Headache
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Randomized Controlled Trial Multicenter Study Comparative Study
OTC analgesics in headache treatment: open-label phase vs randomized double-blind phase of a large clinical trial.
To compare the superior efficacy of the fixed combination of acetylsalicylic acid, paracetamol, and caffeine over the single substances, which was observed in the randomized, double-blind phase of the clinical trial, with the efficacy of the respective usual nonprescription medication taken by the patients in the open-label pre-phase of the same study. ⋯ Time course of PID after intake of the patient's usual medication was very similar to the time course of PID after intake of the randomized study medication. After 2 hours, pain reduction was on average 43.0, 38.2, 38.1, and 37.7 mm as assessed on the visual analog scale in the group of patients who took their usual triple combination containing acetylsalicylic acid, paracetamol, and caffeine, the single agents acetylsalicylic acid, paracetamol, and ibuprofen, respectively, in the open-label phase. The corresponding mean pain reduction was 44.7, 40.7, and 39.5 mm in patients allocated to the triple combination containing acetylsalicylic acid, paracetamol, and caffeine, the single agents acetylsalicylic acid, and paracetamol, respectively, in the randomized, double-blind phase.
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This study examined modulation of trigeminal pain/nociception by 2 supraspinal mechanisms: emotional controls of nociception and diffuse noxious inhibitory controls. ⋯ Emotional controls and diffuse noxious inhibitory controls modulated trigeminal pain and emotional controls modulated trigeminal nociception. These procedures can be used to study supraspinal modulation of nociceptive processing in disorders of the trigeminal pain system, including headache.
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Case Reports
Can indomethacin act as a disease modifying agent in hemicrania continua? A supportive clinical case.
The natural history of hemicrania continua (HC) is not well-known. Most sufferers have the unremitting form and thus may have a lifetime duration of pain. ⋯ The question arises: Does indomethacin have disease-modifying capacities for HC or does it just suppress the pain without altering the underlying disease pathogenesis? A case patient is presented who had indomethacin-responsive unremitting HC and after a period of daily use of indomethacin she was able to reduce her dose to one single 25-mg tablet 3 days per week and still remain pain free, suggesting disease modification. The case patient's history will be further discussed as well as the consideration that in some instances indomethacin can alter the natural history of HC.
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Randomized Controlled Trial Multicenter Study
Rizatriptan 10-mg ODT for early treatment of migraine and impact of migraine education on treatment response.
To examine the efficacy of rizatriptan 10-mg orally disintegrating tablet (ODT) for treating migraines of mild intensity soon after onset, with or without patient-specific migraine education. ⋯ Rizatriptan 10-mg ODT, when taken early, while headache pain is mild, was superior to placebo at providing pain freedom at 2 hours and 24-hour sustained pain freedom.
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Randomized Controlled Trial Multicenter Study
Clinical relevance of efficacy endpoints in OTC headache trials.
This analysis evaluates and ranks efficacy endpoints often used in headache trials concerning their clinical relevance in relation to the patient-related criterion "global assessment of overall efficacy" based on data gained in a large trial investigating different over-the-counter drugs in the treatment of headache. ⋯ The highest correlation with patient's global efficacy assessment was demonstrated for the primary endpoint time to 50% pain relief (r = 0.6727) and the sum of pain intensity difference (r = 0.7037). The frequency distribution of patient's global efficacy assessment depended primarily on the time to 50% pain relief and similarly, but to a somewhat lesser extent, on the reduction of pain intensity to 10 mm as assessed on the visual analog scale. More than 86% of the patients assessed efficacy as very good or good when their pain was reduced by 50% at least within 1 hour after drug intake. The patients accept a longer time span than 2 hours for reaching no pain to give a positive global evaluation of efficacy.