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of COVID-19. In medical practice, treatment guidelines are based on clinical studies. NSAIDS, especially ibuprofen, naproxen, diclofenac and tolfenamic acid, have proven efficacy and safety in clinical trials of symptomatic treatment of migraine and therefore are recommended for acute treatment. Furthermore, indomethacin, is the only available treatment for some Trigeminal Autonomic Cephalalgias. In general, NSAIDs are of great therapeutic value in headaches. The FDA recently released advice (...) Covid-19: HeadacheHEADACHE IN COVID-19 PANDEMIC - eanpages COVID-19 May 13, 2020 COVID-19 May 13, 2020 COVID-19 May 6, 2020 COVID-19 May 6, 2020 COVID-19 May 13, 2020 COVID-19 May 13, 2020 COVID-19 May 6, 2020 COVID-19 May 6, 2020 Executive Page May 1, 2020 Executive Page April 1, 2020 Executive Page March 1, 2020 Executive Page February 1, 2020 Country of the Month May 1, 2020 Country of the Month April 5, 2020 Country of the Month March 1, 2020 Country of the Month February 1, 2020 Paper
morphine 150 µg or normal saline. The primary outcome was the incidence of post-dural puncture headache. Secondary outcomes included onset, duration, and severity of post-dural puncture headache, the presence of cranial nerve symptoms and the type of treatment the patient received. Results: Sixty-one women were included in the study. The incidence of post-dural puncture headache was 21 of 27 (78%) in the intrathecal morphine group and 27 of 34 (79%) in the intrathecal saline group (difference, -1%; 95 (...) % CI, -25% to 24%). There were no differences between groups in the onset, duration, or severity of headache, or presence of cranial nerve symptoms. Epidural blood patch was administered to 10 of 27 (37%) of subjects in the intrathecal morphine and 11 of 21 (52%) of the intrathecal saline group (difference 15%; 95% CI, -18% to 48%). Conclusions: The present findings suggest that a single prophylactic intrathecal morphine dose of 150 µg administered shortly after delivery does not decrease
; Headache and Facial Pain Program, University of Texas Southwestern Medical Center, Dallas, TX, USA. 8 Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 9 Dent Headache Center, Dent Neurologic Institute, Buffalo, NY, USA. 10 Department of Otolaryngology-Head & Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo (...) 7 (3), 162-8. May 2014. PMID 24790646. - Review Cluster headache is a severe, debilitating disorder with pain that ranks among the most severe known to humans. Patients with cluster headaches have few therapeutic optio … D Fontaine et al. J Pain Res 11, 375-381. 2018. PMID 29497328. - Review Cluster headache (CH) is a primary headache and considered as one of the worst pains known to man. The sphenopalatine ganglion (SPG) plays a pivotal role in cranial auton … Show more similar articles
is provided with each new RFID card. Additional gel can be provided at no extra cost. Inno Innovativ vative e aspects aspects gammaCore is currently the only technology that uses non-invasive stimulation of the vagus nerve to treat cluster headache. Intended Intended use use The instructions for using gammaCore state that gammaCore should be used regularly throughout the day to prevent cluster headache attacks and acutely to reduce pain during an attack. gammaCore is intended to be self-administered (...) . In all other studies gammaCore was used in addition to standard of care treatments. The studies show that gammaCore can reduce the frequency of The studies show that gammaCore can reduce the frequency of cluster headache attacks and the intensity of pain during an cluster headache attacks and the intensity of pain during an attack attack 3.3 The evidence for gammaCore comprises a small number of studies which include comparative, non-comparative and observational studies. The external gammaCore
, acetaminophen (in children and adolescents), and triptans (mainly in adolescents) for the relief of migraine pain, although confidence in the evidence varies between agents. There is high confidence that adolescents receiving oral sumatriptan/naproxen and zolmitriptan nasal spray are more likely to be headache-free at 2 hours than those receiving placebo. No acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia (...) Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society To provide evidence-based recommendations for the acute symptomatic treatment of children and adolescents with migraine.We performed a systematic review of the literature and rated risk of bias of included studies according to the American Academy
Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society To provide updated evidence-based recommendations for migraine prevention using pharmacologic treatment with or without cognitive behavioral therapy in the pediatric population.The authors systematically reviewed literature from January 2003 (...) to August 2017 and developed practice recommendations using the American Academy of Neurology 2011 process, as amended.Fifteen Class I-III studies on migraine prevention in children and adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine, or flunarizine are more or less likely than those receiving placebo to have a reduction in headache frequency. Children with migraine receiving
