bluuebunny/crossref_metadata_2025_split huggingface dataset:
Satisfaction With Current Migraine Therapy: Experience From 3 Centers in US and Sweden
Authors: Bigal Marcelo , Rapoport Alan , Aurora Sheena , Sheftell Fred , Tepper Stewart , Dahlof Carl 
Published: August 2010

Objective.—To assess the level of satisfaction and determinants of satisfaction or dissatisfaction of patients presenting in tertiary care, in regard to their usual care (UC) for the acute treatment of migraine.Design/Methods.—Patients seen in 3 headache centers were assessed by means of 21 attributes related to their UC. Questions covered satisfaction with efficacy (including onset of relief, degree of relief, consistency of action, ease of use), tolerability (lack of side effects overall, CNS side effects, other side effects), and willingness to continue using the same medication and to change to another medication. All questions were answered on a 5‐point scale (where 1 was strongly agree, 2 was agree, 3 was neutral, 4 was disagree, and 5 was strongly disagree).Results.—We assessed 183 subjects (74.8% women, mean age = 39.3 years). UC consisted, as a single drug or combination, of: triptan conventional tablets – 62%; triptan disintegrating tablets – 8%; sumatriptan nasal spray 9%; sumatriptan injection, 9%; nontriptans – 19.6%. Most (54%) had no benefit within the first hour of treatment. The maximum benefit took more than 1 hour to be reached in 69%, and more than 2 hours in 36%. After the maximum benefit had been reached, pain worsened in 61%. Although 58% were satisfied with the degree of relief, 37% were dissatisfied with the speed of effect, 50% with the recurrence of pain, and 42% with the need for a second dose. Most were satisfied with the tolerability (56%). Finally, most (79.7%) said they were willing to try another acute medication.Conclusions.—An important subset of patients, including a large subgroup of patients using triptans, is dissatisfied with their UC. Clinical trials assessing patients' preference should be conducted to complement the information from clinical trials.
Patient‐Centered Outcomes for Frequent Headaches
Authors: Coeytaux Remy R. , Frasier Pamela Y. , Reid Alfred 
Published: August 2010

Objective.—To identify clinical outcomes that headache sufferers consider meaningful.Background.—Several standardized instruments have been developed to assess the severity of headaches and the impact of headaches on an individual's quality of life. To our knowledge, however, little research has been conducted to determine which of these many clinical endpoints are considered by headache sufferers themselves to be most important.Methods.—We conducted 4 focus groups with patients with frequent headaches who had recently participated in a randomized clinical trial. Subjects were informed that the purpose of the focus groups was to help healthcare providers learn how to better recognize if their patients' headache conditions improved or worsened over time.Results.—Five salient topics emerged from the discussions: (1) severity of pain associated with headaches; (2) definition of meaningful symptom relief; (3) uncertainty regarding timing and severity of headaches; (4) devaluation of the impact of headaches on sufferers; and (5) assessments of pain. Participants stated unambiguously that headache pain is one of the most important aspects of their headache experience. Each of the 4 groups agreed that an increase in the number of pain‐free days would be meaningful. Participants also reported that daily headache diaries are not overly burdensome to complete and that the diaries helped them identify useful trends over time.Conclusions.—Our findings suggest that severity and frequency of headache pain are important clinical outcomes from patients' perspective, and that headache diaries are a feasible and useful method of assessing meaningful clinical change over time. Although standardized questionnaires that assess functional status, disability, or health‐related quality of life may help quantify patients' response to treatment for frequent headaches, participants in this study did not consider such questionnaires particularly informative. Further research is needed to validate headache diaries among patients with headache in the primary care setting.
Topiramate in Migraine Prophylaxis: Long‐Term Impact on Resource Utilization and Cost
Authors: Silberstein Stephen D. , Feliu Anthony L. , Rupnow Marcia F.T. , Blount Angela C. , Boccuzzi Stephen J. 
Published: August 2010

