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Biomedical subjects

H Massiou

Publications and source records attributed to H Massiou.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Female hormones and migraine].

All the hormonal events of the female life may modify the course of the migrainous disease. Their influence is slightly different on migraine with and without aura. Development of migraine at menarche and menstrually-related migraine attacks are principally observed in migraine without aura. Percutaneous estradiol is often effective for the prevention of pure menstrual migraine. Migraine usually improves during pregnancy; a worsening or a first development of attacks may nevertheless occur during this period, especially for migraine with aura. Oral contraception is not contraindicated in most migraine sufferers; it may worsen, improve or leave unchanged their disease. Migraine represents a risk factor of ischaemic stroke in young women; though a low one, some caution is necessary: tobacco should be forbidden, and the use of low-dose estrogen pills is recommended. Oral contraceptives should be interrupted in case of worsening of migraine, especially with aura. Estrogen replacement therapy is allowed after menopause in migraine sufferers; it may sometimes exacerbate migraine, which is in most cases controlled by therapeutic adjustment.

Contraceptives, Oral↗
PubMed2000

[Migraine and chronic headache in children].

In childhood and adolescence, migraine is the main essential chronic headache. This diagnosis is extensively underestimated and misdiagnosed in pediatric population. Lacks of specific biologic marker, specific investigation or brain imaging reduce these clinical entities too often to a psychological illness. Migraine is a severe headache evolving by stereotyped crises associated with marked digestive symptoms (nausea and vomiting); throbbing pain, sensitivity to sound, light are usual symptoms; the attack is sometimes preceded by a visual or sensory aura. During attacks, pain intensity is severe, most of children must lie down. Abdominal pain is frequently associated, rest brings relief and sleep ends often the attack. The prevalence of the migraine varies between 5p.100 and 10p.100 in childhood. At childhood, headache duration is quite often shorter than in adult population, it is more often frontal, bilateral (2/3 of cases) that one-sided. Migraine is a disabling illness: children with migraine lost more school days in a school year, than a matched control group. Migraine episodes are frequently triggered by several factors: emotional stress (school pressure, vexation, excitement: upset), hypoglycemia, lack of sleep or excess (week end migraine), sensorial stimulation (loud noise, bright light, strong odor, heat or cold.), sympathetic stimulation (sport, physical exercise). Attack treatments must be given at the early beginning of the crisis; oral dose of ibuprofen (10mg/kg) is recommended. If the oral route in not available when nausea or vomiting occurs, the rectal or nasal routes have then to be used. Non pharmacological treatments (biofeedback and interventions combining progressive muscle relaxation) have shown to have good efficacy as prophylactic measure. Daily prophylactic pharmacological treatments are prescribed in second line after failure of non-pharmacological treatment.

Adolescent↗
PubMed2000

[Prophylactic treatments of migraine].

Prophylactic treatment is mainly intended to reduce the frequency of migraine attacks. It is usually proposed to patients who suffer from two or more attacks per month. It should also be considered in patients who suffer from less frequent, but prolonged, disabling attacks with a poor response to abortive treatment, and who consider that their quality of life is reduced between attacks. Excessive intake of acute medication, more than twice a week, is a strong indication for prophylactic treatment. In order to obtain a good compliance to treatment, the patient must be informed of the expected efficacy of the drugs, and of their most frequent side effects. Thus, the choice of a prophylactic drug is made together with the patient. Based on the results of published controlled trials, the main prophylactic drugs are some betablockers, methysergide, pizotifene, oxetorone, flunarizine, amitriptyline, NSAIDs, and sodium valproate. Some less evaluated drugs such as aspirin, DHE, indoramine, verapamil, may be useful. Other substances such as riboflavin and new antiepileptic dugs are being evaluated. The choice of the drug to start with depends on several considerations. The first step is to make sure that there are no contra indications, and no possible interaction with the abortive medications. Then, possible side effects will be taken into account, for example, weight gain is a problem for most young women and patients who practice sports may not tolerate betablockers. Associated pathologies have to be checked. For example, a hypertensive migraine sufferers may benefit from betablockers; in a patient who suffers both from migraine and tension type headaches or from depression, amitriptyline is the first choice drug. The type of migraine should also be considered; for instance, in frequent attacks with aura, aspirin is recommended and betablockers avoided. In most cases, prophylaxis should be given as monotherapy, and it is often necessary to try successively several drugs before finding the most appropriate one. Doses should be increased gradually, in order to reach the recommended daily dose, only if tolerance permits. The treatment efficacy has to be assessed after 2 or 3 months, during which the patient must keep a headache diary. If the drug is judged ineffective, an overuse of symptomatic medications should be checked, as well as a poor compliance, either of which may be responsible. In case of a successful treatment, it should be continued for 6 or 12 months, and then, one should try to taper off the dose in order to stop the treatment or at least to find the minimum active dose. Relaxation, biofeedback, stress coping therapies, acupuncture are also susceptible to be effective in migraine prophylaxis.

