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Migraine Disorders: HELP
Articles from US Federal Service
Based on 114 articles published since 2008

These are the 114 published articles about Migraine Disorders that originated from US Federal Service during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Editorial Pediatric Migraine Headache - Still Searching for Effective Treatments. 2017

Jackson, Jeffrey L. ·From the General Internal Medicine Section, Zablocki Veterans Affairs Medical Center, and the Department of Medicine, Medical College of Wisconsin - both in Milwaukee. ·N Engl J Med · Pubmed #28076719.

ABSTRACT: -- No abstract --

2 Editorial Migraine and the social selection vs causation hypotheses: a question larger than either/or? 2013

Peterlin, B Lee / Scher, Ann I. ·From the Department of Neurology (B.L.P.), Johns Hopkins University School of Medicine, Baltimore · and Department of Preventive Medicine Biometrics (A.I.S.), Uniformed Services University, Bethesda, MD. ·Neurology · Pubmed #23990406.

ABSTRACT: For decades, the question of social selection vs social causation has been raised by public health researchers and social scientists to explain the association between socioeconomic factors and mood disorders.(1,2) The social selection or "downward drift" theory postulates that the disease itself limits an individual's educational and occupational achievements, leading to a lower socioeconomic status (SES). In contrast, the social causation hypothesis suggests that factors associated with low SES (e.g., stressful life events, poor health care access) increase the likelihood of disease onset or prolonged disease duration.(3,4) Simply stated, the end result of each hypothesis is as follows:

3 Review Behavioral and cognitive animal models in headache research. 2019

Vuralli, Doga / Wattiez, Anne-Sophie / Russo, Andrew F / Bolay, Hayrunnisa. ·Department of Neurology and Algology, Gazi University Faculty of Medicine, Besevler, 06510, Ankara, Turkey. · Neuropsychiatry Center, Gazi University, Besevler, 06510, Ankara, Turkey. · Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA. · Center for the Prevention and Treatment of Visual Loss, Iowa VA Health Care System, Iowa City, IA, USA. · Department of Neurology, University of Iowa, Iowa City, IA, USA. · Department of Neurology and Algology, Gazi University Faculty of Medicine, Besevler, 06510, Ankara, Turkey. hbolay@gazi.edu.tr. · Neuropsychiatry Center, Gazi University, Besevler, 06510, Ankara, Turkey. hbolay@gazi.edu.tr. ·J Headache Pain · Pubmed #30704400.

ABSTRACT: Animal models have provided a growing body of information about the pathophysiology of headaches and novel therapeutic targets. In recent years, experiments in awake animals have gained attention as more relevant headache models. Pain can be assessed in animals using behavioral alterations, which includes sensory-discriminative, affective-emotional and cognitive aspects. Spontaneous behavioral alterations such as increased grooming, freezing, eye blinking, wet dog shake and head shake and decreased locomotion, rearing, food or water consumption observed during pain episodes are oftentimes easy to translate into clinical outcomes, but are giving little information about the localization and modality of the pain. Evoked pain response such as tactile and thermal hypersensitivity measures are less translatable but gives more insight into mechanisms of action. Mechanical allodynia is usually assessed with von Frey monofilaments and dynamic aesthesiometer, and thermal allodynia can be evaluated with acetone evaporation test and Hargreaves' test in animal models. Anxiety and depression are the most frequent comorbid diseases in headache disorders. Anxiety-like behaviors are evaluated with the open-field, elevated plus-maze or light/dark box tests. Interpretation of the latter test is challenging in migraine models, as presence of photophobia or photosensitivity can also be measured in light/dark boxes. Depressive behavior is assessed with the forced-swim or tail suspension tests. The majority of headache patients complain of cognitive symptoms and migraine is associated with poor cognitive performance in clinic-based studies. Cluster headache and tension type headache patients also exhibit a reversible cognitive dysfunction during the headache attacks. However, only a limited number of animal studies have investigated cognitive aspects of headache disorders, which remains a relatively unexplored aspect of these pathologies. Thus, the headache field has an excellent and growing selection of model systems that are likely to yield exciting advances in the future.

4 Review Efficacy and safety of levetiracetam for migraine prophylaxis: A systematic review. 2018

Watkins, A K / Gee, M E / Brown, J N. ·Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA. · Pharmacy Service, Durham VA Health Care System, Durham, NC, USA. ·J Clin Pharm Ther · Pubmed #29781197.

ABSTRACT: WHAT IS KNOWN AND OBJECTIVE: Migraine is a common and costly neurological disorder that affects approximately 1 of every 7 people annually. Pharmacological therapy for prevention of migraine is warranted when patients experience at least 6 headache days, 4 headache days with at least some impairment or 3 headache days with severe impairment or requiring bed rest in a month. Levetiracetam is an antiepileptic drug that has the potential to be beneficial for migraine prophylaxis. The objective of this review was to assess the safety and efficacy of levetiracetam for migraine prophylaxis. METHODS: A systematic search was conducted in MEDLINE (1946-August 2017), EMBASE (1947-August 2017) and CENTRAL using the terms: migraine disorders, migraine, or headache and etiracetam or levetiracetam. Animal studies, case reports, abstracts, letters to the editor and those not written in English were excluded. RESULTS AND DISCUSSION: Eleven articles were identified for inclusion. Of the studies included, 2 were retrospective chart reviews, 4 were randomized placebo- or active comparator-controlled trials, and the remaining 5 were prospective, open-label studies. All studies found a statistically significant decrease in headache frequency per month compared to baseline or placebo when used for treatment of episodic migraine (2.96-10.9 headache/mo decrease), and 57.9%-100% of patients had at least a 50% decrease in headache frequency from baseline. Significance was not consistently demonstrated in the prophylactic treatment of chronic migraine. The most common adverse effects noted included somnolence, dizziness and behavioural effects but generally did not require discontinuation. WHAT IS NEW AND CONCLUSION: The studies included in this review indicate that levetiracetam is well-tolerated and may be an alternative treatment option for episodic migraine prophylaxis. Additional clinical evidence is necessary to establish the efficacy of levetiracetam for the prophylactic treatment of chronic migraine.

