Migraine Relief Research Articles

Use of sumatriptan in Denmark in 1994-5: an epidemiological analysis of nationwide prescription data.

We describe the use of medication with symptomatic relief of migraine as specific indication by analysing prescription data from the entire Danish population in 1994 and 1995. The data for sumatriptan were analysed at the level of the individual user. We used aggregated data for ergotamine drugs. Sumatriptan constituted 46% of the total amount of defined daily doses (DDD) sold and 94% of the total pharmacy retail price expenses in the drug-group studied. In total, 43389 users of sumatriptan were identified who presented 340148 prescriptions, corresponding to 2.2 million DDD of sumatriptan. The quarterly consumption increased by 50% during the study period. Tablets accounted for 92% of consumption. The 1 year period prevalence of use of sumatriptan among persons 16 years and older was 7.8 per 1000 in 1995 with a female to male prevalence ratio of 3.8:1. Use was most common in the age interval 35-54 years. Regional differences in use, which were not large, were positively correlated to the degree of urbanization. The incidence of use of sumatriptan was estimated at 3.6 per 1000 person-years. The intensity of use of sumatriptan varied greatly with 1.1% of patients (n = 507) using 60 DDD or more within 30 days at some time during the observation period. Long-term high use of tablets was common in this group. We conclude that sumatriptan had a considerable impact on the treatment of migraine with prescription drugs in Denmark. The underlying reasons for high use of the drug in a smaller fraction of the patients deserve further study.

The safety of concomitant use of sumatriptan and antidepressant treatments.

It is presently contraindicated to use the antimigraine drug sumatriptan with selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, or lithium. Consequently, many patients undergoing these pharmacotherapies for psychiatric disorders may not benefit from the therapeutic effect of sumatriptan in acute migraine attacks. Because sumatriptan does not appear to cross the blood-brain barrier and has a short half-life, it was deemed relatively safe to prescribe sumatriptan with antidepressant treatments. Fourteen patients receiving fluoxetine, fluvoxamine, sertraline, moclobemide, lithium, or buspirone did not experience significant side effects when they took oral sumatriptan for the relief of migraine on a total of 103 episodes. It is concluded that the combined use of sumatriptan with the above-mentioned antidepressant treatments may be safe.

Relief of Migraine and Other Headache Following Surgical Treatment of Varicose Veins

Sixty-eight patients undergoing surgical treatment of varicose veins who also suffered from recurrent headache were studied. In 23 patients this symptom was classified as migraine and in 45 as other headaches. In each group four aspects of headache (frequency, severity, duration, and associated disturbances) were assessed by a self-administered questionnaire before and between twelve and eight een months after surgical treatment of varicose veins. In migraine there were reductions in scores for frequency, p < 0.01; severity, p < 0.01; duration, p < 0.01; associated disturbances, p<0.01; and in total score, p<0.01. In other headaches there were reductions in scores for frquency, p < 0.001; severity, p < 0.001; du ration, p < 0.001; associated disturbances, p < 0.01; and in total score, p < 0.001. Varicose veins and migraine are each associated with impaired regional blood flow. The results of the present study suggest that relief of recurrent headache following surgical treatment of varicose veins may be due to effects of improved blood rheology in the microcirculation on cerebral function.

Propranolol plasma levels and relief of migraine. Relationship between plasma propranolol and 4-hydroxypropranolol concentrations and clinical effects.

The relationship between propranolol and 4-hydroxypropranolol plasma concentrations and relief of migraine was assessed in 17 patients during treatment with oral racemic propranolol hydrochloride in doses of 40 to 240 mg/day. Propranolol decreased the migraine index more than 70% in 13 patients: five patients at a dosage of 40 mg/day, five patients at a dosage of 120 mg/day, and three patients at a dosage of 240 mg/day. Three patients did not achieve a good improvement of migraine at any of the doses used. The relief of migraine was not directly related to the propranolol and 4-hydroxypropranolol plasma concentrations.

Multimodal biofeedback in the treatment of migraine

The purpose of this study was twofold: (a) to compare the effects of three behavioral strategies for the relief of migraine, and (b) to examine different combinations of the treatments to assess the effectiveness of multimodal biofeedback with this problem. Twenty-four volunteer migraine sufferers not on medication, and with at least weekly occurrence of headaches, participated in the study. Results indicated that (a) subjects who learned temporal cooling, frontalis relaxation, and progressive muscular relaxation exhibited the best success with headache relief; (b) control subjects, who did not show the same psychophysiological changes as experimental subjects, reported no headache relief; and (c) subjects in the group with only relaxation exercises performed similarly to control subjects and reported no headache relief.

Vascular headache.

