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Caronna E, Gallardo VJ, Alpuente A, Torres-Ferrus M, Pozo-Rosich P. Epidemiology, work and economic impact of migraine in a large hospital cohort: time to raise awareness and promote sustainability. J Neurol 2021; 269:1456-1462. [PMID: 34282471 DOI: 10.1007/s00415-021-10715-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Migraine is not routinely assessed at work, making impossible to realize its impact and the potential benefit of migraine-related health strategies. We aimed to assess epidemiology, work and economic impact of migraine in a workplace cohort of a tertiary hospital. METHODS Cross-sectional analysis of a cohort of employees working in a Spanish tertiary hospital. Through a web questionnaire, we screened participants for migraine, collecting demographic data, work characteristics, work impairment due to headache (WPAI), treatments and healthcare resource utilization. We calculated direct and indirect costs for the hospital. RESULTS Six hundred sixty-seven employees participated (8.8%). 71.2% (475/667) fulfilled criteria for migraine, being 76.8% (365/475) low-frequency episodic migraine (LFEM), 12.6% (60/475) high-frequency episodic migraine (HFEM) and 10.5% (50/475) chronic migraine (CM). Only 56.2% (267/475) were aware of suffering from migraine. Only 43.3% (26/60) of HFEM and 56.0% (28/50) of CM have been on preventive treatment in the last year. Migraine caused an overall economic loss for the hospital of 439,848.90 €/month, as a result of utilization of healthcare resources at the workplace (136,028.0 €/month) and indirect costs (absenteeism + presenteeism: 303,820.90 €/month). Specifically, only 110 participants (HFEM + CM) were responsible for half of indirect costs (165,017.2€/month). CONCLUSIONS Although healthcare professionals have greater knowledge on health issues, migraine is underdiagnosed and undertreated, leading to a significant economic loss for the hospital. These results urge companies to assess migraine and promote stronger and migraine-specific health strategies at the workplace as a way to improve their own economic sustainability and the burden of migraine in their workforce.
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Affiliation(s)
- Edoardo Caronna
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain.,Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Victor José Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain.,Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain.,Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain. .,Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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Abstract
BACKGROUND In this study, we will assess the efficacy and safety of metoclopramide for the treatment of acute migraine (AM). METHODS We will comprehensively search Cochrane Library, PUMBED, EMBASE, Google Scholar, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the inception to July 1, 2019 to identify any eligible studies. Only randomized controlled trials will be considered for inclusion. The study selection, data collection, and management will be completed by two authors independently. The risk of bias will be assessed using Cochrane risk of bias tool. RevMan 5.3 software will be used for statistical analysis. RESULTS The primary outcome includes pain intensity, as measured by visual analogue scale or others. The secondary outcomes are success rate, requirement of rescue medicine, quality of life, relapse, and adverse events. CONCLUSIONS This study will summarize the latest evidence for the clinical efficacy and safety of metoclopramide for the treatment of AM. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019142795.
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Affiliation(s)
- Chao Jiang
- The Third Department of Neurology, The Second Affiliated Hospital of Xi’an Medical University, Xi’an
- Department of Emergency, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Ting Wang
- School of Economics and Management, Xi Dian University, Xi’an
| | - Zheng-guo Qiu
- Department of Anesthesiology, The Second Affiliated Hospital of Xi’an Medical University
| | - Bo Chen
- Department of Anesthesiology, The Hospital of Xidian Group, Xi’an, Shaanxi, China
| | - Bang-jiang Fang
- Department of Emergency, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai
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3
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Viticchi G, Falsetti L, Bartolini M, Buratti L, Ulissi A, Baldassari M, Provinciali L, Silvestrini M. Migraine: incorrect self-management for a disabling disease. Neurol Int 2018; 10:7510. [PMID: 29844888 PMCID: PMC5937218 DOI: 10.4081/ni.2018.7510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/22/2018] [Indexed: 12/23/2022] Open
Abstract
Migraine is an economically and socially relevant pathology but patients' consciousness and consequently a proper management is often unsatisfactory. In this study, we aimed to evaluate the disease awareness, the general approach and the impact on working activity in a population of headache-affected hospital workers. During an 18-month period, hospital workers responded to a questionnaire investigating headache presence, characteristics and awareness. Specific attention was paid to define headache impact on working activities. 1774 consecutive subjects were enrolled. Headache was documented in 45.7% of the sample, migraine in 16.6%. 40.6% of the patients with headache and 50.7% of the migraneous subjects had a specialist medical evaluation. Triptans use was significantly lower than non-steroidal anti-inflammatory drugs use. 39.5% of migraneous complained of attacks during working time, 60.2% acknowledged a negative influence on work quality. 25.5% of migraneous patients reported a loss of working days attributable to the disease. Migraine is disabling for workers with negative consequences on job capacity and quality. Efforts should be made to improve disease awareness to stimulate a better diagnostic and therapeutic approach.
