1
|
Kuruvilla DE, Mann JI, Tepper SJ, Starling AJ, Panza G, Johnson MAL. Phase 3 randomized, double-blind, sham-controlled Trial of e-TNS for the Acute treatment of Migraine (TEAM). Sci Rep 2022; 12:5110. [PMID: 35332216 PMCID: PMC8948251 DOI: 10.1038/s41598-022-09071-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/16/2022] [Indexed: 12/14/2022] Open
Abstract
Migraine is one of the most common and debilitating neurological disorders worldwide. External Trigeminal Nerve Stimulation (e-TNS) is a non-pharmacological, non-invasive therapeutic alternative for patients with migraine. The TEAM study was a prospective, multicenter, randomized, double-blind, sham-controlled, Phase 3 trial for 2-h, continuous, e-TNS treatment of a single moderate or severe migraine attack at home. A total of 538 adults meeting the International Classification of Headache Disorders 3rd edition criteria for 2–8 migraine headache days per month were recruited and randomized in a 1:1 ratio to 2-h active or sham stimulation. Migraine pain levels and most bothersome migraine-associated symptoms (MBS) were recorded at baseline, 2 h, and 24 h using a paper diary. The primary endpoints for the study were pain freedom at 2 h and freedom from the MBS at 2 h. The secondary endpoints were pain relief at 2 h, absence of most bothersome migraine-associated symptoms (MBSs) at 2 h, acute medication use within 24 h after treatment, sustained pain freedom at 24 h, and sustained pain relief at 24 h. Adverse event data was also collected and compared between groups. Five hundred thirty-eight patients were randomized to either the verum (n = 259) or sham (n = 279) group and were included in an intention-to-treat analysis. The percentage of patients with pain freedom at 2 h was 7.2% higher in verum (25.5%) compared to sham (18.3%; p = 0.043). Resolution of most bothersome migraine-associated symptom was 14.1% higher in verum (56.4%) compared to sham (42.3%; p = 0.001). With regards to secondary outcomes, pain relief at 2 h was 14.3% higher in verum (69.5%) than sham (55.2%; p = 0.001), absence of all migraine-associated symptoms at 2 h was 8.4% higher in verum (42.5%) than sham (34.1%; p = 0.044), sustained pain freedom and pain relief at 24 h was 7.0% and 11.5% higher in verum (22.8 and 45.9%) than sham (15.8 and 34.4%; p = 0.039 and .006, respectively). No serious adverse events were reported. Treatment with 2-h e-TNS is a safe and effective, non-invasive, and non-pharmacological alternative for the acute treatment of migraine attacks in an at-home setting. Trial registration Clinicaltrials.gov Identifier: NCT03465904. Registered 14/03/2018. https://www.clinicaltrials.gov/ct2/show/record/NCT03465904.
Collapse
Affiliation(s)
- Deena E Kuruvilla
- Department of Neurology, Westport Headache Institute, Westport, CT, USA
| | - Joseph I Mann
- Department of Neurology, Rochester Clinical Research, Rochester, NY, USA
| | - Stewart J Tepper
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Gregory Panza
- Department of Research, Hartford Healthcare, Hartford, CT, USA
| | | |
Collapse
|
2
|
Diener HC, Ashina M, Durand-Zaleski I, Kurth T, Lantéri-Minet M, Lipton RB, Ollendorf DA, Pozo-Rosich P, Tassorelli C, Terwindt G. Health technology assessment for the acute and preventive treatment of migraine: A position statement of the International Headache Society. Cephalalgia 2021; 41:279-293. [PMID: 33472427 PMCID: PMC7961634 DOI: 10.1177/0333102421989247] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Clinical Trials Subcommittee of the International Headache Society presents the first Health Technology Assessment for the Acute Treatment of Migraine Attacks and Prevention of Migraine. Health technology assessments are systematic evaluations of the properties, effects, and consequences of healthcare technologies; this position statement is designed to inform decision makers about access to and reimbursement for medications and devices for the acute and preventive treatment of migraine. This position statement extends beyond the already available guidelines on randomized controlled trials for migraine to incorporate real-world evidence and a synthetic approach for considering multiple data sources and modelling methods when assessing the value of migraine treatments.
