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Migraine Disorders: HELP
Articles from Alberta
Based on 59 articles published since 2008

These are the 59 published articles about Migraine Disorders that originated from Alberta during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 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.

2 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.

3 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 --

4 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 --

5 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 --

6 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.

7 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.

8 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.

9 Review The borderland of migraine and epilepsy in children. 2016

Rajapakse, Thilinie / Buchhalter, Jeffrey. ·Section of Neurology, Alberta Children's Hospital, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. · Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta Children's Hospital Research Institute. ·Headache · Pubmed #27103497.

ABSTRACT: OBJECTIVE: To provide a review on the spectrum of migraine-epilepsy disorders in children. BACKGROUND: The migraine-epilepsy continuum covers a fascinating array of disorders that share many clinical similarities but also differ fundamentally in pathophysiology. In the pediatric population, its study can be complicated by the young age of those affected and the lack of clear understanding of the neurobiology of these disorders within the developing brain. DISCUSSION: This review serves to discuss the borderland of migraine and epilepsy in children. It will focus on epidemiology and comorbidity of the two disorders, possible mechanisms for shared pathophysiology informed by basic and translational science, and an overview of clinical similarities and differences. It will also discuss differentiation of migraine aura from childhood occipital epilepsies. Finally, the review concludes with a discussion of current classification methods for capturing cases on the migraine-epilepsy spectrum and a call for a united approach towards a better definition of this spectrum of disorders. CONCLUSION: Recent advances examining the migraine-epilepsy spectrum show clinicopathological similarities between the two disorders in children. Epidemiology demonstrates reciprocally increased incidences of epilepsy in migraineurs and of migraines in children with epilepsy, however, prospective longitudinal in children are currently lacking. Clinically, the two disorders show similarity in preictal, ictal, and postictal phenomena, with close temporal association of the two conditions described by the controversial term of "migralepsy." Basic science research has contributed significant improvements in understanding the generation of both of these episodic neurological conditions, with common links seen at a cellular level involving synaptic glutamate release and the provocation of varying propagation methods including cortical spreading depression in migraine and the paroxysmal depolarizing shift in epilepsy. Despite these significant gains in understanding, improved classification methods are required to identify and further study these interrelated conditions and move towards improved diagnosis and treatment of disorders on the migraine-epilepsy continuum in children.

10 Review Drugs for the acute treatment of migraine in children and adolescents. 2016

Richer, Lawrence / Billinghurst, Lori / Linsdell, Meghan A / Russell, Kelly / Vandermeer, Ben / Crumley, Ellen T / Durec, Tamara / Klassen, Terry P / Hartling, Lisa. ·Department of Pediatrics, Division of Neurology, University of Alberta, 4-478 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, Canada, T6G 1C9. ·Cochrane Database Syst Rev · Pubmed #27091010.

