International Headache Society Criteria Research Articles

The Effect of Feverfew Cultivated in Iran for the Prophylactic Treatment of Migraine: A Randomized Placebo-controlled Clinical Trial

Background: One of the most common types of headache is migraine that often begins before 30 years age. The use of complementary preventive treatments has been growing worldwide that can be decrease the frequency and severity of migraine attacks with minimal side effects. Tanacetum parthenium L. (common name: feverfew) from Compositae family have traditionally been used as a febrifuge and remedy for migraine prophylaxis. Objectives: In present study, the effect of feverfew cultivated in Iran has been studied as a prophylactic treatment of migraine in a placebo-controlled clinical trial during 3 months. Patients and Methods: Criteria for inclusion were migraine without aura diagnosed after a careful medical history-taking according to the International Headache Society (IHS) criteria. The Migraine Disability Assessment Scores (MIDAS) questionnaire is quite a useful tool in clinical trial that the patients were recognized for migraine impact at the baseline and end of the study. Results: In the case group, after three months of treatment with feverfew, the MIDAS score was reduced to 19.18 ± 4.02. Compared to control group, the changes in intensity and frequency of migraine, in the treatment group was significant, at the end of the study (P < 0.05). Regarding the safety of feverfew extract the incidence of side effects in the treatment group was similar to placebo. Conclusions: In conclusion, the extract of feverfew showed a significant migraine prophylactic effect with no adverse events.

Evaluation of headache in children: a retrospective study

Objectives. Headache is a very common symptom that can be seen in the children. It can be seen due to primary or secondary causes. Migraine and tension-type headache are the most commonly seen primary headache types in children. In this study, we retrospectively evaluate etiologic and clinical features of the 228 patients. Methods. In this study, clinical features and neuro-imaging characteristics of the patients, who admitted Eskisehir Osmangazi University pediatric neurology department between 2007 and 2011 were evaluated retrospectively. Headache classification was made according to International Headache Society criteria. Results. The ages of the patients ranged from 4 to 18 years (average 12.9±3.1). There were 136 (59.6 %) girls, and 92 (40.4%) boys. The most frequent causes of the headache were migraine (37.3%) and tension type headache (25%). There were other associating diseases at 54 (23.7%) patients. Allergic rhinitis and asthma bronchilitis were the most commonly associated diseases. Abnormalities were encountered in 3 (6.8%) of the 44 (19.3%) patients taken computerized brain tomography, 18 (20.2%) of the 89 (39%) patients taken magnetic resonance imaging and 8 (3.5%) of the 77 (33.8%) patients taken electroencepahlography. No serious problem is established in patients undergoing neuro-imaging. Conclusions. In this study, it was seen that migraine and tension-type headache are the most frequently seen causes of the headache in the children. It is concluded that unnecessary neuroimaging examination should be avoided by detailed anamnesis and neurologic examination of children that admitted hospital with headache complaint.

Intravenous Caffeine for the Treatment of Acute Migraine: A Pilot Study

Background: Caffeine has a long profile of use as an adjuvant therapy for headache and migraine. This study evaluates the safety and efficacy of intravenous caffeine citrate for patients with acute migraine headache. Methods: In this single arm study, 61 patients were enrolled who were diagnosed with migraine according to International Headache Society criteria. Patients received 60 mg caffeine citrate intravenously (i.v.) in about 10 min. Visual analog scale (VAS) pain scores were measured on baseline and 1 h and 2 h after caffeine infusion. Results: The improvement in VAS pain score was >3 point change from baseline to 1 h after i.v. infusion (p 5 point change from baseline to 2 h after i.v. infusion (p<0.001). Patients who received other medication before caffeine i.v. infusion did not show better improvement after 1 h (p=0.304) or 2 h (p=0.926) compared with other patients. Conclusions: Infusion of 60 mg caffeine citrate i.v. is safe and well tolerated. It achieved therapeutic success for ...

Measuring Serum Level of Ionized Magnesium in Patients with Migraine.

