Differences of Anti-Nociceptive Mechanisms of Migraine Drugs on the Trigeminal Pain Processing during and Outside Acute Migraine Attacks

The aim of this study was to investigate central anti-nociceptive mechanisms of i.v. acetylsalicylic acid (ASA) and oral zolmitriptan (ZOL) in migraine patients and healthy subjects using the ‘nociceptive’ blink reflex (nBR). Twenty-eight migraine patients received ASA ( n = 14, 1000 mg i.v) or ZOL ( n = 14, 5 mg p.o) during the acute migraine attack and interictally. Thirty healthy subjects received either ASA or ZOL vs. placebo using a double blind cross over design. nBR was recorded in all patients and subjects before, 60 and 90 min after treatment. ASA and ZOL did not inhibit nBR responses in healthy subjects. Both ASA and ZOL suppressed nBR responses (ASA by 68%, ZOL by 78%) only during the acute attack but not interictally. The data suggest, that the anti-nociceptive effects of migraine drugs on the trigeminal nociceptive processing are different during and outside an acute migraine attack.

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Abnormal Habituation of ‘nociceptive’ Blink Reflex in Migraine-Evidence for Increased Excitability of Trigeminal Nociception

Cephalalgia ◽

10.1046/j.1468-2982.2003.00591.x ◽

2003 ◽

Vol 23 (8) ◽

pp. 814-819 ◽

Cited By ~ 90

Author(s):

Z Katsarava ◽

N Giffin ◽

H-C Diener ◽

H Kaube

Keyword(s):

Migraine Attack ◽

Healthy Subjects ◽

Migraine Headache ◽

Regression Coefficient ◽

Blink Reflex ◽

Trigeminal Nociception ◽

Nociceptive Blink Reflex ◽

Nociceptive Processing ◽

The Mean ◽

Stimulation Of

We studied the habituation of the ‘nociceptive’ blink reflex (nBR) in 15 healthy subjects and 17 migraine patients interictally as well as during unilateral migraine headache within six hours of onset and after treatment. In healthy volunteers the mean regression coefficient (MRC) was – 3.9 following right sided and – 4.9 left sided stimulation. This equals an amplitude loss of 19.5% (5 X −3.9) and 24.5% (5 X −4.9), respectively, across five consecutive sweeps. An augmentation of nBR responses was found in migraine patients interictally: MRC = 3.3 following stimulation of the headache side (HA) and MRC = 4.0 of the non-headache side (non-HA). The differences were statistically significant (ANOVA: d.f. = 1, F = 25.8, P < 0.001). During the migraine attack MRCs were negative both before (−5.0, HA and – 4.0, non-HA) and after treatment (−2.6, HA and −1.9 non-HA) and significantly differed from those outside the migraine attack (ANOVA: d.f. = 2, F = 12.4, P < 0.001). The demonstrated lack of habituation of the nBR responses indicates an abnormal trigeminal nociceptive processing in migraine patients outside the migraine attack.

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Treatment of Acute Migraine Attack With Diclofenac Sodium: A Double-Blind Study

Headache The Journal of Head and Face Pain ◽

10.1111/j.1526-4610.1992.hed3202098.x ◽

1992 ◽

Vol 32 (2) ◽

pp. 98-100 ◽

Cited By ~ 24

Author(s):

George N. Karachalios ◽

Adroniki Fotiadou ◽

Nickolaos Chrisikos ◽

Alexandros Karabetsos ◽

Kyriakos Kehagioglou

Keyword(s):

Migraine Attack ◽

Diclofenac Sodium ◽

Blind Study ◽

Double Blind Study ◽

Acute Migraine ◽

Double Blind ◽

Acute Migraine Attack

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Treatment of Acute Migraine Attack: Naproxen and Placebo Compared

Cephalalgia ◽

10.1046/j.1468-2982.1985.0502115.x ◽

1985 ◽

Vol 5 (2) ◽

pp. 115-119 ◽

Cited By ~ 39

Author(s):

