Abstracts and Citations

Abstract

PRIMARY HEADACHES Bennetto L, Patel NK, Fuller G. Trigeminal neuralgia and its management. BMJ. 2007;334:201-205.Trigeminal neuralgia is a severe unilateral paroxysmal facial pain, often described by patients as the "the world's worst pain." Data sources and selection criteria. We searched Medline, National Institute for Health and Clinical Excellence (NICE), and Cochrane databases using the terms "trigeminal neuralgia," "tic douloureux," and "facial pain." All related articles from the NICE and Cochrane databases were obtained. We searched Medline citation lists by title and abstract for relevant publications, including randomized control trials and review articles. The citation lists of these articles were hand searched for further relevant articles.Comment: This is a superb review with up-to-date information and graphics, published in a recent issue of the BMJ, and I recommend it.-Stewart J. Tepper, MD MIGRAINE: TREATMENT Tuchman M, Hee A, Emeribe U, Silberstein S. Efficacy and tolerability of zolmitriptan oral tablet in the acute treatment of menstrual migraine. CNS Drugs. 2006;20:1019-1026.Objective: To determine the efficacy and tolerability of zolmitriptan 2.5 mg oral tablet as an acute treatment for menstrual migraine attacks.Methods: This was a 2-phase, multicenter, randomized, double-blind, placebo-controlled, parallel-group outpatient study (Phase I is reported here). The study was conducted at 27 sites in the USA. Eligible women were randomized (1:1) to receive either zolmitriptan 2.5 mg oral tablet or placebo, and instructed to acutely treat up to 2 menstrual migraine attacks per menstrual period for up to 3 menstrual cycles with a single dose of study medication. Menstrual migraine was operationally defined as an attack occurring within the time period of 2 days prior to the expected onset of menses to 5 days after the onset of menses. Participants were asked to treat migraine headaches of moderate or severe intensity only that occurred >24 hours after the end of the last migraine attack and that had not been acutely treated with other medications. Information regarding each migraine attack was recorded by patients in treatment diary cards. The primary efficacy variable was 2-hour headache response (defined as a 2-point drop on a 4-point scale) for all attacks treated. Secondary variables included 1-and 4-hour headache response rate; 1-, 2-, and 4-hour headache response based on a 100-mm visual analogue scale (VAS); pain-free rate at 1, 2, and 4 hours; use of escape medication; the proportion of patients with recurrence within 24 hours of initial treatment; and tolerability.Results: The intention-to-treat population comprised 334 patients (zolmitriptan [n = 174]; placebo [n = 160]). Patients treated 625 attacks with zolmitriptan and 529 attacks with placebo. Twice as many patients who took zolmitriptan achieved a 2-hour headache response compared with placebo recipients (65.7% vs 32.8%; P < .0001). Furthermore, a significantly higher headache response was observed with zolmitriptan than placebo at a...