Dexamethasone decreases migraine recurrence observed after treatment with a triptan combined with a nonsteroidal anti-inflammatory drug

BACKGROUND AND OBJECTIVES: Triptans are effective drugs for the acute treatment of migraine. However, 30-40% of the patients commonly present recurrence before 24 hours therefore requiring another dose. Nonsteroidal anti-inflammatory drugs (NSAID) such as tolfenamic acid and naproxen sodium combined with sumatriptan have demonstrated efficacy in reducing recurrence observed with the single use of this drug. Steroids also have been suggested to treat refractory migraine and status migranosus. The aim of this study was to evaluate whether patients presenting frequent recurrence with the combination triptan plus NSAID, would decrease it with the association of dexamethasone. METHOD: Twenty three patients, 17 women and 6 men with migraine according to IHS criteria were prospectively studied. All patients presented frequent recurrence ( > or = 60%, mean recurrence rate 74,8%) with the single use of sumatritpan 100mg or zolmitriptan 2,5mg or rizatriptan 10mg in at least 5 consecutive attacks, and didn't present a reduction of the recurrence rate superior than 20% with the combination of tolfenamic acid 200mg or rofecoxib 25mg in at least 5 other consecutive attacks (mean recurrence rate 60%). The patients had to treat 6 consecutive moderate or severe migraine attacks with their usual combination plus 4mg of dexamathasone with a maximum of twice a week, and fill out a diary reporting headache parameters. RESULTS: Twenty patients, 16 women and 4 men completed the study. Of those who completed the study, 11 took rizatriptan plus rofecoxib, 4 rizatriptan plus tolfenamic acid, 3 zolmitriptan plus rofecoxib, 1 zolmitriptan plus tolfenamic acid and 1 patient took sumatriptan plus tolfenamic acid, having the 20 patients taken as a third medication, a single tablet of 4mg of dexamethasone. All patients took oral formulations and none presented vomiting after that. Among all 20 patients, one female and one male patient presented recurrence in 3 out of the 6 attacks (50%) while the remaining 18 patients revealed recurrence in 1 or 2 treated attacks (mean 23,4%) (p<0,001). CONCLUSION: We concluded that the judicious use of oral dexamethasone might be useful for a limited population of migraine patients still presenting recurrence with the combination of a triptan and a NSAID. Case-control studies and studies with a randomized double-blind design are necessary to confirm these observations.

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Tolfenamic Acid Decreases Migraine Recurrence When Used with Sumatriptan

Cephalalgia ◽

10.1046/j.1468-2982.1999.1903186.x ◽

1999 ◽

Vol 19 (3) ◽

pp. 186-187 ◽

Cited By ~ 25

Author(s):

AV Krymchantowski ◽

M Adriano ◽

D Fernandes

Keyword(s):

Recurrence Rate ◽

Prospective Studies ◽

Acute Treatment ◽

Tolfenamic Acid ◽

Effective Drug ◽

Acute Migraine ◽

Double Blind ◽

Double Blind Design

Although sumatriptan is an effective drug for the treatment of acute migraine attacks, recurrence has been cited as an important limitation for its use. Tolfenamic acid is also effective in the acute treatment of migraine attacks. We studied the recurrence rate of migraine attacks with the use of sumatriptan plus tolfenamic acid among patients who presented frequent recurrence with sumatriptan. Fifty migraineurs were retrospectively studied, all having treated at least 10 attacks with 100 mg P.O.; sumatriptan was effective in at least eight of them. The patients also presented recurrence in less than 24 h in at least five of the treated attacks. We then used sumatriptan 100 mg plus tolfenamic acid 200 mg P.O. during the first 60 min of the attack; 240 attacks were treated and there was recurrence in 57 (23.8%). With sumatriptan alone, 5 out of 8 attacks (62.5%) presented recurrence. We therefore conclude that the combination sumatritpan plus tolfenamic acid is effective in reducing the recurrence rate from 5 of 8 (62.5%) to 1.19 of 5 (23.8%). Further prospective studies with a double-blind design and a higher number of treated attacks are necessary to confirm these initial observations.

