Migraine induces disability and an impaired quality of life, even between attacks. As most studies are based on subjective reports only, this study was set up to objectively quantify the interictal daily activities and heart rate of migraine patients, in relation to their subjectively reported highest realizable level of activity and of symptoms of mood in their habitual environment. Measurements were obtained during a migraine-free 2-day period of 24 patients (age range: 21-57 years) and 24 controls (age range: 18-59 years). Accelerometry was used to quantify the time spent in different postures and movements. The subjective parameters were documented by daily log. Whereas heart rate was similar for patients and controls, migraineurs were found to be significantly less physically active than controls and reported a significantly lower realizable level of activity. In addition, when active, their body motility was less than that of controls. Migraine patients also showed a higher level of sleepiness and lower level of vigour. These interictal behavioural and subjective phenomena objectively illustrate the individual and societal burden of migraine and its chronic impact on both domains.
We describe the preventive use of naratriptan, mostly as add-on to high-dose verapamil treatment, in nine patients with cluster headache. The addition of the naratriptan further improved the headaches in seven of the nine patients.
This randomized, double-blind, parallel-group study compared the efficacy and tolerability of zolmitriptan (2.5 or 5 mg) and sumatriptan (50 mg) in the acute oral treatment of up to six moderate-to-severe migraine attacks. The intention to treat (ITT) population comprised of 1522 patients: 500 treated with zolmitriptan 2.5 mg (2671 attacks), 514 with zolmitriptan 5 mg (2744 attacks) and 508 with sumatriptan 50 mg (2693 attacks). Overall, the 2-h headache response rates in these groups were 62.9, 65.7 and 66.6%, respectively. There were no statistically significant differences between sumatriptan 50 mg and zolmitriptan 2.5 mg (P = 0.12) or 5 mg (P = 0.80). Approximately 40% of patients in each group reported a 2-h headache response in > or = 80% of attacks. There were no statistically significant differences between the groups in the rates of headache response at 1 h (zolmitriptan 2.5 mg 36.9%, zolmitriptan 5 mg 39.5% and sumatriptan 50 mg 38.0%) or 4 h (70.3, 72.9 and 72.2%, respectively) or in the rates of meaningful migraine relief at 1, 2 or 4 h or sustained (24-h) pain relief. All treatments were well tolerated. In conclusion, zolmitriptan (2.5 or 5 mg) proved similarly efficacious compared with sumatriptan (50 mg), both in terms of response rates and consistency across attacks.
We describe a man with chronic paroxysmal hemicrania, who remained free of headaches on indomethacin, 25 mg once or twice daily. However, in this case, in contrast to typical cases of paroxysmal hemicrania, the pain of the headaches was nonlateralized and was located in the centre of the forehead. The headaches were not associated with local autonomic symptoms or signs involving the eyes or nose. Initially, the pain of the headaches lasted for seconds only and was brought on by coughing.
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