Treatment Of Migraine Headache Research Articles

A New extractive spectrophotometric method for determination of rizatriptan dosage forms using bromocresol green

Background and the purpose of the studyRizatriptan is used effectively for the treatment of migraine headache. In this study, a simple, rapid and low cost spectrophotometric method based on the ion-pair complexation is proposed for the determination of rizatriptan in raw material and dosage forms.MethodsThe ion-pair complexation using bromocresol green as reagent was performed in a buffer solution and the absorbance was measured by a spectrophotometer. The ion-pair formation conditions were optimized and the accuracy and precision of the method were calculated.Results and major conclusionBest results were achieved by using 6 ml of the bromocresol green reagent in the presence of phosphate buffer (pH 3.0). The stoichiometry of the resulted complex was 1:1. The within-day and between-day precision values were lower than 2.9 and 1.8 percent for the calibration range of 0.5–50 and 10–100 μg/ml, respectively. The proposed method was successfully used for the determination of rizatriptan in dosage forms without any interference.

Role of endothelial cells in antihyperalgesia induced by a triptan and β-blocker

While blood vessels have long been implicated in diverse pain syndromes (e.g., migraine headache, angina pectoris, vasculitis, and Raynaud’s syndrome), underlying mechanisms remain to be elucidated. Recent evidence supports a contribution of the vascular endothelium in endothelin-1-induced hyperalgesia, and its enhancement by repeated mechanical stimulation; a phenomenon referred to as stimulus-induced enhancement of (endothelin) hyperalgesia (SIEH). SIEH is thought to be mediated by release of ATP from endothelial cells, to act on P2X3 receptors on nociceptors. In the present study we evaluated the ability of another vasoactive hyperalgesic agent, epinephrine, to induce endothelial cell-dependent hyperalgesia and SIEH. We found that epinephrine also produces hyperalgesia and SIEH. Both P2X3 receptor antagonists, A317491 and octoxynol-9, which attenuate endothelial cell function, eliminated SIEH without affecting epinephrine hyperalgesia. We further evaluated the hypothesis that members of two important classes of drugs used to treat migraine headache, whose receptors are present in endothelial cells – the triptans and β blockers – have a vascular component to their anti-hyperalgesic action. For this, we tested the effect of ICI-118,551, a β2-adrenergic receptor antagonist and sumatriptan, an agonist at 5-HT1B and 5-HT1D receptors, on nociceptive effects of endothelin and epinephrine. ICI-118,551 inhibited endothelin SIEH, and attenuated epinephrine hyperalgesia and SIEH. Sumatriptan inhibited epinephrine SIEH and inhibited endothelin hyperalgesia and SIEH, while having no effect on epinephrine hyperalgesia or the hyperalgesia induced by a prototypical direct-acting inflammatory mediator, prostaglandin E2. These results support the suggestion that triptans and β-blockers interact with the endothelial cell component of the blood vessel to produce anti-hyperalgesia.

Low-Dose Propofol for the Abortive Treatment of Pediatric Migraine in the Emergency Department

Limited progress has been made in the past decade for abortive treatment of migraine headache in the pediatric emergency department (PED). Propofol, a general anesthetic, has been reported to be effective in the treatment of refractory headaches in adults at subanesthetic doses but never in the pediatric population. The goal of this study was to review our institution's experience with subanesthetic doses of propofol for the abortive treatment of pediatric migraine and compare propofol with standard abortive therapy in the PED. Retrospective review of all patients discharged from the Oregon Health and Science University PED with a diagnosis of migraine headache from January 2010 to July 2011. Patients treated with subanesthetic doses of propofol were compared with matched controls who received standard abortive migraine therapy, defined as the combined use of a nonsteroidal anti-inflammatory medication, diphenhydramine, and prochlorperazine. Outcome variables of interest included reduction of pain as measured on a self-reported visual analog scale and length of stay after administration of initial abortive medication. Patients who received subanesthetic doses of propofol achieved significantly greater reduction in pain scores (80.1% vs 61.1%; P < 0.05) compared with matched controls as well as shorter stay (122 minutes vs 203 minutes; P = 0.2) after treatment. No adverse effects (hypotension, respiratory depression, or hypoxia) were recorded in either group. Propofol seems to be effective for the abortive treatment of pediatric migraine headache in the PED. Further prospective trials are warranted to either support or refute these initial findings.