ABSTRACT: BACKGROUND: Numerous medications are available for the acute treatment of migraine in adults, and some have now been approved for use in children and adolescents in the ambulatory setting. A systematic review of acute treatment of migraine medication trials in children and adolescents will help clinicians make evidence-informed management choices. OBJECTIVES: To assess the effects of pharmacological interventions by any route of administration versus placebo for migraine in children and adolescents 17 years of age or less. For the purposes of this review, children were defined as under 12 years of age and adolescents 12 to 17 years of age. SEARCH METHODS: We searched seven bibliographic databases and four clinical trial registers as well as gray literature for studies through February 2016. SELECTION CRITERIA: We included prospective randomized controlled clinical trials of children and adolescents with migraine, comparing acute symptom relieving migraine medications with placebo in the ambulatory setting. DATA COLLECTION AND ANALYSIS: Two reviewers screened titles and abstracts and reviewed the full text of potentially eligible studies. Two independent reviewers extracted data for studies meeting inclusion criteria. We calculated the risk ratios (RRs) and number needed to treat for an additional beneficial outcome (NNTB) for dichotomous data. We calculated the risk difference (RD) and number needed to treat for an additional harmful outcome (NNTH) for proportions of adverse events. The percentage of pain-free patients at two hours was the primary efficacy outcome measure. We used adverse events to evaluate safety and tolerability. Secondary outcome measures included headache relief, use of rescue medication, headache recurrence, presence of nausea, and presence of vomiting. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created 'Summary of findings' tables. MAIN RESULTS: We identified a total of 27 randomized controlled trials (RCTs) of migraine symptom-relieving medications, in which 9158 children and adolescents were enrolled and 7630 (range of mean age between 8.2 and 14.7 years) received medication. Twenty-four studies focused on drugs in the triptan class, including almotriptan, eletriptan, naratriptan, rizatriptan, sumatriptan, sumatriptan + naproxen sodium, and zolmitriptan. Other medications studied included paracetamol (acetaminophen), ibuprofen, and dihydroergotamine (DHE). More than half of the studies evaluated sumatriptan. All but one study reported adverse event data. Most studies presented a low or unclear risk of bias, and the overall quality of evidence, according to GRADE criteria, was low to moderate, downgraded mostly due to imprecision and inconsistency. Ibuprofen was more effective than placebo for producing pain freedom at two hours in two small studies that included 162 children (RR 1.87, 95% confidence interval (CI) 1.15 to 3.04) with low quality evidence (due to imprecision). Paracetamol was not superior to placebo in one small study of 80 children. Triptans as a class of medication were superior to placebo in producing pain freedom in 3 studies involving 273 children (RR 1.67, 95% CI 1.06 to 2.62, NNTB 13) (moderate quality evidence) and 21 studies involving 7026 adolescents (RR 1.32, 95% CI 1.19 to 1.47, NNTB 6) (moderate quality evidence). There was no significant difference in the effect sizes between studies involving children versus adolescents. Triptans were associated with an increased risk of minor (non-serious) adverse events in adolescents (RD 0.13, 95% CI 0.08 to 0.18, NNTH 8), but studies did not report any serious adverse events. The risk of minor adverse events was not significant in children (RD 0.06, 95% CI - 0.04 to 0.17, NNTH 17). Sumatriptan plus naproxen sodium was superior to placebo in one study involving 490 adolescents (RR 3.25, 95% CI 1.78 to 5.94, NNTB 6) (moderate quality evidence). Oral dihydroergotamine was not superior to placebo in one small study involving 13 children. AUTHORS' CONCLUSIONS: Low quality evidence from two small trials shows that ibuprofen appears to improve pain freedom for the acute treatment of children with migraine. We have only limited information on adverse events associated with ibuprofen in the trials included in this review. Triptans as a class are also effective at providing pain freedom in children and adolescents but are associated with higher rates of minor adverse events. Sumatriptan plus naproxen sodium is also effective in treating adolescents with migraine.

11 Review Migrainous Aura, Visual Snow, and "Alice in Wonderland" Syndrome in Childhood. 2016

Rastogi, Reena Gogia / VanderPluym, Juliana / Lewis, Kara Stuart. ·(⁎)Barrow Neurological Institute at Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix, AZ. Electronic address: rrastogi@phoenixchildrens.com. · Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. · (⁎)Barrow Neurological Institute at Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix, AZ. ·Semin Pediatr Neurol · Pubmed #27017016.

ABSTRACT: Migraine is a condition that is common in the pediatric and adolescent population. Among children with migraine, visual aura can consist of either negative or positive features or both. Reports of sensory auras can also be elicited with a careful history. The understanding of the types of aura, as well as their relation to the more typical features of migraine, are discussed. The similar phenomena of visual snow and Alice in Wonderland syndrome in children are also described in detail.

12 Review Nutraceuticals in Migraine: A Summary of Existing Guidelines for Use. 2016

Rajapakse, Thilinie / Pringsheim, Tamara. ·Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada. · Departments of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. ·Headache · Pubmed #26954394.

