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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this paper is to present--from both a patient and neurologist perspective--the pattern of headaches over my lifetime. Migraine often does not remain static, but changes depending on internal and external stimuli. Thus, in my case, the pattern of headaches changed over the years from episodic, predominantly exertional occipital headaches with holocranial spread in late teens to chronic daily headache due to overuse of over-the-counter analgesics in young adulthood, and then to episodic migraine with occasional visual aura, and finally to menstrual migraine and frequent headaches during the perimenopausal years. Migraine sometimes provokes the development of several collateral comorbid disorders, such as mitral valve prolapse, often occurring in response to new environmental stimuli and worsening headaches. Finally, I present here my own experience with preventative therapy and how new effective abortive agents, such as the triptans, have dramatically improved my quality of life.
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PMID:The neurologist-sufferer perspective: "migraine tears me away from my life". 1507 15

Menstrual migraine is commonly encountered in women who are experiencing attacks of migraine without aura. It remains controversial whether attacks of menstrually associated migraine are more severe and have a longer duration than non-menstrually associated attacks. The pathogenesis of menstrual migraine is not understood completely, but it may be related to estrogen withdrawal or prostaglandin release. Preventative therapies may be considered in those who have failed abortive medications or have attacks lasting longer than 2 days. They can be administered short-term during the perimenstrual time period or continuously throughout the menstrual cycle. Short-term prophylactics should be tried first because menstrual migraines generally last for 1 to 4 days only. Continuous prophylactics may be considered in those with attacks refractory to short-term therapies.
Curr Pain Headache Rep 2004 Jun
PMID:Menstrual migraine: a review of prophylactic therapies. 1511 43

This article addresses interesting and enigmatic presentations of headache from a diagnostic and treatment perspective. The emphasis is on migraineurs and other headache patients who represent a significant burden for the primary care provider. In particular, the author focuses on undiagnosed migraine, menstrual migraine, migraine in pregnancy, intractable migraine and status migrainosus,transformed migraine, hemiplegic migraine, basilar migraine, "triptan syndrome," sudden onset of severe headache, post-traumatic headache, and headache in elderly patients.
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PMID:Challenging or difficult headache patients. 1517 17

Various studies have provided evidence that migraine is a multifactorial genetic disorder. The aim of the present study was to compare hereditary patterns of female students with migraine (245 subjects) and non-migraine primary headaches (1053 subjects). The prevalence study was performed combined with a case-control study. Migraineurs had significantly more frequently one or more first-degree and/or second-degree relatives with migraine. Students with menstrual migraine, in comparison with other subtypes of migraine (with the exception of premenstrual migraine), had significantly more frequently > or = 2 relatives with migraine. Among students with non-migraine primary headaches, those with menstrually related headache had more frequently relatives with migraine in comparison with students suffering from menstrually unrelated nonmigraine headache. The results obtained are in line with the results of genetic epidemiologic studies suggesting that genetic factors play a role in the occurrence of migraine.
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PMID:Hereditary patterns of Belgrade university female students with migraine and nonmigraine primary headache. 1531 2

The initial treatment of menstrual migraine (MM) should be the same as that of migraine that occurs at any other time during the month and should include lifestyle modifications and the use of appropriate acute therapies aimed at decreasing attack symptoms, duration, and disability. If results of acute therapy are incomplete or unsatisfactory, then preventive strategies may be required. Comorbidities may, however, influence choice of preventive therapy or accelerate initiation of preventive therapy. Comorbid dysmenorrhea, menometrorrhagia, and endometriosis argue for early use of hormonal therapies. Hormonal strategies may be appropriate because the premenstrual decline in estradiol concentration predictably precipitates MM, and targeting and preventing this decline can decrease headache occurrence. Continuous combined hormonal contraceptives can reduce hormone fluctuations and, for some MM sufferers, can deliver more than contraceptive benefits. Nonsteroidal anti-inflammatory drugs are appropriate for treatment of co-occurring dysmenorrhea or when hormonal strategies are contraindicated; their efficacy may be caused partly by the role of prostaglandins in MM and dysmenorrhea. As with the use of hormonal therapy, use of nonsteroidal anti-inflammatory drugs allows for treatment of breakthrough headache with triptans. Results of clinical trials suggest that daily use of triptans in the menstrual window may bring about as much as 50% reduction in headache frequency, but such use still requires acute treatment of breakthrough headache and adherence to daily triptan limits. Use of this strategy requires that headache occurrence be highly predictable.
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PMID:Menstrual Migraine. 1546 26

