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Objective:To evaluate the onset of efficacy of TEV-48125, a monoclonal antibody against calcitonin gene-related peptide, recently shown to be effective for the preventive treatment of chronic migraine (CM) and high-frequency episodic migraine.Methods:A randomized placebo-controlled study tested once-monthly injections of TEV-48125 675/225 mg or 900 mg vs placebo. Headache information was captured daily using an electronic headache diary. The primary endpoint was change from baseline in the number of headache hours in month 3. Herein, we assess the efficacy of each dose at earlier time points.Results:The sample consisted of 261 patients. For headache hours, the 675/225-mg dose separated from placebo on day 7 and the 900-mg dose separated from placebo after 3 days of therapy (p = 0.048 and p = 0.033, respectively). For both the 675/225-mg and 900-mg doses, the improvement was sustained through the second (p = 0.004 and p < 0.001) and third (p = 0.025 and p < 0.001) weeks of therapy and throughout the study (month 3, p = 0.0386 and p = 0.0057). For change in weekly headache days of at least moderate intensity, both doses were superior to placebo at week 2 (p = 0.031 and p = 0.005).Conclusions:TEV-48125 demonstrated a significant improvement within 1 week of therapy initiation in patients with CM.Classification of evidence:This study provides Class II evidence that for patients with CM, TEV-48125 significantly decreases the number of headache hours within 3 to 7 days of injection.

We were unable to demonstrate any significant benefit from amitriptyline plus fluoxetine over amitriptyline alone in the treatment of chronic daily headache/transformed migraine. Because of the small number of subjects involved and the short duration of our study, a type II error cannot be excluded.

Headache is one of the most common types of recurrent pain in medical practice. Although nearly everyone has occasional headaches, there are well-defined headache disorders that vary in incidence and prevalence. Among the unusual headache syndromes, headache due to external compression is a poorly studied headache considered to arise as a result of continued stimulation of cutaneous nerves by the application of pressure over the scalp or forehead. The wearing of bands around the head, specifically goggles (such as those worn for swimming), tight hats, or even professional helmets have been described as causative factors. The pain is often constant and more severe at the location where the object is pressing the head. In predisposed patients (ie, those with migraine), external compression may lead to a more severe migrainous headache if the stimulus is prolonged. The mechanism responsible is the compression of trigeminal or occipital nerves branches. The headache resolves after pressure is relieved, or is prevented by avoiding the precipitating cause. Drugs are rarely used.