ABSTRACT: BACKGROUND: The use of nutraceuticals or food/herbal products for health benefits is expanding in adults with migraine as they seek relief from pain in an effective and tolerable manner not always afforded by current conventional pharmacologic therapies. Guidelines from the American Academy of Neurology/American Headache Society, Canadian Headache Society, and European Federation of Neurological Societies have discussed nutraceuticals in varying degrees of detail with at times conflicting recommendations. CONCLUSION: This review serves to provide a summary of existing guidelines for the use of certain nutraceuticals including riboflavin, coenzyme Q10, magnesium, butterbur, feverfew, and omega-3 polyunsaturated fatty acids. The review will also discuss the regulation of nutraceuticals in North America and the current controversy regarding butterbur and its safety.

13 Review Guideline for primary care management of headache in adults. 2015

Becker, Werner J / Findlay, Ted / Moga, Carmen / Scott, N Ann / Harstall, Christa / Taenzer, Paul. ·Professor in the Department of Clinical Neurosciences at the University of Calgary in Alberta. wbecker@ucalgary.ca. · Clinical Assistant Professor in the Department of Family Medicine at the University of Calgary. · Research Associate in Health Technology Assessment at the Institute of Health Economics in Edmonton, Alta. · Director of Health Technology Assessment at the Institute of Health Economics. · Adjunct Clinical Assistant Professor in the Faculty of Medicine at the University of Calgary. ·Can Fam Physician · Pubmed #26273080.

ABSTRACT: OBJECTIVE: To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. QUALITY OF EVIDENCE: A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. MAIN MESSAGE: A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. CONCLUSION: A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache.

14 Review Acute Migraine Treatment in Adults. 2015

Becker, Werner J. ·Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. · The Hotchkiss Brain Institute, Calgary, Alberta, Canada. ·Headache · Pubmed #25877672.

ABSTRACT: There are many options for acute migraine attack treatment, but none is ideal for all patients. This study aims to review current medical office-based acute migraine therapy in adults and provides readers with an organized approach to this important facet of migraine treatment. A general literature review includes a review of several recent published guidelines. Acetaminophen, 4 nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, acetylsalicylic acid [ASA], naproxen sodium, and diclofenac potassium), and 7 triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan) have good evidence for efficacy and form the core of acute migraine treatment. NSAID-triptan combinations, dihydroergotamine, non-opioid combination analgesics (acetaminophen, ASA, and caffeine), and several anti-emetics (metoclopramide, domperidone, and prochlorperazine) are additional evidence-based options. Opioid containing combination analgesics may be helpful in specific patients, but should not be used routinely. Clinical features to be considered when choosing an acute migraine medication include usual headache intensity, usual rapidity of pain intensity increase, nausea, vomiting, degree of disability, patient response to previously used medications, history of headache recurrence with previous attacks, and the presence of contraindications to specific acute medications. Available acute medications can be organized into 4 treatment strategies, including a strategy for attacks of mild to moderate severity (strategy one: acetaminophen and/or NSAIDs), a triptan strategy for patients with severe attacks and for attacks not responding to strategy one, a refractory attack strategy, and a strategy for patients with contraindications to vasoconstricting drugs. Acute treatment of migraine attacks during pregnancy, lactation, and for patients with chronic migraine is also discussed. In chronic migraine, it is particularly important that medication overuse is eliminated or avoided. Migraine treatment is complex, and treatment must be individualized and tailored to the patient's clinical features. Clinicians should make full use of available medications and formulations in an organized approach.

15 Review Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings. 2015

Orr, Serena L / Aubé, Michel / Becker, Werner J / Davenport, W Jeptha / Dilli, Esma / Dodick, David / Giammarco, Rose / Gladstone, Jonathan / Leroux, Elizabeth / Pim, Heather / Dickinson, Garth / Christie, Suzanne N. ·University of Ottawa, Canada Children's Hospital of Eastern Ontario, Canada sorr@cheo.on.ca. · Montreal Neurological Institute, McGill University, Canada. · University of Calgary, Faculty of Medicine, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Canada. · University of Calgary Faculty of Medicine, Departments of Clinical Neurosciences and Medical Genetics, Hotchkiss Brain Institute, Canada. · Department of Medicine, Division of Neurology, University of British Columbia, Canada. · Mayo Clinic College of Medicine, Department of Neurology, AZ, USA. · Associate Clinical Professor Hamilton Health Sciences, St Joseph's Healthcare Hamilton, Canada. · Sunnybrook Health Sciences Centre, The Hospital for Sick Children, University of Toronto, Canada. · Centre Hospitalier Universitaire de Montréal, Canada. · University of Ottawa, Canada. ·Cephalalgia · Pubmed #24875925.

