R. Michael Gallagher

Migraine Medication Attributes Important for Patient Compliance: Concerns About Side Effects May Delay Treatment

Objectives.—To determine the level of concern among migraineurs about migraine prescription medication tolerability and adverse effects and the impact of these concerns on their self‐management of migraine.

Vasospasm‐lnduced Myocardial Infarction With Sumatriptan

Sumatriptan, a 5‐hydroxytryptamine1 (5‐HT1) receptor agonist is an effective abortive agent for migraine headaches. A common side effect in 3% to 7.9% of patients is chest pain. Although most cases of chest pain are not thought to be of cardiac origin, its mechanism is not entirely understood. Rare examples of electrocardiogram changes consistent with transient ischemia have been reported. Isolated instances of angina, arrhythmia, myocardial infarction, and death have been temporally associated with sumatriptan administration. In most cases, it is unclear whether underlying cardiovascular disease existed or contributed to this adverse event. We report the history of a 56‐year‐old female patient with migraine who experienced myocardial infarction shortly after using sumatriptan, despite having had a normal cardiovascular evaluation. As she had a normal cardiac catheterization after the event, we find it probable that sumatriptan induced coronary vasospasm and myocardial infarction.

A comparative trial of zolmitriptan and sumatriptan for the acute oral treatment of migraine.

Objective.–This randomized, double‐blind, parallel group multicenter study compared response rates and tolerability of zolmitriptan with sumatriptan in the acute treatment of migraine.

Safety and Effectiveness of Cranial Electrotherapy in the Treatment of Tension Headache

SYNOPSIS

Comparative Study of a Combination of Isometheptene Mucate, Dichloralphenazone With Acetaminophen and Sumatriptan Succinate in the Treatment of Migraine

Objective.—To compare the safety and efficacy of isometheptene mucate, dichloralphenazone with acetaminophen to sumatriptan succinate for the treatment of mild‐to‐moderate migraine, with or without aura, when taken at the first sign of an attack.

Headache in medical education : Medical schools, neurology and family practice residencies

Objective.—To explore the extent of headache education received by medical students and residents.

An Invited Paper. Headache Diagnosis and Treatment

Headache is an exceedingly common complaint that was accurately described as early as 3,000 B.C. For some people headaches are only an occasional annoyance, yet for others they are painful and debilitating experiences that interfere with daily activities. Today, i t is estimated that over 40,000,000 people (Diamond 8c Diamond-Falk, 1982) suffer from chronic headaches and that billions of dollars are spent annually by headache sufferers in their quest to find relief. The problem is formidable, causing much difficulty for patients, families, employers, and health care professionals. Most headaches, though uncomfortable and temporarily disabling, are not associated with serious illness. Nonetheless, their impact can be devastating to sufferers and their families. The majority of headaches are of the chronic recurring type and fall into one of two general categories: vascular and muscle contraction headaches (see Table 1). Vascular headaches involve the swelling or dilation of pain-sensitive cerebral blood vessels. Muscle contraction headaches involve the sustained contraction of muscles of the neck and scalp surface. Some patients experience headaches that have the characteristics of both. Such headaches are referred to as mixed headaches.

Patient Motivation in the Treatment of Migraine. A Non‐medicinal Study

SYNOPSIS

Timolol maleate, a beta blocker, in the treatment of common migraine headache.

SYNOPSIS

Acetaminophen, Aspirin, and Caffeine Versus Sumatriptan Succinate in the Early Treatment of Migraine: Results From the ASSET trial—A response to Drs. Derosier and Kori

OBJECTIVE To address the need for a rigorous, direct comparison of prescription and over-the-counter (OTC) migraine drugs and to expand the database on early treatment of migraine. BACKGROUND Most people who experience migraine use OTC medications to treat their symptoms, but no head-to-head clinical trials comparing these agents with prescription migraine therapies have been published. In addition, even though most migraineurs treat early in the attack, few studies have been conducted to reflect this treatment pattern. METHODS We compared a combination of nonprescription migraine medication (acetaminophen 500 mg, aspirin 500 mg, and caffeine 130 mg) with a prescription migraine product (50 mg sumatriptan) in a randomized, controlled clinical trial in which subjects treated at the first sign of a migraine attack. Subjects who reported vomiting during more than 20% of migraine episodes or who required bedrest during more than 50% of migraine episodes were excluded from the study. Of the 188 subjects randomized, 171 took study medication and were included in the analysis. CONCLUSION The combination of acetaminophen, aspirin, and caffeine was significantly more effective (P > .05) than sumatriptan in the early treatment of migraine, as shown by superiority in summed pain intensity difference, pain relief, pain intensity difference, response, sustained response, relief of associated symptoms, use of rescue medication, disability relief, and global assessments of effectiveness. An additional, larger clinical trial is needed to confirm these results.