Migraine is known as one of the most disabling types of headache. Among the variety of theories to explain mechanism of migraine, role of serum magnesium is of great importance. Serum magnesium, as a pathogenesis factor, was considerably lower in patients with migraine. We established this study to see if serum ionized magnesium, not its total serum level, was different in migraineurs from normal individuals. In this case control study, all participants were recruited from Neurology Clinic of Imam Hossein Hospital, Tehran, Iran. Ninety-six people were entered in the study, 48 for each of case and control groups. The two groups were matched by age and sex. Migrainous patients were selected according to the criteria of International Headache Society. Various characteristics of headache were recorded based on patients' report. Controls had no history of migraine or any significant chronic headaches. Serum ionized magnesium level was measured in both of the case and control groups and the results were compared to each other. P value of <0.05 was considered as significant. Case group consisted of 13 males, 35 females, and control group included 14 males, as well as 34 females. Mean age was 33.47± 10.32 yr for case and 30.45 ±7.12 yr for control group. Twenty-eight patients described the intensity of their headaches as moderate; 15 patients had severe and the 5 remainders had only mild headaches. Mean serum level of ionized Mg was 1.16± 0.08 in case group and 1.13± 0.11 in control group of no significant difference (P >0.05). Serum ionized magnesium, which is the active form of this ion, was not significantly different in migraineurs and those without migraine. This may propose a revision regarding pathogenesis of migraine and question the role of magnesium in this type of headache.

The Epidemiology of Exertional Headache in the General Population of Tehran, Iran.

In this cross-sectional study, we investigated the prevalence and characteristics of primary exertional headache (EH) among the Iranian general population living in Tehran, the capital city of the country. Headache is the most common complaint and is listed in the top 10 most disabling conditions. Epidemiological researches on headache can demonstrate its actual burden. There are still limited data on EH, especially in Iran and the Middle East. A Persian questionnaire was designed based on the International Headache Society (IHS) criteria of headache disorders (ICHD-II). Face-to-face interviews were performed by 5 trained medical interns on a sample size of 2300 people. Data for a total number of 2076 subjects were enrolled for final analysis. The mean age of the subjects at the time of the study was 36.3 ± 14.6 years. The 1-year prevalence of EH was 7.3% (95% confidence interval [CI]: 6.2-8.4%). The prevalence of EH was significantly higher in females compared to males (10.0% vs 5.4%, P < .001). The mean age of the subjects with EH was 32 ± 12.1 years. None of our EH patients received medical consult prior to the study. EH seems to be less prevalent among the Iranian population compared to previous studies.

Evaluation of Relationship Between Childhood Maltreatment and Medication Overuse Headache.

We aimed to evaluate the prevalence and relationship between childhood maltreatment (CMT) among patients with medication overuse headache (MOH) and to investigate whether CMT is associated with medication overuse in patients having headaches or with headaches that become chronic. Epidemiological studies report a relationship between childhood abuse and headache. There is growing knowledge about the evidence that childhood maltreatment leads to neurobiological sequel. Medication overuse is the most important problem for migraine to become chronic. But in the literature, there was no information about the role of childhood abuse in MOH and for migraine to become chronic. A total of 116 patients with headache, aged from 15 to 65 years, were included in the study. Patients having chronic migraine (CM), MOH and episodic migraine (EM) were selected out of patients presented to the headache outpatient clinic. Types of headache were determined according to the revised International Headache Society (IHS) criteria published in 2004. The Childhood Trauma Questionnaire, Beck Depression Inventory and Beck Anxiety Inventory were performed. Presence of psychiatric co-morbidities was evaluated by a clinician using Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, the Fourth Edition. A total of 116 patients with headache were included in the study. Of patients, 64 had MOH, 25 had CM and 27 had EM. The prevalence of CMT, particularly emotional neglect (62%), physical neglect (44%) and emotional abuse (36.2%), was determined higher in all headache groups. There was no statistically significant difference in prevalence of childhood maltreatment between MOH, CM and EM groups. No statistically significant difference was detected between educational status, psychiatric co-morbidities and childhood trauma, except for physical neglect. Childhood maltreatment was observed in MOH as in other forms of migraine and headache. However, no significant difference was observed between the three groups of patients with headache.