5 Review Safety of hormonal contraceptives among women with migraine: A systematic review. 2016

Tepper, Naomi K / Whiteman, Maura K / Zapata, Lauren B / Marchbanks, Polly A / Curtis, Kathryn M. ·Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341. Electronic address: ntepper@cdc.gov. · Division of Reproductive Health, US Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341. ·Contraception · Pubmed #27153744.

ABSTRACT: BACKGROUND: Migraine is common among women of reproductive age and is associated with an increased risk of ischemic stroke. Combined oral contraceptives (COCs) are also associated with an increased risk of ischemic stroke. Use of hormonal contraception among women with migraine might further elevate the risk of stroke among women of reproductive age. OBJECTIVE: To identify evidence regarding the risk of arterial thromboembolism (stroke or myocardial infarction) among women with migraine who use hormonal contraceptives. METHODS: We searched the PubMed database for all articles published from database inception through January 2016. We included studies that examined women with migraine overall or separated by subtype (with or without aura). Hormonal contraceptives of interest included combined hormonal methods (COCs, patch and ring) and progestin-only methods (progestin-only pills, injectables, implants and progestin intrauterine devices). RESULTS: Seven articles met inclusion criteria. All were case-control studies of fair to poor quality reporting on use of COCs or oral contraceptives (OCs) not further described and all reported stroke outcomes. Four studies demonstrated that, among women with migraine (not separated by subtype), COC use was associated with approximately two to four times the risk of stroke compared with nonuse. The only study to examine specific migraine subtypes found an elevated risk of stroke among women with migraine with aura, and this risk was similar regardless of OC use, although these odds ratios were not reported. Two studies did not report risks among women with migraine and COC use combined, but both found increased risks of stroke with migraine and COC use independently. No evidence was found on other hormonal contraceptives or on risk of myocardial infarction. CONCLUSION: Limited evidence suggests a two- to fourfold increased risk of stroke among women with migraine who use COCs compared with nonuse. Additional study is needed on the risks of hormonal contraceptives, including combined and progestin-only methods, among women with different migraine subtypes.

6 Review Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache. 2016

Holtkamp, Matthew D / Grimes, Jamie / Ling, Geoffrey. ·Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bldg 19, 6th Floor, Neurology, Bethesda, MD, 20889, USA. Matthew.D.Holtkamp.mil@mail.mil. · Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD, USA. Matthew.D.Holtkamp.mil@mail.mil. · Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bldg 19, 6th Floor, Neurology, Bethesda, MD, 20889, USA. · Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD, USA. · Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. ·Curr Pain Headache Rep · Pubmed #27084376.

ABSTRACT: Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama's Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders.

7 Review Adipokines and Migraine: A Systematic Review. 2016

Peterlin, B Lee / Sacco, Simona / Bernecker, Claudia / Scher, Ann I. ·Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA. · University of L'Aquila, Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, L'Aquila, Italy. · Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria. · Medical University of Graz, Department of Blood Group Serology and Transfusion Medicine, Graz, Austria. · Uniformed Services University, Bethesda, MD, USA. ·Headache · Pubmed #27012149.

ABSTRACT: BACKGROUND: Migraine is comorbid with obesity. Recent research suggests an association between migraine and adipocytokines, proteins that are predominantly secreted from adipose tissue and which participate in energy homeostasis and inflammatory processes. OBJECTIVES: In this review, we first briefly discuss the association between migraine and obesity and the importance of adipose tissue as a neuroendocrine organ. We then present a systematic review of the extant literature evaluating circulating levels of adiponectin and leptin in those with migraine. METHODS: A search of the PubMed database was conducted using the keywords "migraine," "adiponectin," and "leptin." In addition reference lists of relevant articles were reviewed for possible inclusion. English language studies published between 2005 and 2015 evaluating circulating blood concentration of adiponectin or leptin in those with migraine were included. CONCLUSIONS: While the existing data are suggestive that adipokines may be associated with migraine, substantial study design differences and conflicting results limit definitive conclusions. Future research utilizing carefully considered designs and methodology is warranted. In particular careful and systematic characterization of pain states at the time of samples, as well as systematic consideration of demographic (e.g., age, sex) and other vital covariates (e.g., obesity status, lipids) are needed to determine if adipokines play a role in migraine pathophysiology and if any adipokine represents a viable, novel migraine biomarker, or drug target.

8 Review CGRP as a neuropeptide in migraine: lessons from mice. 2015

Russo, Andrew F. ·Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, 52242, USA. · Department of Neurology, University of Iowa, Iowa City, IA, 52242, USA. · Veterans Affairs Medical Center, Iowa City, IA, 52246, USA. ·Br J Clin Pharmacol · Pubmed #26032833.

ABSTRACT: Migraine is a neurological disorder that is far more than just a bad headache. A hallmark of migraine is altered sensory perception. A likely contributor to this altered perception is the neuropeptide calcitonin gene-related peptide (CGRP). Over the past decade, CGRP has become firmly established as a key player in migraine. Although the mechanisms and sites of action by which CGRP might trigger migraine remain speculative, recent advances with mouse models provide some hints. This brief review focuses on how CGRP might act as both a central and peripheral neuromodulator to contribute to the migraine-like symptom of light aversive behaviour in mice.