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Affiliation(s)
| | | | | | - Laura Buratti
- Neurological Clinic, Marche Polytechnic University, Ancona
| | - Alfio Ulissi
- Occupational Medicine Ward, Ospedali Riuniti Ancona, Italy
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4
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Lardon A, Girard MP, Zaïm C, Lemeunier N, Descarreaux M, Marchand AA. Effectiveness of preventive and treatment interventions for primary headaches in the workplace: A systematic review of the literature. Cephalalgia 2016; 37:64-73. [PMID: 26935099 DOI: 10.1177/0333102416636096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim The purpose of this systematic literature review is to assess the benefits of workplace-based occupational therapies and interventions, including acute and preventive medication, on headache intensity and frequency, related disability as well as work-related outcomes. Methods A search of the literature was conducted in PubMed, MEDLINE, Cochrane library, CINAHL and Embase using terms related to headache, workplace and occupational health. The Cochrane Collaboration's risk of bias assessment tool was used on individual studies to assess internal validity and the Grading of Recommendations Assessment, Development, and Evaluation system was applied to studies by clinical outcome and used to rate quality of evidence. Results Fifteen articles were included in the systematic review. None of them were classified as low risk of bias according to the Cochrane Collaboration's tool for assessing risk of bias. This systematic review found preliminary low-quality evidence suggesting that exercise and acupuncture can reduce workers' headache pain intensity, frequency and related disability. Conclusion Although this systematic review provided preliminary low evidence in favour of work-based intervention, studies with more rigorous designs and methodologies are needed to provide further evidence of the effectiveness of workplace-based headache management strategies.
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Affiliation(s)
- Arnaud Lardon
- 1 Université du Québec à Trois-Rivières, Canada.,2 Institut Franco-Européen de Chiropraxie, France
| | - Marie-Pier Girard
- 1 Université du Québec à Trois-Rivières, Canada.,3 Université de Montréal, Canada
| | | | - Nadège Lemeunier
- 2 Institut Franco-Européen de Chiropraxie, France.,4 University of Ontario Institute of Technology, Canada
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5
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Raggi A, Covelli V, Leonardi M, Grazzi L, Curone M, D’Amico D. Difficulties in work-related activities among migraineurs are scarcely collected: results from a literature review. Neurol Sci 2014; 35 Suppl 1:23-6. [DOI: 10.1007/s10072-014-1736-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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6
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Millier A, Cohen J, Toumi M. Economic impact of a triptan Rx-to-OTC switch in six EU countries. PLoS One 2013; 8:e84088. [PMID: 24367628 PMCID: PMC3868654 DOI: 10.1371/journal.pone.0084088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/19/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Triptans have been safely and effectively used in the management of migraine for more than fifteen years, and it seems reasonable to wonder what would be the economic impact of moving a specific triptan to OTC availability. The objective of this study was then to examine the economic impact of payer policies of a triptan Rx-to-OTC switch in six EU countries (France, UK, Spain, Italy, Germany and Poland). METHODS A decision model was used to model the budgetary impact of a triptan Rx-to-OTC switch from the third-party payer (TPP) and the societal perspectives, using a one-year timeframe. RESULTS From the TPP perspective, it is estimated that the current overall direct spending on the management of migraine attacks across the 6 EU Member States is €582 million annually, and that the savings would reach €75 million (13% of the overall direct economic burden of migraine). From the societal perspective, €86 million annually would be added. CONCLUSIONS Given evidence of effectiveness and safety, and given the potential savings, a triptan Rx-to-OTC switch is a reasonable public policy decision.