Evaluation of migraine in patients with ischaemic stroke

An association between migraine and ischaemic stroke has been observed for many years, but the exact mechanisms by which migraine can lead to stroke are still unknown. The purpose of this study was to determine the prevalence of migraine headaches in patients with ischaemic stroke. In this prospective cohort study, we assessed 323 patients with ischaemic stroke; these diagnoses were assigned based on the International Headache Society criteria for migraine with or without aura. Patients were recruited without major risk factors such as stroke, hypertension, hyperlipidaemia, diabetes, taking oral contraceptive pills, history of drug abuse and trauma in issue of their Stroke. Data were collected via a written questionnaire upon admission and were analysed with SPSS version 16 software. Comparisons were performed using Mann–Whitney's U test and chi-square and t-test. Migraine headache was present in 11.2% (36 of 323) of patients, 8.1% of women and 3.1% of men. Migraine prevalence was highest in the age over 60 years. There was a history of migraine without aura for over 2 years in 6.2% of patients with ischaemic stroke. Also, we found no significant correlation between migraine headache and location of the lesion in patients with ischaemic stroke.

Early Diagnosis of Migraine Necessary in Children: 10-Year Follow-Up

BackgroundThe prevalence of migraine in individuals younger than 20 years old is 8%, with a mean age at onset of younger than 8 years. However, the long-term prognosis of migraine attacks has not been clearly established. ObjectiveOur main objective was to evaluate disease course 10 years after migraine diagnosis in a cohort of children and adolescents. MethodsMigraine was diagnosed in 1999 in a pediatric headache reference center using International Headache Society criteria. In 2009, all patients were interviewed by telephone on the persistence and characteristics of any headaches. The main end point was prevalence of persistent migraine attacks in 2009. Variables associated with persistent attacks were analyzed. ResultsOverall, 142 children were diagnosed with migraine in 1999. Of these, 84 were interviewed by telephone in 2009. In 1999, the mean age was 11.6 ± 3.1 years, 54% were male, and 50% had migraine without aura. Migraine attacks were common (1-3 attacks/week in 38%). Mean age at onset was 7 years and 4 months (±3 years). In 2009, migraine prevalence was 39/84 (46% [95% confidence interval 36-56]), 12 patients (14%) were headache-free, and 62 patients (74%) had tension-type headaches that were isolated headaches in 33 (39%) patients. The rate of patients with at least one migraine attack per week fell from 37% to 8% (P = 0.001) over the 10-year period. Age at the first visit to the center was significantly higher in 2009 migraine sufferers than nonsufferers (12.5 ± 3.0 versus 10.9 ± 3.1 years (P = 0.02)). In multivariate analysis, age ≥12 years at the time of first presentation was the only significant factor associated with long-term chronic migraine (odds ratio = 3.0 [1.1-8.0]). ConclusionsTen years after first presentation, 46% of patients had migraine but the frequency of attacks had diminished. The only factor associated with chronic migraine was age ≥12 years at first presentation.

Sympathetic Skin Responses from the Neck Area in Patients with Unilateral Migraine.

In this study, in patients with unilateral migraine headache and in normal controls, it was aimed to assess the sympathetic function during attack, post attack, and interval periods and to compare these findings by recording sympathetic skin responses from the neck area, which was not studied before. A total of 37 unilateral patients with migraine (30 women, seven men) who fulfilled the criteria of International Headache Society (2004) were recruited from our outpatient clinic. The control group consisted of 21 healthy individuals (16 women, five men) who are employees or students of our Medical Faculty. Mean latency and maximum amplitude values of sympathetic skin responses obtained from neck areas of the patients during attack, post attack, and interval periods were calculated. We compared the mean latency and the maximum amplitude values of the symptomatic side with the data of the asymptomatic side and with the data of the control group. We also compared the responses of the patients with right-sided headache with the responses of the patients with left-sided headache. All statistical analyses were performed using SPSS. On the neck area, we observed sympathetic hypo-function in the attack and interval periods and a relative hyper-function in the post attack period bilaterally, regardless of the symptomatic side. These findings suggest that there is ongoing bilateral sympathetic hypo-function in the neck area and there occurs a temporary increase in the function of sympathetic sudomotor activity in the recovery period of headaches.

