Patient-selected dosing in a six-month open-label study evaluating oral sumatriptan in the acute treatment of migraine. Sumatriptan Tablets S2CM10 Study Group.

BACKGROUND: Dosing recommendations for oral sumatriptan as acute treatment for migraine have ranged from 25 mg to 100 mg. Patient dose preferences have not been studied in a setting mimicking clinical practice. METHODS: In an open-label study evaluating patient acceptance and the relative efficacy and safety of 25 mg, 50 mg, and 100 mg doses of oral sumatriptan over a period of six months, 338 patients treated three migraine attacks with 50 mg sumatriptan and then were allowed to double or halve the dose. After treating another three attacks, they were again allowed to adjust the dose by one level. RESULTS: After migraine attack 3, 37% of patients chose to continue with the 50 mg dose, 50% increased the dose to 100 mg, and 12% decreased it to 25 mg. After attack 6, 8%, 33%, and 58% of patients chose the 25 mg, 50 mg, and 100 mg doses, respectively; only 3% of those taking the 100 mg dose chose to reduce it. Overall, the mean percentages of attacks per patient in which headache relief had been obtained 4 h after dosing were 71%, 71%, and 80% for the 25 mg, 50 mg, and 100 mg doses, respectively. Patients who decreased the dose to 25 mg after attack 3 experienced decreases both in adverse events and percentage of attacks with headache relief, whereas in those who increased the dose to 100 mg, likelihood of headache relief increased but the incidence of adverse events did not. CONCLUSIONS: More patients chose the 50 mg or 100 mg dose than the 25 mg dose. All three doses had similar efficacy and tolerability.

TENS treatment at home: dependence of the efficacy on frequency of use.

The papers of various authors on the efficacy of TENS (transcutaneous electric nerve stimulation) prompted an investigation to determine whether non-responders were in fact using the TENS equipment provided for home use correctly and for adequate periods. The principal factor in deciding on the investigation was the observation that when patients returned the equipment--because they failed to benefit--after having had it at home for a month or two, hardly any of the consumable material supplied had been used. In order to evaluate this observation quantitatively, TEN stimulators were handed out fitted with timing devices that clocked up the hours of operation. Of a total of 151 patients investigated, 86 responded to TENS after regular use for several months. The remaining 65 patients failed to obtain adequate relief. An analysis of the meter records showed that only ten patients of this group had used TENS on a regular basis. Consideration should be given to means of improving patient compliance in the future.

Pain management by contralateral local anaesthesia.

Contralateral local anaesthesia is presented as a possible means of pain management in the form of case studies. Results in the treatment of phantom-limb pains was particularly favourable. The efficacy of contralateral local anaesthesia was also shown in acute postoperative pain states.