cardiovascular-agents and Migraine-Disorders

'Translation' in medicine immediately suggests 'translational research', but there are many other varieties of 'translation'. I have selected 4 translations in the field of vascular neurology in which I have been involved in different respects: (1) the translation of results from men to women, taking the example of aspirin which, in primary prevention, decreases the risk of myocardial infarction in men and the risk of cerebral infarction in women, the reason for this sex difference being so far unknown; (2) the 'inverse translational research', from bedside to bench, taking the example of the disease we have identified--CADASIL--and showing how the study of one patient and his family led to the identification of a gene, Notch3, so far unknown in humans and to the discovery of its key role in the physiology of vascular smooth muscle cells; (3) the translation from individual case reports to multidisciplinary trials taking the example of hemicraniectomy in malignant cerebral infarction and emphasizing the interest in such rare and severe conditions of pooling and reporting the results of randomized clinical trials before the results of individual trials, and (4) the translation from research to practice, emphasizing not the well-known 'evidence to practice gap' but the slippery slope of 'lack of evidence to overpractice', taking the example of patent foramen ovale closure in migraine.

Topics: Aspirin; Awards and Prizes; Biomedical Research; CADASIL; Cardiovascular Agents; Cardiovascular Diseases; Cerebral Infarction; Craniotomy; Evidence-Based Medicine; Female; Foramen Ovale, Patent; Humans; Male; Medical Records; Migraine Disorders; Myocardial Infarction; Neurology; Randomized Controlled Trials as Topic; Receptor, Notch3; Receptors, Notch; Sex Factors; Treatment Outcome

There is a wide array of options for migraine prophylaxis; many of the available drugs are clearly proven to be effective and yet are underused in Australia. "New" drugs which are gaining favour for migraine prophylaxis include topiramate, candesartan, gabapentin and botulinum toxin. The evidence for efficacy is excellent for topiramate and reasonably good but limited for candesartan and gabapentin. The use of botulinum toxin is controversial and has gained substantial popularity through anecdotal experience rather than convincing published evidence. Transformed or chronic migraine with medication overuse is a particularly difficult problem. New strategies to aid in medication withdrawal are reviewed. The approach to menstrual migraine and migraine with prominent aura may differ from that for typical migraine. Novel approaches are being explored for these problems.

Topics: Australia; Cardiovascular Agents; Central Nervous System Agents; Glucocorticoids; Humans; Migraine Disorders

Topics: Analgesics; Anticonvulsants; Antidepressive Agents; Cardiovascular Agents; Chronic Disease; Complementary Therapies; Ergotamines; Headache; Humans; Migraine Disorders; Primary Health Care; Serotonin Receptor Agonists; Sex Distribution; Tension-Type Headache

Topics: Anticoagulants; Anticonvulsants; Antitoxins; Bone Diseases; Calcium; Cardiovascular Agents; Drug Therapy; Ergot Alkaloids; Gynecology; Insulin Antibodies; Methysergide; Migraine Disorders; Monoamine Oxidase Inhibitors; Nutritional Physiological Phenomena; Nutritional Sciences; Propiophenones; Selective Serotonin Reuptake Inhibitors; Serotonin; Toxins, Biological; Ubiquinone

NXY-059 is a free radical-trapping neuroprotectant that reduces infarct size and preserves brain function in animal models of acute ischemic stroke. Acute ischemic stroke patients receiving NXY-059 may also be exposed to diuretics for treatment of heart failure or hypertension. NXY-059 and furosemide are partly eliminated by active tubular secretion via an organic anion transporter. This double-blind, randomized, crossover, placebo-controlled study investigated whether an infusion of NXY-059 (15 mg/mL) during 12 hours affects the diuretic and saluretic effects of a 30-mg intravenous bolus dose of furosemide (10 mg/mL) administered after 6 hours' infusion, in 13 male and 11 female healthy subjects. The net increase in urine volume and sodium excretion in the interval of 6 to 12 hours was 4.15 L and 178 mmol/L, respectively, during NXY-059 treatment (P = .93) and 4.34 L and 190 mmol/L, respectively, during placebo treatment (P = .54). NXY-059 reduced the renal clearance of furosemide by 19% (P = .019), and furosemide reduced the renal clearance of NXY-059 by 8% (P = .005). NXY-059 was well tolerated.

