The journal of headache and pain
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Multicenter Study Clinical Trial
Prevention of episodic migraines with topiramate: results from a non-interventional study in a general practice setting.
The majority of patients with migraine headaches are treated in non-specialized institutions though data on treatment outcomes are largely derived from tertiary care centers. The current non-interventional study explores efficacy and tolerability outcomes of patients with episodic migraines receiving topiramate as preventive agent in a general practice setting. A total of 366 patients (87% female, mean age 41.8 +/- 11.6 years) were eligible for migraine prevention and treated with flexible dose topiramate for 6 months (core phase), and optionally for a total of 12 months (follow-up phase). ⋯ Absenteeism as well as triptan use decreased significantly, and significant improvements in activities of daily living and quality of life were reported. The most frequently reported AEs were paraesthesia (4.2%) and nausea (3%). Results suggest that migraine prevention with topiramate in a general practice is generally well tolerated and associated with a significant improvement in migraine headaches and related functional impairment.
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Multicenter Study Clinical Trial
Treatment of primary headache in children: a multicenter hospital-based study in France.
The aim of this 6-month, prospective, multicenter study of 398 children and adolescents with primary headaches was to collect data on headache treatment in neuropediatric departments. Treatments were compared before and after consultation. Prior to consultation, the acute treatments that had been prescribed most frequently were paracetamol (82.2% of children) and non-steroidal anti-inflammatory drugs treatment (53.5%); 10.3% had received a prophylactic treatment. ⋯ After the neuropediatric consultation, paracetamol was replaced by a non-steroidal anti-inflammatory drug in about three-quarters of cases and by triptan in about one-quarter of cases. The number of children prescribed a prophylactic treatment nearly doubled, whereas there was a 5-fold and 23-fold increase in psychotherapy and relaxation training, respectively, between pre-referral and referral. We conclude that specific treatments were underused for primary headache.
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Multicenter Study
Development and validation of a pharmacy migraine questionnaire to assess suitability for treatment with a triptan.
A questionnaire (Migraine Questionnaire; MQ) was developed to help pharmacists identify consumers with migraine suitable for non-prescription treatment with a triptan. Adults, who knew or thought that they had migraine, participated in three, sequential, community-based studies to validate the MQ. Overall, 1,353 subjects completed independent assessments with a pharmacist and a clinician (reference standard). ⋯ Clinicians using their standard practice determined that triptan therapy was suitable in 76.8% of cases compared with 48.8% for pharmacists using the MQ. The lack of concordance between pharmacists and clinicians in the false-positive cases (n = 113 of 660 subjects considered suitable for triptan by the pharmacists) usually related to headache diagnosis (57.5%), not safety aspects. The MQ is an effective tool for pharmacists to guide appropriate recommendation of a non-prescription triptan for migraine.
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Multicenter Study
Trigeminal autonomic cephalalgias: frequency in a general neurology clinic setting.
Cases of trigeminal autonomic cephalalgia seen in general neurology outpatient clinics by one consultant neurologist over a 4 year period (2004-2007 inclusive) were identified. A total of 40 cases was identified (=1.2% of all referrals, 5.3% of headache referrals), most with cluster headache, the remainder with SUNCT or SUNA. There was evidence of both delayed diagnosis and inappropriate treatment, despite involvement of other secondary care specialties. Increased awareness of this diagnostic category is required to ensure effective deployment of effective, evidence-based treatments.
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Randomized Controlled Trial Multicenter Study
Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial.
Acupuncture treatment is frequently sought for tension-type headache (TTH), but there is conflicting evidence as to its effectiveness. This randomised, controlled, multicentre, patient-and observer-blinded trial was carried out in 122 outpatient practices in Germany on 409 patients with TTH, defined as > or =10 headache days per month of which < or =1 included migraine symptoms. Interventions were verum acupuncture according to the practice of traditional Chinese medicine or sham acupuncture consisting of superficial needling at nonacupuncture points. ⋯ The relative risk on the primary and secondary response criterion was very similar ( approximately 0.8); the difference in statistical significance may be due to differences in event rate. TTH improves after acupuncture treatment. However, the degree to which treatment benefits depend on psychological compared to physiological effects and the degree to which any physiological effects depend on needle placement and insertion depth are unclear.