1
|
Carlsen LN, Stefansen S, Ahnfeldt-Mollerup P, Højland Jensen R, Saxhaug Kristoffersen E, Møller Hansen J, Lykkegaard J. Diagnostics and management of headache in general practice. Fam Pract 2024; 41:470-476. [PMID: 36308304 DOI: 10.1093/fampra/cmac121] [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] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Headache disorders are globally prevalent and insufficient treatment contribute to low quality of life, increased disability, and socioeconomic costs. However, headache can to a large extent be treated appropriately by general practitioners. OBJECTIVE To explore general practitioners' (GPs') management of patients with headache lasting ≥6 months. METHODS In this retrospective descriptive cross-sectional study based on medical audit, all GPs practicing in Vejle municipality (population 116,992), Denmark, were invited to review their latest 20 patients with headache. Outcome measures were headache diagnostics, treatment, and referrals. Factors associated with referral to neurological treatment were examined by logistic regression. RESULTS Of 26 invited practices, 19 participated reporting on 367 patients with lasting headache (71.4% women; mean-age 48.5 years). One hundred and sixty-one patients had migraine (44%; IQR: 28-60%), 140 (38%; IQR: 25-44%) had tension-type headache; 243 (66%; IQR: 50-79%) used simple analgesics, 147 (40%; IQR: 29-59%) triptans, 37 (10%; IQR: 0-14%) opioids, 93 (25%; IQR: 20-35%) were prescribed preventive medication; 176 (48%; IQR: 48-59%) were referred to neurologist, and 92 (25%; IQR: 10-37%) were referred to CT or MRI scan. Associated factors for referral were >1 headache diagnosis (aOR 1.75 [95% CI: 1.05-2.95]; P = 0.03), post-traumatic headache (aOR 2.53 [95% CI: 1.25-5.38]; P = 0.01), unspecific headache (aOR 2.04 [95% CI: 1.08-3.93]; P = 0.03), and using preventive treatment (aOR 2.75 [95% CI: 1.68-4.57]; P < 0.001). CONCLUSION This study provides insights to how GPs manage patients with long-lasting headache. Focus should be on reducing opioids, increasing preventive treatment, and keeping more patients in primary care.
Collapse
Affiliation(s)
- Louise Ninett Carlsen
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
- Danish Knowledge Center on Headache Disorders, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Simon Stefansen
- Danish Knowledge Center on Headache Disorders, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Peder Ahnfeldt-Mollerup
- GP Cluster in Vejle, Vejle, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | | | - Jakob Møller Hansen
- Danish Knowledge Center on Headache Disorders, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Jesper Lykkegaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Stubberud A, Borkenhagen S, Oteiza F, Dueland AN, Bugge C, Sæther EM, Tronvik E, Stovner LJ, Bjørk MH. Patterns of migraine medication use in Norway: A nationwide registry-based observational study. Cephalalgia 2024; 44:3331024241268212. [PMID: 39149980 DOI: 10.1177/03331024241268212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
OBJECTIVE The objective of this study was to describe and discuss patterns of migraine medication use in the entire Norwegian population. METHODS In this nationwide, observational study, all individuals with a migraine-related prescription between 2010 and 2020 were identified using the Norwegian Prescription Database. The outcomes of interest were the incidence and 1-year prevalence of migraine medication users, as well as individuals with triptan overuse. Patterns of medication use were statistically compared between women and men adjusted for age, year of treatment start, comorbidities and county of residence calculating adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS We identified 327,904 migraine medication users. The incidence ranged from 0.39% to 0.46%, and the 1-year prevalence increased from 1.99% to 2.99%. Preventive use increased >50% during the study period. Preventives were significantly more often prescribed to women than to men (39.72% vs. 33.75%; aOR 1.41, 95% CI 1.38 to 1.44). Triptan overuse was significantly more common among women, but women with overuse were more often using preventives, as compared to men (56.64% vs 52.69%; aOR = 1.43, 95% CI 1.37 to 1.49). CONCLUSION The prevalence of medically treated migraine is low. Overuse of triptans is frequent, especially among women. Clinicians should be encouraged to try out different triptans, recognize triptan overuse, and prescribe preventives when indicated.
