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Stephen D Silberstein - One of the best experts on this subject based on the ideXlab platform.
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avp 825 breath powered intranasal delivery system containing 22 mg sumatriptan powder vs 100 mg oral sumatriptan in the acute treatment of Migraines the compass study a comparative randomized clinical trial across multiple attacks
Headache, 2015Co-Authors: Stewart J Tepper, Roger K. Cady, Stephen D Silberstein, John C Messina, Ramy A Mahmoud, Per G Djupesland, Paul Shin, Joao SiffertAbstract:Objective The objective of this study was to compare the efficacy, tolerability, and safety of AVP-825, an investigational bi-directional breath-powered intranasal delivery system containing low-dose (22 mg) sumatriptan powder, vs 100 mg oral sumatriptan for acute treatment of Migraine in a double-dummy, randomized comparative efficacy clinical trial allowing treatment across multiple Migraine attacks. Background In phases 2 and 3, randomized, placebo-controlled trials, AVP-825 provided early and sustained relief of moderate or severe Migraine headache in adults, with a low incidence of triptan-related adverse effects. Methods This was a randomized, active-comparator, double-dummy, cross-over, multi-attack study (COMPASS; NCT01667679) with two ≤12-week double-blind periods. Subjects experiencing 2-8 Migraines/month in the past year were randomized 1:1 using computer-generated sequences to AVP-825 plus oral placebo tablet or an identical placebo delivery system plus 100 mg oral sumatriptan tablet for the first period; patients switched treatment for the second period in this controlled comparative design. Subjects treated ≤5 qualifying Migraines per period within 1 hour of onset, even if pain was mild. The primary end-point was the mean value of the summed pain intensity differences through 30 minutes post-dose (SPID-30) using Headache Severity scores. Secondary outcomes included pain relief, pain freedom, pain reduction, consistency of response across multiple Migraines, Migraine-associated symptoms, and atypical sensations. Safety was also assessed. Results A total of 275 adults were randomized, 174 (63.3%) completed the study (ie, completed the second treatment period), and 185 (67.3%) treated at least one Migraine in both periods (1531 Migraines assessed). There was significantly greater reduction in Migraine pain intensity with AVP-825 vs oral sumatriptan in the first 30 minutes post-dose (least squares mean SPID-30 = 10.80 vs 7.41, adjusted mean difference 3.39 [95% confidence interval 1.76, 5.01]; P < .001). At each time point measured between 15 and 90 minutes, significantly greater rates of pain relief and pain freedom occurred with AVP-825 treatment compared with oral sumatriptan. At 2 hours, rates of pain relief and pain freedom became comparable; rates of sustained pain relief and sustained pain freedom from 2 to 48 hours remained comparable. Nasal discomfort and abnormal taste were more common with AVP-825 vs oral sumatriptan (16% vs 1% and 26% vs 4%, respectively), but ∼90% were mild, leading to only one discontinuation. Atypical sensation rates were significantly lower with AVP-825 than with conventional higher dose 100 mg oral sumatriptan. Conclusions AVP-825 (containing 22 mg sumatriptan nasal powder) provided statistically significantly greater reduction of Migraine pain intensity over the first 30 minutes following treatment, and greater rates of pain relief and pain freedom within 15 minutes, compared with 100 mg oral sumatriptan. Sustained pain relief and pain freedom through 24 and 48 hours was achieved in a similar percentage of attacks for both treatments, despite substantially lower total systemic drug exposure with AVP-825. Treatment was well tolerated, with statistically significantly fewer atypical sensations with AVP-825.
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topiramate in Migraine prevention results of a large controlled trial
JAMA Neurology, 2004Co-Authors: Stephen D Silberstein, Walter Neto, Jennifer Schmitt, David JacobsAbstract:Background Open-label trials and small controlled studies report topiramate's efficacy in Migraine prevention. Objective To assess the efficacy and safety of topiramate as a Migraine-preventive therapy. Design A 26-week, randomized, double-blind, placebo-controlled study. Setting Outpatient treatment at 49 US clinical centers. Patients Patients were aged 12 to 65 years, had a 6-month International Headache Society Migraine history, and experienced 3 to 12 Migraines per month, but had 15 or fewer headache days per month during the 28-day baseline period. Interventions Participants were randomized to placebo or topiramate, 50, 100, or 200 mg/d, titrated by 25 mg/wk to the assigned dose or as tolerated in 8 weeks; maintenance therapy continued for 18 weeks. Main Outcome Measures The primary efficacy assessment was a reduction in mean monthly Migraine frequency across the 6-month treatment phase. Secondary end points were responder rate, time to onset of action, mean change in Migraine days per month, and mean change in rescue medication days per month. Results Four hundred eighty-seven patients were randomized, and 469 composed the intent-to-treat population. The mean ± SD monthly Migraine frequency decreased significantly for the 100-mg/d group (from 5.4 ± 2.2 to 3.3 ± 2.9; P P P = .04]; 100 mg/d, 54.0% [ P P Conclusion Topiramate, 100 or 200 mg/d, was effective as a preventive therapy for patients with Migraine.