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Affiliation(s)
- Aurelie Millier
- Health Economics and Outcomes Research Department, Creativ-Ceutical, Paris, France
| | - Joshua Cohen
- Tufts Center for the Study of Drug Development, Tufts University, Boston, Massachusetts, United States of America
| | - Mondher Toumi
- Unité de Formation et de Recherche d'Odontologie, Université Claude Bernard Lyon I, Lyon, France
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Raggi A, Leonardi M, Bussone G, D'Amico D. A 3-Month Analysis of Disability, Quality of Life, and Disease Course in Patients With Migraine. Headache 2012; 53:297-309. [DOI: 10.1111/j.1526-4610.2012.02279.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2012] [Indexed: 01/11/2023]
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Raggi A, Giovannetti AM, Quintas R, D'Amico D, Cieza A, Sabariego C, Bickenbach JE, Leonardi M. A systematic review of the psychosocial difficulties relevant to patients with migraine. J Headache Pain 2012; 13:595-606. [PMID: 23001069 PMCID: PMC3484254 DOI: 10.1007/s10194-012-0482-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/30/2012] [Indexed: 01/11/2023] Open
Abstract
Migraine is a common disease which causes significant burden to individuals, in terms of personal suffering and activity reduction, and to societies, in terms of disease cost. The purpose of this study is to identify the most relevant psychosocial difficulties related to migraine, the variables associated with them and the most relevant determinants of their evolution over time. MEDLINE and PsychINFO were searched for studies published in English between 2000 and 2010 that examined psychosocial difficulties in persons with migraine with and without aura, from clinical trials and observational studies. Information on the description of each difficulty, its determinants of onset and change over time and associated variables were extracted and categorized at a higher level. In total, 34 difficulties have been collected from 51 papers: the most frequent were reduced vitality and fatigue, emotional problems, pain, difficulties at work, general physical and mental health, social functioning and global disability. Evidence exists that pharmacological treatments have an impact toward improvement in patients’ difficulties, in particular emotional problems, physical and mental health, difficulties with employment and global disability. Migraine treatments and decreased headaches frequency are the major determinants of improvements in psychosocial difficulties, while no information is available for determinants of worsening; understanding the role of such factors is of primary public health relevance, given the high prevalence and the relevant personal and societal costs of migraine.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.
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Stefane T, Napoleão AA, Sousa FAEF, Hortense P. [Influence of treatments for migraine on quality of life: literature integrative review]. Rev Bras Enferm 2012; 65:353-60. [PMID: 22911421 DOI: 10.1590/s0034-71672012000200023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 01/24/2012] [Indexed: 01/11/2023] Open
Abstract
This study aimed to identify the impact of the main treatments for migraine on the quality of life (QOL) as affected people and the instruments used to assess the QOL. It consists of an integrative review of the literature, in which the databases PubMed, BIREME and The Cochrane Library were used, considering articles from 2000 to 2009. We selected 42 articles for analysis, which were fully read. The articles were classified into three categories: pharmacological treatments for the crisis, prophylactic drug treatments and alternative treatments for migraine. In most studies, the tools used to assess QOL were validated and the most commonly used were the Medical Outcomes Study Questionnaire 36 - Item Short Form Health Survey (SF 36), the Migraine-Specific Quality of Life Questionnaire (MSQ) and the Migraine Disability Assessment (MIDAS). We conclude that, in general, the treatments seem to be positive on the QOL of individuals with migraine.