Collapse
Affiliation(s)
- Anker Stubberud
- NorHEAD Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | - Christoffer Bugge
- Oslo Economics, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | | | - Erling Tronvik
- NorHEAD Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
| | - Lars Jacob Stovner
- NorHEAD Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
| | - Marte-Helene Bjørk
- NorHEAD Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
3
|
Chatterjee JH, Blume HK. Triptans in the Acute Migraine Management of Children and Adolescents: An Update. Curr Pain Headache Rep 2024; 28:641-649. [PMID: 38581536 DOI: 10.1007/s11916-024-01213-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE OF REVIEW To summarize recent findings regarding triptan use in the acute treatment of pediatric migraine. RECENT FINDINGS Prevalence of pediatric migraine is rising. The American Headache Society and American Academy of Neurology updated guidelines to provide evidence-based recommendations for the treatment of acute migraine in youth. In the setting of a dearth of new randomized controlled trials (RCTs), we review current guidelines, triptan use in the emergency department, and an era of secondary analyses. Measuring the efficacy of triptans in pediatric migraine has been challenged by high placebo response rates. Secondary analyses, combining data from multiple RCTs, support that triptans are safe and effective in the treatment of migraine. Triptans are a vital tool and the only FDA-approved migraine-specific treatment available in pediatrics. There is a need for further studies and funding support in pediatric headache medicine.
Collapse
Affiliation(s)
- Jessica Hauser Chatterjee
- University of Washington School of Medicine, Department of Neurology, Division of Child Neurology and Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Heidi K Blume
- Child Neurology, Seattle Children's Hospital, 4800 Sand Point Way NE, MB 7.420 Box 5371, Seattle, WA, 98105, USA
| |
Collapse
|
4
|
Lyu S, Zhang CS, Zhang AL, Guo X, Hua R, Mao Z, Su Q, Xue CC, Sun J. Real-world observations and impacts of Chinese herbal medicine for migraine: results of a registry-based cohort study. Front Pharmacol 2024; 15:1330589. [PMID: 38370478 PMCID: PMC10874640 DOI: 10.3389/fphar.2024.1330589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
Background: Migraine is a prevalent, recurrent condition with substantial disease burden. Chinese herbal medicine (CHM) has been used frequently for migraine in controlled clinical settings. This study is to summarise the characteristics of patients who seek clinical care in a tertiary Chinese medicine hospital in China; to gather their preferences and values of using CHM; to explore the effect of CHM for migraine and its comorbidities in a real-world setting, and to collect first-hand expertise of clinicians' practice pattern in prescribing CHM for migraine. Methods: This registry-based cohort study was prospectively conducted at Guangdong Provincial Hospital of Chinese Medicine from December 2020 to May 2022. Adult migraine patients seeking their initial anti-migraine clinical care at the hospital were consecutively recruited and followed up for 12 weeks. Practitioners specialised in headache management prescribed individualised treatments without research interference. Standardised case report forms were employed to gather information on patients' preferences and perspective of seeking clinical care, as well as to assess participants' migraine severity, comorbidities, and quality of life, at 4-weeks intervals. Various analytical methods were utilised based on the computed data. Results: In this study, we observed 248 participants. Of these, 73 received CHM treatment for 28 days or longer. Notably, these participants exhibited a greater disease severity, compared to those treated with CHM for less than 28 days. Of the 248 participants, 83.47% of them expected CHM would effectively reduce the severity of their migraine, around 50% expected effects for migraine-associated comorbidities, while 51.61% expressing concerns about potential side effects. CHM appeared to be effective in reducing monthly migraine days and pain intensity, improving patients' quality of life, and potentially reducing comorbid anxiety, with a minimum of 28 days CHM treatment. Herbs such as gan cao, gui zhi, chuan xiong, fu ling, bai zhu, yan hu suo, etc. were frequently prescribed for migraine, based on patients' specific symptoms. Conclusion: CHM appeared to be beneficial for migraine and comorbid anxiety in real-world clinical practice when used continuously for 28 days or more. Clinical Trial Registration: clinicaltrials.gov, identifier ChiCTR2000041003.
