Cephalalgia : an international journal of headache
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Randomized Controlled Trial Clinical Trial
Response measures in the acute treatment of migraine.
Pain ratings from 268 migraine patients have been used to compare the visual analogue scale (VAS) and a four-point verbal rating scale. All patients completed pain ratings on both scales at the beginning of a migraine attack and 4 h after starting treatment with sumatriptan or placebo. ⋯ In this study, the statistical power of analysing response either as "success or failure" or by means of the VAS score has been investigated by stochastic simulation. The simulations showed that the two response measures resulted in approximately equal power.
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The spontaneous capricious course of cluster headache may give rise to some problems when treatment is being evaluated. This is one of several explanations for there being so few well-designed, randomized, double-blind clinical trials in cluster headache. The standard treatment of acute attacks of cluster headache is inhalation of 100% oxygen. ⋯ Interim analysis of 3 months of data from a recent multinational open trial comprising, 138 patients having treated 6353 attacks with subcutaneous sumatriptan 6 mg revealed a headache relief in 96% of attacks treated. There was no evidence of an increased incidence of adverse events with frequent use of sumatriptan. No tachyphylaxis was seen over the 3 months, suggesting that sumatriptan is effective and well tolerated also in long-term acute treatment for cluster headache.
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Randomized Controlled Trial Clinical Trial
Diagnostic value of C2-3 instantaneous axes of rotation in patients with headache of cervical origin.
Previous investigators have suggested that patients suffering headache stemming from the C2-3 segment of the cervical spine can be identified by detecting an abnormal axis of rotation of that segment. The present study tested this hypothesis by correlating the location of the instantaneous axis of rotation (IAR) of the C2-3 segment with diagnostic blocks of the C2-3 zygapophysial joint in a sample of patients with headache. We found no significant correlation between the location of the axis and the response to diagnostic blocks. Previous false-positive assertions appear to be due to insufficient attention to the precision and reproducibility of the techniques used to determine IARs.
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The objective of the present study was to investigate whether the reliability of tenderness evaluation can be increased by using a new technique called "pressure-controlled palpation" (pcp). The technique has been made possible by a newly invented piece of equipment called a palpometer, with which a pressure-sensitive plastic film attached to the index finger records the pressure exerted. In 15 patients with chronic tension-type headache and in 15 healthy volunteers, 2 investigators studied myofascial tenderness using conventional palpation and pressure-controlled palpation. ⋯ Pain intensity reported by the subjects correlated highly with tenderness scored by the observer (rs = 0.95, p < 0.0001). These results demonstrate for the first time that tenderness scores can be compared between observers if palpation pressure is controlled. Pressure-controlled palpation represents a major improvement on current palpation techniques and should be standard in future research on myofascial pain disorders.