9 Review Antiepileptics in migraine prophylaxis: an updated Cochrane review. 2015

Mulleners, Wim M / McCrory, Douglas C / Linde, Mattias. ·Department of Neurology, Canisius Wilhelmina Ziekenhuis, The Netherlands w.mulleners@cwz.nl. · Department of Medicine, Duke University Medical Center, NC, USA Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC, USA. · Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Norway Norwegian National Headache Centre, St. Olavs University Hospital, Norway. ·Cephalalgia · Pubmed #25115844.

ABSTRACT: INTRODUCTION: The efficacy of several antiepileptics in the preventive treatment of episodic migraine in adults has been systematically reviewed. Because many trial reports have been published since then, an updated systematic review was warranted. METHODS: We searched the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE (1966 to January 15, 2013), MEDLINE In-Process (current week, January 15, 2013), and EMBASE (1974 to January 15, 2013) and hand-searched Headache and Cephalalgia through January 2013. Prospective, controlled trials of antiepileptics taken regularly to prevent the occurrence of migraine attacks, to improve migraine-related quality of life, or both, were selected. RESULTS: Mean headache frequency on topiramate and sodium valproate is significantly lower than placebo. Likewise, topiramate and divalproex demonstrated favorable results for the proportion of subjects with ≥ 50% reduction of migraine attacks. For topiramate, 100 mg and 200 mg outperformed 50 mg, but this was paralleled by a higher adverse event rate. For valproate/divalproex, a dose-effect correlation could not be established. There was no unequivocal evidence of efficacy for any of the other antiepileptics. CONCLUSION: Topiramate, sodium valproate and divalproex are effective prophylactic treatments for episodic migraine in adults. In contrast to previous reports, there is insufficient evidence to further support the use of gabapentin.

10 Review Acute migraine treatment in emergency settings. 2014

Saguil, Aaron / Lax, John W. ·Uniformed Services University of the Health Sciences, Bethesda, MD, USA. · Fort Belvoir Community Hospital Family Medicine Residency, Fort Belvoir, VA, USA. ·Am Fam Physician · Pubmed #24784338.

ABSTRACT: -- No abstract --

11 Review Vertiginous headache and its management. 2014

Chandrasekhar, Sujana S. ·New York Otology, 1421 Third Avenue, 4th Floor, New York, NY 10028, USA; James J. Peters Veterans Administration Medical Center, Bronx, NY, USA; New York Head & Neck Institute, Northshore-LIJ Medical Center, New York, NY, USA; Mount Sinai School of Medicine, New York, NY, USA. Electronic address: ssc@nyotology.com. ·Otolaryngol Clin North Am · Pubmed #24680497.

ABSTRACT: Vertiginous headache encompasses patients with dizziness or vertigo as well as headache, even though the symptoms may not occur in an obvious temporal relationship. The type of dizziness experienced by patients is different from the heavy-headedness experienced during rhinogenic headache. Patients may have a personal or family history of typical or atypical migraine. They should be evaluated for possible Meniere syndrome, migraine headaches, and/or eye movement disorders. Management is directed to treatment of the underlying abnormality. Long-term follow-up of these patients is necessary, because further otologic abnormalities may present later.

12 Review Evaluation and management of "sinus headache" in the otolaryngology practice. 2014

Patel, Zara M / Setzen, Michael / Poetker, David M / DelGaudio, John M. ·Department of Otolaryngology/Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: zara.m.patel@emory.edu. · North Shore University Hospital, New York University School of Medicine, New York, NY, USA. · Division of Otolaryngology, Department of Surgery, Zablocki VAMC, Milwaukee, WI, USA. · Department of Otolaryngology/Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA. ·Otolaryngol Clin North Am · Pubmed #24680494.

ABSTRACT: Patients, primary care doctors, neurologists and otolaryngologists often have differing views on what is truly causing headache in the sinonasal region. This review discusses common primary headache diagnoses that can masquerade as "sinus headache" or "rhinogenic headache," such as migraine, trigeminal neuralgia, tension-type headache, temporomandibular joint dysfunction, giant cell arteritis (also known as temporal arteritis) and medication overuse headache, as well as the trigeminal autonomic cephalalgias, including cluster headache, paroxysmal hemicrania, and hemicrania continua. Diagnostic criteria are discussed and evidence outlined that allows physicians to make better clinical diagnoses and point patients toward better treatment options.

13 Review Chronic headache: stop the pain before it starts. 2013

Latimer, Kelly M. ·Naval Hospital, Camp Lejeune Family Medicine Residency, North Carolina 28542, USA. kelly.latimer@med.navy.mil ·J Fam Pract · Pubmed #23520582.

ABSTRACT: Familiarity with the risks associated with medication overuse and the importance of headache prophylaxis is key to easing your patient's pain.

14 Review Contributions of epidemiology to our understanding of migraine. 2013

Merikangas, Kathleen R. ·Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD 20892, USA. ·Headache · Pubmed #23432441.