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practice parameter evidence based guidelines for Migraine headache an evidence based review report of the quality standards subcommittee of the american academy of neurology
Neurology, 2000Co-Authors: Stephen D SilbersteinAbstract:Mission statement. The Quality Standards Subcommittee (QSS) of the American Academy of Neurology (AAN) is charged with developing practice parameters for physicians. This practice parameter summarizes the results from the four evidence-based reviews on the management of patients with Migraine: specifically, acute, preventive, and nonpharmacologic treatments for Migraine, and the role of neuroimaging in patients with headache. The full papers for these treatment guidelines are published elsewhere,1-6⇓⇓⇓⇓⇓ and only the specific treatment recommendations are summarized below. Migraine is a very common disorder. An estimated 18% of women and 6% of men experience Migraine, but many go undiagnosed and undertreated.7 There have been a number of advances in the diagnosis and treatment of Migraine as well as great strides in understanding its pathogenesis, making it one of the best understood of the neurologic disorders. Migraine is characterized by enhanced sensitivity of the nervous system. The attack is associated with activation of the trigeminal-vascular system. In June 1998, Duke University’s Center for Clinical Health Policy Research, in collaboration with the AAN, completed four Technical Reviews on Migraine sponsored by the Agency for Health Care Policy and Research. These reviews covered self-administered drug treatments for acute Migraine8; parenteral drug treatments for acute Migraine9; drug treatments for the prevention of Migraine10; and behavioral and physical treatments for Migraine.11 The Education and Research Foundation of the AAN later funded additional reports on diagnostic testing for headache patients, an update on sumatriptan and other 5-HT1 agonists, and a report on butalbital-containing compounds for Migraine and tension-type headache, using the same methodology that was used in the original Technical Reviews . A multidisciplinary panel of professional organizations (The US Headache Consortium) produced four treatment guidelines, each related to a distinct set of …
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rizatriptan in the treatment of menstrual Migraine
Obstetrics & Gynecology, 2000Co-Authors: Stephen D Silberstein, Helene Massiou, Claire Le Jeunne, Lisa Johnsonpratt, Kathleen Mccarroll, Christopher LinesAbstract:Abstract Objective: To determine the efficacy of oral rizatriptan 10 mg and 5 mg for treating menstrually associated Migraine attacks. Methods: Data from two large clinical trials with identical designs were included in a retrospective analysis. The studies were randomized, double-masked, placebo-controlled, incomplete block, two-period, crossover designs. Women with Migraines were randomly assigned to one of five treatment sequences for the treatment of two Migraine attacks. Only data from the first attack in women with Migraines who were treated with rizatriptan or placebo were included in the analysis. A menstrually associated attack was defined as one that occurred within 3 days before or after the onset of the last menstrual period. Results: In the subgroup of 335 women with menstrually associated Migraine, rizatriptan was effective compared with placebo. At 2 hours after dosing, 68% of 139 women taking rizatriptan 10 mg and 70% of 115 women taking rizatriptan 5 mg with a menstrually associated Migraine had pain relief compared with 44% of 81 patients taking placebo (P Conclusion: Rizatriptan is effective in the treatment of menstrually associated Migraine attacks.
