Sumatriptan nasal spray may be particularly useful for patients whose nausea and vomiting preclude them from using oral migraine medication or for patients who prefer not to use an injectable migraine medication. The objective of this study was to evaluate in two clinical studies the efficacy and tolerability of the intranasal form of sumatriptan in the acute treatment of a single migraine attack. International Headache Society-diagnosed adult migraineurs in two randomized, double-blind, parallel-group, multicenter studies (n = 409 and 436) used sumatriptan nasal spray 20 mg, 10 mg, or placebo (2:1:1) for the acute treatment of a single migraine attack at home. Predose and at predetermined postdose intervals, patients recorded headache severity (none, mild, moderate, severe); time to meaningful relief; clinical disability (none, mildly impaired, severely impaired, bed rest required); presence/absence of nausea, photophobia, and phonophobia; and the occurrence of adverse events. Two hours postdose in the two studies, moderate or severe baseline pain was reduced to mild or none in 62 to 63% of patients treated with sumatriptan 20 mg, 43 to 54% of patients treated with sumatriptan 10 mg, and 29 to 35% of placebo-treated patients (p < 0.05 20 mg versus placebo for both studies and 10 mg versus placebo for study 1). Onset of relief relative to placebo began as early as 15 minutes postdose (sumatriptan 20 mg, study 2). Clinical disability at 2 hours postdose was reported as mildly impaired or normal in 72 to 74% of patients treated with sumatriptan 20 mg, 56 to 68% of patients treated with sumatriptan 10 mg, and 47 to 58% of placebo-treated patients (p < 0.05 20 mg versus placebo for both studies). Similar efficacy rates were observed for nausea, photophobia, and phonophobia. The most common adverse event in the active treatment groups was disturbance of taste (bad, bitter, or unpleasant taste). Aside from this event, the pattern and incidence of adverse events did not differ among treatment groups. From these results we determined that sumatriptan nasal spray is a rapidly effective, well-tolerated migraine treatment. The 20-mg dose was effective in treating the entire migraine symptom complex, and the 10-mg dose was less consistently effective.

No abstract

We studied one hundred patients with suspected temporomandibular joint (TMJ) arthropathy in whom 64 also complained of headache and/or facial pain, using high field surface coil magnetic resonance (MR) imaging, and found that headache and facial pain are commonly observed in association with inflammatory arthropathy of the TMJ. Each patient complained of pain and/or tenderness localized to the immediate vicinity of at least one TMJ. Pathologic joint effusion was demonstrated by MR in 88 of the painful joints studied. Significant meniscus displacement, with or without meniscus deformity and alteration of intrinsic signal intensity was present in 94 of the 100 painful joints examined. Fascial inflammation and atrophy of the ipsilateral muscles of mastication were observed occasionally with painful joints. There were no mechanical TMJ symptoms, such as joint clicking, crepitus or locking in 14 internally deranged and painful joints, 12 of which exhibited joint effusion and local inflammation. At least 80 patients described occlusal changes within 12 months of imaging. 28 of the pathologic joints in the series underwent subsequent meniscectomy, including routine histologic evaluation of surgical material. We conclude that internal derangement and inflammation of the TMJ should be considered in patients with unexplained headache and/or facial pain, even if mechanical TMJ symptoms are absent.

The purpose of this study was to examine the possible association of signs and symptoms of temporomandibular disorders relative to headache. Fifty-six sequential patients referred to the Headache Institute of Minnesota for evaluation and treatment of migraine and tension headaches were examined for signs and symptoms of temporomandibular disorders. The results of the examination of headache patients were compared to patients suffering from myofascial pain dysfunction and/or TMJ internal derangements from the TMJ and Craniofacial Pain Clinic at the University of Minnesota. Finally the migraine and tension headache patients were compared to each other and an asymptomatic population. Results indicate that patients with temporomandibular disorders exhibit significantly more jaw dysfunction and pericranial muscle tenderness than migraine and tension headache patients. Migraine and tension headache patients were found to have similar amounts of pericranial muscle tenderness. Migraine and tension headache patients exhibited significantly more pericranial and neck muscle tenderness than a general population.

Patients with temporomandibular disorders frequently suffer from headache. The purpose of this study was to develop a simple screening exam which would allow the physician to identify headache patients with coexisting temporomandibular disorders. Twenty-eight migraine and 27 tension headache patients were identified by a board certified neurologist and then were examined by a dentist for signs of temporomandibular disorders. These patients were then compared to 63 patients with temporomandibular internal derangements and 62 patients with myofascial pain dysfunction. Comparisons of the clinical signs showed that the temporomandibular internal derangement and myofascial pain dysfunction patients differed significantly from the headache patients in regards to specific signs of jaw dysfunction. The presence of reciprocal clicking of the temporomandibular joint or pain with maximum jaw opening and pain upon palpation of the temporomandibular joint distinguished temporomandibular internal derangement patients from headache patients. These criteria have a sensitivity of 92% and specificity of 91%. Pain on palpation over the temporomandibular joint, or pain with maximum jaw opening using passive stretch, and pain with lateral movement of the jaw, distinguished myofascial pain dysfunction patients from headache patients. These criteria have a sensitivity of 77% and specificity of 85%. By using these screening tests, the physician can identify the concurrent existence of temporomandibular disorders in headache patients and triage the patient to a clinician knowledgeable in the diagnosis and treatment of temporomandibular disorders for further evaluation.