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Naproxen sodium decreases migraine recurrence when administered with sumatriptan

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2000000300006 ◽

2000 ◽

Vol 58 (2B) ◽

pp. 428-430 ◽

Cited By ~ 43

Author(s):

ABOUCH VALENTY KRYMCHANTOWSKI

Keyword(s):

Recurrence Rate ◽

Acute Treatment ◽

Naproxen Sodium ◽

Double Blind ◽

Inflammatory Drug ◽

Anti Inflammatory ◽

Double Blind Design ◽

Severe Migraine

Forty to 78% of the patients using sumatriptan for the acute treatment of migraine may present recurrence at least occasionally. The concomitant use of a NSAID (nonsteroidal anti-inflammatory drug) has been recommended to decrease the recurrence rate. Sixty seven patients that treated successfully 8 migraine attacks with 100 mg of sumatritpan PO and presented recurrence in at least 5 attacks were studied prospectively. The patients received 100 mg of sumatriptan and 550 mg of naproxen sodium PO to treat 4 consecutive moderate or severe migraine attacks. The recurrence rate, once at least 62.5% (5 out of 8 attacks), decreased to 14.2% (38 out of 268 attacks) with the combination of compounds (p<0.0001). We then studied two groups of 13 patients made randomicaly from the 67 initially evaluated, that were given sumatriptan 100 mg plus naproxen sodium 550 mg or placebo, in a double-blind design, to treat 3 other consecutive migraine attacks. Each group of patients treated 39 attacks. The recurrence among the patients taking sumatriptan plus placebo was 59% (23 out of 39 attacks) and the recurrence presented by the group taking sumatriptan plus naproxen was 25.5% (10 out of 39 attacks) (p<0.0003). We concluded that the combination of sumatriptan plus naproxen sodium decreases significantly migraine recurrence presented by patients taking sumatriptan alone.

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Central Mechanisms of Controlled-Release Metoprolol in Migraine: A Double-Blind, Placebo-Controlled Study

Cephalalgia ◽

10.1111/j.1468-2982.2007.01377.x ◽

2007 ◽

Vol 27 (9) ◽

pp. 1024-1032 ◽

Cited By ~ 22

Author(s):

M Siniatchkin ◽

F Andrasik ◽

P Kropp ◽

U Niederberger ◽

H Strenge ◽

...

Keyword(s):

Information Processing ◽

Controlled Release ◽

Marked Reduction ◽

Controlled Study ◽

Double Blind ◽

Migraine Frequency ◽

Β Blockers ◽

Double Blind Design ◽

Effective Drugs ◽

Cortical Information Processing

β-Blockers are widely used in the prophylaxis of migraine and have been described as very effective drugs in many studies. Some investigators have demonstrated that the clinical improvement of migraine corresponds to the normalization of the contingent negative variation (CNV), a slow cortical potential measuring cortical information processing. However, most of these studies have contained a variety of methodological pitfalls, which we attempted to address in the current study. Twenty patients suffering from migraine without aura were randomly divided into two groups. The groups were treated either with controlled-release metoprolol or placebo for 3 months, using a double-blind design. Twice before and once after each month of the treatment the CNV was recorded. After 3 months, a significant reduction of migraine frequency, duration and intensity was demonstrated for the metoprolol compared with the placebo group. The CNV was characterized by a marked reduction of the amplitude of the total CNV and postimperative negative variation and normalization of the eartly CNV habituation following treatment. Therefore, metoprolol may exert its prophylactic effect in migraine through the influence on cortical information processing and excitability represented by the CNV.

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Cerebellar rTMS in PSP: a Double-Blind Sham-Controlled Study Using Mobile Health Technology

The Cerebellum ◽

10.1007/s12311-021-01239-6 ◽

2021 ◽

Author(s):

Andrea Pilotto ◽

Maria Cristina Rizzetti ◽

Alberto Lombardi ◽

Clint Hansen ◽

Michele Biggi ◽

...

