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Biomedical subjects

A M Rapoport

Publications and source records attributed to A M Rapoport.

17 recordsLinked to original sources
PubMed1996

Early and transient side effects of repetitive intravenous dihydroergotamine.

Side effects associated with administration of repetitive intravenous dihydroergotamine (DHE) were prospectively studied in 72 patients with chronic daily headache who were hospitalized in a dedicated inpatient headache treatment program. All patients received 11 consecutive doses of DHE, starting with 0.25 mg and increasing by 0.25 mg up to a maximum dose of 1.25 mg, depending on side effects and/or headache relief. The adverse events were recorded after each dose administered. The great majority of patients (91.6%) reported at least one side effect. The most common were: nausea (72.2%), increase in previous headache (47.2%), lightheadedness (33.3%), "new" headache (27.8%), and leg cramps (23.6%). The overall number of side effect complaints did not increase proportionally with the strength of the dose of DHE administered. These complaints declined from the earlier to the later doses of DHE, except for leg cramps, which were more common with the later doses. Side effects determined the strength of subsequent doses of DHE in only 18.1% of patients. Only four patients had to have a decrease in dosage and none required termination of DHE due to side effects. Although repetitive intravenous DHE causes frequent side effects, they are usually mild and transient and decrease with subsequent doses, even at higher doses.

Adolescent↗
PubMed1995

Migraine prophylaxis with divalproex.

OBJECTIVE: To compare the effectiveness and safety of divalproex sodium (Depakote) and placebo in the prophylaxis of migraine headache. DESIGN: Multicenter, double-blind, randomized, placebo-controlled investigation, having a 4-week, single-blind placebo baseline phase and a 12-week treatment phase (4-week dose adjustment, 8-week maintenance). SETTING: Eight headache/neurology clinics throughout the United States. PATIENTS: One hundred seven patients randomized to divalproex or placebo (2:1 ratio): 70 receiving divalproex and 37 receiving placebo. INTERVENTION: Divalproex and placebo dosages titrated in blinded fashion during dose adjustment period to achieve actual/sham trough valproate sodium concentrations of approximately 70 to 120 mg/L. MEASUREMENTS AND MAIN RESULTS: During the treatment phase, the mean migraine headache frequency per 4 weeks was 3.5 in the divalproex group and 5.7 in the placebo group (p < or = .001), compared with 6.0 and 6.4, respectively, during the baseline phase. Forty-eight percent of divalproex-treated patients and 14% of placebo-treated patients showed a 50% or greater reduction in migraine headache frequency from the baseline phase (P < .001). Among those with migraine headaches, divalproex-treated patients reported significantly less functional restriction than placebo-treated patients and used significantly less symptomatic medication per episode. No significant treatment group differences were observed in average peak severity or duration of individual migraine headaches. Treatment was stopped in 13% of divalproex-treated patients and 5% of placebo-treated patients because of intolerance (P, not significant). CONCLUSIONS: Divalproex is an effective prophylactic drug for patients with migraine headaches and is generally well tolerated.

Adolescent↗
PubMed1995

Oral sumatriptan in preventing headache recurrence after treatment of migraine attacks with subcutaneous sumatriptan.

Headache recurrence (HR) may occur within 24 hours in approximately 40% of migraine attacks initially treated successfully with 6 mg subcutaneous (SC) sumatriptan. This may be due to the short plasma half-life of sumatriptan. We studied whether an additional dose of 100 mg oral sumatriptan 4 hours after treatment of a migraine attack with 6 mg SC sumatriptan could prevent HR. Patients (n = 667) treated up to three migraine attacks in a randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial. For each attack, they initially took open-label 6 mg SC sumatriptan by autoinjector. Four hours later all patients took either 100 mg oral sumatriptan or matched placebo. Patients could take an additional optional oral dose of 100 mg sumatriptan to treat HR. The primary efficacy end point was the number of successfully treated patients without HR within 24 hours after the initial SC injection for the first study attack. Two hundred twenty-five patients were not assessable for HR, mainly because of protocol violations. Of 442 assessable patients, 82/212 in the sumatriptan-treated group (39%) and 89/230 in the placebo-treated group (39%) reported HR in attack 1. Median times to recurrence were 15.6 hours after sumatriptan and 10.3 hours after placebo (p = 0.006). One hundred mg oral sumatriptan taken 4 hours after 6 mg SC sumatriptan does not prevent HR but significantly delays time to recurrence.

Administration, Oral↗
PubMed1994

Subcutaneous sumatriptan in a clinical setting: the first 100 consecutive patients with acute migraine in a tertiary care center.

