sodium-pertechnetate-tc-99m and Migraine-Disorders

To evaluate the efficacy and safety of AVP-825, a drug-device combination of low-dose sumatriptan powder (22 mg loaded dose) delivered intranasally through a targeted Breath Powered device vs an identical device containing lactose powder (placebo device) in the treatment of migraine headache.. Early treatment of migraine headaches is associated with improved outcome, but medication absorption after oral delivery may be delayed in migraineurs because of reduced gastric motility. Sumatriptan powder administered with an innovative, closed-palate, Bi-Directional, Breath Powered intranasal delivery mechanism is efficiently absorbed across the nasal mucosa and produces fast absorption into the circulation. Results from a previously conducted placebo-controlled study of AVP-825 showed a high degree of headache relief with an early onset of action (eg, 74% AVP-825 vs 38% placebo device at 1 hour, P<.01).. In this double-blind, placebo-controlled, parallel-group study in adults with a history of migraine with or without aura, participants were randomized via computer-generated lists to AVP-825 or placebo device to treat a single migraine headache of moderate or severe intensity. The primary endpoint was headache relief (defined as reduction of headache pain intensity from severe or moderate migraine headache to mild or none) at 2 hours post-dose.. Two hundred and thirty patients (116 AVP-825 and 114 placebo device) were randomized, of whom 223 (112 and 111, respectively) experienced a qualifying migraine headache (their next migraine headache that reached moderate or severe intensity). A significantly greater proportion of AVP-825 patients reported headache relief at 2 hours post-dose compared with those using the placebo device (68% vs 45%, P=.002, odds ratio 2.53, 95% confidence interval [1.45, 4.42]). Between-group differences in headache relief were evident as early as 15 minutes, reached statistical significance at 30 minutes post-dose (42% vs 27%, P=.03), and were sustained at 24 hours (44% vs 24%, P=.002) and 48 hours (34% vs 20%, P=.01). Thirty-four percent of patients treated with AVP-825 were pain-free at 2 hours compared with 17% using the placebo device (P=.008). More AVP-825 patients reported meaningful pain relief (patient interpretation) of migraine within 2 hours of treatment vs placebo device (70% vs 45%, P<.001), and fewer required rescue medication (37% vs 52%, P=.02). Total migraine freedom (patients with no headache, nausea, phonophobia, photophobia, or vomiting) reached significance following treatment with AVP-825 at 1 hour (19% vs 9%; P=.04). There were no serious adverse events (AEs), and no systemic AEs occurred in more than one patient. Chest pain or pressure was not reported, and only one patient taking AVP-825 reported mild paresthesia. No other triptan sensations were reported.. Targeted delivery of a low-dose of sumatriptan powder via a novel, closed-palate, Breath Powered, intranasal device (AVP-825) provided fast relief of moderate or severe migraine headache in adults that reached statistical significance over placebo by 30 minutes. The treatment was well tolerated with a low incidence of systemic AEs.

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Chemistry, Pharmaceutical; Double-Blind Method; Female; Humans; Lactose; Male; Middle Aged; Migraine Disorders; Outcome Assessment, Health Care; Radiopharmaceuticals; Serotonin 5-HT1 Receptor Agonists; Severity of Illness Index; Sodium Pertechnetate Tc 99m; Sumatriptan; Treatment Outcome; Young Adult

Clinical, electroencephalographic, rheoencephalographic and linear cerebral circulation findings were compared for 71 epileptics (group 1), 62 migraine patients (group 2) and 6 patients with epilepsy which had developed in the presence of severe migraine with aura (group 3). One-third of migraine patients, mostly of young age, suffering from migraine with aura and basilar migraine had such consciousness disorders as stupefaction and syncopes. EEG changes in migraine patients were considered nonspecific, paroxysmal spike activity arose only in addition of epileptic seizures. Cerebral blood flow measured by radionuclide tracing in migraine-free interval tended to speeding up, while in groups 1 and 3 hemocirculation was slow. Epileptogenic provocation in group 1 patients accelerated cerebral blood flow on the side of the focus, but decelerated it in group 3. The authors hold that the nature of migraine and epilepsy is different. By disintegration of cerebrovascular regulation and vascular supply of the neuron, migraine may promote secondary epileptogenesis.

Topics: Blood Flow Velocity; Cerebrovascular Circulation; Electroencephalography; Epilepsies, Partial; Epilepsy, Generalized; Female; Humans; Male; Migraine Disorders; Pentylenetetrazole; Radionuclide Imaging; Serum Albumin, Radio-Iodinated; Sodium Pertechnetate Tc 99m

Both CBF and CBV were evaluated by gamma-camera SPECT in 14 patients with classic migraine, all studied while symptom-free. Nuclear data were correlated with CT and MRI. A decreased regional CBF was observed in 13 of the 14 patients. The decreased perfusion was localized in the frontal lobe in 6 patients, the temporal lobe in one, the parietal lobe in 11 and the occipital lobe in 5 patients. The parieto-occipital cortex was involved more often than the frontal cortex; the association of hypoperfusion with parieto-occipital cortex was quite high. The right parieto-occipital regions were affected more often than the left ones. Regional CBV was increased in 8 patients. There was good topographical concordance between decreased CBF and increased CBV, but the increase of CBV was in general more evident at the periphery of the hypoperfusion. It is of interest that the only patient with a normal CBF study had a pathological CBV study. Apparently, CBF derangements are very common in symptom-free patients with classic migraine, a CBF decrease being often accompanied by a CBV increase. In these patients both CT and MRI have a lower diagnostic yield than SPECT.

Topics: Adolescent; Adult; Aged; Blood Volume; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Migraine Disorders; Organotechnetium Compounds; Oximes; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon