Migraine Disorders: Géraud G

Géraud G, Lantéri-Minet M, Lucas C, Valade D, Anonymous00362. · Department of Neurology, Rangueil Hospital, Toulouse, France. · Clin Ther. · Pubmed #15476911 No free full text.

Abstract: BACKGROUND: The French Recommendations for Clinical Practice: Diagnosis and Therapy of Migraine are guidelines concerning the overall management of patients with migraine, including diagnostic and therapeutic strategies and assessment of disability. OBJECTIVE: This article summarizes the guidelines as they apply to adults and children, and proposes future direction for steps toward optimal treatment of migraine in patients in France. METHODS: The recommendations were categorized into 3 levels of proof (A-C) according to the National Agency for Accreditation and Evaluation in Health (ANAES) methodology and were based on a professional consensus reached among members of the Working Group and the Guidelines Review Group of the ANAES. RESULTS: The International Headache Society diagnostic criteria for migraine should be used in routine clinical practice. Recommended agents for the treatment of migraine in adults include nonsteroidal anti-inflammatory drugs, acetylsalicylic acid (ASA) monotherapy or in combination with metoclopramide, acetaminophen monotherapy, triptans, ergotamine tartrate, and dihydroergotamine mesylate. Patients should use the medication as early as possible after the onset of migraine headache. For migraine prophylaxis in adults, the following can be used: propranolol, metoprolol, oxetorone, or amitriptyline as first-line treatment, and pizotifen, flunarizine, valproate sodium, or topiramate as second-line treatment. Migraine in children can be distinguished from that in adults by shorter duration (2-48 hours in children aged <15 years), more frequent bilateral localization, frequent predominant gastrointestinal disturbances, and frequent pallor hailing the onset of the attack. The following drugs are recommended in children and adolescents: ibuprofen in children aged >6 months, diclofenac in children weighing >16 kg, naproxen in children aged >6 years or weighing >25 kg, ASA alone or in combination with metoclopramide, acetaminophen alone or in combination with metoclopramide, and ergotamine tartrate in children aged >10 years. CONCLUSIONS: These guidelines are intended to help general practitioners to manage migraine patients according to the rules of evidence-based medicine.

Géraud G. · No affiliation provided · Presse Med. · Pubmed #15257224 No free full text.

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Géraud G, Denuelle M, Fabre N, Payoux P, Chollet F. · Service de Neurologie et d'Explorations fonctionnelles du Système Nerveux, CHU Toulouse-Rangueil, France. · Rev Neurol (Paris). · Pubmed #16141953 No free full text.

Abstract: Due to technical constraints and randomness of migraine attacks, studies using PET are scarce. Nevertheless, these studies have given new insights into migraine pathogenesis. One of the main facts revealed by PET studies is that posterior cerebral hypoperfusion accompanying migraine auras could also be present in migraine attacks without aura. This hypoperfusion is probably due to an increase of intrinsic vasoconstrictive tone in the cerebral circulation. Using PET within 6 hours after the onset of a spontaneous migraine attack, significant activations of brainstem (midbrain and pons) and of hypothalamus, persisting after headache relief by sumatriptan have been shown. These structures could play the role of migraine attack generators, modulating intrinsic vascular tone and central pain transmission.

Géraud G. · Service de neurologie, Hôpital de Rangueil, Toulouse. · Soins. · Pubmed #15622641 No free full text.

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Géraud G, Keywood C, Senard JM. · Service de Neurologie, CHU Rangueil, 1 Avenue Jean Poulhès, 31054 Toulouse, France. · Headache. · Pubmed #12656709 No free full text.

