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Cephalalgia : An International Journal... Nov 2021There are five headache disorders composing the trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVE
There are five headache disorders composing the trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), and hemicrania continua). Little is known about these disorders in the pediatric population. The objectives of this study are to report the full age ranges of pediatric trigeminal autonomic cephalalgias and to determine if pediatric-onset trigeminal autonomic cephalalgias display similar signs and symptoms as adult onset.
METHODS
Search criteria in Medline Ovid, Embase, PsycINFO, and Cochrane Library were created by a librarian. The remainder of the steps were independently performed by two neurologists using PRISMA guidelines. Inclusion criteria for titles and abstracts were articles discussing cases of trigeminal autonomic cephalalgias with age of onset 18 or younger, as well as any epidemiological report on trigeminal autonomic cephalalgias (as age of onset data was often found in the results section but not in the title or abstract). Data extracted included age of onset, sex, and International Classification of Headache Disorders criteria for trigeminal autonomic cephalalgias (including pain location, duration, frequency, autonomic features, restlessness) and some migraine criteria (photophobia, phonophobia, and nausea). Studies that did not meet full criteria for trigeminal autonomic cephalalgias were examined separately as "atypical trigeminal autonomic cephalalgias"; secondary headaches were excluded from this category.
RESULTS
In all, 1788 studies were searched, 86 met inclusion criteria, and most (56) examined cluster headache. In cluster headache, onset occurred at every pediatric age (range 1-18 years) with a full range of associated features. Autonomic and restlessness features were less common in pediatric patients, while migrainous features (nausea, photophobia, and phonophobia) were found at similar rates. The sex ratio of pediatric-onset cluster headache (1.8, 79 male and 43 female) may be lower than that of adult-onset cluster headache. Data for other trigeminal autonomic cephalalgias, while more limited, displayed most of the full range of official criteria. The data for atypical trigeminal autonomic cephalalgias were also limited, but the most common deviations from the official criteria were abnormal frequencies and locations of attacks.
CONCLUSIONS
Trigeminal autonomic cephalalgias can start early in life and have similar features to adult-onset trigeminal autonomic cephalalgias. Specifically, pediatric-onset cluster headache patients display the full range of each criterion for cluster headache (except maximum frequency of six instead of eight attacks per day). However, cranial autonomic features and restlessness occur at a lower rate in pediatrics. Additional information is needed for the other trigeminal autonomic cephalalgias. As for expanding the ICHD-3 criteria for pediatric-onset trigeminal autonomic cephalalgias, we have only preliminary data from atypical cases, which suggests that the frequency and location of attacks sometimes extend beyond the official criteria. This study was registered as a systematic review in PROSPERO (registration number CRD42020165256).
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Headache; Headache Disorders; Humans; Infant; Male; Paroxysmal Hemicrania; SUNCT Syndrome; Trigeminal Autonomic Cephalalgias
PubMed: 34407646
DOI: 10.1177/03331024211027560 -
Medical Hypothesis, Discovery &... 2022The coronavirus disease 2019 (COVID-19) pandemic has been the most challenging health problem in the last 2 years. Post-COVID-19 multisystem inflammatory syndrome of... (Review)
Review
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic has been the most challenging health problem in the last 2 years. Post-COVID-19 multisystem inflammatory syndrome of children (MIS-C) is a severe post-COVID-19 complication in pediatric patients. Ocular manifestations may be the first presentation of MIS-C, wherein prompt treatment may improve outcomes. In this systematic review, we aimed to summarize the acute and sub-acute ocular manifestations in pediatric patients with laboratory-confirmed COVID-19.
METHODS
We included all online primary studies, with no language restriction and published between January 1, 2019 and November 18, 2020, reporting any acute or sub-acute ocular manifestations in children with laboratory-confirmed COVID-19. PubMed/MEDLINE was searched using the following MeSH and Emtree terms: "eye," "ophthalmologic," "ocular," "vision," "conjunctivitis," "severe acute respiratory syndrome coronavirus 2," "SARS-CoV-2," "corona," "2019-nCoV," "COVID19," and "COVID." The eligibility and quality of the selected records were assessed by two independent reviewers as per the Cochrane Handbook for Systematic Review.
RESULTS
A total of 1,192 records were identified electronically. Seven papers were extracted from the reference lists of the eligible records. Thirty-six papers met the inclusion criteria and were categorized into two subgroups according to acute or sub-acute presentation of ocular manifestations. Among 463 pediatric patients with COVID-19, 72 (15.5%) had acute ocular manifestations. There was one patient with central retinal vein occlusion and another with photophobia and diplopia associated with meningoencephalitis. Among 895 pediatric patients with post-COVID-19 MIS-C, 469 (52.4%) had ocular manifestations, which only included non-purulent conjunctivitis.
