bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Consultation for Migraine: Results From the American Migraine Study
Authors: Lipton Richard B. , Stewart Walter F. , Simon David 
Published: June 2003

Background.—Migraine headaches are often disabling but usually responsive to treatment. Nonetheless, many people with migraine never consult a doctor for headaches. In a sample of the US population, we sought to determine the proportion of active migaineurs who ever consulted a doctor for headache and to identify the headache characteristics and sociodemographic factors associated with consulting.Method.—A mailed questionnaire survey was sent to 15 000 US households, selected from a panel to be representative of the US population. Of 20 468 eligible respondents ranging in age from 12 to 80 years, 2479 met a case definition for migraine. We mailed a second questionnaire to all migraineurs identified on the first survey and achieved a 69.4% response rate. The second survey assessed headache characteristics, patterns of medical care use, medication use, and method of payment for health care.Results.—Sixty‐eight percent of female and 57% of male migraineurs reported having ever consulted a doctor for headache. Consultation was more likely with increasing age and in women who ever married. In females, several headache characteristics including pain intensity, number of migraine symptoms, attack duration, and disability were associated with consultation. Of those who never consult, 61% report severe or very severe pain and 67% report severe disability or the need for bed rest with their headaches.Conclusion.—The results of this survey indicate that a significant proportion of migraine sufferers never consult doctors for their headaches. Given that a large proportion of persons who never consult report high levels of pain and disability, these data suggest that there are opportunities to appropriately increase health care utilization for migraine. Given that 40% of migraineurs who have ever consulted do not report a physician diagnosis of migraine, there is a need to improve headache diagnosis and/or doctor‐patient communication about migraine.
Headache and Analgesic Use in Sweden
Authors: Antonov Karolina , Isacson Dag 
Published: June 2003

In this study, patterns of analgesic use among persons with headache in the general Swedish population were analyzed in association with health factors, health care utilization, sociodemographic factors, and life‐style.Data from the Swedish Survey of Living Conditions for the 2‐year period 1988 through 1989 were used. In this survey, a probability sample of the Swedish population aged 16 years and older was interviewed. Persons with headache were identified by the question, “Have you (during the last 2 weeks) had recurrent headache or migraine?” Analgesic use was defined by the question, “Have you (during the last 2 weeks) used prescription or nonprescription analgesics?” Persons who answered both these questions were included in the present study, yielding a study population of 11 975 persons.Sixteen percent of all women and 8.2 percent of all men reported headache. Seventy‐four percent of all women with headache reported analgesic use as compared to 64% of all men with headache. Analgesic use increased with increasing age among women but not men. While few of the studied factors were associated with analgesic use among persons with headache, the associations found differed by gender. Poor social network and musculoskeletal pain were associated with analgesic use among men with headache; age, being underweight, and visits to a physiotherapist were associated with analgesic use among women with headache.Those studying medication use among persons with headache might consider including these factors in future studies to help better understand the mechanisms behind the decision to use or avoid analgesics.
Acute Treatment of Periodic Severe Headache: Comparison of Three Outpatient Care Facilities
Authors: Linbo L. , Bartleson J.D. , Morgan‐Thompson D. , Greff L. , Naessens J.M. 
Published: June 2003

We compared treatment of patients with episodic, severe, migraine‐vascular headaches in three outpatient settings associated with a major medical center: the Charlton Outpatient Therapy Center (COTC), a dedicated transfusion and injection facility which provides treatment based on physician orders written in advance of the patient's visit; a walk‐in Urgent Care Center (UCC); and a traditional hospital emergency trauma unit (ETU).For a 7‐month period in 1995, all patient visits for acute migraine headache to the COTC, UCC, and ETU were reviewed. Data collected included the treatment and charges. After the study period, a sample of patients was surveyed regarding their outcome and satisfaction with care at each of the three facilities.During the study period, 15 patients visited the COTC 446 times for the treatment of acute migraine, 80 patients visited the UCC 233 times, and 182 patients visited the ETU 238 times. The average charges per visit were $39.93 for the COTC, $57.28 for the UCC, and $317.71 for the ETU. Average time spent in order to obtain care was 35 minutes in the COTC, 62 minutes in the UCC, and 105 minutes in the ETU. Intramuscular meperidine with either promethazine or hydroxyzine was the most commonly administered treatment in all three settings. Patients treated in the COTC reported greater satisfaction than the patients seen in the UCC or ETU.A dedicated outpatient facility with extended hours of operation and the capability of treating acute headache patients with parenteral medications based on standing orders has provided a community of migraine sufferers with cost‐effective care.
The Long‐term Tolerability and Efficacy of Oral Zolmitriptan (Zomig, 31X90) in the Acute Treatment of Migraine. An International Study
Authors: Cady Roger K. ,   The International 311C90 Long‐term Study Group
Published: June 2003