Knut Nestvold ◽

Reidar Kloster ◽

Markku Partinen ◽

Raimo Sulkava

Keyword(s):

Migraine Attack ◽

Randomized Study ◽

Treatment Preferences ◽

Acute Migraine ◽

Treatment Results ◽

Double Blind ◽

Head Pain ◽

Main Complaint ◽

Gastrointestinal Discomfort ◽

Acute Migraine Attack

A double-blind, cross-over, randomized study of acute migraine attack compared treatment results of naproxen with that of placebo. Each treatment period continued for either three months or six migraine attacks, whichever occurred first. The initial dose of naproxen was 750 mg, with additional 250–500 mg doses taken if and when required, to a maximum of five 250 mg tablets within a period of 24 h in each migraine attack. Forty-one patients were enrolled in the study; they had all experienced at least two but not more than eight migraine attacks a month during the preceding year. Thirty-two patients completed the two treatment periods. Naproxen was statistically significantly superior to placebo in reducing the severity of head pain, nausea, and photophobia; in shortening the duration of head pain, nausea, vomiting, photophobia, and lightheadedness; in diminishing the frequency of vomiting; and in decreasing the need for escape medication. Both patient and physician treatment preferences significantly favoured naproxen. Nine side effects were experienced by seven patients while receiving placebo and seven by five patients during naproxen treatment. Mild gastrointestinal discomfort was the main complaint. Only one patient withdrew from treatment because of a side effect, which occurred while receiving placebo.

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Treatment of the Acute Migraine Attack Current Status

Cephalalgia ◽

10.1046/j.1468-2982.1983.0301061.x ◽

1983 ◽

Vol 3 (1) ◽

pp. 61-67 ◽

Cited By ~ 23

Author(s):

Marcia Wilkinson

Keyword(s):

Migraine Attack ◽

Temporal Artery ◽

Acute Attack ◽

Current Status ◽

Acute Migraine ◽

Similar Action ◽

Drug Treatments ◽

Ergotamine Tartrate ◽

Acute Migraine Attack ◽

Gastrointestinal Activity

The main treatment of the acute migraine attack remains sleep, sedation, an anti-nauseant and analgesics, and in some patients 1 or 2 mg of ergotamine tartrate. Drugs containing large amounts of caffeine should not be used. Absorption of drugs may be impaired in a migraine attack. Metoclopramide is probably the anti-emetic of choice because it is an effective anti-nauseant and promotes normal gastrointestinal activity. Domperidone has a similar action but is said not to go through the blood-brain harrier, so is less likely to cause extrapyramidal reactions. All drugs, including analgesics such as aspirin and paracetamol, are best given in a soluble or effervescent form. Where vomiting occurs early in the attack, suppositories may be indicated. Ergotamine tartrate is necessary in about one third of attacks and is best given by suppository or by inhalation. Doses higher than 2 mg per attack or 6 mg in one week may cause toxic symptoms, the early signs of which are headache, nausea, vomiting and a feeling of not being very well. The non-drug treatments of an acute attack include pressing on the temporal artery, hot and cold compresses and relaxation.

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Double-Blind Comparison of An Acetaminophen 400 mg-Codeine 25 mg Combination Versus Aspirin 1000 mg and Placebo in Acute Migraine Attack

Cephalalgia ◽

10.1046/j.1468-2982.1994.1402156.x ◽

1994 ◽

Vol 14 (2) ◽

pp. 156-161 ◽

Cited By ~ 43

Author(s):

F Boureau ◽

JM Joubert ◽

V Lasserre ◽

B Prum ◽

G Delecoeuillerie

Keyword(s):