Keyword(s):

Digital Technology ◽

Repetitive Transcranial Magnetic Stimulation ◽

Health Technology ◽

Controlled Study ◽

Double Blind ◽

Non Invasive ◽

Lower Back ◽

Before And After ◽

Double Blind Design ◽

Theta Burst

AbstractThere are no effective treatments in progressive supranuclear palsy (PSP). The aim of this study was to test the efficacy of theta burst repetitive transcranial magnetic stimulation (rTMS) on postural instability in PSP. Twenty PSP patients underwent a session of sham or real cerebellar rTMS in a crossover design. Before and after stimulation, static balance was evaluated with instrumented (lower back accelerometer, Rehagait®, Hasomed, Germany) 30-s trials in semitandem and tandem positions. In tandem and semitandem tasks, active stimulation was associated with increase in time without falls (both p=0.04). In the same tasks, device-extracted parameters revealed significant improvement in area (p=0.007), velocity (p=0.005), acceleration and jerkiness of sway (p=0.008) in real versus sham stimulation. Cerebellar rTMS showed a significant effect on stability in PSP patients, when assessed with mobile digital technology, in a double-blind design. These results should motivate larger and longer trials using non-invasive brain stimulation for PSP patients.

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Frühgeborene unter maschineller Beatmung: Immunmodulatorischer Effekt der präventiven Gabe von Azithromycin

Karger Kompass Pneumologie ◽

10.1159/000513487 ◽

2020 ◽

pp. 1-3

Author(s):

Maximilian Jorczyk

Keyword(s):

Very Low Birth Weight ◽

Controlled Trial ◽

Preterm Neonates ◽

Double Blind ◽

Mechanically Ventilated ◽

Before And After ◽

Anti Inflammatory ◽

To Receive ◽

Therapeutic Possibilities ◽

Inflammatory Effect

Introduction: Macrolides have anti-inflammatory and immunomodulatory properties that give this class of antibiotics a role that differs from its classical use as an antibiotic, which opens new therapeutic possibilities. Objective: The aim of this study was to evaluate the anti-inflammatory effect of azithromycin in preventing mechanical ventilation (MV)-induced lung injury in very-low-birth-weight preterm neonates. Methods: This is a randomized, double-blind, placebo-controlled trial of preterm neonates who received invasive MV within 72 h of birth. Patients were randomized to receive intravenous azithromycin (at a dose of 10/mg/kg/day for 5 days) or placebo (0.9% saline) within 12 h of the start of MV. Two blood samples were collected (before and after intervention) for measurement of interleukins (ILs) and PCR for Ureaplasma. Patients were followed up throughout the hospital stay for the outcomes of death and bronchopulmonary dysplasia defined as need for oxygen for a period of ≥28 days of life (registered at ClinicalTrials.gov, No. NCT03485703). Results: Forty patients were analyzed in the azithromycin group and 40 in the placebo group. Five days after the last dose, serum IL-2 and IL-8 levels dropped significantly in the azithromycin group. There was a significant reduction in the incidence of death and O2 dependency at 28 days/death in azithromycin-treated patients regardless of the detection of Ureaplasma in blood. Conclusions: Azithromycin has anti-inflammatory effects, with a decrease in cytokines after 5 days of use and a reduction in death and O2 dependency at 28 days/death in mechanically ventilated preterm neonates.

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The Composition and Diversity of the Gut Microbiota in Children Is Modifiable by the Household Dogs: Impact of a Canine-Specific Probiotic

Microorganisms ◽

10.3390/microorganisms9030557 ◽

2021 ◽

Vol 9 (3) ◽

pp. 557

Author(s):

Carlos Gómez-Gallego ◽

Mira Forsgren ◽

Marta Selma-Royo ◽

Merja Nermes ◽

Maria Carmen Collado ◽

...

Keyword(s):

Gut Microbiota ◽

Home Environment ◽

Double Blind ◽

Before And After ◽

Probiotic Intervention ◽

Probiotic Product ◽

Acid Producing Bacteria ◽

Double Blind Design ◽

To Receive ◽

Gut Microbiota Composition

The development of the infant gut microbiota is initiated during pregnancy and continued through early life and childhood, guided by the immediate environment of the child. Our aim was to characterize the shared microbiota between dogs and children as well as to determine whether introduction to dogs of a dog-specific probiotic combination modifies the transfer process. We studied 31 children from allergic families with pet dog(s) and 18 control families without a dog. Altogether 37 dogs were randomized for a 4-week period in a double-blind design to receive canine-derived probiotic product containing a mixture of L. fermentum, L. plantarum, and L. rhamnosus, or placebo. Fecal samples from children and dogs were taken before and after the treatment. Distinctive gut microbiota composition was observed in children with dogs compared to those without a dog, characterized by higher abundance of Bacteroides and short-chain fatty acid producing bacteria such as Ruminococcus and Lachnospiraceae. Probiotic intervention in dogs had an impact on the composition of the gut microbiota in both dogs and children, characterized by a reduction in Bacteroides. We provide evidence for a direct effect of home environment and household pets on children microbiota and document that modification of dog microbiota by specific probiotics is reflected in children’s microbiota.