Adrenergic beta-Antagonists↗
PubMed1998

Zolmitriptan, a 5-HT1B/1D receptor agonist for the acute oral treatment of migraine: a multicentre, dose-range finding study.

Zolmitriptan is a selective 5-HT1B/1D receptor agonist for acute oral migraine therapy. This randomized, placebo-controlled, parallel-group study investigated the efficacy and tolerability of oral zolmitriptan (5, 10, 15 and 20 mg) in the treatment of single acute migraine attacks. Of 1181 patients randomized, 840 were evaluable for the primary efficacy analysis. Headache response rates (a reduction in headache intensity from severe or moderate at baseline to mild or no pain at 2 hours post-treatment) were similar across the zolmitriptan dose groups (66%, 71%, 69% and 77% for 5 mg, 10 mg, 15 mg and 20 mg, respectively) and were significantly higher than that for placebo (19%; all groups P < 0.001). A headache response was reported at 1 hour by 40-50% of zolmitriptan recipients (16% placebo). At 2 hours post dose, 39-47% of zolmitriptan-treated patients were pain-free, compared with 1% of placebo recipients. Headache recurrence occurred in 21-29% (upper 95% CI 37.1) of zolmitriptan-treated patients and in 65% (95% CI 38.3, 85.8) of placebo recipients. Zolmitriptan was well tolerated at each dose. The most commonly reported adverse events were asthenia, dizziness, paraesthesia and feelings of heaviness. Most adverse events were of mild or moderate intensity and were transient. The frequency of adverse events was dose-related. Although, zolmitriptan 5 mg exhibited the most favourable efficacy and tolerability profile, the dose response data suggest that lower doses would also offer significant efficacy. Copyright 1998 Lippincott Williams & Wilkins

Journal Article↗
PubMed1998

Orbital pain as an isolated sign of internal carotid artery dissection. A diagnostic pitfall.

Head pain is one of the main presenting symptoms of internal carotid artery (ICA) dissection, usually in association with ischemic and/or local signs such as Horner's syndrome, lower cranial nerve palsies, or tinnitus. In rare cases, head pain remains isolated and mimics other conditions. We report a patient who suffered isolated prolonged orbital pain as the only sign of intrapetrous ICA dissection. Early recognition of such unusual facial pain may be crucial in decreasing the risk of secondary cerebral or retinal ischemia.

Aortic Dissection↗
PubMed1997

Verbal scales in the acute treatment of migraine: semantic categories and clinical relevance.

Verbal scales are currently used as efficacy parameters in acute migraine trials. In order to determine the correlation between headache intensity, functional disability, and relevant pain reduction, 100 patients completed a questionnaire. Our results showed that a verbal scale of headache intensity alone has different implications from one that includes pain intensity and functional ability. The reduction from a moderate to a mild headache was satisfactory to only 35% of the patients. In contrast, 77% of patients were satisfied when the headache intensity was reduced from severe to mild. These findings imply that, in assessing the efficacy of drugs used for migraine, a reduction in pain intensity from moderate to mild should not be considered as a good outcome.

Acute Disease↗
PubMed1994

Head pain in non-traumatic carotid artery dissection: a series of 65 patients.

In order to assess the prevalence and characteristics of cephalic pain in internal carotid artery (ICA) dissection, and to compare clinical and angiographic features of patients with painful and non-painful dissections, we observed 65 patients with angiographically diagnosed extracranial ICA dissection from 1972 to 1990. Forty-eight patients (74%) complained of a cephalic pain which was inaugural in 38 (58.5%). It was homolateral to the dissection in 79% of cases and lasted from 1 h to 30 days, with a median of 5 days. Signs of cerebral or retinal ischemia were observed in 79% of patients, often delayed and occurring up to 29 days after the onset of pain. A painful Horner's syndrome was present in 31% of patients, and was the only manifestation of dissection in 16%. The clinical presentation of the dissections and angiographic findings were similar in patients with and without pain except for a past history of migraine which was more frequent in patients with painful dissections. Cephalic pain is frequent and often inaugural in carotid dissection. Its recognition is important for early diagnosis and treatment.

Adolescent↗
PubMed1992

Nicardipine in the prevention of spasm-induced neurological deficits after subarachnoid hemorrhage: a dose-ranging study.