Collapse
Affiliation(s)
- Shaohua Lyu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The China-Australia International Research Centre for Chinese Medicine, STEM College, RMIT University, Melbourne, VIC, Australia
| | - Claire Shuiqing Zhang
- The China-Australia International Research Centre for Chinese Medicine, STEM College, RMIT University, Melbourne, VIC, Australia
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, STEM College, RMIT University, Melbourne, VIC, Australia
| | - Xinfeng Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Rong Hua
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Zhenhui Mao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Qiaozhen Su
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Charlie Changli Xue
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The China-Australia International Research Centre for Chinese Medicine, STEM College, RMIT University, Melbourne, VIC, Australia
| | - Jingbo Sun
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine and Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou, China
| |
Collapse
|
5
|
Chiang CC, Fang X, Horvath Z, Cadiou F, Urani A, Poh W, Narimatsu H, Cheng Y, Dodick DW. Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users' Self-Reported Records From a Smartphone Application. Neurology 2023; 101:e2560-e2570. [PMID: 38030397 PMCID: PMC10791049 DOI: 10.1212/wnl.0000000000207964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Many acute treatment options exist for migraine. However, large-scale, head-to-head comparisons of treatment effectiveness from real-world patient experience reports are lacking. METHODS This is a retrospective analysis of 10,842,795 migraine attack records extracted from an e-diary smartphone application between June 30, 2014, and July 2, 2020. We analyzed 25 acute medications among 7 classes-acetaminophen, nonsteroid anti-inflammatory drugs (NSAIDs), triptans, combination analgesics, ergots, antiemetics, and opioids. Gepants and ditan were not included in this analysis. Different doses and formulations of each medication, according to the generic names, were combined in this analysis. We used a 2-level nested logistic regression model to analyze the odds ratio (OR) of treatment effectiveness of each medication by adjusting concurrent medications and the covariance within the same user. Subgroup analyses were conducted for users in the United States, the United Kingdom, and Canada. RESULTS Our final analysis included 4,777,524 medication-outcome pairs from 3,119,517 migraine attacks among 278,006 users. Triptans (mean OR 4.8), ergots (mean OR 3.02), and antiemetics (mean OR 2.67) were the top 3 classes of medications with the highest effectiveness, followed by opioids (mean OR 2.49), NSAIDs (other than ibuprofen, mean OR 1.94), combination analgesics (acetaminophen/acetylsalicylic acid/caffeine) (OR 1.69, 95% CI 1.67-1.71), others (OR 1.49, 95% CI 1.47-1.50), and acetaminophen (OR 0.83, 95% CI 0.83-0.84), using ibuprofen as the reference. Individual medications with the highest ORs were eletriptan (OR 6.1, 95% CI 6.0-6.3), zolmitriptan (OR 5.7, 95% CI 5.6-5.8), and sumatriptan (OR 5.2, 95% CI 5.2-5.3). The ORs of acetaminophen, NSAIDS, combination analgesics, and opioids were mostly around or less than 1, suggesting similar or lower reported effectiveness compared with ibuprofen. The ORs for 24 medications, except that of acetylsalicylic acid, achieved statistical significance with p < 0.0001, and our nested logistic regression model achieved an area under the curve (AUC) of 0.849. Country-specific subgroup analyses revealed similar ORs of each medication and AUC (United States 0.849, United Kingdom 0.864, and Canada 0.842), demonstrating the robustness of our analysis. DISCUSSION Using a big data approach, we analyzed patient-generated real-time records of 10 million migraine attacks and conducted simultaneous head-to-head comparisons of 25 acute migraine medications. Our findings that triptans, ergots, and antiemetics are the most effective classes of medications align with the guideline recommendations and offer generalizable insights to complement clinical practice. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with migraine, selected acute medications (e.g., triptans, ergots, antiemetics) are associated with higher odds of user-rated positive response than ibuprofen.
