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S D Silberstein

Publications and source records attributed to S D Silberstein.

At least 55 records · Page 3Linked to original sources
PubMed2001

The role of headache-related disability in migraine management: implications for headache treatment guidelines.

UNLABELLED: Recently published US Headache Consortium Guidelines recommend a process of diagnosis, patient education, and individualized treatment for the management of migraine. Clinicians are advised to base their treatment choice on attack frequency and duration, degree of disability, non-headache symptoms, patient preference, and prior history of treatment response, using a stratified approach to care. In stratified care, initial treatment is individualized based on an assessment of the patients' medical needs. One approach to stratification uses the Migraine Disability Assessment (MIDAS) Questionnaire to stratify patients into groups with different treatment needs based on the degree of headache-related disability. Stratified care was developed as an alternative to step-care approaches, which begin patients on nonspecific medication with gradual escalation until they obtain effective relief. Results from the Disability in Strategies for Care (DISC) study indicate that stratified care provides superior outcomes compared to step-care and that the approach is cost-effective, supporting the US Headache Consortium GUIDELINES: Stratified care may become the approach of choice for managing migraine in clinical practice. This approach increases the chances of providing appropriate therapy at the patient's initial consultation, sparing the patient a series of failed therapeutic efforts. The MIDAS Questionnaire provides a practical tool for helping to implement the recommendations of the US Headache Consortium

Disability Evaluation↗
PubMed2001

Review of botulinum toxin type A and its clinical applications in migraine headache.

Botulinum toxin type A (BTX-A) has been used successfully for many disorders related to excessive muscle contraction. It works, in part, by causing a dose-dependent, reversible muscle relaxation. BTX-A has also been used for migraine prevention. The mechanism by which BTX-A acts in migraine is probably unrelated to its effect on muscle relaxation. BTX-A may have a distinct antinociceptive mechanism, either through action on the muscle spindles or through a direct effect on the central nervous system. Several trials and case reports have demonstrated the safety and efficacy of BTX-A in migraine headache. BTX-A is distinct from other preventive medications. Adverse events (AEs) are rare and mild. BTX-A is convenient, since the dosing interval may be 3 months or longer. However, before BTX-A can be considered a first-line agent for migraine, larger studies need to be conducted to determine optimum dosing and administration sites as well as patient characteristics that are predictive of response.

Botulinum Toxins, Type A↗
PubMed2000

Menstrual cycle and headache in a population sample of migraineurs.

BACKGROUND: Migraine is three times more common in women than men. There is a clinical impression that migraines are more common and severe around the time of menses. OBJECTIVES: To determine 1) the distribution of headache attacks by day of the menstrual cycle in women with migraine, 2) if the excess occurrence varies by headache type, and 3) if headache features differ by time in the menstrual cycle. METHODS: In a population-based sample, 81 menstruating women with clinically diagnosed migraine were enrolled in a 98-day diary study and completed a total of 7219 diary days. The daily diary was used to record the occurrence of menses, headache days, and, on days with headache, associated headache features (i.e., symptoms, quality-of-pain, attack duration, pain intensity, and disability at work, household work, and nonwork activities). RESULTS: An excess risk of headache occurred perimenstrually and was highest on days 0 and 1 of the cycle (day 0 being the first day of menses). A significantly elevated risk of headache on days 0 and 1 was observed for migraine without aura (OR 2.04; 95% CI 1.49, 2.81) and for tension-type headache (OR 1.67; 95% CI 1.24, 2.25). Elevated risks were also observed in the 2 days before onset of menses for migraine without aura (OR 1.80; 95% CI 1.40, 2.30). A significantly lower risk was observed around the time of ovulation for all headaches (OR 0.44; 95% CI 0.27, 0.72). Few significant differences were observed in headache features (i.e., pain intensity, disability score, symptom score, headache duration) by day of the cycle overall or by headache type. Pain intensity was slightly greater for migraine headaches during the first 2 days of menses. CONCLUSIONS: Attacks of migraine without aura, but not migraine with aura, were more likely to occur 2 days before onset of menses and on the first 2 days of menses. This study does not support the clinical notion that headaches, regardless of type, are more severe during the perimenstrual period compared to other times in the cycle. Although migraine headaches are significantly more painful during the first 2 days of menses, differences are small.

Adolescent↗
PubMed2000

Cluster headache with aura.

Cluster headache with aura is rare. The authors retrospectively reviewed 101 cluster headache patient charts at the Jefferson Headache Center. Six patients had an associated aura, five visual and one olfactory, lasting 5 to 120 minutes. Only one had migraine (without aura). Auras always occurred with or were followed by a severe cluster headache. Two patients were related.