CONCLUSIONS
Ocular manifestations have been reported in less than one-fifth of pediatric patients with acute COVID-19. Furthermore, conjunctivitis was the only ocular manifestation reported in half of the patients with MIS-C, and it may be missed easily due to its non-purulent nature. During the COVID-19 pandemic, pediatricians and health workers must remain vigilant for early detection of signs of this potentially fatal post-COVID-19 inflammatory syndrome.
PubMed: 37641695
DOI: 10.51329/mehdiophthal1440 -
Journal of Clinical Medicine Mar 2024Early-onset myopia increases the risk of irreversible high myopia. This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control... (Review)
Review
Early-onset myopia increases the risk of irreversible high myopia. This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions. Four studies involving 644 children with premyopia aged 4-12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40-0.97 D/y; = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26-0.96 D/y; < 0.01) were observed in the 12-24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12-24-month period. Our meta-analysis supports atropine's efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies.
PubMed: 38592670
DOI: 10.3390/jcm13051506 -
Headache Feb 2021To review the acute migraine clinical trial literature and provide a summary of the endpoints and outcomes used in such trials.
BACKGROUND/OBJECTIVE
To review the acute migraine clinical trial literature and provide a summary of the endpoints and outcomes used in such trials.
METHOD
A systematic literature review, following a prespecified (but unregistered) protocol developed to adhere to recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, was conducted to understand endpoints and outcomes used in acute migraine clinical trials. Predefined terms were searched in PubMed to locate clinical trials assessing acute migraine treatments. Final database search was conducted on October 28, 2019. Identified publications were reviewed against established inclusion and exclusion criteria to determine eligibility. Data related to general trial design characteristics, sample characteristics, and outcomes and endpoints reported in each publication were extracted from eligible publications. Descriptive summaries of design features, sample characteristics, and the endpoints and outcomes employed across publications were constructed. Outcomes are presented within four broad categories: (a) pain-related outcomes (pain relief, pain freedom, etc.), (b) associated symptoms (nausea, photophobia, etc.), (c) disability/impairment/impact, (d) patient-reported outcome measures (PROMs, general health and migraine/headache-specific). Endpoint types were categorized within three broad categories: (a) change from baseline, (b) fixed timepoint, and (c) responder definitions (e.g., 50% reduction). This review focuses on a subset of recent (1998 or later) randomized and blinded publications evaluating drugs or medical devices.
RESULTS
Of 1567 publications found through the initial search and reference section reviews, 705 met criteria and were included for data extraction. Inter-rater agreement kappas for the descriptive variables extracted had an average kappa estimate of 0.86. The more recent, randomized and blinded pharmaceutical and medical device article subset includes 451 publications (451/705, 63.9%). The outcomes and endpoints varied substantially across trials, ranging from pain relief or freedom, freedom from or relief of migraine-associated symptoms, use of acute or rescue medication, and various other PROMs, including measures of satisfaction and quality of life. Within the recent randomized and blinded article subset, most articles examined ≥1 pain-related outcome (430/451, 95.3%). Of the publications that examined pain, outcomes most often used were pain relief (310/430, 72.1%), pain freedom (279/430, 64.9%), and headache recurrence (202/43,051, 47.0%) or rescue medication use (278/430, 64.9%). Associated symptoms such as nausea, photophobia, and phonophobia were more frequently measured (299/451, 66.3%) compared to most bothersome associated symptom (16/451, 3.5%), as it is a new addition to regulatory guidance. Over one-third of eligible publications examined disability/impairment (186/451, 41.2%) or ≥1 PROM (159/451, 35.3%). The definition of the endpoints used (e.g., change from baseline, fixed timepoint comparisons, categorization of "responders" to treatment based on wide variety of "responder definitions") also differed substantially across publications.
CONCLUSION
Acute migraine clinical trials exhibit a large amount of variability in outcomes and endpoints used, in addition to the variability in how outcomes and endpoints were used from trial-to-trial. There were some common elements across trials that align with guidance from the International Headache Society, the Food and Drug Administration and other regulatory agencies (e.g., assessing pain and associated symptoms, 2-hour post-treatment). Other aspects of acute migraine clinical trial design did not follow guidance. For example, multi-item PROMs intended to measure constructs (e.g., scales) are rarely used, the use of pain-related outcomes is inconsistent, some associated symptom assessments are idiosyncratic, and the timing of the assessment of primary endpoints is variable. The development of a core set of outcomes and endpoints for acute migraine clinical trials that are patient-centered and statistically robust could improve the conduct of individual trials, facilitate cross-trial comparisons, and better support informed treatment decisions by healthcare professionals and patients.