ABSTRACT: BACKGROUND: There is a considerable amount of practice variation in managing migraines in emergency settings, and evidence-based therapies are often not used first line. METHODS: A peer-reviewed search of databases (MEDLINE, Embase, CENTRAL) was carried out to identify randomized and quasi-randomized controlled trials of interventions for acute pain relief in adults presenting with migraine to emergency settings. Where possible, data were pooled into meta-analyses. RESULTS: Two independent reviewers screened 831 titles and abstracts for eligibility. Three independent reviewers subsequently evaluated 120 full text articles for inclusion, of which 44 were included. Individual studies were then assigned a US Preventive Services Task Force quality rating. The GRADE scheme was used to assign a level of evidence and recommendation strength for each intervention. INTERPRETATION: We strongly recommend the use of prochlorperazine based on a high level of evidence, lysine acetylsalicylic acid, metoclopramide and sumatriptan, based on a moderate level of evidence, and ketorolac, based on a low level of evidence. We weakly recommend the use of chlorpromazine based on a moderate level of evidence, and ergotamine, dihydroergotamine, lidocaine intranasal and meperidine, based on a low level of evidence. We found evidence to recommend strongly against the use of dexamethasone, based on a moderate level of evidence, and granisetron, haloperidol and trimethobenzamide based on a low level of evidence. Based on moderate-quality evidence, we recommend weakly against the use of acetaminophen and magnesium sulfate. Based on low-quality evidence, we recommend weakly against the use of diclofenac, droperidol, lidocaine intravenous, lysine clonixinate, morphine, propofol, sodium valproate and tramadol.

16 Review Association between tension-type headache and migraine with sleep bruxism: a systematic review. 2014

De Luca Canto, Graziela / Singh, Vandana / Bigal, Marcelo E / Major, Paul W / Flores-Mir, Carlos. ·Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil; School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. ·Headache · Pubmed #25231339.

ABSTRACT: AIM: To evaluate the association between tension-type headache and migraine with sleep bruxism (SB). BACKGROUND: The association between SB and headaches has been discussed in both children and adults. Although several studies suggested a possible association, no systematic analysis of the available published studies exists to evaluate the quantity, quality, and risk of bias among those studies. METHODS: A systematic review was undertaken, including articles that classified the headaches according to the International Classification of Headache Disorders and SB according to the criteria of the American Association of Sleep Medicine. Only articles in which the objective was to investigate the association between primary headaches (tension-type and migraine) and SB were selected. Detailed individual search strategies for The Cochrane Library, MEDLINE, EMBASE, PubMed, and LILACS were developed. The reference lists from selected articles were also checked. A partial grey literature search was taken by using Google Scholar. The methodology of selected studies was evaluated using the quality in prognosis studies tool. RESULTS: Of 449 identified citations, only 2 studies, both studying adults, fulfilled the inclusion criteria. The presence of SB significantly increased the odds (study 1: odds ratio [OR] 3.12 [1.25-7.7] and study 2: OR 3.8; 1.83-7.84) for headaches, although studies reported different headache type. CONCLUSION: There is not enough scientific evidence to either support or refute the association between tension-type headache and migraine with SB in children. Adults with SB appear to be more likely to have headache.

17 Review Triptans for symptomatic treatment of migraine headache. 2014

Pringsheim, Tamara / Becker, Werner J. ·Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta Children's Hospital, Calgary, AB, Canada T3B 6A8. ·BMJ · Pubmed #24711666.

ABSTRACT: -- No abstract --

18 Review Is subcutaneous sumatriptan an effective treatment for adults presenting to the emergency department with acute migraine headache? 2013

Jones, Simon / Lang, Eddy. ·Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada. ·Ann Emerg Med · Pubmed #23433652.

