Migraine is a syndrome, meaning it is defined by observed symptoms rather than known pathophysiology. Multiple pathogenic mechanisms are likely involved in generating this diverse array of symptoms understood as the migraine symptom complex. Sumatriptan and naproxen have independent mechanisms of action and target distinct aspects of the vascular and inflammatory processes hypothesized to underlie migraine. Sumatriptan acts on the 5-HT1B and 5-HT1D receptors, whereas naproxen inhibits the COX-1 and COX-2 enzymes. Sumatriptan has vasoconstricting effects as well as effects
on neurogenic inflammation by decreasing the release of substance P and calcitonin gene-related peptide. In contrast, naproxen affects prostaglandins and other inflammatory mediators. Because sumatriptan and naproxen both relieve migraine yet see more interact
with different cellular targets within the migraine pathway, it is reasonable to assume there is a unique synergy between these medications that improves treatment find more outcomes. Clinical trials supported this contention by demonstrating the combination of sumatriptan/naproxen alleviated migraine pain quickly (primarily based on the sumatriptan mechanism of action), and sustained the response longer (primarily based on the naproxen mechanism of action) than is possible when either drug is given alone. The working hypothesis is that when sumatriptan and naproxen are given at the same time,
they affect different mechanisms of the migraine pathway and produce an enhanced therapeutic effect. The purpose of this article is to apply statistical analyses to data from phase II and phase III studies of the combination of sumatriptan and naproxen to determine if this enhanced therapeutic effect ADAM7 is synergistic. This methodology of accessing synergy can be used in the development of future combination migraine treatments to improve treatment outcomes. “
“To better familiarize the reader with a migraine-related disorder, cyclic vomiting syndrome (CVS) in adults, and to discuss its diagnosis and treatment. CVS is a profoundly disabling disorder characterized by recurrent, stereotypic episodes of incapacitating nausea and vomiting, separated by completely asymptomatic intervals. CVS episodes tend to start at the same time of day, persist for the same duration, and present with the same intensity and associated symptoms. Most patients experience prodromal symptoms and can identify triggers that precipitate attacks, such as menstruation, lack of sleep, certain foods, physical exertion, and stress. The prevalence of CVS in adults is unknown, but since its occurrence in this age group has been little recognized, patients typically experience lengthy delay in diagnosis or misdiagnosis. Literature review, case reports, and discussion.