ABSTRACT: BACKGROUND: During the past decade, the introduction of the second edition of the International Classification of Headache Disorders (ICHD-II) and the initiation of active campaigns to increase awareness of the high magnitude, burden, and impact of migraine have stimulated numerous studies of population-based data on the prevalence, correlates, and impact of migraine. OBJECTIVE: This paper provides an update of the literature on the worldwide epidemiology of migraine from studies that included the ICHD-II criteria. The aims of this paper are: (1) to review evidence regarding the magnitude of migraine; (2) to summarize information on the correlates and impact of migraine; and (3) to discuss the contributions, challenges, and future directions in the epidemiology of migraine. Evidence on the magnitude of migraine is divided into the following types of data: (1) prevalence rates of ICHD-II-defined migraine and tension-type headache from international population-based studies of adults; (2) the magnitude of migraine in U.S. studies; (3) ICHD-II-based international prevalence rates of ICHD-II-defined migraine in children; and (4) incidence rates of migraine from prospective longitudinal studies. METHODS: A comprehensive review of the literature on the prevalence of migraine subtypes and tension-type headache defined by ICHD-II criteria during the past decade was conducted and aggregate weighted rates across studies were derived. RESULTS: Across the 19 studies of adults that employed the ICHD-II criteria, the aggregate weighted estimates of the 12-month prevalence of definite migraine are 11.5%, and probable migraine of 7%, yielding a total of 18.5%. The cross-study weighted aggregate rate of migraine with aura is 4.4%, chronic migraine is 0.5%, and of tension-type headache is 13%. There has been even greater growth in international prevalence data on migraine in children, with a total of 21 studies of children that have employed the ICDH-II criteria. The aggregate weighted rate of definite migraine in children is 10.1% and migraine with aura is 1.6%. The well-established demographic correlates of migraine including the equal sex ratio in childhood, with increasing prevalence of migraine in females across adolescence to mid-adulthood were confirmed in these studies. Despite increasing effort to increase awareness of migraine, approximately 50% of those with frequent and/or severe migraine do not receive professional treatment. CONCLUSIONS: This review demonstrates that the descriptive epidemiology of migraine has reached its maturity. The prevalence rates and sociodemographic correlates have been stable across 50 years. These developments justify a shift in efforts to the application of the designs and methods of analytic epidemiology. Retrospective case-control studies followed by prospective cohort studies that test specific associations are likely to enhance our understanding of the predictors of incidence and progression of migraine, subtypes of migraine with differential patterns of onset and course, and specific environmental exposures that may have either causal or provocative influences on migraine etiology.

15 Review Migraine therapeutics in adolescents: a systematic analysis and historic perspectives of triptan trials in adolescents. 2013

Sun, Haihao / Bastings, Eric / Temeck, Jean / Smith, P Brian / Men, Angela / Tandon, Veneeta / Murphy, Dianne / Rodriguez, William. ·Office of Pediatric Therapeutics, Office of Commissioner, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA. ·JAMA Pediatr · Pubmed #23359002.

ABSTRACT: OBJECTIVES To conduct a systematic review and analysis of trial data submitted to the US Food and Drug Administration (FDA) to identify possible causes for the failure of pediatric trials of triptans for treatment of migraines. DATA SOURCE The FDA website for drug information and published literature. STUDY SELECTION All pediatric efficacy and pharmacokinetics trial data of drugs used for abortive treatment of migraine submitted to the FDA from January 1, 1999, through December 31, 2011. MAIN OUTCOME MEASURES Patient demographic baseline characteristics, inclusion and exclusion criteria, trial designs, efficacy end points, and pharmacokinetic profiles were analyzed and compared across drug products. RESULTS We analyzed data for sumatriptan succinate nasal spray and zolmitriptan, eletriptan hydrobromide, almotriptan malate, and rizatriptan benzoate tablets. Seven efficacy trials had a randomized, double-blinded, placebo-controlled, parallel-group trial design. In 4 trials, patients were required to have a history of migraine attacks lasting at least 4 hours. High response rates for placebo were observed in all trials, with pain relief at 2 hours ranging from 53% to 57.5%. Nonrandomization of patients with an early placebo response design was used in the rizatriptan trial in 2011. Compared with the rizatriptan trial conducted in 1999, the 2011 rizatriptan trial reduced the placebo response rate by 6% for headache freedom at the 2-hour posttreatment end point owing to study design. The pharmacokinetic profiles between adolescents and adults were statistically similar. CONCLUSIONS High placebo response rates are consistent across all trials and may represent the principal challenge in pediatric trials of drugs for abortive treatment of migraine. Enrichment with selection of subjects with long-lasting migraine attacks is not sufficient to overcome high placebo response rates. Another enrichment strategy, the nonrandomization of patients with an early placebo response, successfully reduces the high placebo response rate for rizatriptan and is a trial design that should be considered for future pediatric trials of abortive migraine therapeutics.

16 Review Elementary visual hallucinations and their relationships to neural pattern-forming mechanisms. 2012

Billock, Vincent A / Tsou, Brian H. ·National Research Council, U.S. Air Force Research Laboratory, Wright-Patterson Air Force Base, Ohio, USA. vincent.billock.ctr@wpafb.af.mil ·Psychol Bull · Pubmed #22448914.

ABSTRACT: An extraordinary variety of experimental (e.g., flicker, magnetic fields) and clinical (epilepsy, migraine) conditions give rise to a surprisingly common set of elementary hallucinations, including spots, geometric patterns, and jagged lines, some of which also have color, depth, motion, and texture. Many of these simple hallucinations fall into a small number of perceptual geometries-the Klüver forms-that (via a nonlinear mapping from retina to cortex) correspond to even simpler sets of oriented stripes of cortical activity (and their superpositions). Other simple hallucinations (phosphenes and fortification auras) are linked to the Klüver forms and to pattern-forming cortical mechanisms by their spatial and temporal scales. The Klüver cortical activity patterns are examples of self-organized pattern formation that arise from nonlinear dynamic interactions between excitatory and inhibitory cortical neurons; with reasonable modifications, this model accounts for a wide range of hallucinated patterns. The Klüver cortical activity patterns are a subset of autonomous spatiotemporal cortical patterns, some of which have been studied with functional imaging techniques. Understanding the interaction of these intrinsic patterns with stimulus-driven cortical activity is an important problem in neuroscience. In line with this, hallucinatory pattern formation interacts with physical stimuli, and many conditions that induce hallucinations show interesting interactions with one another. Both types of interactions are predictable from neural and psychophysical principles such as localized processing, excitatory-inhibitory neural circuits, lateral inhibition, simultaneous and sequential contrast, saccadic suppression, and perceptual opponency. Elementary hallucinations arise from familiar mechanisms stimulated in unusual ways.

