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Migraine Disorders: HELP
Articles from Canada
Based on 235 articles published since 2009

These are the 235 published articles about Migraine Disorders that originated from Canada during 2009-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10
1 Guideline Guidelines of the International Headache Society for controlled trials of preventive treatment of chronic migraine in adults. 2018

Tassorelli, Cristina / Diener, Hans-Christoph / Dodick, David W / Silberstein, Stephen D / Lipton, Richard B / Ashina, Messoud / Becker, Werner J / Ferrari, Michel D / Goadsby, Peter J / Pozo-Rosich, Patricia / Wang, Shuu-Jiun / Anonymous2421236. ·1 Headache Science Center, C. Mondino Foundation, Pavia, Italy. · 2 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. · 3 Department of Neurology, University Hospital Essen, Essen, Germany. · 4 Department of Neurology, Mayo Clinic, Phoenix, AZ, USA. · 5 Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA. · 6 Montefiore Headache Center, Department of Neurology and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA. · 7 Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark. · 8 Dept of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. · 9 Hotchkiss Brain Institute, Calgary, Alberta, Canada. · 10 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands. · 11 National Institute for Health Research-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, England. · 12 Headache Research Group, VHIR, Universitat Autònoma de Barcelona, Barcelona Spain. · 13 Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain. · 14 Neurological Institute, Taipei Veterans General Hospital and Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. ·Cephalalgia · Pubmed #29504482.

ABSTRACT: Background Quality clinical trials form an essential part of the evidence base for the treatment of headache disorders. In 1991, the International Headache Society Clinical Trials Standing Committee developed and published the first edition of the Guidelines for Controlled Trials of Drugs in Migraine. In 2008, the Committee published the first specific guidelines on chronic migraine. Subsequent advances in drug, device, and biologicals development, as well as novel trial designs, have created a need for a revision of the chronic migraine guidelines. Objective The present update is intended to optimize the design of controlled trials of preventive treatment of chronic migraine in adults, and its recommendations do not apply to trials in children or adolescents.

2 Guideline Canadian Headache Society guideline for migraine prophylaxis. 2012

Pringsheim, Tamara / Davenport, W Jeptha / Mackie, Gordon / Worthington, Irene / Aubé, Michel / Christie, Suzanne N / Gladstone, Jonathan / Becker, Werner J / Anonymous6130728. ·University of Calgary and the Hotchkiss Brain Institute, Calgary, AB, Canada. ·Can J Neurol Sci · Pubmed #22683887.

ABSTRACT: OBJECTIVES: The primary objective of this guideline is to assist the practitioner in choosing an appropriate prophylactic medication for an individual with migraine, based on current evidence in the medical literature and expert consensus. This guideline is focused on patients with episodic migraine (headache on ≤ 14 days a month). METHODS: Through a comprehensive search strategy, randomized, double blind, controlled trials of drug treatments for migraine prophylaxis and relevant Cochrane reviews were identified. Studies were graded according to criteria developed by the US Preventive Services Task Force. Recommendations were graded according to the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. In addition, a general literature review and expert consensus were used for aspects of prophylactic therapy for which randomized controlled trials are not available. RESULTS: Prophylactic drug choice should be based on evidence for efficacy, side-effect profile, migraine clinical features, and co-existing disorders. Based on our review, 11 prophylactic drugs received a strong recommendation for use (topiramate, propranolol, nadolol, metoprolol, amitriptyline, gabapentin, candesartan, butterbur, riboflavin, coenzyme Q10, and magnesium citrate) and 6 received a weak recommendation (divalproex sodium, flunarizine, pizotifen, venlafaxine, verapamil, and lisinopril). Quality of evidence for different medications varied from high to low. Prophylactic treatment strategies were developed to assist the practitioner in selecting a prophylactic drug for specific clinical situations. These strategies included: first time strategies for patients who have not had prophylaxis before (a beta-blocker and a tricyclic strategy), low side effect strategies (including both drug and herbal/vitamin/mineral strategies), a strategy for patients with high body mass index, strategies for patients with co-existent hypertension or with co-existent depression and /or anxiety, and additional monotherapy drug strategies for patients who have failed previous prophylactic trials. Further strategies included a refractory migraine strategy and strategies for prophylaxis during pregnancy and lactation. CONCLUSIONS: There is good evidence from randomized controlled trials for use of a number of different prophylactic medications in patients with migraine. Medication choice for an individual patient requires careful consideration of patient clinical features.