Hepatotoxicidad de rizatriptán. Descripción de un caso clínico

Triptans are a class of drugs with proven efficacy in the acute treatment of migraine headache. The first component of these drugs was sumatriptan, with various derivatives subsequently emerging. Until now, there has only been one reported case of liver toxicity with zolmitriptan. We now present a case of hepatotoxicity related to another drug in this group: rizatriptan.

Treatment of Headache in the Elderly

Opinion statementMost primary headaches in the elderly are similar to those in younger patients (tension, migraine, and cluster), but there are some differences, such as late-life migraine accompaniments and hypnic headaches. Although migraine in younger persons usually presents with headache, migraine in older persons may initially appear with visual or sensory phenomena, instead of headache (“migraine accompaniments”). Hypnic headaches awaken patients from sleep, are short-lived, and occur only in the elderly. The probability of secondary headache increases steadily with age. Secondary headaches include those associated with temporal arteritis, trigeminal neuralgia, sleep apnea, post- herpetic neuralgia, cervical spondylosis, subarachnoid hemorrhage, intracerebral hemorrhage, intracranial neoplasm, and post-concussive syndrome. Certain rescue treatments for migraine headache in younger individuals (triptans or dihydroergotamine, for example) should not be used in elderly patients because of the risk of coronary artery disease. Naproxen and hydroxyzine are commonly used oral rescue therapies for older adults who have migraine or tension headaches. Intravenous magnesium, valproic acid, and metoclopramide are all effective rescue therapies for severe headaches in the emergency room setting. Some effective prophylactic agents for migraine in younger patients (amitriptyline and doxepin) are not usually recommended for older individuals because of the risks of cognitive impairment, urinary retention, and cardiac arrhythmia. For these reasons, the recommended oral preventive agents for migraine in older adults include divalproex sodium, topiramate, metoprolol, and propranolol. Oral agents that can prevent hypnic headaches include caffeine and lithium. Cough headaches respond to indomethacin or acetazolamide.

Utility of p-Chloranilic Acid and 2,3-Dichloro-5,6-dicyano-p-benzoquinone for the Spectrophotometric Determination of Rizatriptan Benzoate

Rizatriptan is a new selective 5-HT1B/1D agonist which is used in the treatment of migraine headaches. Two simple, rapid, accurate, and economical spectrophotometric methods are described for the determination of rizatriptan benzoate (RTB) in its pure form and pharmaceutical preparations. These methods are based on the charge-transfer complexation reaction between rizatriptan benzoate as n-electron donor and p-chloranilic acid (p-CA) or 2,3-dichloro-5,6-dicyano-1,4-benzoquinone (DDQ) as π-acceptor to form highly colored chromogens. The chromogens formed by the reaction between RTB and p-CA peaked at 530 nm (method A) and that formed by the reaction between RTB and DDQ peaked at 590 nm (method B). Under the optimum conditions Beer’s law is obeyed in the concentration range of 14–245 μg mL−1 for method A and 4–70 μg mL−1 for method B. The coefficient of correlation was found to be 0.9999 for both methods. The molar absorptivity, Sandell sensitivity, limits of detection, and quantification are also reported. The stoichiometric relationship determined by Job’s continuous method was found to be 1 : 1 (drug : reagent) for both methods. Both methods were applied to determination of RTB in the pharmaceutical formulations. Results of the analysis were validated statistically.

