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Lunguț EF, Antal C, Turcu S, Varlas VN, Filipescu AG, Balescu I, Bacalbașa N, Gorecki GP. Neurasites ®-A Standardized Plant Extract in the Treatment and Prevention of Migraine Attacks. J Clin Med 2024; 13:3364. [PMID: 38929892 PMCID: PMC11203885 DOI: 10.3390/jcm13123364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Migraine is one of the most common diseases in highly developed countries, being even more common than diabetes and asthma. Migraines can affect emotional, social, and physical wellbeing as well as professional life. The most common symptoms are severe headaches associated with nausea, vomiting, photophobia and sonophobia, difficulty concentrating, sensitivity and emotional disorders. Many studies have been published to establish the best migraine-management drugs, but not many of them refer to plant extracts, which have been given more attention by patients lately. Among these generically called herbal medicines, the effect of tussilago hybrida standardized extract has been studied since the early twenties. This stands as the fundamental component of Neurasites® and the reason for research on materials and methods, results on treatment schemes for diminishing migraine attack features, as well as migraine prevention. Methods: There are two directions of research (herbal and placebo medicine) considered to be of interest due to the actual trend toward natural medicine and against chemicals and associated drugs. For quantitative research, the research tool used was that of the Neurasites® Questionnaire Survey (NQS). Results: The obtained results prove the efficacy of treatment by reducing the duration of headache attacks, diminishing pain intensity and decreasing the frequency of migraine episodes. Conclusions: Further research development should focus on other dosages and treatment schemes and on other similar natural products to be used in migraine attack treatment.
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Affiliation(s)
- Emilia Furdu Lunguț
- Department of Neurology, Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania;
- Department of Neurology, CF2 Clinical Hospital, 011464 Bucharest, Romania
| | - Claudia Antal
- 2gether NHS Foundation Trust for Gloucestershire, Gloucestershire GL3 4AW, UK;
| | - Suzana Turcu
- Romanian Academy, “Francisc I. Rainer” Institute of Anthropology, 050711 Bucharest, Romania;
| | - Valentin-Nicolae Varlas
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine, 050474 Bucharest, Romania; (V.-N.V.); (A.G.F.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Alexandru George Filipescu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine, 050474 Bucharest, Romania; (V.-N.V.); (A.G.F.)
- Department of Obstetrics and Gynecology, Elias Emergency Clinical Hospital, 011461 Bucharest, Romania
| | - Irina Balescu
- Department of General Surgery, “Carol Davila” University of Medicine, 050474 Bucharest, Romania;
| | - Nicolae Bacalbașa
- Department of Visceral Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania
- Department of Visceral Surgery, Center of Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Gabriel-Petre Gorecki
- Department of Anesthesia and Intensive Care, “Titu Maiorescu” University, Faculty of Medicine, 031593 Bucharest, Romania;
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania
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Alpuente A, Torres-Ferrus M, Caronna E, Pozo-Rosich P. The state of art on the use of patient reported outcomes in migraine. Curr Opin Neurol 2024; 37:271-282. [PMID: 38529698 DOI: 10.1097/wco.0000000000001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW This review aims to explore the use of patient-reported outcome measures (PROMs) in migraine. Traditionally assessed through specific features, recent adoption of PROMs allows for a more objective and quantifiable evaluation. PROMs, which are standardized questionnaires collecting health information directly from a patients' perspective, cover various aspects, including migraine specific aspects. The review focuses on delineating the applications and interpretation of commonly used PROMs in migraine research, with an emphasis on their integration in clinical care. RECENT FINDINGS Generic and migraine-specific PROMs play a crucial role in clinical research, particularly in assessing health-related quality of life, disability, impact, and associated comorbidities. Some of these measures are strongly recommended to be used by the International Guidelines and are, in fact, mandated by the FDA for product labeling. Recently, there has been an expansion in the use of PROMs to assess migraine in diverse populations, in particular pediatric patients. However, the application of these measures in clinical care shows considerable heterogeneity, and some have not been validated specifically for migraine. The existing multitude of PROMs, coupled with ongoing development of new ones to better capture patient concerns, creates complexity in their research and clinical application. To address these challenges, it becomes imperative to streamline their use, focusing on those that are more validated and better aligned with the patients' perspective including different populations' needs. SUMMARY The utilization of PROMs in evaluating migraine enables a more holistic assessment, helps quantify the impact of the disease facilitating change measurement, improves communication between healthcare providers and patients and, guides treatment decisions for improved outcomes. However, the increasing number of PROMs questionnaires, underscores the importance of validating these tools for migraine and, the dynamic nature of the disease makes it relevant to decide with whom, why and when these should be used.