3 Guideline The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and select comorbid medical conditions. 2012

Ramasubbu, Rajamannar / Taylor, Valerie H / Samaan, Zainab / Sockalingham, Sanjeev / Li, Madeline / Patten, Scott / Rodin, Gary / Schaffer, Ayal / Beaulieu, Serge / McIntyre, Roger S / Anonymous2380717. ·Department of Psychiatry and Clinical Neurosciences, University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada. rramasub@ucalgary.ca ·Ann Clin Psychiatry · Pubmed #22303525.

ABSTRACT: BACKGROUND: Medical comorbidity in patients with mood disorders has become an increasingly important clinical and global public health issue. Several specific medical conditions are associated with an increased risk of mood disorders, and conversely, mood disorders are associated with increased morbidity and mortality in patients with specific medical disorders. METHODS: To help understand the bidirectional relationship and to provide an evidence-based framework to guide the treatment of mood disorders that are comorbid with medical illness, we have reviewed relevant articles and reviews published in English-language databases (to April 2011) on the links between mood disorders and several common medical conditions, evaluating the efficacy and safety of pharmacologic and psychosocial treatments. The medical disorders most commonly encountered in adult populations (ie, cardiovascular disease, cerebrovascular disease, cancer, human immunodeficiency virus, hepatitis C virus, migraine, multiple sclerosis, epilepsy, and osteoporosis) were chosen as the focus of this review. RESULTS: Emerging evidence suggests that depression comorbid with several medical disorders is treatable and failure to treat depression in medically ill patients may have a negative effect on medical outcomes. CONCLUSIONS: This review summarizes the available evidence and provides treatment recommendations for the management of comorbid depression in medically ill patients.

4 Guideline Evidence-based guidelines for the chiropractic treatment of adults with headache. 2011

Bryans, Roland / Descarreaux, Martin / Duranleau, Mireille / Marcoux, Henri / Potter, Brock / Ruegg, Rick / Shaw, Lynn / Watkin, Robert / White, Eleanor. ·Guidelines Development Committee Chair and Chiropractor, Private Practice, Clarenville, Newfoundland and Labrador, Canada. rbryans@nfld.net ·J Manipulative Physiol Ther · Pubmed #21640251.

ABSTRACT: OBJECTIVE: The purpose of this manuscript is to provide evidence-informed practice recommendations for the chiropractic treatment of headache in adults. METHODS: Systematic literature searches of controlled clinical trials published through August 2009 relevant to chiropractic practice were conducted using the databases MEDLINE; EMBASE; Allied and Complementary Medicine; the Cumulative Index to Nursing and Allied Health Literature; Manual, Alternative, and Natural Therapy Index System; Alt HealthWatch; Index to Chiropractic Literature; and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, limited, or conflicting) and to formulate practice recommendations. RESULTS: Twenty-one articles met inclusion criteria and were used to develop recommendations. Evidence did not exceed a moderate level. For migraine, spinal manipulation and multimodal multidisciplinary interventions including massage are recommended for management of patients with episodic or chronic migraine. For tension-type headache, spinal manipulation cannot be recommended for the management of episodic tension-type headache. A recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache. Low-load craniocervical mobilization may be beneficial for longer term management of patients with episodic or chronic tension-type headaches. For cervicogenic headache, spinal manipulation is recommended. Joint mobilization or deep neck flexor exercises may improve symptoms. There is no consistently additive benefit of combining joint mobilization and deep neck flexor exercises for patients with cervicogenic headache. Adverse events were not addressed in most clinical trials; and if they were, there were none or they were minor. CONCLUSIONS: Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.