17 Review WITHDRAWN: Oral sumatriptan for acute migraine. 2012

McCrory, Douglas C / Gray, Rebecca N. ·Ambulatory Care (11-C), Durham VA Medical Center, 508 Fulton Street, Durham, NC, USA, 27705. ·Cochrane Database Syst Rev · Pubmed #22336784.

ABSTRACT: BACKGROUND: Migraine is a common neurovascular disorder characterized by recurrent episodes of disabling headache, autonomic nervous system dysfunction, and, in some patients, neurological aura symptoms. Sumatriptan is one of a class of selective serotonin 5-hydroxytryptamine (5-HT1B/1D) agonists (triptans) thought to relieve migraine attacks by several mechanisms, including cranial vasoconstriction and peripheral and central neural inhibition. OBJECTIVES: To describe and assess the evidence from randomized controlled trials (RCTs) concerning the efficacy and tolerability of oral sumatriptan for the treatment of a single acute attack of migraine in adults. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (Cochrane Library, Issue 4, 2001), MEDLINE (1966 through November 2001), and reference lists of articles and books. SELECTION CRITERIA: We included double-blind RCTs comparing oral sumatriptan (100 mg, 50 mg, 25 mg) with placebo, no intervention, other drug treatments, behavioral therapy, or physical therapy for the treatment of an acute attack of migraine in adults. Trials comparing different doses of sumatriptan or dosing regimens were also included. Outcomes considered were: 2-hour pain-free response, headache relief/headache intensity, and functional disability; headache recurrence; and adverse events. DATA COLLECTION AND ANALYSIS: Data were abstracted by one reviewer and over-read by the other. The two reviewers independently assessed trial quality. Information on adverse events was collected from trial reports. MAIN RESULTS: Twenty-five trials involving 16,200 participants were included. Methodological quality was generally good. Sixteen trials were placebo comparisons and showed that sumatriptan in doses of 100 mg (14 trials), 50 mg (five trials), and 25 mg (three trials) provided significantly better pain-free response (100 mg and 25 mg only), headache relief, and relief of disability at 2 hours. Numbers-needed-to-treat (NNTs) for pain-free response at 2 hours were 5.1 (3.9 to 7.1) for the 100-mg dose (n = 2221) and 7.5 (2.7 to 142) for the 25-mg dose (n = 131); there was no significant difference between the 50-mg dose and placebo for this outcome (n = 127). For headache relief at 2 hours, NNTs were 3.4 (3.0 to 4.0), 3.2 (2.4 to 5.1), and 3.4 (2.3 to 6.6) for sumatriptan 100 mg (n = 2940), 50 mg (n = 420), and 25 mg (n = 226), respectively. Precise estimates of the efficacy of the 50- and 25-mg doses relative to the 100-mg dose could not be obtained.Adverse events were more common with sumatriptan 100 mg than with placebo (risk difference [RD] = 0.14 [0.09 to 0.20]; number-needed-to-harm [NNH] = 7.1 [5.0 to 11.1]; n = 3172). RDs for the 50- and 25-mg vs. placebo comparisons were not statistically significant. AUTHORS' CONCLUSIONS: Oral sumatriptan has been shown to be an effective drug for the treatment of a single acute attack of migraine. It is well tolerated, though minor adverse events were not uncommon in the included trials. Other triptans were generally similar in efficacy and adverse events. Among non-triptan drugs, ergotamine + caffeine was significantly less effective than sumatriptan, and other drugs have been insufficiently studied to draw firm conclusions.

18 Review Comorbidity in anxiety disorders. 2010

Merikangas, Kathleen Ries / Swanson, Sonja Alsemgeest. ·Genetic Epidemiology Research Branch, Mood and Anxiety Disorders Program, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, 35 Convent Drive, MSC#3720, Bethesda, MD 20892, USA. Kathleen.Merikangas@nih.gov ·Curr Top Behav Neurosci · Pubmed #21309105.

ABSTRACT: Ever since Feinstein coined the term "comorbidity", referring to the presence of any additional coexisting ailment in a patient with a particular index disease (J Chronic Dis 23:455-468, 1970), aspects of the phenomenon have been extensively studied. The aims of this chapter are: (1) to summarize the evidence of psychiatric comorbidity in anxiety disorders from adult population-based studies; (2) to present findings from the National Comorbidity Survey Replication (NCS-R); (3) to summarize evidence of psychiatric comorbidity in anxiety disorders from child and adolescent population-based samples; (4) to provide a summary of evidence on comorbidity from family and genetic studies; and (5) to examine patterns of comorbidity between anxiety disorders and medical conditions. Throughout each of these aims, implications of the comorbidity are explored, including whether these patterns reflect a need for redefining the disorders or rather an etiologic or even causal path.

