Migraine headache: Difference between revisions
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===Preventive treatment=== | ===Preventive treatment=== | ||
Perhaps a third of patients meet consensus criteria for preventive treatment.<ref name="pmid17261680">{{cite journal |author=Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF |title=Migraine prevalence, disease burden, and the need for preventive therapy |journal=Neurology |volume=68 |issue=5 |pages=343–9 |year=2007 |pmid=17261680 |doi=10.1212/01.wnl.0000252808.97649.21 |issn=}}</ref> The antiepileptic drug topiramate can reduce the frequency of migraine attacks.<ref name="pmid14982912">{{cite journal |author=Brandes JL, Saper JR, Diamond M, ''et al'' |title=Topiramate for migraine prevention: a randomized controlled trial |journal=JAMA |volume=291 |issue=8 |pages=965–73 |year=2004 |pmid=14982912 |doi=10.1001/jama.291.8.965 |issn=}}</ref> | Perhaps a third of patients meet consensus criteria for preventive treatment.<ref name="pmid17261680">{{cite journal |author=Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF |title=Migraine prevalence, disease burden, and the need for preventive therapy |journal=Neurology |volume=68 |issue=5 |pages=343–9 |year=2007 |pmid=17261680 |doi=10.1212/01.wnl.0000252808.97649.21 |issn=}}</ref> | ||
The antiepileptic drug topiramate can reduce the frequency of migraine attacks.<ref name="pmid14982912">{{cite journal |author=Brandes JL, Saper JR, Diamond M, ''et al'' |title=Topiramate for migraine prevention: a randomized controlled trial |journal=JAMA |volume=291 |issue=8 |pages=965–73 |year=2004 |pmid=14982912 |doi=10.1001/jama.291.8.965 |issn=}}</ref> [[topiramate]] can increase response among patients with [[migraine]] according to a [[randomized controlled trial]].<ref name="pmid14982912"/> The [[relative benefit increase]] was 113.0%. For patients at similar risk to those in this study (23.0% had response), this leads to an [[absolute benefit increase]] of 26%. 3.8 patients must be treated for one to benefit ([[number needed to treat]] = 3.8). [http://medinformatics.uthscsa.edu/calculator/calc.shtml?calc_rx_rates.shtml?eer=49.0&cer=23.0 Click here] to adjust these results for patients at higher or lower risk of response. | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 07:27, 15 May 2008
Migraine headaches are "a class of disabling primary headache disorders, characterized by recurrent unilateral pulsatile headaches. The two major subtypes are common migraine (without aura) and classic migraine (with aura or neurological symptoms)."[1]
Classification
- Common migraine (without aura)
- Classic migraine (with aura or neurological symptoms)
Diagnosis
Migraines are underdiagnosed[2] and misdiagnosed.[3] About a third of headaches that patients report as being migraines are truly migraines[4]; while about 90% of headaches that are self-reported not to be migraines are truly not migraines.[4] The diagnosis of migraine without aura, according to the International Headache Society, can be made according to the following criteria, the "5, 4, 3, 2, 1 criteria":
- 5 or more attacks
- 4 hours to 3 days in duration
- 2 or more of - unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
- 1 or more accompanying symptoms - nausea and/or vomiting, photophobia, phonophobia
For migraine with aura, only two attacks are required to justify the diagnosis.
The mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling) can help diagnose migraine. If 4 of the 5 criteria are met, then the positive likelihood ratio for diagnosing migraine is 24.[5]
The presence of either disability, nausea, or sensitivity to light can diagnose migraine with[6]:
- sensitivity of 81%
- specificity of 75%
Treatment
Abortive treatment
Comparative studies
A randomized controlled trial found that high dose acetylsalicylic acid (1000 mg), sumatriptan 50 mg and low dose ibuprofen 400 mg are equally effective at reducing pain to mild or none at two hours; however, sumatriptan was led to more patients being pain free at two hours (37% versus less than 33% for other groups).[7]
Another randomized controlled trial, funded by the manufacturer of the study drug, found that a combination of sumatriptan 85 mg and naproxen sodium 200 mg was better than either drug alone.[8]
Preventive treatment
Perhaps a third of patients meet consensus criteria for preventive treatment.[9]
The antiepileptic drug topiramate can reduce the frequency of migraine attacks.[10] topiramate can increase response among patients with migraine according to a randomized controlled trial.[10] The relative benefit increase was 113.0%. For patients at similar risk to those in this study (23.0% had response), this leads to an absolute benefit increase of 26%. 3.8 patients must be treated for one to benefit (number needed to treat = 3.8). Click here to adjust these results for patients at higher or lower risk of response.
References
- ↑ National Library of Medicine. Migraine Disorders. Retrieved on 2007-11-02.
- ↑ Lipton RB, Stewart WF, Celentano DD, Reed ML (1992). "Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis". Arch. Intern. Med. 152 (6): 1273–8. PMID 1599358. [e]
- ↑ Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C (2004). "Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache". Arch. Intern. Med. 164 (16): 1769–72. DOI:10.1001/archinte.164.16.1769. PMID 15364670. Research Blogging.
- ↑ 4.0 4.1 Lipton RB, Stewart WF, Liberman JN (2002). "Self-awareness of migraine: interpreting the labels that headache sufferers apply to their headaches". Neurology 58 (9 Suppl 6): S21–6. PMID 12011270. [e]
- ↑ Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM (2006). "Does this patient with headache have a migraine or need neuroimaging?". JAMA 296 (10): 1274–83. DOI:10.1001/jama.296.10.1274. PMID 16968852. Research Blogging.
- ↑ Lipton RB, Dodick D, Sadovsky R, et al (2003). "A self-administered screener for migraine in primary care: The ID Migraine validation study". Neurology 61 (3): 375-82. PMID 12913201. [e]
- ↑ Diener HC, Bussone G, de Liano H, et al (2004). "Placebo-controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks". Cephalalgia : an international journal of headache 24 (11): 947–54. DOI:10.1111/j.1468-2982.2004.00783.x. PMID 15482357. Research Blogging.
- ↑ Brandes JL, Kudrow D, Stark SR, et al (2007). "Sumatriptan-naproxen for acute treatment of migraine: a randomized trial". JAMA 297 (13): 1443-54. DOI:10.1001/jama.297.13.1443. PMID 17405970. Research Blogging.
- ↑ Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF (2007). "Migraine prevalence, disease burden, and the need for preventive therapy". Neurology 68 (5): 343–9. DOI:10.1212/01.wnl.0000252808.97649.21. PMID 17261680. Research Blogging.
- ↑ 10.0 10.1 Brandes JL, Saper JR, Diamond M, et al (2004). "Topiramate for migraine prevention: a randomized controlled trial". JAMA 291 (8): 965–73. DOI:10.1001/jama.291.8.965. PMID 14982912. Research Blogging.