Collapse
Affiliation(s)
- Chia-Chun Chiang
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Xuemin Fang
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Zsolt Horvath
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Francois Cadiou
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Alexandre Urani
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Weijie Poh
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Hiroto Narimatsu
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - Yu Cheng
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| | - David W Dodick
- From the Department of Neurology (C.-C.C.), Mayo Clinic, Rochester, MN; Graduate School of Health Innovation (X.F., H.N.), Kanagawa University of Human Services, Kawasaki; IBM Client Engineering (X.F.), Banking Financial Market Unit, Chuo-Ku, Tokyo, Japan; Healint Pte. Ltd. (Z.H., F.C., A.U., W.P.), Singapore; Cancer Prevention and Cancer Control Division (H.N.), Kanagawa Cancer Center Research Institute; Department of Genetic Medicine (H.N.), Kanagawa Cancer Center, Yokohama, Japan; Department of Statistics (Y.C.), University of Pittsburgh, PA; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ
| |
Collapse
|
6
|
Wells-Gatnik WD, Martelletti P. Gepants in the acute management of migraine. Pain Manag 2023; 13:627-630. [PMID: 37942638 DOI: 10.2217/pmt-2023-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
|
7
|
Juhasz G, Gecse K, Baksa D. Towards precision medicine in migraine: Recent therapeutic advances and potential biomarkers to understand heterogeneity and treatment response. Pharmacol Ther 2023; 250:108523. [PMID: 37657674 DOI: 10.1016/j.pharmthera.2023.108523] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
After 35 years since the introduction of the International Classification of Headache Disorders (ICHD), we are living in the era of the second great revolution in migraine therapies. First, discoveries of triptans provided a breakthrough in acute migraine treatment utilizing bench-to-bedside research results on the role of serotonin in migraine. Next, the discovery of the role of neuropeptides, more specifically calcitonin gene-related peptide (CGRP) in migraine attack led to the development of anti-CGRP therapies that are effective both in acute and preventive treatment, and are also able to reduce migraine-related burden. Here, we reviewed the most recent clinical studies and real-world data on available migraine-specific medications, including triptans, ditants, gepants and anti-CGRP monoclonal antibodies. Novel drug targets, such as PACAP and amylins were also discussed. To address the main challenges of migraine therapy, the high heterogeneity of people with migraine, the prevalent presence of various comorbid disorders, and the insufficient medical care of migraine patients were covered. Promising novel approaches from the fields of omics, blood and saliva biomarker, imaging and provocation studies might bring solutions for these challenges with the potential to identify further drug targets, distinguish more homogeneous patient subgroups, contribute to more optimal drug selection strategies, and detect biomarkers in association with headache features or predicting treatment efficacy. In the future, the combined analysis of data of different biomarker modalities with machine learning algorithms may serve precision medicine in migraine treatment.
Collapse
Affiliation(s)
- Gabriella Juhasz
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary; NAP3.0 Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
| | - Kinga Gecse
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary; NAP3.0 Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Daniel Baksa
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary; NAP3.0 Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary; Department of Personality and Clinical Psychology, Institute of Psychology, Faculty of Humanities and Social Sciences, Pazmany Peter Catholic University, Budapest, Hungary
| |
Collapse
|
8
|
Battista S, Lazzaretti A, Coppola I, Falsiroli Maistrello L, Rania N, Testa M. Living with migraine: A meta-synthesis of qualitative studies. Front Psychol 2023; 14:1129926. [PMID: 37057143 PMCID: PMC10086165 DOI: 10.3389/fpsyg.2023.1129926] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionMigraine is one of the top ten causes of disability worldwide. However, migraine is still underrated in society, and the quality of care for this disease is scant. Qualitative research allows for giving voice to people and understanding the impact of their disease through their experience of it. This study aims at synthesising the state of the art of qualitative studies focused on how people with migraine experience their life and pathology.MethodsMEDLINE via PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library were consulted up to November 2021 for qualitative studies. Studies to be eligible had to focus on adults (age > 18 years) with a diagnosis of primary episodic or chronic migraine following the International Classification of Headache. The quality of the study was analysed using the CASP (Critical Appraisal Skills Programme) tool. The synthesis was done through a thematic analysis. CERQual (Confidence in Evidence from Reviews of Qualitative research) approach was used to assess the confidence in retrieved evidence.ResultsTen studies were included, counting 262 people with migraine. Our synthesis produced four main themes. (1) “Negative impact of migraine symptoms on overall life” as migraine negatively impacts people's whole life. (2) “Impact of migraine on family, work and social relationship” as migraine reduces the possibility to focus at work and interact with people. (3) “Impact of migraine on emotional health” as people with migraine experience psychological distress. (4) “Coping strategies to deal with migraine” such as keep on living one's own life, no matter the symptoms.ConclusionsMigraine negatively impacts people's whole life, from private to social and work sphere. People with migraine feel stigmatised as others struggle with understanding their condition. Hence, it is necessary to improve awareness among society of this disabling condition, and the quality of care of these people, tackling this disease from a social and health-policy point of view.
