oxalates and Migraine-Disorders

This review provides a comprehensive selection of the latest clinical trial results in antimigraine treatment.. The oral calcitonine gene-related peptide antagonist telcagepant is efficacious in acute treatment. Compared to triptans, its efficacy is almost comparable but its tolerance is superior. The same is true for the 5HT-1F agonist lasmiditan, another agent devoid of vascular effects. Triptans, as other drugs, are more efficient if taken early but nonsteroidal anti-inflammatory drugs and analgesics remain useful for acute treatment, according to several meta-analyses. Single-pulse transcranial magnetic stimulation during the aura rendered more patients pain-free (39%) than sham stimulation (22%) in one study. Topiramate could be effective for migrainous vertigo, but it did not prevent transformation to chronic migraine in patients with high attack frequency. Onabotulinumtoxin A was effective for chronic migraine and well tolerated, but the therapeutic gain over placebo was modest; the clinical profile of responders remains to be determined before widespread use. Occipital nerve stimulation was effective in intractable chronic migraine with 39% of responders compared to 6% after sham stimulation. This and other neuromodulation techniques, such as sphenopalatine ganglion stimulation, are promising treatments for medically refractory patients but large controlled trials are necessary. One study suggests that outcome of patent foramen ovale closure in migraine might depend on anatomic and functional characteristics.. Drugs with a better efficacy or side-effect profile than triptans may soon become available for acute treatment. The future may also look brighter for some of the very disabled chronic migraineurs thanks to novel drug and neuromodulation therapies.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Azepines; Biofeedback, Psychology; Calcitonin Gene-Related Peptide Receptor Antagonists; Clinical Trials as Topic; Electric Stimulation; Humans; Imidazoles; Migraine Disorders; Oxalates; Transcranial Magnetic Stimulation; Tryptamines

Zolmitriptan hydrogen oxalate [(S)-dimethyl(2-{5-[(2-oxo-1,3-oxazolidin-4-yl)methyl]-1H-indol-3-yl}ethyl)azanium hydrogen oxalate], C16H22N3O2(+)·C2HO4(-), (I), and zolmitriptan camphorsulfonate [(S)-dimethyl(2-{5-[(2-oxo-1,3-oxazolidin-4-yl)methyl]-1H-indol-3-yl}ethyl)azanium (S,R)-{2-hydroxy-7,7-dimethylbicyclo[2.2.1]heptan-1-yl}methanesulfonate], C16H22N3O2(+)·C10H15O4S(-), (II), are the first reported salt complexes of the antimigraine drug zolmitriptan. Compound (I) crystallizes in the space group P2(1) with two molecules of protonated zolmitriptan and two oxalate monoanions in the asymmetric unit, while compound (II) crystallizes in the space group P2(1)2(1)2(1) with one protonated zolmitriptan molecule and one camphorsulfonate anion in the asymmetric unit. The orientations of the ethylamine side chain and the oxazolidinone ring with respect to the indole ring of the zolmitriptan cation are different for (I) and (II). In (I), they are oriented in opposite directions and the molecule adopts a step-like appearance, while in (II) the corresponding side chains are folded in the same direction, giving the molecule a cup-like appearance. The zolmitriptan molecules of (I) form an R2(2)(8) dimer, while in (II) they form a helical chain with a C(11) motif. The oxalate monoanions of (I) interact with the zolmitriptan cations and extend the dimer into a three-dimensional hydrogen-bonded network. In (II), the camphorsulfonate anion forms an R2(2)(15) ring motif with the zolmitriptan cation.

Topics: Crystallography, X-Ray; Migraine Disorders; Molecular Structure; Oxalates; Oxazolidinones; Salts; Tryptamines

Pain perception involves several cortical areas. Our purpose was to examine cortical activity in patients describing their cephalic pain with the MacGill Pain Questionnaire (MPQ). Two SPECT analyses were performed in pain-free periods in 10 patients with migraine (n=8) or myogenous facial pain (n=2). The MPQ was administered in the first session, while no task was to be performed during the second session. Differences were calculated using statistical parametric mapping (SPM99), also taking the MPQ pain rating index (PRI) as covariance. During the MPQ session, clusters of activation were observed in the orbitofrontal cortex, the insula and the anterior cingulate cortex (ACC) of the left brain, but not significantly so. Using the MPQ PRI as covariate, significant areas of activation were found in the left frontal lobe, the Brodmann area 32 and in the ACC. The description of pain seems to activate cortical areas similar to those involved in actual pain perception.

Topics: Adult; Cerebral Cortex; Electroencephalography; Facial Pain; Female; Frontal Lobe; Functional Laterality; Gyrus Cinguli; Headache; Humans; Male; Middle Aged; Migraine Disorders; Oxalates; Surveys and Questionnaires; Tomography, Emission-Computed, Single-Photon

Topics: Food; Humans; Migraine Disorders; Oxalates

Topics: Abdomen; Child; Child, Preschool; Diet; Diet Therapy; Female; Fever; Humans; Male; Migraine Disorders; Nausea; Oxalates; Pain Management; Photosensitivity Disorders; Syndrome; Vomiting