phenylephrine-hydrochloride and Migraine-Disorders

This meta-analysis study was designed to analyze endoscopic surgery's role in treating rhinogenic contact point headache.. We performed a comprehensive review of the last 20 years' English language regarding Rhinogenic contact point headache and endoscopic surgery. We included the analysis papers reporting post-operative outcomes through the Visual Analogue Scale or the Migraine Disability Assessment scale.. We provided 18 articles for a total of 978 RCPH patients. While 777 (81.1%) subjects underwent functional nasal surgery for RCPH, 201 patients (20.9%) were medically treated. A significant decrease from the VAS score of 7.3 ± 1.5 to 2.7 ± 1.8 was recorded (p < 0.0001). At quantitative analysis on 660 patients (11 papers), surgical treatment demonstrated significantly better post-operative scores than medical (p < 0.0001).. At comparison, surgical treatment in patients with rhinogenic contact points exhibited significantly better values at short-term, medium-term, and long term follow up. Endoscopic surgery should be proposed as the choice method in approaching the symptomatic patient.

Topics: Endoscopy; Headache; Humans; Migraine Disorders; Nose; Pain Measurement

AVP-825, formerly 'OptiNose Sumatriptan,' is an investigational Breath-Powered(TM) Bi-Directional(TM) intranasal delivery system containing low-dose sumatriptan (22 mg intranasal powder) that avoids limitations of other types of intranasal administration by taking advantage of unique features of nasal anatomy and physiology.. This review summarizes intranasal drug delivery for migraine, how the breath-powered technology works, and AVP-825 pharmacokinetic, efficacy and safety/tolerability findings. To identify AVP-825 clinical studies, a PubMed/MEDLINE database search was conducted with the terms AVP-825, OptiNose, OptiNose Sumatriptan, Breath-Powered Nasal Delivery or sumatriptan powder. Of 20 articles, 5 clinical studies were identified, including the head-to-head comparative COMPASS trial (AVP-825 vs oral sumatriptan) and two placebo-controlled studies.. AVP-825 has faster sumatriptan absorption versus oral tablets or traditional liquid nasal spray. In Phase II/III randomized, double-blind, placebo-controlled trials, AVP-825 produced early and sustained efficacy with minimal triptan-related adverse effects. In COMPASS, AVP-825 produced earlier reduction of migraine pain intensity and migraine-associated symptoms than 100 mg oral sumatriptan, and higher early rates of pain relief and pain freedom, similar sustained efficacy, and fewer atypical sensations. AVP-825 has the potential to provide migraine patients with improved intranasal administration of sumatriptan that may enhance efficacy and tolerability.

Topics: Administration, Intranasal; Drug Delivery Systems; Humans; Migraine Disorders; Nose; Powders; Randomized Controlled Trials as Topic; Sumatriptan

Two double-blind, placebo-controlled, randomised, multicentre, multinational, parallel-group studies were carried out to identify the optimum dose of intranasal sumatriptan for the acute treatment of migraine. Study medication was taken as a single dose through one nostril in the first study, and as a divided dose through two nostrils in the second study. Totals of 245 and 210 patients with a history of migraine were recruited into the one- and two-nostril studies, respectively. In both studies, headache severity had significantly improved at 120 min after doses of 10-40 mg sumatriptan compared to placebo (P < 0.05) and the greatest efficacy rates were obtained with 20 mg sumatriptan. With 20 mg sumatriptan 78% and 74% of patients experienced headache relief in one- and two-nostril studies respectively. Sumatriptan was generally well tolerated, the most frequently reported event being taste disturbance. The results of the two studies are similar and indicate that administering sumatriptan as a divided dose via two nostrils confers no significant advantage over single-nostril administration.

Topics: Acute Disease; Administration, Intranasal; Adult; Double-Blind Method; Drug Tolerance; Female; Headache; Humans; Male; Middle Aged; Migraine Disorders; Nose; Sumatriptan

Topics: Child; Female; Fingers; Humans; Migraine Disorders; Nose; Vision Disorders

Studies have suggested that contact between opposing mucosal surfaces in the nasal wall and cavity can be a target of the surgical treatment of migraines. Unfortunately, not enough is known about the role of nasal pathology in the pathogenesis of this condition. The co-existence of further rhinological disorders can be an impediment to defining the cause and effect of anatomical variants. The authors compared the MRI scans of migraine- and non-migraine patients (MPs and NMPs, respectively) to determine the prevalence of such mucosal contact points in order to extrapolate whether there is a significant association with migraines.. Coronal and axial MRI brain scans of 522 patients (412 migraineurs and 110 non-migraineurs) were analysed for the prevalence of anatomical variations of the nasal cavity, e.g. concha bullosa, septal deviations, mucosal swelling and contact points.. The results showed no significant difference between MPs and NMPs patients for any of the parameters examined. Moreover, 87% MPs and 79% NMPs had at least one contact point. The most frequent contact point was between the middle turbinate and the septum, observed in 54% of MPs and 45% of NMPs.. Contact points with the nasal mucosa are highly prevalent in both MPs and NMPs. Although a contact point does not cause a migraine in the absence of the disease, the concomitant presence of migraine and contact points can trigger an attack, and therefore, it is necessary to differentiate or exclude a rhinological disorder in these patients.

