MedWorm: Migraine

How Migraine Develops

This Week in Science — Fri, 01 Mar 2013 05:30:33 +0100

Migraine is a common medical disorder. Unfortunately, how and why migraine headache is initiated is unclear. Karatas et al. (p. 1092) now describe a signaling pathway between stressed neurons and … [Read more] (Source: This Week in Science)

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[Report] Spreading Depression Triggers Headache by Activating Neuronal Panx1 Channels

Science: Current Issue — Fri, 01 Mar 2013 05:30:27 +0100

Migraine results from a sequence of events starting from stressed cortical neurons and leading to the trigeminal nucleus.Authors: Hulya Karatas, Sefik Evren Erdener, Yasemin Gursoy-Ozdemir, Sevda Lule, Emine Eren-Koçak, Zümrüt Duygu Sen, Turgay Dalkara (Source: Science: Current Issue)

White matter integrity affected by depressive symptoms in migraine without aura: a tract‐based spatial statistics study

NMR in Biomedicine — Fri, 01 Mar 2013 00:17:49 +0100

Previous studies have proven that migraine and depression are bidirectionally linked. However, few studies have investigated white matter (WM) integrity affected by depressive symptoms in patients suffering from migraine without aura (MWoA). Forty patients with MWoA were divided into two groups according to their self‐rating depression scale (SDS) score in the present study, including 20 in the SDS (+) (SDS > 49) group and 20 in the SDS (−) (SDS ≤ 49) group. Forty healthy participants were also recruited as the control group. Tract‐based spatial statistics analyses with multiple diffusion tensor imaging‐derived indices [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)] were employed collectively to investigate WM integr...

Migraine Increased in Celiac and Inflammatory Bowel DiseaseMigraine Increased in Celiac and Inflammatory Bowel Disease

Medscape Neurology and Neurosurgery Headlines — Thu, 28 Feb 2013 21:18:32 +0100

Although the higher incidence in celiac patients was partly expected, the increase among patients with inflammatory bowel disease was a surprise. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)

A costly revolution for a subgroup of patients with metastatic melanoma

British Journal of Dermatology — Thu, 28 Feb 2013 05:00:00 +0100

This report is based on the cut‐off date of 19 December 2011. Patients with previously untreated stage IV or unresectable stage III BRAF (V600)‐mutated melanoma were randomly assigned (3:1) to receive dabrafenib (150 mg twice daily, orally) or dacarbazine (1000 mg m−2 intravenously every 3 weeks). Patients were stratified according to American Joint Committee on Cancer stage. The primary endpoint was investigator‐assessed progression‐free survival (PFS) and was analysed by intention to treat. Safety was assessed per protocol. Findings Of the 733 patients screened, 250 were randomly assigned to receive either dabrafenib (187 patients) or dacarbazine (63 patients). Median PFS was 5·1 months for dabrafenib and 2·7 months for dacarbazine, with a hazard ratio of 0·30...

A case of lipoprotein glomerulopathy with thrombotic microangiopathy due to malignant hypertension

BMC Nephrology — Thu, 28 Feb 2013 05:00:00 +0100

Conclusion: We report on a rare case of TMA probably due to malignant hypertension in LPG. Early lipid-lowering and antihypertensive treatment may improve outcome. The pathophysiologic relationship between LPG and TMA should be investigated further. (Source: BMC Nephrology)

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This Week in Science

Science: Current Issue — Thu, 28 Feb 2013 05:00:00 +0100

Headache and suicide. A historical note - Maggioni F, Maggioni G, Mainardi F, Zanchin G.

SafetyLit: All (Unduplicated) — Wed, 27 Feb 2013 23:30:53 +0100

[Abstract unavailable] Language: Eng... (Source: SafetyLit: All (Unduplicated))

Underestimated phenomena: Higher cortical dysfunctions during migraine aura - Petrusic I, Zidverc-Trajkovic J, Podgorac A, Sternic N.

SafetyLit: All (Unduplicated) — Wed, 27 Feb 2013 23:30:52 +0100

IntroductionAura occurs in 20-30% of patients with migraine. Some descriptions of aura go far beyond the most frequent visual and sensory symptoms, suggesting the involvement of different cortical areas. The aim of this prospective study was to evaluate th... (Source: SafetyLit: All (Unduplicated))

Limited Access: Rural Communities Struggle to Find Internet Providers

News stories via the Rural Assistance Center — Wed, 27 Feb 2013 06:00:00 +0100

Associated Press article via The Washington Post, (DC), tells why finding reliable and affordable Internet can be a headache in rural areas. (Source: News stories via the Rural Assistance Center)

Vascular ERK mediates migraine‐related sensitization of meningeal nociceptors

Annals of Neurology — Wed, 27 Feb 2013 05:00:00 +0100

Abstract Objective:To examinechanges in the response properties of meningeal nociceptors that might lead to migraine pain and examine endogenous processes that could play a role in mediating them using a clinically relevant model of migraine triggering, namely infusion of the NO donor nitroglycerin (NTG). Methods:Single unit recordings made in the trigeminal ganglion of rats were used to test changes in the activity and mechanosensitivity of meningeal nociceptors in response to administration of the migraine triggerNTGor anotherNO donor SNAPat doses relevant to the human model of migraine headache.Immunohistochemistry and pharmacological manipulations were used to investigate the possible role of meningeal vascular signaling inmediating the responses of meningeal nociceptors to NO. Results...