Collapse
Affiliation(s)
- Hans Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Essen, Berlin, Germany
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France.,Santé Publique Hôpital Henri Mondor, Créteil, France
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michel Lantéri-Minet
- Départment d'Evaluation et Traitement de la Douleur, CHU de Nice, FHU InovPain, Universite Cete Azur, Nice, France
| | | | - Daniel A Ollendorf
- Value Measurement and Global Health Initiatives, Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, 1867Tufts Medical Center, Boston, MA, USA
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gisela Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
3
|
Jakate A, Boinpally R, Butler M, Lu K, Womack K, McGeeney D, Periclou A. Evaluation of the pharmacokinetic interaction and safety of ubrogepant coadministered with acetaminophen or nonsteroidal anti-inflammatory drugs: A randomized trial. CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320921186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Ubrogepant is a novel, oral calcitonin gene–related peptide receptor antagonist approved by the US Food and Drug Administration for acute treatment of migraine with or without aura in adults. Objectives: To assess potential pharmacokinetic (PK) drug–drug interactions in healthy participants and inform the safety and tolerability of ubrogepant alone and in combination with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy participants and participants with migraine. Methods: Two phase 1, three-way crossover studies randomized healthy adults to 100 mg ubrogepant alone, 1000 mg acetaminophen or 500 mg naproxen alone, and 100 mg ubrogepant plus 1000 mg acetaminophen or 500 mg naproxen. Geometric mean ratios (GMRs) and 90% confidence intervals were calculated based on statistical comparison of maximum plasma drug concentration ( C max) and area under the plasma drug concentration–time curve (AUC) for treatment in combination versus alone. Two phase 3 randomized trials included adults with migraine. Treatment-emergent adverse events (TEAEs) were evaluated. Results: Time to C max and terminal elimination half-life for all treatments were unchanged when coadministered. Ubrogepant C max and AUC increased by approximately 40% when coadministered with acetaminophen. Acetaminophen C max decreased by 24% (GMR = 0.76) when coadministered with ubrogepant. There were no significant PK interactions between ubrogepant and naproxen. TEAE rates in the acetaminophen and NSAID rescue medication groups were similar to ubrogepant alone. Conclusions: Coadministration of ubrogepant and acetaminophen resulted in a statistically significant increase in ubrogepant exposure and a decrease in acetaminophen C max; however, these changes were not clinically relevant. No statistically or clinically relevant changes in PK were associated with ubrogepant and naproxen coadministration. No safety concerns were identified for ubrogepant alone or in combination with acetaminophen or NSAIDs.
Collapse
|
4
|
Xie R, Tian J, Wang Y, Cai Y, Li H. Efficacy and safety of different drug monotherapies for tension-type headache in adults: study protocol for a Bayesian network meta-analysis. BMJ Open 2019; 9:e023748. [PMID: 30647037 PMCID: PMC6340443 DOI: 10.1136/bmjopen-2018-023748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Tension-type headache (TTH) is the most prevalent neurological disease, with an estimated 1.5 billion cases worldwide. Pharmacotherapy should be considered by patients with TTH who have a limited response to non-pharmacological treatment. However, recommendations for the vast array of therapeutic drugs for TTH partially overlap, with conflicting recommendations for strength in different guidelines; these may confuse the decision-making process of clinicians. Hence, the aims of this study are to analyse the available direct and indirect evidence on different drug monotherapies for TTH in adults, and to generate a treatment ranking according to their efficacy and safety outcomes by using a Bayesian network meta-analysis (NMA). METHODS AND ANALYSIS We will systematically search the Cochrane Library, PubMed, Web of Science, Embase, China Biomedical Literature Database, International Clinical Trials Registry Platform and other resources for eligible studies. Randomised controlled trials on different drug monotherapies for TTH will be included. Two review authors (RX and YW) will independently search and select the studies, extract the data and assess the risk of bias. A Bayesian NMA will afterwards be conducted to pool the effect measures across all types of monotherapy drugs. The ranking probabilities of the efficacy and safety of different drug monotherapies will be estimated. Heterogeneity will be quantified using the Q statistic and the I² index. Inconsistency between direct and indirect evidence will be assessed by the node-splitting model. In addition, the overall quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION No ethical issues are foreseen. The results will be published in a peer-reviewed journal, which will be disseminated electronically and in print. PROSPERO REGISTRATION NUMBER CRD42018090554.
