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Biomedical subjects

S D Silberstein

Publications and source records attributed to S D Silberstein.

At least 91 records · Page 5Linked to original sources
PubMed1997

Migraine: a problem for employers and managed care plans.

Headache is probably the most common symptom in the workforce and in the general population. Among the many types of headache, the one with perhaps the greatest impact on well-being and functional capacity is migraine. It disrupts work and leisure activities and engenders significant use of healthcare resources. Migraine cannot be cured, but it can usually be managed. Managed care organizations can facilitate the treatment of migraine through disease management programs. Unfortunately, however, many migraineurs receive substandard, ineffectual, and inappropriate care--or no care at all. This article reviews the diagnosis, epidemiology, and treatment of migraine, with an emphasis on the perspectives of employers and managed care plans, with the hope of encouraging them to become more proactive in dealing with individuals with migraine.

Activities of Daily Living↗
PubMed1997

The pharmacology of ergotamine and dihydroergotamine.

The ergot alkaloids are a family of chemical entities that have many pharmacologic effects. Their diversity results from their interaction with multiple receptors, their variable receptor affinity and intrinsic activity, and their variable organ-specific receptor access. Ergotamine tartrate (ET) was one of the first ergot alkaloids to be isolated. Dihydroergotamine (DHE) is synthesized by reducing an unsaturated bond in ergotamine (E); this modification results in a changed pharmacologic profile. Dihydroergotamine exhibits greater alpha-adrenergic antagonist activity and much less potent arterial vasoconstriction and emetic potential. Both E and DHE are 5-HT1A, 5-HT1B, 5-HT1D, and 5-HT1F receptor agonists. The vasoconstrictor activities of these ergot compounds have long been believed to be the basis of their clinical effects, but recent evidence suggests that their antimigraine action may result in part from their inhibitory effects on neurogenic inflammation and neuronal transmission and not from vasoconstriction. Improvements in assay methodology have provided more accurate determination of the pharmacokinetics of E and DHE. The long duration of action appears to result from active metabolites and tight tissue binding. Intranasal (IN) administration of DHE delivers adequate plasma concentrations of the drug without the need for parenteral administration and should further expand its role in migraine pharmacotherapy.

Analgesics, Non-Narcotic↗
PubMed1996

Headache epidemiology. Emphasis on migraine.

Through the use of IHS criteria, large population-based epidemiologic studies in Denmark, the United States, France, Canada, and elsewhere have shed light on the descriptive epidemiology of migraine. Although migraine is a remarkably common cause of temporary disability, many migraineurs, even those with disabling headache, have never consulted a physician for the problem. Prevalence is highest in women, in persons between the ages of 25 and 55, and, at least in the United States, in individuals from low income households. Nonetheless, it occurs with high prevalence outside these groups at highest risk. The prevalence of migraine may be increasing in the United States, but this is uncertain. Longitudinal studies are required to better determine the incidence and natural history of migraine, as well as the life course of comorbid conditions.

Adolescent↗
PubMed1996

Divalproex sodium: migraine treatment and monitoring.

Divalproex sodium is an effective drug for the treatment of migraine. Most adverse drug events are transient and not of great clinical concern. Although rare, well-documented examples of liver toxicity have been reported in children under 2 years of age on polypharmacy. Additional cases occur in children under 10 who are receiving polypharmacy, particularly those who have intractable seizures and degenerative central nervous system disease. Clinicians who treat migraineurs with divalproex sodium do not need to be overly preoccupied with monitoring of drug levels and liver function tests. The most valuable test is clinical observation of the patient.

Adolescent↗
PubMed1996

Divalproex sodium in headache: literature review and clinical guidelines.