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An Important Phase 2 in MigraineAn Important Phase 2 in Migraine

Medscape Today Headlines — Tue, 26 Feb 2013 15:44:59 +0100

A new phase 2 trial evaluates the safety and efficacy of gabapentin enacarbil for migraine prophylaxis. Medscape Neurology (Source: Medscape Today Headlines)

Cerebral venous system and anatomical predisposition to high‐altitude headache

Annals of Neurology — Tue, 26 Feb 2013 05:00:00 +0100

ObjectiveAs inspired oxygen availability falls with ascent to altitude, some individuals develop high‐altitude headache (HAH). We postulated that HAH results when hypoxia‐associated increases in cerebral blood flow occur in the context of restricted venous drainage, and is worsened when cerebral compliance is reduced. We explored this hypothesis in 3 studies. MethodsIn high‐altitude studies, retinal venous distension (RVD) was ophthalmoscopically assessed in 24 subjects (6 female) and sea‐level cranial magnetic resonance imaging was performed in 12 subjects ascending to 5,300m. Correlation of headache burden (summed severity scores [0–4] ≤24 hours from arrival at each altitude) with RVD, and with cerebral/cerebrospinal fluid (CSF)/venous compartment volumes, was sought. In a se...

Sinonasal disease in polyostotic fibrous dysplasia and McCune–Albright Syndrome

The Laryngoscope — Tue, 26 Feb 2013 05:00:00 +0100

ConclusionsSinonasal involvement of fibrous dysplasia in PFD/MAS is common. Symptoms are usually few and mild, and disease progression occurs primarily in young subjects. Concomitant endocrinopathy is associated with disease severity, but not progression. (Source: The Laryngoscope)

Panic Disorder and MigrainePanic Disorder and Migraine

Medscape Today Headlines — Tue, 26 Feb 2013 04:00:00 +0100

How closely are panic disorder and migraine linked? This comprehensive review summarizes current epidemiologic, mechanistic, and clinical research on their association. Headache (Source: Medscape Today Headlines)

Health Tip: When Your Child Has a Headache

MedlinePlus Health News — Mon, 25 Feb 2013 12:00:00 +0100

Follow these tips to soothe the pain Source: HealthDay Related MedlinePlus Pages: Children's Health, Headache (Source: MedlinePlus Health News)

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How to halt migraines without prescription drugs

NaturalNews.com — Mon, 25 Feb 2013 06:00:00 +0100

If you are one of the 30 million Americans that suffers from occasional or frequent migraine headaches, then you already know how debilitating and excruciatingly painful this condition can be. But rather than simply manage the symptoms when they appear by taking powerful... (Source: NaturalNews.com)

Aripiprazole for the treatment of pediatric bipolar I disorder: a 30‐week, randomized, placebo‐controlled study

Bipolar Disorders — Mon, 25 Feb 2013 05:00:00 +0100

Conclusions: Aripiprazole 10 mg/day and 30 mg/day were superior to placebo and generally well tolerated in pediatric subjects with bipolar I disorder up to 30 weeks. Despite the benefits of treatment, completion rates were low in all treatment arms. (Source: Bipolar Disorders)

Randomized controlled trial of trigeminal nerve stimulation for drug-resistant epilepsy

Neurology — Mon, 25 Feb 2013 05:00:00 +0100

Conclusions: This study provides preliminary evidence that eTNS is safe and may be effective in subjects with DRE. Side effects were primarily limited to anxiety, headache, and skin irritation. These results will serve as a basis to inform and power a larger multicenter phase III clinical trial. Classification of evidence: This phase II study provides Class II evidence that trigeminal nerve stimulation may be safe and effective in reducing seizures in people with DRE. (Source: Neurology)

Isolated ocular flutter

Neurology — Mon, 25 Feb 2013 05:00:00 +0100

A previously healthy 30-year-old man presented with gradually worsening oscillopsia 2 weeks after an unusual headache; there was ocular flutter on examination (video on the Neurology® Web site at www.neurology.org) without other findings. Brain MRI was unremarkable. CSF showed mild pleocytosis (11 cells/mm3), but no evidence of active viral infections (herpes simplex virus, cytomegalovirus, varicella-zoster virus, Epstein-Barr virus, human herpesvirus 6, and measles). Serum antiganglioside antibodies (including anti-GQ1b antibody) were negative. The symptom resolved without treatment within 4 weeks. Ocular flutter is rare and may be isolated, although it is usually accompanied by generalized myoclonus or truncal ataxia.1,2 Brainstem (omnipause neurons in the paramedian pontine reticula...

Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society

Neurology — Mon, 25 Feb 2013 05:00:00 +0100

Editors’ Note: Dr. Mauskop reviews the literature on the use of butterbur extract for migraine prophylaxis and concludes that it has the potential for serious toxicity. Authors Holland et al. disagree with Dr. Mauskop's interpretation. Dr. Sethi, in response to Drs. Stone and Edwards' "Trick or treat? Showing patients with functional (psychogenic) motor symptoms their physical signs," airs the difficulty, which most neurologists can relate to, of discussing a psychogenic diagnosis with a patient. Dr. Tfelt-Hansen calls attention to an error in the classification of evidence in the American Academy of Neurology guideline on episodic migraine prevention by Silberstein et al. The authors concur and an erratum appears in this issue. Megan Alcauskas, MD, and Robert C. Griggs, MD (Source: ...