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Affiliation(s)
- Thais Stefane
- Curso de Enfermagem, Departamento de Enfermagem, Universidade Federal de São Carlos, São Carlos, SP, Brazil
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10
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Mehuys E, Paemeleire K, Van Hees T, Christiaens T, Van Bortel LM, Van Tongelen I, De Bolle L, Remon JP, Boussery K. Self-medication of regular headache: a community pharmacy-based survey. Eur J Neurol 2012; 19:1093-9. [PMID: 22360745 DOI: 10.1111/j.1468-1331.2012.03681.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND This observational community pharmacy-based study aimed to investigate headache characteristics and medication use of persons with regular headache presenting for self-medication. METHODS Participants (n = 1205) completed (i) a questionnaire to assess current headache medication and previous physician diagnosis, (ii) the ID Migraine Screener (ID-M), and (iii) the Migraine Disability Assessment questionnaire. RESULTS Forty-four percentage of the study population (n = 528) did not have a physician diagnosis of their headache, and 225 of them (225/528, 42.6%) were found to be ID-M positive. The most commonly used acute headache drugs were paracetamol (used by 62% of the study population), NSAIDs (39%), and combination analgesics (36%). Only 12% of patients physician-diagnosed with migraine used prophylactic migraine medication, and 25% used triptans. About 24% of our sample (n = 292) chronically overused acute medication, which was combination analgesic overuse (n = 166), simple analgesic overuse (n = 130), triptan overuse (n = 19), ergot overuse (n = 6), and opioid overuse (n = 5). Only 14.5% was ever advised to limit intake frequency of acute headache treatments. CONCLUSIONS This study identified underdiagnosis of migraine, low use of migraine prophylaxis and triptans, and high prevalence of medication overuse amongst subjects seeking self-medication for regular headache. Community pharmacists have a strategic position in education and referral of these self-medicating headache patients.
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Affiliation(s)
- E Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
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11
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Stuginski-Barbosa J, Dach F, Bigal M, Speciali JG. Chronic pain and depression in the quality of life of women with migraine--a controlled study. Headache 2012; 52:400-8. [PMID: 22332812 DOI: 10.1111/j.1526-4610.2012.02095.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Migraine is comorbid to depression and widespread chronic pain (WCP), but the influence of these conditions on the health-related quality of life (HRQoL) of individuals with episodic (EM) and chronic migraine (CM) is poorly understood. OBJECTIVE To assess the prevalence of depressive symptoms and WCP in individuals with EM and CM, as well as to estimate the joint impact of these conditions on the HRQoL of these individuals. METHODS All women aged 18 to 65 years with a first diagnosis of EM or CM from September of 2006 to September of 2008 seen in an outpatient headache service were invited to participate. They were asked to attend a separate appointment in the service, and to bring another woman of similar age that also agreed to participate. Depressive symptoms were assessed using the Beck Depression Inventory. Questions about WCP followed the protocol of the American College of Rheumatology. HRQoL was assessed using the Short-Form 36 (SF-36). Multivariate analysis modeled HRQoL as a function of headache status, depressive symptoms, and pain, using quantile regression. RESULTS Sample consisted of 179 women, 53 in the EM group, 37 in the CM group and 89 in control group. Groups did not differ by demographics. Mean scores of SF-36 were 53.6 (standard deviation [SD] = 23.5) for EM, 44.2 (SD = 18.5) for CM and 61.8 (SD = 21.5) for controls. In multivariate analysis, SF-36 scores were predicted by a CM status (P = .02; -10.05 [95% CI -18.52; -1.58]) and by a Beck Depression Inventory score (P < .01; -1.27 [95% CI -1.55; -0.99]). The influence of WCP in the SF-36 scores approached significance (P = .08; -0.78 [95% CI -1.64; 0.88]). Age did not contribute to the model. CONCLUSION Women with migraine are at an increased chance of WCP, and the chance increases as a function of headache frequency. Both depressive symptoms and CM independently predict HRQoL status.