Abstract: BACKGROUND AND OBJECTIVES: Triptan use is associated with headache recurrence, and this has been cited as an important reason for patient dissatisfaction with the treatment. The mechanism by which recurrence occurs is not clear, and the incidence of recurrence varies with the triptan used. In order to explore the pharmacological and physiological interaction of triptans and migraine headache recurrence further, some specific clinical, pharmacological, and pharmacokinetic factors that might influence migraine recurrence were evaluated in a review of the major efficacy data for the drugs in the triptan class. These factors were 5-HT1B and 5-HT1D receptor activities, the pharmacokinetic elimination half-life of each triptan, and the clinical efficacy of each compound, determined by the proportion of patients with headache relief and the therapeutic gain over placebo. METHODS: Clinical data were derived from 31 triptan, placebo-controlled, major efficacy studies used in a previous meta-analysis. The mean recurrence rate, mean headache response, and therapeutic gain were calculated using the results from the individual clinical studies. Mean headache response and therapeutic gain were calculated at the time point used to define recurrence in each study. Data for binding affinity and potency were taken from a direct-comparison in vitro pharmacology study, and the elimination half-life quoted in the data sheet for each triptan was used. Rank correlation with recurrence rate was performed for each of the test parameters. RESULTS: Mean headache recurrence rates ranged from 17% for frovatriptan 2.5 mg to 40% for rizatriptan. Elimination half-life and recurrence were inversely correlated (r = -1.0, P =.0016). There was also a significant inverse correlation between 5-HT1B receptor potency and recurrence (r = -0.68, P =.034), but 5-HT1D receptor potency was not correlated with recurrence (r = -0.20, P =.54). In addition, the binding affinities for the 5-HT1B and 5-HT1D receptors were not correlated to headache recurrence. Importantly, it also was demonstrated that initial clinical efficacy was not correlated to headache recurrence. The correlation coefficient for headache response was 0.18 (P =.53) and for therapeutic gain, -0.11 (P =.71). CONCLUSION: The incidence of migraine headache recurrence varies between drugs in the triptan class. Migraine recurrence does not appear to be related to initial clinical efficacy, but is influenced by the pharmacological and pharmacokinetic properties of the individual triptans. The triptans with longer half-lives and greater 5-HT1B receptor potency had the lowest rates of headache recurrence.

Géraud G. · Service de Neurologie, CHU Rangueil, 31403 Toulouse cedex 4, France. · Rev Neurol (Paris). · Pubmed #11139747 No free full text.

Abstract: There are three categories of rare forms of migraine headache. Atypical aura can raise difficult diagnostic questions due to their clinical expression (visual or sensorial illusions and hallucinations), their mode of onset (sudden aura, developing in less than 4 minute), their duration (prolonged aura lasting more than 60 minutes), and the lack of an accompanying headache. Differential diagnostics include partial epilepsy or AIT, requiring careful search for the underlying cause. Rare migraine syndromes are separate clinical entities, most of which are recognized by the International Headache Society (IHS). These syndromes include basilar migraine, familial hemiplegic migraine, ophthalmoplegic migraine and the exceptional retinal migraine. Confusional migraine, usually observed in children, is no individualized by the IHS but can be included here. For secondary migraines there is a triggering factor leading to migraine in patients with no history of migraine previously. These include post-traumatic migraine and cervical migraine as well as migraine occurring with epileptic seizures and rare symptomatic migraine headache disclosing a general disease or an intracranial neurological lesion.

Lantéri-Minet M, Valade D, Géraud G, Chautard MH, Lucas C. · Department of Evaluation and Treatment of Pain, Hospital Pasteur, Nice, France. · Cephalalgia. · Pubmed #16305603 No free full text.

Abstract: The 2004 International Headache Society (IHS) classification of headache disorders introduced the new category of probable migraine defined by the existence of all but one of typical migraine criteria. FRAMIG 3, the first nationwide population-based survey performed in France using the 2004 IHS classification, assessed the prevalence of probable migraine and compared its features and management with those of strict migraine. Of a representative sample of 10,532 adult subjects interviewed, 1179 subjects (11.2%) were diagnosed as having strict migraine and 1066 (10.1%) as having probable migraine. The criterion most frequently missing was typical headache duration (4-72 h) and most subjects with probable headache had shorter average headache duration. Migraine severity and disability, although lower than those noted in subjects with strict migraine, were significant in subjects with probable migraine and quality of life impairment was identical among the two groups of migraine sufferers. Strict and probable migraine, which have similar prevalence and impact on migraine subjects, deserve similar medical and therapeutic management.

Pradalier A, Lantéri-Minet M, Géraud G, Allain H, Lucas C, Delgado A. · Centre Migraines et Céphalées, Louis Mourier Hospital, Colombes, France. · CNS Drugs. · Pubmed #15581385 No free full text.