PP15.11 – 3031: Brain magnetic resonance imaging findings in children with recurrent headache

Objective To describe the frequency of abnormal findings detected on magnetic resonance imaging (MRI) in children with recurrent headache and to determine the prevalence and significance of nonspesific white matter lesions. Methods Children who were admitted to our pediatric outpatient neurology department with the complaint of recurrent headache between July 2013 and December 2014 were included in the study. We retrospectively reviewed the clinical and neuroimaging data of the patients. The types of headache were classified according to the criteria of International Headache Society. Results A total of 478 patients (273 female, 205 male) were included in the study. The types of headache were migraine in 218 (45.6%), tension-type in 159 (33.3%), secondary in 39 (8.2%) and unspecified headaches in 62 (13%) patients. MRI were performed in 407 (85%) patients and were abnormal in 145 (35%) patients. Eighteen patients had abnormal MRI findings related with headache, 13 of them had sinusitis, the other 5 (3%) had tumors. None of these 5 patients with tumor had abnormal neurologic symptoms or signs. Among the 127 patients, the most common findings were 42 cases of nonspecific white matter abnormalities, 17 cases of enlarged perivasculer spaces, 16 cases of asymmetric ventricles, 17 cases of arachnoid cyst, 12 cases with chiari type 1 and cerebellar tonsillar ectopia. The half of the patients with nonspecific white matter abnormalities had migrane, but no difference between the frequency of nonspecific white matter abnormalities in migraine and the other types of patients was found (p=0.55). Conclusion Due to the demands of the parents, the usage of neuroimaging studies in children with headache is increasing. Despite the increase in neuroimaging studies, the contribution of brain MRI in the diagnosis and the management of the children with recurrent headache is still low.

Prevalence of Migraine and Tension-Type Headache in Yazd, Iran

Background: Migraine and Tension-Type Headache (TTH) are the most frequent neurologic disabilities worldwide. Objectives: This study was conducted to determine the prevalence of migraine and tension-type headache among up to 15 years old. Patients and Methods: A descriptive-analytic study was conducted on 500 people in Yazd through cluster sampling method. International Headache Society criteria were used for diagnosis of migraine and tension headaches. Descriptive statistics and logistic regression in SPSS 16 were used for data analysis. Results: Migraine and TTH prevalence were respectively 6% and 4.9%. Abnormal sleep patterns were in 66.7% of people with migraine that this relationship was significant. The incidence of nausea and vomiting during migraine were respectively 55.6% and 40.7%. Photophobia in 55.9% and phonophobia in 85.2% of patient with migraine were reported. All of 48.1% of migraine sufferers have attacks with visual aura (P = 0.012) and also 48.1% have attacks with sensory aura. Conclusions: Migraine and TTH prevalence rate is relatively low in this study. However, people with migraine and TTH should be identified and optimally treated.

Prevalence of Migraine and Tension-Type Headache in Yazd, Iran

Background:: Migraine and Tension-Type Headache (TTH) are the most frequent neurologic disabilities worldwide. Objectives:: This study was conducted to determine the prevalence of migraine and tension-type headache among up to 15 years old. Patients and Methods:: A descriptive-analytic study was conducted on 500 people in Yazd through cluster sampling method. International Headache Society criteria were used for diagnosis of migraine and tension headaches. Descriptive statistics and logistic regression in SPSS 16 were used for data analysis. Results:: Migraine and TTH prevalence were respectively 6% and 4.9%. Abnormal sleep patterns were in 66.7% of people with migraine that this relationship was significant. The incidence of nausea and vomiting during migraine were respectively 55.6% and 40.7%. Photophobia in 55.9% and phonophobia in 85.2% of patient with migraine were reported. All of 48.1% of migraine sufferers have attacks with visual aura (P = 0.012) and also 48.1% have attacks with sensory aura. Conclusions:: Migraine and TTH prevalence rate is relatively low in this study. However, people with migraine and TTH should be identified and optimally treated.