5 Editorial Migraine with visual aura, incident AF, and stroke risk: Is migraine with aura an embolic TIA? 2018

Fridman, Sebastian / Sposato, Luciano A. ·From the Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry (S.F., L.A.S.), Stroke, Dementia & Heart Disease Lab (L.A.S.), Departments of Anatomy and Cell Biology (L.A.S.), and Epidemiology & Biostatistics (L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada. · From the Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry (S.F., L.A.S.), Stroke, Dementia & Heart Disease Lab (L.A.S.), Departments of Anatomy and Cell Biology (L.A.S.), and Epidemiology & Biostatistics (L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada. lucianosposato@gmail.com lsposato@uwo.ca. ·Neurology · Pubmed #30429280.

ABSTRACT: -- No abstract --

6 Editorial Migraine mimicking stroke: What to do? 2018

Purdy, R Allan / Diener, Hans-Christoph. ·1 Dalhousie University, Department of Medicine, Halifax, NS, Canada. · 2 University Hospital Essen, Headache Center, Essen, Germany. ·Cephalalgia · Pubmed #29661035.

ABSTRACT: -- No abstract --

7 Editorial Cardioembolism as the unsuspected missing link between migraine and ischemic stroke. 2016

Sposato, Luciano A / Peterlin, B Lee. ·From the Department of Clinical Neurological Sciences (L.A.S.), Western University, London, Canada · and Department of Neurology (B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD. ·Neurology · Pubmed #27956562.

ABSTRACT: -- No abstract --

8 Editorial Triptans for Acute Migraine: A Drug Class Review. 2015

Purdy, R Allan. ·Medicine (Neurology), Dalhousie University, Halifax, Nova Scotia, Canada. ·Headache · Pubmed #26140662.

ABSTRACT: -- No abstract --

9 Editorial Reducing migraine return with corticosteroids: An extra chance to improve migraine care. 2015

Davenport, W Jeptha. ·Departments of Clinical Neurosciences and Medical Genetics; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada jeptha.davenport@albertahealthservices.ca. ·Cephalalgia · Pubmed #25573897.

ABSTRACT: -- No abstract --

10 Editorial Improving migraine headache management in emergency departments: the time has come. 2015

Rowe, Brian H / Richer, Lawrence. ·Department of Emergency Medicine, University of Alberta, Canada browe@ualberta.ca. · Department of Pediatrics, University of Alberta, Canada. ·Cephalalgia · Pubmed #24942087.

ABSTRACT: -- No abstract --

11 Editorial Botulinum neurotoxin A for chronic migraine headaches: does it work and how? 2014

Cairns, Brian E / Gazerani, Parisa. ·Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, V6T 1Z3, Canada. ·Pain Manag · Pubmed #25494688.

ABSTRACT: -- No abstract --

12 Editorial Intolerance to topiramate in migraine. 2014

Donat, Jeff. ·Kelowna Headache Clinic, Kelowna, BC, Canada jeff1donat@yahoo.com. ·Cephalalgia · Pubmed #24623126.

ABSTRACT: -- No abstract --

13 Editorial Nutraceuticals for the prevention of migraine in children: Do we know what the benefits and the risks are? 2014

Pringsheim, Tamara / Davenport, W Jeptha. ·Department of Clinical Neurosciences, University of Calgary, AB, Canada Department of Medical Genetics, University of Calgary, AB, Canada tmprings@ucalgary.ca. · Department of Clinical Neurosciences, University of Calgary, AB, Canada Department of Medical Genetics, University of Calgary, AB, Canada Hotchkiss Brain Institute, University of Calgary, AB, Canada. ·Cephalalgia · Pubmed #24436462.