Two randomised, double-blind, parallel-group, placebo-controlled clinical trials were conducted to assess the efficacy of sumatriptan tablets, 50mg and 100mg, for treatment during the mild-pain phase of a menstrually associated migraine among patients who typically experienced moderate to severe migraine preceded by an identifiable phase of mild pain. Subjects (n = 403 in Study 1 and n = 349 in Study 2) treated one menstrually associated migraine on an outpatient basis. The results demonstrate that sumatriptan tablets, 50 mg or 100 mg, were significantly more effective than placebo at conferring pain-free response 1 h and 2 h post-dose; migraine-free response (i.e. no pain and no associated symptoms) 2 h post-dose; returning patients to normal functioning 2 h post-dose; and conferring sustained freedom from pain from 2 through 24 h post-dose. Although the studies were not designed or statistically powered to show differences between the sumatriptan doses, a trend for slightly higher efficacy was observed for the 100-mg dose compared with the 50-mg dose on many measures. Both doses of sumatriptan were well-tolerated. The only adverse events reported in more than 2% of subjects in a treatment group were nausea, paresthesia, dizziness and malaise/fatigue, all of which were reported at incidences comparable to or slightly higher than those with placebo. Considered in the context of other findings, these data suggest that--with menstrually associated migraine as with non-menstrual migraine--optimal therapeutic benefit of sumatriptan tablets may be realised when they are administered during the mild-pain phase of an attack rather than delaying treatment until headache is moderate or severe.
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PMID:Efficacy and tolerability of sumatriptan tablets administered during the mild-pain phase of menstrually associated migraine. 1558 68

Migraine is a common disorder that is disproportionately prevalent in women, especially during the reproductive years. Hormonal changes may play a role in the etiology of migraine, as many women note that their migraine attacks occur in temporal relationship with their menses. The Headache Classification Subcommittee of the International Headache Society has recently defined menstrual and menstrually related migraine. We review the most relevant and recent literature on menstrual migraine, with a special focus on pathophysiology and therapy. Although the pathogenesis of menstrual and menstrually related migraine is not well understood, estrogen withdrawal seems to play an important role as a trigger for menstrual migraine attacks. The therapeutic approach also may differ from the treatment of nonmenstrual migraine. Some patients do not require prophylaxis when they can abort their attacks effectively, whereas others may benefit from perimenstrual prophylaxis or standard migraine prophylaxis.
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PMID:Menstrual migraine. 1574 45

The empirical support for three behavioral treatments (relaxation, biofeedback and cognitive therapy) for managing migraine headaches in children and adults is reviewed. Meta-analyses and evidence-based reports show that these approaches are of considerable value, they appear to work equally well when applied individually, in groups or in limited contact formats. Meta-analyses comparing behavioral and prophylactic medication show equivalent results. However, outcomes are optimized when these treatments are combined. Researchers are currently seeking to identify factors predictive of response to behavioral approaches. Patients experiencing medication-overuse, refractory, cluster or post-traumatic forms of headache or comorbid conditions present special challenges that can require intensive, comprehensive and multidisciplinary approaches to treatment. Behavioral treatments have met with mixed success for menstrual migraine in the few studies that have been conducted. This review concludes by highlighting directions for future research efforts such as importing treatments to settings where headache patients most often seek care and developing algorithms for optimizing combinations of behavioral and pharmacological treatments to enhance effectiveness, reduce costs, minimize dosing requirements and improve adherence to needed medications. Other research efforts include developing treatments that target the underlying pathophysiology more directly, gaining a greater understanding of mediators and moderators of behavioral treatments, exploiting e-technology for assessment and treatment, and assessing outcome in multiple ways--such as quality of life.
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PMID:Behavioral treatment of migraine: current status and future directions. 1585 38

Extended use of oral contraceptive (OC) pills can successfully suppress endometrial activity and prevent menstruation for several months. Given that missed menses in women not using hormonal contraception may be of medical concern, understanding how hormonal contraceptives eliminate these concerns is important for both patient and healthcare provider acceptance. OC withdrawal bleeding is an artificial, iatrogenic event, which results from the deliberate, periodic interruption of hormonal support of the endometrium. Historically, it was important to provide periodic bleeding to reassure OC efficacy, but today it is recognized that these bleeding episodes are medically unnecessary and cause patient discomfort and out-of-pocket expenses. Decades of experience with prolonged use of OCs have been accumulated for women with specific menstrual-related problems such as endometriosis, dysmenorrhea, and menstrual migraine headaches. Today there is a US FDA-approved product to routinely reduce the number of withdrawal periods. Clinical trials show that there is an initial increase in unscheduled bleeding and spotting days with extended-cycle OC use, but an absolute decrease in total days of bleeding and spotting from the first cycle of use. Over time, unscheduled bleeding and spotting decreases to rates found with the use of conventional-cycle regimens. Every woman who is interested in using OC pills should be offered the opportunity to choose how to use them, to determine if and when she will have withdrawal bleeding.
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PMID:Extended-cycle oral contraception: a new option for routine use. 1589 19

Menstrual migraine is not formally recognised by the International Headache Society Diagnostic Classification, but "candidate criteria" for its diagnosis have been published. Attacks of migraine occurring in a consistent relationship with menstruation can be classified as "pure" menstrual migraine if they occur at no other time of the month, and as "menstrually related" if other attacks occur throughout the month. It remains controversial whether such attacks are longer, more severe or more difficult to treat than other attacks, but this form of migraine does lend itself to pre-emptive treatment because its timing and trigger can be anticipated. This paper reviews evidence for specific acute and pre-emptive treatment strategies, including the use of hormonal supplementation, scheduled triptans and nonsteroidal anti-inflammatory drugs.
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PMID:Menstrual migraine: clinical considerations in light of revised diagnostic criteria. 1592 8


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