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Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society

Neurology — Mon, 25 Feb 2013 05:00:00 +0100

Peer Carsten Tfelt-Hansen, Glostrup, Denmark: According to the recent American Academy of Neurology (AAN) guideline update, a drug can be recommended as possibly effective for migraine prevention if it had demonstrated efficacy in one Class II study.1 Eight drugs are recommended as possibly effective,1 and there are several drugs for which I would question the evidence. Due to space limitations, I have chosen just one example. (Source: Neurology)

Paradoxical presentation of orthostatic headache associated with increased intracranial pressure in patients with cerebral venous thrombosis

Annals of Indian Academy of Neurology — Mon, 25 Feb 2013 05:00:00 +0100

Jung B Kim, Do-Young Kwon, Moon-Ho Park, Byung-Jo Kim, Kun-Woo ParkAnnals of Indian Academy of Neurology 2013 16(1):85-87Headache is the most common symptom of cerebral venous thrombosis (CVT); however, the detailed underlying mechanisms and characteristics of headache in CVT have not been well described. Here, we report two cases of CVT whose primary and lasting presentation was orthostatic headache, suggestive of decreased intracranial pressure. Contrary to our expectations, the headaches were associated with elevated cerebrospinal fluid (CSF) pressure. Magnetic resonance imaging and magnetic resonance venography showed characteristic voiding defects consistent with CVT. We suggest that orthostatic headache can be developed in a condition of decreased intracranial CSF volume in both intr...

Spontaneous intracranial hypotension with bilateral subdural hemorrhage: Is conservative management adequate?

Annals of Indian Academy of Neurology — Mon, 25 Feb 2013 05:00:00 +0100

Mohammed Tauqeer Ahmad, Shahul Hameed, Kei Pin Lin, Kumar M PrakashAnnals of Indian Academy of Neurology 2013 16(1):94-96The aim of this study is to report a case of spontaneous intracranial hypotension complicated by bilateral subdural hemorrhage that resolved with conservative management. A young male presented with severe orthostatic headache associated with dizziness, neck pain and diplopia. Brain imaging revealed characteristic pachymeningeal enhancement and bilateral subdural hemorrhage. Radionuclide cisternography confirmed the Cerebrospinal fluid leak at the cervical 5 and cervical 6 vertebral level. He had clinical and radiological resolution with bed rest, hydration and analgesics and has remained symptom free since then. Spontaneous intracranial hypotension may be complicated by...

Low-dose propofol alleviates migraines in pediatric ED patients [HEALTH BRIEFS]

AAP News — Mon, 25 Feb 2013 05:00:00 +0100

(Source: AAP News)

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Ambrisentan: Headache and skin eruption in an elderly patient: case report

Reactions — Sun, 24 Feb 2013 06:03:04 +0100

(Source: Reactions)

Fusing Engineering And Mathematical Principles Helps Create Dynamic Brain Models

Health News from Medical News Today — Fri, 22 Feb 2013 08:00:00 +0100

Models of the human brain, patterned on engineering control theory, may some day help researchers control such neurological diseases as epilepsy, Parkinson's and migraines, according to a Penn State researcher who is using mathematical models of neuron networks from which more complex brain models emerge. "The dual concepts of observability and controlability have been considered one of the most important developments in mathematics of the 20th century," said Steven J. Schiff, the Brush Chair Professor of Engineering and director of the Penn State Center for Neural Engineering... (Source: Health News from Medical News Today)

What Are the Clinical Criteria Justifying Spinal Manipulative Therapy for Neck Pain?— A Systematic Review of Randomized Controlled Trials

Pain Medicine — Fri, 22 Feb 2013 05:00:00 +0100

ConclusionsThis systematic review highlights the absence of reliable and valid diagnostic protocols to determine the need for spinal manipulation in persons presenting with non‐serious, idiopathic, or whiplash‐associated (grade II) neck pain. Guidelines requiring the reporting of valid diagnostic criteria are needed to improve the quality of RCTs concerning manual therapy. (Source: Pain Medicine)

Contributions of Epidemiology to Our Understanding of Migraine

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

ConclusionsThis review demonstrates that the descriptive epidemiology of migraine has reached its maturity. The prevalence rates and sociodemographic correlates have been stable across 50 years. These developments justify a shift in efforts to the application of the designs and methods of analytic epidemiology. Retrospective case–control studies followed by prospective cohort studies that test specific associations are likely to enhance our understanding of the predictors of incidence and progression of migraine, subtypes of migraine with differential patterns of onset and course, and specific environmental exposures that may have either causal or provocative influences on migraine etiology. (Source: Headache: The Journal of Head and Face Pain)

Contraception and Headache

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

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. Migraine with aura, but not migraine without aura, is associated with a twofold increased risk of ischemic stroke, although the absolute risk is very low in healthy, nonsmoking women. Although ethinylestradiol has been associated with increased risk of ischemic st...

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Oral Methylergonovine Maleate for Refractory Migraine and Cluster Headache Prevention

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

Does Ultrasound Guidance Facilitate Facial Botulinum Injections?

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

Comment on Headache Following Intracranial Neuroendovascular Procedures

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

Sublingual Feverfew/Ginger (LipiGesic M) Reanalysis of Data

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

Migraine Relief by Chilis and Other Alternative Medications – Caused by Platelet Inhibition?