Topics: Abdominal Pain; Adolescent; Adult; Area Under Curve; Back Pain; Benzenesulfonates; Cardiovascular Agents; Cross-Over Studies; Diuretics; Double-Blind Method; Drug Interactions; Female; Furosemide; Half-Life; Humans; Infusions, Intravenous; Male; Metabolic Clearance Rate; Middle Aged; Migraine Disorders; Urinary Retention; Vomiting

We evaluated the incidence, prevalence, and patterns of triptan use with a special focus on patients who also received cardiovascular drugs, considered as a deviation from appropriate triptan use.. We collected data on prescriptions reimbursed in between 2006 and 2008 in an Italian region. Patients receiving at least one prescription of triptans from January to December 2007 were divided in two populations: new users (without triptan prescriptions in 2006), and already in treatment. All patients were followed for 12 months in terms of both triptan use and cardiovascular coprescriptions.. One-year prevalence of triptan use was 0.8%, whereas the incidence was 0.4%. New users accounted for 47.5% of total users (34,915). The percentages of very frequent users (>120 and >180 dosage unit per year) were about double among those already in treatment (26.6% and 15.3%, respectively) and new users (1% and 0.3%; p < 0.01). Patients starting with the lowest dose of tablet formulation were more likely to interrupt therapy after their first prescription (p < 0.01). Many users aged >65 received concomitant cardiovascular therapies: 36.6% among new users and 64.3% for already in treatment (p < 0.01). In both groups, about 5% of elderly patients received coprescriptions, suggesting a high deviation from appropriate triptan use.. A higher percentage of very frequent users was detected in patients already in treatment compared with new users. Moreover, the percentage of nonnegligible triptan recipients were in age groups for which the drug is not recommended by the product label (≤18 years and >65) and who had cardiovascular coprescriptions suggestive of vasoconstrictive risk.

Topics: Adolescent; Adult; Aged; Cardiovascular Agents; Child; Drug Prescriptions; Drug Utilization; Female; Humans; Italy; Male; Middle Aged; Migraine Disorders; Risk; Tryptamines; Young Adult

Polypharmacy (the prescription of more than one therapy for a single patient) and subcutaneous (s.c.) sumatriptan tolerability were prospectively studied in 12,339 migraineurs, each followed for up to 1 year. Inclusion/exclusion criteria were minimal and mirrored United States Imitrex labeling. Drug usage and compliance monitoring were automatically interfaced with prescription refill. Concomitant drugs were used by 79% of patients, with analgesics, antidepressants, and sedatives used most commonly. No adverse interactions between sumatriptan and neurological drugs were found, possibly reflecting relative inability of the former to cross the blood-brain barrier. No difference in cardiovascular adverse events was associated with oral contraceptive use, which was more common than expected. No other drug class influenced adverse event probability, although sample sizes for these comparisons was sometimes <400 patients. This study confirms the prevalence of polypharmacy in migraine, identifies the drugs used, and concludes that, on a population basis, the tolerability of s.c. sumatriptan, when used according to labeled instructions, is unaffected by these concomitant drugs.

Topics: Adolescent; Adrenergic beta-Antagonists; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Anti-Asthmatic Agents; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Antidepressive Agents; Cardiovascular Agents; Cohort Studies; Comorbidity; Contraceptives, Oral, Hormonal; Depression; Drug Evaluation; Drug Interactions; Drug Therapy, Combination; Epilepsy; Female; Humans; Hypnotics and Sedatives; Injections, Subcutaneous; Male; Methysergide; Middle Aged; Migraine Disorders; Patient Acceptance of Health Care; Prospective Studies; Serotonin Receptor Agonists; Smoking; Sumatriptan; Valproic Acid; Vasoconstrictor Agents

Changes in the diameter of extracranial and intracranial arteries resulting in changes in cerebral blood flow have previously been assumed to be the most important pathophysiological factor in migraine. To test this hypothesis 20 normal subjects, and three groups of patients (n = 29) with migraine were investigated by means of transcranial Doppler sonography. Blood flow velocities in the middle cerebral (MCA) and in basilar (BA) arteries were measured. Data from patients were obtained in the interval between migraine attacks, during migraine attacks and following treatment with either ergotamine (0.5 mg i.m.; n = 10); flunarizine, a calcium overload blocker (20 mg i.v.; n = 13); or a 5-HT1-like agonist (sumatriptan, 4 mg s.c.; n = 6). Ergotamine and sumatriptan are constrictors of cerebral arteries in animal experiments. The arithmetic mean of flow velocity in the BA was reduced in normal subjects (45 cm/s) as compared with patients with migraine measured in between attacks (53 cm/s). Mean flow velocity in MCA was not different in normals (72.5 cm/s) as compared with migraineurs (75 cm/s). Neither ergotamine nor the 5-HT1 agonist and flunarizine resulted in a significant change in blood flow velocity in MCA and BA. This was true irrespective of whether the drugs were given in the headache-free period, during a migraine attack or during the withdrawal phase of drug-induced headache. Ergotamine was effective in improving headache during migraine attacks and sumatriptan attenuated headache during drug withdrawal from chronic analgesic intake. These results indicate that the action of ergotamine and the 5-HT1-receptor agonist is probably not mediated by their vasoconstrictor action on cerebral arteries.