Collapse
Affiliation(s)
- Runsheng Xie
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences), Guangzhou, China
- Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yangyang Wang
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences), Guangzhou, China
- Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, China
| | - Yefeng Cai
- Department of Internal Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences), Guangzhou, China
| | - Hui Li
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine; Guangdong Provincial Academy of Chinese Medical Sciences), Guangzhou, China
- Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, China
| |
Collapse
|
5
|
Aguila MER, Rebbeck T, Mendoza KG, De La Peña MGL, Leaver AM. Definitions and participant characteristics of frequent recurrent headache types in clinical trials: A systematic review. Cephalalgia 2017; 38:786-793. [PMID: 28440672 DOI: 10.1177/0333102417706974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Clear definitions of study populations in clinical trials may facilitate application of evidence to clinical populations. This review aimed to explore definitions of study populations in clinical trials on migraine, tension-type headache, cluster headache, and cervicogenic headache. Methods We performed a systematic review of clinical trials investigating treatment efficacy for migraine, tension-type headache, cluster headache, and cervicogenic headache. We extracted data on diagnosis, inclusion criteria and baseline headache characteristics. Results Of the 229 studies reviewed, 205 studies (89.5%) defined their populations in adherence to the International Classification of Headache Disorders (ICHD) criteria. Some studies ( n = 127, 55.5%) specified diagnosing through interview, clinical examination and diary entry. The most commonly reported inclusion criteria were pain intensity for migraine and tension-type headache studies ( n = 123, 66.1% and n = 21, 67.7%, respectively), episode frequency ( n = 5, 71.4%) for cluster headache studies, and neck-related pain for cervicogenic headache studies ( n = 3, 60%). Few studies reported details on the extent to which diagnostic criteria were present at baseline. Conclusions ICHD is routinely used in defining populations in headache studies. Details of baseline headache characteristics were not as consistently reported.
Collapse
Affiliation(s)
- Maria-Eliza R Aguila
- 1 University of Sydney, Faculty of Health Sciences, Lidcombe, NSW, Australia.,2 University of the Philippines, College of Allied Medical Professions, Manila, Philippines
| | - Trudy Rebbeck
- 1 University of Sydney, Faculty of Health Sciences, Lidcombe, NSW, Australia.,3 John Walsh Centre of Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, St. Leonards, NSW, Australia
| | | | | | - Andrew M Leaver
- 1 University of Sydney, Faculty of Health Sciences, Lidcombe, NSW, Australia
| |
Collapse
|
6
|
Giorgadze G, Mania M, Kukava M, Dzagnidze A, Mirvelashvili E, Steiner TJ, Katsarava Z. Implementation of effective, self-sustaining headache services in the Republic of Georgia: Evaluation of their impact on headache-related disability and quality of life of people with headache. Cephalalgia 2017; 38:639-645. [PMID: 28376660 DOI: 10.1177/0333102417702131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Headache disorders are widespread and disabling. They are common in Georgia, especially headache on ≥15 days/month (HA ≥ 15), but there are no headache services. Objective We established headache services meeting local needs, investigating feasibility, consumer uptake and satisfaction, and cost, with an exit strategy bequeathing effective, self-sustaining services that could be rolled out nationwide. Methods We created headache centres in Tbilisi and Gori offering free expert care for three visits over three months, and affordable medication thereafter. The primary outcome measure was the percentage of patients using the service beyond the free period - a measure of both satisfaction and sustainability. Results Of 1,445 patients (age 43.7 ± 12.4 years; 10.5% male), 49.8% had episodic migraine, 22.5% episodic tension-type headache, 25.7% HA ≥ 15 (24.5% overusing medication) and 2.0% trigeminal autonomic cephalalgias. Only 454 (31.4%) and 51 (3.5%) returned for second and third visits; in these, headache improved and treatment costs decreased. As information about the service spread, five other headache clinics opened in Tbilisi and Kutaisi (western Georgia). Pharmaceutical companies reduced prices (sumatriptan 100 mg from US$7 to US$1). Conclusion The study failed to achieve its primary outcome, but sustainable headache services operating to international standards were successfully implemented nonetheless, with demand increasing.