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Affiliation(s)
- Juliana Stuginski-Barbosa
- Department of Neuroscience and Behavioral Science, School of Medicine at Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Tfelt-Hansen P, Pascual J, Ramadan N, Dahlöf C, D'Amico D, Diener HC, Hansen JM, Lanteri-Minet M, Loder E, McCrory D, Plancade S, Schwedt T. Guidelines for controlled trials of drugs in migraine: Third edition. A guide for investigators. Cephalalgia 2012; 32:6-38. [DOI: 10.1177/0333102411417901] [Citation(s) in RCA: 279] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Nabih Ramadan
- Nebraska HHS and Beatrice State Developmental Center, USA
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13
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Landy SH, Runken MC, Bell CF, Higbie RL, Haskins LS. Examining the Interrelationship of Migraine Onset, Duration, and Time to Treatment. Headache 2011; 52:363-73. [DOI: 10.1111/j.1526-4610.2011.02029.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE Examine the impact of migraine on work productivity, and particularly the association between time of migraine onset and lost productivity as measured by absenteeism and presenteeism. METHODS A total of 509 people with migraine completed one online baseline survey and a diary survey after each of their next three migraines. All subjects were 18 or older and employed full time. RESULTS Sixty-four percent of migraines occurred on a workday. Of these, 68% resulted in some work productivity impact in the form of absenteeism or presenteeism. Migraines occurring during usual sleeping hours or prior to the start of work had the greatest impact on productivity. CONCLUSIONS Findings indicate that absenteeism and presenteeism are both substantial contributors to work productivity loss. Primary factors associated with lost productivity include pain severity, migraine symptoms, and sleep disturbance.
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Kessler RC, Shahly V, Stang PE, Lane MC. The associations of migraines and other headaches with work performance: results from the National Comorbidity Survey Replication (NCS-R). Cephalalgia 2010; 30:722-34. [PMID: 20511212 PMCID: PMC3486691 DOI: 10.1177/0333102410363766] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is unknown if comorbid conditions account for the association between migraines and work performance. This issue was investigated in the National Comorbidity Survey Replication (n = 9282). Twelve-month severe or persistent migraines and other headaches were assessed with comorbid 12-month mental and physical disorders using the WHO Composite International Diagnostic Interview. Work performance was assessed using the WHO Health and Work Performance Questionnaire. Significant associations of these conditions with work disability disappeared with controls for comorbid disorders, but severe or persistent migraines continued to predict work loss days even with controls. Individual-level and societal-level annual human capital values were $1165 and $9.3 billion for this subset of migraines. Roughly 20% of these associations were due to comorbidity, 60% to direct effects and 20% to indirect effects through temporally secondary comorbidities. These strong associations suggest that workplace interventions for severe or persistent migraines might have a positive return-on-investment for employers.
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Affiliation(s)
- R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
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Ferrari A, Spaccapelo L, Sternieri E. Pharmacoepidemiology of triptans in a headache centre. Cephalalgia 2010; 30:847-54. [PMID: 20647176 DOI: 10.1177/0333102409357956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The aims of this survey were: (i) to examine the pharmacoepidemiology of triptans in a headache centre; (ii) to compare the characteristics of patients who continued to take triptans with those of patients who had discontinued them. METHODS We enrolled all migraine patients according to ICHD-II criteria, ensuring they were over 18 years of age, consecutively examined during a follow-up visit at the Headache Centre of the University Hospital of Modena from October 2008 to March 2009. Only patients who had used or were using a triptan were included. A specific questionnaire about the use and tolerability of triptans was created for the study and administered to every patient. RESULTS On the whole, 343 patients (migraine without aura: 72%; chronic migraine: 26%; migraine with aura: 2%; mean age 40.4 +/- 10 years) had used or were using triptans. Most patients (72%) continued to use triptans, above all for their efficacy. The minority (28%) discontinuing them were younger and suffered from less severe migraine; 59% of them had discontinued triptans because of adverse effects. Indeed, 92% of these patients versus 57% of patients who were currently using triptans reported adverse effects (p < .0001, Fisher's exact test). The number of patients reporting adverse effects significantly decreased with age (r = -0.230, p < .005, simple linear regression analysis). The triptan discontinued by the highest percentage of patients (84%) was subcutaneous 6 mg sumatriptan. Significantly more patients reported adverse effects with subcutaneous 6 mg (89%) and tablet 100 mg sumatriptan (67%) than with any other triptan. CONCLUSIONS The increase of the tolerability of triptans with age could partly explain why younger patients suffering from less severe migraine tend to discontinue triptans more than older patients suffering from more severe migraine. In the latter, the efficacy and better tolerability (but not necessarily safety) of triptans could foster the overuse of these medications.