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

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Medication Overuse Headache in School‐Aged Children: More Common Than Expected?

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

Headache and Suicide. A Historical Note

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

Abstracts and Citations

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

Chronic Migraine

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

Erratum

Headache: The Journal of Head and Face Pain — Fri, 22 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

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Is Benign Paroxysmal Vertigo of Childhood a migraine precursor?

European Journal of Paediatric Neurology — Thu, 21 Feb 2013 05:00:00 +0100

CONCLUSION: We have observed that the prevalence of migraine in patients that had been diagnosed with BPVC is higher than in the general population, which leads us to propose BPVC as a precursor of migraine during childhood. PMID: 23434307 [PubMed - as supplied by publisher] (Source: European Journal of Paediatric Neurology)

The Role of Laboratory Testing in the Evaluation of Headache.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:04 +0100

Authors: Donohoe CD Abstract Blood tests have a minor role in headache management and that role is limited to a few secondary headache conditions. In headache, as with any symptom, laboratory tests should be chosen based on solid clues derived from the targeted history and physical examination. A shotgun approach to blood tests that includes rare diseases or those with low local prevalence frequently yields false-positive results, which exposes the patient to the expense, anxiety, and risk inherent in misdiagnosis. Keep it simple and do not forget about spinal fluid. PMID: 23419622 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)

The Role of the Physical Examination in the Evaluation of Headache.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:04 +0100

Authors: Donohoe CD Abstract The most critical element in headache evaluation is the history. The targeted history differentiates primary from secondary headaches and provides a realistic list of conditions associated with secondary headache. Several of these conditions present with specific physical findings, such as papilledema, Horner's syndrome, or a cranial nerve palsy. The targeted physical examination of the patient with headache takes less than 3 minutes. The ability to recognize a few straightforward clinical findings directs the evaluation in the proper direction. PMID: 23419621 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)

Targeted Headache History.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:04 +0100

Authors: Waldman SD Abstract The targeted headache history is paramount in the diagnosis of headache and facial pain. Through placing symptoms in categories, a clear picture of the headache diagnosis will begin to emerge. The physical examination yields no positive findings in most patients with headache. Medication overuse headache is emerging as a common reason for inability to control headaches. PMID: 23419620 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)

Trigeminal Autonomic Cephalalgias Other than Cluster Headache.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:03 +0100

Authors: Silberstein SD, Vodovskaia N Abstract Trigeminal autonomic cephalalgias are short-lasting primary headache disorders associated with autonomic symptoms. Paroxysmal hemicrania is a rare headache disorder similar to cluster headache. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are unusual headache syndromes typified by a high frequency of severe, brief, unilateral attacks that usually occur in the distribution of the trigeminal nerve. SUNCT is a subtype of SUNA in which both conjunctival injection and tearing are present. SUNA differs from SUNCT in that autonomic symptoms are less prominent. PMID: 23419629 [PubMed - ...

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Headache Pain of Ear, Nose, Throat, and Sinus Origin.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:03 +0100

This article provides the clinician with a concise road map for the evaluation of painful conditions of the ear, nose, sinuses, and throat that may be responsible for headache. PMID: 23419628 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)

Pain of Ocular and Periocular Origin.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:03 +0100

Authors: Waldman CW, Waldman SD, Waldman RA Abstract Most diseases of the eye and periocular regions that cause blindness are relatively painless. Headache pain of ocular and periocular origin represent a special challenge to the clinician. For patients with ocular and periocular pain that is unrelated to primary eye disease, identification and treatment of the painful condition usually become the responsibility of the clinician. PMID: 23419627 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)

Managing and Treating Tension-type Headache.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:03 +0100

Authors: Freitag F Abstract Although tension-type headache is ubiquitous, only a relatively small percentage of the population has these headaches occurring with sufficient frequency and severity to cause them to seek out medical attention. This small group, however, may have substantial impact from their disease on productivity and quality of life. Assessment of the headaches includes other headache disorders and coexisting diseases that may contribute to the process. Treatment is optimized by appropriate use of acute medications and preventive treatments that may include drugs in the antidepressant classes along with nonpharmacologic modalities and other alternative treatments, such as biofeedback, manual therapy, and use of botulinum toxin type A injections. PMID: 23419626 [...

Managing and Treating Headache of Cervicogenic Origin.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:03 +0100

This article reviews and summarizes the points of contention, historical significance, differential diagnosis, and treatments for CGH. This information will be of benefit to clinicians treating patients with this condition and assist providers in reviewing the literature and treatments for CGH. PMID: 23419625 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)

Imaging in the Evaluation of Headache.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:03 +0100

This article reviews when and how to use imaging for headaches, and what abnormalities may be found on these studies. PMID: 23419624 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)

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Factors That Cause Concern.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:03 +0100

Authors: Abrams BM Abstract Headaches can be benign or life threatening but, with careful attention to the details described in this article, the correct diagnosis and treatment can be arrived at in many cases. Modern imaging techniques have taken the guesswork out of many conditions but a high index of suspicion and attention to red flags helps avoid potential adverse outcomes in headache encounters in a high proportion of cases. PMID: 23419623 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)

Medication Overuse Headaches.

