Allodynia‐Associated Symptoms, Pain Intensity and Time to Treatment: Predicting Treatment Response in Acute Migraine Intervention

Cady, Roger; Freitag, Frederick G.; Mathew, Ninan T.; Elkind, Arthur H.; Mao, Ling‐Feng; Fisher, Alan C.; Biondi, David; Finlayson, Gary; Greenberg, Steven J.; Hulihan, Joseph

doi:10.1111/j.1526-4610.2009.01340.x

Cited by 28 publications

(28 citation statements)

References 35 publications

(73 reference statements)

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“…Instead, the presence of allodynia was based on at least 2 positive responses on a 6‐item questionnaire. This threshold level of response compares favorably to allodynia questionnaires used in other trials 10,11 . In addition, a minority of patients in the study had a substantial delay before migraine treatment that would be supportive of a diagnosis of established and maintained allodynia.…”

Section: Discussionmentioning

confidence: 60%

“…Recent studies with almotriptan 9 and rizatriptan 10 have raised questions regarding the necessity of treating patients with triptans prior to the development of allodynia, as no statistically significant differences in efficacy were observed in patients reporting allodynia and those reporting no allodynic symptoms 4,9,11 . However, patients in these studies may have been treated merely near the onset of allodynic symptoms rather than during well‐established allodynia, when sumatriptan was shown to be ineffective.…”

mentioning

confidence: 99%

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Efficacy and Safety of MAP0004, Orally Inhaled DHE in Treating Migraines With and Without Allodynia

et al. 2011

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Section: Discussionmentioning

confidence: 60%

mentioning

confidence: 99%

Efficacy and Safety of MAP0004, Orally Inhaled DHE in Treating Migraines With and Without Allodynia

et al. 2011

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“…Early administration of migraine therapies enhances efficacy [10,Class IV]. If treatment is not early at mild, then treat before severe headache pain, presence of photophobia/phonophobia, and presence of nausea [11,Class I].…”

Section: Treatmentmentioning

confidence: 99%

Symptomatic Treatment of Migraine: When to Use NSAIDs, Triptans, or Opiates

Taylor

Kaniecki

2010

Curr Treat Options Neurol

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Migraine is a biologic disorder of the brain characterized by a heterogeneous array of symptoms and episodes of disabling headache. By definition, such attacks last between 4 and 72 h without treatment, with the disability arising from a variety of factors including severe pain, gastrointestinal symptoms such as nausea or vomiting, and sensory sensitivities to light, noise, or odor. All these features may be exacerbated by stimulation, motion, or activity, often rendering the patient completely immobile. Although retreat and rest, coupled with local application of ice, may provide some measure of comfort, most of those with migraine hunt for therapeutic solutions. In designing acute headache treatment strategies, it is imperative for clinicians to recognize the variability between individuals in the frequency, intensity, and duration of attacks. Certain patients require more aggressive options. It is also crucial to identify the significant intra-individual variability of migraine; most patients describe an assortment of headaches of different intensities and time to disability. Less intense episodes, which patients often term sinus, tension, or regular headaches, usually represent milder versions of migraine, simplifying both diagnostic and therapeutic approaches. Evidence-based guidelines and clinical experience support the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the management of mild to moderate migraine attacks. Recommend migraine-specific agents (triptans and dihydroergotamine) when the attacks are more severe or have consistently failed to respond to the use of NSAIDs in the past. Encourage those with less frequent episodic migraine to use their acute agents at the earliest signs of headache. Advise those with frequent headache (>10 days per month) to limit acute treatments to only the most disabling episodes in order to avoid the "medication overuse" phenomenon. Consider rescue or back-up therapy. Do not use compounds containing butalbital or opiates (or place extreme limits on them), out of concern for progression to chronic migraine.

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“…Triptane können zu jedem Zeitpunkt innerhalb der Attacke wirken, das heißt, sie müssen nicht notwendigerweise unmittelbar zu Beginn der Schmerzphase eingenommen werden. Triptane wirken umso besser, je früher sie in einer Migräneattacke eingenommen werden (73)(74)(75)(76)(77)(78). Um der Entwicklung eines Kopfschmerzes durch Medikamentenübergebrauch vorzubeugen, sollte eine frühe Einnahme nur empfohlen werden, wenn die Attacken nicht zu häufig sind (< 10 Kopfschmerztage pro Monat) und wenn der Patient eindeutig seinen Kopfschmerz als Migräneattacke identifizieren kann.…”

Section: Empfehlungunclassified