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botulinum toxin type a as a Migraine preventive treatment
Headache, 2000Co-Authors: Stephen D Silberstein, Ninan T Mathew, Joel Saper, Stephen JenkinsAbstract:Objective.—To assess the safety and efficacy of botulinum toxin type A (BOTOX; Allergan, Inc) in the prevention of Migraine. Background.—Current Migraine preventive therapies are often unsatisfactory because of their limited efficacy, adverse effects, and drug interactions. Botulinum toxin type A injections often reduce the pain associated with conditions such as cervical dystonia, achalasia, rectal fissures, and myofascial pain syndrome. An open-label, noncontrolled study of botulinum toxin type A suggested benefits for patients with Migraine. Design and Methods.—This was a double-blind, vehicle-controlled study of 123 subjects with a history of two to eight moderate-to-severe Migraine attacks per month, with or without aura. Participants were randomized to receive single administrations of vehicle or botulinum toxin type A, 25 U or 75 U, injected into multiple sites of pericranial muscles at the same visit. During a 1-month baseline period and for 3 months following injection, subjects kept daily diaries in which they recorded Migraine frequency, Migraine severity, and the occurrence of Migraine-associated symptoms. Results.—Compared with vehicle treatment, subjects in the 25-U botulinum toxin type A treatment group showed significantly fewer Migraine attacks per month, a reduced maximum severity of Migraines, a reduced number of days using acute Migraine medications, and reduced incidence of Migraine-associated vomiting. Both the 25-U and 75-U botulinum toxin type A groups were significantly better than the vehicle group on subject global assessment. Botulinum toxin A treatment was well tolerated, with only the 75-U treatment group exhibiting a significantly higher rate of treatment-related adverse events than vehicle. Conclusions.—Pericranial injection of botulinum toxin type A, 25 U, was found to be a safe treatment that significantly reduced Migraine frequency, Migraine severity, acute medication usage, and associated vomiting.
Andrew D Hershey - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Pediatric Migraine
Current Treatment Options in Neurology, 2015Co-Authors: Hope L. O’brien, Marielle A Kabbouche, Joanne Kacperski, Andrew D HersheyAbstract:The diagnosis of Migraine in the pediatric population is increasing as providers are becoming more familiar with recognizing the condition. Over-the-counter and Migraine-specific treatment, once considered off-label, have proven to be effective, especially if given at the early onset of head pain. Mild to severe cases of Migraine should be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), with triptans used alone or in combination in moderate to severe headaches unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine (DHE), a potent vasoconstrictor should be used for intractable Migraines and is preferred in the hospital setting. Anti-emetics that have anti-dopaminergic properties can be helpful in patients with associated symptoms of nausea and vomiting along with headache, especially when used in combination therapy. Preventative treatment should be initiated early in patients with frequent headaches to improve headache outcomes and quality of life. Patients and families should be educated on non-pharmacologic management, such as lifestyle modification and avoidance of triggers, that can prevent progression and worsening of Migraine.
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genomic expression patterns in menstrual related Migraine in adolescents
Headache, 2012Co-Authors: Andrew D Hershey, Paul S Horn, Marielle A Kabbouche, Hope L Obrien, Scott W PowersAbstract:Background Exacerbation of Migraine with menses is common in adolescent girls and women with Migraine, occurring in up to 60% of females with Migraine. These Migraines are oftentimes longer and more disabling and may be related to estrogen levels and hormonal fluctuations.
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Treatment of Acute Migraine in the Pediatric Population
Current Treatment Options in Neurology, 2010Co-Authors: Hope L. O’brien, Marielle A Kabbouche, Andrew D HersheyAbstract:The recognition of the diagnosis of Migraine in the pediatric population is increasing. Early and aggressive treatment of Migraine in children and adolescents with the use of over-the-counter medications has proven effective. In addition, the off-label use of many Migraine-specific medications is often accepted in the absence of sufficient evidence-based trials. Mild to severe cases of Migraine should be treated with NSAIDs, with triptans used for moderate to severe headaches that are unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine (DHE) should be used for intractable Migraines, preferably in the hospital setting. In patients with associated symptoms of nausea and vomiting, antiemetics with antidopaminergic properties can be helpful through their action on central Migraine generation. Furthermore, patients and families should be educated about nonpharmacologic aspects of management such as preventing episodic Migraine through lifestyle modification and avoidance of triggers.
Roger K. Cady - One of the best experts on this subject based on the ideXlab platform.