Topics: Adult; Blood Flow Velocity; Cardiovascular Agents; Cerebrovascular Circulation; Ergotamine; Female; Flunarizine; Humans; Indoles; Male; Middle Aged; Migraine Disorders; Reference Values; Sulfonamides; Sumatriptan; Vasoconstrictor Agents

Topics: Anti-Infective Agents; Antineoplastic Agents; Antiparkinson Agents; Blindness; Cardiovascular Agents; Color Perception; Contraceptives, Oral; Hallucinations; Humans; Migraine Disorders; Parasympatholytics; Perceptual Disorders; Psychotropic Drugs; Visual Cortex; Visual Perception

Topics: Biomedical Research; Cardiovascular Agents; Ergot Alkaloids; Geriatrics; Headache; Methysergide; Migraine Disorders; Selective Serotonin Reuptake Inhibitors; Serotonin; Toxicology

Topics: Cardiovascular Agents; Ergot Alkaloids; Methysergide; Migraine Disorders; Pathology; Selective Serotonin Reuptake Inhibitors; Serotonin

Topics: Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Methysergide; Migraine Disorders; Toxicology

Topics: Caffeine; Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders; Phenytoin

Topics: Adolescent; Cardiovascular Agents; Ergot Alkaloids; Ischemia; Leg; Lower Extremity; Methysergide; Migraine Disorders; Toxicology; Vascular Diseases

Topics: Aspirin; Caffeine; Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Headache; Humans; Meprobamate; Methysergide; Migraine Disorders; Oxytocics; Pharmacology; Phenacetin; Phenobarbital; Scopolamine; Toxicology

Topics: Cardiovascular Agents; Drug Therapy; Headache; Humans; Migraine Disorders; Muscle Relaxants, Central; Parasympatholytics; Vascular Headaches

Topics: Cardiovascular Agents; Ergot Alkaloids; Headache; Methysergide; Migraine Disorders; Vascular Headaches

Topics: Cardiovascular Agents; Ergot Alkaloids; Lysergic Acid; Methysergide; Migraine Disorders; Serotonin Antagonists; Vascular Headaches

Topics: Cardiovascular Agents; Ergot Alkaloids; Isocarboxazid; Methysergide; Migraine Disorders; Monoamine Oxidase Inhibitors

Topics: Cardiovascular Agents; Communication; Ergot Alkaloids; Humans; Migraine Disorders; Oxytocics; Tranylcypromine; Trifluoperazine

Topics: Cardiovascular Agents; Cerebral Palsy; Chorea; Ergot Alkaloids; Giant Cell Arteritis; Headache; Humans; Methysergide; Migraine Disorders; Oxytocics; Selective Serotonin Reuptake Inhibitors; Serotonin; Trigeminal Neuralgia

Methysergide was used as a regular medication to prevent migraine in a series of 87 patients with frequently recurring severe attacks of three types, common, classical and cluster migraine, in a study conducted during a 30-month period. Results were classified as excellent, good, fair and nil. The total reporting excellent and good results was 50.6%. In a few patients the drug appeared to lose effectiveness in long-term treatment. Other investigators have described more favourable results, notably Friedman, who reported improvement in common migraine in 79% of patients and in cluster migraine in 90% of patients. Side effects were noted in 34.2% of patients and led to discontinuing the trial in 10.4%; these promptly subsided when the drug was withdrawn. Methysergide appears to be a useful additional agent for prevention of severe, frequently recurring migraine of common and cluster type. In this small series it had little effect on headaches of combined tension and vascular type.