The Medical Clinics of North America — Thu, 21 Feb 2013 00:00:02 +0100

Authors: Abrams BM Abstract Overuse of any class of drugs, Triptans, ergots, opioids, simple, or combination analgesics used to treat acute headaches, especially migraine, can lead to the development of medication overuse headache. People suffering from primary headache types, such as migraine or tension-type headache, are at higher risk to develop chronic headache following the overuse of acute headache drugs. Treatment of medication overuse headache requires withdrawal as an initial step, coincident initiation of preventive treatment, a multidisciplinary setting, and includes education of patients. PMID: 23419631 [PubMed - as supplied by publisher] (Source: The Medical Clinics of North America)

Is osteopathic manipulative treatment effective in migraine?

International Journal of Osteopathic Medicine — Wed, 20 Feb 2013 19:30:55 +0100

Discussion: This preliminary data, even though not completed, showed a significant difference between OMT group and the other two, suggesting that the OMT may be considered an efficient procedure in the management of patients with migraine. (Source: International Journal of Osteopathic Medicine)

EFSA’s Extremely Flimsy Safety argument for Aspartame

Alliance for Natural Health — Wed, 20 Feb 2013 15:29:52 +0100

European Food Safety Authority gets out the whitewash yet again (Source: Alliance for Natural Health)

CGRP in the trigeminovascular system: a role for CGRP, adrenomedullin and amylin receptors?

British Journal of Pharmacology — Wed, 20 Feb 2013 05:00:00 +0100

Summary The neuropeptide calcitonin gene‐related peptide (CGRP) is reported to play an important role in migraine. It is expressed throughout the trigeminovascular system. Antagonists targeting the CGRP receptor have been developed and have shown efficacy in clinical trials for migraine. However, no CGRP antagonist is yet approved for treating this condition. The molecular composition of the CGRP receptor is unusual because it comprises two subunits. One is a G protein‐coupled receptor (GPCR), the calcitonin receptor‐like receptor (CLR). This associates with receptor activity‐modifying protein (RAMP) 1 to yield a functional receptor for CGRP. However, RAMP1 also associates with the calcitonin receptor, creating a receptor for the related peptide amylin but this also has high affini...

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Ambulatory Blood Pressure Monitoring in Patient With Hypnic Headache: A Case Study

Headache: The Journal of Head and Face Pain — Wed, 20 Feb 2013 05:00:00 +0100

(Source: Headache: The Journal of Head and Face Pain)

Migraine After Sneezing: Pathophysiological Considerations, Focused on the Difference With Coughing

Headache: The Journal of Head and Face Pain — Wed, 20 Feb 2013 05:00:00 +0100

We describe a patient who suffered 3 headache attacks after sneezing, each fulfilling criteria of migraine without aura. Sneezing as a specific trigger for migraine has not been described before. DiscussionThe differential diagnosis of acute headache after sneezing (eg, subarachnoid hemorrhage and reversible cerebral vasoconstriction), and the differences between migraine after sneezing and “benign cough headache” are discussed. We conclude that a pathophysiological association between migraine and sneezing might exist and hypothesize on underlying mechanisms. (Source: Headache: The Journal of Head and Face Pain)

Laughing Headache With Giant Pacchionian Granulations

Headache: The Journal of Head and Face Pain — Wed, 20 Feb 2013 05:00:00 +0100

We report a single case of severe headache, provoked almost exclusively by outbursts of laughing, where venous magnetic resonance imaging revealed the presence of giant Pacchioni granulations in both right and transverse sinuses. Reviewing published cases of laughing headache, we discuss possible mechanisms of pain and the role of giant Pacchionian granulations. (Source: Headache: The Journal of Head and Face Pain)

Radiologically isolated syndrome - incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review

Multiple Sclerosis — Wed, 20 Feb 2013 05:00:00 +0100

With increasing availability of magnetic resonance imaging (MRI), there is also an increase in incidental abnormal findings. MRI findings suggestive of multiple sclerosis in persons without typical multiple sclerosis symptoms and with normal neurological findings are defined as radiologically isolated syndrome (RIS). Half of the persons with RIS have their initial MRI because of headache, and some have a subclinical cognitive impairment similar to that seen in multiple sclerosis. Radiological measurements also show a similarity between RIS and multiple sclerosis. Approximately two-thirds of persons with RIS show radiological progression and one-third develop neurological symptoms during mean follow-up times of up to five years. Cervical cord lesions are important predictors of clinical con...

Randomized Trial of Supervised Versus Unsupervised Optokinetic Exercise in Persons With Peripheral Vestibular Disorders

Neurorehabilitation and Neural Repair — Wed, 20 Feb 2013 05:00:00 +0100

Conclusions. The DVD may be an effective and economical method of integrating OK into VR. However, rehabilitation should be supervised for greater compliance and improvements, particularly for postural stability and psychological state. (Source: Neurorehabilitation and Neural Repair)

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MKG Provisions Voluntarily Recalls Atlantic Smoked Salmon Due to Possible Health Risk

Food and Drug Administration — Wed, 20 Feb 2013 00:13:00 +0100

MKG Provisions of Miami, FL is recalling Atlantic Smoked Salmon Batch# 1768 consisting of several brands of products listed below which have the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, listeria infection can cause miscarriages and stillbirths among pregnant women. (Source: Food and Drug Administration)

