James A. Charles

Prevention of Migraine With Olmesartan in Patients With Hypertension/Prehypertension

Objective.—To explore the effects of olmesartan on frequency and severity of migraine attacks in patients with comorbid hypertension and prehypertension.

Ischemic colitis associated with naratriptan and oral contraceptive use

Ischemic colitis has not been reported in association with naratriptan therapy. We describe the occurrence of ischemic colitis in a patient who was treated with abortive doses of naratriptan for migraine and was also taking long‐term oral contraceptives. Concurrent use of naratriptan and oral contraceptives should probably be avoided.

Almotriptan in the acute treatment of migraine in patients 11-17 years old: an open-label pilot study of efficacy and safety.

The objective was to investigate the safety and efficacy of almotriptan in patients aged 11–17 years old with acute migraine. Fifteen patients aged 11–17 with a history of migraine with or without aura were treated with almotriptan. Reduction in headache severity, disability and adverse effects were studied. Almotriptan in doses ranging from 6.25 to 12.5 mg was well tolerated. There were virtually no adverse effects except for one case of transient mild stiffness. Of the 15 patients, only 2 demonstrated no efficacy without adverse effects. In the other 13 patients, not only was almotriptan effective, but again, no significant adverse effects were reported. Almotriptan is probably safe and effective in patients aged 11–17. This small open–label pilot study should support the feasibility of a large randomised controlled study to demonstrate tolerability and efficacy of almotriptan in children and adolescents with episodic migraine.

Favorable outcome of early treatment of new onset child and adolescent migraine-implications for disease modification

There is evidence that the prevalence of migraine in children and adolescents may be increasing. Current theories of migraine pathophysiology in adults suggest activation of central cortical and brainstem pathways in conjunction with the peripheral trigeminovascular system, which ultimately results in release of neuropeptides, facilitation of central pain pathways, neurogenic inflammation surrounding peripheral vessels, and vasodilatation. Although several risk factors for frequent episodic, chronic, and refractory migraine have been identified, the causes of migraine progression are not known. Migraine pathophysiology has not been fully evaluated in children. In this review, we will first discuss the evidence that early therapeutic interventions in the child or adolescent new onset migraineur, may halt or limit progression and disability. We will then review the evidence suggesting that many adults with chronic or refractory migraine developed their migraine as children or adolescents and may not have been treated adequately with migraine-specific therapy. Finally, we will show that early, appropriate and optimal treatment of migraine during childhood and adolescence may result in disease modification and prevent progression of this disease.

Observations of the "carry-over effect" following successful termination of chronic migraine in the adolescent with short-term dihydroergotamine, dexamethasone and hydroxyzine: a pilot study.

Chronic migraine management almost always requires daily oral preventative medication with potential adverse effects. Daily oral preventative therapy may also not be effective in terminating chronic migraine. Chronic central sensitisation caused by repetitive migraine attacks in a young person may lower the threshold for future migraine episodes leading to an intractable and debilitating disease course. The objective was to determine if short–term parenteral dihydroergotamine, dexamethasone and hydroxyzine can terminate chronic migraine and be followed by a continuous respite or conversion to a more benign episodic form without the need for daily oral preventative medication (“carry–over effect”). We treated ten patients, seven adolescents and three adults, with parenteral dihydroergotamine, dexamethasone and hydroxyzine given once a week for a maximum of three weeks. No oral preventative daily medication was administered. The setting was a private practice. Chronic migraine was terminated in all 7 adolescents. Their post–treatment course was converted to a more benign episodic migraine course and no adolescent required daily oral migraine preventative therapy for significantly long carry–over post–treatment observational periods. None of the three adult chronic migraine cases could be terminated satisfactorily as they all required daily oral preventative therapy. In the adolescent group only, this strategy terminated chronic migraine and resulted in a significant carry–over effect that appeared to favourably modify the long–term course without the need for daily pharmacological, potentially toxic, preventive therapy. Although this is a very small study, which requires confirmation by a larger controlled study, our data suggest a significant carryover effect in the young migraineur by administering short–term parenteral dihydroergotamine, dexamethasone and hydroxyzine.

Outpatient home-based continuous intravenous dihydroergotamine therapy for intractable migraine.

(Headache 2010;50:852‐860)

EMG/NCS in the evaluation of spine trauma with radicular symptoms

SummaryIn the management of spine trauma with radicular symptoms (STRS), EMG/nerve conduction studies (NCS) often have low combined sensitivity and specificity in confirming root injury. The anatomic level of injury may not correspond to the root level. Paraspinal studies are nonlocalizing and can be falsely positive and negative. Unlike MRI and CT imaging, EMG/NCS do not reveal the biological morphology of the lesion. There are no studies that confirm the efficacy of EMG/NCS in the management of STRS. EMG/NCS may be indicated if there is a differential diagnosis between a root and distal neuropathic/myopathic lesion. Otherwise, as shown in this series of cases typically referred for outpatient EMG/NCS testing, there is limited evidence to support the use of often uncomfortable and costly EMG/NCS in STRS.

Disease-modifying drugs for multiple sclerosis in pregnancy: A systematic reviewAuthor Response

Based on fair quality Level 3 evidence, Lu et al.1 note that glatiramer acetate (GA) exposure was not associated with lower mean birthweight, lower mean gestational age, preterm birth (37 weeks), congenital anomaly, or spontaneous abortion. However, GA was given an indeterminate recommendation because further research is needed. The results are not compelling: 3 of the 4 existing human studies of GA were small case series.1

Ischemic Colitis Associated With Naratriptan and Oral Contraceptive Use: A Rebuttal

Ischemic colitis has not been reported in association with naratriptan therapy. We describe the occurrence of ischemic colitis in a patient who was treated with abortive doses of naratriptan for migraine and was also taking long-term oral contraceptives. Concurrent use of naratriptan and oral contraceptives should probably be avoided.

Neurogenic orthostatic hypotension with critical illness neuropathy treated with droxidopa

☆ Dr. Allen contributed to the drafting and editing; drafting and editing; Dr. Papadopoulos contributed to the contributed to the drafting, editing, and all final decisio interest; Dr. Charles has no conflict of interest; Dr. Pa interest; Dr. Avila has no conflict of interest.Funding: Non ⁎ Corresponding author at: Department of Neurology, M Center, 1275 York Avenue, New York, NY 10065, United S E-mail address: avilae@mskcc.org (E.K. Avila).