2 Relpax package insert 3 Goldstein J et al 9th Congress of the IHS

2 relpax package insert 3 goldstein j et al 9th

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2 Relpax ® [package insert]. 3 Goldstein J et al. 9th Congress of the IHS. June 22-26, 1999. Barcelona, Spain. 4 Klassen A et al. Headache . 1997;37:640-645. 5 Teall J et al. Headache . 1998;38:281-287. 6 Perry CM et al. Drugs . 1998;55:889-922. 7 Schoenen J. Curr Opin Neurol . 1997;10:237-243. Percentage of Patients 16 1 2 3 * 4 5† 6,7 7
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Migraines Can Be Triggered by Stress and Exercise Adapted from Scharff et al. Headache. 1995;35:397-403. 0 20 40 60 80 Physical Exertion Stress Percent of Migraine Patients With Triggers 17
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Principles of Preventive Drug Treatment Start with low dose and increase slowly Need adequate trial (2-3 months) Avoid drug overuse and interfering drugs Evaluate therapy use migraine calendar/diary consider taper (or stop) if HA well controlled Take co-existing conditions into account determine contraindications (eg, pregnancy) to minimize potential risks Adapted from the US Headache Consortium Guidelines. Available at: . 18
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Tailor Therapy Appropriately to Comorbid Conditions Condition Avoid Asthma Depression Athletic -Blockers Epilepsy Arrhythmia Bipolar Tricyclic antidepressants (TCAs) Peptic ulcer disease NSAIDs Peripheral vascular disease Ergots/triptans Adapted from Silberstein S et al. Headache in Clinical Practice . 2nd ed. 2002:93. 19
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Preventive Medication Groups Anticonvulsants divalproex topiramate Antidepressants TCAs SSRIs MAOIs -blockers propranolol timolol Calcium-channel blockers Serotonin antagonists Others botulinum toxin type A* coenzyme Q10* NSAIDs Petasites hybridus* riboflavin* Silberstein SD. Lancet. 2004;363:381-391. MAOI=monoamine oxidase inhibitor SSRI=selective serotonin reuptake inhibitor TCA=tricyclic antidepressant *Not approved by FDA for this use. 20
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Differentiating Migraine and Sinus HA: HA Is Minor AAO-HNS Sinusitis Criteria Migraine (primary) Moderate to severe headache, throbbing, pulsing Exacerbated by routine activity Frequently unilateral Attacks infrequent; symptom- free between attacks Attacks last 4-72 hours Nausea, photo-/phonophobia common; vomiting may be present Sinus (secondary) Dull, aching headache, exacerbated by lying down Purulence in nose on exam Sense of smell impaired Sinusitis evident from CT, MRI, radiography, or using a flexible scope Headache in sinus areas coincident with sinusitis Face pain/pressure/ congestion Dowson AJ et al. Curr Med Res Opin. 2002;18:414-439. Lanza DC et al. Otolaryngol Head Neck Surg . 1997;117:S1-S7. 21
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Medication Overuse Headache (MOH) Management Bridging program during withdrawal parenteral dihydroergotamine mesilate low-dose tizanidine with long-acting NSAIDs daily doses of a triptan for up to 10 days short course of steroids, long-acting NSAIDs Prophylactic medication tricyclic antidepressants, SSRIs, -blockers, calcium-channel blockers, antiepileptics, NSAIDs Rescue therapy, as needed parenteral ketorolac*, antiemetics Smith TR et al. Drugs . 2004;64:2503-2514.
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