Objective.—To evaluate the medical resource utilization and overall cost of care among patients treated with topiramate (TPM) for migraine prevention in a commercially insured population.Background.—Preventive migraine therapy with TPM significantly reduces the frequency of migraine attacks. Limited data exist on the real‐world health care consumption associated with TPM therapy for migraine prevention.Methods.—Data were obtained from a large geographically diverse integrated medical and pharmacy claims database representative of the commercially insured population. The date of the first TPM claim between July 2000 and December 2003 was considered the index date. Patients needed at least 1 triptan prescription (Rx) claim during the 6‐month preindex period, and ≥2 TPM Rx claims in the 12 months following index TPM Rx to be included in the analysis. Headache‐related inpatient and outpatient resource use were compared: preindex vs postindex period 1 (months 1‐6) and preindex vs postindex period 2 (months 7‐12). Subgroup analyses were conducted based on the triptan consumption during the 6‐month preindex period: Cohort L (low triptan users) with ≤36 triptan doses, and Cohort H (high triptan users) with >36 triptan doses.Results.—The sample included 2645 plan members (1778 patients in Cohort L, and 867 patients in Cohort H). TPM utilization was associated with significantly less triptan utilization in the first (34.8 quantity dispensed; 7.5% decrease) and second (30.2; 19.6% decrease) follow‐up periods compared to the preindex period (37.6; both P < .0001). In postindex period 1, there was a 46% decrease in emergency department (ED) visits, 39% decrease in diagnostic procedures (eg, CT scans and MRIs), and a 33% decrease in hospital admission; physician office visits were unchanged. In postindex period 2, there was a 46% decrease in ED visits, 72% decrease in diagnostic procedures, 61% decrease in hospital admissions, and a 35% decrease in physician office visits. Decreases in resource use were observed in both cohorts L and H. Mean ± SD total headache‐related cost was $2118 ±$3406 per patient in the preperiod, versus $2450 ±$3318 in follow‐up period 1 and $2009 ±$3136 in follow‐up period 2.Conclusion.—In this sample of patients from a diverse set of health plans receiving TPM, significant decreases in resource use were observed within 6 months of TPM initiation, and this trend continued in follow‐up period 2. Although there was an initial increase in total headache‐related cost upon introduction of TPM (follow‐up period 1), the cost in follow‐up period 2 was lower than in the preindex period, suggesting that benefits of long‐term treatment with TPM can be achieved without increasing total cost.
Migraine and the Risk of Stroke, TIA, or Death in the UK (CME)
Authors: Becker Claudia , Brobert Gunnar P. , Almqvist Per M. , Johansson Saga , Jick Susan S. , Meier Christoph R. 
Published: August 2010

Background.— Previous observational studies have reported a higher risk of stroke in migraine patients.Objective.— We aimed to estimate the risk of stroke, transient ischemic attack (TIA), or death in migraineurs in the UK.Method.— We conducted a population‐based follow‐up study within the General Practice Research Database from 1994 to 2001.Results.— The relative risk (RR) of stroke in migraineurs compared with non‐migraineurs was 2.2 (95% confidence interval [CI] 1.7‐2.9). It was highest for patients with a migraine diagnosis recorded within 30 days prior to a stroke (odds ratio 11.1, 95% CI 5.69‐21.5). The RR of TIA in migraineurs compared with non‐migraineurs was 2.4 (95% CI 1.8‐3.3), the mortality of migraineurs was slightly decreased.Conclusion.— In our study, the RR of developing a stroke or a TIA was doubled in migraineurs as compared with non‐migraineurs, while that for death was close to unity.
Prevalence of Vertigo, Dizziness, and Migrainous Vertigo in Patients With Migraine
Authors: Vuković Vlasta , Plavec Davor , Galinović Ivana , Lovrenčić‐Huzjan Arijana , Budišić Mislav , Demarin Vida 
Published: August 2010

Objective.— The aim of this study was to determine the lifetime prevalence of vertigo and dizziness in patients with migraine as compared with controls and to establish the lifetime prevalence of migrainous vertigo.Background.— Dizziness and vertigo are relatively frequent complaints in general population; however, the prevalence of migrainous vertigo has not been extensively studied so far.Methods.— The study included 327 migraine patients and 324 controls who do not suffer from frequent headaches. The study and control group were assessed clinically and through diagnostic workup for having vertigo, dizziness, hypotension, and sideropenic anemia.Results.— Vertigo or dizziness was experienced by 51.7% of migraine patients (MVL group) and 31.5% in the control group (CVL group), P < .0001. Among the MVL group, 23.2% of patients met the criteria for migrainous vertigo. There was no difference between the MVL group and CVL group in frequency of attacks or the pattern of symptom appearance in relation to head movement. Patients in the MVL group more frequently had hypotension, P = .011. Patients with migraine with aura significantly more often had migraine attacks in association with vertigo or dizziness, P < .0001.Conclusion.— The lifetime prevalence of migrainous vertigo is relatively frequent in migraine patients, especially in migraine with aura.
Botulinum Toxin Type A and Divalproex Sodium for Prophylactic Treatment of Episodic or Chronic Migraine
Authors: Blumenfeld Andrew M. , Schim Jack D. , Chippendale Thomas J. 
Published: August 2010