Investigating the Dreaming Content of Migraineurs

Background:: Migraine is common and nocturnal attacks, sometimes, at night make the individual awake. Migraine often induces heavy pressure on the individual and society, and mostly co morbid with psychiatric disorders. Dreaming is a personal and psychological experience that never can be recorded while happening. Different physical-mental situations cause variation in dreaming form. Dreaming content can affect on procedure and features of some psychiatric disorders and it seems some accelerate migraine headaches. Objectives:: Present study investigated the dreaming content of migraineurs. Patients and Methods:: In this cross sectional study, 185 patients with migraine were selected and investigated by available sampling. Migraine diagnosis was based on International Headache Society (HIS) criteria. Dreams were interpreted based on Hall/ Van de Castle, which consisted 11 dreaming content categories. Data was analyzed in SPSS 17 and variables through descriptive statistical tests, analytical χ2, ANOVA and Logistic regression. Results:: Out of 185 patients, 133 were women. In nocturnal migraine, the average number of attacks were more per month (P = 0.006). Out of 130 patients, 231 dreams were recorded. Those with nocturnal attacks remembered and recorded their dreams more (P = 0.02). Friendliness, sexual and bad fortune contents were more in those with nocturnal attacks (P = 0.001). Sadness, bad fortune, aggression, confusion, sexual (P = 0.001) and failure accelerated headaches (P = 0.039). Conclusions:: Positive or negative emotions increase headaches. More advanced studies about dreaming contents in different patients and cultures and their comparison with healthy individuals can be helpful in this issue.

Investigating the Dreaming Content of Migraineurs

Background:: Migraine is common and nocturnal attacks, sometimes, at night make the individual awake. Migraine often induces heavy pressure on the individual and society, and mostly co morbid with psychiatric disorders. Dreaming is a personal and psychological experience that never can be recorded while happening. Different physical-mental situations cause variation in dreaming form. Dreaming content can affect on procedure and features of some psychiatric disorders and it seems some accelerate migraine headaches. Objectives:: Present study investigated the dreaming content of migraineurs. Patients and Methods:: In this cross sectional study, 185 patients with migraine were selected and investigated by available sampling. Migraine diagnosis was based on International Headache Society (HIS) criteria. Dreams were interpreted based on Hall/ Van de Castle, which consisted 11 dreaming content categories. Data was analyzed in SPSS 17 and variables through descriptive statistical tests, analytical χ2, ANOVA and Logistic regression. Results:: Out of 185 patients, 133 were women. In nocturnal migraine, the average number of attacks were more per month (P = 0.006). Out of 130 patients, 231 dreams were recorded. Those with nocturnal attacks remembered and recorded their dreams more (P = 0.02). Friendliness, sexual and bad fortune contents were more in those with nocturnal attacks (P = 0.001). Sadness, bad fortune, aggression, confusion, sexual (P = 0.001) and failure accelerated headaches (P = 0.039). Conclusions:: Positive or negative emotions increase headaches. More advanced studies about dreaming contents in different patients and cultures and their comparison with healthy individuals can be helpful in this issue.

Effects of pregabalin on central sensitization in patients with migraine.