ABSTRACT: -- No abstract --

19 Review Ketorolac in the treatment of acute migraine: a systematic review. 2013

Taggart, Erin / Doran, Shandra / Kokotillo, Andrea / Campbell, Sandy / Villa-Roel, Cristina / Rowe, Brian H. ·Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada. ·Headache · Pubmed #23298250.

ABSTRACT: This systematic review examined the effectiveness of parenteral ketorolac (KET) in acute migraine. Acute migraine headaches are common emergency department presentations, and despite evidence for various treatments, there is conflicting evidence regarding the use of KET. Searches of MEDLINE, EMBASE, Cochrane, CINAHL, and gray literature sources were conducted. Included studies were randomized controlled trials in which KET alone or in combination with abortive therapy was compared with placebo or other standard therapy in adult patients with acute migraine. Two reviewers assessed relevance, inclusion, and study quality independently, and agreement was measured using kappa (k). Weighted mean differences (WMD) and relative risks are reported with 95% confidence intervals (CIs). Overall, the computerized search identified 418 citations and 1414 gray literature citations. From a list of 34 potentially relevant studies (k = 0.915), 8 trials were included, involving over 321 (141 KET) patients. The median quality scores were 3 (interquartile range: 2-4), and two used concealed allocation. There were no baseline differences in 10-point pain scores (WMD = 0.07; 95% CI: -0.39, 0.54). KET and meperidine resulted in similar pain scores at 60 minutes (WMD = 0.31; -0.68, 1.29); however, KET was more effective than intranasal sumatriptan (WMD = -4.07; 95% CI: -6.02 to -2.12). While there was no difference in pain relief at 60 minutes between KET and phenothiazine agents (WMD = 0.82; 95% CI: -1.33 to 2.98), heterogeneity was high (I(2)  = 70%). Side effect profiles were similar between KET and comparison groups. Overall, KET is an effective alternative agent for the relief of acute migraine headache in the emergency department. KET results in similar pain relief, and is less potentially addictive than meperidine and more effective than sumatriptan; however, it may not be as effective as metoclopramide/phenothiazine agents.

20 Review The premonitory phase of migraine and migraine management. 2013

Becker, Werner J. ·Division of Neurology, University of Calgary and Alberta Health Services, Canada. ·Cephalalgia · Pubmed #22337860.

ABSTRACT: OBJECTIVE: The objective was to determine, through a literature review, whether treatment during the premonitory phase of migraine is a potentially useful migraine management strategy. METHODS: A general literature review was done with regard to the nature of migraine premonitory symptoms, their frequency, their reliability in predicting migraine attacks, and the effectiveness of medication treatment when given during the premonitory phase. RESULTS: Many different symptoms have been reported as premonitory symptoms that occur before migraine attacks. Up to 87% of patients with migraine may experience premonitory symptoms, although some studies have provided estimates as low as 33%. In selected patients, premonitory symptoms may be relatively reliable predictors of a migraine attack to follow. Both naratriptan (open-label study) and domperidone (double-blind, randomized, placebo-controlled study) have been reported to be effective when given during the premonitory phase. CONCLUSIONS: More research is needed, but there is some evidence that medication treatment during the premonitory phase has the potential to be helpful in selected patients with migraine.

21 Review Pediatric migraine teaching for families. 2012

Craddock, Lindsay / Ray, Lynne D. ·Stollery Children's Hospital, Alberta, Canada. lindsay.craddock@albertahealthservices.ca ·J Spec Pediatr Nurs · Pubmed #22463470.

ABSTRACT: PURPOSE: Child and family education regarding management of pediatric migraine is essential to reduce acute pain, prevent chronic daily migraine, and minimize the total number of headache attacks. This paper summarizes current evidence and provides a foundation for family teaching. CONCLUSIONS: Effective management of pediatric migraine can be achieved with a combination of individually tailored biobehavioral strategies, lifestyle modifications, and optimal scheduling of rescue and preventative pharmacologic treatment. PRACTICE IMPLICATIONS: Included are goal setting recommendations, common triggers, key comorbidities, lifestyle modifications, principles of pharmacologic management, commonly used naturopathic compounds, and a link to an online downloadable teaching handout.