Symptomatic and prophylactic approaches can offer effective relief and control of migraine and cluster headaches. Therapeutic alternatives and caveats are examined.

An integrated blood volume pulse biofeedback system for migraine treatment

A blood volume pulse (BVP) biofeedback system is described that integrates BVP amplitude to provide a signal appropriate for auditory feedback. In comparison to binary BVP feedback methods, this integrated system offers the advantages of continuous feedback and increased scoring ease. The validity of this system was established by correlating the integrated BVP output with trough-to-peak measurements of the raw BVP signal during unassisted relaxation and temporal BVP biofeedback with eight migraine headache patients. Within-subject correlations of the integrated and raw BVP outputs ranged from .82 to .98 (means = .95). Although the integrated method admits unwanted BVP changes in rate, correlation analyses showed this confound factor to be small. Increments in biofeedback training effects were observed during the treatment course. Substantive migraine relief was achieved by the end of treatment and therapeutic gains were maintained at 1-year follow-up. In conclusion, it appears that this method successfully presents continuous auditory feedback from an integrated BVP signal resulting in therapeutic benefits to migraineurs.

Behavior therapy for psychosomatic disorders

Because learned emotional or psychophysiologic responses are a factor in the causation of psychosomatic disorders, such illnesses lend themselves to treatment with behavior therapy. A behavior analysis must be done initially to establish a correlation between the psychological factors and the somatic illness. Then systematic desensitization, flooding, biofeedback, and other techniques are effective in most patients. The author discusses the application of behavior therapy for relief of asthma, essential hypertension, migraine, tension headache, neurodermatitis, and gastrointestinal psychosomatic reactions.

Migraine and oral contraceptives.

SYNOPSISTo ascertain the effect of oral contraceptives on migraine, an analysis was made of self administered questionnaires from 886 non‐pregnant migraine sufferers aged 15‐45 years (241 Pill takers, 290 ex‐takers and 355 non‐takers), together with a 3 months record of migraine attacks in 416 women covering 1,239 menstruations.Migraine was worse on the Pill in 34% of takers and 60% of ex‐takers. On stopping the Pill 39% of ex‐takers improved. During menstruation 35% of attacks occurred in takers, 32% of attacks in ex‐takers and 27% of attacks in non‐takers. A significant increase in migraine at mid‐cycle was most marked among those whose migraine increased on the Pill and those with severe attacks. Other significant differences are reported relating to length of menstrual cycle. Deterioration of migraine on Pill related to age, parity, cycle length, menstrual attacks, relief of migraine in late pregnancy and onset after pregnancy.

YOGA AND BIO-FEEDBACK IN THE MANAGEMENT OF HYPERTENSION

Yogic relaxation and bio-feedback techniques were used in the treatment of 20 patients with hypertension. As a result, antihypertensive therapy was stopped altogether in 5 patients and reduced by 33-60% in a further 7 patients. Blood-pressure control was better in 4 other patients, while 4 patients did not respond to therapy. Of these 4 patients, at least 1 had derived indirect benefit by the relief of migraine and depression. The results of this study promise a useful new approach to the treatment of hypertension.

PLASMA SEROTONIN AND MIGRAINE HEADACHE

The research of the late Harold G. Wolff and his colleagues established that the symptoms of migraine are linked closely with reactions of the cranial blood vessels. The main contribution to the pain of migraine headache comes from excessive dilatation of the scalp arteries, although the cerebral vessels may follow suit in some patients. The focal neurological symptoms of migraine are associated with constriction of the cerebral arteries which may initiate more subtle metabolic changes in cortical cells. What mechanism maintains normal tonic vasoconstriction of scalp vessels and how is this disordered in migraine? It is unlikely to be a neural mechanism since scalp nerves exert a predominantly vasodilator action on extracranial arteries, and operations on sympathetic and parasympathetic nerve pathways have not provided lasting relief of migraine. Two communications in the May issue of the<i>Archives of Neurology</i>demonstrate that serotonin exerts a potent constrictor effect upon extracranial arteries

Rectal use of ergotamine tartrate and caffeine alkaloid for the relief of migraine.

IN 1894 Thomson1 recommended the treatment of periodic neuralgia of the head by a rectal infusion of tincture of ergot. Despite the reported success of this method the derivatives of ergot were not widely employed in the treatment of headache of the migraine type until 1928, when Tzanck2 used ergotamine tartrate for migraine in Europe; Lennox3 introduced it into this country in 1934, recommending both oral and parenteral administration. The rectal route seems to have been neglected until the past three years, when several observers4 , 5 reported the efficacy of ergotamine tartrate and caffeine alkaloid for migraine when used in the . . .