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avp 825 breath powered intranasal delivery system containing 22 mg sumatriptan powder vs 100 mg oral sumatriptan in the acute treatment of Migraines the compass study a comparative randomized clinical trial across multiple attacks
Headache, 2015Co-Authors: Stewart J Tepper, Roger K. Cady, Stephen D Silberstein, John C Messina, Ramy A Mahmoud, Per G Djupesland, Paul Shin, Joao SiffertAbstract:Objective The objective of this study was to compare the efficacy, tolerability, and safety of AVP-825, an investigational bi-directional breath-powered intranasal delivery system containing low-dose (22 mg) sumatriptan powder, vs 100 mg oral sumatriptan for acute treatment of Migraine in a double-dummy, randomized comparative efficacy clinical trial allowing treatment across multiple Migraine attacks. Background In phases 2 and 3, randomized, placebo-controlled trials, AVP-825 provided early and sustained relief of moderate or severe Migraine headache in adults, with a low incidence of triptan-related adverse effects. Methods This was a randomized, active-comparator, double-dummy, cross-over, multi-attack study (COMPASS; NCT01667679) with two ≤12-week double-blind periods. Subjects experiencing 2-8 Migraines/month in the past year were randomized 1:1 using computer-generated sequences to AVP-825 plus oral placebo tablet or an identical placebo delivery system plus 100 mg oral sumatriptan tablet for the first period; patients switched treatment for the second period in this controlled comparative design. Subjects treated ≤5 qualifying Migraines per period within 1 hour of onset, even if pain was mild. The primary end-point was the mean value of the summed pain intensity differences through 30 minutes post-dose (SPID-30) using Headache Severity scores. Secondary outcomes included pain relief, pain freedom, pain reduction, consistency of response across multiple Migraines, Migraine-associated symptoms, and atypical sensations. Safety was also assessed. Results A total of 275 adults were randomized, 174 (63.3%) completed the study (ie, completed the second treatment period), and 185 (67.3%) treated at least one Migraine in both periods (1531 Migraines assessed). There was significantly greater reduction in Migraine pain intensity with AVP-825 vs oral sumatriptan in the first 30 minutes post-dose (least squares mean SPID-30 = 10.80 vs 7.41, adjusted mean difference 3.39 [95% confidence interval 1.76, 5.01]; P < .001). At each time point measured between 15 and 90 minutes, significantly greater rates of pain relief and pain freedom occurred with AVP-825 treatment compared with oral sumatriptan. At 2 hours, rates of pain relief and pain freedom became comparable; rates of sustained pain relief and sustained pain freedom from 2 to 48 hours remained comparable. Nasal discomfort and abnormal taste were more common with AVP-825 vs oral sumatriptan (16% vs 1% and 26% vs 4%, respectively), but ∼90% were mild, leading to only one discontinuation. Atypical sensation rates were significantly lower with AVP-825 than with conventional higher dose 100 mg oral sumatriptan. Conclusions AVP-825 (containing 22 mg sumatriptan nasal powder) provided statistically significantly greater reduction of Migraine pain intensity over the first 30 minutes following treatment, and greater rates of pain relief and pain freedom within 15 minutes, compared with 100 mg oral sumatriptan. Sustained pain relief and pain freedom through 24 and 48 hours was achieved in a similar percentage of attacks for both treatments, despite substantially lower total systemic drug exposure with AVP-825. Treatment was well tolerated, with statistically significantly fewer atypical sensations with AVP-825.
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clinical efficacy and tolerability of 2 5 mg zolmitriptan for the acute treatment of Migraine
Neurology, 1997Co-Authors: Glen D Solomon, Roger K. Cady, J A Klapper, N L Earl, Joel R Saper, Nabih M RamadanAbstract:Previous studies demonstrated that zolmitriptan at doses of 1 to 25 mg was highly effective in treating acute Migraine attacks. The 2.5-mg dose had a favorable therapeutic effect with high efficacy and good tolerability. The objective of this study was to further evaluate the efficacy of a single 2.5-mg dose of zolmitriptan (Zomig, formerly known as 311C90) for acute treatment of a single moderate or severe Migraine attack. The study was a randomized, double-blind, placebo-controlled clinical trial. Female and male patients, 12 to 65 years old, with Migraine (with or without aura) for ≥1 year, one to six Migraines per month, and age at onset p p
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responsiveness of non ihs Migraine and tension type headache to sumatriptan
Cephalalgia, 1997Co-Authors: Roger K. Cady, Donna L Gutterman, Jane Saiers, M E BeachAbstract:In a long-term efficacy and satiety 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. Analysis of this population revealed they treated 232 headaches. Of these headaches, 114 were classified per IHS criteria as Migraine; 76 as tension-type; and 42 as. non-IHS Migraine (not classifiable as IHS Migraine or IHS tension-type headache). Of the 114 Migraines a positive response to sumatriptan occurred in 109 (96%) cases; of the 76 tension-types, 73 responded to sumatriptan (97%); of the 42 non-IHS Migraine, 40 (95%) responded to sumatriptan. An equivalent response to sumatriptan among three diagnost...
Donna L Gutterman - One of the best experts on this subject based on the ideXlab platform.