This international open‐label study evaluated the tolerability and efficacy of zolmitriptan (Zomig®, 311C90), a selective 5‐HT1B/1D receptor agonist in the long‐term treatment of multiple migraine attacks. Patients who had previously participated in placebo‐controlled zolmitriptan studies were recruited. A total of 2058 patients treated 31 579 migraine attacks (average 15 per patient), for up to 1 year. Twenty‐six percent of attacks treated with a single zolmitriptan 5‐mg dose were associated with at least one adverse event (24% treated with two doses). The most frequent adverse events induded asthenia (14% of patients), nausea (12%), somnolence (10%), dizziness (11%), and paresthesia (11%). The rank order of the most common adverse events was not influenced by sex, age, or number of zolmitriptan doses taken and was similar between attacks 1 and 45. The majority of adverse events (59%) occurred within 2 hours of dosing, were of either mild (59%) or moderate (35%) intensity, of 4 hours' duration or less (67%), and required no further action (94%).Following an initial 5‐mg dose of zolmitriptan, the 2‐hour headache response rate (reduction in headache pain from moderate or severe before treatment to mild or no pain at 2 hours posttreatment) was 81% in patients treating moderate and severe attacks (19 639 of 24 161). Patients were pain‐free at 2 hours in 55% of all attacks (16 510 of 29 808). The efficacy of zolmitriptan was not influenced by age, sex, weight, use of prophylactic antimigraine medication, or association of attacks with menstruation. Analysis of the overall population and a subgroup who treated 30 or more migraine attacks showed that zolmitriptan was consistently effective across attacks. Overall, 67% of patients who treated five or more attacks reported zolmitriptan to be effective in 80% to 100% of attacks. Zolmitriptan produced meaningful migraine relief and improvement in normal activity impairment in 73% and 78% of moderate and severe attacks, respectively. Patients treated recurrence of moderate or severe headache with a second zolmitriptan dose in 32% of attacks which responded to the first dose within 2 hours. Where required, a second zolmitriptan 5‐mg dose for treatment of recurrence produced a headache response rate of 90% at 2 hours postdose. Thus, zolmitriptan 5 mg (plus an optional second 5‐mg dose for treatment of recurrence) is well tolerated and effective in the acute treatment of multiple migraine attacks over periods up to 1 year.
Presentation of Chronic Daily Headache: A Clinical Study
Authors: Spierings Egilius L.H. , Schroevers Maya , Honkoop Peter C. , Sorbi Marjolijn 
Published: June 2003

We studied the presentation of chronic daily headache in 258 patients from a private headache practice, 50 men and 208 women. Chronic daily headache was defined as headaches, occurring at least 5 days per week for at least 1 year.Seventy‐seven percent of the patients experienced the onset of headache before the age of 30. The daily headaches were present on awakening in the morning or came about in the course of the morning in 79% of the patients. In 53%, they were worst in the afternoon or evening. The headaches awoke the patients at night at least once per week in 36%. At least twice per week, they were associated with nausea in 35% of the patients and with vomiting in 9%. Common aggravating factors included light, physical activity, bending over, noise, stress or tension, and menstruation. Ninety‐four percent of the patients experienced severe headaches in addition to the daily headaches. In 63%, the severe headaches occurred 10 days per month or less. The daily caffeine intake of the patients averaged 170 mg, and the daily analgesic intake, 1860 mg of aspirin equivalents.
Chronic Paroxysmal Hemicrania and Hemicrania Continua: Lack of Efficacy of Sumatriptan
Authors: Antonaci Fabio , Pareja Juan A. , Caminero Ana B. , Sjaastad Ottar 
Published: June 2003