19 Clinical Trial Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine. 2017

Powers, Scott W / Coffey, Christopher S / Chamberlin, Leigh A / Ecklund, Dixie J / Klingner, Elizabeth A / Yankey, Jon W / Korbee, Leslie L / Porter, Linda L / Hershey, Andrew D / Anonymous2771008. ·From the Department of Pediatrics, University of Cincinnati College of Medicine (S.W.P., A.D.H.), and the Division of Behavioral Medicine and Clinical Psychology (S.W.P., L.A.C.), the Office for Clinical and Translational Research (L.L.K.), and the Division of Neurology (A.D.H.), Cincinnati Children's Hospital Medical Center - all in Cincinnati · the Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa, Iowa City (C.S.C., D.J.E., E.A.K., J.W.Y.) · and the National Institute of Neurological Disorders and Stroke, Bethesda, MD (L.L.P.). ·N Engl J Med · Pubmed #27788026.

ABSTRACT: BACKGROUND: Which medication, if any, to use to prevent the headache of pediatric migraine has not been established. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of amitriptyline (1 mg per kilogram of body weight per day), topiramate (2 mg per kilogram per day), and placebo in children and adolescents 8 to 17 years of age with migraine. Patients were randomly assigned in a 2:2:1 ratio to receive one of the medications or placebo. The primary outcome was a relative reduction of 50% or more in the number of headache days in the comparison of the 28-day baseline period with the last 28 days of a 24-week trial. Secondary outcomes were headache-related disability, headache days, number of trial completers, and serious adverse events that emerged during treatment. RESULTS: A total of 361 patients underwent randomization, and 328 were included in the primary efficacy analysis (132 in the amitriptyline group, 130 in the topiramate group, and 66 in the placebo group). The trial was concluded early for futility after a planned interim analysis. There were no significant between-group differences in the primary outcome, which occurred in 52% of the patients in the amitriptyline group, 55% of those in the topiramate group, and 61% of those in the placebo group (amitriptyline vs. placebo, P=0.26; topiramate vs. placebo, P=0.48; amitriptyline vs. topiramate, P=0.49). There were also no significant between-group differences in headache-related disability, headache days, or the percentage of patients who completed the 24-week treatment period. Patients who received amitriptyline or topiramate had higher rates of several adverse events than those receiving placebo, including fatigue (30% vs. 14%) and dry mouth (25% vs. 12%) in the amitriptyline group and paresthesia (31% vs. 8%) and weight loss (8% vs. 0%) in the topiramate group. Three patients in the amitriptyline group had serious adverse events of altered mood, and one patient in the topiramate group had a suicide attempt. CONCLUSIONS: There were no significant differences in reduction in headache frequency or headache-related disability in childhood and adolescent migraine with amitriptyline, topiramate, or placebo over a period of 24 weeks. The active drugs were associated with higher rates of adverse events. (Funded by the National Institutes of Health; CHAMP ClinicalTrials.gov number, NCT01581281 ).

20 Clinical Trial Throbbing pain is related to Queckenstedt's test effect in migraine patients. 2009

Chou, C-H / Fuh, J-L / Hu, H-H / Wu, J-C / Wang, S-J. ·Department of Neurology, Yuan-Shan Veterans Hospital, Yi-Lan, Taiwan. ·Cephalalgia · Pubmed #19055510.

ABSTRACT: The Queckenstedt's (Q)-test can aggravate headache intensity during migraine attacks (Q-test effect). The objective of this study was to delineate the Q-test effect in patients experiencing migraine attacks. We performed a 30-s Q- and a sham test on 39 patients with acute migraine attacks in both supine and sitting positions. Headache intensities during and 30 s after the Q- or sham tests were recorded on a 0-10 verbal scale. Brushing allodynia (BA) was recorded after using a gauze-brushing test over the patient's face and forearms. The Q- but not the sham test aggravated headache intensity in both sitting and supine positions. The presence of throbbing pain and higher pain intensities was associated with the Q-test effect in the supine position. However, the presence or absence of BA was not correlated. We concluded that the Q-test effect is likely to be related to peripheral sensitization of the meninges but not central sensitization. The Q-test effect may be used as an objective marker for peripheral sensitization.

21 Article Emergency Department Use of Intravenous Prochlorperazine for Acute Migraine. 2018

Cook, Calli / Newberry, Brittany. ·Emory Brain Health Center, and Department of Neurology, The Atlanta VA Medical Center, Atlanta, Georgia (Ms Cook) · and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Newberry). ·Adv Emerg Nurs J · Pubmed #30059368.

ABSTRACT: The Research to Practice Column is designed to improve translational research critique skills of nurse practitioners (NPs). In this issue, the article "Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine" is discussed in the context of a patient with an acute headache presenting to the emergency department (ED). The study was designed to assess the efficacy of intravenous prochlorperazine and diphenhydramine as compared with intravenous hydromorphone for patients with acute migraine in the ED. With the growing trend to avoid the use of opiates to curb potential addiction and increased ED length of stay, NPs need to be aware of efficacious, evidence-based treatments for acute migraines, a common ED presentation.

22 Article One-Day Behavioral Intervention for Distressed Veterans with Migraine: Results of a Multimethod Pilot Study. 2018

Huddleston, C / Martin, L / Woods, K / Dindo, L. ·Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX. · Department of Medicine, Section of Health Services Research, Baylor College of Medicine, One Baylor Plaza, Suite 011D, Houston, TX. · Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, 2450 Holcombe Blvd, Houston, TX. ·Mil Med · Pubmed #29420786.

