Primary Headache Disorders Part I- Migraine and the Trigeminal Autonomic Cephalalgias

PurposePremonitory symptoms (PSs) of migraine are those that precede pain in a migraine attack. Previous studies suggest that treatment during this phase may prevent the onset of pain; however, this approach requires that patients be able to recognize their PSs. Our objectives were to evaluate patients’ actual ability to predict migraine attacks based on their PSs and analyze whether good predictors meet any characteristic profile.Patients and methodsThis prospective, observational study included patients with migraine with and without aura. Patients’ baseline characteristics were recorded. During a 2-month follow-up period, patients used a mobile application to record what they believed to be PSs and later to record the onset of pain, if this occurred. When a migraine attack ended, patients had to complete a form on the characteristics of the episode (including the presence of PSs not identified prior to the attack).ResultsFifty patients were initially selected. A final total of 34 patients were analyzed, recording 229 attacks. Of whom, 158 (69%) were accompanied by PSs and were recorded prior to the pain onset in 63 (27.5%) cases. A total of 67.6% of the patients were able to predict at least one attack, but only 35.3% were good predictors (>50% of attacks). There were only 11 cases in which a patient erroneously reported their PSs (positive predictive value: 85.1%). Good predictors were not differentiated by any specific clinical characteristic. However, a range of symptoms were particularly predictive; these included photophobia, drowsiness, yawning, increased thirst, and blurred vision.ConclusionA large majority of patients with migraine experienced a PS and were able to predict at least one attack. Besides, only a small percentage of patients were considered as good predictors; however, they could not be characterized by any specific profile. Nonetheless, when patients with migraine believed that they were experiencing PSs, they were frequently correct.

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“…This argument supports the need of targeting the patients in a direct manner, as previously described in Jay and Barkin. 27 …”

Section: Discussionmentioning

confidence: 99%

To what extent are patients with migraine able to predict attacks?

Gago-Veiga

Pagán

Henares

et al. 2018

JPR

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“…As a sodium channel blocker and local anesthetic, the proposed mechanism of lidocaine in this context is blockade of the sphenopalatine ganglion (SPG), a parasympathetic ganglion that lies behind a layer of mucosa in the posteromedial aspect of the nasal cavity . Activation of the SPG has been associated with triggering the cascade of cerebral and dural vasodilation, and consequent neurogenic inflammation and trigeminal nociception involved in primary headaches, as well as the autonomic features typical of cluster headaches (e.g., lacrimation, rhinorrhea, ptosis) . Thus, SPG blockade with intranasal lidocaine serves as a targeted strategy to mitigate these downstream effects and resultant headache features.…”

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confidence: 99%

Intranasal Lidocaine for Acute Management of Primary Headaches: A Systematic Review

Dagenais

Zed

2018

Pharmacotherapy

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Intranasal lidocaine has been studied and recommended as an alternative in the management of acute headache. The objective of this systematic review was to evaluate the efficacy and safety of intranasal lidocaine in the acute management of primary headaches. The MEDLINE (1946 to May 2018), EMBASE (1974 to May 2018), Cochrane Central Register of Controlled Trials (2008 to May 2018), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to May 2018), and ClincialTrials.gov online databases were searched. Studies conducted in patients with acute primary headache were included if lidocaine was compared with placebo or alternative treatments, lidocaine dosing was specified, and patients' pain before and after treatment were clearly reported. Six studies met the inclusion criteria. Intranasal lidocaine demonstrated potential benefit over placebo in acute pain reduction and need for rescue medication only in the four studies deemed to be of poor quality, not in the two fair-quality studies. No study reported benefit in preventing headache recurrence or repeat visits to the emergency department. Lidocaine was associated with significantly higher rates of adverse events compared with placebo and may result in lower rates of patient satisfaction. There is insufficient evidence to support the use of intranasal lidocaine in acute management of primary headaches. Further research is warranted to better elucidate whether intranasal lidocaine has a role in the management of specific primary headache subtypes and whether there is an optimal regimen.

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Headache

Rasool¹

2019

The Columbia Guide to Basic Elements of Eye Care

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Primary Headache Disorders Part I- Migraine and the Trigeminal Autonomic Cephalalgias

Cited by 8 publications

References 228 publications

To what extent are patients with migraine able to predict attacks?

To what extent are patients with migraine able to predict attacks?

Intranasal Lidocaine for Acute Management of Primary Headaches: A Systematic Review

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