Collapse
Affiliation(s)
| | - Maka Mania
- 1 Department of Neurology, LTD Aversi Clinic, Tbilisi, Georgia
| | - Maka Kukava
- 2 Department of Neurology, Institute of Medical Research, Ilia State University, Georgia
| | - Ana Dzagnidze
- 3 Department of Neurology, S Khechinashvili University Hospital Tbilisi, Georgia
| | | | - Timothy J Steiner
- 5 Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,6 Division of Brain Sciences, Imperial College London, London, UK
| | - Zaza Katsarava
- 7 Department of Neurology, Evangelical Hospital Unna, Germany.,8 University of Duisburg-Essen, Germany
| |
Collapse
|
7
|
Iannacchero R, Cipolla M, Costa A, Conforti D. O008. Improvement in clinical governance of chronic headache by an information network: HealthSOAF - Calabria Headache Network pilot study. J Headache Pain 2015; 16:A72. [PMID: 28132316 PMCID: PMC4715075 DOI: 10.1186/1129-2377-16-s1-a72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
8
|
Allais G, Rolando S, De Lorenzo C, Benedetto C. The efficacy and tolerability of frovatriptan and dexketoprofen for the treatment of acute migraine attacks. Expert Rev Neurother 2014; 14:867-77. [DOI: 10.1586/14737175.2014.940901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
9
|
Allais G, Benedetto C. A review of the use of frovatriptan in the treatment of menstrually related migraine. Ther Adv Neurol Disord 2013; 6:55-67. [PMID: 23483096 DOI: 10.1177/1756285612470191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Menstrual migraine (MM) is a highly prevalent condition associated with considerable disability. Migraine attacks occur exclusively around the menstrual period in approximately 10% of women with migraine, that is, pure menstrual migraine, while at least 50% of them also experience migraine at other times of the month, that is, menstrually related migraine (MRM). The therapeutic approach to patients with MRM is based on treatment of the attack, or prophylactic strategies. Triptans are recommended as first-line treatments for moderate to severe migraine attacks, including MM. Frovatriptan is one of the newest triptans. Its high affinity for 5-HT1B/1D receptors and long half-life contribute to its distinctive clinical effect, characterized by a more sustained and prolonged effect than other triptans. Indeed, frovatriptan proved to be effective in treating the acute attack, but was particularly effective in the short-term preventive therapy of MM. In addition, frovatriptan is one of the safest triptans, with the lowest risk of treatment-emergent adverse events. Following extensive evidence from randomized pharmacological trials, frovatriptan has now gained a grade A recommendation from the guidelines for short-term prophylaxis of MM. Recent post-hoc analyses of direct comparative trials also suggest that frovatriptan might have an important role in the acute treatment of MRM. In these studies, frovatriptan showed pain relief and pain-free rates similar to those of zolmitriptan, rizatriptan, and almotriptan, but with significantly lower recurrence rates. More well-designed, randomized, prospective studies, specifically enrolling women with MM, will be needed in the near future to confirm the efficacy of frovatriptan in this migraine subtype.