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Affiliation(s)
- Anna Ferrari
- Headache and Drug Abuse Inter-Dep Research Centre,Division of Toxicology and Clinical Pharmacology, University of Modena and Reggio Emilia, Italy.
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17
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Cevoli S, D'Amico D, Martelletti P, Valguarnera F, Bene ED, Simone RD, Sarchielli P, Narbone MC, Testa L, Genco S, Bussone G, Cortelli P. Underdiagnosis and Undertreatment of Migraine in Italy: A Survey of Patients Attending for The First Time 10 Headache Centres. Cephalalgia 2009; 29:1285-93. [DOI: 10.1111/j.1468-2982.2009.01874.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this study was to asses the clinical features, pattern of healthcare and drug utilization of migraine patients attending 10 Italian headache centres (HC). Migraine is underdiagnosed and undertreated everywhere throughout the world, despite its considerable burden. Migraine sufferers often deal with their problem alone using self-prescribing drugs, whereas triptans are used by a small proportion of patients. All patients attending for the first time 10 Italian HCs over a 3-month period were screened for migraine. Migraine patients underwent a structured direct interview about previous migraine diagnosis, comorbidity, headache treatments and their side-effects and healthcare utilization for migraine. Patient satisfaction with their usual therapy for the migraine attack was evaluated with the Migraine-Assessment of Current Therapy (ACT) questionnaire. The quality of life of migraine patients was assessed by mean of Short Form (SF)-12 and Migraine-Specific Quality of life (MSQ) version 2.1 questionnaires. Of the 2675 patients who attended HCs for the first time during the study period, 71% received a diagnosis of migraine and the first 953 subjects completed the study out of 1025 patients enrolled. Only 26.8% of migraine patients had a previous diagnosis of migraine; 62.4% of them visited their general practitioner (GP) in the last year, 38.2% saw a specialist for headache, 23% attended an Emergency Department and 4.5% were admitted to hospital for migraine; 82.8% of patients used non-specific drugs for migraine attacks, whereas 17.2% used triptans and only 4.8% used a preventive migraine medication. Triptans were used by 46.4% of patients with a previous diagnosis of migraine. About 80% of migraine patients took over-the-counter medications. The Migraine-ACT revealed that 60% of patients needed a change in their treatment of migraine attacks, 85% of whom took non-specific drugs. Both the MSQ version 2.1 and the SF-12 questionnaires indicated a poor quality of life of most patients. Migraine represents the prevalent headache diagnosis in Italian HCs. Migraine is still underdiagnosed in Italy and migraine patients receive a suboptimal medical approach in our country, despite the healthcare utilization of migraine subjects being noteworthy. A cooperative network involving GPs, neurologists and headache specialists is strongly desirable in order to improve long-term migraine management in Italy.
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Affiliation(s)
- S Cevoli
- Department of Neurological Sciences, Alma Mater Studiorum, Università di Bologna, Bologna
| | - D D'Amico
- Department of Neurological Sciences, Fondazione IRCCS Istituto Neurologico C. Besta, Milan
| | - P Martelletti
- Centro di Riferimento Regionale per le Cefalee, Dipartimento di Scienze Mediche, A.O. Sant'Andrea, Roma
| | - F Valguarnera
- Centro Cefalee, Ospedale Antero Micone, Sestri Ponente, Genova
| | - E Del Bene
- Centro Cefalee, Dipartimento di Medicina Interna, Villa Monna Tessa, Firenze
| | - R De Simone
- Centro Cefalee, Dipartimento di Scienze Neurologiche, Università Federico II, Napoli
| | - P Sarchielli
- Centro Cefalee Clinica Neurologica, Università degli Studi di Perugia, Perugia
| | - MC Narbone
- Department of Neurosciences—A.O.U. ‘G. Martino’—Contesse, Messina
| | - L Testa
- Centro Cefalee della Clinica Neurologica, Università del Piemonte Orientale A. Avogadro, A.O. Maggiore della Carità-Novara
| | - S Genco
- Clinica Neurologica, II Policlinico, Bari, Italy
| | - G Bussone
- Department of Neurological Sciences, Fondazione IRCCS Istituto Neurologico C. Besta, Milan
| | - P Cortelli
- Department of Neurological Sciences, Alma Mater Studiorum, Università di Bologna, Bologna