Non-pharmacological treatment of chronic neck-shoulder myofascial pain in patients with forward head posture. Introduction: Today, chronic pain remains a pressing medical and socio-economic problem, despite the rapid development of medical technologies, the presence of a vast arsenal of drug and non-drug treatments. Estimates for chronic pain prevalence ranged from 8% to 60%. At the same time, about 40% of patients report insufficient effectiveness in the treatment of chronic pain syndrome (...) . The aim of the study was to compare the effectiveness of MTrPS management by biomechanical correction of the musculoskeletal system combined with therapeutic exercises, DN and TrPs-pressure release with the effectiveness of MTrPS management by therapeutic exercises combined with DN and TrPs-pressure release in patients with chronic neck-shoulder myofascial pain and FHP.Materials and methods: 87 patients (mean age - 39±4,9 years) with chronic neck-shoulder myofascial pain and FHP were randomly assigned
the following clinical questions: (1) In the adult emergency department patient presenting with acute headache, are 60 there risk-stratification strategies that reliably identify the need for emergent neuroimaging? (2) In the adult 61 emergency department patient treated for acute primary headache, are nonopioids preferred to opioid medications? 62 (3) In the adult emergency department patient presenting with acute headache, does a normal noncontrast head 63 computed tomography scan performed within 6 hours (...) of headache onset preclude the need for further diagnostic 64 workup for subarachnoid hemorrhage? (4) In the adult emergency department patient who is still considered to be 65 at risk for subarachnoid hemorrhage after a negative noncontrast head computed tomography, is computed 66 tomography angiography of the head as effective as lumbar puncture to safely rule out subarachnoid hemorrhage? 67 Evidence was graded and recommendations were made based on the strength of the available data. 68 69 INTRODUCTION
Trial of Galcanezumab in Prevention of Episodic Cluster Headache. Episodic cluster headache is a disabling neurologic disorder that is characterized by daily headache attacks that occur over periods of weeks or months. Galcanezumab, a humanized monoclonal antibody to calcitonin gene-related peptide, may be a preventive treatment for cluster headache.We enrolled patients who had at least one attack every other day, at least four total attacks, and no more than eight attacks per day during (...) a baseline assessment, as well as a history of cluster headache periods lasting at least 6 weeks, and randomly assigned them to receive galcanezumab (at a dose of 300 mg) or placebo, administered subcutaneously at baseline and at 1 month. The primary end point was the mean change from baseline in the weekly frequency of cluster headache attacks across weeks 1 through 3 after receipt of the first dose. The key secondary end point was the percentage of patients who had a reduction from baseline of at least
are relatively similar with 83%–99% sensitivity and specificity . MRA of the neck is most commonly performed with gadolinium contrast, whereas MRA of the head is most commonly performed without contrast. MRA of the brain with contrast is generally indicated if embolization coils or intracranial stents have been placed . Headache of Trigeminal Autonomic Origin Trigeminal autonomic cephalgia is a group of primary headache disorders characterized by pain in unilateral trigeminal distribution (...) , but head MRI may be appropriate since secondary causes need to be excluded. Head MRA and CTA are not usually indicated initially. The ophthalmic form of trigeminal neuralgia may be confused with these entities [64-66]. Clusters of severe, strictly unilateral pain lasting a few hours at most characterize a cluster headache. It is often accompanied by ipsilateral Horner syndrome, tearing, and nasal congestion. The pain stays on the same side from attack to attack. The clusters typically last several
Intravenous Fluid for the Treatment of Emergency Department Patients With Migraine Headache: A Randomized Controlled Trial The objective of this pilot study is to assess the feasibility and necessity of performing a large-scale trial to measure the effect of intravenous fluid therapy on migraine headache pain.This was a single-center, pilot randomized controlled trial. We randomized adult emergency department migraine headache patients to receive 1 L of normal saline solution during 1 hour (...) (fluid group) or saline solution at 10 mL/hour for 1 hour (control group). All patients received intravenous prochlorperazine and diphenhydramine at the start of fluid administration. Participants and outcome assessors were blinded; nurses administering the intervention were not. Outcomes were assessed at 60 and 120 minutes, and 48 hours. The primary outcome was the difference in the verbal pain rating (on a scale of 0 to 10) between 0 and 60 minutes. Key secondary outcomes included additional
The role of intravenous acetaminophen in post-operative pain control in head and neck cancer patients. This study investigated the role of intravenous acetaminophen for alleviation of postoperative pain after surgical resection of head and neck cancers.A single-center study was conducted, which investigated a prospective group of 48 participants who underwent surgery between April 2016 and May 2017 and postoperatively received scheduled IV acetaminophen (1 g every 6 hours for 4 doses) plus (...) the standard opioid PCA and breakthrough narcotics. These were compared to a similar retrospective cohort of 51 patients who had surgery between January 2014 to March 2015 and only received an opioid patient controlled analgesia (PCA) pump and breakthrough narcotics. Outcome measures included averaged pain scores, total amount of narcotics received (in morphine equivalents), and number of PCA attempts measured in 8-hour intervals over the first 24 hours, as well as duration of PCA and length of stay
