Susan Hutchinson

Consensus Statement: Cardiovascular Safety Profile of Triptans (5-HT1B/1D Agonists) in the Acute Treatment of Migraine

Background.—Health care providers frequently cite concerns about cardiovascular safety of the triptans as a barrier to their use. In 2002, the American Headache Society convened the Triptan Cardiovascular Safety Expert Panel to evaluate the evidence on triptan‐associated cardiovascular risk and to formulate consensus recommendations for making informed decisions for their use in patients with migraine.

Childhood Maltreatment and Migraine (Part I). Prevalence and Adult Revictimization: A Multicenter Headache Clinic Survey

(Headache 2010;50:20‐31)

Allodynia in Migraine: Association With Comorbid Pain Conditions

Background.— Cutaneous allodynia (CA) in migraine is a clinical manifestation of central nervous system sensitization. Several chronic pain syndromes and mood disorders are comorbid with migraine. In this study we examine the relationship of migraine‐associated CA with these comorbid conditions. We also evaluate the association of CA with factors such as demographic profiles, migraine characteristics, and smoking status that may have an influence on the relationships of CA to pain and mood.

Childhood maltreatment and migraine (part III). Association with comorbid pain conditions.

(Headache 2010;50:42‐51)

Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification

(Headache 2010;50:32‐41)

Depression and anxiety : Effect on the migraine-obesity relationship

Objective.—To discern the effects of depression and anxiety on the migraine–obesity relationship.

Use of Common Migraine Treatments in Breast-Feeding Women: A Summary of Recommendations

Breast‐feeding has important health and emotional benefits for both mother and infant, and should be encouraged. While there are some data to suggest migraine may improve during breast‐feeding, more than half of women experience migraine recurrence with 1 month of delivery. Thus, a thorough knowledge base of the safety and recommended use of common acute and preventive migraine drugs during breast‐feeding is vital to clinicians treating migraine sufferers. Choice of treatment should take into account the balance of benefit and risk of medication. For some of the medications commonly used during breast‐feeding, there is not good evidence about benefits.

Diagnosis and treatment of the menstrual migraine patient.

Women presenting with recurrent disabling headache frequently have migraine; but physicians need to rule out other headache disorders before they reach a diagnosis of migraine with or without aura. Many women who experience migraine in close association to their menstrual cycle may meet the diagnostic criteria for either menstrually related migraine (MRM), or pure menstrual migraine (PMM). Once an accurate diagnosis is made, treatment may be established to best suit the individual needs of that patient. Most women will find that migraine associated with hormone fluctuations respond well to standard treatment approaches including pharmacological and nonpharmacological treatments. Pharmacological approaches include acute, preventive, and short‐term prophylaxis. Herein we review the difference between non‐menstrual migraine, PMM, and MRM and identify effective treatment strategies for appropriate management of migraine associated with hormonal fluctuations.

Oral Sumatriptan for the Acute Treatment of Probable Migraine: First Randomized, Controlled Study

Objective.—To evaluate the efficacy and tolerability of sumatriptan tablets in adults who meet International Headache Society (IHS) criteria for probable migraine but who do not meet IHS criteria for migraine with or without aura.

Menstrual Migraine : Case Studies of Women with Estrogen-Related Headaches

This paper presents 2 case scenarios that illustrate the complexity of diagnosing and managing migraine associated with hormonal changes. Migraine is commonly associated with comorbidies such as depression, anxiety, obesity, cardiovascular disease, as well as other conditions, thereby making management more challenging for the physician and the patient. The first case is a 35‐year‐old woman who has migraine almost exclusively during menstruation. She is under a physicians care for long‐term management of premenstrual dysphoric disorder (PMDD). Achieving a differential diagnosis of pure menstrual migraine is illustrated, and a detailed treatment plan including use of a migraine miniprophylaxis protocol, management of her PMDD, and prescription of acute treatment medications is reviewed. The second case scenario describes the diagnosis of menstrually associated migraine in a woman who suffers from a frequent disabling migraine along with work‐related anxiety and depression. This paper reviews her differential diagnosis, laboratory testing, treatment plan, including management of her comorbid anxiety and depressive symptoms.