Abstract: INTRODUCTION: Seglor capsules, a unique modified-release formulation of dihydroergotamine mesilate, have long been in clinical use in France for migraine prophylaxis. The aim of the PROMISE (PROphylaxis of MIgraine with SEglor) study was to establish the efficacy and tolerability of Seglor in the prevention of migraine in a general practice setting. METHODS: The PROMISE study was a double blind, placebo-controlled, parallel-group study carried out in primary care practice. It included 363 migraine patients treated with Seglor or placebo for 5 months after a 1-month placebo run-in phase. RESULTS: Migraine attack frequency (primary efficacy criterion) decreased markedly in the two treatment groups so that the difference in favour of Seglor did not reach statistical significance. However, most secondary outcome measures (duration of single attack, total duration of attacks over 1 month, consumption of mild opiate analgesics, subjective improvement) improved to a significantly greater degree in patients receiving Seglor than in those receiving placebo. In the 84.5% of patients who had impaired quality of life at entry, the percentage of reduction in attack frequency and most other efficacy measures showed significant improvement with Seglor. The safety profile for Seglor was comparable to that of placebo. CONCLUSION: These results support the effectiveness of Seglor in patients with migraine-related quality-of-life impairment. The findings of the PROMISE study also suggest that patients' quality of life should be assessed systematically before initiating a preventive treatment for migraine.

Géraud G, Spierings EL, Keywood C. · CHU de Rangueil, Service de Neurologie, Toulouse, France. · Headache. · Pubmed #12028325 No free full text.

Abstract: OBJECTIVE: To evaluate the tolerability and safety of frovatriptan 2.5 mg in patients with migraine. BACKGROUND: Frovatriptan is a new, selective serotonin agonist (triptan) developed for the acute treatment of migraine. Dose range-finding studies identified 2.5 mg as the dose that conferred the optimal combination of efficacy and tolerability. METHODS: The tolerability and safety of frovatriptan 2.5 mg were assessed during controlled, acute migraine treatment studies, including a study that compared frovatriptan 2.5 mg with sumatriptan 100 mg, as well as a 12-month open-label study during which patients could take up to three doses of frovatriptan 2.5 mg within a 24-hour period. Safety and tolerability were assessed through the collection of adverse events, monitoring of heart rate and blood pressure performance of 12-lead electrocardiogram, hematology screen, and blood chemistry studies. RESULTS: In the short-term studies, 1554 patients took frovatriptan 2.5 mg and 838 took placebo. In the 12-month study, 496 patients treated 13 878 migraine attacks. Frovatriptan was well tolerated in the short- and long-term studies with 1% of patients in the short-term studies and 5% of patients in the long-term study withdrawing due to lack of tolerability. The incidence of adverse events was higher in the frovatriptan-treated patients than in the patients who took placebo (47% versus 34%) and the spectrum of adverse events was similar. When compared to sumatriptan 100 mg, significantly fewer patients taking frovatriptan experienced adverse events (43% versus 36%; P=.03) and the number of adverse events was lower (0.62 versus 0.91), there were also fewer adverse events suggestive of cardiovascular symptoms in the frovatriptan group. Analysis of the entire clinical database (n=2392) demonstrated that frovatriptan was well tolerated by the patients regardless of their age, gender, race, concomitant medication, or the presence of cardiovascular risk factors. No effects of frovatriptan on heart rate, blood pressure, 12-lead electrocardiogram, hematology screen, or blood chemistry were observed. No patient suffered any treatment-related serious adverse event. CONCLUSIONS: Short- and long-term use of frovatriptan 2.5 mg was well tolerated by a wide variety of patients. Frovatriptan treatment produced an adverse events profile similar to that of placebo, and in a direct comparison study was better tolerated than sumatriptan 100 mg.

Ryan R, Géraud G, Goldstein J, Cady R, Keywood C. · Ryan Headache Center, St. Louis, MO, USA. · Headache. · Pubmed #12028324 No free full text.

Abstract: OBJECTIVE: To confirm the clinical efficacy of frovatriptan 2.5 mg. BACKGROUND: Frovatriptan is a new 5-hydroxytryptamine (5-HT)(1B/1D) receptor agonist being developed for the acute treatment of migraine with or without aura. Results from preclinical and clinical pharmacology studies showed frovatriptan to be a potent 5-HT(1B) receptor agonist with a long terminal elimination half-life (26 hours) and a broad therapeutic index. DESIGN: Three randomized, placebo-controlled, double-blind, parallel-group trials, in a total of 2676 patients, were performed to confirm the clinical efficacy of frovatriptan 2.5 mg for the acute treatment of migraine. RESULTS: In all three studies, headache response 2 hours after frovatriptan dosing was significantly greater than that seen with placebo (P < or = .001) with approximately a two-fold measure of effect over placebo for headache response at 2 and 4 hours postdosing. Time to headache response occurred within 1.5 hours in a substantial proportion of patients. The incidence of 24-hour headache recurrence with frovatriptan was low (10% to 25%). Frovatriptan therapy also was associated with a high degree of patient satisfaction. CONCLUSIONS: Frovatriptan represents a consistently effective acute treatment for migraine and accompanying symptoms.