Collapse
Affiliation(s)
- Gianni Allais
- Women's Headache Center, Department of Gynecology and Obstetrics, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | | |
Collapse
|
10
|
Westergaard MLS, Steiner TJ, MacGregor EA, Antonaci F, Tassorelli C, Buse DC, Lipton RB, Jensen RH. The Headache Under-Response to Treatment (HURT) Questionnaire: Assessment of utility in headache specialist care. Cephalalgia 2012; 33:245-55. [DOI: 10.1177/0333102412469740] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The HURT Questionnaire consists of eight questions which the patient answers as a measure of effectiveness of intervention against headache. This first assessment of clinical utility was conducted in headache specialist centres in three countries in order to demonstrate that HURT was responsive to change induced by effective management. We administered HURT on three occasions to 159 consecutive patients seeking non-urgent care from centres in Denmark and the United Kingdom: the first before the initial visit to the centres; the second at the initial visit; and the third when the specialist judged that the best possible outcome had been achieved in each patient. Questionnaires were also answered by 42 patients at initial and final visits to a centre in Italy. Internal consistency reliability was very good ( α = 0.85) while test-retest reliability was fair to low ( κ = 0.38–0.62 and rs = 0.49–0.76), possibly because headache was unstable prior to start of management. There were significant changes in responses post-intervention compared with baseline ( p < 0.01), indicating a favourable outcome overall in up to 77% of patients, and responsiveness to change, but there was no improvement in patients’ concerns about side effects of medication ( p = 0.18). We conclude that the questionnaire has utility across headache disorders. It can help patients describe headache frequency and headache-attributed disability, medication use/efficacy/tolerability, self-efficacy and knowledge about headache. It may guide physicians in assessment of disability of individual patients, how to proceed with management towards the best possible outcome, and in evaluating the quality of management.
Collapse
Affiliation(s)
- Maria LS Westergaard
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| | - Timothy J Steiner
- Imperial College London, UK
- Norwegian University of Science and Technology, Norway
| | | | - Fabio Antonaci
- University Consortium for Adaptive Disorders and Head Pain, Italy
| | - Cristina Tassorelli
- Headache Science Centre, Department of Neurology, C. Mondino Foundation, University of Pavia, Italy
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, USA
- Montefiore Headache Center, Montefiore Medical Center, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, USA
- Montefiore Headache Center, Montefiore Medical Center, USA
| | - Rigmor H Jensen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
| |
Collapse
|
11
|
Abstract
Headache is an extremely common symptom and collectively headache disorders are among the most common of the nervous system disorders, with a prevalence of 48.9% in the general population.(1) Headache affects people of all ages, races and socioeconomic status and is more common in women. Some headaches are extremely debilitating and have significant impact on an individual's quality of life, imposing huge costs to healthcare and indirectly to the economy in general. Only a small proportion of headache disorders require specialist input. The vast majority can be effectively treated by a primary care physician or generalist with correct clinical diagnosis that requires no special investigation. Primary headache disorders - migraine, tension headache and cluster headache - constitute nearly 98% of all headaches; however, secondary headaches are important to recognise as they are serious and may be life threatening. This article provides an overview of the most common headache disorders and discusses the red flag symptoms that help identify serious causes that merit urgent specialist referral. The current pathway of headache care in the UK is discussed with a view to proposing a model that might fit well in the financially constrained National Health Service (NHS) and with new NHS reforms. The role of the national society, the British Association for the Study of Headache, and the patient organisations such as Migraine Trust in headache education to the professionals and the general public in shaping headache care in the UK is described. The article concludes by summarising evidence-based management of common headache diagnoses.