pain in his bilateral lower extremities, particularly in his calves, without any weakness or parasthesias. He also experiences a bi-frontal, throbbing headache over this time period, without any photophobia, nausea, or vomiting. He feels generally fatigued with a poor appetite and decreased PO intake. He takes ibuprofen 600mg every six hours and gabapentin 300mg nightly, but these don’t bring him any relief. Three days after his symptoms begin, he presents to an outside ER where he is diagnosed (...) 34m with fever, headache and myalgias Core IM Hoofbeats: 34M with Fever, Headache and Myalgias – Clinical Correlations Search Core IM Hoofbeats: 34M with Fever, Headache and Myalgias January 16, 2019 15 min read Podcast: | Subscribe: | By Shira Sachs MD, Stephanie Sherman MD, Cindy Fang MD and John Hwang MD || Audio Editing by Richard Chen || Graphic by Amy Ou MD Time Stamps Player three has entered the game! [0:15] Case presentation, part 1 [1:20] First impressions [3:24] Rethinking another
A Randomized Trial of a Long-Acting Depot Corticosteroid Versus Dexamethasone to Prevent Headache Recurrence Among Patients With Acute Migraine Who Are Discharged From an Emergency Department Migraine patients continue to report headache during the days and weeks after emergency department (ED) discharge. Dexamethasone is an evidence-based treatment of acute migraine that decreases the frequency of moderate or severe headache within 72 hours of ED discharge. We hypothesize that intramuscular (...) methylprednisolone acetate, a long-acting steroid that remains biologically active for 14 days, will decrease the number of days with headache during the week after ED discharge by at least 1 day compared with intramuscular dexamethasone.We conducted a randomized, blinded clinical trial comparing intravenous metoclopramide at 10 mg+intramuscular dexamethasone at 10 mg with intravenous metoclopramide at 10 mg+intramuscular methylprednisolone acetate at a dose of 160 mg for patients presenting to 2 different EDs
Effect of Pregabalin on Radiotherapy-Related Neuropathic Pain in Patients With Head and Neck Cancer: A Randomized Controlled Trial Neuropathic pain is an unavoidable treatment-related adverse event among patients with head and neck cancer who are undergoing radiotherapy. We aimed to test the efficacy and safety of pregabalin versus placebo in the treatment of radiotherapy-related neuropathic pain.This randomized, double-blind, placebo-controlled trial was conducted in four centers in China (...) . Eligible patients with a mean pain intensity score of 4 or more on an 11-point numeric rating scale were randomly assigned to receive either active treatment with a flexible dose of pregabalin or placebo for 16 weeks. The primary efficacy outcome was pain reduction measured on the numeric rating scale.There were 128 patients who received treatment as randomly assigned. Pain intensity reduction was 2.44 in the pregabalin arm and 1.58 in the placebo arm at week 16, yielding an adjusted mean difference
Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial Postdural puncture headache (PDPH) lacks a standard evidence-based treatment. A patient treated with neostigmine for severe PDPH prompted this study.This randomized, controlled, double-blind study compared neostigmine and atropine (n = 41) versus a saline placebo (n = 44) for treating PDPH in addition to conservative management of 85 patients with hydration
with 2,996 participants. Of these, 12 trials provided moderate- quality evidence of increased incidence of post–dural puncture headache with bed rest compared with immediate mobi- lization (RR 1.24; 95% CI 1.04 to 1.48). Furthermore, 18 trials similarly provided moderate- quality evidence that bed rest increased incidence of any head- ache compared with immediate mobilization (RR 1.16; 95% CI 1.02 to 1.32). Subgroup analyses based on indication for dural puncture, including diagnostic lumbar puncture (...) Review Snapshot (SRS) series. The source for this systematic review snapshot is: Arevalo-Rodriguez I, Ciapponi A, Roque I Figuls M, et al. Posture and?uids for preventing post- dural puncture headache. Cochrane Database Syst Rev. 2016;3:CD009199. 1. Headache Classi?cation Subcommittee of the International Headache Society. The International Classi?cation of Headache Disorders, 3rd edition (beta version). Cephalgia. 2013;33: 629-808. 2. HigginsJPT,AltmanDG,SterneJAC.Chapter 8
gammaCore for cluster headache gammaCore for cluster headache gammaCore for cluster headache Medtech innovation briefing Published: 22 October 2018 nice.org.uk/guidance/mib162 pathways Summary Summary The technology technology described in this briefing is gammaCore. It is used as a daily preventative measure for cluster headache and can be used to treat pain during a headache. The inno innovativ vative aspects e aspects compared with other vagus nerve stimulators is that gammaCore is applied (...) current for 2 minutes at a time. The aim is to modify pain signals by stimulating the vagus nerve through the skin of the neck. gammaCore can be used daily to help prevent cluster headache or when the person feels a cluster headache beginning. The device is small and portable and, after brief training, can be used anywhere that is convenient. Innovations gammaCore differs from other vagus nerve stimulators in being applied to the skin of the neck rather than implanted by a surgical procedure. Current