Adult↗
PubMed2000

Rizatriptan in the treatment of menstrual migraine.

OBJECTIVE: To determine the efficacy of oral rizatriptan 10 mg and 5 mg for treating menstrually associated migraine attacks. METHODS: Data from two large clinical trials with identical designs were included in a retrospective analysis. The studies were randomized, double-masked, placebo-controlled, incomplete block, two-period, crossover designs. Women with migraines were randomly assigned to one of five treatment sequences for the treatment of two migraine attacks. Only data from the first attack in women with migraines who were treated with rizatriptan or placebo were included in the analysis. A menstrually associated attack was defined as one that occurred within 3 days before or after the onset of the last menstrual period. RESULTS: In the subgroup of 335 women with menstrually associated migraine, rizatriptan was effective compared with placebo. At 2 hours after dosing, 68% of 139 women taking rizatriptan 10 mg and 70% of 115 women taking rizatriptan 5 mg with a menstrually associated migraine had pain relief compared with 44% of 81 patients taking placebo (P <.05). In all women, rizatriptan was as effective in treating menstrual as well as nonmenstrual migraine: 68% of 139 patients taking rizatriptan 10 mg with a menstrually associated migraine had pain relief at 2 hours after dosing compared with 69% of 393 patients with nonmenstrually associated attacks (test of menstrual association = nonsignificant; the analysis had 80% power to detect a difference of six percentage points between groups). Similar results were found for rizatriptan 5 mg (menstrual = 70%, nonmenstrual = 66%; not statistically significant). CONCLUSION: Rizatriptan is effective in the treatment of menstrually associated migraine attacks.

Administration, Oral↗
PubMed2000

Physiology of the menstrual cycle.

The normal female life cycle is associated with a number of hormonal milestones: menarche, pregnancy, contraceptive use, menopause, and the use of replacement sex hormones. All these events and interventions alter the levels and cycling of sex hormones and may cause a change in the prevalence or intensity of headache. The menstrual cycle is the result of a carefully orchestrated sequence of interactions among the hypothalamus, pituitary, ovary, and endometrium, with the sex hormones acting as modulators and effectors at each level. Oestrogen and progestins have potent effects on central serotonergic and opioid neurons, modulating both neuronal activity and receptor density. The primary trigger of menstrual migraine appears to be the withdrawal of oestrogen rather than the maintenance of sustained high or low oestrogen levels. However, changes in the sustained oestrogen levels with pregnancy (increased) and menopause (decreased) appear to affect headaches. Headaches that occur with premenstrual syndrome appear to be centrally generated, involving the inherent rhythm of CNS neurons, including perhaps the serotonergic pain-modulating systems.

Contraceptives, Oral↗
PubMed2000

Cluster headache.

Cluster headache is a stereotypic, primary headache disorder that is marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Cluster headache is probably due to an abnormality in the circadian hypothalamic generator with subsequent trigeminovascular activation. We have reviewed the clinical manifestations, pathophysiology, gender differences, and treatment options in cluster headache.

Cluster Headache↗
PubMed2000

Opioids.

Explore the source record for details and available documents.

Analgesics, Opioid↗
PubMed2000

Chronic daily headache.

Primary chronic daily headache can be subclassified into disorders of short duration (<4 h/attack) including chronic cluster and disorders of long duration (> or =4 h/attack). Primary chronic daily headache disorders of long duration include chronic tension-type headache, chronic daily migraine (previously called transformed migraine), new daily persistent headache, and hemicrania continua. Four to 5% of the general population have primary chronic daily headache. Most chronic daily headache patients overuse analgesics or ergots. This article will consider recent insights into specific disorders, then psychiatric comorbidity, epidemiology, pathophysiology, and treatment.

Chronic Disease↗
PubMed2000

Rizatriptan versus usual care in long-term treatment of migraine.

Because of the recurrent nature of migraine, a major concern with pharmacologic therapy is whether it will remain effective, safe, and tolerable over the long term. The development of sumatriptan offered an improvement in migraine therapy, although concerns remain about chest symptoms associated with this class of drugs. In early clinical trials, rizatriptan was shown to have good bioavailability and favorable effects on quality of life. Long-term extension trials ran for up to 12 months and compared rizatriptan with "usual care" (i.e., medications used for acute therapy). These studies showed that the 10-mg rizatriptan dose was consistently superior to usual care with regard to pain relief and complete pain relief (pain-free). Side effects were generally mild and transient in all treatment groups. Nausea, dizziness, and somnolence were the most commonly reported adverse effects.