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Amoozegar F, Pringsheim T. Rizatriptan for the acute treatment of migraine: Consistency, preference, satisfaction, and quality of life. Patient Prefer Adherence 2009; 3:251-8. [PMID: 19936168 PMCID: PMC2778411 DOI: 10.2147/ppa.s6152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Indexed: 11/23/2022] Open
Abstract
Rizatriptan is a 5HT (IB/ID) agonist with proven efficacy in the acute treatment of migraine headache. We performed a systematic review of the literature for clinical trials of rizatriptan incorporating important patient outcomes including consistency of response, preference, satisfaction, and quality of life. We found evidence that rizatriptan provides consistent relief of migraine attacks and that patients prefer rizatriptan over other treatments because of its speed of relief. Patient satisfaction with rizatriptan is significantly higher than placebo, but appears equivalent to most other triptans. Migraine-specific quality of life at 24 hours is significantly better in patients treated with rizatriptan compared to placebo, while overall long-term quality of life is less affected. The published clinical trials included in this systematic review are subject to bias due to the open-label nature of preference trials and the doses chosen for comparison in head-to-head trials.
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Affiliation(s)
| | - Tamara Pringsheim
- Correspondence: Tamara Pringsheim, C4-431, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary AB, T3B 6A8, Canada, Tel +1 403 955 7921, Fax +1 403 955 5990, Email
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Mérelle SYM, Couturier EGM, van Bokhorst J, Busschbach JJV, Passchier J. Large-Scale Screening and Subsequent Effects of Migraine Treatment on the Work Floor in the Netherlands. Cephalalgia 2009; 29:606-15. [DOI: 10.1111/j.1468-2982.2008.01769.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a large retail business group the ID Migraine Screening Test was sent to employees with three or more absences from work in the past year ( n = 2893). Employees with positive results were invited for a neurological consultation and migraine patients were randomly assigned to: first attack ‘treated as usual’ and the second attack treated with 40 mg eletriptan, or reversed order. Of the 2893 employees, 799 responded (28%), 260 were positively screened for migraine (33%), 84 patients were diagnosed by a neurologist and 41 of the 75 included patients completed the protocol. Eletriptan induced pain-free response in 33.3% of the patients at 4 h compared with 0% after ‘non-specific’ treatment ( P = 0.03). Eletriptan also significantly improved quality of life, but differences in absence from work and productivity loss could not be detected. In conclusion, in-company screening can be beneficial for undertreated employees, but implementation obstacles can reduce the effectiveness of screening.
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Affiliation(s)
- SYM Mérelle
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Centre, Rotterdam
| | - EGM Couturier
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Centre, Rotterdam
- Medical Centre Boerhaave, Amsterdam, the Netherlands
| | - J van Bokhorst
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Centre, Rotterdam
| | - JJV Busschbach
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Centre, Rotterdam
| | - J Passchier
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Centre, Rotterdam
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Becker C, Brobert GP, Almqvist PM, Johansson S, Jick SS, Meier CR. Migraine and the risk of stroke, TIA, or death in the UK (CME). Headache 2008; 47:1374-84. [PMID: 18052947 DOI: 10.1111/j.1526-4610.2007.00937.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous observational studies have reported a higher risk of stroke in migraine patients. Objective.- We aimed to estimate the risk of stroke, transient ischemic attack (TIA), or death in migraineurs in the UK. METHOD We conducted a population-based follow-up study within the General Practice Research Database from 1994 to 2001. RESULTS The relative risk (RR) of stroke in migraineurs compared with non-migraineurs was 2.2 (95% confidence interval [CI] 1.7-2.9). It was highest for patients with a migraine diagnosis recorded within 30 days prior to a stroke (odds ratio 11.1, 95% CI 5.69-21.5). The RR of TIA in migraineurs compared with non-migraineurs was 2.4 (95% CI 1.8-3.3), the mortality of migraineurs was slightly decreased. CONCLUSION In our study, the RR of developing a stroke or a TIA was doubled in migraineurs as compared with non-migraineurs, while that for death was close to unity.
