Headache
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Randomized Controlled Trial
Botulinum toxin type A as migraine preventive treatment in patients previously failing oral prophylactic treatment due to compliance issues.
To examine the efficacy and safety of and satisfaction with botulinum toxin type A (BoNTA; BOTOX: Allergan, Inc., Irvine, CA) for prophylactic treatment of migraine headache in patients previously failing prophylaxis because of issues pertaining to compliance. Background.- Numerous factors (eg, adverse effects, tolerability, cost, frequency of dosage, hesitancy to take daily medication, failure to complete treatment) negatively influence compliance with the preventive pharmacology for migraine prophylaxis. BoNTA may offer benefit in improving compliance because of its long duration of action, injectable route of administration, and its tolerability (adverse event [AE]) profile. ⋯ BoNTA-treated subjects showed improvements from baseline in measures of headache frequency, and improvements from baseline and in comparison with placebo treatment in headache impact and treatment satisfaction at multiple time points in this study. However, BoNTA-treated subjects did not differ from placebo-treated subjects in measures of headache frequency and severity. BoNTA may be a useful treatment option for headache patients demonstrating poor compliance, adherence, or AE profile with oral prophylactic regimens.
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Randomized Controlled Trial
Examining the utility of in-clinic "rescue" therapy for acute migraine.
Management options currently are limited for patients with acute migraine whose symptoms prove refractory to self-administered therapy. ⋯ Providing the alternative of in-clinic "rescue" for acute migraine refractory to self-administered therapy offers an attractive alternative for patients and appears to substantially lower use of an ED for headache treatment and the cost associated with that use.
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A thunderclap headache is a sudden and severe headache and is sometimes a sign of a medical emergency such as aneurysmal subarachnoid hemorrhage and pituitary apoplexy. We report a case of pheochromocytoma in the urinary bladder in a 37-year-old man who presented with recurrent thunderclap headache after voiding and exercises. Bladder pheochromocytoma should be included in the differential diagnosis of recurrent thunderclap headache after micturition or exercises.
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There are a number of reasons to attempt to define and classify refractory headache disorders. Particularly important are the potential benefits in the areas of research, treatment, and medical cost reimbursement. There are challenges in attempting to classify refractory forms of headaches, including the lack of biological or other objective markers and a lack of consensus among practitioners as to what qualifies as refractoriness, or even if a separate category for refractory migraine and other refractory headaches needs to be established. ⋯ It seems reasonable to consider adding this defined syndrome to the International Classification of Headache Disorders, second edition (ICHD-II). In this article, options for adding refractory headache syndromes to the ICHD are discussed with pros and cons for each. Two "best" options for adding the disorder "refractory migraine" to the ICHD are presented along with an illustrative case example.
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Migraine is a complex disorder of the brain whose mechanisms are only now being unravelled. It is common, disabling, and economically costly. Brain imaging has suggested a role for the brainstem. ⋯ Indeed, no specific structural or pharmacological explanation can be seen from the data as they have been generated. It is clear that patients with more frequent headache are very likely to go on to even more frequent headache, but again these data are complex. A challenge going forward is to establish the biology of these very challenging patients who undoubtedly have substantial disability.