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Tosin Anthony A, Olukayode AF, Olusoji Abidemi S, Azeez Oyemomi I, Adefunke BO, Ayodeji OJ, Babatope Ebenezer A, Adekoya Joshua I, Joseph Olusesan F. Prevalence, practice, determinants and adverse effects of self-medication among young people living in a suburban community of Ekiti, Nigeria: A community-based cross-sectional study. SAGE Open Med 2024; 12:20503121241261002. [PMID: 38911442 PMCID: PMC11193929 DOI: 10.1177/20503121241261002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/26/2024] [Indexed: 06/25/2024] Open
Abstract
Objectives Health hazards such as adverse drug reactions and prolonged morbidity are fallouts of self-medication among young people in sub-Saharan Africa. The aim of this study was to assess the prevalence, practice, determinants, and adverse effects of self-medication among young people living in a suburban community of Ekiti, Nigeria. Methods This survey was a descriptive, cross-sectional study of 602 young people aged 16-24 years., who were randomly selected in the community. A predesigned self-administered questionnaire was used for data collection. The study was conducted from 1st March to 31st May 2023. The independent variables measured include the sociodemographic characteristics, while the dependent variables are the practice of self-medication and factors that predisposes to self-medication. The general characteristics of the participants were analyzed using descriptive statistics. The categorical variables were reported as frequency distribution and proportions with 95% confidence intervals and were compared using the Chi-square test or Fisher's exact test. A p-value of <0.05 was considered statistically significant. Results Over 30% (31.7%) of the participants engage in self-medication. A larger proportion of the people who practiced self-medication lived a trekking distance of less than 1 km from the nearest health facility with a doctor (p = 0.044). The practice of self-medication was statistically related with being a student when compared with gainfully employed and unemployed people (p = 0.006). Fever (39.8%), abdominal pain (17.3%) and headaches (16.2%) were the topmost three ailments that necessitated self-medication. Antimalarials (44.0%), antibiotics (25.1%), and antipyretics (16.8%) were high on the list of drugs used for self-medication. Headache (34.0%) was the most common adverse reaction from self-medication among the participants studied. Conclusion Adverse reactions and drug addiction were negative fallouts of self-medication, which can affect the health of young people as they grow into adulthood. Therefore, monitoring of drug outlets must be taken seriously by government agencies to prevent the worsening of the negative effects of self-medication.
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Affiliation(s)
- Agbesanwa Tosin Anthony
- Agbesanwa Tosin Anthony, Department of Family Medicine, College of Medicine, Ekiti State University, PMB 5363, Ado Ekiti, Ekiti, Nigeria. Emails: ;
| | - Aina Felixelix Olukayode
- Department of Family Medicine, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti, Nigeria
| | - Solomon Olusoji Abidemi
- Department of Family Medicine, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti, Nigeria
| | - Ibrahim Azeez Oyemomi
- Department of Family Medicine, College of Medicine, Afe Babalola University, Ado Ekiti, Ekiti, Nigeria
| | | | - Owoyemi John Ayodeji
- Department of Family Medicine, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti, Nigeria
| | | | - Inubile Adekoya Joshua
- Department of Research and Statistics, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti, Nigeria
| | - Fadare Joseph Olusesan
- Department of Family Medicine, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti, Nigeria
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado Ekiti, Ekiti, Nigeria
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Lin CL, Lane HY, Sun CK, Chen MH, Lee CY, Li L, Lee JJ, Yeh PY. Effects of chronic daily headache with subclinical depression on brain volume: A systematic review and meta-analysis. Eur J Pain 2024. [PMID: 38563383 DOI: 10.1002/ejp.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND OBJECTIVE The relationship between chronic daily headache (CDH), depression symptoms, and brain volume remains unclear. METHODS To investigate the effects of CDH on brain volume and the impact of depressive symptoms (DSs) as well as the effects of demography and medication overuse, PubMed, Embase, and Web of Science databases were systematically searched using appropriate keyword strings to retrieve observational studies from inception to May 2023. RESULTS Two distinct comparisons were made in CDH patients: (1) those with DSs versus their pain-free counterparts and (2) those without DSs versus pain-free controls. The first comprised nine studies enrolling 225 CDH patients with DSs and 234 controls. Beck depression inventory, Hamilton depression scale, and Hospital anxiety/depression scale were used to assess DSs, revealing significantly more DSs in CDH patients with DSs compared to their controls (all p < 0.05). Besides, the second analysed four studies involving 117 CDH patients without DSs and 155 comparators. Compared to CDH patients without DSs, those with DSs had a smaller brain volume than controls (p = 0.03). Furthermore, CDH patients with DSs who did not overuse medications showed a smaller right cerebral cortical volume than overusers (p = 0.003). A significant inverse correlation between female prevalence and brain volume (p = 0.02) was revealed using regression analysis. CONCLUSIONS Pain-induced persistent depressive symptoms not only incur structural alterations but also encompass affective-motivational changes, involving medication use and gender-specific health concerns. SIGNIFICANCE This study highlighted the importance of an integrated CDH treatment, emphasizing psychological interventions for the affective-motivational component alongside pain management.
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Affiliation(s)
- Chih-Lung Lin
- Department of Neurosurgery, Asia University Hospital, Taichung, Taiwan
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiao-Yu Lee
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Lin Li
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jia-Jie Lee
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Pin-Yang Yeh
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan
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Martinez CI, Liktor-Busa E, Largent-Milnes TM. Problems in management of medication overuse headache in transgender and gender non-conforming populations. Front Neurol 2024; 15:1320791. [PMID: 38352134 PMCID: PMC10861768 DOI: 10.3389/fneur.2024.1320791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Primary headache disorders, such as migraine, account for a significant portion of disability rates worldwide, yet patients still struggle to receive the adequate medical and emotional support necessary to improve health outcomes. Insufficient pain management through either impractical pharmaceutical treatments or absent emotional support networks can worsen physical and mental health outcomes since comorbidities commonly associated with headache include hypertension, diabetes, depression, and anxiety. A lack of awareness on headache pathology and its observable severity can lead to pain-related prejudice that destroys beneficial aspects of patient self-advocacy and self-efficacy, thus potentially discouraging the use of healthcare services in favor of maladaptive coping skills. Acute treatments for primary headache disorders include non-steroidal anti-inflammatory drugs (i.e., aspirin, ibuprofen), triptans (i.e., sumatriptan), and opioids; however, continuous use of these pain-relieving agents can generate a secondary headache known as medication overuse headache (MOH). Recent work highlighting the overlap of morphological and functional brain changes in MOH and substance use disorder (SUD) suggests that insufficient pain management encourages analgesic misuse. The LGBTQ+ community-specifically transgender and gender non-conforming persons-struggles with high rates of mental illness and substance abuse. Since gender-affirming sex hormone therapy influences migraine progression, transgender and gender non-conforming (trans*) patients on hormone therapy have a higher risk for worsening migraine symptoms. However, trans* patients are less likely to have access to appropriate pain management techniques, thus preventing positive health outcomes for this vulnerable population.
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Affiliation(s)
| | | | - Tally M. Largent-Milnes
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, United States
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Shen W, Fan X, Fu G, Liu H, Liang X, Wei J, Sun L, Zhang L, Chi X, Zhang Y. Efficacy and safety of the Chaixiong Qiwei granule for tension-type headache: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e074871. [PMID: 38035742 PMCID: PMC10689380 DOI: 10.1136/bmjopen-2023-074871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Tension-type headache (TTH) is the most prevalent headache disorder worldwide. Although current treatments for TTH are beneficial, they are not without adverse effects. Chaixiong Qiwei granule (CXQW) is an experienced prescription medicine for TTH management. This study will evaluate the efficacy and safety of CXQW for the treatment of TTH. METHODS AND ANALYSIS This study will be a multicentre, randomised, double-blind, placebo-controlled trial. A total of 148 eligible participants will be divided into the intervention (CXQW treatment) and control (placebo treatment) groups. The primary outcome will be the reduction in the number of headache days (headache-days reduction) within 9-12 weeks after randomisation, while secondary outcomes will include the number of headache days, headache intensity, responder rate, drug consumption for acute treatment, quality of life and symptoms related to traditional Chinese medicine use based on a symptom-observation table. This protocol describes the design of the randomised controlled trial. ETHICS AND DISSEMINATION The study design was approved by the Institutional Review Board of Human Research at Xiyuan Hospital, China Academy of Chinese Medical Sciences (No. 2020XLA030-2). TRIAL REGISTRATION NUMBER ChiCTR2100042514.
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Affiliation(s)
- Wei Shen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Xueming Fan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Guojing Fu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Hongxi Liu
- Graduate School, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xiao Liang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Jingjing Wei
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Linjuan Sun
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Lu Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Xiansu Chi
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
| | - Yunling Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China
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Sebastianelli G, Casillo F, Abagnale C, Renzo AD, Cioffi E, Parisi V, Lorenzo CD, Fazio F, Petricola F, Mattia C, Serrao M, Schoenen J, Coppola G. Central sensitization mechanisms in chronic migraine with medication overuse headache: a study of thalamocortical activation and lateral cortical inhibition. Cephalalgia 2023; 43:3331024231202240. [PMID: 37795647 DOI: 10.1177/03331024231202240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND It is unclear whether cortical hyperexcitability in chronic migraine with medication overuse headache (CM-MOH) is due to increased thalamocortical drive or aberrant cortical inhibitory mechanisms. METHODS Somatosensory evoked potentials (SSEP) were performed by electrical stimulation of the median nerve (M), ulnar nerve (U) and simultaneous stimulation of both nerves (MU) in 27 patients with CM-MOH and, for comparison, in 23 healthy volunteers (HVs) of a comparable age distribution. We calculated the degree of cortical lateral inhibition using the formula: 100 - [MU/(M + U) × 100] and the level of thalamocortical activation by analyzing the high frequency oscillations (HFOs) embedded in parietal N20 median SSEPs. RESULTS Compared to HV, CM-MOH patients showed higher lateral inhibition (CM-MOH 52.2% ± 15.4 vs. HV 40.4% ± 13.3; p = 0.005), which positively correlated with monthly headache days, and greater amplitude of pre-synaptic HFOs (p = 0.010) but normal post-synaptic HFOs (p = 0.122). CONCLUSION Our findings suggest that central neuronal circuits are highly sensitized in CM-MOH patients, at both thalamocortical and cortical levels. The observed changes could be due to the combination of dysfunctional central pain control mechanisms, hypersensitivity and hyperresponsiveness directly linked to the chronic intake of acute migraine drugs.