Objective.— To compare the efficacy and safety of botulinum toxin type A (BoNTA; BOTOX®: Allergan, Inc.) and divalproex sodium (DVPX; DEPAKOTE®: Abbott Laboratories) as prophylaxis in reducing disability and impact associated with migraine.Background.— There is a need for effective, well‐tolerated prophylactic treatment of migraine.Design/Methods.— This was a randomized, double‐blind, single‐center prospective study. Fifty‐nine patients received either BoNTA 100 U/placebo‐DVPX bid or placebo‐BoNTA/DVPX 250 mg bid. BoNTA/placebo injections were given at Day 0 and at Month 3. Patients were evaluated at Months 1, 3, 6, and 9.Results.— Both treatments showed significant improvements in migraine disability scores and reductions in headache days and headache index. A trend to decreased headache severity was observed with BoNTA. A greater percentage of DVPX patients reported adverse events possibly related to treatment (DVPX 75.8% vs BoNTA 50%, P = .04) and discontinued because of adverse events (DVPX 27.6% vs BoNTA 3.3%, P = .012).Conclusions.— Both BoNTA and DVPX significantly reduced disability associated with migraine; BoNTA had a favorable tolerability profile compared with DVPX.
Heart Rate Recovery in Migraine and Tension‐Type Headache
Authors: Yerdelen Deniz , Acil Tayfun , Goksel Basak , Karatas Mehmet 
Published: August 2010

Objective.— There are reports proposing that migraine and tension‐type headache (TTH) may affect the autonomic nervous system (ANS). Abnormalities in both sympathetic and parasympathetic nervous system have been suggested in migraineurs. However, in TTH, reports on the ANS function are limited and only associated with sympathetic system. Techniques for evaluating parasympathetic activity are more limited when compared with sympathetic function. Hence, the aim of the study was to measure heart rate recovery (HRR), an index of vagal activity, in migraine, TTH, and control subjects.Methods.— Forty‐seven episodic migraine, 10 episodic TTH, 11 chronic TTH, and 25 control subjects underwent exercise tolerance test according to modified Bruce protocol, and HRR at 1 minute and 3 minutes (HRR1 and HRR3) were calculated.Results.— The HRR 1 and 3 were found to be similar in 3 groups of subjects. However, resting heart rate of migraine and chronic TTH were found to be higher than episodic TTH, but not different from the control group.Consclusion.— These results suggest that parasympathetic function has not been affected in migraine and TTH patients. However, sympathetic tonus, which is evaluated by resting heart rate, is higher in migraine and chronic TTH than in episodic TTH.
Meta‐Analysis of the Efficacy and Safety of Zolmitriptan in the Acute Treatment of Migraine
Authors: Chen Li‐Chia , Ashcroft Darren M. 
Published: August 2010

Objective.— To assess the relative efficacy and safety of zolmitriptan in the treatment of acute migraine attacks.Background.— Zolmitriptan is a second‐generation triptan developed for the treatment of migraine. Numerous randomized controlled trials (RCTs) have been carried out to compare different dosages and formulations of zolmitriptan against other treatments for acute migraine.Methods.— Random effects meta‐analysis of 24 RCTs, including 15,408 patients suffering from acute migraine attacks. Subgroup analyses compared differences in response between different dosages and formulations of zolmitriptan, and other triptan comparators.Results.— Zolmitriptan 2.5 mg tablet was found to be as effective as almotriptan 12.5 mg, eletriptan 40 mg, sumatriptan 50 mg and 100 mg and more effective than naratriptan 2.5 mg in terms of 2‐hour pain‐free rates. Likewise, zolmitriptan 5 mg tablet was as effective as sumatriptan 50 mg and 100 mg in 2‐hour pain‐free rates. Compared against zolmitriptan 2.5 mg tablet, eletriptan 80 mg was more effective in achieving headache relief, pain‐free and sustained pain‐free responses, and rizatriptan 10 mg was more effective in terms of sustained pain‐free rates. Zolmitriptan 2.5 mg tablet was associated with a lower risk of adverse events than eletriptan 80 mg but higher risk than naratriptan 2.5 mg and rizatriptan 10 mg. Zolmitriptan 5 mg tablet was superior to zolmitriptan 2.5 mg tablet in achieving 1‐ and 2‐hour pain‐free response. There were no significant differences in 1‐ and 2‐hour headache relief and adverse event rates between the different formulations of zolmitriptan 2.5 mg.Conclusions.— Zolmitriptan 2.5 mg tablet is an effective treatment for acute attacks of migraine showing similar efficacy to almotriptan 12.5 mg, eletriptan 40 mg, and sumatriptan 50 mg, and being more effective than naratriptan 2.5 mg in terms of pain‐free response at 2 hours post dose. Zolmitriptan 2.5 mg tablet was also as effective as rizatriptan 10 mg in terms of headache relief and pain‐free response but less effective in terms of sustained pain‐free response.
A Migraine Prophylaxis Educational Intervention in a Medicaid Population
Authors: Owens Christopher , Pugmire Brooke , Owens Kimball 
Published: August 2010