ABSTRACT: Introduction: Migraine, a chronic neurological disorder characterized by episodic severe headache pain and functional impairment, affects approximately 12% of the general US population. Veterans returning from Iraq or Afghanistan have two to four times the incidence of migraine of the general population. Veterans with migraines are more than twice as likely to have comorbid psychiatric conditions as veterans without migraines, with depression and post-traumatic stress disorder being most prevalent. This psychiatric-migraine comorbidity is of major public health significance, as it leads to decreased quality of life, poorer response to migraine and mental health treatment, and overall worse prognosis. Unfortunately, acceptable and effective treatments for these comorbid problems have rarely been investigated. The aims of this study are to examine the acceptability, feasibility, and preliminary efficacy of a 1-d acceptance and commitment therapy (ACT) plus Migraine Education workshop. Method: Twenty-five veterans with migraines and co-occurring depression and/or anxiety completed the 1-d ACT plus Migraine Education workshop. Veterans completed assessments of depressive and anxiety symptoms, general functioning, headache-related disability, and ACT-specific skills at baseline and 3 mo after the workshop. Changes from baseline to 3-mo follow-up on the self-report and clinician-rated measures were assessed using the paired t-test and Wilcoxon signed-rank test. Veterans also completed semistructured qualitative interviews documenting their experiences with the workshop 2 wk and 3 mo following the intervention. Qualitative data were analyzed via directed content analysis. Individual codes were aggregated into larger themes agreed upon by consensus. Results: At 3-mo follow-up, veterans significantly improved in depressive and anxiety symptoms, general functioning, and headache-related disability compared with baseline. Additionally, veterans significantly improved in pain acceptance and engagement in valued life areas. In interviews, veterans indicated that the migraine education helped them feel more knowledgeable about their condition, and this empowered them to better manage their headaches, including talking to their physician about medication adjustments. The ACT component led to greater awareness of the role stress plays in exacerbating pain and ways to manage this stress, including greater acceptance and greater engagement in valued life activities. For some, however, the role of stress in exacerbating migraines needed to be highlighted more. Veterans appreciated being in a group with other veterans with similar health difficulties and wanted this to be incorporated into ongoing care at the Veterans Affairs medical center. The patient education manuals were useful to the veterans, with some referring to them during the months following the workshop. Conclusion: Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. A 1-d ACT plus Migraine Education workshop is an acceptable and feasible treatment approach for veterans with migraines and significant distress. Significantly reduced distress and disability, as well as improved coping skills, suggest that veterans were activated to engage more fully in their lives and clinical care. The availability of an effective transdiagnostic intervention that can be completed in 1 d is particularly valuable for veterans who have multiple comorbid conditions and who encounter practical barriers to engaging in the usual prescribed weekly therapy treatments.

23 Article A sixteen-week three-armed, randomized, controlled trial investigating clinical and biochemical effects of targeted alterations in dietary linoleic acid and n-3 EPA+DHA in adults with episodic migraine: Study protocol. 2018

Mann, John Douglas / Faurot, Keturah R / MacIntosh, Beth / Palsson, Olafur S / Suchindran, Chirayath M / Gaylord, Susan Ann / Lynch, Chanee / Johnston, Angela / Maiden, Kristen / Barrow, David A / Hibbeln, Joseph R / Ramsden, Christopher E. ·Department of Neurology, UNC, 2133 Physicians Office Bld, 170 Manning Drive, Chapel Hill, NC 27599-7025, United States. Electronic address: mannj@neurology.unc.edu. · Department of Physical Medicine and Rehabilitation, UNC School of Medicine, 171 Wing D, C.B.#7200, 170 Manning Drive, Chapel Hill, NC 27599-7200, United States. Electronic address: faurot@med.unc.edu. · UNC Healthcare Department of Nutrition & Food Services - Metabolic & Nutrition Research Core, 102 Mason Farm Rd., CB#7777, Chapel Hill, NC 27599, United States. Electronic address: beth.macintosh@unchealth.unc.edu. · Department of Medicine, 4111 Bioinformatics Building, Campus Box 7080, 130 Mason Farm Rd., Chapel Hill, NC 27599-7080, United States. Electronic address: opalsson@med.unc.edu. · Department of Biostatistics, Gillings School of Global Public Health, CB # 7420, 3103-A, McGavran-Greenberg Hall, Chapel Hill, NC 27599-7420, United States. Electronic address: suchi@bios.unc.edu. · Department of Physical Medicine and Rehabilitation, UNC School of Medicine, 183 Wing D, C.B.#7200, 170 Manning Drive, Chapel Hill, NC 27599-7025, United States. Electronic address: gaylords@med.unc.edu. · Department of Physical Medicine and Rehabilitation, UNC School of Medicine, 183 Wing D, C.B.#7200, 170 Manning Drive, Chapel Hill, NC 27599-7025, United States. Electronic address: chanee_lynch@med.unc.edu. · North Carolina Department of Agriculture and Consumer Services, 2 West Edenton St., Raleigh, NC 27601, United States. Electronic address: angela.johnston@ncagr.gov. · Lipid Mediators, Inflammation, and Pain Unit, Laboratory of Clinical Investigation, National Institute on Aging, NIH, 251 Bayview Blvd., Baltimore, MD 21224, United States. Electronic address: kristen.maiden@nih.gov. · UNC Cytokine Analysis Facility, North Carolina Oral Health Institute, 3412 Koury Oral Health Sciences Bldg., CB #7455, Chapel Hill, NC 27599-7455, United States. Electronic address: David_Barrow@unc.edu. · Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, NIH, 5625 Fishers Lane, Room 3N-07, Rockville, MD 20892, United States. Electronic address: jhibbeln@mail.nih.gov. · Lipid Mediators, Inflammation, and Pain Unit, Laboratory of Clinical Investigation, National Institute on Aging, NIH, 251 Bayview Blvd., Baltimore, MD 21224, United States; Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD 20892, United States; Department of Physical Medicine and Rehabilitation, UNC School of Medicine, 171 Wing D, C.B.#7200, 170 Manning Drive, Chapel Hill, NC 27599, United States. Electronic address: chris.ramsden@nih.gov. ·Prostaglandins Leukot Essent Fatty Acids · Pubmed #29413360.