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Affiliation(s)
- Gabriele Sebastianelli
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Francesco Casillo
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Chiara Abagnale
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | | | - Ettore Cioffi
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | | | - Cherubino Di Lorenzo
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Federica Fazio
- Specialization School in Medicine and Palliative Care, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Fausto Petricola
- Specialization School in Medicine and Palliative Care, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Consalvo Mattia
- Specialization School in Medicine and Palliative Care, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Mariano Serrao
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Jean Schoenen
- CHU de Liège, Neurology, Headache Research Unit, Citadelle Hospital, Liège, Belgium
| | - Gianluca Coppola
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
- Specialization School in Medicine and Palliative Care, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
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Niddam DM, Wu SW, Lai KL, Yang YY, Wang YF, Wang SJ. An altered reward system characterizes chronic migraine with medication overuse headache. Cephalalgia 2023; 43:3331024231158088. [PMID: 36855934 DOI: 10.1177/03331024231158088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Medication overuse headache shares several characteristics with substance use disorders. However, key features of substance use disorders such as increased impulsivity and alterations in reward processing remain little explored in medication overuse headache. METHODS Temporal discounting and impulsive decision making behavior and the associated brain mechanisms were assessed in 26 chronic migraine patients with medication overuse headache and in 28 healthy controls. Regions-of-interest analyses were first performed for task-related regions, namely the ventral striatum and the ventromedial and dorsomedial prefrontal cortices. Resting-state functional connectivity between these regions were then explored. An additional 27 chronic migraine patients without medication overuse headache were included for comparison in the latter analysis. RESULTS Patients with medication overuse headache showed steeper temporal discounting behavior than healthy controls. They also showed weaker subjective value representations in the dorsomedial prefrontal cortex, when accepting larger delayed rewards, and in ventral striatum and ventromedial prefrontal cortex, when accepting the smaller immediate reward. Resting-state functional connectivity was reduced among the valuation regions when comparing patients with medication overuse headache to the other two control groups. CONCLUSIONS Patients with medication overuse headache were characterized by altered processing and dysconnectivity in the reward system during intertemporal choices and in the resting-state.
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Affiliation(s)
- David M Niddam
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Wei Wu
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuan-Lin Lai
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yun-Yen Yang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Fang Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Abstract
Medication overuse headache (MOH) is a secondary headache disorder attributed to overuse of acute headache medications by a person with an underlying headache disorder, usually migraine or tension-type headache. MOH is common among individuals with 15 or more headache days per month. Although MOH is associated with substantial disability and reductions in quality of life, this condition is often under-recognized. As MOH is both preventable and treatable, it warrants greater attention and awareness. The diagnosis of MOH is based on the history and an unremarkable neurological examination, and is made according to the diagnostic criteria of the International Classification of Headache Disorders third edition (ICHD-3). Pathophysiological mechanisms of MOH include altered descending pain modulation, central sensitization and biobehavioural factors. Treatment of MOH includes the use of headache preventive therapies, but essential to success is eliminating the cause, by reducing the frequency of use of acute headache medication, and perhaps withdrawing the overused medication altogether. Appropriate treatment is usually highly effective, leading to reduced headache burden and acute medication consumption.
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Sebastianelli G, Casillo F, Di Renzo A, Abagnale C, Cioffi E, Parisi V, Di Lorenzo C, Serrao M, Pierelli F, Schoenen J, Coppola G. Effects of Botulinum Toxin Type A on the Nociceptive and Lemniscal Somatosensory Systems in Chronic Migraine: An Electrophysiological Study. Toxins (Basel) 2023; 15:76. [PMID: 36668895 PMCID: PMC9863777 DOI: 10.3390/toxins15010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
(1) Background: OnabotulinumtoxinA (BoNT-A) is a commonly used prophylactic treatment for chronic migraine (CM). Although randomized placebo studies have shown its clinical efficacy, the mechanisms by which it exerts its therapeutic effect are still incompletely understood and debated. (2) Methods: We studied in 15 CM patients the cephalic and extracephalic nociceptive and lemniscal sensory systems using electrophysiological techniques before and 1 and 3 months after one session of pericranial BoNT-A injections according to the PREEMPT protocol. We recorded the nociceptive blink reflex (nBR), the trigemino-cervical reflex (nTCR), the pain-related cortical evoked potential (PREP), and the upper limb somatosensory evoked potential (SSEP). (3) Results: Three months after a single session of prophylactic therapy with BoNT-A in CM patients, we found (a) an increase in the homolateral and contralateral nBR AUC, (b) an enhancement of the contralateral nBR AUC habituation slope and the nTCR habituation slope, (c) a decrease in PREP N-P 1st and 2nd amplitude block, and (d) no effect on SSEPs. (4) Conclusions: Our study provides electrophysiological evidence for the ability of a single session of BoNT-A injections to exert a neuromodulatory effect at the level of trigeminal system through a reduction in input from meningeal and other trigeminovascular nociceptors. Moreover, by reducing activity in cortical pain processing areas, BoNT-A restores normal functioning of the descending pain modulation systems.
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Affiliation(s)
- Gabriele Sebastianelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-ICOT, 04100 Latina, Italy
| | - Francesco Casillo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-ICOT, 04100 Latina, Italy
| | | | - Chiara Abagnale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-ICOT, 04100 Latina, Italy
| | - Ettore Cioffi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-ICOT, 04100 Latina, Italy
| | | | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-ICOT, 04100 Latina, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-ICOT, 04100 Latina, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-ICOT, 04100 Latina, Italy
| | - Jean Schoenen
- Headache Research Unit, CHU de Liège, Neurology, Citadelle Hospital, B-4000 Liège, Belgium
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-ICOT, 04100 Latina, Italy
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Onan D, Wells-Gatnik WD, Martelletti P. Reaching the Nadir of Medication Overuse in Chronic Migraine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14696. [PMID: 36429413 PMCID: PMC9690126 DOI: 10.3390/ijerph192214696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
The introduction of new drug classes for chronic migraine, such as monoclonal antibodies for calcitonin-gene-related peptide or its receptor (CGRPr), or antagonists of the same CGRP, have opened a new scenario in a selected population of individuals with migraine, and those presenting with chronic form of migraine in association with medication overuse. Medication overuse is now considered a complication of chronic migraine and, in fact, the treatment with CGRP(r)-MAbs of chronic migraine with medication overuse results in a clinical improvement of chronic migraine itself, accompanied by a parallel and obvious reduction in the intake of specific and non-specific acute migraine drugs. Education on the correct use of these drugs will be an essential tool to reduce the disability and costs of people suffering from CM complicated by MO, considering the long-term safety of the new therapies targeting the CGRP pathways. Only in this way can medication overuse risk can be reduced at its nadir in the scenario of chronicity of migraines.
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Affiliation(s)
- Dilara Onan
- Back and Neck Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06800, Turkey
- Department of Clinical and Molecular Medicine, Sapienza University, 00185 Rome, Italy
| | | | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, 00185 Rome, Italy
- Regional Referral Headache Center, Emergency Medicine Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
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Romozzi M, Di Tella S, Rollo E, Quintieri P, Silveri MC, Vollono C, Calabresi P. Theory of Mind in migraine and medication-overuse headache: A cross-sectional study. Front Neurol 2022; 13:968111. [PMID: 36119667 PMCID: PMC9479534 DOI: 10.3389/fneur.2022.968111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background Theory of Mind (ToM) is the ability to predict and anticipate others' behaviors through the mental state attribution process. This study aims to investigate the ToM in patients with medication-overuse headache (MOH) and episodic migraine (EM) and to compare it with healthy controls (HC). Methods This study enrolled patients with MOH, patients with EM, and HC. ToM was assessed through the Theory of Mind Assessment Scale (ThOMAS), which includes four subscales: Scale A, I-Me, Scale B, Other-Self, Scale C, I-Other, and Scale D, Other-Me, through the Reading the Mind in the Eyes test (RMET), which measures complex emotion recognition, and through the Toronto Alexithymia Scale (TAS-20), which measures alexithymia. Concomitant psychiatric disturbances were evaluated through the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Dissociative Experiences Scale-II. Results The study involved 21 patients with EM, 22 patients with MOH, and 18 HC. In all the four subscales of the ThOMAS, there was a significant difference between HC, EM, and MOH patients: Scale A (p = 0.009), Scale B (p = 0.004), Scale C (p = 0.039), and Scale D (p = 0.008). In the RMET, MOH patients had worse performances than EM patients and HC (p = 0.039). MOH group exhibited higher levels of alexithymia when compared to the HC (p = 0.033) and higher levels of anxiety than HC (p = 0.001). Conclusion MOH patients showed a subtle psychopathological pattern characterized by impaired social adaptation.
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Affiliation(s)
- Marina Romozzi
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Neurologia, Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sonia Di Tella
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Eleonora Rollo
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Neurologia, Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paolo Quintieri
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Catello Vollono
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Neurofisiopatologia, Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- *Correspondence: Catello Vollono
| | - Paolo Calabresi
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Neurologia, Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Serenko A, Turel O. Directing Technology Addiction Research in Information Systems. DATA BASE FOR ADVANCES IN INFORMATION SYSTEMS 2022. [DOI: 10.1145/3551783.3551789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this second part of a series of articles to direct technology addiction research in the information systems discipline, we discuss the history, conceptualization, and measurement of technology addiction. We admit that it is possible to label the phenomenon as overuse or excessive use as long as it is defined and measured by the presence and the magnitude of the six core symptoms of behavioral addictions: salience, mood modification, tolerance, withdrawal, conflict, and relapse. The advantage of this terminology is that it does not attribute one's problems to helplessness and does not pathologize the behavior, implying that it may possibly be corrected. Nevertheless, we posit that the term technology addiction is currently the most reasonable choice that may need to be adjusted as we learn more about this phenomenon and its potential similarities to and differences from established behavioral addictions. Dependence, obsessive/compulsive use, and pathological/problem use terms should not be used as synonyms for technology addiction as a form of mental disorder. Researchers should not include the name of the IT artifact as the subject of addiction (e.g., "Facebook addiction"). Instead, they should focus on the activity that is mediated through the IT artifact (e.g., "addiction to Facebook use").
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Affiliation(s)
| | - Ofir Turel
- The University of Melbourne, Melbourne, Australia
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Al-Qahtani AM, Shaikh IA, Shaikh MAK, Mannasaheb BA, Al-Qahtani FS. Prevalence, Perception, and Practice, and Attitudes Towards Self-Medication Among Undergraduate Medical Students of Najran University, Saudi Arabia: A Cross-Sectional Study. Risk Manag Healthc Policy 2022; 15:257-276. [PMID: 35210887 PMCID: PMC8859296 DOI: 10.2147/rmhp.s346998] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Awad Mohammed Al-Qahtani
- Department of Family and Community Medicine, College of Medicine, Najran University, Najran, Saudi Arabia
- Correspondence: Awad Mohammed Al-Qahtani, Department of Family and Community Medicine, College of Medicine, Najran University, Najran, Saudi Arabia, Tel +966 530540450, Email
| | - Ibrahim Ahmed Shaikh
- Department of Pharmacology, College of Pharmacy, Najran University, Najran, Saudi Arabia
| | | | | | - Faisal Saeed Al-Qahtani
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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13
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Dare SS, Eze ED, Echoru I, Usman IM, Ssempijja F, Bukenya EE, Ssebuufu R. Behavioural Response To Self-Medication Practice Before and During Covid-19 Pandemic in Western Uganda. Patient Prefer Adherence 2022; 16:2247-2257. [PMID: 36034331 PMCID: PMC9400814 DOI: 10.2147/ppa.s370954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-medication has become a serious public health problem posing great risks, especially with the increasing number of cases of COVID-19 disease globally and in Uganda. This may be partly because of the absence of a recognized treatment for the disease, however, the differing prevalence and nature from country to country may influence human behavioral responses. PURPOSE This study aimed to investigate the behavioral response to self-medication practices during the COVID-19 pandemic and lockdown in comparison to the pre-COVID period in Western Uganda. METHODS A descriptive cross-sectional survey was conducted from June to August 2020 in western Uganda using online Google forms and printed questionnaires to investigate the level of self-medication practice before and during the COVID-19 pandemic. This included 280 participants, aged 18 and above who consented to participate in the study. Participants were selected using a convenience sampling technique, and sampling was done by sending a structured online questionnaire via Google forms and printed questionnaires to participants who did not use the online Google forms. RESULTS Respondents that knew about self-medication were 97% of the 272 participants. Those that are aware of self-medication, have heard about it either through different avenues. Respondents who practiced self-medication before the COVID-19 pandemic were 239 (88%); those who practiced self-medication during the COVID-19 pandemic were 156 (57%); those that did not were 115 (43%). There was a statistically significant decrease in the number of respondents who practice self-medication during the COVID-19 pandemic lockdown compared to the practice before the pandemic lockdown. p < 0.05 at 95% confidence interval (OR = 5.39, 95% CI = 3.48, 8.32). CONCLUSION Our investigation showed adequate knowledge of self-medication and a high level of self-medication practice with a decrease in self-medication practices during the COVID-19 pandemic lockdown compared to the practice before the lockdown.