Collapse
Affiliation(s)
- Fayyaz Ahmed
- Hull and East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, UK
| |
Collapse
|
12
|
Ng-Mak DS, Chen YT, Ho TW, Stanford B, Roset M. Results of a 2-year retrospective cohort study of newly prescribed triptan users in European nationwide practice databases. Cephalalgia 2012; 32:875-87. [DOI: 10.1177/0333102412449929] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: This study was conducted to characterize prescription refill patterns for triptans among European patients with new prescriptions of triptans. Background: Persistency with prescriptions of triptan monotherapy for migraine headache among newly prescribed users in European primary-care practices has not been well described. Methods: Using electronic medical databases in the UK ( N = 3618), France ( N = 2051) and Germany ( N = 954), we conducted a retrospective cohort analysis to identify refill patterns over 2 years among migraineurs receiving new prescriptions of triptan monotherapy in 2006. Results: Of all patients, >33% of migraineurs with new triptan prescriptions received ≥1 refill of their index triptan prescriptions (UK, 44.3%; France, 34.2%; Germany, 37.7%). More than 50% never received index-triptan refill prescriptions (UK, 55.7%; France, 65.8%; Germany, 63.3%). Small proportions of patients (<7.0%) switched to alternative triptans, and even fewer switched to different prescription-medication classes (UK and Germany, 2.3%; France, 4.0%). More than 48% of patients received no further prescriptions for migraine after index prescriptions (UK, 48.5%; France, 54.9%; Germany, 54.7%). After the second year, >83.0% of patients in each country had no further prescriptions for migraine medications, <14.0% remained persistent with index prescriptions, <4.0% switched to other triptans, and <3.0% switched to alternative medication classes. Conclusions: In migraine patients who received new prescriptions of triptan monotherapy from their primary-care physicians, poor triptan prescription refill frequency was observed in Europe. Although consistent with potential clinical challenges in migraine management, our findings should be interpreted with caution given certain inherent limitations associated with the database study design. Further research is warranted to confirm our findings and to identify reasons for, or predictors of, triptan discontinuation.
Collapse
Affiliation(s)
- Daisy S Ng-Mak
- Global Health Outcomes, Merck Sharp & Dohme Corp., West Point, PA, USA
| | - Ya-Ting Chen
- Global Access Strategy Team, Merck & Co., Inc., Whitehouse Station, NJ, USA
| | - Tony W Ho
- Innovative Medicine, AstraZeneca, Wilmington, DE, USA
| | | | - Montse Roset
- Health Economics & Outcomes Research, IMS Health, Barcelona, Spain
| |
Collapse
|
13
|
|
14
|
|
15
|
Dynamics of Changes in Self-Efficacy and Locus of Control Expectancies in the Behavioral and Drug Treatment of Severe Migraine. Ann Behav Med 2010; 40:235-47. [DOI: 10.1007/s12160-010-9223-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
16
|
Jensen R, Mitsikostas DD, Valade D, Antonaci F. Guidelines for the organization of headache education in Europe: the headache school II. J Headache Pain 2010; 11:161-5. [PMID: 20179986 PMCID: PMC3452286 DOI: 10.1007/s10194-010-0195-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 01/26/2010] [Indexed: 10/29/2022] Open
Abstract
In order to promote education on headache disorders, European Headache Federation (EHF) in conjunction with National Headache Societies organizes educational courses meeting uniform standards according to previous published guidelines. Based on six headache summer schools' experience, an EHF subcommittee has reviewed these guidelines, and here the revised version is presented. The goals remain the same: quality courses that will attract physicians and neurologists seeking to increase their knowledge, skills, and understanding in the area of primary and secondary headache. Detailed guidelines, a day-to-day program, and a multiple-choice test battery have now been outlined. It is recommended to include practical sessions with patient interviews and hands-on demonstrations of non-pharmacological treatment strategies. For countries that want a 'low cost' education program, a Video School program of a similar scientific standard has been developed. To be certified for CME credits, patronage, and financial support from EHF, it is highly recommended to adhere to the suggested teaching strategies. We hereby aim to promote and professionalize the education in headache disorders and endorse the educational courses meeting uniform standards of excellence.
