Vestibular Migraine: Treatment and Prognosis

2019 ◽  
Vol 40 (01) ◽  
pp. 083-086
Author(s):  
Michael von Brevern ◽  
Thomas Lempert
Keyword(s):  
Scientific Basis ◽  
Vestibular Migraine ◽  
Migraine Treatment ◽  
Relaxation Techniques ◽  
Limited Data ◽  
Pharmacological Prophylaxis ◽  
Migraine Headaches ◽  
Antiemetic Drugs ◽  
Acute Attacks ◽  
Firm Scientific Basis

AbstractTreatment of vestibular migraine currently lacks a firm scientific basis, as high quality randomized controlled trials are not available. Therefore, recommendations are largely borrowed from the migraine sphere. The first therapeutic step is explanation and reassurance. Many patients do not need pharmacological treatment, as attacks may be infrequent and tolerable. Acute attacks can be ameliorated in some patients with antiemetic drugs such as diphenhydramine, meclizine, and metoclopramide. Frequent attacks may warrant pharmacological prophylaxis with metoprolol, amitriptyline, topiramate, valproic acid, or flunarizine. Nonpharmacological measures including regular exercise, relaxation techniques, stress management, and biofeedback may be similarly effective and can be combined with a pharmacological approach. Limited data indicate that the prognosis appears to be less favorable for vestibular migraine than for migraine headaches.

scholarly journals Comparison of efficacy and safety of three drugs levetiracetam, sodium valproate, and nortriptyline in the prevention of migraine headache

2020 ◽  
pp. 336-343
Keyword(s):  
Sodium Valproate ◽  
Severe Headache ◽  
Migraine Treatment ◽  
Chi Square ◽  
Migraine Headaches ◽  
Neurology Clinic ◽  
Quasi Experimental ◽  
The Mean ◽  
Acute Attacks ◽  
Mild Headache

Background and Aim: Headache is the most common cause of referral to a physician. Two approaches of the migraine treatment include: treat the acute attacks and prevent future attacks. In this regard, the aim of this study was to investigate the effect of three drugs lutiracetam, sodium valproate and nortriptyline in the control of migraine headaches in patients with migraine in Birjand Neurology Clinic. Materials and Methods: This study is a quasi-experimental study. According to the physician, 120 migraine patients were divided into one of three groups: Lutiracetam with a daily dose of 250 mg, sodium valproate 500 mg and nortriptyline 25 mg for 4 weeks. Patientschr('39') information was collected through a questionnaire. Then the data were analyzed by SPSS) Version 16) software by using chi-square, paired t-test, and ANOVA. Results: 120 patients were divided into three groups of 40 patients. The mean age of the subjects was 33±11 years, 53.3% of them were female and 46.7% of them were male. In total, 46.7% of patients had severe headache before taking these three drugs. None of them had severe headache after taking the drug and 77.5% of them had mild headache. Lutiracetam group showed the greatest decrease in headache intensity. (P=0.01). Conclusion: Levetiracetam appears to be more effective than the other two drugs, especially sodium valproate, in reducing different degrees of headache.

scholarly journals Vestibular migraine: An update on current understanding and future directions

Cephalalgia ◽  
2019 ◽  
Vol 40 (1) ◽  
pp. 107-121 ◽  
Author(s):  
Tzu-Chou Huang ◽  
Shuu-Jiun Wang ◽  
Amir Kheradmand
Keyword(s):  
Clinical Symptoms ◽  
Vestibular Function ◽  
Vestibular Migraine ◽  
Current Understanding ◽  
Laboratory Findings ◽  
Treatment Regimens ◽  
Migraine Headaches ◽  
Narrative Literature ◽  
Vestibular Symptoms ◽  
Narrative Literature Review

Background Vestibular migraine is among the most common causes of recurrent vertigo in the general population. Despite its prevalence and high impact on healthcare cost and utilization, it has remained an under-recognized condition with largely unknown pathophysiology. In the present article, we aim to provide an overview of the current understanding of vestibular migraine. Methods We undertook a narrative literature review on the epidemiology, presentations, clinical and laboratory findings, pathophysiology, and treatments of vestibular migraine. Results Currently, the diagnosis of vestibular migraine relies solely on clinical symptoms since clinical tests of vestibular function are typically normal, or difficult to interpret based on inconsistent results reported in earlier studies. The challenges related to diagnosis of vestibular migraine lie in its relatively broad spectrum of manifestations, the absence of typical migraine headaches with vestibular symptoms, and its very recent definition as a distinct entity. Here, we highlight these challenges, discuss common vestibular symptoms and clinical presentations in vestibular migraine, and review the current aspects of its clinical diagnosis and evaluation. The concepts related to the pathophysiology and treatment of vestibular migraine are also discussed. Conclusion Vestibular migraine is still underdiagnosed clinically. Future studies are needed to address the pathophysiological mechanisms and investigate effective treatment regimens.