Objectives.— To assess migraine prophylactic drug utilization in the Idaho Medicaid population and to evaluate responsiveness of practitioners to an educational intervention from the Idaho Medicaid Drug Utilization Review (DUR) Program.Background.— While established guidelines recommend migraine prophylactic therapies for defined patient populations and several drugs have demonstrated efficacy, their actual utilization is reportedly low.Methods.— Profiles for Idaho Medicaid patients were reviewed retrospectively to identify candidates for migraine prophylactic therapy based on excessive triptan utilization. Use of a prophylactic agent was then characterized for these patients, and an educational mailing was sent to practitioners directly involved in the care of patients who did not appear to be using prophylaxis. Patient profiles were again assessed 6 months following the mailing to determine if a trial of a prophylactic drug had been attempted.Results.— A total of 1909 patients were identified as having at least one claim for a triptan drug in the year studied. Of these patients, 360 appeared to be candidates for prophylaxis, but 154 had no record of prophylactic drug use. In the 6 months following the intervention mailing, 27 of the 91 non‐prophylaxis patients (30%) who were still active clients of Idaho Medicaid and who had seen their physician during that time, appeared to have been given a trial of a migraine prophylactic drug.Conclusions.— Following an educational intervention for Idaho Medicaid patients identified through retrospective DUR, a trial of a migraine prophylactic drug was initiated for approximately one‐third of potential candidates.
The Antidepressant and Antiinflammatory Effects of Rolipram in the Central Nervous System
Authors: Zhu Jie , Mix Eilhard , Winblad Bengt 
Published: August 2010

ABSTRACTRolipram is a selective inhibitor of phosphodiesterases (PDE) IV, especially of the subtype PDE IVB. These phosphodiesterases are responsible for hydrolysis of the cyclic nucleotides cAMP and cGMP, particularly in nerve and immune cells. Consequences of rolipram‐induced elevation of intracellular cAMP are increased synthesis and release of norepinephrine, which enhance central noradrenergic transmission, and suppress expression of proinflammatory cytokines and other mediators of inflammation. In humans and animals rolipram produces thereby a variety of biological effects. These effects include attenuation of endogenous depression and inflammation in the central nervous system (CNS), both effects are of potential clinical relevance. There are some discrepancies betweenin vitroandin vivoeffects of rolipram, as well as between results obtained in animal models and clinical studies. The clinical use of rolipram is limited because of its behavioral and other side effects. Newly developed selective PDE IV inhibitors with presumably higher potency and lower toxicity are currently under investigation.
Recent Developments in the Discovery of Novel Adenosine Kinase Inhibitors: Mechanism of Action and Therapeutic Potential
Authors: McGaraughty Steve , Cowart Marlon , Jarvis Michael F. 
Published: August 2010

ABSTRACTAdenosine (ADO) is an endogenous inhibitory neuromodulator that limits cellular excitability in response to tissue trauma and inflammation. Adenosine kinase (AK; EC 2.7.1.20) is the primary metabolic enzyme regulating intra‐ and extracellular concentrations of ADO. AK inhibitors have been shown to significantly increase ADO concentrations at sites of tissue injury and to provide effective antinociceptive, antiinflammatory, and anticonvulsant activity in animal models. Structurally novel nucleoside and non‐nucleoside AK inhibitors that demonstrate high specificity for the AK enzyme compared with other ADO metabolic enzymes, transporters, and receptors have recently been synthesized. These compounds have also demonstrated improved cellular and tissue penetration compared with earlier tubercidin analogs. These compounds have been shown to exert beneficial effects in animal models of pain, inflammation and epilepsy with reduced cardiovascular side effects compared with direct acting ADO receptor (P1) agonists, thus supporting the hypothesis that AK inhibitors can enhance the actions of ADO in a site‐and event‐specific fashion.
Ensaculin (KA‐672. HCl): A Multitransmitter Approach to Dementia Treatment
Authors: Hoerr Robert , Noeldner Michael 
Published: August 2010