Collapse
Affiliation(s)
- Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Arianna Lazzaretti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
| | - Ilaria Coppola
- Department of Education Sciences, School of Social Sciences, University of Genova, Genova, Italy
| | - Luca Falsiroli Maistrello
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
- Department of Physical Medicine and Rehabilitation, AULSS9 Scaligera, G. Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Nadia Rania
- Department of Education Sciences, School of Social Sciences, University of Genova, Genova, Italy
| | - Marco Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
- *Correspondence: Marco Testa
| |
Collapse
|
9
|
Do TP, Dømgaard M, Stefansen S, Steiner TJ, Ashina M. Characterizing healthcare utilization patterns in a Danish population with headache: results from the nationwide headache in Denmark (HINDER) panel. J Headache Pain 2023; 24:18. [PMID: 36829124 PMCID: PMC9951480 DOI: 10.1186/s10194-023-01553-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Worldwide, far from all of those who would benefit make use of headache services, largely because of clinical, social, and political barriers to access. Identifying the factors contributing to low healthcare utilization can generate evidence to guide health policy. Our purpose here is better to characterize healthcare utilization patterns in Denmark. METHODS The Headache in Denmark (HINDER) study is a nationwide cross-sectional survey of people with headache, conducted using SurveyXact (Rambøll Group A/S, Copenhagen). Healthcare utilization was assessed in a study sample generated by population screening and recruitment. Data collection occurred over two weeks, from September 23rd until October 4th, 2021. The questions enquired into disease characteristics, management, burden, medication intake and healthcare utilization. RESULTS The number of participants included in the HINDER panel was 4,431, with 2,990 (67.5%: 2,522 [84.3%] female, 468 [15.7%] male; mean age 40.9 ± 11.6 years) completing the survey. One quarter of participants (27.7%) disagreed or strongly disagreed that they were able to manage their headache attacks. Most participants (81.7%) agreed or strongly agreed that their headache was a burden in their everyday lives. The most reported acute medications, by 87.2% of participants, were simple analgesics; of note, 8.6% reported using opioids for their headache. One quarter of participants (24.4%) had never consulted a medical doctor for their headache; one in six (16.5%: more than two thirds of the 24.4%) had never done so despite agreeing or strongly agreeing that their headache was a burden in their everyday lives. Two thirds (65.3%) of participants overall, and almost three quarters (72.4%) of those with weekly headache, had tried one or more complementary or alternative therapies outside conventional medical care. CONCLUSIONS Our findings are indicative of inadequate delivery of headache care in a country that provides free and universal coverage for all its residents. The implications are twofold. First, it is not sufficient merely to make services available: public education and increased awareness are necessary to encourage uptake by those who would benefit. Second, educational interventions in both pre- and postgraduate settings are necessary, but a prerequisite for these is a resetting of policy priorities, properly to reflect the very high population ill-health burden of headache.