Topics: Acute Disease; Clinical Trials as Topic; Humans; Migraine Disorders; Outcome Assessment, Health Care
PubMed: 33611818
DOI: 10.1111/head.14067 -
The Journal of Headache and Pain Mar 2022Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the significant benefits in terms of reduced risk of hospitalization and death, different adverse events may present after vaccination: among them, headache is one of the most common, but nowadays there is no summary presentation of its incidence and no description of its main features.
METHODS
We searched PubMed and EMBASE covering the period between January 1 2020 and August 6, 2021, looking for record in English and with an abstract and using three main search terms (with specific variations): COVID-19/SARS-CoV-2; Vaccination; headache/adverse events. We selected manuscript including information on subjects developing headache after injection, and such information had to be derived from a structured form (i.e. no free reporting). Pooled estimates and 95% confidence intervals were calculated. Analyses were carried out by vaccine vs. placebo, by first vs. second dose, and by mRNA-based vs. "traditional" vaccines; finally, we addressed the impact of age and gender on post-vaccine headache onset.
RESULTS
Out of 9338 records, 84 papers were included in the review, accounting for 1.57 million participants, 94% of whom received BNT162b2 or ChAdOx1. Headache was generally the third most common AE: it was detected in 22% (95% CI 18-27%) of subjects after the first dose of vaccine and in 29% (95% CI 23-35%) after the second, with an extreme heterogeneity. Those receiving placebo reported headache in 10-12% of cases. No differences were detected across different vaccines or by mRNA-based vs. "traditional" ones. None of the studies reported information on headache features. A lower prevalence of headache after the first injection of BNT162b2 among older participants was shown.
CONCLUSIONS
Our results show that vaccines are associated to a two-fold risk of developing headache within 7 days from injection, and the lack of difference between vaccine types enable to hypothesize that headache is secondary to systemic immunological reaction than to a vaccine-type specific reaction. Some descriptions report onset within the first 24 h and that in around one-third of the cases, headache has migraine-like features with pulsating quality, phono and photophobia; in 40-60% of the cases aggravation with activity is observed. The majority of patients used some medication to treat headache, the one perceived as the most effective being acetylsalicylic acid.
Topics: BNT162 Vaccine; COVID-19; Headache; Humans; SARS-CoV-2; Vaccination
PubMed: 35361131
DOI: 10.1186/s10194-022-01400-4 -
Asia-Pacific Journal of Ophthalmology...The purpose of this study was to pool the prevalence rate of monkeypox-associated eye manifestations and/or complications during the current and previous outbreaks. (Meta-Analysis)
Meta-Analysis
PURPOSE
The purpose of this study was to pool the prevalence rate of monkeypox-associated eye manifestations and/or complications during the current and previous outbreaks.
DESIGN
A systematic review and meta-analysis.
MATERIALS AND METHODS
On August 7, 2022, PubMed, Scopus, Web of Science, EMBASE, and Google Scholar were searched for relevant articles. We included all studies that reported the involvement of the eye (either as a manifestation or a complication) among patients with monkeypox. The primary outcome included pooling the effect size (ES) of reported manifestations and complications, and the secondary outcome included the conduct of a subgroup analysis based on the timing of the monkeypox outbreak (before vs. during 2022).
RESULTS
Eleven studies reporting 3179 monkeypox-confirmed cases were included. Eye manifestations included conjunctivitis, corneal, conjunctival, and eyelid lesions, photophobia, and eye pain. Compared with previous monkeypox outbreaks, the current outbreak revealed much lower rates of ocular involvement in terms of conjunctivitis (ES=1%; 95% CI: 0%-1% vs. ES=17%; 95% CI: 11%-22%), corneal and conjunctival lesions (ES=1%; 95% CI: 0%-2% vs. ES=13%; 95% CI: 4%-22%), and eyelid lesions (ES=1%; 95% CI: 0%-4% vs. ES=13%; 95% CI: 5%-28%). Monkeypox-associated eye complications were reported only in the previous outbreaks which included keratitis (ES=4%; 95% CI: 3%-6%), corneal ulceration (ES=4%; 95% CI: 2%-5%), unilateral (ES=3%; 95% CI: 1%-4%) and bilateral blindness (ES=0%; 95% CI: 0%-2%), and impaired vision (ES=4%; 95% CI: 1%-8%).