The first 100 consecutive patients at our center receiving subcutaneous sumatriptan (6 mg) were evaluated over a total of 455 migraine attacks. Parameters included overall efficacy, average time to relief, recurrence rate, average time to recurrence, adverse events, comparison to previous abortive agents, and subjective global ratings. Overall efficacy (defined as headache severity reduction from severe or moderate to mild or none) was 84%. Average time to relief was 40 minutes. Nine percent failed to respond at all. Recurrence rate was 46.5% with 36% of patients having no recurrence. Fourteen percent of patients reported 100% recurrence (minimum 3 attacks; average 5.4 attacks). Time to recurrence varied widely, but averaged 9.1 hours. Eighty-one percent rated the drug better or much better than previous abortive medications in terms of sumatriptan's ability to abort the attack. Seventy-seven percent reported some adverse event (generally mild and transient) with 23% reporting no adverse events. Sixty-nine percent reported a global rating of Good to Excellent and 31% rated Poor or Fair. The rate of recurrence and average time to recurrence were the most significant factors affecting the global ratings. These parameters were further evaluated with respect to a variety of subgroups: 1) migraine alone 2) migraine with co-existent tension-type headache 3) drug-induced headache (analgesic rebound headache) 4) posttraumatic headache 5) preventive versus no preventive medication 6) presence or absence of adverse events 7) presence or absence of recurrence and 8) average duration of migraine with no medication.

Acute Disease↗
PubMed1994

Recurrent migraine: cost-effective care.

The cost of untreated or ineffectively treated migraine is staggering. A case study is presented that demonstrates the importance of developing an individually tailored home treatment program for migraine patients aimed at keeping them out of healthcare facilities on an acute basis. Treatment programs should include preventive medications if attacks occur more than twice per month, as well as appropriate abortive and symptomatic agents in the event of a severe, acute migraine attack. New agents and treatment modalities are making acute treatment more cost-effective and making it less likely that unnecessary time be spent seeking medical help at the time of an attack.

Adult↗
PubMed1992

Cluster headache syndrome. Ways to abort or ward off attacks.

Cluster headache is a syndrome of severe head and facial pain accompanied by autonomic abnormalities. Men are affected more frequently than women. Headaches occur daily during periods of susceptibility, which may be followed by periods of remission. The etiology of cluster headache is uncertain. Recent work suggests that hypothalamic dysfunction and/or oxyhemoglobin desaturation may be involved in its pathogenesis. Effective medical regimens are available for aborting acute attacks and for preventing attacks. Surgical ablation of the trigeminal ganglion has been effective in some patients when conventional medical therapy has failed.

Cluster Headache↗
PubMed1992

The diagnosis of migraine and tension-type headache, then and now.

Making an accurate headache diagnosis is important, and most medical personnel believe that they can do it properly. Until 1988, the diagnostic schema of the Ad Hoc Committee had been used, but it was found to be vague and too general. The operational criteria proposed by the Classification Committee of the International Headache Society (IHS) and published in Cephalalgia in 1988 are more specific. Their strong and weak points are reviewed and compared with the older criteria. The literature is reviewed with the conclusion that although the IHS criteria are not perfect, they represent a positive step. Further study will help to refine the criteria to make them more accurate and easier to use.

Diagnosis, Differential↗
PubMed1992

Emergency treatment of headache.

The first approach in the emergency treatment of headache is the use of abortive measures in an attempt to forestall progression of early signs and symptoms. Abortive measures include analgesics, antiemetics, and anxiolytics; nonsteroidal anti-inflammatory drugs; ergots, generally preceded by administration of an antiemetic; conservative use of corticosteroids; major tranquilizers; and even narcotics (in certain extreme and selective situations). If abortive measures fail, IM or IV administration of dihydroergotamine mesylate, preceded by promethazine (IM) or metoclopramide (IM or IV) and followed by dexamethasone (IM or IV), is an effective emergency procedure. Every patient seeking care for headache from an emergency department should be instructed on how and where to obtain definitive follow-up and long-term treatment.

Emergencies↗
PubMed1983

Geriatric headaches.

Headaches, although common occurrences in the elderly, can be the symptoms of a serious problem. Specific headaches found in this population need careful consideration and diagnosis. When the diagnosis is elusive, or the headache is sudden, severe, and incapacitating, a neurologist or neurosurgeon should be consulted.

Aged↗
PubMed1977

Moya-Moya disease in black adults.

We describe two instances of Moya-Moya disease in black adults. Little is known concerning the origin of this disease. Currently, there is no effective treatment.

Adult↗