Headache as a Rare Presenting Symptom of Löfgren’s Syndrome

Consultant Live — Tue, 19 Feb 2013 12:00:00 +0100

Löfgren’s syndrome is a form of acute sarcoidosis characterized by a triad of symptoms: hilar adenopathy, erythema nodosum, and arthralgias. This case highlights the typical progression of the disease, following a rare presentation. (Source: Consultant Live)

Headache as a Rare Presenting Symptom of Löfgren Syndrome

Consultant Live — Tue, 19 Feb 2013 12:00:00 +0100

Löfgren syndrome is a form of acute sarcoidosis characterized by a triad of symptoms: hilar adenopathy, erythema nodosum, and arthralgias. This case highlights the typical progression of the disease, following a rare presentation. (Source: Consultant Live)

Hysterectomy Association February Newsletter

The Hysterectomy Association — Tue, 19 Feb 2013 11:46:16 +0100

Welcome to our latest newsletter, we are already six weeks into 2013 and so much is happening. Before I go any further though I’d really like to ask for your help and support. Earlier this month I launched a project called ‘In My Own Words: Women’s Experiences of Hysterectomy‘ on a website called Kickstarter. The purpose of the project is to bring together all the stories we have gathered over the years from women having a hysterectomy. We’d like them to be in just one book for women, just like you, to read and realise that they aren’t aren’t stupid for the questions they ask and they aren’t alone. But in order to bring this book to life we need to fund the project, which is where Kickstarter comes in. Can you help us? You’ll find much ...

Uganda: Are You Treating Imaginary Malaria Parasites?

AllAfrica News: Malaria — Tue, 19 Feb 2013 06:18:43 +0100

[New Vision]Many people attribute common disease symptoms such as a fever, headache and general body weakness to malaria. Without a confirmed diagnosis of the suspected disease, they rush to treat themselves with antimalarials of their choice. (Source: AllAfrica News: Malaria)

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The efficacy of radiofrequency volumetric tissue reduction of hypertrophied inferior turbinate in allergic rhinitis

Indian Journal of Medical Sciences — Tue, 19 Feb 2013 05:00:00 +0100

Conclusion: RFVTR is safe and effective in treatment of ITH in allergic rhinitis patients. (Source: Indian Journal of Medical Sciences)

Pain referral patterns of the C1‐C3 nerves: Implications for headache disorders

Annals of Neurology — Tue, 19 Feb 2013 05:00:00 +0100

Abstract The cervical nerves may play a significant role in primary headache disorders. We reviewed the patterns of pain evoked by stimulation of the first 3 cervical nerves (;C1‐C3) in 10 patients with chronic occipital pain, 6 of whom also had migraine. Stimulation at the C1 level evoked periorbital and frontal pain in 6/6 patients with migraine but evoked occipital or cervical pain in those without migraine. C2 and C3 stimulation resulted in occipital or cervical pain in all patients. The C1 nerve may have an important sensory function in headache disorders that have orbital and frontal pain as a prominent feature. Ann Neurol 2013. (Source: Annals of Neurology)

Engineering control theory helps create dynamic brain models

EurekAlert! - Medicine and Health — Tue, 19 Feb 2013 05:00:00 +0100

(Penn State) Models of the human brain, patterned on engineering control theory, may some day help researchers control such neurological diseases as epilepsy, Parkinson's and migraines, according to a Penn State researcher who is using mathematical models of neuron networks from which more complex brain models emerge. (Source: EurekAlert! - Medicine and Health)

Orgasmic Headache Treated with Nimodipine

The Journal of Sexual Medicine — Tue, 19 Feb 2013 05:00:00 +0100

Conclusions.We postulated a pathophysiological relationship between OH and migraine, especially with respect to vasoconstriction, and believe that in such cases, nimodipine may be an effective therapy. (Source: The Journal of Sexual Medicine)

Hearing and vestibular disorders in patients with systemic lupus erythematosus.

Lupus — Tue, 19 Feb 2013 05:00:00 +0100

ConclusionsMigraine, SNHL and episodic vertigo are comorbid conditions in patients with SLE, but migraine is not associated with SNHL or vertigo in these patients. However, SNHL and vertigo are associated conditions in SLE, suggesting a common audiovestibular dysfunction. PMID: 23423252 [PubMed - as supplied by publisher] (Source: Lupus)

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Hematopoietic stem cell donation.

International Journal of Hematology — Tue, 19 Feb 2013 05:00:00 +0100

Authors: Chen SH, Wang TF, Yang KL Abstract Allogeneic hematopoietic stem cell transplantation is now an important treatment for numerous diseases. Donation of hematopoietic stem cells, either through bone marrow (BM) harvesting or peripheral blood stem cell (PBSC) collection, is a well-established and generally accepted procedure. The BM is aspirated from the posterior iliac crest under spinal or general anesthesia, and common side effects include fatigue and local pain. PBSC collection requires 4-6 days of G-CSF injections and leukapheresis 1-2 times. Common side effects of these procedures include bone pain, fatigue, and headache. The side effects of BM and PBSC collections are mostly transient and well tolerated. Severe adverse events are uncommon in healthy donors. At present...

