Conclusions.— Problematic headache is highly prevalent among patients with HIV/AIDS, most of which conform to the semiology of chronic migraine, although with some atypical features such as bilateral location and pressing/tightening quality. A low frequency of identifiable secondary causes is likely attributable to reduced frequency of opportunistic infections in the current era of HAART. Disease severity is strongly predictive of headache, highlighting
the importance of physician attention to headache symptoms and of patient adherence to treatment. (Headache 2012;52:455-466) “
“(Headache 2011;51;S2:93-100) XL765 Chronic migraine (CM) is a complex disorder requiring a multifaceted management approach encompassing lifestyle modification, trigger avoidance, behavioral therapy, pharmacotherapy, patient education and support, management of expectations, and close follow-up. The lack of pharmacotherapies approved by the US Food and Drug Administration (FDA) hinders CM prophylaxis and management. Topiramate, gabapentin, tizanidine, fluoxetine,
amitriptyline, and onabotulinumtoxinA have been evaluated for prophylactic treatment of CM in randomized, double-blind, placebo-controlled or active comparator-controlled trials. Additional well-designed, placebo-controlled studies are needed to assess the effectiveness of new and existing treatment options for CM. Understanding current clinical trial design and management guidelines is
critical Sitaxentan to designing future trials that overcome the challenge of consistent find more use of sensitive and clinically meaningful outcome measures. Topiramate is approved for episodic migraine management and has been studied for CM management. A growing body of evidence has shown it to be safe, effective, and well-tolerated in specific patient populations. However, intolerable adverse effects and inadequate efficacy associated with topiramate may lead to poor adherence. The efficacy, safety, and tolerability of onabotulinumtoxinA have been demonstrated in studies in various migraine patient populations, leading to recent FDA approval of onabotulinumtoxinA for the prophylactic treatment of CM in adults. These studies included patients with or without medication overuse, which may affect 30% to 80% of CM patients in the USA. In this program, we will analyze and discuss recent clinical trials investigating topiramate and onabotulinumtoxinA for CM. “
“The term New Daily Persistent Headache (NDPH) has been used for nearly 25 years and yet the entity remains enigmatic. It can be argued the simplest, indeed most appropriate, approach is to use the term to mean simply what it says- i.e. as an umbrella description, rather like chronic daily headache. NDPH should be used as a diagnostic umbrella inviting better characterization, not be an achievement in itself.