Cinnarizine for the prophylaxis of migraine associated vertigo: a retrospective study

Abstract Objective To assess the efficacy and safety of cinnarizine for the prophylaxis of migraine associated vertigo in the vestibular migraine and migraine with brainstem aura. Background Vestibular migraine and migraine with brainstem aura are two principal clinical syndromes that frequently are associated with vertigo. Since cinnarizine is a well-tolerated calcium channel blocker which has acceptable effect on both vertigo and migraine headache, we carried out this study to evaluate the efficacy and safety of this medication in vestibular migraine and also migraine with brainstem aura associated with vertigo. Methods This was a retrospective, single-center, open-label, investigation of the effects of cinnarizine on vestibular migraine and migraine with associated with vertigo. We assessed the change in monthly frequency of vertigo and also frequency, duration and intensity of migraine attacks after one, two and three months of cinnarizine administration. Results The mean frequency of vertigo and also the mean frequency, duration and intensity of migraine headaches per month were reduced significantly after three months of cinnarizine therapy (all p &lt; 0.001). Conclusion This study suggests that cinnarizine is safe and effective in reducing both headache and vertigo aspects of “migraine plus vertigo” among the patients who suffer from either vestibular migraine or migraine with brainstem aura associated with vertigo. </jats:sec

A computerized expert system for diagnosing primary headache based on International Classification of Headache Disorder (ICHD-II)

BACKGROUND: The authors developed a computerized program designed to diagnose primary headache based on international classification of headache disorders, 2nd edition (ICHD-II) criteria for use by physicians. METHODS: An appropriate questionnaire was designed according to the ICHD-II criteria for all types of primary headaches and the computerized system provided diagnosis based on the criteria. The software was tested by analyzing 80 patients, recruited from an outpatient headache clinic, affected by primary headache. Each patient with a unique card number was interviewed up to 15 minutes. At the end of each day, software and neurologist diagnoses were evaluated for each patient. RESULTS: Of 80 patients, the software was able to come up with correct results in 78 cases. The age of the patients ranged from 30 to 80 years old. Migraine headache accounted for 71 cases, five patients had tension type headache, and 2 had cluster headaches; all were correctly diagnosed by software. Two cases were not concordant with the neurologist’s diagnosis. The neurologist diagnosed these two cases as “Medical overuse syndrome headache” and “cluster headache”, which our software was not able to diagnosis them. CONCLUSIONS: This software permitted the diagnosis of more than 97% of the patients similar to the physician's. We hope this questionnaire and applying the software to diagnose headache based on ICHD could be of help to better the diagnosis of headaches. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/2193-1801-2-199) contains supplementary material, which is available to authorized users

Prevalence of new-onset migraine in patients with idiopathic intracranial hypertension in comparison to the general population

Background: Idiopathic intracranial hypertension (IIH) encompasses patients with elevated intracranial pressure (ICP). Generally, it is difficult to make a differential diagnosis between IIH and co-existing migraine headaches. Thus, this article intends to estimate the prevalence of migraine in patients with IIH and explain the occurrence of new-onset migraine after the diagnosis of IIH. &#x0D; Methods: The case group included 108 patients with IIH referred to the neurology wards of three university hospitals. A random sample of controls (n = 103) were recruited from patients hospitalized in the surgery and orthopedics ward. A checklist for migraine diagnosis was filled out. Cerebrospinal fluid (CSF) pressure and presence or absence of papilloedema (PE) in the patients and any necessary data were also recorded from the inpatient medical documents. All statistical analyses were done by SPSS software.&#x0D; Results: There were 70 (64.80%) and 22 (21.40%) migraineurs in the case and control groups, respectively, and the difference was found to be &#x0D; significant (P &lt; 0.001). In 26 (37.14%) migraine cases in the IIH group, the disorder was diagnosed after developing IIH. Also, there was a past medical history of having migraine in 44 (62.85%) migraineurs. In the fully adjusted regression models, the odds of being affected by migraine in patients with IIH was 6.17 times greater than the controls [odds ratio (OR) = 7.15, 95% confidence interval (CI) = 3.56-14.36, P &lt; 0.010]. The patients’ mean CSF opening pressure was 32.10 ± 1.03 cmH2O and 93 (81.60%) subjects were found to have PE.&#x0D; Conclusion: It was demonstrated that subjects with IIH might have about a 6-time higher likelihood of developing migraine headache than the general population. These considerations can help prevent misdiagnosis of migraine headache as the recurrence of IIH or uncontrolled IIH and subsequent inappropriate management.</jats:p