CONCLUSIONS
Ophthalmic manifestations and complications are common among monkeypox-confirmed cases. Although these data are mainly related to previous outbreaks, health care workers should familiarize themselves with these signs to provide better care for monkeypox patients.
Topics: Humans; Mpox (monkeypox); Conjunctiva; Disease Outbreaks; Conjunctivitis; Keratitis
PubMed: 37249903
DOI: 10.1097/APO.0000000000000608 -
Survey of Ophthalmology 2022Ocriplasmin is used to treat vitreomacular traction (VMT), with or without full-thickness macular hole (MH). We systematically reviewed the evidence on ocriplasmin's... (Meta-Analysis)
Meta-Analysis Review
Ocriplasmin for treatment of vitreomacular traction and macular hole: A systematic literature review and individual participant data meta-analysis of randomized, controlled, double-masked trials.
Ocriplasmin is used to treat vitreomacular traction (VMT), with or without full-thickness macular hole (MH). We systematically reviewed the evidence on ocriplasmin's effect on vitreomacular adhesion resolution (VMAR), MH closure, vitrectomy, and best-corrected visual acuity (BCVA) and investigated the effect of baseline covariates on outcome. We applied individual participant data meta-analyses to the entire population and to subgroups defined by MH or epiretinal membrane (ERM) presence. Safety data were pooled and tabulated. Five randomized controlled trials (1,067 participants) were included. Six months after treatment, ocriplasmin achieved higher rates of VMAR and MH closure versus control, lowered vitrectomy odds, and increased the likelihood of a ≥10-letter BCVA increase. VMAR rates were lower when ERM, broad VMA (> 1500 µm), diabetic retinopathy, or pseudophakia were present and higher in younger participants, women, and eyes with MHs. Ocriplasmin-treated participants experienced more short-term visual impairment that was not predictive of final BCVA, as well as vitreous floaters, photopsia, photophobia, eye pain, blurred vision, and dyschromatopsia. The most common serious adverse events for ocriplasmin and control, respectively, were MH progression (22.5%, 17.3%), new MH (1.5%, 3.4%) and retinal detachment (0.8%, 1.2%). Ocriplasmin promotes VMAR and MH closure. Transient visual phenomena are not uncommon.
Topics: Female; Fibrinolysin; Humans; Intravitreal Injections; Peptide Fragments; Retinal Diseases; Retinal Perforations; Tomography, Optical Coherence; Traction; Treatment Outcome; Vision Disorders; Visual Acuity; Vitreous Body; Vitreous Detachment
PubMed: 34480895
DOI: 10.1016/j.survophthal.2021.08.003 -
BMJ Clinical Evidence Nov 2009Subarachnoid haemorrhage (SAH) may arise spontaneously or as a result of trauma. Spontaneous SAH accounts for about 5% of all strokes. Ruptured aneurysms are the cause... (Review)
Review
INTRODUCTION
Subarachnoid haemorrhage (SAH) may arise spontaneously or as a result of trauma. Spontaneous SAH accounts for about 5% of all strokes. Ruptured aneurysms are the cause of 85% of spontaneous SAH. The most characteristic clinical feature is sudden-onset severe headache. Other features include vomiting, photophobia, and focal neurological deficit or seizures, or both. As the headache may have insidious onset in some cases, or may even be absent, a high degree of suspicion is required to diagnose SAH with less typical presentations.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of surgical treatments for people with confirmed aneurysmal subarachnoid haemorrhage? What are the effects of medical treatments to prevent delayed cerebral ischaemia in people with confirmed aneurysmal subarachnoid haemorrhage? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 6 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: endovascular coiling; surgical clipping; timing of surgery; and oral and intravenous nimodipine.
Topics: Acute Disease; Administration, Oral; Aneurysm, Ruptured; Humans; Subarachnoid Hemorrhage; Surgical Instruments
PubMed: 21726472
DOI: No ID Found -
Progress in Brain Research 2020Visual snow syndrome is a debilitating disorder characterized by tiny flickering dots (like TV static) in the entire visual field and a set of accompanying visual...
BACKGROUND
Visual snow syndrome is a debilitating disorder characterized by tiny flickering dots (like TV static) in the entire visual field and a set of accompanying visual (palinopsia, enhanced entoptic phenomena, photophobia, nyctalopia), nonvisual (e.g. tinnitus) and nonperceptional (e.g. concentration problems, irritability) symptoms. Its pathophysiology is enigmatic and therapy is often frustrating.
OBJECTIVES
To summarize our current understanding of pathophysiology and treatment of visual snow syndrome.