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Affiliation(s)
- Samuel Sunday Dare
- School of Medicine, Kabale University, Kabale, Uganda
- Correspondence: Samuel Sunday Dare, School of Medicine, Kabale University, P.O. Box 317, Kabale, Uganda, Tel +256757802099, Email
| | | | - Isaac Echoru
- School of Medicine, Kabale University, Kabale, Uganda
| | - Ibe Michael Usman
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Ishaka, Uganda
| | - Fred Ssempijja
- Faculty of Biomedical Sciences, Kampala International University Western Campus, Ishaka, Uganda
| | | | - Robinson Ssebuufu
- Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Ishaka, Uganda
- Uganda Medical and Dental Practitioners Council, Kampala, Uganda
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14
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Cámara MS, Martín Bujanda M, Mendioroz Iriarte M. Epigenetic changes in headache. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:369-376. [PMID: 34714235 DOI: 10.1016/j.nrleng.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Multiple factors, including both genetic and environmental mechanisms, appear to play a role in the aetiology of headache. An interesting area of study is the possible involvement of epigenetic mechanisms in headache development and the transformation to chronic headache, and the potential role of these factors as a therapeutic target. METHODS We performed a literature review of the involvement of different epigenetic mechanisms in headache, mainly using the Medline/PubMed database. To this end, we used the following English search terms: headache, migraine, epigenetics, DNA methylation, histones, non-coding RNA, and miRNA. RESULTS A total of 15 English-language publications related to the above terms were obtained. CONCLUSION There is limited but consistent evidence of the relationship between epigenetics and headache; it is therefore essential to continue research of epigenetic changes in headache. This may help to understand the pathophysiology of headache and even to identify candidate biomarkers and new, more effective, therapeutic targets.
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Affiliation(s)
- M S Cámara
- Servicio de Neurología, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - M Martín Bujanda
- Servicio de Neurología, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - M Mendioroz Iriarte
- Servicio de Neurología, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain; Laboratorio de Neuroepigenética, Navarrabiomed, IdiSNA, Pamplona, Spain.
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Bottiroli S, Galli F, Ballante E, Pazzi S, Sances G, Guaschino E, Allena M, Tassorelli C. Validity of the Severity of Dependence Scale for detecting dependence behaviours in chronic migraine with medication overuse. Cephalalgia 2021; 42:209-217. [PMID: 34541932 DOI: 10.1177/03331024211039817] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS In this study, we tested the validity of the Severity of Dependence Scale in detecting dependence behaviours in patients with chronic migraine and medication overuse (CM + MO) using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the Leeds Dependence Questionnaire as gold standard measures. METHODS Four hundred and fifty-four patients with CM + MO filled in the Severity of Dependence Scale and the Leeds Dependence Questionnaire and underwent a psychological evaluation for the diagnosis of substance dependence according to the DSM-IV criteria. RESULTS Sixty-nine percent of subjects (n = 313) presented substance dependence according to the DSM-IV criteria. These patients scored significantly higher than those without substance dependence in Severity of Dependence Scale total score (Z = -3.29, p = 0.001), and in items 1 (Z = -2.44, p = 0.015), 2 (Z = -2.50, p = 0.012), 4 (Z = -2.05, p = 0.04), and 5 (Z = -3.39, p = 0.001). Severity of Dependence Scale total score (β = 0.13, SE = 0.04, z = 3.49, p < 0.001) was a significant predictor for substance dependence. Receiver Operating Characteristic (ROC) curves showed that Severity of Dependence Scale discriminated patients with or without substance dependence. CONCLUSION Severity of Dependence Scale could represent an interesting screening tool for dependency-like behaviors in CM + MO patients.
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Affiliation(s)
- Sara Bottiroli
- Giustino Fortunato University, Benevento, Italy.,Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Federica Galli
- Department of Dynamic and Clinical Psychology, and Health Studies-Faculty of Medicine and Psychology, 9311Sapienza University of Rome, Sapienza University of Rome, Rome, Italy
| | - Elena Ballante
- BioData Science Unit, IRCCS C. Mondino Foundation, Pavia, Italy.,Department of Mathematics, 19001University of Pavia, University of Pavia, Italy
| | - Stefania Pazzi
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
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Takahashi TT, Ornello R, Quatrosi G, Torrente A, Albanese M, Vigneri S, Guglielmetti M, Maria De Marco C, Dutordoir C, Colangeli E, Fuccaro M, Di Lenola D, Spuntarelli V, Pilati L, Di Marco S, Van Dycke A, Abdullahi RA, Maassen van den Brink A, Martelletti P. Medication overuse and drug addiction: a narrative review from addiction perspective. J Headache Pain 2021; 22:32. [PMID: 33910499 PMCID: PMC8080402 DOI: 10.1186/s10194-021-01224-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 12/27/2022] Open
Abstract
Chronic headache is particularly prevalent in migraineurs and it can progress to a condition known as medication overuse headache (MOH). MOH is a secondary headache caused by overuse of analgesics or other medications such as triptans to abort acute migraine attacks. The worsening of headache symptoms associated with medication overuse (MO) generally ameliorates following interruption of regular medication use, although the primary headache symptoms remain unaffected. MO patients may also develop certain behaviors such as ritualized drug administration, psychological drug attachment, and withdrawal symptoms that have been suggested to correlate with drug addiction. Although several reviews have been performed on this topic, to the authors best knowledge none of them have examined this topic from the addiction point of view. Therefore, we aimed to identify features in MO and drug addiction that may correlate. We initiate the review by introducing the classes of analgesics and medications that can cause MOH and those with high risk to produce MO. We further compare differences between sensitization resulting from MO and from drug addiction, the neuronal pathways that may be involved, and the genetic susceptibility that may overlap between the two conditions. Finally, ICHD recommendations to treat MOH will be provided herein.
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Affiliation(s)
- Tatiane Teru Takahashi
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 20 Newcomen St, London, SE1 1YR, UK. .,Present address: Medicines Discovery Catapult, Block 35, Mereside, Alderley Park, Cheshire, SK10 4TG, UK.
| | - Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1, Coppito, 67100, L'Aquila, Italy
| | - Giuseppe Quatrosi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Angelo Torrente
- Department of Biomedicine, Neurosciences and Diagnostic (Bi.N.D.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Maria Albanese
- Department of Systems Medicine, University of Rome "Tor Vergata"; Neurology Unit, "Tor Vergata" Hospital, Viale Oxford, 81, 00133, Rome, Italy
| | - Simone Vigneri
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy.,Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, Italy
| | - Martina Guglielmetti
- Regional Headache Referral Center, Sant'Andrea Hospital, Via di Grottarossa 1039, 00189, Rome, Italy.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Piazza Università, 21, 07100, Sassari, Italy
| | - Cristiano Maria De Marco
- Regional Headache Referral Center, Sant'Andrea Hospital, Via di Grottarossa 1039, 00189, Rome, Italy
| | - Camille Dutordoir
- Department of Neurology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Enrico Colangeli
- Present address: Medicines Discovery Catapult, Block 35, Mereside, Alderley Park, Cheshire, SK10 4TG, UK
| | - Matteo Fuccaro
- Department of Neurology, Conegliano Hospital, Via Brigata Bisagno, 2, 31015, Conegliano, Italy
| | - Davide Di Lenola
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Viale XXIV Maggio 7, 04100, Latina, Italy
| | - Valerio Spuntarelli
- Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, The Netherlands
| | - Laura Pilati
- Department of Biomedicine, Neurosciences and Diagnostic (Bi.N.D.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Salvatore Di Marco
- Department of Biomedicine, Neurosciences and Diagnostic (Bi.N.D.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Annelies Van Dycke
- Department of Neurology, AZ Sint-Jan Brugge, Ruddershove 10, 8000, Brugge, Belgium
| | - Ramla Abuukar Abdullahi
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 20 Newcomen St, London, SE1 1YR, UK.,Headache Centre, Guy's and St Thomas NHS Trust, London, UK
| | | | - Paolo Martelletti
- Regional Headache Referral Center, Sant'Andrea Hospital, Via di Grottarossa 1039, 00189, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1039, 00189, Rome, Italy
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Documento de revisión y actualización de la cefalea por uso excesivo de medicación (CUEM). Neurologia 2021; 36:229-240. [DOI: 10.1016/j.nrl.2020.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/17/2022] Open
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18
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Document of revision and updating of medication overuse headache (MOH). NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
PURPOSE OF REVIEW Medication overuse headache (MOH)is a disabling problem worldwide with areas of controversy regarding its cause. This article reviews the recent ideas regarding the development of this disorder and its effective management. RECENT FINDINGS It has been proposed that all acute migraine medications can lead to MOH, with differences in the propensity of different agents to cause the problem. Early data suggests that gepants, which are small-molecule calcitonin gene-related peptide antagonists used for the acute treatment of migraine, may be an exception. Recent studies show that practitioners and the general public are still largely unaware of the problem of medication overuse and its damaging effects. SUMMARY MOH is an accepted concept of an increase in headaches driven by the frequent administration of acute antimigraine drugs. The impressions of providers, and studies documenting the concept may be flawed. Although it is likely that MOH does occur, and restricting the amount of acute medications is necessary to prevent it, it is also possible that increasing amounts of acute medications are simply a reflection of poorly controlled headaches, rather than a cause. Objective markers need to be developed to identify those who have MOH, which does not include all with chronic migraine, and to use these markers in diagnosis and management, particularly in those patients where the frequent acute drugs might only be a reflection of frequent headaches, rather than a cause.
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Di Lorenzo C, Di Lorenzo G, Coppola G, Parisi V, Grieco GS, Santorelli FM, Pascale E, Pierelli F. Genetics Influences Drug Consumption in Medication Overuse Headache, Not in Migraine: Evidence From Wolframin His611Arg Polymorphism Analysis. Front Neurol 2021; 11:599517. [PMID: 33551959 PMCID: PMC7862332 DOI: 10.3389/fneur.2020.599517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/15/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The Wolframin His611Arg polymorphism can influence drug consumption in psychiatric patients with impulsive addictive behavior. This cross-sectional study aims to assess the prevalence of the Wolframin His611Arg polymorphism in MOH, a secondary headache belonging to the spectrum of addictive disorders, episodic migraine (EM), and healthy subjects (HS), and its influence on drug consumption. Methods: One-hundred and seventy-two EM, 107 MOH, and 83 HS were enrolled and genotyped for the Wolframin His611Arg polymorphism. Subjects were classified as homozygous for allele His (H/H subjects), homozygous for allele Arg (R/R subjects), and heterozygous (H/R subjects), regrouped as R/R and carriers of allele H (non-R/R), and matched for clinical data. Results: There were no differences in allelic distributions between the three groups (p = 0.19). Drug consumption and other clinical characteristics were not influenced by the Wolframin His611Arg polymorphism (p = 0.42; β = 0.04) in the EM group. Among the MOH population, R/R subjects consumed more analgesics (p < 0.0001; β = −0.38), particularly combination drugs (p = 0.0001; d = 2.32). Discussion: The Wolframin His611Arg polymorphism has a similar prevalence between the MOH, EM, and HS groups. The presence of the R/R genotype does not influence symptomatic drug consumption in EM, whereas it determines an increased use of symptomatic drugs in the MOH group, in particular combination drugs (i.e., drugs containing psychoactive compounds). Conclusions: Our findings are consistent with the hypothesis that the Wolframin His611Arg polymorphism plays its effect only in the MOH population, influencing the impulsivity control underlying addictive behavior.
