Glycerol gangliotomyGlycerol, radiofrequency thermocoagulation, and gamma knife have been used for gasserian ganglio rhizolysis in patients with trigeminal neuralgia and chronic intractable cluster headache with variable success. Radiofrequency lesions of cervical (C2) g-angw were reported to be helpful in patients with "cervicogenic" hkadache, instead of more invasive surgical procedures.In the November 1998 issue of CephalaZgk, Ludwig/and associates reported the morphological changes and the time course of those changes after injection of glycerol in the cervical ganglion in rats. They conch&xl that the immediate "nerve block" effect may be due to the effect of glycerol on neuronal membrane and the permanent effects are due to degenerative changes in the glial as well as neuronal and myelin morphology. They did not confirm the old notion that glycerol selectively affects pamcarryingfibers. * Clinical application of glycerol gangliolysis in cervicogenic headache remains to be explored. Overall, in trigeminal neuralgia and cluster headache, analgesia obtained by glycerol is not as effective as radio fr=F==yorgam= knife lesions. 7 in determining the dose
The patient's opinion on sumatriptan treatment has been obtained from 351 migraineurs (299F and 52M) by means of a telephone survey. The results are based on the patients’ cumulative experience of more than 20,000 subcutaneous injections and more than 2,000 tablet doses. The average period during which subcutaneous sumatriptan (12 mg/ml, 0.5 ml) was used was 19.1 ± 0.4 months and 84% of the patients had used more than 10 injections. The average number of migraine attacks per month was 3.0 ± 0.1, injections per attack 1.7 ± 0.1, and number of tablets (100 mg) per attack 1.8 ± 0.2. Attack duration was decreased from on average 38.4 ± 2.1 h to 2.3 ± 0.5 h by subcutaneous sumatriptan and to 3.4 ± 1.0 by orally administered sumatriptan. The average degree of efficiency at work with migraine was 76.3 ± 1.9% on sumatriptan compared with 26.6% on other treatment options; 85% said that sumatriptan was much better than previous conventional therapies tested. During their experience with sumatriptan, 89% of the migraineurs reported altogether 1,058 adverse events (average 3.6 ± 01, range 1 to 12) in connection with subcutaneous sumatriptan treatment. The three most frequent were drowsiness/sedation (49%), chest symptoms (40%) and injection site symptoms (37%). Among the table users, 87% reported altogether 122 adverse events (average 2.6 ± 0.3, range 1 to 11). Seventy-eight percent of the responders responded to subcutaneous sumatriptan sometimes (22% always, 15% every second attack, 40% seldom) experienced a recurrence of their headache within 24 h. The average number of recurrences was 1.7 ± 0.1 and the average time to recurrence 13.0 ± 0.6 h (range 1.5–24 h). It is concluded that the selected group of migraineurs found sumatriptan to be very effective in reducing the symptoms of their migraine attacks, but also to cause several adverse events, in many cases, with short-lasting effect.
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