Gelstat Migraine (sublingually administered feverfew and ginger compound) for acute treatment of migraine when administered during the mild pain phase.

Background: Treatment of migraine headaches is often delayed due to assessing the potential severity of an evolving headache or anticipating unwanted consequences from prescription medication. Studies have demonstrated improved pain-free response when prescription treatments are taken during the mild headache phase of a migraine. This study was designed to evaluate the efficacy of an OTC product, GelStat Migraine, when taken in the early, mild pain phase of migraine.

Sinus headache: a neurology, otolaryngology, allergy, and primary care consensus on diagnosis and treatment.

Sinus headache is a widely accepted clinical diagnosis, although many medical specialists consider it an uncommon cause of recurrent headaches. The inappropriate diagnosis of sinus headache can lead to unnecessary diagnostic studies, surgical interventions, and medical treatments. Both the International Headache Society and the American Academy of Otolaryngology-Head and Neck Surgery have attempted to define conditions that lead to headaches of rhinogenic origin but have done so from different perspectives and in isolation of each other.

Cosensitization of pain and psychiatric comorbidity in chronic daily headache.

Chronic migraine occurs in approximately 20% of migraineurs, typically developing over a period of many years. The pathophysiology of this transformation is unknown. However, experts have associated chronic headache with analgesic overuse, physical injury, and psychologic trauma.

Migraine treatment with rizatriptan and non-triptan usual care medications: a pharmacy-based study.

Objective: To compare the effectiveness of rizatriptan to other non-triptan medications in the relief of migraine headache in usual care settings.

Background: Although rizatriptan has been shown to provide effective relief of migraine symptoms in clinical trials, limited data exist directly comparing its effectiveness with non-triptan medications.

Methods: Migraineurs aged 18 to 55 who had been prescribed a new antimigraine drug (rizatriptan 10 mg or a selected class of non-triptan oral medications) were recruited to participate in the study through a national retail pharmacy chain.

Randomized, placebo-controlled comparison of early use of frovatriptan in a migraine attack versus dosing after the headache has become moderate or severe.

Objective: To evaluate whether frovatriptan would provide greater relief if given early during a migraine attack.

Research Design And Methods: Adults with a history of migraine of at least 1 year, and who had 2-8 headaches in the previous month were recruited from 19 US centres for a prospective, placebo-controlled crossover study over 2 migraine attacks. Dose 1 was taken at the onset of mild migraine headache, Dose 2 was taken at least 2 h later if the headache progressed to moderate/severe.

Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache.

Background: Symptoms referable to the sinus area are frequently reported during migraine attacks, but are not recognized in diagnostic criteria. Underrecognition of migraine may be partly attributed to a variable clinical presentation, and migraines with "sinus" symptoms contribute to this problem. This study was conducted to determine the prevalence of migraine-type headache (International Headache Society [IHS]-defined migraine without aura [IHS 1.

Headache in women.

Women have more migraine than men. Some secondary headaches are more common in women. Menses, pregnancy, and menopause have an impact on the frequency and treatment of headache.

The pathophysiology of primary headache.

Headache research has been a productive area, and understanding of primary headache pathophysiology has increased greatly. There are many more questions that need to be answered to gain a better understanding of the primary headache process. For the clinician,there is value in understanding the pathophysiology of primary headache, because this understanding can help improve diagnostic acumen and shape treatment plans to provide patients with more effective treatment.

Understanding the patient with migraine: the evolution from episodic headache to chronic neurologic disease. A proposed classification of patients with headache.

Traditionally, episodic primary headache disorders are characterized by a return of preheadache (normal) neurologic function between episodes of headache. In contrast, patients with chronic headache often do not return to normal neurologic function between headache attacks. This article proposes that the evolution from episodic migraine to chronic headache may parallel the neurologic disruption observed during the progression of an acute migraine attack and that changes in baseline neurologic function between episodes of headache may be a more sensitive indicator of headache transformation than headache frequency alone.

Simple and efficient recognition of migraine with 3-question headache screen.

Objective: To correlate the results of a new 3-question headache screen to 3 established methods of diagnosing migraine: the International Headache Society diagnostic criteria, physician's clinical impression, and presence of recurring disabling headaches.

Background: A simple tool to recognize patients who experience migraine may facilitate diagnosis of this debilitating and frequently undiagnosed condition.

Methods: Primary care physicians and neurologists in the United States enrolled 3014 adults with a diagnosis of migraine based on one of the following: International Headache Society criteria, an investigator's clinical impression, or presence of recurring disabling headaches.

Sinus headache: a clinical conundrum.

The concept of sinus disease as a common cause of headache is deeply ingrained in the American public, but there is little evidence to support the sinuses as a common cause of disabling headache. On the other hand, a body of evidence supports the concept that migraine can present with facial pain and nasal symptoms such as congestion and rhinorrhea. In clinical studies nearly 90% of participants with self-diagnosed or physician-diagnosed sinus headache met criteria for IHS migraine-type headache and responded to triptan interventions in a manner similar to that witnessed in migraine.

Sinus headache or migraine? Considerations in making a differential diagnosis.

Sinus headache is commonly diagnosed, and patients with headache often cite sinus pain and pressure as a cause of their headaches. A high frequency of diagnosis of sinus headache, which specialists consider to be relatively rare, among patients meeting International Headache Society (IHS) diagnostic criteria for migraine raises the possibility that migraine and perhaps other headache types are sometimes mistaken for sinus headache. This article considers clinical, epidemiologic, and pathophysiologic relationships between sinus headache and migraine and discusses the implications for clinical management of headache.