Collapse
Affiliation(s)
- Rigmor Jensen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Ndr. Ringvej 69, Building 24, Glostrup, Denmark.
| | | | | | | |
Collapse
|
17
|
Simmaco M, Borro M, Missori S, Martelletti P. Pharmacogenomics in migraine: catching biomarkers for a predictable disease control [corrected]. Expert Rev Neurother 2009; 9:1267-9. [PMID: 19769441 DOI: 10.1586/ern.09.80] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
18
|
Farinelli I, De Filippis S, Coloprisco G, Missori S, Martelletti P. Future drugs for migraine. Intern Emerg Med 2009; 4:367-73. [PMID: 19551474 DOI: 10.1007/s11739-009-0273-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 06/01/2009] [Indexed: 11/30/2022]
Abstract
Migraine is a complex, neurovascular disorder in which genetic and environmental factors interact. At present, frontline therapies in the acute treatment of migraine include the use of non-steroidal anti-inflammatory drugs and triptans. Evidence indicates that calcitonin gene-related peptide (CGRP) plays a fundamental role in the mechanism of migraine. CGRP is a strong vasodilatatory neuropeptide that is released from activated trigeminal sensory nerves. The development of CGRP antagonists has also been driven by the fact that triptans are vasoconstrictive and cannot be safely used in patients with cardiovascular risk factors. Olcegepant (BIBN4096) is the first CGRP antagonist for the treatment of migraine that has been tested in clinical trials, but because of its poor oral bioavailability, only the intravenous formulation has been tested. The first oral non-peptide CGRP antagonist, telcagepant, has been shown recently to be highly effective in the treatment of migraine attacks. This development can be considered as the most important pharmacological breakthrough for migraine treatment since the introduction of sumatriptan in the early 1990s. These results are also of importance, since they support an interesting pathophysiological hypothesis of migraine. The pipeline of future compounds for the treatment of acute migraine headaches include TPRV1 antagonists, prostaglandin E receptor 4 (EP(4)) receptor antagonists, serotonin 5HT1(F) receptor agonists and nitric oxide synthase inhibitors. The immediate future of a preventative treatment for migraine headaches is well represented by botulinum toxin type-A, glutamate NMDA receptor antagonists, gap-junction blocker tonabersat and an angiotensin type 1 blocker candesartan.
Collapse
Affiliation(s)
- Ivano Farinelli
- Department of Medical and Molecular Sciences, Regional Referral Headache Centre, II School of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1039, 00189 Rome, Italy
| | | | | | | | | |
Collapse
|
19
|
Affiliation(s)
- Luigi Alberto Pini
- Headache Centre, University of Modena and Reggio Emilia, via del Pozzo, 71, 41100 Modena, Italy.
| |
Collapse
|
20
|
Martelletti P, Farinelli I, Steiner TJ. Acute migraine in the Emergency Department: extending European principles of management. Intern Emerg Med 2008; 3 Suppl 1:S17-24. [PMID: 18785015 DOI: 10.1007/s11739-008-0188-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The World Health Organization (WHO) placed migraine 19th among all causes of disability (12th in women) measured in years of healthy life lost to disability (YLD). The importance of headache disorders, particularly of the primary forms, is established by their distribution worldwide, their duration (the majority being life-long conditions) and their imposition of both disability and life-style restrictions among large numbers of people. For these reasons, headache disorders should represent a public-health priority. In the Emergency Department (ED), as elsewhere, migraine is often under-diagnosed-and under-treated when it is diagnosed. The result is likely to be failure of treatment. Particular attention to diagnosis is needed in ED patients with acute headache, since there is a higher probability of secondary headache due to underlying pathologies. According to European principles of management, acute migraine treatment generally is stepwise. Of the two main steps, the first relies on symptomatic medication, preferably NSAIDs with or without antiemetics. The second step uses specific therapies, usually triptans. Modifications to routine practice are appropriate in the ED. Parenteral administration of symptomatic therapies is a preferred first choice, whilst immediate resort to triptans may be appropriate, and achieve better outcomes, in patients with severe headache and diagnostic confirmation of migraine.