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Affiliation(s)
- Alicia Alpuente
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Clinic, Neurology Department, Vall d'Hebron University Hospital
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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3
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Mollan SP, Fraser CL, Digre KB, Diener HC, Lipton RB, Juhler M, Miller NR, Pozo-Rosich P, Togha M, Brock K, Dinkin MJ, Chan CKM, Tassorelli C, Sinclair AJ, Terwindt GM, Jensen RH. Guidelines of the International Headache Society for Controlled Clinical Trials in Idiopathic Intracranial Hypertension. Cephalalgia 2023; 43:3331024231197118. [PMID: 37661711 DOI: 10.1177/03331024231197118] [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: 09/05/2023]
Abstract
The quality of clinical trials is essential to advance treatment, inform regulatory decisions and meta-analysis. With the increased incidence of idiopathic intracranial hypertension and the emergence of clinical trials for novel therapies in this condition, the International Headache Society Guidelines for Controlled Clinical Trials in Idiopathic Intracranial Hypertension aims to establish guidelines for designing state-of-the-art controlled clinical trials for idiopathic intracranial hypertension.
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Affiliation(s)
- Susan P Mollan
- Neuro-ophthalmology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Clare L Fraser
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Kathleen B Digre
- Neuro-ophthalmology Division, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Hans-Christoph Diener
- Institut für Medizinische Informatik, Biometrie undEpidemiologie (IMIBE), Medizinische Fakultät der Universität Duisburg-Essen, Essen, Germany
| | - Richard B Lipton
- The Saul R. Korey Department of Neurology, and the Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Neil R Miller
- Wilmer Eye Institute and Departments of Ophthalmology, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mansoureh Togha
- Headache Department, Iranian Centre of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Headache Department, Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kristian Brock
- Cancer Research Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marc J Dinkin
- Department of Ophthalmology, Weill Cornell Medical College, NY Presbyterian Hospital, New York, New York, USA
- Department of Neurology, Weill Cornell Medical College, NY Presbyterian Hospital, New York, New York, USA
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Cristina Tassorelli
- Unit of Translational Neurovascular Research, IRCCS Mondino Foundation, 27100, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, 27100, Pavia, Italy
| | - Alex J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Mitsikostas DD, Waeber C, Sanchez-Del-Rio M, Raffaelli B, Ashina H, Maassen van den Brink A, Andreou A, Pozo-Rosich P, Rapoport A, Ashina M, Moskowitz MA. The 5-HT 1F receptor as the target of ditans in migraine - from bench to bedside. Nat Rev Neurol 2023:10.1038/s41582-023-00842-x. [PMID: 37438431 DOI: 10.1038/s41582-023-00842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Abstract
Migraine is a leading cause of disability in more than one billion people worldwide, yet it remains universally underappreciated, even by individuals with the condition. Among other shortcomings, current treatments (often repurposed agents) have limited efficacy and potential adverse effects, leading to low treatment adherence. After the introduction of agents that target the calcitonin gene-related peptide pathway, another new drug class, the ditans - a group of selective serotonin 5-HT1F receptor agonists - has just reached the international market. Here, we review preclinical studies from the late 1990s and more recent clinical research that contributed to the development of the ditans and led to their approval for acute migraine treatment by the US Food and Drug Administration and the European Medicines Agency.
