Headache
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Efficacy of a fixed combination of indomethacin, prochlorperazine, and caffeine versus sumatriptan in acute treatment of multiple migraine attacks: a multicenter, randomized, crossover trial.
To compare the efficacy of a fixed combination of indomethacin, prochlorperazine, and caffeine suppositories with sumatriptan suppositories in the treatment of 2 consecutive migraine attacks of moderate or severe intensity in a multicenter, randomized, crossover study. ⋯ This study, analyzed according to the more recent guidelines for controlled trials in migraine, showed that a fixed combination of indomethacin, prochlorperazine, and caffeine is significantly more effective than sumatriptan in the acute treatment of migraine attacks. It is notable that the combination is less expensive than sumatriptan per unit dose.
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To investigate potential differences in various aspects of personality in women with migraine with aura, without aura, and in healthy volunteers. ⋯ Our results suggest that migraineurs with aura differ from migraineurs without aura and healthy control subjects in terms of anxiety and depression. With regard to health-related locus of control, there was no correlation among mean number of migraine attacks per year, duration of disease, time of last migraine attack, and number of aura symptoms.
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Comparative Study
Confirmation of the distinction between chronic migraine and chronic tension-type headache by the McGill Pain Questionnaire.
To investigate if the McGill Pain Questionnaire confirms the distinction between chronic migraine and chronic tension-type headache. ⋯ In the disorders characterized by a daily and near-daily headache, the McGill Pain Questionnaire consistently can discriminate between those evolving from migraine and those evolving from tension-type headache, indirectly confirming the validity of a distinction between these 2 clinical conditions. The differences are similar to those observed between patients with migraine and patients with episodic tension-type headache. This seems to be independent of the pain level since the difference of the total pain-rating index and the visual analog scale between chronic migraine and chronic tension-type headache was not statistically significant.
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The overuse of short-acting barbiturate medications for the acute treatment of headache is a common problem in the United States. Most experts agree that withdrawal from these medications is necessary for subsequent headache treatment to be successful, yet there are few published articles outlining effective methods of drug withdrawal. ⋯ Management of butalbital withdrawal can be simplified by using a phenobarbital-loading protocol, taking advantage of the natural tapering afforded by the drug's long half-life. This method possesses most of the characteristics of an ideal drug withdrawal program for patients with headache who are overusing medications.
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Botulinum toxin type A, a neurotoxin, is effective for treating a variety of disorders of involuntary muscle contraction including cervical dystonia, blepharospasm, and hemifacial spasm. It inhibits neuromuscular signaling by blocking the release of acetylcholine at the neuromuscular junction. The biological effects of the toxin are transient, with normal neuronal signaling returning within approximately 3 to 6 months postinjection. ⋯ Although the majority of patients in these studies experienced no botulinum toxin type A-mediated side effects, a small percentage of patients did report transient minor side effects including blepharoptosis, diplopia, and injection-site weakness. Currently, 4 randomized, placebo-controlled, clinical trials are being conducted to evaluate the efficacy, optimal dosing, and side-effect profile of botulinum toxin type A as a novel treatment for migraine and other types of headache. These studies may provide further evidence that botulinum toxin type A is an effective option for the preventive treatment of migraine.