Géraud G, Valette C. · Service de neurologie, Centre Hospitalo-Universitaire de Rangueil, Toulouse. · Rev Neurol (Paris). · Pubmed #10891800 No free full text.

Abstract: The primary objective of this prospective, open, non controlled, multicenter study was to collect data on migraine patients' health related quality of life before and after treatment of their migraine attacks by sumatriptan nasal spray 20 mg over a 12 week period. The impact on health related quality of life was evaluated by the mean change from pre-treatment scores french migraine health related quality of life specific questionnaire (QVM). A total of 219 patients have been included in the study, whose migraine attacks were not usually relieved by first line therapy. A statistically significant improvement in health related quality of life (as measured by the global score and the four scores related to the four dimensions of the QVM questionnaire (functional, psychological, social and therapeutic) were observed compared to the pre-treatment score values. At the end of the treatment period, 60% of patients preferred sumatriptan nasal spray 20 mg to their usual treatment. Headache relief was reported 2 hours after administration in 66% of attacks treated by sumatriptan nasal spray 20 mg during the study period and pain free in 46% of treated attacks. The nature and incidence of adverse events were similar to these observed in previous studies performed with sumatriptan nasal spray 20 mg and no unexpected events were reported. CONCLUSION: Those data suggest for the first time that the use of sumatriptan nasal spray 20 mg for the treatment of migraine attacks during a 12 week period may be associated with a significant improvement in migraine patients' quality of life. The clinical efficacy and tolerability results observed in this study are similar to those from controlled studies previously published with sumatriptan nasal spray 20 mg.

Radat F, Mekies C, Géraud G, Valade D, Vivès E, Lucas C, Joubert JM, Lantéri-Minet M. · Department of Treatment of Chronic Pain Patients, Pellegrin University Teaching Hospital, Bordeaux, France. · Cephalalgia. · Pubmed #18644041 No free full text.

Abstract: The objectives of the SMILE study were to assess anxiety, stress, depression, functional impact and coping behaviours in migraine patients consulting in primary care in France. General practitioners (n = 1467) and 83 neurologists included 5417 consulting migraine patients. Of these patients, 67% were found anxious, of whom 59% were also depressive. Patients with both anxiety and depressive dimensions showed a profile similar to that of chronic migraine patients (severe attacks, poor treatment effectiveness and pronounced stress, functional impact and maladaptive behaviours). A quantitative progression in the levels of stress, maladaptive coping behaviours and functional impact was noted from patients with neither dimension to those with both anxious and depressive dimensions. Stress and maladaptive coping strategies were found to be major determinants of anxiety. Anxious and depressive dimensions were associated with elevated consumption of acute treatments for migraine and low treatment effectiveness. Stress and anxiety should be looked for carefully in migraine patients.

Géraud G, Valade D, Lantéri-Minet M, Radat F, Lucas C, Vives E, Joubert JM, Mekies C. · Department of Neurology, Rangueil Hospital, Toulouse, France. · Cephalalgia. · Pubmed #18039338 No free full text.

Abstract: The SMILE study was conducted among migraine patients consulting in primary care in France. The first phase aimed to describe the study sample of patients at entry to the study, especially emotional dimension (Hospital Anxiety and Depression scale), functional impact (abridged Migraine Specific Questionnaire), stress (Perceived Stress Scale) and coping behaviours (brief COPE inventory avoidance subscale, Coping Strategies Questionnaire catastrophizing subscale), as well as treatments used and their effectiveness and treatments prescribed at end of consultation. Results indicate that consulting migraine patients suffer frequent migraine attacks, exhibit substantial levels of anxiety, functional impact and stress, and often use maladaptive coping strategies. Abortive treatments appear ineffective in most patients (74%). Patients with more affected psychometric variables and treatment ineffectiveness are more likely to be deemed eligible for prophylactic treatment. These data highlight the seriousness of migraine and maladjustment of patients consulting in primary care.

Donnet A, Lanteri-Minet M, Guegan-Massardier E, Mick G, Fabre N, Géraud G, Lucas C, Navez M, Valade D, Anonymous00183. · Department of Neurology, Clinical Neuroscience Federation, La Timone Hospital, Marseille, France. · J Neurol Neurosurg Psychiatry. · Pubmed #17442761 No free full text.