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Affiliation(s)
- Dimos D Mitsikostas
- 1st Neurology Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Christian Waeber
- School of Pharmacy, University College Cork, Cork, Ireland
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | | | - Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Antoinette Maassen van den Brink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Anna Andreou
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Headache Centre, Guy's and St Thomas's NHS Foundation Trust, King's Health Partners, London, UK
| | - Patricia Pozo-Rosich
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alan Rapoport
- Department of Neurology, The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael A Moskowitz
- Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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Khurana P, Gupta M, Gupta N, Bansal RK, Jain V. Retrospective Observational Study Amidst Myriad Conundrums and Myths of Pediatric Headaches: A Critique on Diagnostics and Effectiveness of Interventions. Cureus 2023; 15:e42424. [PMID: 37637669 PMCID: PMC10448782 DOI: 10.7759/cureus.42424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To study the etiological profile of pediatric headaches (PH) in a tertiary child neurology clinic and to determine the utility of diagnostics, interventions, and long-term prognosis. Methods Children (ages 4-15) observed over four years were recruited retrospectively. In primary headaches, the headache frequency and impact on quality of life (QOL) parameters at pre-treatment (T1) were compared post-treatment at follow-up (T2). Results Of the 311 eligible patients, 285 had primary headaches (Tension-Type Headache {TTH}: 156; Migraine: 129), and 26 had secondary headaches. The mean (±SD) onset age was 10 (±3) years with a male-to-female ratio of 2.3:1. Migraine was more common in children aged less than seven years (17/28) and TTH in older patients (146/283). The most common causes of secondary headache were intracranial hypertension (ICH) in 11/26 patients (four idiopathic intracranial hypertension (IIH), four following aseptic meningitis, three with cortical vein thrombosis), and ophthalmologic causes in 7/26 (of these five had convergence insufficiency). Hypertension was a rare cause of secondary headaches (2/26 patients). Neuroimaging was performed in 173/311 (56%), primarily for parental anxiety (160/173; 92%), and was abnormal in only four. At T2 (Median time to follow-up: 29 months; Interquartile range: 22-37 months), data were collected in 207/285 patients with primary headaches (TTH: 109; Migraine: 98). In both migraine and TTH groups, there were statistically significant reductions (p-value <0.0001) in headache frequency and QOL parameters. Conclusion In our study, TTH was the most common cause of PH. Neuroimaging was normal in most cases. Psychological interventions were effective but underutilized. The symptoms of primary headaches improved significantly over time, despite poor adherence to prophylactic medications.
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Affiliation(s)
| | - Mayank Gupta
- Psychiatry and Behavioral Sciences, Southwood Psychiatric Hospital, Pittsburgh, USA
| | - Nihit Gupta
- Psychiatry, Dayton Children's Hospital, Dayton, USA
| | | | - Vivek Jain
- Pediatric Neurology, Neo Clinic Children's Hospital, Jaipur, IND
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6
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Carlsen LN, Bendtsen L, Jensen RH, Schytz HW. Telephone follow-up on treatment and patient satisfaction at a Danish tertiary headache center: A prospective study. Headache 2022; 62:1312-1321. [PMID: 36373785 PMCID: PMC10099919 DOI: 10.1111/head.