ABSTRACT: -- No abstract --

14 Editorial Perceptual illusions provide clues to excitatory: inhibitory balance in migraine neocortex. 2011

Wilkinson, Frances. ·York University, Canada. ·Cephalalgia · Pubmed #21727145.

ABSTRACT: -- No abstract --

15 Review Women and Migraine: the Role of Hormones. 2018

Todd, Candice / Lagman-Bartolome, Ana Marissa / Lay, Christine. ·Toronto Western Hospital, The University of Toronto, University Health Network, 399 Bathurst St. 5WW441, Toronto, ON, M5T 2S8, Canada. · Centre for Headache, Women's College Hospital, The University of Toronto, 76 Grenville Street, 3rd floor, Toronto, ON, M5S 1B2, Canada. · Centre for Headache, Women's College Hospital, The University of Toronto, 76 Grenville Street, 3rd floor, Toronto, ON, M5S 1B2, Canada. Christine.Lay@wchospital.ca. ·Curr Neurol Neurosci Rep · Pubmed #29855724.

ABSTRACT: PURPOSE OF REVIEW: Migraine is a debilitating disease, that is encountered in countless medical offices every day and since it is highly prevalent in women, it is imperative to have a clear understanding of how to manage migraine. There is a growing body of evidence regarding the patterns we see in women throughout their life cycle and how we approach migraine diagnosis and treatment at those times. RECENT FINDINGS: New guidelines regarding safety of medication during pregnancy and lactation are being utilized to help guide management decisions in female migraineurs. There is also new data surrounding the risk of stroke in individuals who suffer from migraine with aura. This article seeks to provide an overview of a woman's migraine throughout her lifetime, the impact of hormones and an approach to management.

16 Review Dysautonomia in the pathogenesis of migraine. 2018

Gazerani, Parisa / Cairns, Brian Edwin. ·a Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark. · b Faculty of Pharmaceutical Sciences , The University of British Columbia , Vancouver , BC , Canada. ·Expert Rev Neurother · Pubmed #29212396.

ABSTRACT: INTRODUCTION: Migraine is a common complex neurological disorder involving multiple brain areas that regulate autonomic, affective, cognitive, and sensory functions. This review explores autonomic nervous system (ANS) dysfunction in migraine headache sufferers. Areas covered: Reference material for this review was obtained through PubMed searches. Migraine attacks can present with up to 4 phases (premonitory, aura, headache, postdrome) each with distinguishable signs and symptoms. Altered ANS tone can be found from the premonitory through the postdrome phases. Features of the migraine attack that are indicative of altered autonomic function, which include nausea, vomiting, diarrhea, polyuria, eyelid edema, conjunctival injection, lacrimation, nasal congestion, and ptosis, are discussed and putative mechanisms explored. In addition, alteration of ANS function by endogenous and exogenous stressors, such as bright lights, hunger, poor sleep quality, menses, and special dietary components is discussed. The influence of currently employed pharmacological treatments on altered autonomic function during the migraine attack is explored. Expert commentary: Migraine-related alterations in ANS function have a complex pattern, but, in general, an imbalance occurs between sympathetic and parasympathetic tone. Through an improved understanding the role of autonomic changes in pathogenesis of migraine, it may be possible to develop even more effective treatments for migraine sufferers.

17 Review Experts' opinion about the primary headache diagnostic criteria of the ICHD-3rd edition beta in children and adolescents. 2017