Abstract: BACKGROUND: Cluster headache (CH) is a relatively rare disease and episodic CH is more frequent than chronic CH. Few studies have described the characteristics of patients with chronic CH. METHODS: This was a descriptive study carried out by eight tertiary care specialist headache centres in France participating in the Observatory of Migraine and Headaches (OMH). From 2002 to 2005, OMH collected data from 2074 patients with CH, of whom 316 had chronic CH. From January to June 2005, 113 patients with chronic CH were interviewed using standardised questionnaires during a consultation. RESULTS: The male to female ratio was 4.65:1. Median age was 42 years. The majority of patients were smokers or former smokers (87%). 46% had primary chronic CH (chronic at onset) and 54% secondary chronic CH (evolving from episodic CH). Most patients had unilateral pain during attacks and 7% had sometimes bilateral pain during an attack. 48% reported a persisting painful state between attacks. Symptoms anteceding pain onset (mainly discomfort/diffuse pain, exhaustion, mood disorders) and auras were reported by 55% and 20% of patients, respectively. The functional impact of chronic CH was estimated as severe by 74% of patients, and 75.7% suffered from anxiety, as assessed by the Hospital Anxiety and Depression scale. There was no substantial difference in clinical presentation between primary and secondary CH. DISCUSSION: This study confirms the existence of auras and interictal signs and symptoms in patients with chronic CH, and male sex and smoking as CH risk factors. Primary and secondary chronic CH appear equally prevalent. Male sex does not appear to favour the shift from episodic to chronic CH.

Lucas C, Géraud G, Valade D, Chautard MH, Lantéri-Minet M. · Neurological Clinic, Hospital Salengro, Lille, France. · Headache. · Pubmed #16643573 No free full text.

Abstract: OBJECTIVE: To evaluate the proportion of migraineurs who are self-aware of their disease in France, to determine the factors (disability, quality of life, psychiatric comorbidities, and medical consultation) that may promote self-awareness of migraine, and to assess the influence of these factors on migraine attacks. BACKGROUND: New recommendations for migraine diagnosis and medical management were released in 2003 by the French medicoeconomic evaluation service (ANAES). In addition, the revised classification of headache disorders recently issued by the International Headache Society includes probable migraine as a form of migraine. However, strict and probable migraine now appear to be part of the same spectrum of disease. METHODS: Subjects with migraine (strict or probable) according to the revised classification were identified by a postal questionnaire from a large representative sample of the French adult population. Migraine-related disability was assessed using the MIDAS questionnaire, anxiety and depression by the Hospital Anxiety and Depression scale (HADS), and health-related quality of life (HRQoL) by the 8 concepts of the Short-Form 12 (SF-12) questionnaire. Migraine management was assessed according to the use of recommended or nonrecommended treatments, and treatment efficacy according to the set of 4 questions designed by the ANAES. RESULTS: Of the 10,532 subjects interviewed, 1,179 subjects (21.3%) were identified as migraineurs. Sixty percent of all migraine subjects were not self-aware that they had migraine. Medical consultation, duration of migraine history, severe intensity of attacks, impact on daily living, and female gender promoted self-awareness of migraine. On the other hand, HRQoL and anxiety and depression scores were not different between subjects self-aware or not self-aware of migraine. Only 20% of all migraine subjects were medically followed-up. Quality of the first medical consultation appears determinant for continued consulting. Subjects self-aware of migraine more frequently used recommended acute treatments of migraine, which proved more effective than nonrecommended treatments as assessed according to the ANAES set of questions. CONCLUSIONS: Migraine medical diagnosis and follow-up remain low in France. Careful medical consultation is a prime factor for migraine subject self-awareness of migraine, continued consultation, and use of recommended medications for the treatment of migraine attacks.

Aubertin A, Fabre-Thorpe M, Fabre N, Géraud G. · Centre de recherche Cerveau et cognition, faculté de médecine de Rangueil, Toulouse, France. · C R Acad Sci III. · Pubmed #10505242 No free full text.

Abstract: It has been suggested that the visual cortex of migraine sufferers is hypersensitive. To test this hypothesis, we compared the speed of visual processing in eight migraine patients (including three with aura) and nine controls performing two categorisation tasks of different complexity. In the complex task developed by Thorpe et al. (1996), subjects had to detect the presence of animals in briefly presented photographs (20 ms). The speed of visual processing was measured by the latency of the differential cerebral activity that appears around 150 ms between target and non-target trials. In the simple task, subjects performed a square/circle categorisation. All subjects were faster (445 ms/497 ms) with a higher rate of success (97%/91%) in the simple task. But in both tasks, the behavioural performance and the associated evoked potentials did not show any difference suggesting a cortical hypersensitivity in migraine sufferers.