IGRAINE IS A COMMON AND disabling condition that typically manifests as attacks of severe, pulsating, 1-sided headaches, often accompanied by nausea, phonophobiaor or photophobia. Population-based studies suggest that 6% to 7% of men and 15% to 18% of women experience migraine headaches. 1,2 Although in most cases it is sufficient to treat acute headaches, many patients require interval treatment as attacks occur often or are insufficiently controlled. Drug treatment with ␤-blockers, calcium antagonists, or other agents has been shown to reduce the frequency of migraine attacks; however, the success of treatment is usually modest and tolerability often suboptimal. 3 Acupuncture is widely used for preventing migraine attacks although its effectiveness has not yet been fully established. 4 Since 2001, German social health insurance companies have reimbursed accredited physicians who provide acupuncture treatment for chronic pain. By December 2004 more than 2 million patients had been treated with acupuncture , about a third of these had migraine or tension-type headaches. In this study, the Acupuncture Randomized Trial (ART-Migraine), we investigated whether acupuncture reduced headache frequency more effectively than sham acupuncture or no acupuncture in patients with migraines.

Criteria for the diagnosis of cervicogenic headache are proposed, which include unilateral head pain, symptoms and signs of neck involvement, non-clustering episodic moderate pain originating in the neck then spreading to the head, and response to root or nerve blockade; plus rarer and non-obligatory features such as autonomic disturbances, dizziness, phonophotophobia, monocular visual blurring, and difficulty swallowing.

ISRCTN9737659.

SYNOPSISCriteria for the diagnosis of cervicogenic headache are proposed, which include unilateral head pain, symptoms and signs of neck involvement, non-clustering episodic moderate pain originating in the neck then spreading to the head, and response to root or nerve blockade; plus rarer and non-obligatory features such as autonomic disturbances, dizziness, phonophotophobia, monocular visual blurring, and difficulty swallowing.

We investigated efficacy, safety, and tolerability of two tablets of the fixed combination of 250 mg acetylsalicylic acid (ASA) + 200 mg paracetamol + 50 mg caffeine (Thomapyrin) in comparison with two tablets of 250 mg ASA + 200 mg paracetamol, two tablets of 500 mg ASA, two tablets of 500 mg paracetamol, two tablets of 50 mg caffeine, and placebo in patients who were used to treating their episodic tension-type headache or migraine attacks with non-prescription analgesics. For the primary endpoint "time to 50% pain relief" in the intention-to-treat dataset (n = 1743 patients), the fixed combination of ASA, paracetamol and caffeine was statistically significantly superior to the combination without caffeine (P = 0.0181), the mono-substances ASA (P = 0.0398), paracetamol (P = 0.0016), caffeine (P < 0.0001) and placebo (P < 0.0001). All active treatments except caffeine differed significantly (P < 0.0001) from placebo. The superior efficacy of the triple combination could also be shown for all secondary endpoints such as time until reduction of pain intensity to 10 mm, weighted sum of pain intensity difference (%SPIDweighted), extent of impairment of daily activities, global assessment of efficacy. All treatments were well tolerated. The incidence of adverse events observed was low.