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Affiliation(s)
- Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Giorgio Di Lorenzo
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Vincenzo Parisi
- IRCCS Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia, Rome, Italy
| | - Gaetano S Grieco
- Genomic and Post-Genomic Center, IRCCS Fondazione Istituto Neurologico Casimiro Mondino, Pavia, Italy
| | | | - Esterina Pascale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
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Abstract
BACKGROUND AND AIMS Medication-overuse headache (MOH) is a common chronic headache caused by overuse of headache analgesics. It has similarities with substance dependence disorders. The treatment of choice for MOH is withdrawal of the offending analgesics. Behavioral brief intervention treatment using methods adapted from substance misuse settings is effective. Here we investigate the severity of analgesics dependence in MOH using the Severity of Dependence Scale (SDS), validate the SDS score against formal substance dependence diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and examine whether the SDS predicts successful withdrawal. METHODS Representative recruitment from the general population; 60 MOH patients, 15 chronic headache patients without medication overuse and 25 population controls. Headaches were diagnosed using the International Classification of Headache Disorders, medication use was assessed and substance dependence classified according to the DSM-IV. The SDS was scored by interviewers blinded to patient group. Descriptive statistics were used and validity of the SDS score assessed against a substance dependence diagnosis using ROC analysis. RESULTS Sixty-two percent of MOH patients overused simple analgesics, 38% centrally acting analgesics (codeine, opiates, triptans). Fifty percent of MOH patients were classified as DSM-IV substance dependent. Centrally active medication and high SDS scores were associated with higher proportions of dependence. ROC analysis showed SDS scores accurately identified dependence (area under curve 88%). Lower SDS scores were associated with successful withdrawal (P = 0.004). CONCLUSIONS MOH has characteristics of substance dependence which should be taken into account when choosing treatment strategy. TRIAL REGISTRATION Based on data collected in previously reported randomized BIMOH trial (; in the present manuscript, Clinical trials registration number: NCT01314768). The present part, however, represents observational data and is not a treatment trial.
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Lau CI, Liu MN, Chen WH, Walsh V, Wang SJ. Clinical and biobehavioral perspectives: Is medication overuse headache a behavior of dependence? PROGRESS IN BRAIN RESEARCH 2020; 255:371-402. [PMID: 33008514 DOI: 10.1016/bs.pbr.2020.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 02/08/2023]
Abstract
Medication overuse headache (MOH), previously known as analgesic abuse headache or medication misuse headaches, is a common form of chronic headache disorder that has a detrimental impact on health and society. Although it has been widely accepted that overusing abortive medications is paradoxically the cause of MOH and drug discontinuation is the treatment of choice, ongoing debates exist as to whether drug consumption per se is the cause or consequence of headache chronification. Certain features in MOH such as their compulsive drug-seeking behavior, withdrawal headaches and high relapse rates share similarities with drug dependence, suggesting that there might be common underlying biological and psychobehavioral mechanisms. In this regard, this article will discuss the updated evidence and current debates on the possible biobehavioral overlap between MOH and drug dependence. To begin with, we will discuss whether MOH has characteristics of substance dependence based on standard psychiatry diagnostic criteria and other widely used dependence scales. Recent epidemiological studies underscoring common psychiatric comorbidities between the two disorders will also be presented. Although both demonstrate seemingly distinct personality traits, recent studies revealed similar decision-making impairment from a cognitive perspective, indicating the presence of a maladaptive reward system in both disorders. In addition, emerging imaging studies also support this notion by showing reversible morphological and functional brain changes related to the mesocorticolimbic reward circuitry in MOH, with a strong resemblance to those in addiction. Finally, an increased familial risk for drug dependence and genetic association with dopaminergic and drug dependence molecular pathways in MOH also support a possible link between MOH and addiction. Understanding the role of dependence in MOH will have a great impact on disease management as this will provide the missing piece of the puzzle in current therapeutic strategies.
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Affiliation(s)
- Chi Ieong Lau
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan; University Hospital, Taipa, Macau
| | - Mu-N Liu
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, Memory and Aging Centre, University of California, San Francisco, CA, United States
| | - Wei-Hung Chen
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Vincent Walsh
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Brain Research Center and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Krymchantowski AV, Jevoux CC, Krymchantowski AG, Vivas RS, Silva-Néto R. Medication overuse headache: an overview of clinical aspects, mechanisms, and treatments. Expert Rev Neurother 2020; 20:591-600. [PMID: 32463304 DOI: 10.1080/14737175.2020.1770084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Medication-overuse headache (MOH) is a common debilitating neurological disorder, with a prevalence of 1% to 7% in general population. It affects more than 60 million people worldwide and provokes substantial burden. Despite that, most practitioners don't know MOH. This review aims at presenting MOH clinical features, pathophysiology insights, and recent knowledge and guidance regarding treatments. AREAS COVERED A literature search in the major medical databases including the terms 'medication overuse headache,' 'chronic daily headache,' 'chronic migraine,' 'symptomatic medication overuse' and others, published between 1990 and 2020, was carried out. EXPERT COMMENTARY Primary headache sufferers such as migraineurs and tension-type headache patients may increase the headache frequency and induce the transition from episodic to chronic forms, as well as develop MOH, in the presence of medication overuse. There is evidence of structural and functional changes in some areas of the brain, which may identify those likely to respond or not to treatments. Despite the geographical differences and lack of consensus regarding approaches, to educate the patients about reducing medication intake, to withdraw overused medications and to start prophylaxis in some sufferers are crucial steps. Emerging treatments as monoclonal antibodies to migraine may result in better adherence and tolerability profiles as well as outcomes.
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Affiliation(s)
| | | | | | | | - Raimundo Silva-Néto
- Department of Neurology, Universidade Federal do Delta do Parnaíba , Piauí, Brazil
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Subashini N, Udayanga L. Demographic, socio-economic and other associated risk factors for self-medication behaviour among university students of Sri Lanka: a cross sectional study. BMC Public Health 2020; 20:613. [PMID: 32366238 PMCID: PMC7197154 DOI: 10.1186/s12889-020-08622-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/31/2020] [Indexed: 12/17/2022] Open
Abstract
Background Self-prescribing practices are considered as a significant issue in the health sector due to mal-practices. This has become a more worsen issue in developing countries with easy access to medication. Current study was undertaken to estimate the prevalence of self-medication and to evaluate the driving factors behind this behavior, among university students of Sri Lanka. Method A total of 700 randomly selected undergraduates of three state universities in Sri Lanka, were recruited as the study population for the cross-sectional study. Information on socio-demographic, Knowledge, Attitudes and Practices relevant to Self-Medication (SM) were gathered using an interviewer administered questionnaire. Binary logistic regression was used to calculate the Odds Ratios (OR) and the 95% confidence intervals of the OR for socio-demographic risk factors on SM. Results Around 78% of the studied population denoted a SM behaviour. Only, 37.7% of respondents were familiar with the classification of “Over the Counter” (OTC) drugs, while majority were well aware of the risks of SM (> 50%). Fever (61.3%) and cough (56.7%) were the major health issues for SM, while antipyretics and drugs for cough and runny nose (73.6%) were the mostly used medication. Previous experience (76%) and trivial nature of health issues (73%) were recognized as the major reasons for SM. Majority of respondents declared that community pharmacies (86.9%) and left over medication from previous prescriptions (51%) were the sources for SM. Based on the binary logistic regression, age, residence locality, field of study and academic year were recognized as significant risk factors (P < 0.05) for SM within the studied undergraduate population. Conclusion Based on the high prevalence rate of SM, the health authorities of Sri Lanka should pay more attention towards the wellbeing and responsible medication usage of undergraduates. Designing of effective tools and regulations to monitor the selling of medication and improving the health education are recommended to ensure responsible SM within the country.
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Affiliation(s)
- Nirma Subashini
- Department of Horticulture & Landscape Gardening, Faculty of Agriculture & Plantation Management, Makadura, Wayamba University of Sri Lanka, Gonawila, Sri Lanka
| | - Lahiru Udayanga
- Department of Biosystems Engineering, Faculty of Agriculture & Plantation Management, Makadura, Wayamba University of Sri Lanka, Gonawila, Sri Lanka.
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Maladaptive activation of Nav1.9 channels by nitric oxide causes triptan-induced medication overuse headache. Nat Commun 2019; 10:4253. [PMID: 31534133 PMCID: PMC6751217 DOI: 10.1038/s41467-019-12197-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/26/2019] [Indexed: 01/03/2023] Open
Abstract
Medication-overuse headaches (MOH) occur with both over-the-counter and pain-relief medicines, including paracetamol, opioids and combination analgesics. The mechanisms that lead to MOH are still uncertain. Here, we show that abnormal activation of Nav1.9 channels by Nitric Oxide (NO) is responsible for MOH induced by triptan migraine medicine. Deletion of the Scn11a gene in MOH mice abrogates NO-mediated symptoms, including cephalic and extracephalic allodynia, photophobia and phonophobia. NO strongly activates Nav1.9 in dural afferent neurons from MOH but not normal mice. Abnormal activation of Nav1.9 triggers CGRP secretion, causing artery dilatation and degranulation of mast cells. In turn, released mast cell mediators potentiates Nav1.9 in meningeal nociceptors, exacerbating inflammation and pain signal. Analysis of signaling networks indicates that PKA is downregulated in trigeminal neurons from MOH mice, relieving its inhibitory action on NO-Nav1.9 coupling. Thus, anomalous activation of Nav1.9 channels by NO, as a result of chronic medication, promotes MOH.
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Tuyishimire J, Okoya F, Adebayo AY, Humura F, Lucero-Prisno Iii DE. Assessment of self-medication practices with antibiotics among undergraduate university students in Rwanda. Pan Afr Med J 2019; 33:307. [PMID: 31692864 PMCID: PMC6815470 DOI: 10.11604/pamj.2019.33.307.18139] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/14/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Antimicrobial resistance (AR) is on a rise as one of the major global public health threats. It is therefore important to assess contributory factors to the rise in the cases of resistance reported. The main objective of this study was to assess the self-medication practices with antibiotics among the University of Rwanda students in Huye Campus. Methods A sample of 570 students from all levels and colleges of the University of Rwanda in Huye Campus were selected using a simple random sampling to participate in this study. A questionnaire was administered to be answered individually by the consented respondents where the self-medication practices with antibiotics in the past 6 months were assessed. The results were statistically analyzed using SPSS v.16. Results The study showed that 12.1% (n=69) practiced self-medication with antibiotics. The major reason for self-medication with antibiotics was illness not serious to have a consultation (50.72%). The main diseases being treated were common cold/fever/cough (47.83%). The most used antibiotic for self-medication was Amoxicillin capsules (59.42%), while the main source of antibiotics was the community pharmacy (72.42%). Conclusion Self-medication with antibiotics is not uncommon among the university students. Regarding the main reasons of self-medication with antibiotics, diseases being treated, and the antibiotics used, it was found that all these may be related to the students' lack of knowledge about the need for rational use of antibiotics and a study was needed to confirm it.