The tolerability of four doses of intravenous nicardipine (0.03, 0.08, 0.11, and 0.15 mg/kg/h) was assessed in this randomized multicenter, parallel-group study. Fifty-two patients with Hunt and Hess grade I-III aneurysmal subarachnoid hemorrhage were treated with intravenous nicardipine beginning within 4 days of bleeding, for a mean duration of 12.6 days; this treatment was followed by administration of oral nicardipine 90-120 mg until day 30. Hypotension was the main side effect, and it occurred only in the two groups that received the highest doses. However, it was possible to continue nicardipine in all cases at lower doses or even without modification, and hypotension was never responsible for any deleterious clinical effect.

Administration, Oral↗
PubMed1992

[Management of migraine].

When considering treatment for migraine patient, the physician should bear in mind how little is known about this remarkably complex and diverse condition with no miracle cure or single uniform method of treatment. Experience suggests that adherence to a number of principles based on a combination of common sense, modesty, and open-mindedness is essential to effective management of migraine. The patient needs to be both reassured and taken seriously, and should be told that the cause of migraine is unknown and that performing multiple investigations would be unhelpful. The difference between acute treatments and maintenance prophylactic treatments should be clearly explained. The patient should participate in therapeutic decisions such as whether or not to use prophylaxis and whether pharmacologic or nonpharmacologic treatment is most appropriate. Finally, and most importantly, both the physician and patient must be aware that much patience is needed but that this patience will usually be rewarded, not by complete resolution of the disease, but by an often dramatic improvement in the migraine patient's quality of life.

Adolescent↗
PubMed1992

[Beta-blockers and migraine].

Five beta-blocking agents are effective as long-term prophylactic treatment of migraine: propranolol, metoprolol, timolol, atenolol and nadolol. Propranolol has been most extensively studied and proved effective in 19 of 21 controlled trials. The optimal dose should be determined on a case-by-case basis, by increasing the daily dosage gradually. Among the properties of beta-blockers, the only one which appears to be correlated--albeit negatively--with effectiveness on migraine is intrinsic sympathomimetic activity (ISA): drugs without ISA are effective against migraine whereas partial agonists are not. The mode of action of beta-blockers in migraine is still poorly understood; one of the most cogent current hypotheses involves reduction of brain catecholaminergic hyperactivity.

Adrenergic beta-Antagonists↗
PubMed1992

[Methodology of clinical trials in migraine: a rating system].

Several problems confront trials of drugs for migraine: no clinical or biological markers for objective diagnosis are available, severity of the attack cannot be readily evaluated, the placebo effect is significant, and both compliance with therapy and patient follow-up may be difficult to ensure. No statistical method is capable of solving these problems and it is the clinicians' role to minimize them by consistent efforts at establishing good communication with their patients during the trial. Because of these significant intrinsic difficulties, trials of drugs for migraine require especially stringent data collection and analysis protocols in order to minimize the risk of errors which exist in any drug trial. The protocol used have not always been satisfactory with this respect. A rating system for helping non-specialists to evaluate the reliability of migraine drug trials is proposed.

Clinical Trials as Topic↗
PubMed1991

Effectiveness of oral diclofenac in the acute treatment of common migraine attacks: a double-blind study versus placebo.

In a multicentre double-blind cross-over trial, oral diclofenac at a dose of 50 mg to 100 mg was compared to placebo in the acute treatment of migraine attacks. A hundred and seven patients suffering from migraine without aura were included, and 91 were analysed for efficacy; they had to treat four successive attacks--two with diclofenac and two with placebo. Diclofenac was significantly more effective than placebo (p less than 0.05) on the main judgement parameter, which was the number of attacks aborted within 2 h of drug intake, as well as on the following secondary parameters: the necessity for an escape medication and the evaluation of global efficacy. Diclofenac was well tolerated. This trial demonstrates the efficacy of diclofenac in the acute treatment of migraine attacks. It confirms the good clinical relevance of the main judgement parameter chosen, which is the one recommended by the International Headache Society, but appears to be a severe one in terms of successes.

Administration, Oral↗
PubMed1990

[What is new in the treatment of migraine?].

No miracle treatment has occurred which would cure the migraineur, but treatments able to improve him are more numerous and better defined. Conditions are now achieved for significant progress in the field of migraine treatment: better knowledge of the pathophysiology progress in the field of migraine treatment: better knowledge of the pathophysiology of the attack, definition of diagnostic criteria unanimously accepted and of rigorous and specific methodologic rules for therapeutic trials in migraine, discovery of new drugs such as more and more specific agonists or antagonists of serotonin-receptors subtypes.

Administration, Cutaneous↗