Özge, Aynur / Faedda, Noemi / Abu-Arafeh, Ishaq / Gelfand, Amy A / Goadsby, Peter James / Cuvellier, Jean Christophe / Valeriani, Massimiliano / Sergeev, Alexey / Barlow, Karen / Uludüz, Derya / Yalın, Osman Özgür / Lipton, Richard B / Rapoport, Alan / Guidetti, Vincenzo. ·Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey. · Phd program in Behavioural Neuroscience, Department of Paediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Rome, Italy. · Royal Hospital for Sick Children, Glasgow, G3 8SJ, UK. · UCSF Headache Center and UCSF Benioff Children's Hospital, Pediatric Brain Center 2330 Post St 6th Floor San Francisco, Campus Box 1675, San Francisco, CA, 94115, USA. · NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, England. · Division of Paediatric Neurology, Department of Paediatrics, Lille Faculty of Medicine and Children's Hospital, Lille, France. · Division of Neurology, Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, 00165, Rome, Italy. · Center for Sensory-Motor Interaction Aalborg University, Aalborg, Denmark. · Department of Neurology and Clinical Neurophysiology, University Headache Clinic, Moscow State Medical University, Moscow, Russia. · Faculty of Medicine, University of Calgary, Alberta Children's Hospital, C4-335, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada. · Cerrahpaşa Medical Faculty, Department of Neurology, İstanbul University, Kocamustafapaşa, İstanbul, Turkey. · İstanbul Research and Education Hospital, Kocamustafapaşa, İstanbul, Turkey. · Department of Neurology Montefiore Headache Center, Albert Einstein College of Medicine, Louis and Dora Rousso Building, 1165 Morris Park Avenue, Room 332, Bronx, NY, 10461, USA. · The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. · Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy. vincenzo.guidetti@uniroma1.it. ·J Headache Pain · Pubmed #29285570.

ABSTRACT: BACKGROUND: The 2013 International Classification of Headache Disorders-3 (ICHD-3) was published in a beta version to allow the clinicians to confirm the validity of the criteria or to suggest improvements based on field studies. The aim of this work was to review the Primary Headache Disorders Section of ICHD-3 beta data on children and adolescents (age 0-18 years), and to suggest changes, additions, and amendments. METHODS: Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the literature available on pediatric headache, they made observations and proposed suggestions for the primary headache disorders section of ICHD-3 beta data on children and adolescents. RESULTS: Some headache disorders in children have specific features which are different from those seen in adults and which should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psycho-social basis in children and adolescents making primary headache disorders in children distinct from those in adults. CONCLUSIONS: Several recommendations are presented in order to make ICHD-3 more appropriate for use with children.

18 Review Special Considerations for Primary and Secondary Stroke Prevention in Women. 2017

Alrasheed, Deema / Jaigobin, Cheryl. ·Division of Neurology, University Health Network Stroke Program, University of Toronto, Toronto, Canada. · Department of Medicine, University of Toronto, Toronto, Canada. ·Semin Neurol · Pubmed #28759918.

ABSTRACT: -- No abstract --

19 Review Depression comorbidity in migraine. 2017

Amoozegar, Farnaz. ·a Department of Clinical Neurosciences & Hotchkiss Brain Institute, Cumming School of Medicine , University of Calgary , Calgary , AB , Canada. ·Int Rev Psychiatry · Pubmed #28681617.

ABSTRACT: Migraine and Major Depressive Disorder (MDD) are highly prevalent conditions that can lead to significant disability. These conditions are often comorbid, and several studies shed light on the underlying reasons for this comorbidity. The purpose of this review article is to have a closer look at the epidemiology, pathophysiology, genetic and environmental factors, temporal association, treatment options, and prognosis of patients suffering from both conditions, to allow a better understanding of what factors underlie this comorbidity. Studies show that patients with migraine are 2-4-times more likely to develop lifetime MDD, predominantly due to similar underlying pathophysiologic and genetic mechanisms. There appears to be a bidirectional temporal association between the two conditions, although longitudinal studies are needed to determine this more definitively. Quality-of-life and health-related outcomes are worse for patients that suffer from both conditions. Thus, a careful assessment of the patient with access to appropriate resources and follow-up is paramount. Future studies in genetics and brain imaging will be helpful in further elucidating the underlying mechanisms in these comorbid conditions, which will hopefully lead to better treatment options.