Humans↗
PubMed2000

Management of migraine: an algorithmic approach.

Good management of migraine requires that the patient participate actively in decisions regarding therapeutic intervention. Most patients, when carefully informed, will engage in a wellness program that includes regular exercise and rest, good nutrition, and avoidance of headache triggers. Acute treatment is probably most likely to be beneficial if it is started early in the migraine attack. Headache severity and associated features, such as nausea, vomiting, or previous treatment responses, can guide selection of medication for acute treatment. Simple analgesics or nonsteroidal anti-inflammatory drugs, with or without antiemetics, are usually the first line of treatment and are effective for some attacks. Combination analgesics or ergotamine preparations represent second-line therapies for patients with infrequent attacks. For patients unlikely to respond to simpler treatments, 5-HT1B/1D receptor agonists or dihydroergotamine offer the best chance for relief. Narcotic analgesics may be needed when other antimigraine drugs prove ineffective, but must be prescribed judiciously. Patients with 3 or more days of headache-related disability per month, or with headaches refractory to acute treatment, are candidates for preventive therapy. Coexisting disease can contribute to decisions on prophylaxis. In many cases, a single agent may be used to treat both migraine and a coexisting disorder. beta-blockers are most often used for preventive therapy. Other options include divalproex, antidepressants, calcium-channel antagonists, serotonin antagonists, and riboflavin.

Algorithms↗
PubMed2000

Sex hormones and headache.

The normal female life cycle is associated with a number of hormonal milestones: menarche, pregnancy, contraceptive use, menopause, and the use of replacement sex hormones. Menarche marks the onset of menses and cyclic changes in hormone levels. Pregnancy is associated with rising noncyclic levels of sex hormones, and menopause with declining noncyclic levels. Hormonal contraceptive use during the reproductive years and hormone replacement in menopause are therapeutic hormonal interventions that alter the levels and cycling of sex hormones. These events and interventions may cause a change in the prevalence or intensity of headache. The menstrual cycle is the result of a carefully orchestrated sequence of interactions between the hypothalamus, pituitary, ovary, and endometrium, with the sex hormones acting as modulators and effectors at each level. Estrogen and progestins have potent effects on central serotonergic and opioid neurons, modulating both neuronal activity and receptor density. The primary trigger of Menstrually-related migraine (MM) appears to be the withdrawal of estrogen rather than the maintenance of sustained high or low estrogen levels. However, changes in the sustained estrogen levels with pregnancy (increased) and menopause (decreased) appear to affect headaches. Headaches associated with OC use or menopausal hormonal replacement therapy may be related, in part, to periodic discontinuation of oral sex hormone preparations. The treatment of migraine associated with changes in sex hormone levels is frequently difficult and the patients are often refractory to therapy. Based on what is known of the pathophysiology of migraine, we have attempted to provide a logical approach to the treatment of headaches that are associated with menses, menopause, and OCs using abortive and preventive medications and hormonal manipulations. Considerable evidence suggests a link between estrogen and progesterone, the female sex hormones, and migraine. (Silberstein and Merriam, 1997; Lipton and Stewart, 1993; Epstein et al., 1975; Goldstein and Chen, 1982; Selby and Lance, 1960) Although no gender difference is apparent in prepubertal children, with migraine occurring equally in 4p. 100 of boys and girls, (Goldstein and Chen, 1982, Waters and O'Connor, 1971) migraine occurs more frequently in adult women (18p. 100) than in men (6p. 100). (Lipton and Stewart, 1993) Migraine develops most frequently in the second decade, with the peak incidence occurring with adolescence. (Selby and Lance, 1960; Epstein et al., 1975) Menstrually-related migraine (MM) begins at menarche in 33p. 100 of affected women (Epstein et al. , 1975). MM occurs mainly at the time of menses in many migrainous women, and exclusively with menses (true menstrual migraine [TMM]) in some (Epstein et al., 1975). Menstrual migraine can be associated with other somatic complaints arising before and often persisting into menses, such as nausea, backache, breast tenderness, and cramps and like them appears to be the result of falling sex hormone levels (Silberstein and Merriam, 1997; American Psychiatric Association, 1994). In addition, premenstrual migraine can be associated with premenstrual dysphoric disorder (PDD), also called "premenstrual syndrome" (PMS), which is distinct from the physical symptoms of the perimenstrual period and is probably not directly driven by declining progesterone levels (Mortola, 1998). Migraine occurring during (rather than prior to) menstruation is usually not associated with PMS (Silberstein and Merriam, 1997). Migraine may worsen during the first trimester of pregnancy and, although many women become headache-free during the last two trimesters, 25p. 100 have no change in their migraine (Silberstein, 1997). MM typically improves with pregnancy, perhaps due to sustained high estrogen levels (Silberstein, 1997). Hormonal replacement with estrogens can exacerbate migraine and oral contraceptives (OCs) can change its character and frequency