Central Nervous System Acting Drugs in Treatment of Migraine Headache

Migraine is a primary headache disorder with an unknown pathophysiology. The growing evidence in recent years indicates migraine being a brain disorder, a sensory dysmodulation, and a system failure of normal sensory processing of the brainstem that involves the vascular tone and pain. At the moment, triptan family and NSAIDs are the first choice drugs for the treatment of acute migraine. There are several prophylactic drugs including the antiepileptic drugs (AEDs), betablockers, and Ca2+ channel blockers that are used for the treatment of migraine. Although many drugs including the triptans, NSAIDs, and others target the peripheral sites of activation, several novel drugs are being developed to target neural sites of action in the central nervous system (CNS). The first trigeminal synapses in the brain stem as well as the ascending and descending pathways and higher brain centers are involved in the transmission of pain and therefore be the main targets of several drugs some of which are in clinical trials. Central sensitization may also aggravate the headache and some drugs tend to alleviate pain by targeting neurotransmitters, receptors, or signalling molecules involved in this phenomenon. This article discusses the CNS acting novel drugs and those that are currently in use for the treatment of migraine.

The Localization of the Supraorbital Notch or Foramen is Crucial for Headache and Supraorbital Neuralgia Avoiding and Treatment

The aim of this study was to provide the morphological and morphometric data of the supraorbital foramina or notches related to sex, side, and the climatic conditions where the population lived. It was hypothesized that the distribution of the occurrence and location of these openings depends on climatic conditions in which the population lived. Orbits from 866 dried skulls obtained from three climatic regions: warm, temperate, and cold were examined. The examination concentrated on the configuration (notch/foramen) and on the distances to the reference points: nasion, frontomalare orbitale, infraorbital foramen and the superior orbital rim. In 14.3% of cases a smooth supraorbital rim was observed while different variants of the structures were observed in 85.7% of the cases. In cold climatic conditions, supraorbital foramina were found in the highest frequency (35.4%). In warm and temperate climates, the observed frequencies of supraorbital foramen were the lowest (18.8% and 19.9%, respectively). Frequency of supraorbital notches was the lowest of those skulls from a cold climate (44.0%) and the highest in those from a warm climate (59.0%). These results support the hypothesis that the occurrence of the supraorbital notches is greater in populations from warm compared with cold regions. This would provide a greater exit route for the neurovascular bundle and this may be related to the thermoregulatory processes in the supraorbital region. Furthermore, knowledge of precise locations of supraorbital structures is important when a supraorbital nerve block is given, for example, in the treatment of migraine headaches.

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults

To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention? The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications available in the United States for migraine prevention. The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein. Divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A). Frovatriptan is effective for prevention of menstrual migraine (Level A). Lamotrigine is ineffective for migraine prevention (Level A).

Lavender Essential Oil in the Treatment of Migraine Headache: A Placebo-Controlled Clinical Trial

Lavender essential oil has been used as an anxiolytic drug, a mood stabilizer, a sedative, spasmolytic, antihypertensive, antimicrobial, analgesic agent as well as a wound healing accelerator. We have studied for the first time the efficacy of lavender essential oil inhalation for the treatment of migraine in a placebo-controlled clinical trial. Methods: Forty-seven patients with definite diagnosis of migraine headache were divided into cases and controls. Cases inhaled lavender essential oil for 15 min, whereas the control group used liquid paraffin for the same time period. Patients were asked to record their headache severity and associated symptoms in 30-min intervals for a total of 2 h. We matched the two groups for key confounding factors. Results: The mean reduction of headache severity in cases was 3.6 ± 2.8 based on Visual Analogue Scale score. The reduction was 1.6 ± 1.6 in controls. This difference between the controls and cases was statistically significant with p < 0.0001. From 129 headache attacks in cases, 92 responded entirely or partially to lavender. In the control group, 32 out of 68 recorded headache attacks responded to placebo. The percentage of responders was significantly higher in the lavender group than the placebo group (p = 0.001). Conclusion: The present study suggests that inhalation of lavender essential oil may be an effective and safe treatment modality in acute management of migraine headaches.

