OBJECTIVE Limited progress has been made in the past decade for abortive treatment of migraine headache in the pediatric emergency department (PED). Propofol, a general anesthetic, has been reported to be effective in the treatment of refractory headaches in adults at subanesthetic doses but never in the pediatric population. The goal of this study was to review our institution's experience wit...

Policy Aetna considers parenteral administration of dihydroergotamine (DHE) medically necessary for the treatment of intractable migraine or cluster headache. Prolonged multi-day administration of DHE is considered medically necessary when both of the following conditions are met: 1. Member has intractable cluster headache or severe migraine headache (i.e., status migrainosus, chronic daily hea...

Isolated reports of a possible positive effect of anti-coagulant drugs, among them heparin, warfarin and acenocumarol, in migraine prophylaxis are found in the literature. We report the case of a 37 years old man suffering from refractory chronic cluster headache that presented remission with the administration of warfarin for the treatment of deep venous thrombosis associated to arterial throm...

Background: Migraines affect 28 million people in the United States. Surgical treatment for migraine headaches refractory to medical treatment has grown recently for patient with limited options. Utility scores are standardized tools offering validated means of measuring the health state preference of a health condition or disease state. The aim of this study was to prospectively determine the ...

The thalamus is a key center in migraine: nociceptive signals are conveyed there from the trigeminal brainstem nuclear complex. Not surprisingly, it is activated during the acute attack and some drugs like triptanss or propanolol elicit their pain-relief effect by locally activating thalamic neurons. By the same token, thalamic structural lesions could potentially modify the course of this diso...

As I NOTED in another paper, whenever I see a patient with a severe, bizarre, or long-lasting migraine refractory to treatment, I suspect that I am dealing with migraine plus something else -such as a mild psychosis, an unrecognized epilepsy, a cerebral arteriosclerosis, or a constitutional inadequacy. Elsewhere, I have described a series of patients with migraine plus a mild psychosis. Now I p...

OBJECTIVE To test treatment combining a beta-blocker plus topiramate in migraine patients previously resistant to the two medications in monotherapy. PATIENTS AND METHODS Those patients who had not responded to a beta-blocker and topiramate received combined treatment. RESULTS Fifty-eight patients (47 women, age 25-76 years) received the combined treatment. Thirty-three (57%) met criteria f...

About 2% of the adult population has chronic migraine with only 20% diagnosed with this disorder. Those with medication overuse may improve with withdrawal of overuse medications. The intravenous dihydroergotamine regimen usually produces short-term benefit for those with medically refractory chronic migraine. OnabotulinumtoxinA and topiramate have shown efficacy in large placebo-controlled ran...

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