The pathophysiology of migraine: implications for clinical management

Charles, Andrew

doi:10.1016/s1474-4422(17)30435-0

Cited by 435 publications

(381 citation statements)

References 95 publications

Supporting

Mentioning

313

Contrasting

Unclassified

Order By: Relevance

“…The headache characteristics of RCVS [38] are distinct from the primary headaches such as migraine [39] or cluster headache [40]. Although 20% of the patients with RCVS have pre-existing migraine [38], the cardiovascular or neurological comorbidities known to be associated with migraine [41–43] have not been well explored in patients with RCVS.…”

Section: Discussionmentioning

confidence: 99%

Vascular wall imaging in reversible cerebral vasoconstriction syndrome – a 3-T contrast-enhanced MRI study

Chen

Fuh

et al. 2018

J Headache Pain

View full text Add to dashboard Cite

BackgroundLimited histopathology studies have suggested that reversible cerebral vasoconstriction syndromes (RCVS) does not present with vascular wall inflammation. Previous vascular imaging studies have had inconsistent vascular wall enhancement findings in RCVS patients. The aim of this study was to determine whether absence of arterial wall pathology on imaging is a universal finding in patients with RCVS.MethodsWe recruited patients with RCVS from Taipei Veterans General Hospital prospectively from 2010 to 2012, with follow-up until 2017 (n = 48). We analyzed the characteristics of vascular wall enhancement in these patients without comparisons to a control group. All participants received vascular wall imaging by contrasted T1 fluid-attenuated inversion recovery with a 3-T magnetic resonance machine. The vascular wall enhancement was rated as marked, mild or absent.ResultsOf 48 patients with RCVS, 22 (45.8%) had vascular wall enhancement (5 marked and 17 mild). Demographics, clinical profiles, and cerebral artery flow velocities were similar across patients with versus without vascular wall enhancement, except that patients with vascular wall enhancement had fewer headache attacks than those without (p = 0.04). Follow-up imaging completed in 14 patients (median interval, 7 months) showed reduced enhancement in 9 patients, but persistent enhancement in 5.ConclusionAlmost half of our RCVS patients exhibited imaging enhancement of diseased vessels, and it was persistent for approximately a third of those patients with follow-up imaging. Both acute and persistent vascular wall enhancement may be unhelpful for differentiating RCVS from central nervous system vasculitis or subclinical atherosclerosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Vascular wall imaging in reversible cerebral vasoconstriction syndrome – a 3-T contrast-enhanced MRI study

Chen

Fuh

et al. 2018

J Headache Pain

View full text Add to dashboard Cite

show abstract

“…However, it has been suggested that dopamine receptor antagonists may reverse some of the symptoms that are experienced by patients in the premonitory phase of migraine and prevent the occurrence of subsequent headache . Concisely, a migraine attack can be divided into 4 phases of the premonitory, aura, headache, postdrome, and interictal . During the premonitory phase, complex interactions occur between various cortical and subcortical brain regions that can modify nociceptive signaling and trigger the migraine attack …”

Section: Discussionmentioning

confidence: 99%

“…In this regard, several drugs are available for acute treatment of migraine in the ED, including nonsteroidal antiinflammatory drugs (NSAIDs) such as ketorolac; 100% oxygen; opioids such as meperidine, tramadol, hydromorphone, and nalbuphine; triptans such as sumatriptan; anesthetics such as ketamine and lidocaine; dopamine receptor antagonists such as metoclopramide; phenothiazines such as prochlorperazine and chlorpromazine; and ergot alkaloids such as dihydroergotamine and ergotamine . Nevertheless, regarding the optimal therapy for aborting the acute migraine attack, there are significant practical differences among EDs …”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Prochlorperazine in Patients With Acute Migraine: A Systematic Review and Meta‐Analysis

et al. 2019

View full text Add to dashboard Cite

Objective The aim of this review was to evaluate the efficacy and safety of prochlorperazine (PCP) in patients with acute migraine headache in the emergency department (ED). Methods Electronic databases (Medline, Scopus, Web of Science, and Cochrane) were searched for randomized clinical trials that investigated the effect of PCP on headache relief. The outcomes were the number of patients without headache or with reduced headache severity, the number of adverse events, and the need for rescue analgesia. Results From 450 citations, 11 studies (n = 771) with 15 comparison arms met the inclusion criteria. Overall, PCP was more effective than placebo (OR = 7.23; 95% CI = 3.82‐3.68), metoclopramide (OR = 2.89; 95% CI = 1.42‐5.86), and other active comparators (OR = 3.70; 95% CI = 2.41‐5.67) for headache relief. The odds ratio of experiencing adverse events with PCP compared with placebo was 5.79 (95% CI = 2.43‐13.79). When PCP compared with other active comparators, no statistical difference was found regarding the overall number of adverse events (OR = 1.88; 95% CI = 0.99‐3.59). However, PCP significantly increased the odds of akathisia/dystonia (OR = 2.55; 95% CI = 1.03‐6.31). The request for rescue analgesia was significantly lower in the PCP group compared with other groups (16% vs 84%; OR = 0.16; 95% CI = 0.09‐27). Conclusions For adult patients with acute migraine, PCP could effectively abort the acute attack and reduce the request for rescue analgesia in the ED. However, compared with placebo, PCP could increase the risk of adverse events.

show abstract

“…45 Mini prophylaxis of MM is most effective in women with regular, predictable menstrual cycles, whose headaches occur on a consistent day in relation to flow. 94,95 It is important that physicians inform their patients that an initial worsening of their headaches, signifying withdrawal, can occur and last for several weeks. 11 Overuse of abortive headache treatments can lead to the chronification of migraine, which is associated with decreased response to both acute and preventive migraine treatments.…”

Section: Expert Opinionmentioning

confidence: 99%