Cardiovascular safety of triptans in the acute treatment of migraine

The article highlights the issues of safety when using triptans in the treatment of migraine and the risks of cardiovascular complications. Results of a large prospective population study are provided demonstrating that triptans in patients with migraine are not associated with a significantly increased risk of cardiovascular events

Fibromyalgia: development of symptoms and principles of therapy

Fibromyalgia is one of the most complex problems of clinical practice. Despite its high prevalence rates in the population and high medical visit rates, fibromyalgia is maldiagnosed. Its clinical symptom development, nosological independence, and the choice of priority treatments are debatable questions. By now the number of randomized trials dealing with the efficiency of treatment for fibromyalgia has substantially increased. This permits the identification of its treatment priorities

Medication-induced headache: pathogenesis, diagnosis and treatment

Medication-induced headache (MIH) is one of the most common forms of chronic headache (HA), management of patients with MIH remains an urgent problem of the modern healthcare. MIH is defined as HA lasting for more than 15 days per month for over 3 months against a background of excessive use of drugs for relief of HA. Epidemiological data, current diagnostic criteria, risk factors, pathophysiology and treatment of MIH are described. Risks and causes of recurrence, and prognosis of the disease are described. The only effective strategy for the management of patients is withdrawal of the drug that caused MIH. For the purpose of managing MIH and its different symptoms, a variety of symptomatic drugs with the exception of the class of drugs that caused MIH may be prescribed. The focus is on Excedrin - a combination analgesic which proved effective in the acute phase of drug withdrawal. For most patients, detoxification and preventive therapy on an outpatient basis may be feasible. An important role belongs to educational programs devoted to the aspects of MIH formation and transformation of HA to chronic

Cervicogenic headache

The article review literature on cervicogenic headache (CGH). Nosological independence of CGH still remains a subject of numerous debates. Presently, the type of headache (cephalgia) should be considered a syndrome. Current diagnostic criteria for CGH are provided. The pathophysiology, differential diagnosis with primary and secondary cephalgias and the main treatment approaches are discussed. The modern concept of CGH is based on anatomical and functional relationship between trigeminal and upper cervical structures as confirmed by clinical and experimental studies. The preference is given to the use of conservative treatment methods, such as non-steroidal anti-inflammatory drugs in combination with manual therapy and therapeutic exercise

Chronobiological features of primary headaches and the role of melatonin in the regulation of biological rhythms

Frequency is considered as a key sign of the course of some forms of primary headaches (PH). One of the most prominent representatives is the hypnical and cluster headache, which predetermined their name. Clinical observations demonstrate a clear circadian rhythm and seasonal pattern of cluster headache (CH) and migraine (M) attacks. In accordance with modern concepts, the phenomenon of the periodicity of painful episodes of a number of forms of primary headaches is associated with dysfunction of the suprachiasmatic nucleus of the hypothalamus, the main pacemaker of biological rhythms. The connection of PH with chronopathology is confirmed by revealing the disturbances of melatonin secretion in CH and M. Melatonin has proven to be effective in treatment of these PH