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We investigated whether telephone follow-up consultations could lead to appropriate adjustment of treatments and a higher degree of patient satisfaction among patients with migraine and tension-type headache (TTH). BACKGROUND Migraine and TTH are disabling headache forms requiring optimized treatment. METHODS In a prospective, non-randomized, quality control study with controls comparing telephone-interview intervention (TeII) with business-as-usual (BAU) treatment, we included newly referred patients with migraine and/or TTH. The TeII group was contacted by telephone by healthcare professionals at 8 and 16 weeks after the first visit addressing headache treatment. Electronic questionnaires were sent to all participants before the first visit and after 6 months. Predefined outcomes were number of patients with change in preventive and acute medication; change in headache frequency; migraine frequency; scores from the eight-item Headache Under-Response to Treatment (HURT-8) questionnaire, Insomnia Severity Index (ISI), and Hospital Anxiety and Depression Scale (HADS); and patient satisfaction after 6 months. RESULTS From May 2020 to April 2021, there were 230 patients enrolled in the TeII program, whereof 96 patients were included in the analysis. For the BAU group, 91 patients with similar sex and age distribution were identified via medical-record reviews in the same period. More patients in the TeII group than in the BAU group had a change in acute medication (27/96 [28%] vs. five of 91 [6%], p < 0.001) and preventive medication (28/96 [29%] vs. 12/91 [13%], p = 0.006). Headache days per month decreased in the TeII group (-4.6, 95% confidence interval [CI] -6.5 to -2.7; p = 0.001) and the BAU group (-2.5, 95% CI -4.6 to -0.4; p = 0.018), without significant difference between the groups (p = 0.080). There was no difference in migraine frequency between the groups (TeII: 1.0 day, 95% CI, -1.3 to 1.0; BAU: 1.0 day, 95% CI, -2.5 to 0.5; p = 0.718) or HURT-8 score (TeII: 10.5, 95% CI 9.5-11.5; BAU: 13.0, 95% CI 11.7-14.2; p = 0.053). There were no changes in the ISI score (TeII: 1.0, interquartile range [IQR] 6; p = 0.152; BAU: 0.5, IQR 4.5; p = 0.824), HADS-Anxiety score (TeII: -5, IQR 5.3; p = 0.186; BAU: 1.0, IQR 4.0; p = 0.445), or HADS-Depression score (TeII: 0.0, IQR 3.0; p = 0.163; BAU: 0.0, IQR 2.0; p = 0.303) in any of the groups. There was a higher degree of patient satisfaction in the TeII group compared with the BAU group in treatment (median [IQR] score 4 [3-5] vs. 3 [3-4], p < 0.001), headache improvement (median [IQR] 3 [2-4] vs. 2 [1-3], p = 0.002), the headache program (median [IQR] 4 [3-5] vs. 3 [3-4], p < 0.001), and information (median [IQR] 4 [3-5] vs. 3 [3-4], p = 0.005). CONCLUSION Patients with migraine and/or TTH benefit from a telephone follow-up approach within the first 6 months of their treatment course in terms of more efficient treatment and higher patient satisfaction.
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Affiliation(s)
- Louise Ninett Carlsen
- Danish Headache Center, Neurological Department, University of Copenhagen, Rigshospitalet - Glostrup, Copenhagen, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Neurological Department, University of Copenhagen, Rigshospitalet - Glostrup, Copenhagen, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Neurological Department, University of Copenhagen, Rigshospitalet - Glostrup, Copenhagen, Denmark
| | - Henrik Winther Schytz
- Danish Headache Center, Neurological Department, University of Copenhagen, Rigshospitalet - Glostrup, Copenhagen, Denmark
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7
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Steiner TJ, Birbeck GL, Jensen RH, Martelletti P, Stovner LJ, Uluduz D, Leonardi M, Olesen J, Katsarava Z. The Global Campaign turns 18: a brief review of its activities and achievements. J Headache Pain 2022; 23:49. [PMID: 35448941 PMCID: PMC9022610 DOI: 10.1186/s10194-022-01420-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/10/2022] [Indexed: 01/11/2023] Open
Abstract
The Global Campaign against Headache, as a collaborative activity with the World Health Organization (WHO), was formally launched in Copenhagen in March 2004. In the month it turns 18, we review its activities and achievements, from initial determination of its strategic objectives, through partnerships and project management, knowledge acquisition and awareness generation, to evidence-based proposals for change justified by cost-effectiveness analysis.
