Migraine Headache Health Article

Prevention

Drug therapy, biofeedback training, stress reduction, and the elimination of certain foods from the diet are the most common methods of preventing migraine headaches. Regular exercise (eg, swimming, vigorous walking) can also reduce the frequency and severity of migraines. Scientists estimate that a small percentage of these patients will benefit from a treatment program focused solely on eliminating headache-provoking foods and beverages. Finally, many specialists recommend that persons with migraines avoid oversleeping on weekends.

Updated - September 16, 2005.

Migraine headaches in children are significantly associated with recurrent epistaxis, according to an article found in the August 2005 issue of Pediatric Neurology. .

Pennsylvania researchers studied 45 patients between the ages of 6 and 11 years old who met the criteria for a diagnosis of migraine headache and who were being followed in a pediatric neurology clinic. These patients were compared with a set of 64 control subjects who did not have recurrent headaches. The children in the control group were matched for age and sex, and they were drawn from an elementary school and from 2 general pediatric practices. A detailed questionnaire was the method used to obtain study data.

In these 2 groups, it was found that 16 of the 45 patients (36%) with migraine headaches had epistaxis, whereas only 7 of the 64 control subjects (11%) had epistaxis (odds ratio, =4.5; 95% confidence interval, 1.6-12.1; P = .002). The odds of migraine were therefore 4-fold higher when patients had a history of recurrent epistaxis.

In the migraine group, it was also noted that epistaxis began, on average, 3 years before migraine. The epistaxis episodes in this group bore similar characteristics to those of patients who have been diagnosed with idiopathic epistaxis. These characteristics included a high incidence of occurrence during sleep, an early childhood onset, and a positive family history of epistaxis.

In conclusion, the researchers found that a significant association exists between recurrent epistaxis and migraine in children. These data also create speculation that epistaxis could be an antecedent to childhood migraine, and it is suggested that a prospective, longitudinal study should be conducted to further define the relationship between the two disorders.

In other news, it was found that fast-disintegrating/rapid-release sumatriptan tablets are an effective, acute treatment for patients who have moderate to severe attacks of migraine pain. Findings were combined on 2 identically designed, randomized, double-blind, parallel-group studies to arrive at this conclusion, and the results were reported in the April 2005 issue of Clinical Therapeutics. .

Led by Dr. Fred D. Sheftell of the New England Center for Headache in Stamford, Conn, researchers evaluated the responses of 2696 patients to either placebo, sumatriptan 50 mg, or sumatriptan 100 mg. Most of the patients in the study were women (83%-87%) and white (92%-93%), and they ranged in age from 40.2 to 40.8 years old. The participants had been diagnosed with a moderate or severe attack of migraine headache and were being seen as outpatients. Each patient was given a personal digital assistant and was asked to qualify the intensity of their migraine pain (as none, mild, moderate, or severe) at predetermined points after dosing. Each patient was also asked to record the time of dosing and the time at which they achieved pain relief (ie, when pain was considered mild or absent). Data regarding adverse events were gathered at a clinic visit that occurred within 1 week of migraine treatment.

In the first study, treatment with sumatriptan tablets was significantly more effective than placebo at 50 minutes after taking the 50-mg dose and at 25 minutes after taking the 100-mg dose. Similarly, in the second study, it was found that treatment with sumatriptan tablets was significantly more effective than placebo at 30 minutes after the 50-mg dose and at 17 minutes after the 100-mg dose ( P = .05). In the individual studies, significantly more patients receiving sumatriptan enjoyed pain relief and remained pain-free over 24 hours as compared with placebo ( P = .001, both sumatriptan doses vs placebo).

When data from both studies were pooled, it was determined that the percentages of patients achieving pain relief by 2 hours after they were dosed was 67% for the 50-mg dose and 72% for the 100-mg dose as compared with just 42% for placebo ( P = .001, both sumatriptan doses vs placebo). In addition, The cumulative percentages of patients who became pain-free by 2 hours were 40% for the 50-mg dose, 47% for the 100-mg dose, and 15% for placebo ( P = .001, both sumatriptan doses vs placebo).

Drug-related adverse events that were reported in >2% of patients in any group in either study included paresthesia (study 1: >1% sumatriptan 100 mg, >1% sumatriptan 50 mg, 0% placebo; study 2: 3% sumatriptan 100 mg, 1% sumatriptan 50 mg, >1% placebo) and nausea (both studies: 3% sumatriptan 100 mg, 2% sumatriptan 50 mg, 1% placebo).

The researchers concluded that the fast-disintegrating/rapid-release formulation of sumatriptan was efficacious for relieving moderate to severe acute migraine pain and that the medication was generally well tolerated. The time to the onset of pain relief for the 100-mg dose occurred in as few as 20 minutes, and it occurred in as few as 30 minutes for the 50-mg dose.