Headache
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Most women have used at least 1 method of contraception during their reproductive years, with the majority favoring combined oral contraceptives. Women are often concerned about the safety of their method of choice and also ask about likely effects on their pre-existing headache or migraine and restrictions on using their headache medication. While there should be no restriction to the use of combined hormonal contraceptives by women with migraine without aura, the balance of risks vs benefits for women with aura are debatable. ⋯ Low-dose pills currently used are considerably safer than pills containing higher doses of ethinylestradiol but they are not risk-free. This review examines the evidence available regarding the effect that different methods of contraception have on headache and migraine and identifies strategies available to minimize risk and to manage specific triggers such as estrogen "withdrawal" headache and migraine associated with combined hormonal contraceptives. The independent risks of ischemic stroke associated with migraine and with hormonal contraceptives are reviewed, and guidelines for use of contraception by women with migraine are discussed in light of the current evidence.
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The expansion of technologies available for the study of migraine pathophysiology has evolved greatly over the last 15 years. Two areas of rapid progress are investigations focusing on the genetics of migraine and others utilizing novel functional neuroimaging techniques. ⋯ At the same time, neuroimaging studies have provided novel insights into the altered neuronal and network dynamics of the migrainous brain. These 2 parallel approaches provide complementary insights into the complexity and heterogeneity of migraine.
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To describe a short-term "real-life" longitudinal evolution of migraine course, quality of life, and disability in a sample of patients attending to a specialty center and to evaluate the association between the changes in patient-reported outcomes, number of reported headaches, their severity, and treatment consumption. ⋯ In this study, migraine frequency and intensity were almost stable over 3 months, and an evident trend toward improvement was found in disability and in some health-related quality of life aspects, particularly in the social activity domain. Our results clearly indicate that continuity of care has a positive impact on patients' health status and functioning, also in stable patients already on anti-migraine therapy, and that the use of patient-oriented outcome measures is a viable way to capture such improvements.
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We aimed to identify clinical features in patients with severe headaches that predicted obstructive sleep apnea (OSA) and determine clinical and sleep study characteristics that predicted headache improvement with continuous positive airway pressure (CPAP). ⋯ Headache patients should be evaluated for the presence of OSA. Treating OSA improves headaches in some patients.
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To assess pain-related attentional biases among individuals with episodic migraine. ⋯ In light of the large sample size and prior pilot testing of presented images, results suggest that episodic migraineurs do not differentially attend to headache-related facial stimuli. Given modest evidence of attentional biases among chronic headache samples, these findings suggest potential differences in attentional processing between chronic and episodic headache subforms.