Divalproex sodium is an anticonvulsant agent approved for use either alone or in combination with other antiepileptic drugs for simple and complex absences seizures and mania. Four double-blind placebo-controlled studies have confirmed that divalproex sodium/valproate is an effective migraine treatment. In all of the clinical studies, whether open, retrospective, or placebo-controlled and double-blind, valproate was an effective preventive treatment for migraine. There was a reduction in the number of migraine attacks, and migraine duration and intensity were also reduced in some instances. It is equally as effective in patients with severe frequent migraines as in those with less severe migraines. In clinical trials, the most frequent adverse events reported by patients treated with divalproex sodium were nausea, asthenia, dyspepsia, dizziness, somnolence, and diarrhea, with most adverse events being mild to moderate in severity.

Chronic Disease↗
PubMed1996

Classification of daily and near-daily headaches: field trial of revised IHS criteria.

Primary chronic daily headache can be subdivided into transformed migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. We proposed and tested criteria in 150 consecutive outpatients with chronic daily headache. Based on preliminary analysis, we revised the criteria for transformed migraine. Using the International Headache Society criteria, 43% of the patients could not be classified; using our old criteria, 25% could not be classified; however, using our new criteria, we were able to classify 100%. Seventy-eight percent had transformed migraine, 15.3% had chronic tension-type headache, and 6.7% had other headache disorders.

Adult↗
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

Migraine: association with personality characteristics and psychopathology.

The relationship between migraine and psychopathology has been discussed far more often than it has been systematically studied. Twentieth-century investigators have frequently described the obsessional rigid, angry personality postulated to characterize migraine sufferers. More recent population-based studies have demonstrated associations between migraine and depression and migraine and panic disorder. This article discusses the relationship of migraine and personality and migraine and psychopathology.

Controlled Clinical Trials as Topic↗
PubMed1995

Development of a brief 24-hour migraine-specific quality of life questionnaire.

The objective of this study was to develop a questionnaire to assess the short-term quality of life decrements associated with an acute migraine headache attack. A total of 101 potential quality of life items were generated by interviewing migraineurs and migraine specialists and reviewing the literature. To reduce the items, 76 migraineurs (18 years and older) were asked to identify which of the 101 items affected their quality of life in the 24 hours following onset of a migraine and to rate them on a five-point scale from "not very important" to "extremely important." Reduction of the 101 items to a 15-item questionnaire was performed by evaluating the results of subject-perceived importance (number of times an item was chosen x mean importance score) in combination with principal components analysis. Five domains were identified: (1) work functioning, (2) social functioning, (3) energy/vitality, (4) migraine headache symptoms, and (5) feelings and concerns. Each domain has three items and the correlation between the five domains, as measured by the Spearman correlation coefficient, ranged from 0.08 to 0.38 suggesting minimal overlap. The brief migraine quality of life questionnaire was pilot-tested in two groups of 10 migraineurs and revised to improve clarity.

Adult↗
PubMed1995

Validation of a new quality of life questionnaire for acute migraine headache.

A brief migraine-specific quality of life questionnaire was developed to assess the quality of life decrement associated with an acute migraine attack in the 24-hour period following headache onset. The migraine quality of life questionnaire has 15 questions across five domains (work functioning, social functioning, energy, concerns, and symptoms). A prospective, observational study was conducted to evaluate the characteristics of internal consistency, construct and discriminant validity, and responsiveness of the migraine quality of life questionnaire. One hundred thirty-eight subjects with migraine were recruited. One hundred seven subjects completed a baseline and a 24-hour postmigraine quality of life questionnaire, along with a migraine diary for recording headache severity, activity limitation, associated symptoms, duration of headache, and use of migraine medication. All five migraine quality of life questionnaire domains showed good internal consistency (Cronbach's alpha, 0.74-0.95). The strongest correlations were seen between activity limitation and associated symptoms and the migraine quality of life questionnaire work, social, and energy domains. Significant differences in mean questionnaire scores between subjects were found with frequency of medication use, global change in symptoms, headache duration, and severity. All five domains showed significant responses within subjects from a migraine-free period to an acute migraine period (P < 0.0001). In summary, the migraine quality of life questionnaire showed good internal consistency, construct and discriminant validity, and responsiveness to acute migraine attacks.

