Cephalalgia : an international journal of headache
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Randomized Controlled Trial Multicenter Study
OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial.
This is the second of a pair of studies designed to evaluate the efficacy and safety of onabotulinumtoxinA (BOTOX) for prophylaxis of headaches in adults with chronic migraine. ⋯ The results of PREEMPT 2 demonstrate that onabotulinumtoxinA is effective for prophylaxis of headache in adults with chronic migraine. Repeated onabotulinumtoxinA treatments were safe and well tolerated.
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Randomized Controlled Trial
Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial.
It is well-known that specific foods trigger migraine attacks in some patients. We aimed to investigate the effect of diet restriction, based on IgG antibodies against food antigens on the course of migraine attacks in this randomised, double blind, cross-over, headache-diary based trial on 30 patients diagnosed with migraine without aura. ⋯ This is the first randomised, cross-over study in migraineurs, showing that diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks.
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Review Historical Article
History of migraine with aura and cortical spreading depression from 1941 and onwards.
Several personal descriptions of migraine with aura from 1870 onwards reported a slow, gradual progression of symptoms. Lashley in 1941 meticulously chartered his own auras and concluded that the symptomatology reflected a cortical process progressing with a speed of 3 mm/min across the primary visual cortex. Leão described cortical spreading depression (CSD) in rabbits in 1944 and noticed its similarity to the migraine aura. ⋯ Finally, mutations for familial hemiplegic migraine have been expressed in mice and lower the threshold for CSD. The seminal papers on rCBF and CSD published in the 1980s caused a dramatic shift in our concepts of migraine aura. They moved attention from ischaemia to CSD and thereby to the brain itself, and paved the way for subsequent discoveries of brainstem mechanisms.
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Cutaneous allodynia (CA), pain in response to innocuous cutaneous stimuli, is recognized as a sign of central sensitization during migraine episodes. It is either restricted within the pain area on the ipsilateral head, or extends within and outside the head. Moreover, CA can be elicited in response to thermal (heat or cold) and/or mechanical stimuli. ⋯ Occurrence and extension of CA correlated (P = 0.005) with headache intensity. Modalities of cephalic and extracephalic CA were different (chi2 = 12.03; P = 0.002), extracephalic CA being mostly thermal (75%) whereas cephalic CA was mostly mechanical (92%). This suggests that cephalic and extracephalic CAs involve different mechanisms.
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Occipital nerve stimulation (ONS) has been employed off-label for medically refractory head pain. Identification of specific headache diagnoses responding to this modality of treatment is required. Forty-four patients with medically refractory head pain and treated with ONS were invited to participate in a retrospective study including a clinical interview and, if necessary, an indomethacin test to establish the headache phenotype according to the International Classification of Headache Disorders, 2nd edn (ICHD-II). ⋯ We conclude that careful clinical phenotyping may help in defining subgroups of patients with medically refractory headache that are more likely to respond to ONS. The data suggest medication overuse should be managed appropriately when considering ONS in migraine. A controlled prospective study for ONS in ICHD-II 13.12 is warranted.