Topics: Biomedical Research; Cardiovascular Agents; Ergot Alkaloids; Headache; Methysergide; Migraine Disorders; Migraine without Aura; Oxytocics; Pharmacology; Preventive Medicine; Selective Serotonin Reuptake Inhibitors; Serotonin; Toxicology

Topics: Alkaloids; Cardiovascular Agents; Dihydroergotoxine; Ergot Alkaloids; Humans; Migraine Disorders; Migraine with Aura

Topics: Aerosols; Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Migraine Disorders; Respiratory Therapy

Topics: Caffeine; Cardiovascular Agents; Chloral Hydrate; Ergot Alkaloids; Migraine Disorders; Oxytocics; Treatment Outcome

Topics: Anencephaly; Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Headache; Migraine Disorders; Oxytocics

Topics: Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders

Topics: Aerosols; Cardiovascular Agents; Cluster Headache; Ergot Alkaloids; Ergotamine; Headache; Migraine Disorders

Topics: Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Headache; Migraine Disorders; Oxytocics; Respiratory Therapy

Topics: Cardiovascular Agents; Disease Management; Ergot Alkaloids; Ergotamine; Headache; Migraine Disorders; Vascular Headaches

Topics: Animals; Behavior, Animal; Caffeine; Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders; Scopolamine; Social Behavior

Topics: Caffeine; Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders; Oxytocics

Topics: Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Migraine Disorders; Oxytocics

Topics: Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Migraine Disorders; Oxytocics

Topics: Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Migraine Disorders; Oxytocics

Topics: Administration, Rectal; Caffeine; Cardiovascular Agents; Drug Combinations; Ergot Alkaloids; Ergotamine; Migraine Disorders; Tartrates

Topics: Caffeine; Cardiovascular Agents; Cluster Headache; Drug Combinations; Ergot Alkaloids; Ergotamine; Headache; Migraine Disorders; Suppositories

Topics: Caffeine; Cardiovascular Agents; Ergot Alkaloids; Headache; Migraine Disorders

Topics: Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders; Muscle Relaxants, Central; Oxytocics

Topics: Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Migraine Disorders; Oxytocics

Topics: Cardiovascular Agents; Drug Tolerance; Ergot Alkaloids; Ergotamine; Migraine Disorders; Oxytocics

Topics: Caffeine; Cardiovascular Agents; Drug Combinations; Ergot Alkaloids; Ergotamine; Headache; Migraine Disorders

Topics: Cardiovascular Agents; Ergot Alkaloids; Headache; Humans; Migraine Disorders

Topics: Anti-Allergic Agents; Cardiovascular Agents; Ergot Alkaloids; Histamine H1 Antagonists; Humans; Migraine Disorders

Topics: Administration, Oral; Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders; Social Behavior

Topics: Cardiovascular Agents; Claviceps; Ergonovine; Ergot Alkaloids; Migraine Disorders

Topics: Cardiovascular Agents; Dihydroergocornine; Dihydroergocristine; Dihydroergocryptine; Dihydroergotoxine; Ergot Alkaloids; Migraine Disorders; Oxytocics; Safe Sex

Topics: Barbiturates; Caffeine; Cardiovascular Agents; Ergot Alkaloids; Humans; Migraine Disorders

Topics: Caffeine; Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Migraine Disorders; Oxytocics; Social Behavior

Topics: Caffeine; Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Migraine Disorders; Oxytocics

Topics: Administration, Rectal; Aminopyrine; Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders; Oxytocics

Topics: Administration, Rectal; Alkaloids; Caffeine; Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Migraine Disorders

Topics: Cardiovascular Agents; Disease Management; Ergot Alkaloids; Migraine Disorders; Oxytocics; Vascular Headaches

Topics: Cardiovascular Agents; Disease Management; Ergot Alkaloids; Headache; Migraine Disorders; Niacin; Nicotinic Acids

Topics: Aspirin; Caffeine; Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders

Topics: Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Humans; Migraine Disorders

Topics: Cardiovascular Agents; Ergot Alkaloids; Headache; Migraine Disorders; Oxytocics; Suppositories

Topics: Caffeine; Cardiovascular Agents; Drug Combinations; Ergot Alkaloids; Ergotamine; Migraine Disorders

Topics: Caffeine; Cardiovascular Agents; Ergot Alkaloids; Ergotamine; Humans; Migraine Disorders; Suppositories; Tartrates

Topics: Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders; Oxytocics; Suppositories

Topics: Cardiovascular Agents; Ergot Alkaloids; Migraine Disorders; Oxytocics

Topics: Cardiovascular Agents; Claviceps; Ergonovine; Ergot Alkaloids; Migraine Disorders

Topics: Cardiovascular Agents; Ergot Alkaloids; Humans; Immune Tolerance; Migraine Disorders