The role of magnesium in migraine pathogenesis. Potential use of magnesium compounds in prevention and treatment of migraine headaches

One of the major functions of magnesium is the maintenance of proper electric potential of neurons. Pathological conditions associated with systemic magnesium deficiencies may be associated with disturbance of numerous neurophysiological processes. These may include neuron function, transmission of nerve impulses, neuromuscular transmission, muscle contraction and vasomotor reflex. Therefore, magnesium deficiencies, particularly those associated with hypomagnesemia, are a source of problems for neurologists. Migraine is one of the most common neurological disorders. Despite many years of research, pathophysiology of migraine has not been elucidated. The predominant opinion is that the onset of migraine headaches is associated with cerebral vascular spasms. Based on the available knowledge of biological functions of magnesium, at least several feasible mechanisms for prevention or reduction of the intensity of migraine attacks by magnesium ions have been proposed. The goal of this review is to summarize the literature re

A Socioeconomic Analysis of Surgical Treatment of Migraine Headaches

This study is meant to compare the direct and indirect cost of migraine headache care before and after migraine surgery and to evaluate any postoperative changes in patient participation in daily activities. Eighty-nine patients enrolled in a migraine surgery clinical trial completed the Migraine-Specific Quality-of-Life Questionnaire, the Migraine Disability Assessment questionnaire, and a financial cost report preoperatively and 5 years postoperatively. Mean follow-up was 63.0 months (range, 56.9 to 72.6 months). Migraine medication expenses were reduced by a median of $1997.26 annually. Median cost reduction for alternative treatment expenses was $450 annually. Patients had a median of three fewer annual primary care visits for the migraine headache treatment, resulting in a median cost reduction of $320 annually. Patients missed a median of 8.5 fewer days of work or childcare annually postoperatively, with a median regained income of $1525. The median total cost spent on migraine headache treatment was $5820 per year preoperatively, declining to $900 per year postoperatively. Total median cost reduction was $3949.70 per year postoperatively. The mean surgical cost was $8378. Significant improvements were demonstrated in all aspects of the Migraine-Specific Quality-of-Life Questionnaire and the Migraine Disability Assessment questionnaire. Surgical deactivation of migraine trigger sites has proven to be effective for the treatment of severe migraine headache. This study illustrates that the surgical treatment is a cost-effective modality, reducing direct and indirect costs. Patients may also expect improvements in the performance of and increased participation in activities of daily living. Therapeutic, IV.

Results of a patient survey for an implantable neurostimulator to treat migraine headaches

Migraine attacks are believed to involve activation of the trigeminovascular system and trigeminal-parasympathetic reflex, which is mediated through the sphenopalatine ganglion (SPG). An implantable SPG neurostimulator has been developed to apply on-demand SPG stimulation for the treatment of severe primary headache. The neurostimulator is implanted via an oral incision and placed along the maxilla, with the lead placed at the SPG. The neurostimulator contains no battery and is powered and controlled via a handheld remote controller. The potential interest of patients with high-frequency, high-disability migraine in having a SPG neurostimulator implanted to treat migraine is unknown. We aimed to evaluate patient interest to undergo such an implantation procedure and to participate in a clinical investigation of on-demand SPG stimulation for migraine by conducting a survey at the Ghent University Hospital in 41 migraineurs. Seventy-seven percent (77%) of subjects expressed an interest in participating in a clinical investigation requiring implantation of a SPG neurostimulator when headache frequency and severity were considered and 69% when pain relief experienced with current migraine treatment was considered. Preventive and acute medications were used in 64 and 95% of the subjects, respectively, and provided a reported reduction of headache frequency, duration and pain. However, acute medications were frequently associated with headache recurrence and bothersome side effects. Results indicate that a majority of high-frequency, high-disability migraineurs, many of whom achieve pain relief with their current medications, have an interest in participating in a clinical investigation of an implantable SPG neurostimulator for the treatment of migraine headache.

Calcitonin gene-related peptide (CGRP) receptor antagonists: Pyridine as a replacement for a core amide group

In our continuing efforts to identify CGRP receptor antagonists that can be dosed orally for the treatment of migraine headache, we have investigated a pyridine bioisosteric replacement of a polar amide portion of a previous lead compound, BMS-694153. Pyridine derivatives were discovered and their SAR was studied. Some of them showed excellent binding potency. However, oral bioavailability was low, even for compounds with good Caco-2 cell permeability.

