Expert review of neurotherapeutics
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Medication-overuse headache (MOH) has developed into the third most common type of headache after tension-type headache and migraine. The prevalence reaches approximately 1% of the world's population and shows an increasing trend. ⋯ Several large population-based longitudinal studies clearly demonstrated that overuse of any kind of acute headache medication is the main risk factor leading to the development of chronic headache. Management of MOH remains difficult; the only effective treatment concept is consequent withdrawal therapy.
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Headaches of the thunderclap variety become severe in intensity within seconds to a minute of onset. Patients with thunderclap headache are to be evaluated in an emergent fashion as many of the underlying causes are associated with significant morbidity and mortality. ⋯ In accordance with the increased utilization of cerebral imaging, availability of noninvasive techniques to image the cerebral vasculature and interest in identifying causes of thunderclap headaches, the list of potential causes is growing rapidly. Included in this growth are the reversible cerebral vasoconstriction syndromes, terminology recently introduced to unify several disorders all presenting with thunderclap headache and similar diagnostic findings including reversible vasoconstriction of the intracranial arteries.
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Expert Rev Neurother · Jul 2007
Comparative StudyThrombolysis with alteplase for acute ischemic stroke: review of SITS-MOST and other Phase IV studies.
Thrombolytic therapy is the only approved therapy for acute ischemic stroke patients. As part of the European approval process, the Safe Implementation of Thrombolysis in Stroke - Monitoring Study (SITS-MOST) was demanded as a Phase IV study to evaluate the safety and efficacy of alteplase in a 3-h time-window. This article summarizes SITS-MOST and compares it with other Phase IV studies. ⋯ The results of SITS-MOST are comparable with the results of the randomized placebo-controlled trials and other Phase IV studies such as standard treatment with Alteplase to Reverse Stroke and Canadian Alteplase for Stroke Effectiveness Study. They confirm that intravenous alteplase is safe and effective in routine clinical practice when used for acute stroke within 3 h of stroke onset, even in centers with little previous experience of thrombolytic therapy but only if the licensing approval criteria are strictly followed. These findings should encourage wider use of thrombolytic therapies for suitable stroke patients treated in stroke centers.