Topics: Adult; Case-Control Studies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Migraine Disorders; Nasal Cavity; Nasal Mucosa; Nasal Septum; Neuroimaging; Nose; Risk Factors; Turbinates

The aim of this study was to identify the facial areas defined by thermal gradient, in individuals compatible with the pattern of normality, and to quantify and describe them anatomically.. The sample consisted of 161 volunteers, of both genders, aged between 26 and 84 years (63 ± 15 years).. The results demonstrated that the thermal gradient areas suggested for the study were present in at least 95% of the thermograms evaluated and that there is significant difference in temperature between the genders, racial group and variables "odontalgia", "dental prothesis" and "history of migraine" (p < 0.05). Moreover, there was no statistically significant difference in the absolute temperatures between ages, and right and left sides of the face, in individuals compatible with the pattern of normality (ΔT = 0.11°C).. The authors concluded that according to the suggested areas of thermal gradients, these were present in at least 95% of all the thermograms evaluated, and the areas of high intensity found in the face were medial palpebral commissure, labial commissure, temporal, supratrochlear and external acoustic meatus, whereas the points of low intensity were inferior labial, lateral palpebral commissure and nasolabial.

Topics: Adult; Aged; Aged, 80 and over; Dental Prosthesis; Ear Canal; Eyelids; Face; Female; Humans; Infrared Rays; Lip; Male; Middle Aged; Migraine Disorders; Nose; Sex Factors; Skin Temperature; Temporal Arteries; Thermography; Toothache; Vasomotor System; Veins

Migraine attacks exclusively felt in the face are very rare, the pain involving the territories supplied by the second and third branches of the trigeminal nerve.. Two patients suffering from heminasal pain attacks accompanied with typical migrainous features and responsive to oral or intranasal triptans - but not to intranasal lidocaine or oxymetazoline. In one patient, the attacks could be precipitated upon slight touching on the tip of the nose, in the other attacks were preceded by the nasal sensation typically heralding sneezing.. Migraine pain mostly develops within the innervation territory of the first branch of the trigeminal nerve, which includes the nose. Therefore, episodes of unilateral nasal pain with migrainous features could be considered a migraine with unusual topography (nasal migraine). Painful nasal attacks occasionally preceded by stimulation of trigeminal afferents in the nose, could be conceived of as migraine-tic syndrome.

Topics: Administration, Intranasal; Aged; Analgesics; Female; Functional Laterality; Humans; Male; Migraine Disorders; Nose; Pain; Tryptamines

Nitroglycerin (NTG) often induces headaches when used to treat cardiac diseases. Such property of NTG has been widely used in modelling of migraine-like headaches. However, background reasons, predisposing to the development of NTG-headache, are less studied. The main aim of our study was to find, using NTG model, easily accessible markers of the vascular changes associated with headache. Because changes in the blood flow alter the local skin temperature (Tsk), we studied the relationship between the regional changes in the facial Tsk and NTG-induced headaches. Tsk was measured with infrared thermography in 11 healthy women during 3 h after sublingual NTG administration. NTG caused headache in five women, and four of them were the first-degree relatives of migraine patients. Notably, before NTG administration, subjects in the headache group had lower Tsk values, especially in the nose area, than women in the pain-free group (n = 6). NTG-induced headache was associated with a long-lasting increase of Tsk over the baseline. In sharp contrast, in the pain-free group, the Tsk reduced and returned rapidly to the baseline. Thus, the low baseline level and greater increase of regional Tsk correlated with the incidence of headache that supports a role of greater vascular changes in headache happening on the basis of the dissimilarities in vascular tone. An easily accessible phenomenon of 'cold nose' may indicate background vascular dysfunctions in individuals with predisposition to headache. Facial infrared thermography, coupled with NTG administration, suggests a novel temporally controlled approach for non-invasive investigation of vascular processes accompanying headaches.