-Forty to 78% of the patients using sumatriptan for the acute treatment of migraine may present recurrence at least occasionally. The concomitant use of a NSAID (nonsteroidal anti-inflammatory drug) has been recommended to decrease the recurrence rate. Sixty seven patients that treated successfully 8 migraine attacks with 100 mg of sumatritpan PO and presented recurrence in at least 5 attacks were studied prospectively. The patients received 100 mg of sumatriptan and 550 mg of naproxen sodium PO to treat 4 consecutive moderate or severe migraine attacks. The recurrence rate, once at least 62.5% (5 out of 8 attacks), decreased to 14.2% (38 out of 268 attacks) with the combination of compounds (p<0.0001). We then studied two groups of 13 patients made randomicaly from the 67 initially evaluated, that were given sumatriptan 100 mg plus naproxen sodium 550 mg or placebo, in a double-blind design, to treat 3 other consecutive migraine attacks. Each group of patients treated 39 attacks. The recurrence among the patients taking sumatriptan plus placebo was 59% (23 out of 39 attacks) and the recurrence presented by the group taking sumatriptan plus naproxen was 25.5% (10 out of 39 attacks) (p<0.0003). We concluded that the combination of sumatriptan plus naproxen sodium decreases significantly migraine recurrence presented by patients taking sumatriptan alone.KEY WORDS: migraine, recurrence, sumatriptan, naproxen sodium. Naproxeno sódico diminui a recorrência da migrânea quando administrado com o sumatriptanRESUMO -Quarenta a 78% dos pacientes que utilizam sumatriptan para o tratamento agudo das migrâneas ou enxaquecas apresentam recorrência pelo menos ocasionalmente. O uso concomitante de um anti-inflamatório não esteroidal (AINE) tem sido recomendado para reduzir a frequência da recorrência. Sessenta e sete pacientes que haviam tratado com sucesso pelo menos 8 ataques de migrânea com 100 mg de sumatriptan VO, e apresentaram recorrência em pelo menos 5 ataques foram estudados prospectivamente. Os pacientes receberam 100 mg de sumatriptan e 550 mg de naproxen sodium VO para tratar 4 ataques consecutivos de intensidade moderada ou severa. A frequência da recorrência, que manifestava-se em pelo menos 62,5% (5 em cada 8 ataques), diminuiu para 14,2% (38 em 268 ataques) com a combinação destes compostos (p<0,0001). Estudamos então 2 grupos de 13 pacientes formados randomicamente entre os 67 iniciais, aos quais foi dado sumatriptan 100 mg, e naproxen sodium 550 mg ou placebo, de forma duplo-cega, para tratar 3 ataques consecutivos. Cada um dos 2 grupos tratou 39 ataques moderados ou intensos. A recorrência entre os pacientes do grupo que utilizou o sumatriptan mais placebo foi 59% (23 em 39 ataques) e a recorrência apresentada pelo grupo que utilizou sumatriptan e naproxen sodium foi 25,5% (10 em 39 ataques) (p<0,0003). Concluímos que a combinação de sumatriptan e naproxen sodium diminui significativamente a recorrência dos ataques de migrânea em pacientes que fazem uso de sumatriptan isolado.

The prevalence of CDH in the rural area of Brazil is similar to what has been reported in previous studies. A significant proportion of them have psychiatric comorbidities and/or TMD. In this sample, comorbidities were as frequent as reported in convenience samples from tertiary headache centers.

Background: Rizatriptan is an effective and fast acting drug for the acute treatment of migraine. Some nonsteroidal anti-inflammatory drugs (NSAID) have also demonstrated efficacy in treating migraine attacks. There is evidence that the combination of a triptan and a NSAID decreases migraine recurrence in clinical practice. The primary aim of this randomized open label study was to assess the recurrence rates in migraine sufferers acutely treated with rizatriptan (RI) alone vs. rizatriptan plus a COX-2 enzyme inhibitor (rofecoxib, RO) vs. rizatriptan plus a traditional NSAID (tolfenamic acid, TO). We were also interested in comparing the efficacy rates within these three groups.

Migraine is a common, chronic neurologic disorder that affects 11% of the adult population in Western countries. In this article, we review the current approaches to the pharmacologic treatment of migraine. Once migraine is diagnosed, and illness severity has been assessed, clinicians and patients should work together to develop a treatment plan based on the patient needs and preferences. The goals of the treatment plan usually include reducing attack frequency, intensity, and duration; minimizing headache-related disability; improving health-related quality of life; and avoiding headache escalation and medication misuse. Medical treatments for migraine can be divided into preventive drugs, which are taken on a daily basis regardless of whether headache is present, and acute drugs taken to treat individual attacks as they arise. Acute treatments are further divided into nonspecific and migraine-specific treatments. The US Headache Consortium Guidelines recommend stratified care based on the level of disability to help physicians individualize treatment. Simple analgesics are appropriate as first-line acute treatments for less disabled patients; if simple analgesics are unsuccessful, treatment is escalated. For those with high disability levels, migraine-specific acute therapies, such as the triptans, are recommended as the initial treatment, with preventive drugs in selected patients. A variety of behavioral interventions are helpful. The clinicians have in their armamentariums an ever-expanding variety of medications. With experience, clinicians can match individual patient needs with the specific characteristics of a drug to optimize therapeutic benefit.