Schwedt TJ. A prospective, randomized trial of intravenous prochlorperazine versus subcutaneous sumatriptan in acute migraine therapy in the emergency department. Busch V, Gaul C. Exercise in migraine therapy--is there any evidence for efficacy? Please confirm that you would like to log out of Medscape. Jeffrey S. FDA Okays First Drug for Migraine Prevention in Adolescents. Scott NA, Genome-wide association study reveals three susceptibility loci for common migraine in the general population. Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults. Nezvalová-Henriksen K, Bachrach EA, Available at Brandes JL, Kudrow D, Stark SR, O'Carroll CP, Adelman JU, O'Donnell FJ, et al. Silberstein SD, Migraines are diverse in everybody. Ertan C, Less commonly, headache lacks migrainous features or is completely absent (isolated aura).Associated with blurred vision, nausea, vomiting, and seeing halos around lights; ophthalmologic emergencyAntecedent trauma; may have subacute onset; altered level of consciousness or neurologic deficit may be presentMarked blood pressure elevation (systolic > 210 mm Hg or diastolic > 120 mm Hg); may have confusion or irritabilityBenign intracranial hypertension (pseudotumor cerebri)Often abrupt onset; associated with nausea, vomiting, dizziness, blurred vision, and papilledema; may have cranial nerve V1 palsy; aggravated by coughing, straining, or changing positionMay be insidious or associated with dyspnea; occurs more commonly in colder monthsCause of stroke; can be spontaneous or follow minor trauma or sudden neck movement; unilateral headache or face pain; ipsilateral Horner syndromeWorse with neck movement; posterior distribution; pain is neuralgic in character and sometimes referred to vertex or forehead; more common in older patientsUncommon; sudden onset; duration of minutes to hours; repeats over a course of weeks, then may disappear for months or years; unilateral lacrimation and nasal congestion; severe unilateral and periorbital pain; more common in men; patient is restless during episodeNeurologic abnormalities, confusion, altered mental status or level of consciousnessUsually worse when lying down; nasal congestion; tenderness over affected sinusOccipital location; tenderness at base of skull; pain is neuralgic in character and referred to vertex or foreheadWorse on awakening; generally progressive; aggravated by coughing, straining, or changing positionChronic headache with few features of migraine; tends to occur daily; hormone therapy and hormonal contraceptives are frequent culprits; includes analgesic reboundAntecedent head trauma; vertigo, lightheadedness; poor concentration and memory; lack of energy; irritability and anxietyExplosive onset of severe headache; 10% preceded by sentinel headachesAlmost exclusively in patients older than 50 years; associated with tenderness of scalp or temporal artery and jaw claudication; visual changesPain generally involves the temporomandibular joint and temporal areas; associated with symptoms when chewingCommon; duration of 30 minutes to seven hours; typically bilateral; nonpulsating; mild to moderate intensity without limiting activity; no nausea or vomitingBrief episodes of sharp, stabbing pain and trigeminal nerve face distributionAssociated with blurred vision, nausea, vomiting, and seeing halos around lights; ophthalmologic emergencyAntecedent trauma; may have subacute onset; altered level of consciousness or neurologic deficit may be presentMarked blood pressure elevation (systolic > 210 mm Hg or diastolic > 120 mm Hg); may have confusion or irritabilityBenign intracranial hypertension (pseudotumor cerebri)Often abrupt onset; associated with nausea, vomiting, dizziness, blurred vision, and papilledema; may have cranial nerve V1 palsy; aggravated by coughing, straining, or changing positionMay be insidious or associated with dyspnea; occurs more commonly in colder monthsCause of stroke; can be spontaneous or follow minor trauma or sudden neck movement; unilateral headache or face pain; ipsilateral Horner syndromeWorse with neck movement; posterior distribution; pain is neuralgic in character and sometimes referred to vertex or forehead; more common in older patientsUncommon; sudden onset; duration of minutes to hours; repeats over a course of weeks, then may disappear for months or years; unilateral lacrimation and nasal congestion; severe unilateral and periorbital pain; more common in men; patient is restless during episodeNeurologic abnormalities, confusion, altered mental status or level of consciousnessUsually worse when lying down; nasal congestion; tenderness over affected sinusOccipital location; tenderness at base of skull; pain is neuralgic in character and referred to vertex or foreheadWorse on awakening; generally progressive; aggravated by coughing, straining, or changing positionChronic headache with few features of migraine; tends to occur daily; hormone therapy and hormonal contraceptives are frequent culprits; includes analgesic reboundAntecedent head trauma; vertigo, lightheadedness; poor concentration and memory; lack of energy; irritability and anxietyExplosive onset of severe headache; 10% preceded by sentinel headachesAlmost exclusively in patients older than 50 years; associated with tenderness of scalp or temporal artery and jaw claudication; visual changesPain generally involves the temporomandibular joint and temporal areas; associated with symptoms when chewingCommon; duration of 30 minutes to seven hours; typically bilateral; nonpulsating; mild to moderate intensity without limiting activity; no nausea or vomitingBrief episodes of sharp, stabbing pain and trigeminal nerve face distributionChange in established headache pattern or “the worst headache ever”Persistent headache after Valsalva maneuver or exertionSymptoms of systemic disorders (e.g., fever, hypertension, myalgia, weight loss)Change in established headache pattern or “the worst headache ever”Persistent headache after Valsalva maneuver or exertionSymptoms of systemic disorders (e.g., fever, hypertension, myalgia, weight loss)Evidence-based guidelines from the United States, Canada, and Europe provide consistent recommendations, including lifestyle modifications, avoidance of triggers, and healthy coping mechanisms.Oral and intranasal formulations, and subcutaneous injectionPreferred in patients with contraindications to vasoconstrictorsSevere nausea is common; do not use within 24 hours of triptan administrationHigh abuse potential; use sparingly and infrequentlyOral and intranasal formulations, and subcutaneous injectionPreferred in patients with contraindications to vasoconstrictorsSevere nausea is common; do not use within 24 hours of triptan administrationHigh abuse potential; use sparingly and infrequentlyGuidelines stress basic treatment principles for acute migraine.Strong evidence supports the use of acetaminophen and oral NSAIDs such as aspirin, diclofenac, ibuprofen, and naproxen as first-line treatments for mild to moderate migraine attacks.Triptans are an effective first-line treatment for moderate to severe migraine.A meta-analysis of the effectiveness of the seven available triptans (almotriptan [Axert], eletriptan [Relpax], frovatriptan [Frova], naratriptan [Amerge], rizatriptan [Maxalt], sumatriptan [Imitrex], and zolmitriptan [Zomig]) found that standard doses provided headache relief at two hours in 42% to 76% of patients and complete pain relief at two hours in 18% to 50%.Sumatriptan is the most extensively studied triptan.

