities that predispose to migraine with aura illustrate the importance of physiologic events associated with neuronal hyperexcitability, and provide a basis for understanding a more generalized view of migraine.
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To gain knowledge of episodic headache patients who seek care at an urban university emergency department (ED), to evaluate the care they receive and to examine the impact of the ED on these headache patients. ⋯ Migraine ICHD-2 criteria are underused, and patients are undertreated in the ED. Many patients leave without a discharge diagnosis, outpatient medications, or instructions. ED physicians could help identify the migraineurs and channel them toward appropriate outpatient treatment.
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Clinical Trial
Efficacy of duloxetine as a migraine preventive medication: possible predictors of response in a retrospective chart review.
This case series is a retrospective chart analysis conducted to evaluate the efficacy of duloxetine as a migraine preventive medication and to suggest possible predictors of response. ⋯ Duloxetine demonstrates minimal effectiveness as a headache preventive medication. An interesting trend suggests that the presence of anxiety may be a positive predictor in treatment with duloxetine.