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Affiliation(s)
- Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway. .,Division of Brain Sciences, Imperial College London, London, UK.
| | - Gretchen L Birbeck
- UTH Neurology Research Office, University of Zambia, Lusaka, Zambia.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Centre, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, Norwegian Advisory Unit On Headaches,, St Olavs Hospital, Trondheim, Norway
| | - Derya Uluduz
- Neurology Department, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Matilde Leonardi
- Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico C Besta, NeurologyMilan, Italy
| | - Jes Olesen
- Department of Neurology, Danish Headache Centre, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Zaza Katsarava
- Centre of Neurology, Geriatric Medicine and Early Rehabilitation, Evangelical Hospital, Unna, Germany.,Medical Faculty, University of Essen, Essen, Germany
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8
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Eigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, Pozo-Rosich P, Martelletti P, Ducros A, Lantéri-Minet M, Braschinsky M, Del Rio MS, Daniel O, Özge A, Mammadbayli A, Arons M, Skorobogatykh K, Romanenko V, Terwindt GM, Paemeleire K, Sacco S, Reuter U, Lampl C, Schytz HW, Katsarava Z, Steiner TJ, Ashina M. Diagnosis and management of migraine in ten steps. Nat Rev Neurol 2021; 17:501-514. [PMID: 34145431 PMCID: PMC8321897 DOI: 10.1038/s41582-021-00509-5] [Citation(s) in RCA: 183] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 02/05/2023]
Abstract
Migraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.
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Affiliation(s)
- Anna K Eigenbrodt
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina Khan
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra J Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Anne Ducros
- Neurology Department, Montpellier University Hospital, Montpellier, France
| | - Michel Lantéri-Minet
- Departement d'Evaluation et Traitement de la Douleur, Centre Hospitalo-Universitaire de Nice, Nice, France
| | | | | | - Oved Daniel
- Headache & Facial Pain Clinic, Laniado Medical Center, Netanya, Israel
| | - Aynur Özge
- Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Ayten Mammadbayli
- Department of Neurology, Azerbaijan State Medical University, Baku, Azerbaijan
| | - Mihails Arons
- Department of Anesthesiology and Intensive Care, P. Stradins University, Riga, Latvia
| | | | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Lampl
- Headache Medical Center, Seilerstaette Linz, Linz, Austria
- Department of Geriatric Medicine, Ordensklinikum Linz, Linz, Austria
| | - Henrik W Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- EVEX Medical Corporation, Tbilisi, Georgia
- Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia.
- Danish Knowledge Center on Headache Disorders, Glostrup, Denmark.
- Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
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Khan M, Al Madani A, Habboush S, Abdulla M, Al Basti AK, Villanueva MJ, Goadsby PJ, Kamal Y. Multidisciplinary headache clinic-impact of a new model for headache care in Dubai. Clin Neurol Neurosurg 2021; 208:106845. [PMID: 34352629 DOI: 10.1016/j.clineuro.2021.106845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Primary headache disorders pose a huge burden to health systems around the world. A new model for headache care was introduced at two primary health centers (PHCs) in Dubai, UAE. Our objective is to describe the model, and the impact it had on increasing the number of patients receiving specialist care as well as on patient's response and satisfaction level. METHODS The model consisted of a weekly multi-disciplinary headache clinic with a neurologist, a general physician, a psychologist and a nurse, at each of the two PHCs. Patients were referred from all PHCs in Dubai. Follow up visits were either with the general physician or through tele-headache with the neurologist. We used the HURT questionnaire to evaluate the headache for each patient at baseline and then again at follow up. Information on patient satisfaction was also collected. Data were analyzed using SPSS version 21. RESULTS The model proved to be effective in terms of increase in the number of headache patients receiving specialist care. Using HURT questionnaire, improvement was seen in good control and in the sense of control over headache, and in risk of medication overuse between baseline and follow up visits. Patient satisfaction with various aspects of headache care was 80-90% after the first visit and improved further at follow up. CONCLUSION Our multi-disciplinary headache model improved the access of patients to neurologists, and resulted in improved headache control and patient satisfaction levels. Other countries can adopt such models to improve headache care for their patients.