Attacks of chronic paroxysmal hemicrania are prevented by the continuous administration of indomethacin. Sumatriptan, an agonist of 5‐HT1‐like receptors, has proven effective in the treatment of cluster headache attacks. There are clear clinical similarities between chronic paroxysmal hemicrania and cluster headache. A natural consequence of these considerations would be to establish whether chronic paroxysmal hemicrania also responds similarly to sumatriptan. Since hemicrania continua is another unilateral headache responsive to indomethacin, it would be meaningful to also include hemicrania continua in such a study. Sumatriptan, 6 mg subcutaneous, was tried in an open fashion in 7 patients (6 women and 1 man) with chronic paroxysmal hemicrania and 7 patients (5 women and 2 men) with hemicrania continua. In chronic paroxysmal hemicrania, the mean interval between the last three attacks prior to sumatriptan treatment (40 ± 23 minutes) was not statistically different from the mean interval between the three attacks subsequent to sumatriptan treatment of an attack (32 ± 20 minutes). In none of the patients did the mean duration of the “test attack” decrease as compared to the attacks antedating the test attach (25 ± 11 minutes and 19 ± 9 minutes, respectively) (P=0.027, Wilcoxon). In 2 patients with chronic paroxysmal hemicrania, placebo (saline) administration did not lead to any change in the interval between attacks.There was a mild, but statistically significant reduction in visual analog scale values for headache intensity in hemicrania continua (P=0.04, Wilcoxon). There was no clear, ie, clinically meaningful, reduction in visual analog scale values in any particular patient with hemicrania continua. Taken together, these results seem to show that sumatriptan is of no benefit in chronic paroxysmal hemicrania, but may have a partial efficacy in hemicrania continua. However, the latter effect is clinically unimportant This minor difference in regard to the clinical effect may, nevertheless, be of some interest pathogenetically, indicating minor differences between the two headaches. The lack of sumatriptan effect in chronic paroxysmal hemicrania clearly and markedly strengthens the nonalignment concept in regard to chronic paroxysmal hemicrania and cluster headache.
Tolfenamic Acid Rapid Release Versus Sumatriptan in the Acute Treatment of Migraine: Comparable Effect in a Double‐Blind, Randomized, Controlled, Parallel‐Group Study
Authors: Myllylä Vilho V. , Havanka Hannele , Herrala Lauri , Kangasniemi Pentti , Rautakorpi Ilkka , Turkka Jukka , Vapaatalo Heikki , Eskerod Ole 
Published: June 2003

The efficacy and safety of tolfenamic acid and oral sumatriptan in the acute treatment of migraine was studied at five neurological centers in Finland. One hundred forty‐one patients experiencing 289 migraine attacks, fulfilling the diagnostic criteria for migraine with or without aura as defined by the International Headache Society, were randomized.For first attacks, 77% of patients receiving tolfenamic acid experienced a reduction of the initial severe or moderate headache to mild or no headache after 2 hours, as compared to 79% in the sumatriptan group and 29% in the placebo group. No significant difference was found between active treatments (P=0.85, 95% Cl [−22%, 18%]), however, both active treatments were significantly better than placebo; P=0.001, 95% Cl (26%, 69%) for tolfenamic acid and P=0.001, 95% Cl (28%, 71%) for sumatriptan. For second attacks, results were similar with 70% of patients receiving tolfenamic acid experiencing relief, as compared to 64% in the sumatriptan group and 39% in the placebo group.No significant differences were observed in accompanying symptoms.Both drugs were well tolerated with the frequency of adverse events; 30% for tolfenamic acid and 41% for sumatriptan, a nonsignificant difference.In this study, tolfenamic acid and oral sumatriptan are comparably effective in the acute treatment of migraine. When comparably effective, factors like individual effect, tolerance, and cost of treatment should be considered when prescribing migraine medication.
Social Environment and Headache in 8‐ to 9‐Year‐Old Children: A Follow‐up Study
Authors: Metsähonkala Liisa , Sillanpää Matti , Tuominen Juhani 
Published: June 2003