Acute Disease↗
PubMed1995

Headache associated with aseptic meningitis.

A retrospective analysis of all patients admitted with the diagnostic codes of aseptic or viral meningitis was performed at two institutions over 3 years. Forty-one patients with cerebrospinal fluid confirmation of aseptic meningitis (increased protein; increased white count; negative gram stain; and negative fungal, tuberculosis, and bacterial cultures) were analyzed. All the patients had headache, which was typically severe and bilateral in 39 of the 41 patients. The headache was of abrupt onset or the worst of the patient's life in 24 of the patients. The quality of the headache, when described, was usually throbbing (11 of 14). Nineteen patients had prodromal symptoms, including malaise, myalgia, gastrointestinal symptoms, and urinary tract infections. All had associated symptoms, including nausea (25), vomiting (23), photophobia (18), stiff neck (25), and back pain (11). Thirty patients were febrile. Lumbar puncture was performed for headache and fever unexplained by systemic illness in 30 patients, meningeal signs in 15, headache of abrupt onset or the worst headache ever in 24, neurologic signs or symptoms in 12, and for other reasons in 2. Computerized tomography, when performed, was negative in all cases. Focal neurologic findings were present in 5 patients, a decreased level of consciousness in 6, and papilledema in 1. A severe headache that worsens, is abrupt in onset, or is the worst of the patient's life could be due to aseptic meningitis, bacterial meningitis, or a subarachnoid hemorrhage. Although not universally present, meningeal signs, fever, and neurologic signs or symptoms should alert one to a possible central nervous system infection.

Adolescent↗
PubMed1995

Migraine and women. The link between headache and hormones.

Levels of sex hormones fluctuate throughout the female life cycle, and these fluctuations may trigger, intensify, or alleviate migraine. Drugs can be used both preventively and therapeutically to combat the headache that results in some women from such fluctuations. Effective prophylactic agents include beta blockers, antidepressants, calcium channel blockers, and hormones. Nonsteroidal anti-inflammatory drugs, ergotamine and its derivatives, and narcotics are among the abortive therapy options. Pharmacologic management of migraine in pregnant women must be conservative because of the risks of injury and dependence to the fetus and newborn.

Contraceptives, Oral↗
PubMed1994

Concomitant administration of antiemetics is not necessary with intramuscular dihydroergotamine.

The influence of concomitant administration of an antiemetic agent on the course of nausea was assessed in a field trial of intramuscular dihydroergotamine for the treatment of acute migraine. Of 311 migraine patients enrolled onto the study, 62% (191 of 311) experienced nausea at the outset; 38% (119 of 311) did not. Of those with nausea at the outset, 54% (103 of 191) received an antiemetic. Of those without nausea at the outset, 25% (30 of 119) received an antiemetic. Thus, a total of 43% (133 of 311) of patients received a concomitant antiemetic, whereas 57% (177 of 311) received dihydroergotamine alone. When changes in the incidence of nausea were compared at 30 and 60 minutes after dihydroergotamine, an antiemetic effect was discerned in patients treated with or without a concomitant antiemetic. Antiemetic treatment yielded no significant difference in the percentage of patients experiencing nausea during the study. At baseline, 50% (88 of 177) of patients who received dihydroergotamine alone experienced nausea compared with 77% (103 of 133) of those who received an antiemetic. At the 30-minute point, 35% (61 of 173) of patients who received dihydroergotamine alone still experienced nausea versus 47% (62 of 133) of patients who received an antiemetic. At the 60-minute point, only 24% (42 of 174) of those given dihydroergotamine alone had nausea, compared with 38% (50 of 132) given concomitant antiemetic. Ongoing nausea seems to be a manifestation of the migraine process rather than an adverse effect associated with intramuscular dihydroergotamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