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Update in Neurology
- 1998-99 Series; John Roberts, MD, Editor From Brigham and Women's Hospital, Boston, Massachusetts. Requests for Reprints: Martin A. Samuels, MD, Department of Neurology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115. Current Author Addresses: Dr. Samuels: Department of Neurology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115. Dr. Roberts (Series Editor): Madrona Medical Group, 3199 Steller Court, Bellingham, WA 98226.
Advances in neurology in the past 2 years have focused on a variety of basic issues, including migraine headache, stroke, neuroimaging, degenerative diseases, neurologic aspects of medical conditions, and seizure disorders.
Migraine Headache
Patients with migraine headaches often have difficulty explaining their suffering. In the physician's office, the typical patient places the heel of the hand in one orbit and the fingers up over the forehead, all in the first division of the fifth cranial nerve. Migraine pain is actually pain that is referred into the first division of the trigeminal nerve, and it is probably due to an abnormality in the way in which the central nervous system processes nociceptive information.
Promotility Agent Was Effective in Treatment
Tfelt-Hansen P, Henry P, Mulder LJ, et al. The effectiveness of combined oral lysine acetylsalicylate and metoclopramide compared with oral sumatriptan for migraine. Lancet. 1995; 346:923-6.
Sumatriptan has become a commonly used agent for migraine headaches. It is expensive, however, and patients often delay taking a drug that costs as much as $35 a dose. The injectable form is difficult for some patients to take, and the nasal form is poorly absorbed and leaves a bitter aftertaste. The oral drug is poorly absorbed because migraine attacks also cause gastric stasis and therefore decrease absorption of all oral drugs.
In this clinical trial, Tfelt-Hansen and colleagues assessed the effectiveness of salicylates (the class of drug most commonly used for migraine) plus a promotility agent. They randomly assigned 421 patients with migraine to receive metoclopramide, 10 mg, followed by lysine acetylsalicylate (equivalent to 900 mg of aspirin); oral sumatriptan (100 mg); or placebo. In 57% of patients receiving the combined regimen, 53% of those receiving sumatriptan, and 24% of those receiving placebo, the intensity of headache decreased from severe to mild or absent.
This study makes a critical point about the treatment …
This 100-word excerpt has been provided in the absence of an abstract.