Coping Style and Cognitive Dysfunction in Schizophrenic Patients

1992 ◽  
Vol 161 (S18) ◽  
pp. 123-128 ◽  
Author(s):  
Robert J. Bosch Van Den ◽  
Maria J. O. Asma Van ◽  
René Rombouts ◽  
Jan Willem Louwerens
Keyword(s):  
Cognitive Dysfunction ◽  
Coping Style ◽  
Cognitive Vulnerability ◽  
Scientific Basis ◽  
Schizophrenic Disorder ◽  
Subjective Experiences ◽  
Daily Lives ◽  
Know How ◽  
Schizophrenic Patients ◽  
Firm Scientific Basis

It is important to know how people with a schizophrenic disorder experience their cognitive vulnerability and how that experience affects their daily lives. Rehabilitation, as we understand it, has the aim of stimulating patients to make the best use of their residual capacities, especially in dealing with social complexity. Unfortunately, the rehabilitation approach in psychiatry still lacks a firm scientific basis. Strong links need to be developed between the practice of rehabilitation and theories of basic cognitive and behavioural dysfunction in schizophrenic patients (Watts & Bennett, 1983). It is a prerequisite that the subjective experiences of patients are included in this endeavour: schizophrenia is an ‘I am’ illness (Estroff, 1989).

Early treatment of acute migraine: New evidence of benefits

Cephalalgia ◽  
2009 ◽  
Vol 29 (3_suppl) ◽  
pp. 15-21
Author(s):  
D Valade
Keyword(s):  
Perceived Barriers ◽  
Management Approach ◽  
Migraine Treatment ◽  
Positive Outcomes ◽  
Barriers To Adoption ◽  
Current Management ◽  
Migraine Headaches ◽  
Therapeutic Outcomes ◽  
Lower Pain ◽  
New Evidence

The current management approach to migraine headaches advocates use of triptan medications early in the course of an attack while pain is still mild, rather than waiting to treat the pain when it has progressed to moderate-severe. Recently, strong new evidence for the benefits of early intervention has become available. The AEGIS, AIMS and AwM studies of almotriptan in patients with migraine indicate that earlier treatment initiation and lower pain intensity at the time of treatment are important predictors of enhanced therapeutic outcomes. The opportunity to treat early exists for about 50% of all migraine attacks, which offers considerable scope for improving migraine management. Importantly, treating pain early and before it has progressed beyond ‘mild’ meets many of the expectations patients have of their migraine treatment. It is believed that consistent, positive outcomes may assist in overcoming the various physician-and patient-perceived barriers to adoption of this beneficial treatment strategy.

scholarly journals Ubrogepant: a new era in migraine treatment

2020 ◽  
Vol 9 (5) ◽  
pp. 819
Author(s):  
Sangeeta Bhanwra ◽  
Kaza Ahluwalia
Keyword(s):  
Pain Perception ◽  
Migraine Treatment ◽  
New Era ◽  
Calcitonin Gene ◽  
United States Food ◽  
Cgrp Receptor Antagonists ◽  
Inflammatory Drugs ◽  
States Food ◽  
Acute Attacks ◽  
Good Oral Bioavailability

Migraine is the most common neurological disorder that leads to incapacitating neurological symptoms. Acute attacks of migraine have been dealt with effectively with non-steroidal anti-inflammatory drugs (NSAIDs), ergot derivatives and triptans since long, but their use is limited by various adverse effects. Recent studies have shown that a neuropeptide, calcitonin gene related peptide (CGRP) plays a major role in pathophysiology of migraine by increasing the pain perception, both at the peripheral and central nervous system levels. So, in the last few years, some CGRP antagonists have found their way in the treatment of both episodic and chronic migraine. Ubrogepant is the first oral CGRP antagonist, that was approved by USFDA (United States food and drug administration) in December 2019, for the acute treatment of migraine with or without aura. It is more potent than the earlier CGRP receptor antagonists, has a good oral bioavailability and the risk of hepatotoxicity is also lesser than the previous Gepants.

Rimegepant: acute treatment for migraine headaches

2021 ◽  
Author(s):  
Golden L Peters ◽  
Erin K Hennessey
Keyword(s):  
Migraine Headache ◽  
Acute Treatment ◽  
Treatment Options ◽  
Migraine Treatment ◽  
Acute Migraine ◽  
The Past ◽  
Vasoactive Peptides ◽  
Migraine Headaches ◽  
Calcitonin Gene ◽  
Acute Migraine Treatment

Migraine headache treatment is quickly evolving. There have been three new acute migraine treatment options (i.e., lasmiditan, rimegepant, ubrogepant) and four new preventive migraine treatment options (i.e., erenumab, fremanezumab, galcanezumab, eptinezumab) released in the past 3 years. The new migraine treatments are focusing on pathways within the newly, better understood neurovascular hypothesis that further describes the pathophysiology of migraine headaches in more detail than before. The discovery of vasoactive peptides, such as calcitonin gene-related peptide, has led to the development of many of these migraine agents. Rimegepant is one of these newly approved agents for acute migraine treatment in adults with or without aura. Rimegepant has been found to decrease pain and symptoms associated with migraine attacks and is generally well-tolerated.