20 Review The Diagnosis and Management of Chronic Migraine in Primary Care. 2017

Becker, Werner J. ·Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. ·Headache · Pubmed #28548676.

ABSTRACT: BACKGROUND: Chronic migraine is common, affecting approximately 1% of the general population, and causes significant disability. OBJECTIVE: To summarize optimal involvement of primary care physicians in chronic migraine care, and to provide algorithms to assist them in the diagnosis and management of patients with chronic migraine. METHODS: An analysis of diagnostic and treatment needs in chronic migraine, based on a synthesis of the medical literature and clinical experience. RESULTS: Chronic migraine represents the more severe end of the migraine spectrum, usually arises out of previous episodic migraine, and is characterized by headache on 15 days a month or more. Importantly, the headache needs to meet migraine diagnostic criteria on only 8 days a month in order to meet chronic migraine diagnostic criteria. When acute medication overuse is present, a second diagnosis of medication overuse headache should be made. If patients meet criteria for chronic migraine, this excludes a diagnosis of chronic tension-type headache. Acute therapy of chronic migraine is similar to episodic migraine, except that medication overuse is a much greater risk in chronic migraine and must be addressed. All patients should be considered for pharmacological prophylaxis, and the behavioral aspects of therapy should be emphasized. The two prophylactic drugs with the best evidence for efficacy in chronic migraine are topiramate and onabotulinumtoxinA. Given the disability caused by chronic migraine, these should both be available to patients as necessary. CONCLUSION: Management of chronic migraine is complex, and many patients are relatively refractory to therapy. Specialist referral will often be required and should not be unduly delayed. On the other hand, the primary care physician should be able to make the diagnosis, initiate therapy, and manage some less refractory patients without referral. The timing of referral should depend both on the expertise of the primary care physician in headache management and the patient's response to initial therapy.

21 Review Recurrent Gastrointestinal Disturbance: Abdominal Migraine and Cyclic Vomiting Syndrome. 2017

Irwin, Samantha / Barmherzig, Rebecca / Gelfand, Amy. ·Department of Neurology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. Samantha.Irwin@Sickkids.ca. · Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada. · Department of Neurology, University of California, UCSF Benioff Children's Hospital, San Francisco, CA, USA. ·Curr Neurol Neurosci Rep · Pubmed #28283964.

ABSTRACT: Primary headache disorders, including migraine, are some of the most common neurological disorders presenting to hospital. Episodic syndromes that may be associated with migraine, including recurrent gastrointestinal disturbances such as abdominal migraine and cyclic vomiting, often pre-date or co-occur with the onset of migraine in a child who is at risk of developing the headache condition. The purpose of this review is to evaluate the two most common episodic syndromes, abdominal migraine and cyclic vomiting syndrome, including their pathophysiology, common presentations, and diagnostic criteria. Differential diagnosis and "red flag" features are outlined, and an approach to diagnostic work-up is offered. Finally, we provide an evidence-based review of management options and long-term prognosis. Future research should include randomized trials for the acute and preventive treatment of these disorders, as well as research as to whether early intervention can prevent progression to migraine and/or mitigate migraine severity.

22 Review Comparative tolerability of treatments for acute migraine: A network meta-analysis. 2017

Thorlund, Kristian / Toor, Kabirraaj / Wu, Ping / Chan, Keith / Druyts, Eric / Ramos, Elodie / Bhambri, Rahul / Donnet, Anne / Stark, Richard / Goadsby, Peter J. ·1 Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada. · 2 Redwood Outcomes, Vancouver, British Columbia, Canada. · 3 School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · 4 Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · 5 Pfizer Ltd, New York, New York, USA. · 6 Department of Evaluation and Treatment of Pain, Clinical Neuroscience Federation, La Timone Hospital, Marseille, France. · 7 Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia. · 8 Department of Medicine, Monash University, Melbourne, Victoria, Australia. · 9 NIHR-Wellcome Trust Clinical Research Facility, King's College London, London, UK. ·Cephalalgia · Pubmed #27521843.

