I.v. verapamil and negative results.
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Biomedical subjects
Publications and source records attributed to S Diamond.
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Proper selection of patients is the most critical aspect in designing clinical trials in migraine research. We establish specific research diagnostic criteria for the definition of migraine. Additional factors in patient selection, migraine frequency, duration, medications and previous treatments, are reviewed. Exclusion criteria and the mixed headache syndrome patient are discussed.
We report the results of a study conducted recently at the Diamond Headache Clinic, Chicago, on the effectiveness of application of cold as an adjunctive therapy for acute headache. Ninety clinic outpatients were divided evenly into three groups according to headache type--migraine, cluster, and mixed. They used the standard headache medication for two attacks and the standard medication plus application of cold with a reusable, frozen gel pack for two attacks. There was no significant difference in patient response to the gel pack by headache type. Seventy-one percent of patients considered the pack effective; 52% reported an immediate decrease in pain, and 63% reported an overall decrease in pain. Seventy-one percent of patients intended to use the gel pack in the future. Use of such gel packs, which are available commercially, does not damage the skin. Our study indicates that cold application does provide some symptomatic relief of headache; it may also offer psychological alleviation of the pain.
Diet has been implicated as a source of migraine since antiquity. Now, diet is thought of as one of many factors that can trigger migraine. Improved understanding of the migraine process and an attempt to delineate the most common causes of diet-precipitated migraine have resulted in a more rational treatment strategy. We recognize that a small group of patients will have migraine after ingesting certain foods with vasoactive properties or by missing a meal; thus, we suggest a nutritional course to limit this influence. The role of allergy in migraine is not yet determined and remains controversial.
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Cluster headache and trigeminal neuralgia (tic douloureux) share a common pattern of exacerbation and remission of pain that is described in similar terms by patients. Although the treatment of these conditions is markedly different, the results of adequate prophylaxis can be extremely impressive in both. The physician who treats headache patients should be aware of the common characteristics of each condition and of the possibility of their concomitant occurrence.
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As discussed in the introduction, the rote laboratory and neuroimaging evaluation of a patient with headache but without other neurologic symptoms or signs is often unrewarding. Such evaluations are dictated by the clinical history and examination, hence rely on the diagnostic acumen of the physician. In the case of patients during their initial visit, it is frequently useful to proceed with skull radiographs and, if the symptoms warrant, contrast-enhanced CT scanning. In the future, as NMR imaging becomes more widely available, it may prove useful for these initial clinical evaluations. More invasive procedures, such as angiography, are undertaken only if specific indications, such as those summarized in Table 1, are present.
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