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- Page navigation anchor for RE: migraine reviewRE: migraine review
Thanks for your consolidated, up-to-date review on this frequent medical condition which is oft managed sub-optimally.
Although medications are the mainstay treatments, it is important to consider more durable and increasingly accessible procedures not reviewed in depth in your article. This includes cervical nerve-generated headaches which may respond to RFA (radiofrequency ablation) of the third occipital nerve and provide months of symptom relief. Such procedures are often covered by provincial insurance, may be more accessible and are less invasive than neuromodulation treatments, Such treatments also provides the patient a respite from headaches and an opportunity to decrease other headache medications *.
Neuromodulation implanted devices will remain valuable for a population of migraine suffers, but a stepwise interventional approach with weaning of oral medication/rescue medication use is warranted in advance.
Respectfully submitted,
Dr. Sarah Koles
* Hamer JF, Purath TA. Headache. 2014 Mar;54(3):500-10.
doi: 10.1111/head.12295. Epub 2014 Jan 16. PMID: 24433241.Competing Interests: None declared.References
- Hamer JF, Purath TA. Response of cervicogenic headaches and occipital neuralgia to radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerve. Headache. 2014 Mar;54(3):500-10. doi: 10.1111/head.12295. Epub 2014 Jan 16. PMID: 24433
- Page navigation anchor for RE: Naproxen-sumatriptan combination in Table 2RE: Naproxen-sumatriptan combination in Table 2
The recommendation of naproxen is from the guideline/article (see reference below, attn: to page Supp 3, S 27 and S 29) Recommendation from the Canadian Headache Society (2012) is based on level of evidence and safety. If there are sufficient RCTs (>2) to support the efficacy of a treatment option, it has high quality evidence. If the safety profile is favorable (expert opinion), it will deserve a high recommendation from the group. The Canadian Headache Society is currently updating the guideline for migraine treatment hence hopefully it will incorporate the newer treatment option including combination sumatriptan with naproxen compound which most likely deserve high recommendation based on efficacy and safety. Naproxen on its own may have a different recommendation with future guideline - to be determined.
As for the specifics from this Cochrane review, I disagree with the final statement -"Naproxen is not a good drug for treating migraine at the doses of 500 mg or 825 mg used in the studies we found". To label a drug to be good or not good, it is important to consider both the efficacy and safety profile of the drug which is important in migraine treatment.
Competing Interests: None declared.References
- Worthington I, Pringsheim T, Gawel MJ, et al. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci 2013;40:S1-S80.
- Page navigation anchor for RE: Naproxen-sumatriptan combination in Table 2RE: Naproxen-sumatriptan combination in Table 2
In their review of the diagnosis and acute management of migraine, Tzankova and colleagues strongly recommend naproxen–sumatriptan (Table 2). However, a Cochrane review finds naproxen to be ineffective(1). I am interested in how the authors reconcile their recommendation with the results of the Cochrane review.
Competing Interests: None declared.References
- 1. https://www.cochrane.org/CD009455/SYMPT_naproxen-acute-migraine-adults