Headache
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Comparative Study
Quantitative assessment of the tension-type headache and migraine severity continuum.
Two quantitative measures for Waters' tension-type headache and migraine severity continuum are proposed. To ensure face validity, symptoms and precipitants of this disorder were complied from the literature as a basis for the Auckland Migraine and Headache Inventory. This inventory was completed by 84 participants (mean age +/- SD, 26.0 +/- 9.7 years; range, 18 to 59 years) who complied with the criteria of the International Headache Society for migraine or tension-type headache. ⋯ These scores yielded significant internal reliability (r = .77 and .84), test-retest reliability (r = .86 and .74), and concurrent validity (r = .57) coefficients. The data, therefore, support the notion that the migraine headache index and the number of precipitants are reliable and valid indices of tension-type headache and migraine severity, suitable for participant selection and assessment of treatment. This study offers support for Waters' suggestion that tension-type headache and migraine are extremes of a severity continuum.
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Randomized Controlled Trial Clinical Trial
Naratriptan is effective and well tolerated in the acute treatment of migraine. Results of a double-blind, placebo-controlled, parallel-group study. Naratriptan S2WA3001 Study Group.
To evaluate the efficacy and tolerability of naratriptan, a novel 5-HT1 agonist, in the acute treatment of migraine. ⋯ Naratriptan is effective and well tolerated for the acute treatment of migraine. The 2.5-mg dose appears to offer the optimum ratio of efficacy to tolerability.
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The aim of the present study was to examine the ability of pericranial muscle tenderness and the second exteroceptive suppression period to distinguish chronic tension-type headache sufferers, migraine sufferers, and controls in a young adult population utilizing a blind design. The second exteroceptive suppression periods were assessed using the methodology recommended by the European Headache Federation and were scored with an automated computer software program designed in our laboratory to provide reliable, standardized, and precise quantification of exteroceptive suppression periods and eliminate any influence of experimenter bias that may occur with manual scoring. Our sample consisted of 45 subjects diagnosed according to IHS criteria: 25 with chronic tension-type headache and 20 with migraine without aura. ⋯ Pericranial muscle tenderness was quite successful in distinguishing recurrent headache sufferers from controls, but failed to distinguish chronic tension-type headache sufferers from migraineurs. Our findings raise the possibility that pericranial muscle tenderness is present early in the development of chronic tension-type headache and migraine without aura, and thus might contribute to the etiology of headache disorders. Our findings also indicate that a shortened second exteroceptive suppression period is not a reliable marker for chronic tension-type headache in young adults.
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Refractory headache patients who require narcotic injections for acute attacks frequently utilize health care facilities. The experience is often unpleasant and costly to the patient and health care system. We have developed an oral narcotic protocol for home administration. ⋯ An annual cost savings of $1960 for office visits and $3024 for emergency department visits was realized. This was offset by an oral narcotic protocol medication cost of only $392. This treatment method has been well accepted by patients and has proven to be a safe and cost-effective approach to treating refractory migraine patients.
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Randomized Controlled Trial Clinical Trial
Ketoprofen versus paracetamol in the treatment of acute migraine.
The efficacy and safety of ketoprofen and paracetamol were compared for the treatment of acute migraine in a randomized, double-blind study of 64 patients. Thirty-four patients received ketoprofen 100 mg intramuscularly, and 30 patients received paracetamol 500 mg intramuscularly. Partial or complete relief of pain and other symptoms was achieved 15 to 20 minutes after administration in the ketoprofen group and within 35 minutes in the paracetamol group. ⋯ Six of the patients treated with ketoprofen needed a second dose for complete relief of pain during the 4-hour follow-up period. Side effects were rare and minimal. Our findings suggest that ketoprofen produced statistically significant benefit in the treatment of acute migraine.