Managing and Treating Headache of Cervicogenic Origin

Medical Clinics of North America — Mon, 18 Feb 2013 20:00:30 +0100

Trigeminal Autonomic Cephalalgias Other than Cluster Headache

Medical Clinics of North America — Mon, 18 Feb 2013 20:00:30 +0100

Trigeminal autonomic cephalalgias are short-lasting primary headache disorders associated with autonomic symptoms. Paroxysmal hemicrania is a rare headache disorder similar to cluster headache. Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are unusual headache syndromes typified by a high frequency of severe, brief, unilateral attacks that usually occur in the distribution of the trigeminal nerve. SUNCT is a subtype of SUNA in which both conjunctival injection and tearing are present. SUNA differs from SUNCT in that autonomic symptoms are less prominent. (Source: Medical Clinics of North America)

Targeted Headache History

Medical Clinics of North America — Mon, 18 Feb 2013 20:00:29 +0100

The targeted headache history is paramount in the diagnosis of headache and facial pain. Through placing symptoms in categories, a clear picture of the headache diagnosis will begin to emerge. The physical examination yields no positive findings in most patients with headache. Medication overuse headache is emerging as a common reason for inability to control headaches. (Source: Medical Clinics of North America)

The Role of the Physical Examination in the Evaluation of Headache

Medical Clinics of North America — Mon, 18 Feb 2013 20:00:29 +0100

The most critical element in headache evaluation is the history. The targeted history differentiates primary from secondary headaches and provides a realistic list of conditions associated with secondary headache. Several of these conditions present with specific physical findings, such as papilledema, Horner's syndrome, or a cranial nerve palsy. The targeted physical examination of the patient with headache takes less than 3 minutes. The ability to recognize a few straightforward clinical findings directs the evaluation in the proper direction. (Source: Medical Clinics of North America)

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Factors That Cause Concern

Medical Clinics of North America — Mon, 18 Feb 2013 20:00:29 +0100

Headaches can be benign or life threatening but, with careful attention to the details described in this article, the correct diagnosis and treatment can be arrived at in many cases. Modern imaging techniques have taken the guesswork out of many conditions but a high index of suspicion and attention to red flags helps avoid potential adverse outcomes in headache encounters in a high proportion of cases. (Source: Medical Clinics of North America)

How do we fashion better trials for neurostimulator studies in migraine?

Neurology — Mon, 18 Feb 2013 05:00:00 +0100

Numerous investigators make tremendous and respectable efforts so that well-designed and -executed prospective, double-blind, randomized, controlled trials can determine definitively whether therapies of interest are indeed safe and effective. In this issue of Neurology®, Schoenen et al.1 report the results of such a trial conducted at 5 tertiary headache centers in Belgium. They determined whether migraine attacks can be prevented by trigeminal neurostimulation with a supraorbital transcutaneous stimulator: Cefaly. This stimulation device is fashionably designed and its frame resembles a lightweight tiara or sporty sunglasses. (Source: Neurology)

Migraine prevention with a supraorbital transcutaneous stimulator: A randomized controlled trial

Neurology — Mon, 18 Feb 2013 05:00:00 +0100

Conclusions: Supraorbital transcutaneous stimulation with the device used in this trial is effective and safe as a preventive therapy for migraine. The therapeutic gain (26%) is within the range of those reported for other preventive drug and nondrug antimigraine treatments. Classification of evidence: This study provides Class III evidence that treatment with a supraorbital transcutaneous stimulator is effective and safe as a preventive therapy for migraine. (Source: Neurology)

Safety, tolerability, pharmacokinetics and pharmacodynamics following 4 weeks' treatment with empagliflozin once daily in patients with type 2 diabetes

Diabetes, Obesity and Metabolism — Sun, 17 Feb 2013 05:00:00 +0100

ConclusionsOral administration of empagliflozin at doses of 10, 25 or 100 mg once daily over 28 days resulted in significant increases in UGE and reductions in blood glucose compared with placebo, and were well tolerated in patients with type 2 diabetes. (Source: Diabetes, Obesity and Metabolism)

Meta-Analysis: Evidence of Efficacy Lacking for Pediatric Headache Prophylaxis

Consultant Live — Sat, 16 Feb 2013 14:00:01 +0100

Topiramate and trazadone showed only limited efficacy in treating pediatric headache. No evidecne was found for flunarizine, pizotifen, propranolol, and valproate, to support their use in this population. How to use this information? (Source: Consultant Live)

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Hold the Heparin

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine — Fri, 15 Feb 2013 15:02:37 +0100

We present a case of a young man presenting with headache and dizziness found to have marked hypertension, deepening T-wave inversions, and troponin elevation. Initial concerns were for acute coronary syndrome (ACS); however, before anticoagulant and antithrombotic therapy was instituted, further evaluation with noncontrast computed tomography of the head showed intraventricular hemorrhage. Electrocardiographic T-wave inversions are nonspecific and have a broad differential diagnosis, but ACS is of the highest concern especially in the setting of elevated troponin. However, as in this case, T-wave inversion and troponin elevation have been well described in intracranial bleeds as well, and full evaluation is required for such findings before initiation of therapy for presumed ACS to avoid ...

Element of the week: lead - video | @GrrlScientist

Guardian Unlimited Science — Fri, 15 Feb 2013 10:10:00 +0100

What do California condors, Beethoven and crime rates share in common?This week's element is lead, which has the atomic number 82 and the symbol Pb. Its symbol comes from the Latin word, plumbum, for lead. Lead rarely occurs in its elemental form in the wild. It is typically found in ores along with copper, and in smaller quantities with zinc and silver. Pure lead is a dense, soft and malleable metal with a lustrous bluish-white colour, although its surface quickly tarnishes to a dull grayish color in air. Lead is widespread and easy to work with, making it a popular material throughout the history of human tool-making. Lead has been used in all sorts of items ranging from a variety of pigments to car batteries and bullets. It was also commonly used in pipes for many hundreds of years, giv...

