Rapid Responders to Frovatriptan in Acute Migraine Treatment: Results from a Long-Term, Open-Label Study

Background. the Chronic Nature of Migraine and the Reliance on Acute Treatment Constitute the Basis of the Present Long-Term, Open-Label Study. Objectives. First, Assessment of the Tolerability and Safety of Frovatriptan, 2.5-7.5 Mg Taken Orally over 24 Hours, for the Acute Treatment of Migraine, Repeatedly over a 12-Month Period. Second, Assessment of the Efficacy and Tolerability of a Second, Double-Blind Dose of 2.5-Mg Frovatriptan, Compared with Placebo, for Nonresponse at 2 Hours after Treatment of Moderate or Severe Headache with 2.5-Mg Frovatriptan. Results. with Regard to the First Attack Treated, 173 (36%) of the 486 Subjects in the Study Did Not Take a Second Dose at 2 Hours for Nonresponse. at 2 Hours and 4 Hours, These Rapid Responders Experienced a Decrease in Headache Intensity from Moderate or Severe to Mild or No Pain in 84% and 98%, Respectively ( Headache Response ). Six Percent of Them Experienced Recurrence of Moderate or Severe Headache within 24 Hours Following a Response at 4 Hours and 12% Took Rescue Medication. the Response, Measured in Terms of Median Time to Complete Migraine Relief, Was Maintained over 30 Subsequent Migraine Attacks, Treated from Attack 2 Onwards over the Course of 12 Months. Conclusion. Frovatriptan Provides a Remarkably Fast and High Headache Response in a Subgroup of More Than One-Third of Migraineurs, with a Very Low 24-Hour Headache Recurrence and Low Rescue Medication Intake. © 2009 American Academy of Pain Medicine

Chronic paroxysmal hemicrania in paediatric age: report of two cases

Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as trigeminal autonomic cephalalgia (TACs). CPH is characterised by short-lasting (2–30 min), severe and multiple (more than 5/day) pain attacks. Headache is unilateral, and fronto-orbital-temporal pain is combined with cranial autonomic symptoms. According to the International Classification of Headache Disorders, 2nd edition, the attacks are absolutely responsive to indomethacin. CPH has been only rarely and incompletely described in the developmental age. Here, we describe two cases concerning a 7-year-old boy and a 11-year-old boy with short-lasting, recurrent headache combined with cranial autonomic features. Pain was described as excruciating, and was non-responsive to most traditional analgesic drugs. The clinical features of our children’s headache and the positive response to indomethacin led us to propose the diagnosis of CPH. Therefore, our children can be included amongst the very few cases of this trigeminal autonomic cephalgia described in the paediatric age

A review of diagnostic and functional imaging in headache

The neuroimaging of headache patients has revolutionised our understanding of the pathophysiology of primary headaches and provided unique insights into these syndromes. Modern imaging studies point, together with the clinical picture, towards a central triggering cause. The early functional imaging work using positron emission tomography shed light on the genesis of some syndromes, and has recently been refined, implying that the observed activation in migraine (brainstem) and in several trigeminal-autonomic headaches (hypothalamic grey) is involved in the pain process in either a permissive or triggering manner rather than simply as a response to first-division nociception per se. Using the advanced method of voxel-based morphometry, it has been suggested that there is a correlation between the brain area activated specifically in acute cluster headache — the posterior hypothalamic grey matter — and an increase in grey matter in the same region. No structural changes have been found for migraine and medication overuse headache, whereas patients with chronic tension-type headache demonstrated a significant grey matter decrease in regions known to be involved in pain processing. Modern neuroimaging thus clearly suggests that most primary headache syndromes are predominantly driven from the brain, activating the trigeminovascular reflex and needing therapeutics that act on both sides: centrally and peripherally