We studied the occurrence of migraine and nonmigrainous headache and the factors associated with headache in a group of 3580 children. These children belong to a 1‐year age cohort which has been followed since birth. When the children were 8 to 9 years old, data on their headaches were gathered through a postal questionnaire. Ninety‐five of the children (2.7%) had migraine and 977 (27.3%) reported nonmigrainous headache at the age of 8 to 9 years. Thirty‐four percent of the children with migraine had already had headache at the age of 5 years.Children with migraine and children with nonmigrainous headache both reported more often being bullied in school, stress in school, and problems in getting along with other children than children without headache. The association of stress in school with headache was strongest in girls with migraine, even though they reported the least difficulties in school subjects. As many as one third of the boys with migraine reported that they had problems with peer relationships.
Practicability and Acceptance of Subcutaneous Self‐administration of the Selective Serotonin Agonist Sumatriptan
Authors: Göbel Hartmut , Baar H. , Beiküfner H.D. , Böhme K. , Beckmann‐Reinhold A. 
Published: June 2003

To cater to the special situation of much reduced oral bio‐availability which occurs in severe migraine attacks with pronounced nausea and vomiting, sumatriptan can also be used in a subcutaneous form that can be self‐administered. The aim of this study was to analyze the practicability and acceptance of a method of self‐administration (“Glaxo‐Pen”) for treatment of severe migraine attacks by subcutaneous injection of sumatriptan. The Glaxo‐Pen was compared with the conventional autoinjector for subcutaneous administration of sumatriptan. The multicenter study was conducted under practical conditions by 150 office‐based physician in Germany. Patients who commonly suffered from severe migraine attacks were given a careful explanation of how to use the device (“Glaxo‐Pen”) for self‐administration of subcutaneous sumatriptan and were able to practice using it under guidance.They were given a Glaxo‐Pen with two sumatriptan refills to take with them for treating their own migraine attacks. The patients used a headache diary to document administration outside the practice session. A total of 376 patients were included in the study.The major findings were that 80% of the patients rated the Glaxo‐Pen “very easy” or “easy” to use, and only 6.4% rated it “difficult” or “very difficult.” Compared with the conventional autoinjector, the Glaxo‐Pen was rated “much better” or “better” by 77.9% of patients. Only 8.5% considered the Glaxo‐Pen “worse” or “much worse” than the conventional autoinjector. The figures show that the great majority of patients found it easy to use sumatriptan for treating severe migraine attacks by self‐administration under practical conditions. Thus, especially for patients who suffer from severe nausea, vomiting, or diarrhea during migraine attacks, this method of delivery is an easily used means of arresting migraine attacks.
Psychological Well‐being in Older Adults Suffering From Chronic Headache
Authors: Jelicic Marko , Kempen Gertrudis I.J.M. , Passchier Jan 
Published: June 2003

Objective.—The aim of this study was to examine two components of psychological well‐being—life satisfaction and effective well‐being—in community‐dwelling elderly with (n=321) and without chronic headache (n=4955).Methods.—A checklist of chronic medical conditions was used to determine whether respondents were suffering from headache. Cantril's ladder was employed to measure life satisfaction. The subscale, Mental Health, from the MOS SF‐20 was used to assess affective well‐being.Results.—Headache sufferers reported lower life satisfaction as well as lower affective well‐being. However, the difference in life satisfaction between the two groups disappeared after controlling for comorbidity. The difference in affective well‐being disappeared after controlling for neuroticism.Conclusions.—Lower life satisfaction in patients with chronic headache is caused by more comorbid diseases in the headache group. Lower affective well‐being in headache sufferers is due to higher levels of neuroticism in the headache group.
Melatonin‐Responsive Headache in Delayed Sleep Phase Syndrome: Preliminary Observations
Authors: Nagtegaal J.E. , Smits M.G. , Swart A.C.W. , Kerkhof G.A. , van der Meer Y.G. 
Published: June 2003