[In Context] News in brief

Lancet Neurology — Fri, 15 Feb 2013 08:35:40 +0100

Two studies have aimed to provide a clearer picture of which treatments are most useful for children and adolescents with headache and to investigate why the results of many trials have been negative. In a meta-analysis of randomised trials of prophylactic treatments in patients under 18 years of age (JAMA Pediatr 2013; published online Jan 28. DOI:10.1001/jamapediatrics.2013.508), only two drugs were more effective than placebo for episodic migraine (weighted mean differences in headaches per month −0·71, 95% CI −1·19 to −0·24, for two trials of topiramate; −0·60, −1·09 to −0·11, for one trial of trazodone). (Source: Lancet Neurology)

[Case Report] In need of something better than sleep

LANCET — Fri, 15 Feb 2013 07:45:08 +0100

In July, 2010, a 32-year-old woman was refered to us with history of mild fever and headache. She had no other symptoms and signs and initial clinical examination and laboratory tests including chest X-ray and urine analysis were done to find the origin of fever. Results of the examination and laboratory tests were negative, and aseptic meningitis was suspected. Cerebrospinal fluid showed 125 cells (64% neutrophils and 27% lymphocytes) and protein and glucose at 0·57 g/L and 3·28 mmol/l, respectively. (Source: LANCET)

Bevacizumab: Headache, hypertension and exacerbation of a wound infection: 3 case reports

Reactions — Fri, 15 Feb 2013 05:33:21 +0100

(Source: Reactions)

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Acute confusional migraine: is it a distinct form of migraine?

International Journal of Clinical Practice — Fri, 15 Feb 2013 05:00:00 +0100

ConclusionACM may present as either the only manifestation of a migraine attack or in the context of other migraine forms. ACM should have its own distinct place in the ICHD‐II, may be as a subtype of migraine with complex aura. (Source: International Journal of Clinical Practice)

Idiopathic hypertrophic cranial pachymeningitis: a rare but treatable cause of headache and facial pain

Journal of Neurology, Neurosurgery and Psychiatry — Fri, 15 Feb 2013 05:00:00 +0100

Introduction Idiopathic Hypertrophic Cranial Pachymeningitis (IHCP) is a rare disease with pain and compression related cranial nerve dysfunction as main clinical features. The leading diagnostic finding of IHCP consists of diffuse or localised thickening of the dura, which demands appropriate imaging and image interpretation. This case description aims at increasing the awareness for the clinical symptoms and imaging findings of this rare disease to allow prompt diagnosis and treatment initiation. Case description An 82-year-old man presented with recurrent left sided headache and worsening facial pain, which had begun more than 1 year ago. Neurological examination at presentation revealed ptosis of the left eye and gaze-induced nystagmus when looking to the left; visual function was...

GOODYS HEADACHE RELIEF SHOT (Acetaminophen And Caffeine) Liquid [Medtech Products Inc.]

DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST) — Fri, 15 Feb 2013 05:00:00 +0100

Updated Date: Feb 15, 2013 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

Review: Phosphodiesterase inhibitors for erectile dysfunction in men with severe renal disease

NeLM - News — Fri, 15 Feb 2013 05:00:00 +0100

Source: Journal of Sexual Medicine Area: News Phosphodiesterase inhibitors are generally well tolerated and effective for treating erectile dysfunction (ED), including in patients with significant comorbidity. A review, published in the Journal of Sexual Medicine, examined the safety and efficacy of phosphodiesterase type 5 inhibitors (PDE5) in adult men with erectile dysfunction and severe renal disease or who had received renal transplants. The authors reviewed published studies of PDE5 inhibitors in patients receiving dialysis or renal transplants. They reported the following findings: . Sildenafil significantly improved erectile function as assessed by the International Index of Erectile Function (IIEF), and 75-85% of patients reported improved erectile func...

Republished: Drug-induced valvular heart disease

Postgraduate Medical Journal — Fri, 15 Feb 2013 05:00:00 +0100

Drug-induced valvular heart disease (DIVHD) was first described in the 1960s. Initially, associations with ergot derivatives used for migraine prevention, or with anorectic drugs, were described. Drugs used for the treatment of Parkinson’s disease and endocrine diseases, like hyperprolactinemia, may also induce VHD. More recently, the use of 3,4-methylendioxymetamphetamine (MDMA, ‘Ecstasy’) and benfluorexhave been found to be associated with DIVHD. Although some of these drugs were withdrawn from the market, several cases of patients requiring valve surgery even years after the cessation of therapy have been reported. DIVHD is not infrequent, may be severe, and has been described in association with several drugs. Even after drug cessation, long-term implications of this ...

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Migraine Management Practices Among Pediatricians: A Questionnaire-Based Survey

Clinical Pediatrics — Fri, 15 Feb 2013 05:00:00 +0100

(Source: Clinical Pediatrics)

Teriflunomide Efficacy and Safety in Patients with Relapsing Multiple Sclerosis: Results from TOWER, a Second, Pivotal, Phase 3 Placebo-Controlled Study (S01.004)