Migraine preventive treatment

Antibiotic-associated vanishing bile duct syndrome: a real-world retrospective and pharmacovigilance database analysis

PURPOSE

Vanishing bile duct syndrome (VBDS) is a rare, but potentially fatal adverse reaction triggered by certain medications. Few real-world studies have shown association between antibiotics and VBDS. We sought to quantify the risk and evaluate the clinical features of VBDS associated with antibiotics.

METHODS

Data from 2004 to 2022 on VBDS events induced by antibiotics were retrieved from the FDA Adverse Event Reporting System (FAERS) database and disproportionality analyses were conducted. Furthermore, case reports from 2000 to 31 December 2022 on antibiotics-induced VBDS were retrieved for retrospective analysis.

RESULTS

We collected 132 VBDS reports from the FAERS database. Fluoroquinolones had the greatest proportion and highest positive signal values of VBDS. The RORs (95% CIs) for antibiotics were fluoroquinolones 23.68 (18.12-30.95), macrolides 19.37 (13.58-27.62), carbapenems 17.39 (7.77-38.96), beta-lactam 13.28 (9.69-18.20), trimethoprim/sulfamethoxazole 9.05 (5.57-14.7), and tetracycline 4.02 (1.50-10.77). Twenty-three cases from 22 studies showed evidence of VBDS, beta-lactam (52.2%) was the most frequently reported agent. The median age was 45 years, the typical initial symptoms included rash (30.4%), fatigue/asthenia (26.1%), dark urine (21.7%) and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) (21.7%). The median time to onset of VBDS was 2 weeks. All cases had abnormal liver function test, and the median level of total bilirubin was 23.6 mg/dl (range 3.2-80 mg/dl). Cessation of culprit drugs and treatment with ursodeoxycholic acid (83.3%) were not associated with improved outcomes (57.1%).

CONCLUSION

This study identified thirteen antibacterial agents with significant reporting associations with VBDS. Fluoroquinolones may be a neglected agent of inducing VBDS.

Do doctors treat themselves differently than their patients? Study on the self-treatment of migraine among German neurologists and pain specialists

AIM

To investigate whether the self-treatment of migraine among neurologists and pain specialists corresponds to national medical guidelines and treatment of patients.

METHODS

An email cross-sectional survey was sent to members of the German Society for Neurology, German Pain Society and German Migraine and Headache Society containing questions on demographics, professional experience and specialization and - in case participants suffered from migraine - questions about their migraine and its treatment.

RESULTS

175/418 (41.9%) participants suffered from migraine (m: 29.3%; f: 55.2%, 45.9 ± 10.7 years). For acute migraine attacks, 96.6 % of them use a first-line treatment according to the medical guidelines. Seventeen (9.7%) are currently taking a migraine prophylaxis, 52.9% of these use a recommended first-line prophylaxis. In all, 21.7% are not taking a prophylactic treatment despite an indication (based on number of monthly migraine days) for it, due to fear of side-effects, low intensity of migraine attacks and a sufficient effect of acute medication. This group of participants was younger, less experienced and specialized and was mainly employed (vs. self-employed) compared to those taking a prophylaxis. A total of 96.6% reported treating their patients in line with current guidelines; 14.3% would treat themselves differently when they were their own patients.

CONCLUSION

The self-treatment of acute migraine attacks for the most part complies with the guidelines but, regarding the indication for a prophylaxis, a more divergent treatment approach was observed among younger, less experienced physicians. For the majority of physicians there is no difference between self-treatment and treatment of migraine patients.

Evaluation of headache and regional cerebral flood flow in patients with migraine

PURPOSE OF THE REPORT

The aim of this study is to observe the abnormalities of regional cerebral blood flow (rCBF) in migraine patients and to evaluate its relation to the severity of the headache in patients with migraine.

PATIENTS AND METHODS

The rCBF imaging was done on 19 patients with migraine and 15 normal controls using single-photon emission computed tomography (SPECT). The abnormal character of cerebral perfusion function was analyzed with Statistical Parametric Mapping (SPM) software, and the headache grade of patients was evaluated with the headache severity measuring scale.

RESULTS

The results of SPM analysis demonstrated a decreased rCBF on both sides of the frontal and temporal lobes, left parietal lobe, and right occipital lobe (P < 0.001), and increased rCBF focus on the left prefrontal lobe and right temporal lobe (P < 0.001). The headache scores in migraineurs were correlated to the rCBF on the bilateral temporal lobes and right frontal lobe (P < 0.001).

CONCLUSIONS

The migraineurs had lower rCBF at the frontal and temporal lobes, and the lower rCBF was correlated to the degree of headache.