The occurrence of headache and its change after treatment with melatonin 5 mg were studied in 30 patients with delayed sleep phase syndrome. The medication was taken 5 hours before the endogenous nocturnal plasma melatonin concentration had reached 10 pg/mL.Three women (aged 14, 14, and 23 years) suffered from chronic tension‐type headache. Their headache disappeared within 2 weeks after the start of treatment with melatonin. One 54‐year‐old man suffered from disabling migraine attacks without aura, twice a week. After starting melatonin treatment, only three migraine attacks were reported in 12 months. Ever since his 4Os, a 60‐year‐old man complained of cluster headache episodes lasting about 2 months, twice a year. In the year since starting melatonin treatment, only one 5‐day cluster episode occurred.Nocturnal melatonin secretion in the patients with delayed sleep phase syndrome and headache did not differ significantly from that in the patients with the sleep disorder but without headache.Melatonin may be helpful in patients with headache who are suffering from delayed sleep phase syndrome. Its effectiveness may be due to modification of vascular and nociceptive systems or to its chronobiological action which adjusts the patient's biological clock to his/her life‐style.
Oral Magnesium Oxide Prophylaxis of Frequent Migrainous Headache in Children: A Randomized, Double‐Blind, Placebo‐Controlled Trial
Authors: Wang Fong , Van Den Eeden Stephen K. , Ackerson Lynn M. , Salk Susan E. , Reince Robyn H. , Elin Ronald J. 
Published: June 2003

Objective.—To assess whether, in children, oral magnesium oxide reduces migrainous headache frequency, severity, and associated features compared to placebo.Background.—There is no single, safe, widely well‐tolerated, and effective prophylactic treatment for all children and adolescents with frequent migrainous headache.Design.—Randomized, double‐blind, placebo‐controlled, parallel‐group trial.Methods.—This study was conducted between June 1997 and January 2000 using 7 selected Northern California Kaiser Permanente sites. We recruited children of ages 3 to 17 years who reported a 4‐week history of at least weekly, moderate‐to‐severe headache with a throbbing or pulsatile quality, associated anorexia/nausea, vomiting, photophobia, sonophobia, or relief with sleep, but no fever or evidence of infection. Subjects were randomly assigned to receive either magnesium oxide (9 mg/kg per day by mouth divided 3 times a day with food) (n  =  58) or matching placebo (n  =  60) for 16 weeks. The number of headache days (days with at least one headache) during each of eight 2‐week intervals was chosen to be the primary outcome variable.Results.—Of those enrolled, 86 (73%) completed the study (42 received magnesium oxide and 44 placebo); 74 of 192 eligible subjects declined to participate. Baseline information on demographic factors, health status, and headache history was similar comparing the 2 groups. By intention‐to‐treat analysis, we found a statistically significant decrease over time in headache frequency in the magnesium oxide group (P  =  .0037) but not in the placebo group (P  =  .086), although the slopes of these 2 lines were not statistically significantly different from each other (P  =  .88). The group treated with magnesium oxide had significantly lower headache severity (P  =  .0029) relative to the placebo group.Conclusions.—This study does not unequivocally determine whether oral magnesium oxide is or is not superior to placebo in preventing frequent migrainous headache in children, but treatment with the active agent did lead to a significant reduction in headache days. Larger trials involving this safe, appealing complementary therapy are needed.
Abnormal Neuromuscular Transmission in Cluster Headache
Authors: Ertas Mustafa , Baslo M. Baris 
Published: June 2003

Objective.—To identify and investigate any dysfunction of neuromuscular transmission in episodic cluster headache.Background.—Abnormal neuromuscular transmission has been shown in migraine with aura and in migraine without aura by using single fiber electromyography. Especially for migraine with aura, a genetic cause has been postulated. Episodic cluster headache is a primary headache disorder in which genetic factors may, at times, play a strong role.Methods.—Single fiber electromyography during voluntary contraction of the extensor digitorum communis muscle, nerve conduction studies of upper and lower extremities, and concentric needle electromyography of the extensor digitorum communis were performed on 6 patients with episodic cluster headache and 6 age‐matched normal controls. Twenty potential pairs were recorded from each subject. Twenty individual jitter values and a mean jitter value were calculated for each subject. Both mean individual jitter values and numbers of abnormal individual jitter values were compared in patients with cluster headache versus normal controls.Results.—Three of 6 patients with episodic cluster headache showed pronounced neuromuscular transmission abnormalities by single fiber electromyography. None of the controls had any neuromuscular transmission abnormality. Another patient with episodic cluster headache had borderline dysfunction of neuromuscular transmission. Transmission was clearly normal in only 2 of 6 patients with cluster headache.Conclusion.—These results suggest that episodic cluster headache may share the same abnormality of neuromuscular transmission observed in migraine.