Formulation and Evaluation of Bilayer Tablets of Metoclopramide Hydrochloride and Diclofenac Sodium

The main objective of the present research work was to develop a bilayer tablet of metoclopramide hydrochloride (MTH) and diclofenac sodium (DS) in separate layers to avoid incompatibility and thus to maximize the efficacy of both drugs in combination for the effective treatment of migraine headaches. MTH and DS were formulated as immediate and sustained release layers respectively. In vitro dissolution kinetic studies of an optimized (D10) batch of DS in both sustained release layer and bilayer tablet forms show good linearity of regression coefficient 0.9773 (first order equation). The results reveal that an optimized immediate release layer (M5) of MTH and a sustained release layer (D10) of DS might be suitable for the treatment of migraine by sequential release of the two drugs in a bilayer tablet. Migraine is a type of recurring headache of moderate to severe intensity associated with gastrointestinal, neurological, and autonomic symptoms. In migraine, a combination of pretreatment with antiemetics is required for symptomatic treatment, when nausea and vomiting are severe. In our present research, we have selected the metoclopramide hydrochloride (MTH) active ingredient for study because it has an antiemetic effect and is a prokinetic agent. MTH is more effective to counteract gastric stasis associated with migraine, and it enhances the rate of absorption of non-steroidal anti-inflammatory drugs (NSAIDs). In the present investigation we combine MTH and a second active ingredient, diclofenac sodium, as a formulated bilayer tablet to prevent degradation of MTH.

Migraine Surgery Practice Patterns and Attitudes

Minimally invasive techniques have been developed to treat migraine headache, and several reports have shown efficacy in treating select patients who are refractory to conventional therapies. Although there is a growing body of evidence supporting migraine surgery, no study has examined its adoption by plastic surgeons in the United States. A Web-based survey consisting of 17 ad hoc questions was designed to ascertain respondents' demographics, experience, knowledge, and attitudes regarding migraine surgery. After pilot testing, the survey was distributed by means of email to the entire membership of the American Society of Plastic Surgeons. A total of 3747 American Society of Plastic Surgeons members were surveyed, and 193 surveys were completed, for a response rate of 5.2 percent. Thirty-four respondents (18 percent) had performed surgery to treat migraine headache. Among those who have performed migraine surgery, over 80 percent reported improvement in patient symptoms. Of those who have not performed migraine surgery, 60 percent would be interested if an appropriate patient was referred to them by a neurologist. Although there is interest in migraine surgery among a subset of plastic surgeons, significant barriers to performing migraine surgery include deficient referral patterns from neurologists and lack of familiarity with the concept and techniques of migraine surgery.

A Comparison of Outcome of Surgical Treatment of Migraine Headaches Using a Constellation of Symptoms versus Botulinum Toxin Type A to Identify the Trigger Sites

This study was designed to assess whether preoperative trigger-site confirmation using botulinum toxin type A injections significantly improved migraine surgery outcomes. The medical charts of 335 migraine surgery patients were reviewed. Patients who received stepwise diagnostic botulinum toxin type A injections were placed in the botulinum toxin type A group (n = 245). Patients who did not receive botulinum toxin type A or received only therapeutic botulinum toxin type A were placed in the control group (n = 90). The preoperative and 12-month postoperative migraine headache frequency, duration, and intensity were compared to determine the success of the operations. Seventy-two of 90 control patients (80 percent) experienced a significant improvement (a decrease of at least 50 percent in migraine headache frequency, duration, or intensity) at 12 months after surgery, with 29 (32 percent) reporting complete elimination. Of the 245 botulinum toxin type A patients, 207 (84 percent) experienced a significant improvement, with 89 (36 percent) experiencing complete elimination. The surgical success rate of the botulinum toxin type A group was not significantly higher than that of the control group (p = 0.33). Confirmation of trigger sites using botulinum toxin type A does not significantly improve the outcome of migraine surgery. Although botulinum toxin type A can be a useful diagnostic tool, this study demonstrates that there is no statistically significant difference between the injection of botulinum toxin type A and the use of a constellation of symptoms to identify trigger sites. Therapeutic, III.