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Analgesic and anti-inflammatory dose–response relationship of 7.5 and 15mg meloxicam after lower third molar removal: a double-blind, randomized, crossover study

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2006.09.006 ◽

2007 ◽

Vol 36 (1) ◽

pp. 26-31 ◽

Cited By ~ 24

Author(s):

A.M. Calvo ◽

V.T. Sakai ◽

F.P.M. Giglio ◽

K.C.S. Modena ◽

B.L. Colombini ◽

...

Keyword(s):

Crossover Study ◽

Dose Response ◽

Third Molar ◽

Response Relationship ◽

Dose Response Relationship ◽

Double Blind ◽

Anti Inflammatory ◽

Relationship Of ◽

Randomized Crossover Study

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Antioxidant and anti-inflammatory response to curcumin supplementation in hemodialysis patients: a randomized, double-blind, placebo-controlled clinical trial

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.06.006 ◽

2021 ◽

Author(s):

Hellen Christina Neves Rodrigues ◽

Tatiane Fagundes Pereira Martins ◽

Nayara Cristina Freitas e Silva Santana ◽

Clarice Carneiro Braga ◽

Marina Alves Coelho Silva ◽

...

Keyword(s):

Clinical Trial ◽

Inflammatory Response ◽

Hemodialysis Patients ◽

Controlled Clinical Trial ◽

Double Blind ◽

Double Blind Placebo ◽

Anti Inflammatory

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Cytokine changes after a marathon race

Journal of Applied Physiology ◽

10.1152/jappl.2001.91.1.109 ◽

2001 ◽

Vol 91 (1) ◽

pp. 109-114 ◽

Cited By ~ 170

Author(s):

David C. Nieman ◽

Dru A. Henson ◽

Lucille L. Smith ◽

Alan C. Utter ◽

Debra M. Vinci ◽

...

Keyword(s):

Inflammatory Cytokines ◽

Plasma Glucose ◽

Plasma Levels ◽

Major Effect ◽

Double Blind ◽

Plasma Cytokine ◽

Carbohydrate Ingestion ◽

Marathon Race ◽

Gender And Age ◽

Anti Inflammatory

The influence of carbohydrate (1 l/h of a 6% carbohydrate beverage), gender, and age on pro- and anti-inflammatory plasma cytokine and hormone changes was studied in 98 runners for 1.5 h after two competitive marathon races. The marathoner runners were randomly assigned to carbohydrate (C, n = 48) and placebo (P, n = 50) groups, with beverages administered during the races in a double-blind fashion using color codes. Plasma glucose was higher and cortisol was lower in the C than in the P group after the race ( P < 0.001). For all subjects combined, plasma levels of interleukin (IL)-10, IL-1 receptor antagonist (IL-1ra), IL-6, and IL-8 rose significantly immediately after the race and remained above prerace levels 1.5 h later. The pattern of change in all cytokines did not differ significantly between the 12 women and 86 men in the study and the 23 subjects ≥50 yr of age and the 75 subjects <50 yr of age. The pattern of change in IL-10, IL-1ra, and IL-8, but not IL-6, differed significantly between the C and the P group, with higher postrace values measured for IL-10 (109% higher) and IL-1ra (212%) in the P group and for IL-8 (42%) in the C group. In conclusion, plasma levels of IL-10, IL-1ra, IL-6, and IL-8 rose strongly in runners after a competitive marathon, and this was not influenced by age or gender. Carbohydrate ingestion, however, had a major effect in attenuating increases in cortisol and two anti-inflammatory cytokines, IL-10 and IL-1ra.

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