Primary headaches: a convergence hypothesis.

After reviewing the historic differentiation between migraine and tension-type headache, the authors note that the similarities between these two types of primary headaches outweigh the differences, and so hypothesize that these headaches share a common pathophysiology. The convergence hypothesis for primary headaches links the clinical features of an evolving headache to current pathophysiological models. The authors suggest that successive symptoms experienced clinically reflect an escalating pathophysiological process, beginning with the premonitory period and progressing into tension-type headache and, if uninterrupted, finally into migraine.

Diagnosis and treatment of migraine.

Despite recent advances in understanding the pathophysiology and treatment of migraine, considerable uncertainty remains surrounding the diagnosis and treatment of this disorder. This uncertainty is reflected in studies that show both underdiagnosis and undertreatment of migraine. While the diagnosis can be assisted by criteria from the International Headache Society, other approaches may be useful in clinical practice.

Long-term efficacy and tolerability of rizatriptan wafers in migraine.

Context: Rizatriptan is a selective 5-HT1B/1D receptor agonist for the acute treatment of migraine. It is available in a unique wafer formulation that dissolves rapidly in the mouth and can be taken without liquids, thereby offering patients a very convenient way to take treatment.

Objective: To investigate the long-term efficacy of rizatriptan 10-mg and 5-mg wafers in migraineurs.

Sumatriptan nasal spray and cognitive function during migraine: results of an open-label study.

Objective: To examine measures of cognitive function during acute migraine, before and after treatment with sumatriptan nasal spray, 20 mg.

Background: Migraineurs frequently report symptoms of cognitive impairment during migraine. The efficacy of sumatriptan for treatment of migraine-related cognitive impairment is undocumented.

Economic implications of early treatment of migraine with sumatriptan tablets.

Background: Early treatment of migraine with sumatriptan 50 mg and 100 mg, while pain is mild, has been reported to enhance pain-free response 2 hours and 4 hours postdose and sustained pain-free response 2 to 24 hours postdose compared with treatment when pain has become moderate to severe. Early treatment with sumatriptan 50 mg and 100 mg also resulted in less redosing, which translated to a reduction in the mean number of doses used per migraine episode.

Objective: We examined the economic implications of early treatment with sumatriptan 50 mg and 100 mg while pain is mild versus treatment when pain has become moderate to severe.

Treatment of mild headache in disabled migraine sufferers: results of the Spectrum Study.

Objective: To evaluate the effectiveness of sumatriptan, 50-mg tablets, versus placebo for early intervention while head pain was mild in patients with disabling migraine.

Methods: A post hoc analysis was performed in a subgroup of patients from a large, randomized, placebo-controlled study of patients with disabling headache who treated while pain was mild. Pain-free response 2 and 4 hours postdose, headache recurrence, and safety were examined.

Effect of early intervention with sumatriptan on migraine pain: retrospective analyses of data from three clinical trials.

Objective: This study assessed the efficacy of sumatriptan 50- and 100-mg tablets in the treatment of migraine attacks while the pain is mild rather than moderate/severe.

Background: Results from The Spectrum Study suggested that early treatment of migraine attacks with sumatriptan 50-mg tablets while the pain is mild might enhance pain-free response and reduce headache recurrence.

Methods: Retrospective analyses of headaches treated during mild pain were performed using data from 3 studies of sumatriptan tablets (protocols S2CM09, S2BT25, and S2BT26).

A pilot study to measure cognitive efficiency during migraine.

Background And Objectives: The measurement of cognitive efficiency during migraine has produced conflicting results primarily due to the types of tests used. The objectives of this pilot study were two-fold: to measure cognitive efficiency during migraine, compared to a migraine-free period, and to evaluate the effects of therapy with a 5-HT1 agonist (sumatriptan injection, 6 mg) on the cognitive efficiency of migraineurs during a migraine.

Method: The Headache Care Center-Automated Neuropsychological Assessment Metrics was administered to 10 migraineurs, three times without a migraine, once during a migraine, and three times after administration of sumatriptan injection (6 mg).

Evaluation of migraineurs' preferences for naratriptan over conventional first-line agents.

Objective: To assess patient satisfaction with and preference for naratriptan hydrochloride therapy over previous "nontriptan" therapy for migraines.

Design And Setting: Open-label study conducted at 15 primary care clinics.

Patients: One hundred forty-three adults meeting International Headache Society diagnostic criteria for migraine who were not using triptans as first-line therapy for migraines were enrolled; 115 completed the study.

Diagnosis and treatment of migraine.

Migraine is one of the most common and misunderstood disease encountered in general medical practice. An estimated 23 million Americans suffer disabling migraines, yet only a minority are diagnosed (1,2). An even smaller percentage receive optimal care.

Sumatriptan injection reduces productivity loss during a migraine attack: results of a double-blind, placebo-controlled trial.

Objective: To evaluate the impact of sumatriptan succinate injection compared with placebo on productivity loss during a migraine attack in the workplace.

Design: Randomized, double-blind, placebo-controlled, parallel-group clinical trial.

Setting: Fifteen clinical centers in the United States.

Responsiveness of non-IHS migraine and tension-type headache to sumatriptan.

In a long-term efficacy and safety study, 424 patients were treated with sumatriptan (6 mg sc) for 1,904 migraine attacks. The patients were diagnosed with migraine based on IHS criteria but individual migraine attacks treated in the study were physician diagnosed; not necessarily required to meet IHS criteria. A re-analysis of the treatment response to open label sumatriptan (6 mg sc) indicated that 43 patients had treated at least one migraine that fulfilled IHS criteria for tension-type headache.