Methods.— The 72 subjects meeting CDHwMO criteria coming from an epidemiological study in the general population (Neurology 2004; 62: 1338-42) were offered follow-up and treatment for 1 year and then discharged to their general practitioner with treatment recommendations. Four years later, they were interviewed again. They filled in a diary for 1 month and the SF-12 test. Results.— After 1 year, 46 (64%) did not fulfill MO criteria while 26 (36%) did. After 4 years, 68 subjects were contacted. Of those, 38 (58%) did not have CDHwMO, while 30 (44%) still had MO. Among
those 38 subjects without MO criteria, 6 still met CDH criteria. Remission at year 1 was a significant predictor for sustained remission at year 4. Age, gender, civil status, socioeconomic situation, and CDH type were not different in the group Pirfenidone cost with MO vs those without MO. Consumption of nonsteroidal anti-inflammatory drugs and/or selleck compound triptans was significantly higher in subjects without CDH and MO, while the use of ergotics and/or opioids was significantly higher in those patients who still met CDHwMO criteria. Quality of life (QoL) was significantly better at 4 years for the whole group. Conclusions.— After 4 years, almost 60% of subjects did not
fulfill CDHwMO criteria and their QoL was also improved. This justifies public health interventions that should include recommendations on a judicious use of symptomatic medications together with an early use of preventatives. “
“The pain of the so-called functional or primary headache disorders, such as tension headache, migraine, or cluster headache, can be associated with autonomic symptoms that are localized in nature. The localized autonomic symptoms probably involve higher centers of autonomic regulation, for example the hypothalamus,
for which there is support from functional magnetic resonance imaging studies. Hemicrania continua, a continuous, unilateral, side-locked headache, absolutely responsive to preventive treatment with indomethacin, is contrasted with so-called medication-overuse headache, in which the paradoxical situation exists of tremendous suffering despite excessive use of abortive medications. In classification, clinical presentation trumps experimental testing: Not only is there no basis enough to classify hemicrania continua in the category of the so-called trigeminal autonomic cephalalgias, also the very existence of this category lacks solid foundation. “
“The expansion of technologies available for the study of migraine pathophysiology has evolved greatly over the last 15 years. Two areas of rapid progress are investigations focusing on the genetics of migraine and others utilizing novel functional neuroimaging techniques. Genetic studies are increasingly focusing on sporadic migraine and the utilization of unbiased searches of the human genome to identify novel variants associated with disease susceptibility.