Kurth T, Winter AC, Eliassen AH, Dushkes R, Mukamal KJ, Rimm EB, et al. Stauffer VL, Dodick DW, Zhang Q, Carter JN, Ailani J, Conley RR.

A randomized, double-blind, placebo-controlled study. Migraine headache in middle age and late-life brain infarcts. Baerlocher MO, By identifying various triggers, we can often reduce the severity and frequency of pain and its intervals. Do not prescribe valproate sodium and topiramate to women who are not using birth control and who may become pregnant.Start oral treatments at a low dose and titrate slowly.Give oral treatments for at least 8 weeks to optimize therapeutic response.Use evidence-based treatment at the first sign of a migraine attack.Use NSAIDs (including aspirin), nonopioid analgesics, acetaminophen, or caffeinated analgesic combinations for mild‐to‐moderate attacks and migraine‐specific agents (triptans, dihydroergotamine) for moderate or severe attacks and mild‐to‐moderate attacks that respond poorly to NSAIDs or caffeinated combinations. EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force. Medscape [serial online]. Migraine has become a significant health problem that affects over 10% of the population globally, and it is the another cause of disability worldwide. Barclay L. FDA Approves Transdermal Patch for Migraine. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society [published correction appears in Derry S, The vascular risk associations with migraine: relation to migraine susceptibility and progression. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial.

2003. Fayyaz Ahmed chairs the committee for the next BASH guidelines due to come out in 2016 with Anish Bahra, Stuart Weatherby and Alok Tyagi being the other members. Acute treatments lead to adverse events [Guideline] Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E, et al. Waeber C, Moskowitz MA. Tepper DE. This example shows loss of the entire right visual field as described by a person who experiences migraines.

Stone AM, Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. Gudmundsson LS, Scher AI, Aspelund T, Eliasson JH, Johannsson M, Thorgeirsson G, et al. Mathew NT, Rapoport A, Saper J, Magnus L, Klapper J, Ramadan N, et al. Repeating the same dose of the same medication may not relieve persistent symptoms.Triptans are generally well tolerated. Sándor PS, Di Clemente L, Coppola G, Saenger U, Fumal A, Magis D, et al. Tietjen GE, Herial NA, White L, Utley C, Kosmyna JM, Khuder SA.

Sw��r�����W�&��J]��1�h�Sa"zR")vj� �6��Q��/�ۘ����t�fCϚ������ Phase 3 randomized, placebo-controlled, double-blind study of lasmiditan for acute treatment of migraine. Migraine therapeutics in adolescents: a systematic analysis and historic perspectives of triptan trials in adolescents. Different circulating metalloproteinases profiles in women with migraine with and without aura. Fluctuations in estrogen, like before or during menstrual periods, pregnancy as well as menopause, seem to trigger many women headaches. 3 0 obj GlaxoSmithKline. US Food and Drug Administration. Evidence-based guidelines for migraine headache in the primary care setting: Pharmacological management of acute attacks. American Academy of Neurology. Smitherman TA. Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Migraines impose significant health and financial burdens. 60(7):S38-44. Orr SL, Friedman BW, Christie S, Minen MT, Bamford C, Kelley NE, et al. Review of clinical trials using early acute intervention with oral triptans for migraine management. Loder E. Migraine with aura and increased risk of ischaemic stroke. American Academy of Neurology.

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