Chronic ergotamine abuse: evidence of functional impairment of long ascending spinal tracts

22 migraine patients with a history of chronic ergotamine abuse were compared with 12 patients with a similar intake of dihydroergotamine. The study of somatosensory-evoked potentials showed that 50% of the patients with a history of ergotamine abuse had increased central conduction times after stimulation of the tibial nerve. Corticomotoneuronal latencies obtained by noninvasive electrical stimulation of the motor cortex were normal in 5 patients. The functional sensory deficits were not related to clinical impairment and were more frequently observed in patients with a comparatively high mean daily and cumulative intake.     

Alternatives in Drug Treatment of Chronic Paroxysmal Hemicrania

Indomethacin is the drug of first choice in chronic paroxysmal hemicrania with clear relief of pain as a diagnostic criterion. In a few cases, indomethacin is not tolerated because of side effects. Therefore, the efficacy of carbamazepine, verapamil. sumatriptan. acetylsalicylic acid, and oxygen as drugs in the prophylactic or acute treatment of chronic paroxysmal hemicrania was studied in a prospective open trial with 10 patients suffering from chronic paroxysmal hemicrania. The trial results, in accordance with a review of the literature. suggest that acetylsalicylic acid (and probably naproxen and diclofenac) and verapamil are the most effective drugs of second choice in chronic paroxysmal hemicrania. The efficacy of sumatriptan in this condition needs still to be clarified. although there is evidence for partial efficacy. Carbamazepine and oxygen did not show any significant influence on chronic paroxysmal hemicrania.     

Migr?ne w?hrend Schwangerschaft und Stillzeit

In pregnancy and during lactation headache and migraine are severe therapeutic problems. The aim of this paper is to present treatment recommendations for drug and non-drug therapies based on scientific evidence. Pregnant women often lose or experience a substantial reduction in migraine attacks which reappear during lactation. During pregnancy acute headache is treated using paracetamol, in the middle trimester acetylsalicylic acid (ASA) and ibuprofen are also possible. Sumatriptan for the acute treatment of migraine is not in principle contraindicated. Metoprolol and magnesium are recommended for prophylaxis. During lactation up to 800?mg ibuprofen in addition to paracetamol is the first choice medication.