ABSTRACT: Introduction Migraine headache is a neurological disorder whose attacks are associated with nausea, vomiting, photophobia and phonophobia. Treatments for migraine aim to either prevent attacks before they have started or relieve attacks (abort) after onset of symptoms and range from complementary therapies to pharmacological interventions. A number of treatment-related adverse events such as somnolence, fatigue, and chest discomfort have previously been reported in association with triptans. The comparative tolerability of available agents for the abortive treatment of migraine attacks has not yet been systematically reviewed and quantified. Methods We performed a systematic literature review and Bayesian network meta-analysis for comparative tolerability of treatments for migraine. The literature search targeted all randomized controlled trials evaluating oral abortive treatments for acute migraine over a range of available doses in adults. The primary outcomes of interest were any adverse event, treatment-related adverse events, and serious adverse events. Secondary outcomes were fatigue, dizziness, chest discomfort, somnolence, nausea, and vomiting. Results Our search yielded 141 trials covering 15 distinct treatments. Of the triptans, sumatriptan, eletriptan, rizatriptan, zolmitriptan, and the combination treatment of sumatriptan and naproxen were associated with a statistically significant increase in odds of any adverse event or a treatment-related adverse event occurring compared with placebo. Of the non-triptans, only acetaminophen was associated with a statistically significant increase in odds of an adverse event occurring when compared with placebo. Overall, triptans were not associated with increased odds of serious adverse events occurring and the same was the case for non-triptans. For the secondary outcomes, with the exception of vomiting, all triptans except for almotriptan and frovatriptan were significantly associated with increased risk for all outcomes. Almotriptan was significantly associated with an increased risk of vomiting, whereas all other triptans yielded non-significant lower odds compared with placebo. Generally, the non-triptans were not associated with decreased tolerability for the secondary outcomes. Discussion In summary, triptans were associated with higher odds of any adverse event or a treatment-related adverse event occurring when compared to placebo and non-triptans. Non-significant results for non-triptans indicate that these treatments are comparable with one another and placebo regarding tolerability outcomes.

23 Review Risk of medication overuse headache across classes of treatments for acute migraine. 2016

Thorlund, Kristian / Sun-Edelstein, Christina / Druyts, Eric / Kanters, Steve / Ebrahim, Shanil / Bhambri, Rahul / Ramos, Elodie / Mills, Edward J / Lanteri-Minet, Michel / Tepper, Stewart. ·Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada. kthorlund@redwoodoutcomes.com. · Redwood Outcomes, 302-1505 2nd Ave. West, Vancouver, BC, Canada. kthorlund@redwoodoutcomes.com. · Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia. · Redwood Outcomes, 302-1505 2nd Ave. West, Vancouver, BC, Canada. · Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. · School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. · Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada. · Pfizer Ltd, New York, NY, USA. · Pain Department, CHU Nice, France - FHU InovPain, Université Nice Côte d'Azur, Nice, France. · INSERM U1107, Neuo-Dol, Trigeminal Pain and Migraine Université Auvergne, Clermont-Ferrand, France. · Geisel School of Medicine at Dartmouth, Hanover, NH, USA. ·J Headache Pain · Pubmed #27882516.

ABSTRACT: BACKGROUND: The most commonly prescribed medications used to treat migraine acutely are single analgesics, ergots, opioids, and triptans. Due to varying mechanisms of action across drug classes, there is reason to believe that some classes may be less likely than others to elicit Medication Overuse Headache (MOH) than others. We therefore aimed to determine whether certain classes of acute migraine drugs are more likely to elicit MOH than others. METHODS: A comprehensive systematic literature was conducted to identify studies of varying designs that reported on MOH within the considered treatment classes. Only studies that reported MOH according to the International Classification of Headache Disorders (ICHD) were considered. Since no causal comparative design studies were identified; data from prevalence studies and surveys were retrieved. Prevalence-based relative risks between treatment classes were calculated by integrating both medication overuse and medication use from published studies. For each pair wise comparison, pooled relative risks were calculated as the inverse variance weighted average. RESULTS: A total of 29 studies informed the relative risk between treatment classes, all of which reported country-specific data. Five studies reported country-specific medication use data. For triptans versus analgesics the study relative risks generally favored triptans. The pooled relative risk was 0.65 (i.e., relative risk reduction of 35 %). For ergots versus analgesics, a similar trend was observed in favor of ergots with a relative risk of 0.41. For triptans versus ergots, the direction of effect was mixed, and the pooled relative risk was 1.07. Both triptans and ergots appeared favorable when compared to opioids, with pooled relative risks of 0.35 and 0.76, respectively. However, the evidence was limited for these comparisons. Analgesics and opioids also appeared to yield similar risk of MOH (pooled relative risk 1.09). CONCLUSION: Our study suggests that in patients receiving acute migraine treatment, analgesics and opioids are associated with a higher risk of developing MOH compared with other treatments. These findings provide incentive for better monitoring of use of analgesics and opioids for treating acute migraine, and suggest possible clinical preference for use of so-called "migraine-specific" treatments, that is, triptans and ergots.

24 Review Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. 2016

Orr, Serena L / Friedman, Benjamin W / Christie, Suzanne / Minen, Mia T / Bamford, Cynthia / Kelley, Nancy E / Tepper, Deborah. ·University of Ottawa, Ottawa, Ontario, Canada. · Albert Einstein College of Medicine, Bronx, NY, USA. · New York University Langone Medical Center, New York, NY, USA. · Cleveland Clinic, Cleveland, OH, USA. · Geisinger Medical Center, Danville, PA, USA. · Beth Israel Deaconess, Sandwich, MA, USA. ·Headache · Pubmed #27300483.

ABSTRACT: OBJECTIVE: To provide evidence-based treatment recommendations for adults with acute migraine who require treatment with injectable medication in an emergency department (ED). We addressed two clinically relevant questions: (1) Which injectable medications should be considered first-line treatment for adults who present to an ED with acute migraine? (2) Do parenteral corticosteroids prevent recurrence of migraine in adults discharged from an ED? METHODS: The American Headache Society convened an expert panel of authors who defined a search strategy and then performed a search of Medline, Embase, the Cochrane database and clinical trial registries from inception through 2015. Identified articles were rated using the American Academy of Neurology's risk of bias tool. For each medication, the expert panel determined likelihood of efficacy. Recommendations were created accounting for efficacy, adverse events, availability of alternate therapies, and principles of medication action. RESULTS/CONCLUSIONS: The search identified 68 unique randomized controlled trials utilizing 28 injectable medications. Of these, 19 were rated class 1 (low risk of bias), 21 were rated class 2 (higher risk of bias), and 28 were rated class 3 (highest risk of bias). Metoclopramide, prochlorperazine, and sumatriptan each had multiple class 1 studies supporting acute efficacy, as did dexamethasone for prevention of headache recurrence. All other medications had lower levels of evidence. RECOMMENDATIONS: Intravenous metoclopramide and prochlorperazine, and subcutaneous sumatriptan should be offered to eligible adults who present to an ED with acute migraine (Should offer-Level B). Dexamethasone should be offered to these patients to prevent recurrence of headache (Should offer-Level B). Because of lack of evidence demonstrating efficacy and concern about sub-acute or long-term sequelae, injectable morphine and hydromorphone are best avoided as first-line therapy (May avoid-Level C).

25 Review Managing Pediatric Pain in the Emergency Department. 2016

Bailey, Benoit / Trottier, Evelyne D. ·Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada. benoit.bailey@umontreal.ca. · Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada. ·Paediatr Drugs · Pubmed #27260499.

ABSTRACT: Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.