Migraines linked to intrapulmonary right-to-left shunt.

Objective: To determine if there is an association between migraines and intrapulmonary right-to-left shunt.

Background: Several studies have described an association between migraines and intracardiac right-to-left shunt.

Methods: Patients with hereditary hemorrhagic telangiectasia (HHT) were retrospectively recruited from the Toronto Hereditary Hemorrhagic Telangiectasia Center Clinical Database.

Defining response in migraine: which endpoints are important?

The primary endpoint traditionally measured in clinical trials of triptans for acute migraine therapy has been 2-hour pain relief, a decrease in pain intensity from moderate/severe to mild/none. Although harder to achieve, endpoints such as 2-hour pain free and the composite measure sustained pain free are now preferred as they better reflect what patients desire from medication, namely rapid onset of action, and complete and lasting relief of pain. A comprehensive meta-analysis has shown that oral triptans differ in their ability to achieve these endpoints, with almotriptan 12.

Is there an easy way to diagnose migraine? Challenges faced by primary care physicians include lack of time, training.

Migraine is an important issue in primary care medicine because surveys in North America consistently show that about 6% of men and 18% of women experience these recurrent and often debilitating headaches. Of those identified by surveyors as having migraine, only about 60% had consulted a physician about their headaches, and less than half of these patients reported having received a medical diagnosis of migraine.

Effective treatment of migraine. Terminating acute attacks, reducing their frequency.

Migraine is the headache most commonly encountered in primary care practice. In one US population survey, 17.6% of women and 6% of men reported migraine.

The economic impact of migraine: an analysis of direct and indirect costs.

Objective: This study examined whether individuals with migraine incurred greater direct and indirect costs than a matched group free of migraines.

Methods: Using population-based survey data, we matched individuals with migraine (n = 1087) and a migraine-free control group one-to-one for age, sex, employment status, and number of comorbidities. We assessed the prior six months' direct medical care in terms of self-reported hospital days and emergency department and physician visits.

Communication issues in migraine diagnosis.

Objectives: To examine the importance of good communication when informing the patient of the diagnosis of migraine; to review the essentials of successful communication between physician and patient on the aspect of diagnosis; to survey learning resources for physicians on communicating information to patients.

Methods: This paper is based on observations made by the author of the successful interactions of numerous international "headache experts" with their patients, on a review of the medical education literature pertaining to the teaching of communication skills, and on 30 years of not always successful communication with patients.

Results: Communicating the diagnosis of migraine is an opportunity to educate and reassure the patient, to lay the foundation for rational treatment and to help establish the successful doctor-patient relationship which is essential for effective management.

Clinical utility of an instrument assessing migraine disability: the Migraine Disability Assessment (MIDAS) questionnaire.

Objective: We evaluated the agreement between Migraine Disability Assessment (MIDAS) scores and independent physician judgments about pain, disability, and treatment needs based on patient medical histories.

Background: The MIDAS questionnaire measures headache-related disability as lost time due to headache from paid work or school, household work, and nonwork activities.

Methods: Twelve histories from patients with migraine were presented to 49 primary and specialty care physicians unaware of the MIDAS scores.

Potential of the Migraine Disability Assessment (MIDAS) Questionnaire as a public health initiative and in clinical practice.

Migraine is not always well managed in clinical practice, often being under-diagnosed and under-treated. As a result, many sufferers never consult a physician or lapse from care after physician contact. Although most migraine care is provided by general practitioners, others, including specialists, emergency room physicians, pharmacists, and alternative practitioners, may also be involved.

History of migraine treatment.

The history of the treatment of headache in general, and migraine in particular, spans the millennia, from the Neanderthal era to the Space Age. Beginning with a magical hypothesis of the cause of headache, which spawned a magical therapy, rational treatment for this ancient complaint evolved slowly and tortuously. Now, in the age of molecular medicine, a knowledge of where headache treatment began, and how it got to its current stage, aids in the continuing quest for the safe, effective treatment of migraine.

Why is migraine so common?

Migraine is clearly a very common biological disorder, but this knowledge has not been sufficient as yet to ensure completely effective treatment strategies. There appears to be discrepancy between what migraine patients desire as the outcome of consultations and what doctors think patients want. Patients seem, from Packard's selective study (11), to want explanation and reassurance before they get pain relief, whereas doctors view pain relief as the most important aim of management.

Guidelines for the nonpharmacologic management of migraine in clinical practice. Canadian Headache Society.

Objective: To provide physicians and allied health care professionals with guidelines for the nonpharmacologic management of migraine in clinical practice.

Options: The full range and quality of nonpharmacologic therapies available for the management of migraine.

Outcomes: Improvement in the nonpharmacologic management of migraine.

Tolerability profile of zolmitriptan (Zomig; 311C90), a novel dual central and peripherally acting 5HT1B/1D agonist. International clinical experience based on > 3000 subjects treated with zolmitriptan.

Zolmitriptan (Zomig, formerly 311C90) at doses of 0.5-50 mg was administered to 316 unique volunteers in clinical pharmacology studies and 2,750 unique patients in eight clinical studies of acute migraine treatment. Overall, subjects received almost 50,000 doses; 97% of exposures were at doses > or = 2.

Strategies for diagnosing and managing medication-induced headache.

Problem Addressed: Headache is a common clinical disorder. Nearly 50% of patients with headaches use prescription medications, and 90% regularly use nonprescription drugs. Medication-induced headaches (MIH) are chronic daily headaches caused by overuse of medicine.

Headaches in older people. How are they different in this age-group?

The cause of headaches in older people is more likely to be disease than in younger people. Therefore, a high index of suspicion and a willingness to investigate new headaches in the elderly are essential. Benign dysfunctional headaches (eg, migraine, tension-type headaches) that have carried over from youth are found most often.

Guidelines for the diagnosis and management of migraine in clinical practice. Canadian Headache Society.

Objective: To provide physicians and allied health care professionals with guidelines for the diagnosis and management of migraine in clinical practice.

Options: The full range and quality of diagnostic and therapeutic methods available for the management of migraine.

Outcomes: Improvement in the diagnosis and treatment of migraine, which will lead to a reduction in suffering, increased productivity and decreased economic burden.