METHODS
A systematic search of PubMed database was performed using the key word "visual snow" and predefined in- and exclusion criteria. The results were stratified into "treatment" and "pathophysiology." Additionally, we conducted a search with the key words "persistent migraine aura" and "persistent visual aura" and screened for mis-diagnosed patients actually fulfilling the criteria for visual snow syndrome. The reference lists of most publications and any other relevant articles known to the authors were also reviewed and added if applicable.
RESULTS
From the 50 original papers found by searching for "visual snow," 21 were included according to the inclusion and exclusion criteria. Additional four publications came searching for "persistent migraine aura" or "persistent visual aura." Further publications derived from literature references resulting in a total of 20 articles for pathophysiology and 15 for treatment with some overlaps. Regarding pathophysiology, hyperexcitability of the visual cortex and a processing problem of higher order visual function are assumed, but the location is still in discussion. In particular, it is unclear if the primary visual cortex, the visual association cortex or the thalamocortical pathway is involved. Regarding treatment, data is available on a total of 153 VSS patients with medication mentioned for 54 resulting in a total of 136 trials. From the 44 different medications tried, only eight were effective at least once. The best data is available for lamotrigine being effective in 8/36 (22.2%, including one total response and no worsening), followed by topiramate being effective in 2/13 (15.4%, no total response and one worsening). The only other medication resulting in worsening of VSS was amitriptyline according to our literature review. The others reported to be effective at least once were valproate, propranolol, verapamil, baclofen, naproxen and sertraline. The nonpharmacological approach using color filters of the yellow-blue color spectrum might also be helpful in some patients.
CONCLUSIONS
Visual snow syndrome is still far from being fully understood. In respect of pathophysiology, a disorder of visual processing is likely. The best pharmacological evidence exists for lamotrigine, which can be discussed off-label. As nonpharmacological option, patients might benefit from tinted glasses for everyday use.
Topics: Humans; Migraine with Aura; Vision Disorders
PubMed: 33008511
DOI: 10.1016/bs.pbr.2020.05.020 -
The Annals of Pharmacotherapy Nov 2007Nonsteroidal antiinflammatory drugs such as aspirin and ibuprofen have been shown to be effective in treating migraine. (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Nonsteroidal antiinflammatory drugs such as aspirin and ibuprofen have been shown to be effective in treating migraine.
OBJECTIVE
To evaluate the efficacy of low-dose ibuprofen for treatment of acute migraine attack.
METHODS
Clinical trials were identified through electronic searches (MEDLINE, EMBASE, EBM review, and the Cochrane Library) up to November 2006 and historical searches of relevant articles. Studies were included if they (1) were double-blind, randomized, placebo-controlled trials that evaluated ibuprofen tablets in moderate or severe migraine attacks in patients greater than 16 years of age, (2) evaluated at least one migraine attack, and (3) reported headache relief, pain-free, sustained pain-free, or relief of other migraine-associated symptoms at 2 hours. The MeSH search terms used were migraine disorders, headache, vascular headache, ibuprofen, adult, and clinical trial. This was followed by a key word search using migraine, cephalalgia, and cephalgia as key words. The reference lists of relevant articles were also scanned to identify possible published trials. There was no language restriction. Two authors extracted data independently. Disagreements were resolved through discussion.
RESULTS
Ibuprofen 200 and 400 mg were more effective than placebo in reducing pain intensity and eliminating pain (pain-free) within 2 hours in adults with moderate or severe migraine attacks. For the 200 mg dose, the number needed to treat was 8 (95% CI 5 to 20) for headache relief and 13 (95% CI 8 to 50) for pain-free. The risk ratios for headache relief and pain-free were 1.89 (95% CI 1.45 to 2.46; p < 0.0001) and 2.15 (95% CI 1.24 to 3.73; p = 0.0063), respectively, for ibuprofen 400 mg. The 24-hour sustained pain-free outcome with ibuprofen was no better than with placebo. Ibuprofen 400 mg increased the chance of relief in photophobia and phonophobia by 30% (95% CI 8 to 57; p < 0.01) and 49% (95% CI 23 to 81; p < 0.0001), respectively.
CONCLUSIONS
The available evidence suggests that ibuprofen 200 and 400 mg are effective in reducing headache intensity and rendering patients pain-free at 2 hours. Photophobia and phonophobia improved with 400 mg dosing. Due to the limited data and the shortcomings of the available evidence, further studies are needed.
Topics: Acute Disease; Anti-Inflammatory Agents, Non-Steroidal; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Ibuprofen; Male; Migraine Disorders; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 17878396
DOI: 10.1345/aph.1K121