Adult↗
PubMed1999

Treatment of menstruation-associated migraine with the nonprescription combination of acetaminophen, aspirin, and caffeine: results from three randomized, placebo-controlled studies.

This retrospective study sought to examine the benefits of the nonprescription combination of acetaminophen, aspirin, and caffeine (AAC; Excedrin Migraine, Bristol-Myers Squibb Company, New York, New York) for the treatment of menstruation-associated migraine compared with migraine not associated with menses. Data were derived from 3 double-masked, randomized, placebo-controlled, single-dose trials enrolling subjects who met the International Headache Society's diagnostic criteria for migraine with or without aura. Subjects with incapacitating disability (attacks requiring bed rest >50% of the time) and those who usually experienced vomiting > or =20% of the time were excluded. Retrospective analysis of the 1220 subjects included in the efficacy-evaluable data set indicated that 185 women treated menstruation-associated migraine, 781 women treated migraine not associated with menses, and 1 woman provided no information regarding menstrual status. At baseline and at 0.5, 1, 2, 3, 4, and 6 hours postdose, subjects assessed the intensity of headache pain, functional disability, nausea, photophobia, and phonophobia. Pain intensity, nausea, photophobia, and phonophobia were rated on a 4-point scale ranging from 0 = none to 3 = severe; functional disability was rated on a 5-point scale ranging from 0 = none to 4 = incapacitating. For both menstruation-associated migraine and migraine not associated with menses, the proportion of subjects with pain intensity reduced to mild or none (responders) was significantly greater with AAC than with placebo at all postdose time points from 0.5 through 6 hours (P< or =0.05), with no statistically significant difference in treatment effect between menstruation-associated migraine and migraine not associated with menses at any postdose time point. Migraine characteristics such as photophobia, phonophobia, and functional disability were significantly improved in AAC-treated subjects at all time points from 1 through 6 hours (P< or =0.01) in both the menstruating and nonmenstruating groups. Significant relief from nausea was experienced in both menstruation-associated migraine and migraine not associated with menses, but relief appeared earlier in the AAC nonmenstruating subjects (2 hours postdose, P< or =0.01) than in the menstruating subjects (6 hours postdose, P< or =0.05). Beginning at 3 hours postdose, significantly fewer subjects treated with AAC required rescue medication (P< or =0.05) for menstruation-associated migraine (AAC 6%, placebo 15%) and migraine not associated with menses (AAC 7%, placebo 14%). The most commonly used rescue medications in both the menstruating and nonmenstruating groups were nonsteroidal anti-inflammatory drugs, prescription combination analgesics/narcotics, and prescription migraine preparations. AAC was well tolerated in both menstruation-associated migraine and migraine not associated with menses; in general, adverse experiences were similar in both groups. The proportion of subjects who had 1 or more adverse experiences was significantly higher among those receiving AAC than among those receiving placebo (menstruation-associated migraine: AAC 26.4%, placebo 12.6%, P = 0.025; nonmenstruation-associated migraine: AAC 18.6%, placebo 11.4%, P = 0.005). Adverse experiences were similar in type and severity to those previously associated with single doses of acetaminophen, aspirin, or caffeine. Thus the nonprescription combination of AAC was highly effective in treating the pain, disability, and associated symptoms of both menstruation-associated migraine and migraine not associated with menses.

Acetaminophen↗
PubMed1999

Classification and epidemiology of headache.

Headache disorders are remarkably common. Like back pain, headache is a symptom that has a broad range of possible causes. Diagnosis of primary headache disorders (migraine, tension-type headache, cluster headache) depends on systematic exclusion of secondary disorders and systematic identification of the specific features of the primary disorders. Thus, migraine should be viewed as an episodic syndrome of pain, involving intracranial structures associated with other neurologic disturbances. Because of the large number of potential etiologies, clinicians must approach headache classification systematically. In this chapter, we provide an overview of headache classification followed by discussions of epidemiology.

Adolescent↗