Clinical Trials ◽

Migraine Attack ◽

Evaluation Criteria ◽

Complete Disappearance ◽

Acute Migraine ◽

Double Blind ◽

Significant Difference ◽

The Difference ◽

Blind Comparison ◽

Acute Migraine Attack

The purpose of this study was to compare the efficacy and tolerance of a single dose of the acetaminophen 400 mg-codeine 25 mg combination (ACC) aspirin 1000 mg (A) and a placebo (P) for the treatment of acute migraine attack. The study design was randomized, multicentre, double-blind and double dummy with cross-over on three periods. Of the 198 patients who had three attacks 29.8%, 52.3% and 49.7% had recorded the complete or almost complete disappearance of the pain at 2 h after P, A and ACC respectively. When compared with the placebo, the difference was significant for the A and ACC. When complete disappearance of pain at 2 h was used as a criterion, no significant difference was observed. These results enabled the sensitivity of the evaluation criteria suggested for clinical trials of migraine attack to be discussed.

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Intravenous metoclopramide versus dexketoprofen trometamol versus metoclopramide+ dexketoprofen trometamol in acute migraine attack in the emergency department: A randomized double-blind controlled trial

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.04.038 ◽

2020 ◽

Vol 38 (11) ◽

pp. 2254-2258

Author(s):

E. Yavuz ◽

U. Gulacti ◽

U. Lok ◽

K. Turgut

Keyword(s):

Emergency Department ◽

Migraine Attack ◽

Controlled Trial ◽

Acute Migraine ◽

Double Blind ◽

Dexketoprofen Trometamol ◽

Acute Migraine Attack

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Comparison of Greater Occipital Nerve and Supra Orbital Nerve Blocks Methods in the Treatment of Acute Migraine Attack: A randomized double-blind controlled trial

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106821 ◽

2021 ◽

pp. 106821

Author(s):

Nihat M. Hokenek ◽

Duygu Ozer ◽

Erdal Yılmaz ◽

Nurhayat Baskaya ◽

Ummahan Dalkilinc Hokenek ◽

...

Keyword(s):

Migraine Attack ◽

Controlled Trial ◽

Acute Migraine ◽

Nerve Blocks ◽

Double Blind ◽

Occipital Nerve ◽

Greater Occipital Nerve ◽

Acute Migraine Attack

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Acute migraine attack, angina-like chest pain with documented ST-segment elevation and slow coronary flow

Acta Cardiologica ◽

10.2143/ac.60.2.2005036 ◽

2005 ◽

Vol 60 (2) ◽

pp. 221-223 ◽

Cited By ~ 8

Author(s):

Hüseyin UYAREL ◽

Ismail ERDEN ◽

Nese CAM

Keyword(s):

Chest Pain ◽

Migraine Attack ◽

Coronary Flow ◽

Acute Migraine ◽

Slow Coronary Flow ◽

St Segment Elevation ◽

St Segment ◽

Acute Migraine Attack

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A Treatment for the Acute Migraine Attack

Journal of International Medical Research ◽

10.1177/030006058701500202 ◽

1987 ◽

Vol 15 (2) ◽

pp. 71-75 ◽

Cited By ~ 8

Author(s):

E. I. Adam

Keyword(s):

Acute Attack ◽

Response To Treatment ◽

Codeine Phosphate ◽

Double Blind ◽

Recent Onset ◽

Randomized Crossover Trial ◽

History Of ◽

Specific Factors ◽

Acute Attacks ◽

Acute Migraine Attack

A compound analgesic/anti-emetic formulation was significantly effective in reducing the severity of acute attacks of migraine, in a double-blind, randomized, crossover trial of 34 patients referred to a migraine clinic. The preparation contained paracetamol (acetaminophen) 500 mg, codeine phosphate 8 mg, buclizine hydrochloride 6.25 mg and dioctyl sodium sulphosuccinate 10 mg. The dosage was two tablets taken as early as possible in the acute attack. No specific factors could be identified which influenced response to treatment Patients with a long history of migraine (more than 10 years) responded as well as those with a recent onset of the condition.

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