Severe acute caffeine poisoning due to intradermal injections: Mesotherapy hazard

Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient with acute iatrogenic caffeine poisoning. A 51-year-old woman, with preexisting hypertension and hypertensive cardiomyopathy was subjected to cosmetic treatment in order to remove fat by intradermal caffeine injections. During the treatment the patient felt sickness, an urge to vomit, and a pronounced deterioration of general condition. Upon examination, the patient exhibited somnolence, hypotension and nonsustained ventricular tachycardia, which was sufficient enough evidence for further hospitalization. On admission to the intensive care unit the patient was anxious with increased heart rate, normotensive, with cold, damp skin, and visible traces of injection sites with surrounding hematomas on the anterior abdominal wall. Paroxysmal supraventricular tachycardia (PSVT) on electrocardiographic monitoring was found. The laboratory analysis determined a lowered potassium level of 2.1 mmol/L (normal range 3,5 - 5.2 mmol/L), and a toxicological analysis (liquid chromatography with ultraviolet detection) proved a toxic concentration of caffeine in plasma - 85.03 mg/L (toxic concentration over 25 mg/L). On application of intensive therapy, antiarrhythmics, and substitution of potassium, as well as both symptomatic and supportive therapy, there was a significant recovery. The patient was discharged without any sequele within four days. A presented rare iatrogenic acute caffeine poisoning occured due to massive absorption of caffeine from the subcutaneous adipose tissue into the circulation when injected directly into the tiny blood vessels, as evidenced by hematoma formation. Poisoning manifestations were registered in gastrointestinal, CNS (anxiety, somnolence) and cardiovascular (hypotension, ventricular tachycardia and nonsustained PSVT) system. In this era of mesotherapeutic treatment promotion, one should keep in mind toxic prevention, with application being carried out exclusively in a specialized institution.

Effects of Neurofeedback on Memory of Migraine Patient

Introduction: Migraine is sever and painful type of headache which can be treated in different ways. Recent studies have demonstrated that neurofeedback is a good option for treatment of migraine headaches. Method: The main aim of present research was to investigate the effect of neurofeedback on Memory of migraine patients. To do so, a sample of 30 subjects was selected for experimental and control groups by a accessible sampling procedure. Subjects were assessed with the Wechsler Memory Scale in two stages (pretest and posttest). The obtained data were analyzed through covariance analysis method. Result: After 30 sessions of neurofeedback training, considerable improvement in general memory of the experimental group was observed. Also the two groups (experimental and placebo) presented significant differences in the memory. Conclusion: According to the researcher’s view, migraine patients are able to control their brainwaves with participating in neurofeedback training sessions, so their total memory would be increased.

Acute and preventive treatment of migraine headache

Migraine is a widespread primary headache disorder which requires a broad and an inclusive approach. This requires the use of appropriate pharmacological agents along with the integration of non-pharmacological therapies. There are 2 main categories of medication that are utilized for the treatment of migraine. Acute medications aim to relieve the pain and other symptoms associated with individual attacks and halt progression. Preventive therapies are used to reduce attack frequency, severity, and duration. There are a variety of medications available for both acute and preventive therapies. Some of them are specific for migraine while others are nonspecific headache or pain medications. Specific acute treatment for migraine includes triptans and ergots, which by definition are effective in migraine but not other non-headache pain disorders. Nonsteroidal anti-inflammatory drugs, neuroleptics/antiemetics, barbiturates, antihistamines, and opioids are some of the nonspecific medications that can be utilized for acute treatment. Preventive options for the treatment include beta-blockers, calcium channel blockers, antidepressants, and antiepileptic medications. With preventive and acute therapy, many patients are able to find relief from the debilitating effects of migraine.