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Affiliation(s)
| | - Funmbi Okoya
- Department of Pharmaceutical Services, Lagos State Ministry of Health, Nigeria
| | | | - Fabrice Humura
- International Pharmaceutical Federation, the Hague, Netherlands
| | - Don Eliseo Lucero-Prisno Iii
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou,China.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom
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Personality and Personality Disorders in Medication-Overuse Headache: A Controlled Study by SWAP-200. Pain Res Manag 2019; 2019:1874078. [PMID: 31281555 PMCID: PMC6594272 DOI: 10.1155/2019/1874078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/04/2019] [Indexed: 12/17/2022]
Abstract
Background Medication-overuse headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. The impact of psychological factors has been matter of debate from different perspectives. The role of personality and personality pathology in processes involved in MOH development has been advanced but was poorly studied. The hypothesis of addiction-like behaviors sustaining the drug misuse has been examined and reached contrasting findings. Objectives This study is aimed at detecting personality and its disorders (PDs) in MOH, with a specific attention to the addiction aspect. Methods Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with substance use disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a clinician-report tool that assesses both normal and pathological personality. MANCOVAs were performed to evaluate personality differences among MOH, SUD, and PD groups, controlling for age and gender. Results MOH patients were predominantly women and older. They showed lower traits of the SWAP-200's cluster A and B disorders than SUD and PD patients, who presented more severe levels of personality impairment. No differences in the SWAP-200's cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients showed higher obsessive and dysphoric traits and better overall psychological functioning than SUD and PD patients. Conclusion Although MOH, SUD, and PD populations have been evaluated in multiple sites with different levels of expertise, the study supported the presence of a specific constellation of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities to drug-addicted and personality-disordered patients were found. Practitioners' careful understanding of the personality characteristics of MOH patients may be useful to provide a road map for the implementation of more effective treatment strategies and intervention programs.
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van Hoogstraten WS, MaassenVanDenBrink A. The need for new acutely acting antimigraine drugs: moving safely outside acute medication overuse. J Headache Pain 2019; 20:54. [PMID: 31096904 PMCID: PMC6734450 DOI: 10.1186/s10194-019-1007-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background The treatment of migraine is impeded by several difficulties, among which insufficient headache relief, side effects, and risk for developing medication overuse headache (MOH). Thus, new acutely acting antimigraine drugs are currently being developed, among which the small molecule CGRP receptor antagonists, gepants, and the 5-HT1F receptor agonist lasmiditan. Whether treatment with these drugs carries the same risk for developing MOH is currently unknown. Main body Pathophysiological studies on MOH in animal models have suggested that decreased 5-hydroxytryptamine (5-HT, serotonin) levels, increased calcitonin-gene related peptide (CGRP) expression and changes in 5-HT receptor expression (lower 5-HT1B/D and higher 5-HT2A expression) may be involved in MOH. The decreased 5-HT may increase cortical spreading depression frequency and induce central sensitization in the cerebral cortex and caudal nucleus of the trigeminal tract. Additionally, low concentrations of 5-HT, a feature often observed in MOH patients, could increase CGRP expression. This provides a possible link between the pathways of 5-HT and CGRP, targets of lasmiditan and gepants, respectively. Since lasmiditan is a 5-HT1F receptor agonist and gepants are CGRP receptor antagonists, they could have different risks for developing MOH because of the different (over) compensation mechanisms following prolonged agonist versus antagonist treatment. Conclusion The acute treatment of migraine will certainly improve with the advent of two novel classes of drugs, i.e., the 5-HT1F receptor agonists (lasmiditan) and the small molecule CGRP receptor antagonists (gepants). Data on the effects of 5-HT1F receptor agonism in relation to MOH, as well as the effects of chronic CGRP receptor blockade, are awaited with interest.
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Affiliation(s)
| | - Antoinette MaassenVanDenBrink
- Div. of Pharmacology, Dept. of Internal Medicine, Erasmus University Medical Centre, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
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Assessment of Self-Medication Practices and Its Associated Factors among Undergraduates of a Private University in Nigeria. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:5439079. [PMID: 30671097 PMCID: PMC6317103 DOI: 10.1155/2018/5439079] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/14/2018] [Accepted: 12/05/2018] [Indexed: 11/17/2022]
Abstract
Background Self-medication is the use of drugs to treat self-diagnosed disorders or symptoms or the intermittent or continued use of prescribed drug for chronic or recurrent disease or symptoms, and it is mostly common in developing countries. This study therefore assessed the practice of self-medication among undergraduate students of a private university in Nigeria. Methods The study employed a descriptive cross-sectional design. A pretested questionnaire was self-administered to 384 undergraduate students of the university. Data were analysed and summarised using descriptive and inferential statistics such as chi-squared and Fisher's exact tests. Results Overall, 297 (81.8%) undergraduate students practiced self-medication. About 71% of the students had used analgesic, antibiotics (10.5%), and antimalarial drugs (33%) without prescription within one month prior to the survey. The most commonly used drug for self-medication was paracetamol (75.1%). Furthermore, self-medication was found to be significantly associated with age (p=0.021), gender (p < 0.001), college (p=0.025), and year of study (p=0.004). Some of the reasons why undergraduate students practiced self-medication were because of the unfriendly attitude of health care workers (27.7%), lack of time to go to school clinic (26.7%), school clinic is too far from hostel (15.3%), and drugs prescribed in the school clinic do not improve health condition (15.3%). Conclusion Majority of the students attributed the practice of self-medication to unfriendly attitude of health care workers in the university clinic.
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Jeong H, Moye LS, Southey BR, Hernandez AG, Dripps I, Romanova EV, Rubakhin SS, Sweedler JV, Pradhan AA, Rodriguez-Zas SL. Gene Network Dysregulation in the Trigeminal Ganglia and Nucleus Accumbens of a Model of Chronic Migraine-Associated Hyperalgesia. Front Syst Neurosci 2018; 12:63. [PMID: 30618656 PMCID: PMC6305622 DOI: 10.3389/fnsys.2018.00063] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/03/2018] [Indexed: 12/28/2022] Open
Abstract
The pharmacological agent nitroglycerin (NTG) elicits hyperalgesia and allodynia in mice. This model has been used to study the neurological disorder of trigeminovascular pain or migraine, a debilitating form of hyperalgesia. The present study validates hyperalgesia in an established mouse model of chronic migraine triggered by NTG and advances the understanding of the associated molecular mechanisms. The RNA-seq profiles of two nervous system regions associated with pain, the trigeminal ganglia (TG) and the nucleus accumbens (NAc), were compared in mice receiving chronic NTG treatment relative to control (CON) mice. Among the 109 genes that exhibited an NTG treatment-by-region interaction, solute carrier family 32 (GABA vesicular transporter) member 1 (Slc32a1) and preproenkephalin (Penk) exhibited reversal of expression patterns between the NTG and CON groups. Erb-b2 receptor tyrosine kinase 4 (Erbb4) and solute carrier family 1 (glial high affinity glutamate transporter) member 2 (Slc1a2) exhibited consistent differential expression between treatments across regions albeit at different magnitude. Period circadian clock 1 (Per1) was among the 165 genes that exhibited significant NTG treatment effect. Biological processes disrupted by NTG in a region-specific manner included adaptive and innate immune responses; whereas glutamatergic and dopaminergic synapses and rhythmic process were disrupted in both regions. Regulatory network reconstruction highlighted the widespread role of several transcription factors (including Snrnp70, Smad1, Pax6, Cebpa, and Smpx) among the NTG-disrupted target genes. These results advance the understanding of the molecular mechanisms of hyperalgesia that can be applied to therapies to ameliorate chronic pain and migraine.
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Affiliation(s)
- Hyeonsoo Jeong
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Laura S. Moye
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Bruce R. Southey
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Alvaro G. Hernandez
- Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Isaac Dripps
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Elena V. Romanova
- Department of Chemistry and the Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Stanislav S. Rubakhin
- Department of Chemistry and the Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jonathan V. Sweedler
- Department of Chemistry and the Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Amynah A. Pradhan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Sandra L. Rodriguez-Zas
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Statistics, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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Mehnert J, Hebestreit J, May A. Cortical and Subcortical Alterations in Medication Overuse Headache. Front Neurol 2018; 9:499. [PMID: 29988531 PMCID: PMC6026656 DOI: 10.3389/fneur.2018.00499] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/07/2018] [Indexed: 01/05/2023] Open
Abstract
Medication-overuse headache is an increasing problem in headache clinics and therapy includes drug withdrawal. Although it has been shown that the orbitofrontal cortex is hypo-metabolic and exhibits less gray matter in these patients the functional role of this finding is still unclear as virtually no functional imaging studies exploring withdrawal of medication have been published. We compared structural and functional magnetic resonance images of 18 patients before and after drug withdrawal with age and gender matched controls using a well-established trigeminal, nociceptive fMRI paradigm. We reproduced structural changes in the orbitofrontal cortex of the patients which highly correlated with the clinical outcome of medication withdrawal. The neuronal activity before drug withdrawal in pain related regions (operculum, insula, spinal trigeminal nucleus) was reduced compared to after drug withdrawal and the orbitofrontal cortex showed a reduced functional connectivity to the nociceptive input region (spinal trigeminal nucleus) and the cerebellum which regained after withdrawal. These data suggest the seminal role of the orbitofrontal cortex as a mediator between bottom-up and top-down stream in headache processing.
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Affiliation(s)
- Jan Mehnert
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Julia Hebestreit
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
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Trigeminal ganglion transcriptome analysis in 2 rat models of medication-overuse headache reveals coherent and widespread induction of pronociceptive gene expression patterns. Pain 2018; 159:1980-1988. [DOI: 10.1097/j.pain.0000000000001291] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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González-Hernández A, Marichal-Cancino BA, MaassenVanDenBrink A, Villalón CM. Side effects associated with current and prospective antimigraine pharmacotherapies. Expert Opin Drug Metab Toxicol 2018; 14:25-41. [PMID: 29226741 DOI: 10.1080/17425255.2018.1416097] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Migraine is a neurovascular disorder. Current acute specific antimigraine pharmacotherapies target trigeminovascular 5-HT1B/1D, 5-HT1F and CGRP receptors but, unfortunately, they induce some cardiovascular and central side effects that lead to poor treatment adherence/compliance. Therefore, new antimigraine drugs are being explored. Areas covered: This review considers the adverse (or potential) side effects produced by current and prospective antimigraine drugs, including medication overuse headache (MOH) produced by ergots and triptans, the side effects observed in clinical trials for the new gepants and CGRP antibodies, and a section discussing the potential effects resulting from disruption of the cardiovascular CGRPergic neurotransmission. Expert opinion: The last decades have witnessed remarkable developments in antimigraine therapy, which includes acute (e.g. triptans) and prophylactic (e.g. β-adrenoceptor blockers) antimigraine drugs. Indeed, the triptans represent a considerable advance, but their side effects (including nausea, dizziness and coronary vasoconstriction) preclude some patients from using triptans. This has led to the development of the ditans (5-HT1F receptor agonists), the gepants (CGRP receptor antagonists) and the monoclonal antibodies against CGRP or its receptor. The latter drugs represent a new hope in the antimigraine armamentarium, but as CGRP plays a role in cardiovascular homeostasis, the potential for adverse cardiovascular side effects remains latent.