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Affiliation(s)
- Claudia Becker
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Switzerland
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Abstract
In 2006, the triptans sumatriptan 50mg and naratriptan 2.5mg were approved as over-the-counter (OTC) drugs in pharmacies in the UK and Germany, respectively. Both drugs have been used in a large number of patients with migraine and are considered to have good safety profiles. The implications of OTC triptan availability for clinical practice are that more migraine patients will use a triptan and will tend to medicate early when their headache is still mild, which should be beneficial. The problem with OTC access to triptans is medication overuse; therefore, patients should be warned of this and advised to use a triptan on fewer than 10 days per month. Pharmacists should be educated regarding migraine types and symptoms and on contraindications to triptans, so they are then able to discern the patients who should receive triptans and, as importantly, those who should not. The annual cost of migraine is euro27 billion in Europe, $US1.4 billion in the UK and $US16.6 billion in the US. By far the greatest opportunity for cost-savings comes from the potential to reduce costs associated with lost productivity from migraine. OTC availability of triptans will inevitably result in easier access to these medications, which, in turn, may result in improved treatment and lower migraine-related disability. There is currently a lack of empirical evidence that treating migraine effectively does in fact recover lost productivity; well designed studies are required to show this. The availability of triptans OTC is a logical development for the better management of a common, benign, self-limiting but nonetheless burdensome disorder that is currently grossly undertreated. We welcome this development, but recognise that advice at the point of sale is crucial for effective and safe use of these drugs.
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Affiliation(s)
- Peer Tfelt-Hansen
- Department of Neurology, Danish Headache Centre, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark.
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Abstract
Migraine is a common, disabling disorder associated with considerable personal and societal burden. Current guidelines recommend triptans for the acute treatment of migraine unlikely to respond to less effective therapies. Rizatriptan is a second-generation triptan available in tablet or orally disintegrating tablet (wafer) formulations that offers several advantages over other members of its class. Rizatriptan is rapidly absorbed from the gastrointestinal tract and achieves maximum plasma concentrations more quickly than other triptans, providing rapid pain relief. Clinical trials have shown that rizatriptan is at least as effective or superior to other oral migraine-specific agents in the acute treatment of migraine, and has more consistent long-term efficacy across multiple migraine attacks. Rizatriptan has a favorable tolerability profile, and patients have reported greater satisfaction and a preference for rizatriptan over other migraine-specific agents. Improvements in quality of life reported with rizatriptan are consistent with its favorable efficacy and tolerability profiles. Notably, multi-attribute decision models that combine clinical data with patient- and physician-reported treatment preferences have identified rizatriptan as one of three triptans closest to a hypothetical "ideal". The efficacy and tolerability of rizatriptan for the acute treatment of migraine have thus been well established.
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Affiliation(s)
- Miguel J A Láinez
- Department of Neurology, University Clinic Hospital, University of Valencia, Valencia, Spain.
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D'Amico D, Moschiano F, Bussone G. Early treatment of migraine attacks with triptans: a strategy to enhance outcomes and patient satisfaction? Expert Rev Neurother 2006; 6:1087-97. [PMID: 16831121 DOI: 10.1586/14737175.6.7.1087] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treating migraine attacks early with triptans may be more effective than late triptan administration. However, in published studies, the definition of 'early' varied (in terms of time, pain intensity or presence of allodynia) or was unclear. Therefore, clear clinical indications have not been established. Appropriately designed trials to address this issue remain a priority. Early triptan treatment may also have disadvantages, including inadvertent treatment of tension-type headaches and danger of medication overuse. At present, only those migraineurs with rapid pain worsening, high pain recurrence rate and clinical indications of allodynia should be encouraged to take triptans as quickly as possible. This recommendation implies a requirement for patient education and the need to carefully tailor treatment to individual needs.
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Affiliation(s)
- Domenico D'Amico
- C. Besta National Neurological Institute, Clinical Neurosciences Department, Via Celoria 11, 20133 Milano, Italy.
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