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responsiveness of non ihs Migraine and tension type headache to sumatriptan
Cephalalgia, 1997Co-Authors: Roger K. Cady, Donna L Gutterman, Jane Saiers, M E BeachAbstract:In a long-term efficacy and satiety 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. Analysis of this population revealed they treated 232 headaches. Of these headaches, 114 were classified per IHS criteria as Migraine; 76 as tension-type; and 42 as. non-IHS Migraine (not classifiable as IHS Migraine or IHS tension-type headache). Of the 114 Migraines a positive response to sumatriptan occurred in 109 (96%) cases; of the 76 tension-types, 73 responded to sumatriptan (97%); of the 42 non-IHS Migraine, 40 (95%) responded to sumatriptan. An equivalent response to sumatriptan among three diagnost...
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impact of sumatriptan on workplace productivity nonwork activities and health related quality of life among hospital employees with Migraine
Headache, 1996Co-Authors: George R Mushet, Bill Clements, Gayla Pait, David P. Miller, Donna L GuttermanAbstract:This prospective, open-label study evaluated the effects of subcutaneous sumatriptan versus usual therapy on workplace productivity, activity time outside of work, and health-related quality of life in 43 men or women who were hospital employees diagnosed with Migraine according to International Headache Society criteria. Patients treated Migraines with their usual therapy for 12 to 18 weeks followed by subcutaneous sumatriptan for 6 months. Health-related quality of life measurements obtained at baseline, after usual therapy, and after sumatriptan therapy included the Short Form-36 Health Surveyo and the Migraine-Specific Quality of Life Questionnaireo . Patient daily diaries were used to capture data on Migraine symptoms and on Lost Workplace Productivity and Non-workplace Activity Time. Traditional clinical efficacy measures were obtained to support the pharmacoeconomic data. Clinical data showed that the percentage of treated Migraine days per patient on which the patient experienced relief (moderate or severe pain reduced to mild or none) was 75% with sumatriptan and 25% with usual therapy. The mean time to meaningful relief was 1.1 hours during the sumatriptan phase and 4.2 hours during the usual therapy phase. Lost Workplace Productivity and Nonworkplace Activity Time was 35% lower with sumatriptan therapy (1.5 hours) compared with usual therapy (2.3 hours). Time missed from work due to symptoms time worked with symptoms, and time normal activities were carried on with symptoms were each lower during sumatriptan therapy compared with usual therapy. Scores on each of the three Migraine-Specific Quality of Life Questionnaire dimensions and on the Role-Emotional dimension of the Short Form-36 were significantly more favorable after sumatriptan than after usual therapy (P<0.05). These data demonstrate that treatment of Migraines with sumatriptan for 6 months following usual therapy for 12 to 18 weeks was associated with improvement in clinical efficacy, reduction in lost workplace productivity and nonworkplace activity time, and enhancement of key dimensions of health-related quality of life among employees of a large university hospital.
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improvements in health related quality of life with sumatriptan treatment for Migraine
Journal of Family Practice, 1996Co-Authors: P Jhingran, R K Cady, J Rubino, D Miller, R B Grice, Donna L GuttermanAbstract:BACKGROUND: The debilitating effects of Migraine might be reduced in patients using an effective Migraine medication. The serotonin (5HT1) receptor agonist sumatriptan has been shown in clinical trials to alleviate headache and associated symptoms in the majority of patients treated. METHODS: Three hundred forty-four (344) patients with Migraine were allowed to treat an unlimited number of Migraine attacks for up to 24 months with subcutaneous sumatriptan (6 mg). Open-label oral sumatriptan (100 mg) could be used between 1 hour and 24 hours after the initial injection for treatment of recurrent or persistent headache. On four occasions during the treatment period, patients completed the Medical Outcomes Study Short Form-36 Health Survey, a general health status instrument; the Migraine-Specific Quality of Life Questionnaire, a disease-specific instrument; and a series of questions designed to measure the impact of Migraine on productivity and disability. RESULTS: Treatment with sumatriptan was associated with significant (P < .05) improvements relative to baseline in three of the Short Form-36 Health Survey quality-of-life dimensions (Bodily Pain, General Health Perceptions, and Social Functioning) and three of the Migraine-Specific Quality of Life Questionnaire dimensions (Role Function-Restrictive, Role Function-Preventive, and Emotional Function). Significant (P < .05) improvements in patient-rated productivity and reductions in patient-rated disability also occurred during the trial. CONCLUSIONS: Patients using sumatriptan to treat Migraines for up to 24 months experienced improvements in disability and productivity as well as in health-related quality of life as measured either by a general health status instrument or a disease-specific instrument.
