Prophylatic treatment of migraine and migraine clinical variants with topiramate: an update

Migraine and migraine variants are common, chronic and incapacitating neurovascular disorders with a high impact on health resources. There is an extensive evidence base provided by double-blind, placebo-controlled trials showing that topiramate is a safe, effective and well tolerated drug in the management of migraine and its variants, being especially promising in the management of migraine-vertigo syndrome. Models both in the US and the UK have also shown that it offers a cost benefit when direct and indirect costs are evaluated, by reducing work loss, improving quality of life and reducing the use of increasingly scarce health resources

SUNCT syndrome responding absolutely to steroids in two cases with different etiologies

SUNCT is a syndrome of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. We are presenting now two cases absolutely responders to steroid therapy, one of them a SUNCT-like secondary to a prolactinoma and the other primary.Fil: Figuerola, Maria de Lourdes. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Bruera, Osvaldo. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Pozzo, María Josefina. Hospital Alemán; ArgentinaFil: Leston, Jorge. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentin

Plasma melatonin pattern in chronic and episodic headaches. Evaluation during sleep and waking

To look for a relationship between pineal function in chronic migraine (CM), cluster headache (CH) (during active and remission periods), chronic tension-type headache (CTTH) patients and controls during NREM sleep, REM sleep and waking, we performed serial sampling of plasma melatonin in the different sleep stages during the first half of the night, in order to avoid chronobiological interferences. Plasma melatonin levels did not show a normal curve either in the CTTH or in the CM patients and no significant differences between these groups were found in any of the sleep stages studied. Plasma melatonin values of CH patients during the cluster period showed an abnormal pattern. The curve showed a pathological lack of peaks during the active period, melatonin levels remaining within normal daytime range throughout the study. A trend to normalization of the curve during the remission period was observed. On the basis of these different melatonin secretion patterns, it might be hypothesized that the involvement of the hypothalamus in chronic-type headaches differs from that displayed in episodic forms

Burden and attitude to resistant and refractory migraine

Background: New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standar