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Affiliation(s)
| | - Bruno A Marichal-Cancino
- b Departamento de Fisiología y Farmacología, Universidad Autónoma de Aguascalientes , Ciudad Universitaria , Aguascalientes , México
| | - Antoinette MaassenVanDenBrink
- c Division of Vascular Medicine and Pharmacology, Department of Internal Medicine , Erasmus University Medical Center , Rotterdam , The Netherlands
| | - Carlos M Villalón
- d Departamento de Farmacobiología , Cinvestav-Coapa , Ciudad de México , México
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Abstract
INTRODUCTION Multiple factors, including both genetic and environmental mechanisms, appear to play a role in the aetiology of headache. An interesting area of study is the possible involvement of epigenetic mechanisms in headache development and the transformation to chronic headache, and the potential role of these factors as a therapeutic target. METHODS We performed a literature review of the involvement of different epigenetic mechanisms in headache, mainly using the Medline/PubMed database. To this end, we used the following English search terms: headache, migraine, epigenetics, DNA methylation, histones, non-coding RNA, and miRNA. RESULTS A total of 15 English-language publications related to the above terms were obtained. CONCLUSION There is limited but consistent evidence of the relationship between epigenetics and headache; it is therefore essential to continue research of epigenetic changes in headache. This may help to understand the pathophysiology of headache and even to identify candidate biomarkers and new, more effective, therapeutic targets.
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Affiliation(s)
- M S Cámara
- Servicio de Neurología, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, España
| | - M Martín Bujanda
- Servicio de Neurología, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, España
| | - M Mendioroz Iriarte
- Servicio de Neurología, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, España; Laboratorio de Neuroepigenética, Navarrabiomed, IdiSNA, Pamplona, España.
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Coppola G, Petolicchio B, Di Renzo A, Tinelli E, Di Lorenzo C, Parisi V, Serrao M, Calistri V, Tardioli S, Cartocci G, Ambrosini A, Caramia F, Di Piero V, Pierelli F. Cerebral gray matter volume in patients with chronic migraine: correlations with clinical features. J Headache Pain 2017; 18:115. [PMID: 29322264 PMCID: PMC5762618 DOI: 10.1186/s10194-017-0825-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 12/23/2022] Open
Abstract
Background To date, few MRI studies have been performed in patients affected by chronic migraine (CM), especially in those without medication overuse. Here, we performed magnetic resonance imaging (MRI) voxel-based morphometry (VBM) analyses to investigate the gray matter (GM) volume of the whole brain in patients affected by CM. Our aim was to investigate whether fluctuations in the GM volumes were related to the clinical features of CM. Methods Twenty untreated patients with CM without a past medical history of medication overuse underwent 3-Tesla MRI scans and were compared to a group of 20 healthy controls (HCs). We used SPM12 and the CAT12 toolbox to process the MRI data and to perform VBM analyses of the structural T1-weighted MRI scans. The GM volume of patients was compared to that of HCs with various corrected and uncorrected thresholds. To check for possible correlations, patients’ clinical features and GM maps were regressed. Results Initially, we did not find significant differences in the GM volume between patients with CM and HCs (p < 0.05 corrected for multiple comparisons). However, using more-liberal uncorrected statistical thresholds, we noted that compared to HCs, patients with CM exhibited clusters of regions with lower GM volumes including the cerebellum, left middle temporal gyrus, left temporal pole/amygdala/hippocampus/pallidum/orbitofrontal cortex, and left occipital areas (Brodmann areas 17/18). The GM volume of the cerebellar hemispheres was negatively correlated with the disease duration and positively correlated with the number of tablets taken per month. Conclusion No gross morphometric changes were observed in patients with CM when compared with HCs. However, using more-liberal uncorrected statistical thresholds, we observed that CM is associated with subtle GM volume changes in several brain areas known to be involved in nociception/antinociception, multisensory integration, and analgesic dependence. We speculate that these slight morphometric impairments could lead, at least in a subgroup of patients, to the development and continuation of maladaptive acute medication usage. Electronic supplementary material The online version of this article (10.1186/s10194-017-0825-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gianluca Coppola
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy.
| | - Barbara Petolicchio
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Antonio Di Renzo
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy
| | - Emanuele Tinelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Vincenzo Parisi
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Valentina Calistri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Stefano Tardioli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Gaia Cartocci
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Francesca Caramia
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,IRCCS-Neuromed, Pozzilli, IS, Italy
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Cargnin S, Viana M, Sances G, Tassorelli C, Terrazzino S. A systematic review and critical appraisal of gene polymorphism association studies in medication-overuse headache. Cephalalgia 2017; 38:1361-1373. [DOI: 10.1177/0333102417728244] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose of review Medication-overuse headache is a secondary chronic headache disorder, evolving from an episodic primary headache type, caused by the frequent and excessive use of headache symptomatic drugs. While gene polymorphisms have been deeply investigated as susceptibility factors for migraine, little attention has been paid to medication-overuse headache genetics. In the present study we conducted a systematic review to identify, appraise and summarize the current findings of gene polymorphism association studies in medication-overuse headache. Methods A comprehensive literature search was conducted on PubMed and Web of Knowledge databases of primary studies that met the diagnostic criteria for medication-overuse headache according to the temporally-relevant Classification of Headache Disorder of the International Headache Society. Results A total of 17 candidate gene association studies focusing on medication-overuse headache were finally included in the qualitative review. Among these, 12 studies investigated the role of common gene polymorphisms as risk factors for medication-overuse headache susceptibility, six studies focused on the relationship with clinical features of medication-overuse headache patients, and four studies evaluated their role as determinants of clinical outcomes in medication-overuse headache patients. Conclusion Results of single studies show a potential role of polymorphic variants of the dopaminergic gene system or of other genes related to drug-dependence pathways as susceptibility factors for disease or as determinants of monthly drug consumption, respectively. In this systematic review, we summarize the findings of gene polymorphism association studies in medication-overuse headache and discuss the methodological issues that need to be addressed in the design of future studies.
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Affiliation(s)
- Sarah Cargnin
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale “A. Avogadro”, Novara, Italy
| | - Michele Viana
- Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - Grazia Sances
- Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale “A. Avogadro”, Novara, Italy
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Lindstrøm JC, Wyller NG, Halvorsen MM, Hartberg S, Lundqvist C. Psychometric properties of a Norwegian adaption of the Barratt Impulsiveness Scale-11 in a sample of Parkinson patients, headache patients, and controls. Brain Behav 2017; 7:e00605. [PMID: 28127523 PMCID: PMC5256188 DOI: 10.1002/brb3.605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/12/2016] [Accepted: 09/17/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the psychometric properties of a Norwegian translation of the Barratt Impulsiveness Scale (BIS-11) for use in populations of headache, Parkinson's disease (PD), and healthy controls. MATERIALS AND METHODS The BIS-11 was forward and backward translated by native speakers of both Norwegian and English to give Norwegian BIS-11 (Nor-BIS-11). A convenience sample (110 subjects) of healthy controls (47), PD patients (43), and chronic headache patients (20) (the latter two recruited from a Neurology outpatient clinic), were asked to complete the scale (a subset twice for test-retest). Exploratory and confirmatory factor analyses were done for a single-factor model, the original three-factor model and a two-factor model. Test-retest results were analyzed using the Bland-Altman approach. RESULTS The Nor-BIS-11 scale showed good utility and acceptability as well as good test-retest reliability in this sample. Cronbach's α was .68, test-retest bias was -0.73, Cohen's δ = -.134, and limits of agreement were -11.48 to 10.01. The factor structure was found to fit better with a two-factor model than with the original model with three factors. The model fit indices indicated a moderate fit. CONCLUSIONS The Nor-BIS-11 scale is acceptable and reliable to use in Parkinson's disease patients, chronic headache patients, and healthy controls. The results should be interpreted in a two-factor model but with caution due to low construct validity. External validity needs to be further tested.
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Affiliation(s)
- Jonas C Lindstrøm
- Health Services Research Centre (HØKH)Akershus University HospitalLørenskogNorway; Institute of Clinical MedicineCampus Akershus University HospitalUniversity of OsloOsloNorway
| | - Nora G Wyller
- Health Services Research Centre (HØKH) Akershus University Hospital Lørenskog Norway
| | - Marianne M Halvorsen
- Health Services Research Centre (HØKH) Akershus University Hospital Lørenskog Norway
| | - Silje Hartberg
- Health Services Research Centre (HØKH) Akershus University Hospital Lørenskog Norway
| | - Christofer Lundqvist
- Health Services Research Centre (HØKH)Akershus University HospitalLørenskogNorway; Institute of Clinical MedicineCampus Akershus University HospitalUniversity of OsloOsloNorway; Department of NeurologyAkershus University HospitalLørenskogNorway
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Fuller-Thomson E, Jayanthikumar J, Agbeyaka SK. Untangling the Association Between Migraine, Pain, and Anxiety: Examining Migraine and Generalized Anxiety Disorders in a Canadian Population Based Study. Headache 2016; 57:375-390. [PMID: 27991658 DOI: 10.1111/head.13010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 10/29/2016] [Accepted: 10/30/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aims of this study were to investigate: (1) the prevalence and unadjusted and adjusted odds of 12-month generalized anxiety disorder (GAD) among adults with migraine in comparison to those without migraine; (2) If debilitating pain and/or limitations in instrumental activities of daily living (IADLs) are mediators of the migraine-GAD association; and (3) Factors associated with past year GAD among adults with migraine. METHODS Secondary data analysis of the nationally representative 2012 Canadian Community Health Survey-Mental Health (CCHS-MS), a population-based survey of community dwellers with a response rate of 68.9%. The first subsample included those with (n = 2232) and without migraine (n = 19,270), and the second subsample was restricted to those with migraine (n = 2232). GAD was based on the WHO-CIDI scale. RESULTS Fully, 6% of those with migraines had past year GAD in comparison of 2.1% of those without migraine (P < .001). The socio-demographically adjusted odds of past year GAD were two and a half times higher among those with migraine than those without (OR= 2.46; 95% CI = 2.00, 3.02). A path analysis indicated that debilitating pain and limitations in IADLs were mediators in the relationship between migraine and GAD. In the sample restricted to migraineurs, the factors associated with higher odds of 12-month GAD included having a university degree, having low income, being without a confidant, and being male. CONCLUSIONS Generalized anxiety disorder is robustly associated with migraine and targeted outreach and interventions are warranted.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Janany Jayanthikumar
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Senyo K Agbeyaka
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Torta DM, Costa T, Luda E, Barisone MG, Palmisano P, Duca S, Geminiani G, Cauda F. Nucleus accumbens functional connectivity discriminates medication-overuse headache. NEUROIMAGE-CLINICAL 2016; 11:686-693. [PMID: 27330969 PMCID: PMC4900511 DOI: 10.1016/j.nicl.2016.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 03/06/2016] [Accepted: 05/11/2016] [Indexed: 01/07/2023]
Abstract
Medication-overuse headache (MOH) is a secondary form of headache related to the overuse of triptans, analgesics and other acute headache medications. It is believed that MOH and substance addiction share some similar pathophysiological mechanisms. In this study we examined the whole brain resting state functional connectivity of the dorsal and ventral striatum in 30 patients (15 MOH and 15 non-MOH patients) to investigate if classification algorithms can successfully discriminate between MOH and non-MOH patients on the basis of the spatial pattern of resting state functional connectivity of the dorsal and ventral striatal region of interest. Our results indicated that both nucleus accumbens and dorsal rostral putamen functional connectivity could discriminate between MOH and non-MOH patients, thereby providing possible support to two interpretations. First, that MOH patients show altered reward functionality in line with drug abusers (alterations in functional connectivity of the nucleus accumbens). Second, that MOH patients show inability to break habitual behavior (alterations in functional connectivity of the dorsal striatum). In conclusion, our data showed that MOH patients were characterized by an altered functional connectivity of motivational circuits at rest. These differences could permit the blind discrimination between the two conditions using classification algorithms. Considered overall, our findings might contribute to the development of novel diagnostic measures. Nucleus accumbens functional connectivity could discriminate between MOH and non-MOH patients. Dorsal rostral putamen functional connectivity could also discriminate between MOH and non-MOH patients. Our data provide insights on possible pathophysiological mechanisms of medication abuse.
