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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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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Randomized Controlled Trial Clinical Trial
Domperidone plus paracetamol in the treatment of migraine.
This study was designed to evaluate the safety and efficacy of domperidone in combination with paracetamol in the treatment of migraine. Severity of headache, duration of migraine attack and overall efficacy of treatment were amongst the variables assessed in a randomized, double-blind, three-way cross-over comparison of 1 g paracetamol plus either domperidone 30 mg, domperidone 20 mg or placebo, taken at onset of headache. Forty-six patients attending the City of London Migraine Clinic completed the study. ⋯ No significant adverse events were reported. A reduction in pain intensity and nausea was noted but this was not statistically significant. It was concluded that domperidone shortens the duration of a migraine attack and may help reduce headache and associated symptoms.
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Randomized Controlled Trial Clinical Trial
Experimental pain in human temporal muscle induced by hypertonic saline, potassium and acidity.
The study was aimed at developing a reference model for experimental pain and tenderness in the human temporal muscle by the local injection of hypertonic saline, potassium chloride and acidic phosphate buffer, using isotonic saline as control. The design was randomized and double-blind. Twenty healthy subjects had 0.2 ml test solution injected into one temporal muscle and saline into the other. ⋯ Compared to control injections, hypertonic saline and potassium chloride induced a significant reduction in pressure-pain threshold (ANOVA, p less than 0.0001 and p less than 0.05). Forty-eight percent of the injections led to the referral of pain most often to the jaws. A positive correlation between the relative occurrence of referred pain and pain intensity was observed (p less than 0.001) as was a negative correlation between the decrease in pressure-pain threshold and pain intensity (p less than 0.05).
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Randomized Controlled Trial Clinical Trial
Responders and non-responders to metoprolol, propranolol and nifedipine treatment in migraine prophylaxis: a dose-range study based on time-series analysis.
The aim of the present study was to ascertain, on the basis of single case statistics and time-series analysis, responder and non-responder rates for metoprolol, propranolol and nifedipine in migraine prophylaxis. In addition, an attempt was made to identify the dose relationship for the various drugs on headache parameters. In a double-blind dose-finding study, 58 patients were treated in five consecutive dosage steps each lasting 1-3 months. ⋯ Higher doses of propranolol and metoprolol were more effective. Multiple regression analysis explained a considerable part of variance for propranolol (but not for metoprolol) as a result of reduced intake of ergotamine preparations and analgesics. It can therefore be concluded that part of the prophylactic effect of propranolol is attributable to a reduction in the use of migraine medication.