Toxicokinetic Model Development for the Insensitive Munitions Component 3-Nitro-1,2,4-Triazol-5-One

2015 ◽  
Vol 34 (5) ◽  
pp. 408-416
Author(s):  
Lisa M. Sweeney ◽  
Elizabeth A. Phillips ◽  
Michelle R. Goodwin ◽  
Desmond I. Bannon
Keyword(s):  
Model Development ◽  
Scientific Basis ◽  
In Vivo Studies ◽  
Limited Data ◽  
Blood Concentrations ◽  
Physiologically Based Pharmacokinetic ◽  
Insensitive Munitions ◽  
Toxicokinetic Model ◽  
Exposure Levels

3-Nitro-1,2,4-triazol-5-one (NTO) is a component of insensitive munitions that are potential replacements for conventional explosives. Toxicokinetic data can aid in the interpretation of toxicity studies and interspecies extrapolation, but only limited data on the toxicokinetics and metabolism of NTO are available. To supplement these limited data, further in vivo studies of NTO in rats were conducted and blood concentrations were measured, tissue distribution of NTO was estimated using an in silico method, and physiologically based pharmacokinetic models of the disposition of NTO in rats and macaques were developed and extrapolated to humans. The model predictions can be used to extrapolate from designated points of departure identified from rat toxicology studies to provide a scientific basis for estimates of acceptable human exposure levels for NTO.

Phase 1 of Integrated EMDR An Abortive Treatment for Migraine Headaches

2008 ◽  
Vol 2 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Steven V. Marcus
Keyword(s):  
Standard Care ◽  
Phase 1 ◽  
Migraine Treatment ◽  
Comparison Standard ◽  
Eye Movement Desensitization Reprocessing ◽  
Medication Treatment ◽  
Treatment Groups ◽  
Migraine Headaches ◽  
Migraine Pain ◽  
Independent Evaluator

Forty-three individuals diagnosed with classic or common migraine headache were randomly assigned to either phase 1 of integrated eye movement desensitization reprocessing (EMDR) treatment or a standard care medication treatment. Integrated EMDR combines diaphragmatic breathing, cranial compression, and EMDR for abortive migraine treatment. The comparison standard care medication group received various abortive medications, including Demerol, DHE, oral triptans, Excedrin, Fiorinal, Percocet, Toradol, and Vicodin. Participants were treated during mid- to late-stage acute migraine and assessed by an independent evaluator at pretreatment, posttreatment, 24 hours, 48 hours, and 7 days for migraine pain level. Both standard care medication and integrated EMDR treatment groups demonstrated reduced migraine pain levels immediately at posttreatment, 24 hours, 48 hours, and 7 days. However, integrated EMDR treatment reduced or eliminated migraine pain with greater rapidity and showed significantly greater improvement compared to standard care medication immediately posttreatment.

Vestibular Migraine I: Mechanisms, Diagnosis, and Clinical Features

2020 ◽  
Vol 40 (01) ◽  
pp. 076-082 ◽  
Author(s):  
Robert W. Baloh
Keyword(s):  
Negative Impact ◽  
Vestibular Migraine ◽  
Migraine Headaches ◽  
Related Quality ◽  
Health Related ◽  
Vestibular Symptoms ◽  
Extreme Sensitivity ◽  
Accompanying Symptoms ◽  
Evidence Based Guidelines ◽  
Relationship Of

AbstractVestibular migraine (VM), also known as migrainous vertigo or migraine-associated vertigo, is characterized by recurrent vestibular attacks often accompanied by migraine headaches and other migraine symptoms. It is one of the most common presenting complaints to physicians in primary care, otolaryngology, and neurology. Epidemiologic data suggest that VM may affect 1 to 3% of the general population and 10 to 30% of patients seeking treatment for dizziness. Attacks typically last minutes to hours and range from spontaneous and positional vertigo to extreme sensitivity to self and surround motion. As with headaches, nausea, and vomiting, phonophobia and photophobia are common accompanying symptoms. The clinical spectrum of VM and its underlying pathophysiological mechanisms are just being identified, with much debate about the causal relationship of vestibular symptoms and headache, no evidence-based guidelines for clinical management, limited characterization of its disease burden, and little information about its negative impact on health-related quality of life.

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