22 Review Pacing as a treatment modality in migraine and tension-type headache. 2012

McLean, Allison / Coutts, Kathryn / Becker, Werner J. ·Foothills Medical Center, Calgary Headache Assessment and Management Program, Calgary, Alberta, Canada. allison.mclean@albertahealthservices.ca ·Disabil Rehabil · Pubmed #21980991.

ABSTRACT: PURPOSE: To review the pacing literature; describe the use of pacing in a specialty headache clinic; and provide client feedback regarding the effectiveness of pacing in headache self-management. METHOD: The evidence for this report was derived from a structured literature review, an established pacing intervention program for patients with headache, and patient self-report questionnaire. RESULTS: There are frequent references to pacing in the chronic pain and rheumatic disease literature, but no universal definition and, until recently, few outcome studies. References to pacing in the headache literature are limited. For a small sub-group of clients at a specialty headache clinic (n = 20), pacing principles taught by occupational therapists were reported to prevent increases in headache intensity (70%); decrease headache intensity (65%), and shorten the duration of a headache (40%). Additionally, 70% of respondents used pacing to prevent headache onset. Pacing was seen to contribute to increased quality of life, headache self-efficacy, function, and independence. There were a variety of opinions regarding the most helpful pacing components. The most frequently endorsed were identify and prioritize responsibilities; balance activity and rest; schedule regular rest breaks; and delegate or eliminate tasks. CONCLUSIONS: Pacing appears to play an important role in headache self-management. More pacing research is required in both headache and chronic pain populations.

23 Review High-tech family planning: reproductive regulation through computerized fertility monitoring. 2010

Genuis, Stephen J / Bouchard, Thomas P. ·Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada T6K 4C1. sgenuis@ualberta.ca ·Eur J Obstet Gynecol Reprod Biol · Pubmed #20655652.

ABSTRACT: Issues related to family planning have profound public health significance as they directly impact individuals, couples, and families throughout the world. A new method of family planning is now available using a computerized fertility monitor that accurately measures urinary surges in estrone-3-glucuronide (E3G) and luteinizing hormone (LH) prior to ovulation, thus identifying the short-lived fertile phase of the cycle and providing women with the choice to achieve or avoid conception. As well as ease of use and instruction, hand-held computerized fertility monitors are accurate and effective and can be used indefinitely. An algorithm for computerized monitoring is presented for use in situations of infrequent or irregular ovulation such as with polycystic ovarian syndrome and the post-partum period. Hormone-based fertility monitoring is compared to other computerized fertility monitoring techniques. A case series of seven reports reflecting varied clinical backgrounds and medical histories demonstrates broad-based success and high satisfaction with computerized monitoring for regulation of reproductive potential. Limitations of fertility monitoring are also discussed.

24 Review Cervicogenic headache: evidence that the neck is a pain generator. 2010

Becker, Werner J. ·University of Calgary and Alberta Health Services, Calgary, Alberta, Canada. ·Headache · Pubmed #20456156.

ABSTRACT: This review was developed as part of a debate, and takes the "pro" stance that abnormalities of structures in the neck can be a significant source of headache. The argument for this is developed from a review of the medical literature, and is made in 5 steps. It is clear that the cervical region contains many pain-sensitive structures, and that these are prone to injury. The anatomical and physiological mechanisms are in place to allow referral of pain to the head including frontal head regions and even the orbit in patients with pain originating from many of these neck structures. Clinical studies have shown that pain from cervical spine structures can in fact be referred to the head. Finally, clinical treatment trials involving patients with proven painful disorders of upper cervical zygapophysial joints have shown significant headache relief with treatment directed at cervical pain generators. In conclusion, painful disorders of the neck can give rise to headache, and the challenge is to identify these patients and treat them successfully.

25 Review Prophylaxis of migraine headache. 2010

Pringsheim, Tamara / Davenport, W Jeptha / Becker, Werner J. ·Department of Clinical Neurosciences, University of Calgary, Calgary Headache Assessment and Management Program, Foothills Medical Centre, 1403-29th St. NW, Calgary AB T2N 2T9. tmprings@ucalgary.ca ·CMAJ · Pubmed #20159899.

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