Topics: Administration, Sublingual; Adult; Blood Pressure; Cold Temperature; Female; Heart Rate; Humans; Middle Aged; Migraine Disorders; Nitroglycerin; Nose; Predictive Value of Tests; Risk Factors; Skin Temperature; Thermography; Time Factors; Vasodilator Agents; Young Adult

Some migraine and cluster headaches may be triggered by stimulation of intranasal contact points via the trigeminovascular system. Endonasal surgery is successful in some patients, but long-term outcomes have not been reported.. Prospective.. This investigation included 20 patients with a mean 18-year history of refractory cluster or migraine headaches who were selected for surgery. All had endoscopically visible endonasal contact as well as a positive preoperative cocaine test result. Changes in pain severity and frequency and duration of headache attacks were statistically rated using a MANOVA. Follow-up averaged 112 months.. Almost 10 years after surgery, six patients remained completely free of pain, seven had significant symptom improvement, and seven received no benefit from surgery (65% improvement). Two patients had been free of all symptoms for 7 and 8 years, respectively, before complaints returned.. Our data suggest that some patients with refractory headaches and endonasal contact areas benefit from surgery, thereby supporting the existence of a connection between the two. Even though it is clear that surgery should be considered only if all other treatments have failed, a success rate of 65% over almost 10 years justifies evaluation of this option. Preoperative patient selection remains crucial and warrants further investigation.

Topics: Adult; Aged; Cluster Headache; Ethmoid Bone; Ethmoid Sinus; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Migraine Disorders; Nasal Septum; Nose; Patient Selection; Prospective Studies; Treatment Outcome; Turbinates

Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Migraine Disorders; Nose

This work reports for the first time on the pathological background and the successful definitive surgical treatment of migraine attacks caused by weather (Foehn) changes, menstruation, nutrition (cheese, chocolates, red wines etc), and psychophysical stress. Forty-two patients between the ages of 13 and 48, who were subdivided into an earlier and later treatment group, were surgically treated for migraines caused by the factors mentioned above. In the first group of 15 female patients that was treated, the surgical technique consisted of subperichondral septum correction crushing and partial or total resection of the middle concha and ethmoidal opening. In four of the patients where no septum deviation was observed, a resection of the middle nasal concha and a transnasal opening of the ethmoidal cells in the area of the middle nasal passage was performed. In the later group consisting of 27 patients, the surgical technique was simplified so that only subperichondral septum correction and crushing of the middle concha was performed, without total resection of the concha and ethmoidal cell opening. Up to the present all the 42 patients operated on have been free from migraine attacks, the first operation having been performed seven years ago and the last eight months ago.

Topics: Adolescent; Adult; Drug Combinations; Female; Humans; Male; Menstruation; Middle Aged; Migraine Disorders; Models, Biological; Naphazoline; Nasal Septum; Nose; Tetracaine; Weather

Studies on the nasal cycle have demonstrated that the autonomic tone to the nose is asymmetrical and oscillates in a regular cycle. Autonomic tone may be regulated from a centre in the hypothalamus and normally there is a balance between he autonomic tone of the right and left halves of the body. However, under stress or with hypothalamic instability this balance may be disrupted and result in the marked autonomic asymmetry seen in migraine or Meniér's syndrome. Research on the nasal cycle in conditions where autonomic asymmetry is apparent could change the entire concept of autonomic control.

Topics: Airway Resistance; Autonomic Nervous System; Humans; Meniere Disease; Migraine Disorders; Nasal Mucosa; Nose; Pupil; Reflex, Pupillary

Animal and clinical pharmacological studies show in certain vascular beds a biphasic action [potentiation and inhibition of serotonin (5-HT) responses] of some anti-migraine drugs, such as ergotamine, methysergide and more recently Org GC 94. Potentiation occurs at therapeutic drug concentrations. The present investigations seem to support the 5-HT theory of migraine and other essential headaches. In this theory, anti-migraine drugs, such as ergotamine, methysergide, pizotifen, and Org GC 94 could reduce the occurrence of pain in migraine and other esscutial headaches by acting as partial agonists tending to correct a deficiency of central 5-HT concentrations or turnover.

Topics: Animals; Bronchodilator Agents; Dibenzoxazepines; Dogs; Female; Guinea Pigs; In Vitro Techniques; Male; Migraine Disorders; Muscle Contraction; Nose; Rats; Regional Blood Flow; Serotonin Antagonists; Stomach; Time Factors; Uterus; Vasoconstrictor Agents

Topics: Denervation; Follow-Up Studies; Headache; Humans; Migraine Disorders; Nose; Turbinates

Topics: Aerosols; Caffeine; Diagnosis; Ergotamine; Headache; Humans; Migraine Disorders; Neuralgia; Nose; Vascular Diseases; Vascular Headaches

Topics: Basilar Artery; Facial Paralysis; Humans; Meniere Disease; Migraine Disorders; Nose; Pharynx; Rhinitis; Rhinitis, Allergic, Seasonal; Rhinitis, Atrophic; Skin Diseases

Topics: Administration, Intranasal; Cautery; Dysmenorrhea; Female; Humans; Migraine Disorders; Nose

Topics: Aerosols; Bronchi; Bronchial Diseases; Humans; Migraine Disorders; Nose