Despite the fact that the most recently articulated theory of migraine is the central sensitization hypothesis, few basic and clinical research studies on central sensitization have been conducted in patients with migraine. Here, we aim to reveal the risk factors of migraine with allodynia and to illustrate the effects of pregabalin on alleviating allodynia. 63 migraine patients meeting the International Headache Society criteria were prospectively included. The cutaneous allodynia (CA) symptoms that occurred during headache attacks were examined with the Allodynia Symptom Checklist (ASC). The risk factors of allodynia were determined using logistic regression analysis. 41 patients with allodynia were treated with pregabalin (150 - 600 mg/d) for 12 weeks. The improvements in allodynia and headache severity as well as the side effects of the drug were recorded at 1 and 3 months following drug administration. Among the 63 patients, there were 41 cases (65.1%) of allodynia, including 35 cases (85.4%) of thermal allodynia, 12 cases (29.4%) of static mechanical allodynia, and 9 cases (22.0%) of dynamic mechanical allodynia. The allodynia appeared to be associated with gender (female), disease duration, and medication overuse. Compared with baseline, both the ASC scores in the three types of CA and the number of patients with allodynia were significantly decreased (p < 0.05) in patients treated with pregabalin. The frequency, severity, and duration of headache as well as the migraine disability assessment (MIDAS) and headache impact test (HIT-6) scores were significantly decreased (p < 0.05) when compared with baseline. The overall efficiency of drug therapy was 85.4% among all patients who received pregabalin. There were few side effects detected, and the patients showed good tolerability to drug therapy. Our results showed that 65.1% of patients with migraine had allodynia and that migraine with allodynia was related to the patient gender (female), disease duration, and medication overuse. Pregabalin was effective at relieving allodynia in migraine.

Efficacy of regular sauna bathing for chronic tension-type headache: a randomized controlled study.

Chronic tension-type headache (CTTH) is a chronic syndrome characterized by frequent headache occurring more than 15 days per month. The intensity and duration of headache pain can be very distressing and disabling on an individuals' well-being. The purpose of this study was to examine the applicability of sauna bathing as a new method of treatment for reducing pain in patients with CTTH. Thirty-seven people who fulfilled the International Headache Society criteria for CTTH were randomly assigned into two groups. The control group (n=20) received advice and education while the intervention group (n=17) received the same advice and attended a sauna regularly for 8 weeks. Reductions in subjective pain were determined using the numerical pain rating scale (NPRS). Disturbance in sleep, depression as assessed by Beckman Disability Index (BDI), and Headache Disability Index (HDI) were measured. Mean change in headache intensity significantly differed between the sauna and control group by 1.27 (95% confidence interval, 0.48-2.07; F=10.17; df=1, 117; p=0.002). There was no statistically significant change in duration of headache or improvement in sleep, depression, or HDI between the sauna and control groups. Regular sauna bathing is a simple, self-directed treatment that is effective for reducing headache pain intensity in CTTH.

Investigation of obsessive-compulsive symptoms in patients with migraine

A migraine is not just a headache. Migraines are characterized by the co-occurrence of various systemic changes and known to be associated with many psychiatric disorders in the interictal period, especially major depression and anxiety disorders. Obsessive-compulsive disorder (OCD) in patients with migraines is relatively less studied. Obsessive-compulsive symptoms were investigated in consecutive patients with a diagnosis of migraine and compared with that of a control group of healthy individuals. The relationship of these symptoms with the defined clinical features of migraine was analyzed. 74 patients and 36 controls were included in this study. Patients were chosen from those admitted with headache complaints to the Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Headache Outpatient Clinics between December 2010-March 2012. A headache specialist diagnosed all patients with migraine using the International Headache Society criteria.. The Yale Brown Obsessive and Compulsive Scale (Y-BOCS) was used to score OCD symptoms in all participants. In comparing Y-BOCS total scores between the migraine patients and the control group, we found a statistically significant difference (z(109)= -3.100, p<0.05). Furthermore, both the Y-BOCS obsession and compulsion sub-scores were significantly different between the groups. The duration, frequency and side of migraine did not have any correlation with our findings. In conclusion, our study suggested that migraine sufferers tend to have higher obsessive and compulsive symptoms. These findings could be based on genetic changes and/or functional differences in the brain.