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Affiliation(s)
- D M Torta
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy; Department of Psychology, University of Turin, Turin, Italy; Institute of Neuroscience, IoNS, Université catholique de Louvain, Brussels, Belgium.
| | - T Costa
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy; Department of Psychology, University of Turin, Turin, Italy
| | - E Luda
- Division of Neurology, Rivoli Hospital, Turin, Italy
| | - M G Barisone
- Division of Neurology, Rivoli Hospital, Turin, Italy; Neuropsychology Unit, Division of Neurology, Rivoli Hospital, Turin, Italy
| | - P Palmisano
- Division of Neurology, Rivoli Hospital, Turin, Italy; Neuropsychology Unit, Division of Neurology, Rivoli Hospital, Turin, Italy
| | - S Duca
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy
| | - G Geminiani
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy; Department of Psychology, University of Turin, Turin, Italy
| | - F Cauda
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy; Department of Psychology, University of Turin, Turin, Italy
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Haseeb A, Bilal M. Prevalence of using non prescribed medications in economically deprived rural population of Pakistan. ACTA ACUST UNITED AC 2016; 74:1. [PMID: 26807216 PMCID: PMC4722669 DOI: 10.1186/s13690-015-0113-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/31/2015] [Indexed: 11/28/2022]
Abstract
Background Self medication is described as an act of procurement and consumption of medical drugs without the advice of medical physician for diagnosis, prescription and surveillance of treatment. There is a paucity of literature with regards to self medication among rural dwellers of Pakistan and no initiatives have been taken to resolve this issue. Therefore, the study aimed to evaluate frequency, practice and prevalence of self medication among economically deprived rural population of Karachi (South Pakistan). Methods This was the descriptive, epidemiological cross sectional survey which was conducted at the two largest tertiary care government based teaching hospitals of Karachi, Civil hospital and Jinnah Postgraduate Medical Centre, from January 2015 until March 2015. Seven hundred rural dwellers were recruited; who were the residents of outskirts of Karachi city were enrolled in the above mentioned period through the outpatient department (OPD) of the respective hospitals. Results According to the survey, 595 (85 %) subjects practiced self medication. The most common reasons evaluated for self medication were cost of consultation (90.3 %) and availability of transport (81.0 %) from rural area to health care facility. The paracetamol as a painkiller (93.0 %), acetylsalicylic acid as an anti pyretic (69.0 %), anti biotic (52.0 %) and anti allergic (51.0 %) were the commonest drug used without prescription of a health care physician. A significant difference was obtained in carrying out self medication between participants earning less than 50,000 PKR and greater than this amount (p = 0.029; 61 % vs. 24 %) and for the self medicated patients having education less than graduation with the participants having education of graduation or above it (p = 0.03; 63 % vs. 22 %). Conclusion The self medication among rural dwellers of Karachi is high . As a result, urgent steps must be taken to initiate the awareness and educational programs regarding potential risks of self medication. Secondly, strict measures must be introduced to stop supply of prescription drugs from pharmacies without prescription. Thirdly, provision of cost effective treatment from public sector hospitals to rural population can help to reduce self medication among rural population of Pakistan.
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Affiliation(s)
- Abdul Haseeb
- Dow University of Health Sciences, Karachi, Pakistan
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Afridi MI, Rasool G, Tabassum R, Shaheen M, Siddiqullah, Shujauddin M. Prevalence and pattern of self-medication in Karachi: A community survey. Pak J Med Sci 2015; 31:1241-5. [PMID: 26649022 PMCID: PMC4641291 DOI: 10.12669/pjms.315.8216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To study the prevalence and pattern of self-medication among adult males and females in Karachi, Pakistan. Methods: This cross-sectional community- based survey was carried out at five randomly selected towns of Karachi (Defence, Gulshan-e-Iqbal, North Nazimabad, Malir, Orangi town) over a period of 3 months (October, November & December 2012). A sample size of 500 adult cases (250 males & 250 females), with systemic random selection from different towns of Karachi were inducted in this study. The city was divided in 5 zones and one town from each zone was selected by systemic randomization. First available male and female from each randomly selected house were included in the study. After consent and confidentiality assurance they were interviewed on semi-structured Performa designed for this purpose. Results were analyzed and tabulated through SPSS v14.0. Result: The prevalence of self-medication in males and females in Karachi is found to be 84.8% (males 88.4% and females 81.2%). The most frequent symptoms for which self-medication used were headache (32.7%), fever (23.3%) and the medicines used were painkillers (28.8%), fever reducer medicines (19.8%). The most common reason 33.3% was previous experience with similar symptom. Conclusion: Self-medication is highly prevalent (84.8%) in Karachi. It was frequently used for headache followed by fever. Predominantly painkillers, fever reducer and cough syrups were used in the form of tablets and syrups. Main source of medicines for males were friends and for females were relatives.
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Affiliation(s)
- M Iqbal Afridi
- Prof. M. Iqbal Afridi, FCPS, FRCP. Head, Dept. of Psychiatry & Behavioural Sciences, Head, Dept. of Neurology, Secretary, Faculty of Psychiatry, College of Physicians & Surgeons, Pakistan. Jinnah Post Graduate Medical Centre (JPMC), Karachi, Pakistan
| | - Ghulam Rasool
- Dr. Ghulam Rasool, MBBS. Postgraduate FCPS-II Trainee, Dept. of Psychiatry & Behavioural Sciences, Jinnah Post Graduate Medical Centre (JPMC), Karachi, Pakistan
| | | | - Marriam Shaheen
- Dr. Marriam Shaheen, MBBS. Dow University of Health Sciences, Karachi, Pakistan
| | - Siddiqullah
- Dr. Siddiqullah, MBBS. Dow University of Health Sciences, Karachi, Pakistan
| | - M Shujauddin
- Dr. M. Shujauddin, MBBS. Dow University of Health Sciences, Karachi, Pakistan
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Pisanu C, Caproni S, Congiu D, Cupini LM, Squassina A, Patrinos GP, Corbelli I, Calabresi P, Del Zompo M, Sarchielli P. HDAC3 role in medication consumption in medication overuse headache patients: a pilot study. Hum Genomics 2015; 9:30. [PMID: 26542778 PMCID: PMC4635554 DOI: 10.1186/s40246-015-0051-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/26/2015] [Indexed: 12/13/2022] Open
Abstract
Background Medication overuse headache (MOH) is a common and debilitating disorder characterized by generation, perpetuation, and persistence of intense chronic migraine, caused by overuse of analgesics, triptans, or other acute headache compounds. It has been suggested that MOH could share some pathogenetic mechanisms with other kinds of drug addiction. In this regard, histone deacetylases 3 (HDAC3) seems to have a role in the memory processes involved in extinction of drug-seeking behavior in animal models. HDAC3 is inhibited by sodium valproate, a drug with proven efficacy in MOH. Recent evidence suggests an involvement of genetic factors in predisposition to medication overuse. Results In this association study, we sequenced all exons, intron/exon junctions, and 3′-5′UTR regions of HDAC3 in 23 MOH patients to investigate its role in medication overuse. Associations between genotypes with continuous and dichotomous clinical characteristics were tested by multivariate analysis and Fisher’s exact test, respectively. Sequencing of HDAC3 revealed six single-nucleotide polymorphisms. The G allele of rs2530223 was significantly associated with the number of acute medications/month used and with the number of days/month in which medications were used (p = 0.006 and p = 0.007, respectively), but neither with headache frequency or intensity. None of the single-nucleotide polymorphisms (SNPs) was associated with clinical characteristics or response to sodium valproate. Conclusions HDAC3 could be implicated in excessive medication consumption in MOH patients. Our preliminary findings provide support for the need of further investigation on larger independent samples to confirm and extend the role of HDAC3 in medication overuse headache.
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Affiliation(s)
- Claudia Pisanu
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, SP8 Km. 0,700, 09042, Monserrato (CA), Italy
| | | | - Donatella Congiu
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, SP8 Km. 0,700, 09042, Monserrato (CA), Italy
| | - Letizia M Cupini
- Headache and Cerebrovascular Diseases Center, Ospedale S. Eugenio, Rome, Italy
| | - Alessio Squassina
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, SP8 Km. 0,700, 09042, Monserrato (CA), Italy
| | - George P Patrinos
- Department of Pharmacy, University of Patras, School of Health Sciences, Patras, Greece.
| | | | - Paolo Calabresi
- Neurologic Clinic, University of Perugia, Perugia, Italy.,IRCCS Fondazione "S. Lucia", Rome, Italy
| | - Maria Del Zompo
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, SP8 Km. 0,700, 09042, Monserrato (CA), Italy. .,Institute of Neuroscience, CNR, Cagliari, Italy.
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Johnson JL, Kwok YH, Sumracki NM, Swift JE, Hutchinson MR, Johnson K, Williams DB, Tuke J, Rolan PE. Glial Attenuation With Ibudilast in the Treatment of Medication Overuse Headache: A Double-Blind, Randomized, Placebo-Controlled Pilot Trial of Efficacy and Safety. Headache 2015; 55:1192-208. [DOI: 10.1111/head.12655] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 01/08/2023]
Affiliation(s)
| | - Yuen H. Kwok
- Discipline of Pharmacology, University of Adelaide; Adelaide Australia
| | | | - James E. Swift
- Discipline of Pharmacology, University of Adelaide; Adelaide Australia
| | | | | | - Desmond B. Williams
- School of Pharmacy and Medical Sciences; University of South Australia; Adelaide Australia
| | - Jonathon Tuke
- School of Mathematical Sciences; University of Adelaide; Adelaide Australia
| | - Paul E. Rolan
- Discipline of Pharmacology, University of Adelaide; Adelaide Australia
- Pain and Anaesthesia Research Clinic, Royal Adelaide Hospital; Adelaide Australia
- Pain Management Unit, Royal Adelaide Hospital; Adelaide Australia
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Sarchielli P, Corbelli I, Messina P, Cupini LM, Bernardi G, Bono G, Di Piero V, Petolicchio B, Livrea P, Prudenzano MP, Pini LA, Sandrini G, Allena M, Tedeschi G, Russo A, Caproni S, Beghi E, Calabresi P. Psychopathological comorbidities in medication-overuse headache: a multicentre clinical study. Eur J Neurol 2015; 23:85-91. [PMID: 26228376 DOI: 10.1111/ene.12794] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/15/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE In medication-overuse headache (MOH) patients, the presence of psychopathological disturbances may be a predictor of relapse and poor response to treatment. This multicentre study aimed to assess the occurrence of psychopathological disorders in MOH patients by comparing the incidence of psychopathological disturbances with episodic migraine (EM) patients and healthy controls (HC). METHODS The psychopathological assessment of patients and HC involved the administrations of the Beck Depression Inventory, the Beck Anxiety Inventory, the Modified Mini International Neuropsychiatric Interview (M-MINI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Leeds Dependence Questionnaire. RESULTS The MOH, EM and HC groups (88, 129 and 102 subjects, respectively) differed significantly from each other for the presence of moderate/severe anxiety, whereas mood disorder and depression were revealed in similar proportions for both MOH and EM patients. By stratifying the M-MINI questionnaire results according to the number of psychiatric disorders, it was found that MOH patients had a more complex profile of psychiatric comorbidity. Furthermore, clinically relevant obsessive-compulsive disturbances for abused drugs assessed by Y-BOCS appeared to be more represented in the MOH group, whilst the prevalence of this trait in the EM group was comparable to that of HC (12.5%, 0.8% and 0%, respectively). CONCLUSIONS Our study indicates the multiple presence of psychopathological comorbidities in patients with MOH. In light of this, it is recommended that the assessment of the psychopathological profile be included in an evaluation of MOH patients, allowing the clinician to more rapidly start an appropriate behavioural treatment, which would greatly improve MOH management.
