Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Randomized Controlled Trial Multicenter Study
Efficacy of frovatriptan versus other triptans in the acute treatment of menstrual migraine: pooled analysis of three double-blind, randomized, crossover, multicenter studies.
The objective of this study was to review the efficacy and safety of frovatriptan (F) versus rizatriptan (R), zolmitriptan (Z) and almotriptan (A), in women with menstrually related migraine (IHS criteria) through a pooled analysis of three individual studies. Subjects with a history of migraine with or without aura were randomized to F 2.5 mg or R 10 mg (study 1), F or Z 2.5 mg (study 2), and F or A 12.5 mg (study 3). The studies had an identical multicenter, randomized, double-blind, crossover design. ⋯ Pain relief episodes at 2, 4 and 24 h were 37, 60 and 66 % for F and 43, 55 and 61 % for comparators (P = NS). Rate of recurrence was significantly (P < 0.05) lower under F either at 24 h (11 vs. 24 % comparators) or at 48 h (15 vs. 26 % comparators). Number of menstrual migraine attacks associated with drug-related adverse events was equally low (P = NS) between F (5 %) and comparators (4 %).
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Alcoholic drinks (AD) have been known as migraine triggers in about one-third of migraine patients in retrospective studies. We have reviewed the studies concerning the role of AD in triggering the various types of primary headaches published after the International Headache Society classification of 1988. There are many studies showing that AD are triggers of migraine without aura (MO), migraine with aura (MA), cluster headache (CH) and tension-type headache (TH). ⋯ If AD are capable of triggering practically all primary headaches, they should act at a common pathogenetic level. Vasodilatation is unlikely to be compatible as common mechanism. An action at cortical or more likely at subcortical level is plausible.
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In the last 15 years, the neuroimaging of patients suffering from migraine with or without aura has improved our understanding of the mechanisms underlying the pathophysiology of the disease. A great number of studies based on modern imaging techniques, such as structural imaging and functional imaging emphasize that in migraine patients suffering from repetitive pain attacks, both significant abnormalities of function and diffuse structural changes of brain white and gray matter become striking features of the disease. ⋯ Clinical application of functional imaging findings in migraine is yet to be considered, since the specificity of some results has to be determined. Nevertheless, functional MRI techniques have a vast potential for exploring the pathophysiology of pain in migraine patients.
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It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies affecting small cerebral vessels, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, retinal vasculopathy with cerebral leukodystrophy and hereditary infantile hemiparesis, retinal arteriolar tortuosity and leucoencephalopathy. Moreover, several studies have reported an association between migraine and white matter lesions or clinically silent infarct-like abnormalities in the posterior circulation. In this review, we focus on genetic vasculopathies associated with migraine and speculate about the pathophysiological mechanism that can explain this comorbidity.
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The burden of migraine strongly increases, considering its linkage with sleep disorders. Migraine is positively associated with many sleep-complaint disorders; some are confirmed by several studies, such as restless leg syndrome, whereas others still remain uncertain or controversial, e.g. narcolepsy. Many studies have investigated the association between headache and other sleep disturbances such as daytime sleepiness, insomnia, snoring and/or apnea, but only a few have focused on migraine. Highlighting the comorbidity between migraine and sleep disorders is important to improve treatment strategies and to extend the knowledge of migraine pathophysiology.