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Balance Disorders in Children
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Louisa Murdin, Gavin A.J. Morrison
Attacks of vestibular migraine can be treated with domperidone, cinnarizine or cyclizine for nausea, vomiting or dizziness. Serotonin 5-HT1B/1D receptor agonists such as sumatriptan may be useful in management of headaches. Rizatriptan is reported to be more effective than other drugs of this class and other simple analgesics.14 Preventative measures, if necessary, would be those currently recognized – pizotifen or propanolol – and if those fail, a neurologist might prescribe the full range of antimigraine medications available to use in adults.16 Topiramate and flunairizine have randomized double-blind placebo-controlled trials in children that support their use, and there are open label studies in favour of sodium valproate.14
Migraine: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Pizotifen is a benzocycloheptathiophene derivative that is structurally similar to cyproheptadine and the TCAs. It has a long elimination half-life (about 23 hours) and can be given as a single evening dose. Pizotifen is a 5-HT2 and histamine-1 antagonist with the side-effects of drowsiness and increased appetite with associated weight gain. Pizotifen has proven effective in controlled117 and placebo–controlled118–120 trials. In an open trial, it was less effective than methysergide121 but more effective than placebo. In another placebo–controlled trial, it was as effective as naproxen sodium, and both were more effective than placebo. Pizotifen (2–3 mg) daily was as effective as fiunarazine 10 mg daily. Pizotifen is often used for adolescent migraineurs at doses of 0.5–1.5 mg daily. Adults, in contrast, may require up to 3 mg daily. Pizotifen has no interaction with specific antimigraine compounds, such as ergotamine or the triptans. Pizotifen is not available in the USA.
Migraine: Management and Treatment with Herbal Drugs
Published in Vikas Kumar, Addepalli Veeranjaneyulu, Herbs for Diabetes and Neurological Disease Management, 2018
Arulmozhi D. Kandasamy, Yogesh Anant Kulkarni, Addepalli Veeranjaneyulu, Ram S. Gaud
Migraine is characterized by episodes of head pain that is often throbbing and frequently unilateral and may be severe. In migraine without aura (previously known as common migraine) attacks are usually associated with nausea, vomiting, or sensitivity to light, sound, or movement and when treated, the attacks typically last 4–72 h. A combination of features is required for the diagnosis, but not all features are present in every attack or in every patient. These symptoms distinguish migraine from tension type headache, the most common form of primary headache, which is characterized by the lack of associated features. Any severe and recurrent headache is most likely to a form of migraine and to be responsive to antimigraine therapy.20 In 15% of patients migraine attacks are usually preceded or accompanied by transient focal neurotic symptoms, which are usually visual; such patients have migraine with aura (previously known as classic migraine).21,22 In a recent large population-based study, 64% of patients with migraine had only migraine without aura, 18% had only migraine with aura and 13% had both types of migraine (the remaining 5% had aura without headache).
Safety of drugs used for the treatment of migraine during pregnancy: a narrative review
Published in Expert Review of Clinical Pharmacology, 2023
Jessica A Spiteri, Gabrielle Camilleri, Carlo Piccinni, Janet Sultana
Several effective antimigraine medications are reasonably safe for use by pregnant women. For the acute episode, acetaminophen remains a recommended first-line agent although concerns with its possible association with negative endocrine and neurodevelopmental outcomes cannot be ignored and require further research. NSAIDs in the first trimester, with perhaps exception of ibuprofen, have been associated with spontaneous abortion. They do not seem to be major teratogens although the available evidence is less clear on this point. While as a class they seem safe during the second trimester, they are less so beyond 20–30 weeks and are associated with adverse neonatal renal and vascular effects. Triptans seem not to be associated with congenital malformations or spontaneous abortions with sumatriptan being the drug with most evidence behind it. Ergot alkaloids remain contraindicated in pregnancy and have lost their role in migraine management in general due to the advent of better alternatives.
Treating status migrainosus in the emergency setting: what is the best strategy?
Published in Expert Opinion on Pharmacotherapy, 2018
László Vécsei, Délia Szok, Aliz Nyári, János Tajti
The difficulties of effective therapy stem from the unclear exact pathomechanism and genetic background of migraine. One of the leading hypotheses of the pathogenesis of the initiation and maintenance of a migraine attack emphasizes the activation and sensitization of the trigeminovascular system via the involvement of different neuropeptides. Currently, a few specific (such as serotonergic agents (i.e. DHE and triptans)) and nonspecific (such as NSAIDs and antiemetics) acute antimigraine drugs are available. The weakness of this therapeutic regime is that they are not effective in every single attack and migraineur. Even more, the available medications may have adverse events, which can result in intolerability and loss of patient adherence. Concomitant diseases can contraindicate the use of these pharmacons. These unfavorable conditions can lead to the admission of these seriously ill migraineurs to the ED.
Side effects associated with pharmacotherapy for pediatric irritable bowel syndrome and functional abdominal pain – not otherwise specified: a systematic review
Published in Expert Opinion on Drug Safety, 2019
Robyn Rexwinkel, Judith Zeevenhooven, Faridi S. van Etten-Jamaludin, Marc A. Benninga, Merit M. Tabbers
Four RCTs investigated antispasmodics [25,36–38], three trials studied antidepressants [26,39,41], one trial studied antihistaminic agents [40], and another one laxatives [35]. Also, antireflux agents and anti-emetics were investigated by two RCTs [27,34]. Two cohort studies investigated antidepressants [32,33]. Furthermore, antihistaminic agents [30], serotonergic agents and antibiotics were studied in cohort studies [29,31]. Antimigraine agents were investigated by a case-control study [28]. No studies were included on antidiarrheal agents and pain medication.