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Affiliation(s)
- P Sarchielli
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - I Corbelli
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - P Messina
- IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - L M Cupini
- Centro Cefalee e Malattie Cerebrovascolari, Ospedale S. Eugenio, Rome, Italy
| | - G Bernardi
- Clinica Neurologica, Policlinico TorVergata, Rome, Italy
| | - G Bono
- UCADH-Varese, Department Biotechnology and Life Sciences University of Insubria-Varese, Varese, Italy
| | - V Di Piero
- Dipartimento di Neurologia e Psichiatria, 'Sapienza' Università di Roma, Rome, Italy
| | - B Petolicchio
- Dipartimento di Neurologia e Psichiatria, 'Sapienza' Università di Roma, Rome, Italy
| | - P Livrea
- Clinica Neurologica, Policlinico di Bari, Bari, Italy
| | | | - L A Pini
- Centro Cefalee, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - G Sandrini
- Department of Brain and Behavioural Sciences, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - M Allena
- Department of Brain and Behavioural Sciences, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - G Tedeschi
- Clinica Neurologica, II Università degli Studi di Napoli, Napoli, Italy
| | - A Russo
- Clinica Neurologica, II Università degli Studi di Napoli, Napoli, Italy
| | - S Caproni
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - E Beghi
- IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - P Calabresi
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy.,IRCCS Fondazione 'S. Lucia', Rome, Italy
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Caproni S, Bianchi E, Cupini LM, Corbelli I, Beghi E, Calabresi P, Sarchielli P. Migraine-specific quality of life questionnaire and relapse of medication overuse headache. BMC Neurol 2015; 15:85. [PMID: 25991008 PMCID: PMC4460700 DOI: 10.1186/s12883-015-0339-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of Medication overuse headache (MOH) represents a difficult challenge for clinicians and headache experts, particularly for the responder rate after a successful withdrawal treatment. The purpose of this study was to investigate the role of demographic and clinical characteristics as well as the score of Migraine-Specific Quality of Life Questionnaire (MSQ), Migraine Disability Questionnaire and Leeds Dependence Questionnaire in predicting a response after a successful withdrawal treatment in patients with MOH. METHODS This ancillary study is part of a randomized trial that demonstrated the safety and the efficacy of a 3-month treatment with sodium valproate (VPA) (800 mg/day vs placebo) in MOH. Demographic and clinical characteristics and questionnaire results were obtained from the entire sample. RESULTS A significant correlation was found only between MOH relapse and the total MSQ score, the Role Preventive sub-scale and the Emotional Function sub-scale, suggesting a poorer quality of life in non responders. CONCLUSION A high MSQ score could be associated with a poor short-term outcome in MOH patients after a successful treatment with detoxification followed by a new treatment.
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Affiliation(s)
- Stefano Caproni
- Clinica Neurologica, Azienda Ospedaliera - Università di Perugia, Perugia, Italy.
| | - Elisa Bianchi
- IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Letizia M Cupini
- Centro Cefalee e Malattie Cerebrovascolari, Ospedale S. Eugenio, Rome, Italy.
| | - Ilenia Corbelli
- Clinica Neurologica, Azienda Ospedaliera - Università di Perugia, Perugia, Italy.
| | - Ettore Beghi
- IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Paolo Calabresi
- Clinica Neurologica, Azienda Ospedaliera - Università di Perugia, Perugia, Italy. .,IRCCS Fondazione "S. Lucia", Rome, Italy.
| | - Paola Sarchielli
- Clinica Neurologica, Azienda Ospedaliera - Università di Perugia, Perugia, Italy.
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Cargnin S, Pautasso C, Viana M, Sances G, Mittino D, Cantello R, Tassorelli C, Nappi G, Terrazzino S. Association ofRAMP1 rs7590387 With the Risk of Migraine Transformation Into Medication Overuse Headache. Headache 2015; 55:658-68. [DOI: 10.1111/head.12559] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Cargnin
- Department of Pharmaceutical Sciences; Università del Piemonte Orientale; Novara Italy
| | - Chiara Pautasso
- Department of Pharmaceutical Sciences; Università del Piemonte Orientale; Novara Italy
| | - Michele Viana
- Headache Science Centre; National Neurological Institute C. Mondino; Pavia Italy
| | - Grazia Sances
- Headache Science Centre; National Neurological Institute C. Mondino; Pavia Italy
| | - Daniela Mittino
- Division of Neurology; Maggiore Hospital; Università del Piemonte Orientale; Novara Italy
| | - Roberto Cantello
- Division of Neurology; Maggiore Hospital; Università del Piemonte Orientale; Novara Italy
| | - Cristina Tassorelli
- Headache Science Centre; National Neurological Institute C. Mondino; Pavia Italy
- Department of Brain and Behaviour; University of Pavia; Pavia Italy
| | - Giuseppe Nappi
- Headache Science Centre; National Neurological Institute C. Mondino; Pavia Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences; Università del Piemonte Orientale; Novara Italy
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Pathophysiology of Medication Overuse Headache: Current Status and Future Directions. PATHOPHYSIOLOGY OF HEADACHES 2015. [DOI: 10.1007/978-3-319-15621-7_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Caproni S, Bianchi E, Cupini LM, Corbelli I, Beghi E, Calabresi P, Sarchielli P. Long term headache duration is a factor predicting nonresponse to detoxification and advice in medication overuse headache. J Headache Pain 2014; 15:88. [PMID: 25510673 PMCID: PMC6755585 DOI: 10.1186/1129-2377-15-88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/15/2014] [Indexed: 01/03/2023] Open
Abstract
Background Medication overuse headache (MOH) is a very heterogeneous disorder for which a recommended treatment is not yet available. The purpose of this study was to investigate any possible roles of demographic and clinical characteristics of MOH patients that might predict a response to detoxification and advice with or without preventive treatment. Findings This ancillary study is part of the Sodium vAlproate in the treatment of Medication Overuse HeadAche (SAMOHA) study that randomized 88 MOH patients for 3-month treatment period with sodium valproate (VPA) (800 mg/day) or placebo after a 6-day outpatient detoxification regimen. Demographic and clinical characteristics obtained on patients from both study arms were analyzed to point out an association with the response to the treatment. While for patients from VPA arm no significant results were obtained, comparing responders to non-responders to detoxification and advice to withdraw from MOH, a significant difference in headache duration was observed. Specifically, the efficacy of such treatment resulted ineffective in headache lasting longer than 30 years. Conclusions Our findings suggest that the benefit from detoxification and advice can be excluded in MOH of long duration. Therefore, a preventive treatment is suggested particularly for these patients.
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Cargnin S, Viana M, Sances G, Bianchi M, Ghiotto N, Tassorelli C, Nappi G, Canonico PL, Genazzani AA, Terrazzino S. Combined effect of common gene variants on response to drug withdrawal therapy in medication overuse headache. Eur J Clin Pharmacol 2014; 70:1195-202. [PMID: 25096645 DOI: 10.1007/s00228-014-1726-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/29/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE No information is currently available on genetic determinants of short-term response to drug withdrawal in medication overuse headache (MOH). In the present study, we aimed to evaluate the role of 14 polymorphisms in 8 candidate genes potentially relevant for drug addiction (OPRM1, DRD2, DBH, COMT, BDNF, SLC6A4, 5HT2A, and SLC1A2) as predictors for detoxification outcome of MOH patients at 2 months of follow-up. METHODS Genotyping was conducted by PCR, PCR-RFLP analysis, or real-time PCR allelic discrimination assay on genomic DNA extracted from peripheral blood. The association between gene variants and risk of unsuccessful detoxification was evaluated by univariate and multivariate logistic regression analyses. RESULTS One hundred and eight MOH patients with effective drug withdrawal therapy and 65 MOH patients with unsuccessful detoxification were available for the analysis. In the multivariable logistic regression analysis, triptan overuse (odds ratio (OR) 0.271, 95% confidence interval (CI) 0.083-0.890, P = 0.031) and TT genotype carriage of DRD2 NcoI (OR 0.115, 95% CI 0.014-0.982, P = 0.048) emerged as independent predictors for unsuccessful detoxification. In addition, carriers of at least four of the six top-ranked gene variants (P < 0.10) were found at higher odds for unsuccessful detoxification than patients with ≤3 high-risk genotypes (OR 3.40, 95% CI 1.65-7.01, P = 0.001). CONCLUSION This exploratory study suggests that DRD2 NcoI may be a genetic determinant of detoxification outcome in MOH patients. Our findings also show that an approach based on the combination of multiple genetic markers could be clinically useful for identification of MOH patients at higher risk for unsuccessful detoxification.
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Affiliation(s)
- Sarah Cargnin
- Dipartimento di Scienze del Farmaco and Centro di Ricerca Interdipartimentale di Farmacogenetica e Farmacogenomica (CRIFF), Università del Piemonte Orientale "A. Avogadro", Largo Donegani 2, 28100, Novara, Italy
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Sodium valproate in migraine without aura and medication overuse headache: a randomized controlled trial. Eur Neuropsychopharmacol 2014; 24:1289-97. [PMID: 24862255 DOI: 10.1016/j.euroneuro.2014.03.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 03/20/2014] [Accepted: 03/27/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the efficacy, safety and tolerability of sodium valproate (800mg/die) compared with placebo in medication-overuse headache patients with a history of migraine without aura. METHODS This is a multicenter, randomized, double-blind, placebo-controlled study enrolled medication-overuse headache patients for a 3-month treatment period with sodium valproate (800mg/day) or placebo after a 6 day outpatient detoxification regimen, followed by a 3-month follow-up. Primary outcome was defined by the proportion of patients achieving ≥50% reduction in the number of days with headache per month (responders) from the baseline to the last 4 weeks of the 3-month treatment. Multivariate logistic regression models were used on the primary endpoint, adjusting for age, sex, disease duration, comorbidity and surgery. The last-observation-carried-forward method was used to adjust for missing values. RESULTS Nine sites enrolled 130 patients and, after a 6-day detoxification phase, randomized 88 eligible patients. The 3-month responder rate was higher in the sodium valproate (45.0%) than in the placebo arm (23.8%) with an absolute difference of about 20% (p=0.0431). Sodium valproate had safety and tolerability profiles comparable to placebo. CONCLUSIONS The present study supports the efficacy and safety of sodium valproate in the treatment of medication overuse headache with history of migraine after detoxification.
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