Collapse
Affiliation(s)
- Paolo Martelletti
- Department of Medical Sciences, Internal Medicine, Regional Referral Headache Centre, 2nd School of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
| | | | | |
Collapse
|
21
|
Abstract
An association between migraine and ischemic stroke has been observed for many years but the exact mechanisms by which migraine can lead to stroke are currently still under investigation. Migraine seems to affect neurovascular factors and substances that increase the risk of stroke during and in between migraine attacks. Ischemic stroke can occur as a complication of an attack of migraine with aura. Epidemiological studies suggest that vascular risk factors are increased in migraineurs, thus increasing the incidence of stroke. Another important issue is a patent foramen ovale (PFO), which is a well-known risk factor for stroke and which, on the other hand, seems to be more frequent in migraineurs than in people without. The purpose of this review is to summarize the current literature linking the two neurological diseases: migraine and stroke.
Collapse
Affiliation(s)
- Zaza Katsarava
- Department of Neurology, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
| | | | | |
Collapse
|
22
|
Sacco S, Cerone D, Carolei A. Comorbid neuropathologies in migraine: an update on cerebrovascular and cardiovascular aspects. J Headache Pain 2008; 9:237-48. [PMID: 18600300 PMCID: PMC3451940 DOI: 10.1007/s10194-008-0048-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 06/03/2008] [Indexed: 01/01/2023] Open
Abstract
Several conditions are comorbid with migraine; our review is focused on the relation between migraine, and cerebrovascular and cardiovascular diseases. Despite many studies showed an association between migraine and patent foramen ovale, it is still not known whether its presence might be causal for the migraine pathogenesis and currently its closure cannot be recommended for migraine prevention. On the contrary, conflicting epidemiological data link migraine to arterial hypertension and the use of antihypertensive agents acting on the renin-angiotensin system sounds promising in migraine prevention. A complex bidirectional relation exists between migraine and stroke, and new evidences show a clear association between migraine and coronary heart disease. In both conditions, migraine represents a defined risk factor although the magnitude of the risk varies across the different studies. However, since the risk is low in the general population, it is not possible to identify which migraineurs will develop a cardiovascular or a cerebrovascular event making difficult to apply preventive measures.
Collapse
Affiliation(s)
- Simona Sacco
- Department of Neurology, University of L'Aquila, Piazzale Salvatore Tommasi, L'Aquila, Italy
| | | | | |
Collapse
|
23
|
Jesurum JT, Fuller CJ, Velez CA, Spencer MP, Krabill KA, Likosky WH, Gray WA, Olsen JV, Reisman M. Migraineurs with patent foramen ovale have larger right-to-left shunt despite similar atrial septal characteristics. J Headache Pain 2007; 8:209-16. [PMID: 17901924 PMCID: PMC3451677 DOI: 10.1007/s10194-007-0396-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 07/25/2007] [Indexed: 11/25/2022] Open
Abstract
The objective of the study was to assess differences in proportion of large right-to-left shunt (RLS) and atrial septal characteristics between migraineurs and non-migraineurs referred for transcatheter closure of patent foramen ovale (PF0). This retrospective study took place in a large metropolitan medical centre. The patients were migraineurs with aura (n=52), migraineurs without aura (n=19) and non-migraineurs (n=149). RLS was evaluated before closure using bilateral power m-mode transcranial Doppler at rest and after calibrated, sustained Valsalva manoeuvre, and graded with a validated 0–5 scale. Intracardiac echocardiography was used to assess atrial septal characteristics. Migraineurs had a higher proportion of large RLS (Grade IV or V) than nonmigraineurs at rest and after calibrated Valsalva (rest, p=0.04; Valsalva, p=0.01). Atrial septal characteristics were similar between groups. Migraine is associated with larger RLS at rest and strain; however migraine status does not predict PFO characteristics.
Collapse
Affiliation(s)
- Jill T Jesurum
- Department of Cardiovascular Research, Swedish Medical Center, Seattle, WA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|