ABSTRACT: Migraine is a prevalent neurological disorder, affecting over 16% of adult women and 7% of adult men in the U.S., causing significant pain, disability, and medical expense, with incomplete benefits from conventional medical management. Migraine, as a chronic pain syndrome, provides a practical model for investigating the impact of dietary modifications in omega-3 (n-3) and omega-6 (n-6) fatty acids. This paper reports the protocol of a trial to assess whether targeted dietary modifications designed to increase n-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), with or without concurrent reduction in n-6 linoleic acid (LA), will alter nociceptive lipid mediators and mediate decreases in frequency and severity of migraine. This prospective, randomized, controlled trial in 153 male and female adult subjects, ages 18-99, with diagnosed and actively managed episodic migraine tests the efficacy, safety, and biochemical effects of targeted, controlled alterations in dietary omega-3 and omega-6 fatty acids. Participants are masked to diet hypotheses and all assessors are masked to treatment assignment. Following a four-week baseline period, participants with migraine headache frequency of 5-20 per month are randomized to one of three intensive dietary regimens for 16 additional weeks followed by a less intensive observation period. Dietary intervention arms include: 1) increased n-3 EPA+DHA with low n-6 linoleic acid (H3 L6); 2) increased n-3 EPA+DHA with usual US dietary intake of n-6 linoleic acid (H3 H6); and 3) usual US dietary content of n-3 and n-6 fatty acids (L3 H6). During the actual intervention, subjects receive content-specific study oils and foods sufficient for two meals and two snacks per day, as well as dietary counseling. Biochemical and clinical outcome measures are performed at intervals throughout this period. This randomized controlled trial is designed to determine whether targeted alterations in dietary n-3 and n-6 fatty acids can alter nociceptive lipid mediators in a manner that decreases headache pain and enhances quality of life and function in adults with frequent migraines. TRIAL REGISTRATION: NCT02012790.

24 Article Group Education and Multidisciplinary Management for Chronic Headaches Among Adolescents in a Military Treatment Facility: A Retrospective Chart Review. 2018

Ormond, Andrew / Faux, Brian M / Zickefoose, Betty A / Aden, James / Kapunan, Patricia E / Roberts, Timothy A. ·Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA. · Department of Biostatistics and Epidemiology, Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA. ·Headache · Pubmed #29411353.

ABSTRACT: OBJECTIVE: To assess the effect of group education on the frequency of chronic headaches among adolescents. BACKGROUND: Chronic headaches are a common problem among adolescents with significant psychosocial morbidity. Brief education on lifestyle interventions to decrease headache frequency has established benefits among adult patients but is less proven among adolescents. METHODS: This study is a chart review examining our experience with a group education program for 155 adolescents, aged 12-17 years old, enrolled in the U.S. military medical system with at least 3 months of chronic headaches who were referred to a headache evaluation clinic. The primary outcome of our study was self-reported number of days with a headache in the previous 30 days based on patient recall. We used a paired samples t-test to measure the change in headache frequency between the frequency reported at the headache class and follow-up more than 6 months after the class. RESULTS: Most of the adolescents seen in the program were female (114/155 [73.5%]) and suffered from migraine headaches (108/155 [69.8%]). Severe headache-related disability was reported by 40.6% of subjects (63/155). Subjects reported an average of 19 days with headache during the previous 30 days. Females and patients with higher headache-related disability reported a higher number of days with headache. Participation in the group education was associated with an 11.5 (SD 11.9, P < .001) day decrease in the frequency of headaches during the previous 30 days at follow-up at least 6 months after the class, with largest decline seen in patients with the highest level of migraine-related disability at baseline. CONCLUSION: Based on our retrospective chart review study, group education on headache evaluation and lifestyle management has potential as an effective, low-cost intervention for treatment of chronic headaches among adolescents.

25 Article Benign Headache Management in the Emergency Department. 2018

Long, Brit J / Koyfman, Alex. ·Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas. · Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas. ·J Emerg Med · Pubmed #29395690.

ABSTRACT: BACKGROUND: Headache is a common complaint managed in the emergency department (ED), with emergency physicians focusing on evaluation for life-threatening conditions while treating pain and nausea. OBJECTIVE: This review evaluates the treatment of benign, primary headaches in the ED, with recommendations provided based on the literature. DISCUSSION: Headaches are a major cause of disability in the United States and a common condition managed in the ED. The primary objectives of emergency evaluation of these patients include evaluation for a life-threatening, secondary cause of headache, with treatment of primary headaches. Close evaluation for a secondary cause of headache include consideration of red flags and focused neurologic examination. The diagnosis of primary headaches is clinical. Literature has evaluated medication efficacy in headache treatment, with antidopaminergic medications demonstrating high rates of efficacy when used in combination with nonsteroidal inflammatory drugs or acetaminophen. Dexamethasone can be used for the reduction of headache recurrence. If dehydration is present, intravenous fluids should be provided. Diphenhydramine is not recommended for analgesia but may reduce akathisia associated with prochlorperazine. Ketamine, propofol, and nerve blocks demonstrate promise. Triptan agents are also efficacious, provided absence of contraindications. Most patients are appropriate for discharge with pain improvement. CONCLUSIONS: A variety of medications is available for the treatment of primary headaches in the ED. Antidopaminergic agents demonstrate the highest efficacy and should be provided with acetaminophen and nonsteroidal inflammatory drugs. Dexamethasone may reduce headache recurrence. Other treatments include ketamine, propofol, and nerve blocks.