Marielle A Kabbouche - One of the best experts on this subject based on the ideXlab platform.
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Quantitative neuromagnetic signatures of aberrant cortical excitability in pediatric chronic Migraine
The Journal of Headache and Pain, 2016Co-Authors: Kimberly A. Leiken, Marielle A Kabbouche, Jing Xiang, Emily Curry, Hisako Fujiwara, Douglas F. Rose, Janelle R. Allen, Joanne E. Kacperski, Hope L. O’brien, Scott W PowersAbstract:Background Reports have suggested that abnormal cortical excitability may be associated with acute Migraines. The present study quantitatively assesses the degree of cortical excitability in chronic Migraine as compared to acute Migraine and healthy controls within the pediatric population. Methods We investigated 27 children suffering from chronic Migraine, 27 children suffering from acute Migraine, and 27 healthy controls using a magnetoencephalography (MEG) system, recording at a sampling rate of 6000 Hz. All groups were age-matched and gender-matched. Neuromagnetic brain activation was elicited by a finger-tapping motor task. The spatiotemporal and spectral signatures of MEG data within a 5–2884 Hz range were analyzed using Morlet wavelet transform and beamformer analyses. Results Compared with controls, the chronic Migraine group showed (1) significantly prolonged latencies of movement-elicited magnetic fields (MEFs) between 5 and 100 Hz; (2) increased spectral power between 100 and 200 Hz, and between 2200 and 2800 Hz; and (3) a higher likelihood of neuromagnetic activation in the ipsilateral sensorimotor cortices, supplementary motor area, and occipital regions. Compared with acute Migraine group, chronic Migraine patients showed (1) significantly higher odds of having strong MEFs after 150 ms; and (2) significantly higher odds of having neuromagnetic activation from the deep brain areas. Conclusions Results demonstrated that chronic Migraine subjects were not only different from the healthy controls, but also different from acute Migraine subjects. The chronification of Migraines may be associated with elevated cortical excitability, delayed and spread neural response, as well as aberrant activation from deep brain areas.
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Treatment of Pediatric Migraine
Current Treatment Options in Neurology, 2015Co-Authors: Hope L. O’brien, Marielle A Kabbouche, Joanne Kacperski, Andrew D HersheyAbstract:The diagnosis of Migraine in the pediatric population is increasing as providers are becoming more familiar with recognizing the condition. Over-the-counter and Migraine-specific treatment, once considered off-label, have proven to be effective, especially if given at the early onset of head pain. Mild to severe cases of Migraine should be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), with triptans used alone or in combination in moderate to severe headaches unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine (DHE), a potent vasoconstrictor should be used for intractable Migraines and is preferred in the hospital setting. Anti-emetics that have anti-dopaminergic properties can be helpful in patients with associated symptoms of nausea and vomiting along with headache, especially when used in combination therapy. Preventative treatment should be initiated early in patients with frequent headaches to improve headache outcomes and quality of life. Patients and families should be educated on non-pharmacologic management, such as lifestyle modification and avoidance of triggers, that can prevent progression and worsening of Migraine.
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genomic expression patterns in menstrual related Migraine in adolescents
Headache, 2012Co-Authors: Andrew D Hershey, Paul S Horn, Marielle A Kabbouche, Hope L Obrien, Scott W PowersAbstract:Background Exacerbation of Migraine with menses is common in adolescent girls and women with Migraine, occurring in up to 60% of females with Migraine. These Migraines are oftentimes longer and more disabling and may be related to estrogen levels and hormonal fluctuations.
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Treatment of Acute Migraine in the Pediatric Population
Current Treatment Options in Neurology, 2010Co-Authors: Hope L. O’brien, Marielle A Kabbouche, Andrew D HersheyAbstract:The recognition of the diagnosis of Migraine in the pediatric population is increasing. Early and aggressive treatment of Migraine in children and adolescents with the use of over-the-counter medications has proven effective. In addition, the off-label use of many Migraine-specific medications is often accepted in the absence of sufficient evidence-based trials. Mild to severe cases of Migraine should be treated with NSAIDs, with triptans used for moderate to severe headaches that are unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine (DHE) should be used for intractable Migraines, preferably in the hospital setting. In patients with associated symptoms of nausea and vomiting, antiemetics with antidopaminergic properties can be helpful through their action on central Migraine generation. Furthermore, patients and families should be educated about nonpharmacologic aspects of management such as preventing episodic Migraine through lifestyle modification and avoidance of triggers.
