Interval therapy of migraine: long-term results

Chronic Muscle Contraction Headache: The Importance of Depression and Anxiety

Seventy consecutive patients presenting with a clinical diagnosis of chronic muscle contraction headache over a two-year period were evaluated for depression and anxiety scores, along with other possible aetiological factors in this form of headache. Fifty-five of these patients (33 from a hospital neurology clinic and 22 from a local general practice) completed a double-blind study to evaluate flupenthixol 0.5 mg twice daily, diazepam 5 mg twice daily and placebo as prophylactic agents.

Patients evaluated in the hospital neurology clinic had more frequent headaches of longer duration, higher analgesic consumption and higher depression, but no higher anxiety scores than those in general practice. Flupenthixol and diazepam were both significantly superior to placebo in reducing headaches and analgesic consumption. The trend was for flupenthixol to be superior to diazepam without reaching statistical significance. Flupenthixol was significantly better than diazepam and placebo in the reduction of Hamilton depression scores. This effect was independent of the effect on headache and analgesic reduction.

[Therapy for migraine-the current state of the art and perspectives.]

Migraine is a syndrome and not a nosological entity. It is therefore relatively improbable that a uniform etiology can be defined, and it must be assumed that there are different multifactorial etiological conditions for each individual. It is probable that a therapy concept that is equally valid and promising for all patients can therefore never be developed. On the one hand, there is a variable palette of therapeutic possibilities with a fixed differential indication with regard to the different variants of migraine, and on the other subtle analysis of individual cases is necessary by means of recording the individually relevant somatic, psychological, familial and social parameters. A treatment strategy must then be developed on an individual basis, in which both elements are taken into account. Therapy studies are carried out to investigate various questions and, accordingly, may have different experimental paradigms. The intrinsic action of a therapy method should be compared to the placebo effect on a randomized doubleblind basis. If this preconditions is fulfilled, appraisals of the real chances of success in the practice can be made more accurately on the basis of large-scale open studies comprising a representative cross-section of migraine patients. Further topics for therapy studies should include the analysis of responders and nonresponders and the development of differential indications for certain methods of therapy.

Migraine

The most widely accepted classification of the migraine syndrome includes common, classic, complicated and cluster migraines. Migraine variants refer to episodic dysfunctions of an organ or system which either occur in the migraine sufferer, or replace the headache. While migraine appears to be a primary disorder of the cerebral vessels, there is current experimentation into the role of circulating serotin, prostaglandins, platelet abnormalities and estrogen levels. Both nonnarcotic and narcotic treatments are available, and prophylactic measures may be indicated.

Parenteral chlorpromazine treatment of migraine

A prospective, uncontrolled clinical trial was conducted to test the safety and efficacy of intramuscular chlorpromazine (1 mg/kg) in the acute, outpatient treatment of migraine. One hundred adult patients were included in the study. There was complete relief of both pain and nausea/emesis symptoms in 96 patients within 55 minutes of the injection. Eighteen patients experienced orthostatic hypotension following injection. All but one responded to noninvasive therapy. The results suggest that chlorpromazine is a safe, effective alternative medication in the outpatient treatment of acute migraine.

Observations on the efficacy of propranolol for the prophylaxis of migraine

Among 1,036 patients treated for migraine headache between 1973 and 1980, 865 were given a daily maximum dose of 320 mg of propranolol, while 171 served as differently treated controls. At least one year of treatment was prescribed, at the end of which time 84% of the propranolol group reported sustained improvement compared with similar improvement in only 32% of controls (p less than 0.01). The success rate progressively increased during the entire year.