Frequency of migraine as a chief complaint in otolaryngology outpatient practice.

Objective. To identify the frequency of typical (headache and dizziness) and common atypical (ear fullness, pressure, pain, tinnitus, facial fullness, and nasal congestion) migraine symptoms as chief complaints among patients presenting to otolaryngology clinic. Methods. This is a descriptive study of prospectively collected data from a general otolaryngology practice. Typical migraine presentations were diagnosed by applying international headache society (IHS) criteria for migraine headache and Neuhauser's criteria for migrainous vertigo. Atypical otologic and rhinologic migraine symptoms were diagnosed using individualized criteria. Charts were reviewed at 6-month interval from the first presentation. Results. Out of 1002 consecutive patients, 10.8% presented with “migrainous chief complaint.” All migrainous chief complaint patients had a history of headache but not all of them presented with headache. Corrected female to male ratio in the migraine group was 3 to 1; age distributions were significantly different between the migraine and nonmigraine groups by applying t-test. Out of the atypical complaints, 86% of the patients had a history of concomitant typical presentation. Conclusion. Actual diagnostic criteria for migraine do not satisfy the diversity of its presentation. Investigating the history of migraine is enough to diagnose most atypical presentations. Sound knowledge about migraine seems essential for any ENT practitioner.

Celecoxib vs prednisone for the treatment of withdrawal headache in patients with medication overuse headache: a randomized, double-blind clinical trial.

To compare the efficacy of celecoxib for treatment of withdrawal headache vs prednisone in patients with medication overuse headache (MOH). In this prospective, double-blind, parallel-group clinical trial, 97 consecutive subjects with MOH were randomized (simple randomization using computer-generated numbers) for treatment with either 400 mg/day celecoxib (for the first 5 days then decreased at a rate of 100 mg every 5 days) or prednisone 75 mg/day orally (for the first 5 days then tapered off every 5 days). Subjects who met the International Headache Society criteria for MOH were included in the trial. The change in headache days and intake of rescue medication were considered as primary outcomes while the change in headache severity defined as a secondary outcome. Patients treated with celecoxib experienced lower headache intensity during the first 3 weeks after withdrawal (after 3 weeks, the median of visual analog scale was 3 for patients in celecoxib group vs 4.5 for prednisone group [P<.001]). However, headache frequency and the need for rescue medication intake were not different between 2 groups. During withdrawal in MOH, in order to reduce headache days or rescue medication intake, using either of celecoxib or prednisone as a bridge is not different.

Comparative study of lipid profile between episodic migraineurs and healthy volunteers

Background: The lipid profile of migraineurs showed atherogenic condition. Cardiovascular and cerebrovascular events were found to be frequent and appeared one decade earlier in migraine patients compared with the general population. No comprehensive study is available regarding these aspects in migraineurs in India. Objectives: To compare lipid profile parameters between episodic migraineurs and healthy volunteers. Materials and Methods: This was a case–control study performed in a sample of migraine cases selected from the Outpatient Department, G.B. Pant Hospital, New Delhi, India, and normal healthy individuals as control group were chosen from the students of medicine, Maulana Azad Medical College, New Delhi, India. Migraineurs were selected based on the clinical diagnosis by neurologists, each fulfilling the International Headache Society criteria 2004. Subjects aged between 20 and 40 years were enrolled for study irrespective of the aura status. Lipid profile parameters studied were total choles terol, high-density lipoprotein (HDL), very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), and triglycerides. Results: The lipid profile of migraineurs showed abnormal condition. When LDL levels were compared, 24 of 54 cases and 5 of 30 controls showed abnormal levels (P = 0.020), whereas the remaining lipids showed no statistical significance between the two groups. Conclusion: Atherogenic lipid profile of migraineurs in our study coincided with the results of earlier studies. LDL levels were higher in cases when compared with those of controls. The values of total cholesterol, triglycerides, HDL, and VLDL levels did not differ significantly between the controls and the cases.