Observations of the “carry–over effect” following successful termination of chronic migraine in the adolescent with short–term dihydroergotamine, dexamethasone and hydroxyzine: a pilot study

Abstract

IntroductionDaily oral preventive therapies for frequent and/or disabling migraine attacks are fraught with possible adverse effects and drug-drug interactions. Curative therapy is non-existent.Sensitisation of peripheral and central nociceptors are common mechanisms contributing to the development of chronic pain and, along with other morphological changes J Headache Pain (2005) 6:51-54 DOI 10.1007 Observations of the "carry-over effect" following successful termination of chronic migraine in the adolescent with short-term dihydroergotamine, dexamethasone and hydroxyzine: a pilot study Abstract Chronic migraine management almost always requires daily oral preventative medication with potential adverse effects. Daily oral preventative therapy may also not be effective in terminating chronic migraine. Chronic central sensitisation caused by repetitive migraine attacks in a young person may lower the threshold for future migraine episodes leading to an intractable and debilitating disease course. The objective was to determine if short-term parenteral dihydroergotamine, dexamethasone and hydroxyzine can terminate chronic migraine and be followed by a continuous respite or conversion to a more benign episodic form without the need for daily oral preventative medication ("carry-over effect"). We treated ten patients, seven adolescents and three adults, with parenteral dihydroergotamine, dexamethasone and hydroxyzine given once a week for a maximum of three weeks. No oral preventative daily medication was administered. The setting was a private practice. Chronic migraine was terminated in all 7 adolescents. Their post-treatment course was converted to a more benign episodic migraine course and no adolescent required daily oral migraine preventative therapy for significantly long carry-over post-treatment observational periods. None of the three adult chronic migraine cases could be terminated satisfactorily as they all required daily oral preventative therapy. In the adolescent group only, this strategy terminated chronic migraine and resulted in a significant carry-over effect that appeared to favourably modify the long-term course without the need for daily pharmacological, potentially toxic, preventive therapy. Although this is a very small study, which requires confirmation by a larger controlled study, our data suggest a significant carryover effect in the young migraineur by administering short-term parenteral dihydroergotamine, dexamethasone and hydroxyzine.

Does the Addition of Dexamethasone to Standard Therapy for Acute Migraine Headache Decrease the Incidence of Recurrent Headache for Patients Treated in the Emergency Department? A Meta‐analysis and Systematic Review of the Literature

“…11,12,[14][15][16][17][18] In 1986, Gallagher 20 published the first clinical trial with a control arm that supported the use of dexamethasone in the ED. In this trial of 130 patients, those receiving adjunctive dexamethasone therapy had a significantly lower rate of moderate or severe headache at 24 hours compared to the control group (28% vs. 71%, p < 0.05).…”

“…9,10 Uncontrolled clinical trials have shown that, in both the inpatient setting and the outpatient clinic setting, dexamethasone is highly effective in reducing the severity of migraine headache and the rate of headache recurrence. [11][12][13][14][15][16][17][18][19] Although initial controlled clinical trials demonstrated the same high-level of efficacy, [20][21][22][23][24][25][26] the results of several recent ED-based trials have questioned the utility of dexamethasone for this purpose. [27][28][29][30][31][32][33][34][35][36][37][38][39][40] The goals of this systematic review were to critically appraise the existing literature and to provide recommendations for patient care regarding the use of dexamethasone for the prevention of headache relapse in patients with acute migraine headache in the ED.…”

Chronic Daily Headache in Children and Adolescents: A Multi-Faceted Syndrome

“…Chronic migraine remitted in seven adolescents given dihydroergotamine, dexamethasone and hydroxyzine parenterally once a week for three weeks. 97 We are unaware of evidence for the benefit of oral cyproheptadine, flunarizine, propanolol or riboflavin but these were considered effective in one clinic based study. 10 Riboflavin and Coenzyme Q10, singly or in combination, are worthy of trial because they are innocuous.…”

Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections- A quasi-randomized controlled crossover study

“…Physiological effects of clowning were shown in a randomized control study reporting increased conception following in vitro fertilization procedures with clown-care [ 30 ]. The altered pain memory had a carry-over effect to other procedures similar to other pain treatments; effective pain medication alleviates pain in subsequent episodes [ 31 , 32 ]. However, if the procedure was experienced as traumatic, clowning could not alter this.…”