ABSTRACTEnsaculin, a novel benzopyranone substituted with a piperazine moiety, showed memory‐enhancing effects in paradigms of passive and conditioned avoidance in both normal and artificially amnesic rodents. It exhibited neuroprotective activities in an NMDA toxicity model and neurotrophic effects in primary cultured rat brain cells. The compound could be characterized as a weak NMDA receptor–operated channel blocker. In receptor‐binding studies, ensaculin was found to have high affinities to serotonergic 5‐HT1Aand 5‐HT7receptors, adrenergic α1, and dopaminergic D2and D3receptors. Due to its unique pharmacodynamic profile, ensaculin may have potential as an antidementia agent acting on various transmitter systems.
The 19th Annual National Neurotrauma Society Symposium, A Satellite to 31st Annual Meeting of the Society for Neuroscience San Diego Marriott Hotel and Marina, San Diego, CA November 9–10, 2001
Authors: Scriabine Alexander 
Published: August 2010

The 19th Annual National Neurotrauma Symposium was held as a satellite meeting to the 31st Annual Meeting of the Society for Neuroscience in San Diego, CA on November 9 and 10, 2001. The symposium consisted of 18 lectures, each of 25 min duration, 10 short open communications, and 255 posters. Over 400 scientists and students participated. The symposium was sponsored by the Medical College of Virginia. It was supported financially by the National Institute of Neurological Disorders and Stroke, National Institute for Child Health & Human Development, Acorda Therapeutics, DuPont Pharmaceutical Co., Guilford Pharmaceuticals, Pfizer, Kent Waldrep National Paralysis Foundation and The Ameritec Foundation. The abstracts from this symposium were published in the J. of Neurotrauma, Vol. 18, No. 10, 2001.This report covers oral and poster presentations, which dealt with the new therapeutic approaches to head and spinal cord trauma, with potential targets for new drugs and with new methods for evaluation of potential drugs for the treatment of neurotrauma.
Selective Estrogen Receptor Modulators: Tissue Actions and Potential for CNS Protection
Authors: Littleton‐Kearney M. T. , Ostrowski N. L. , Cox D. A. , Rossberg M. I. , Hurn P. D. 
Published: August 2010

ABSTRACTSignificant physiologic changes occur during menopause. Evidence exists to suggest that estrogen may be neuroprotective under specific conditions. However, there are limitations in the neuroprotection afforded by standard hormone therapy. Accordingly, alternative agents with selected estrogenic effects may hold even greater promise rather than conventional hormone replacement therapy for the prevention and treatment of CNS injury. Recently, a variety of selective estrogen receptor modulators (SERMs) have been developed to retain the favorable and minimize the adverse side effects of estrogens. This review focuses on the CNS and known neuroprotective effects of two specific SERMs, raloxifene and arzoxifene. Recent studies hint that raloxifene and arzoxifene are neuroprotective and may preserve some elements of cognitive function. However, the mechanism of action is not well described and it is unclear if the beneficial effects of SERMs rely on activation of estrogen receptors.
Valproate: Past, Present, and Future
Authors: Johannessen Cecilie U. , Johannessen Svein I. 
Published: August 2010

ABSTRACTPreclinical studies have been carried out during the past four decades to investigate the different mechanisms of action of valproate (VPA). The mechanisms of VPA which seem to be of clinical importance include increased GABAergic activity, reduction in excitatory neurotransmission, and modification of monoamines. These mechanisms are discussed in relation to the various clinical uses of the drug. VPA is widely used as an antiepileptic drug with a broad spectrum of activity. In patients, VPA possesses efficacy in the treatment of various epileptic seizures such as absence, myoclonic, and generalized tonic‐clonic seizures. It is also effective in the treatment of partial seizures with or without secondary generalization and acutely instatus epilepticus.The pharmacokinetic aspects of VPA and the frequent drug interactions between VPA and other drugs are discussed. The available methods for the determination of VPA in body fluids are briefly evaluated.At present, investigations and clinical trials are carried out and evaluated to explore the new indications for VPA in other conditions such as in psychiatric disorders, migraine and neuropathic pain. Furthermore, the toxicity of VPA, both regarding commonly occurring side effects and potential idiosyncratic reactions are described. Derivatives of VPA with improved efficacy and tolerability are in development.