Collapse
Affiliation(s)
- Thien Phu Do
- grid.475435.4Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark ,Danish Knowledge Center On Headache Disorders, Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikala Dømgaard
- Danish Knowledge Center On Headache Disorders, Glostrup, Denmark
| | - Simon Stefansen
- Danish Knowledge Center On Headache Disorders, Glostrup, Denmark
| | - Timothy J. Steiner
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway ,grid.7445.20000 0001 2113 8111Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. .,Danish Knowledge Center On Headache Disorders, Glostrup, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
10
|
Gupta S, Perla A, Roy A, Vitore JG, K B, Salave S, Rana D, Sharma A, Rathod R, Kumar H, Benival D. In Vivo Evaluation of Almotriptan malate Formulation through Intranasal Route for the Treatment of Migraine: Systematic Development and Pharmacokinetic Assessment. AAPS PharmSciTech 2023; 24:32. [PMID: 36627414 DOI: 10.1208/s12249-022-02496-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Migraine headaches are usually intolerable, and a quick-relief treatment remains an unmet medical need. Almotriptan malate is a serotonin (5-HT1B/1D) receptor agonist approved for the treatment of acute migraine in adults. It is currently available in an oral tablet dosage form and has a Tmax of 1-3 h, and therefore, there is a medical need to develop a non-invasive rapidly acting formulation. We have developed an intranasal formulation of almotriptan malate using the quality-by-design (QbD) approach. A 2-factor 3-level full factorial design was selected to build up the experimental setting. The developed formulation was characterized for pH, viscosity, in vitro permeation, ex vivo permeation, and histopathological tolerance. To assess the potential of the developed formulation to produce a rapid onset of action following intranasal delivery, a pharmacokinetic study was performed in the Sprague-Dawley rat model and compared to the currently available marketed oral tablet formulation. For this, the LC-MS/MS bioanalytical method was developed and used for the determination of plasma almotriptan malate concentrations. Results of a pharmacokinetic study revealed that intranasal administration of optimized almotriptan malate formulation enabled an almost five-fold reduction in Tmax and about seven-fold increase in bioavailability in comparison to the currently available oral tablet formulation, suggesting the potential of developed almotriptan malate intranasal formulation in producing a rapid onset of action as well as enhanced bioavailability.
Collapse
Affiliation(s)
- Shubham Gupta
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Akhil Perla
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Abhishek Roy
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Jyotsna G Vitore
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Bharathi K
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Sagar Salave
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Dhwani Rana
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Amit Sharma
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Rajeshwari Rathod
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Hemant Kumar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India
| | - Derajram Benival
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A), Gandhinagar, 382355, India. .,Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), Gandhinagar, 382355, Gujarat, India.
| |
Collapse
|
11
|
Erikstrup C, Sørensen E, Nielsen KR, Bruun MT, Petersen MS, Rostgaard K, Thørner LW, Larsen M, Mikkelsen S, Dinh KM, Schwinn M, Rigas AS, Didriksen M, Dowsett J, von Stemann JH, Brodersen T, Paulsen IW, Hindhede L, Sækmose SG, Kaspersen KA, Boldsen JK, Kjerulff B, Werge T, Brunak S, Banasik K, Hansen TF, Ullum H, Hjalgrim H, Ostrowski SR, Pedersen OB. Cohort Profile: The Danish Blood Donor Study. Int J Epidemiol 2022:6747973. [PMID: 36194120 DOI: 10.1093/ije/dyac194] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kaspar R Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Mie T Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Mikkel S Petersen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lise W Thørner
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Margit Larsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Khoa M Dinh
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Schwinn
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas S Rigas
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Didriksen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joseph Dowsett
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jakob H von Stemann
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thorsten Brodersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Isabella W Paulsen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Lotte Hindhede
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne G Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Kathrine A Kaspersen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.,Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Jens K Boldsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.,Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Bertram Kjerulff
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.,Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark.,LF Center for GeoGenetics, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark.,iPSYCH Initiative, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karina Banasik
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas F Hansen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Glostrup, Denmark
| | | | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Haematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole B Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|