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Affiliation(s)
- Maria Khan
- Department of Neurology, Rashid Hospital, Dubai, UAE.
| | | | | | | | | | | | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College London, UK & Department of Neurology, University of California, Los Angeles, CA USA.
| | - Yasmine Kamal
- Department of Neurology, Rashid Hospital, Dubai, UAE.
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10
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Steiner TJ, Linde M, Schnell-Inderst P. A universal outcome measure for headache treatments, care-delivery systems and economic analysis. J Headache Pain 2021; 22:63. [PMID: 34210258 PMCID: PMC8247243 DOI: 10.1186/s10194-021-01269-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The first manuscript in this series delineated a model of structured headache services, potentially cost-effective but requiring formal cost-effectiveness analysis (CEA). We envisaged a need for a new outcome measure for this purpose, applicable to all forms of treatment, care and care-delivery systems as opposed to comparisons of single-modality treatments. CONCEPTION AND DELINEATION A literature review confirmed the lack of any suitable established measure. We prioritised construct validity, simplicity, comprehensiveness and expression in intuitive units. We noted that pain was the key burdensome symptom of migraine and episodic tension-type headache (TTH), that pain above a certain level was disabling, that it was difficult to put economic value to pain but relatively easy to do this for time, a casualty of headache leading to lost productivity. Alleviation of pain to a non-disabling level would be expected to bring restoration of function. We therefore based the measure on time spent in the ictal state (TIS) of migraine or TTH, either as total TIS or proportion of all time. We expressed impact on health, in units of time, as TIS*DW, where DW was the disability weight for the ictal state supplied by the Global Burden of Disease (GBD) studies. If the time unit was hours, TIS*DW yielded hours lived with (or lost to) disability (HLDs), in analogy with GBD's years lived with disability (YLDs). UTILITY ASSESSMENT Acute treatments would reduce TIS by shortening attack duration, preventative treatments by reducing attack frequency; health-care systems such as structured headache services would have these effects by delivering these treatments. These benefits were all measurable as HLDs-averted. Population-level estimates would be derived by factoring in prevalence, but also taking treatment coverage and adherence into account. For health-care systems, additional gains from provider-training (promoting adherence to guidelines and, therefore, enhancing coverage) and consumer-education (improving adherence to care plans), increasing numbers within populations gaining the benefits of treatments, would be measurable by the same metric. CONCLUSIONS The new outcome measure expressed in intuitive units of time is applicable to treatments of all modalities and to system-level interventions for multiple headache types, with utility for CEA and for informing health policy.
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Affiliation(s)
- Timothy J Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway.
- Division of Brain Sciences, Imperial College London, London, UK.
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
- Norwegian Advisory Unit on Headache, Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
- Tjörn Headache Clinic, Rönnäng, Sweden
| | - Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, Medical Informatics and Technology, UMIT - University for Health Sciences, Hall in Tirol, Austria
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11
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Lenz B, Katsarava Z, Gil-Gouveia R, Karelis G, Kaynarkaya B, Meksa L, Oliveira E, Palavra F, Rosendo I, Sahin M, Silva B, Uludüz D, Ural YZ, Varsberga-Apsite I, Zengin ST, Zvaune L, Steiner TJ. Headache service quality evaluation: implementation of quality indicators in primary care in Europe. J Headache Pain 2021; 22:33. [PMID: 33910500 PMCID: PMC8080333 DOI: 10.1186/s10194-021-01236-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Lifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. METHODS We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients' records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. RESULTS The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 ("headache") rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. CONCLUSIONS The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients' satisfaction is not, on its own, a good indicator of service quality.
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Affiliation(s)
- B. Lenz
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Z. Katsarava
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Republic of Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - G. Karelis
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | | | - L. Meksa
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | - E. Oliveira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - F. Palavra
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Centre for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - I. Rosendo
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Family Health Unit “Coimbra Centro”, Coimbra, Portugal
| | - M. Sahin
- Kartal 10 Nolu ASM Istanbul, Istanbul, Turkey
| | - B. Silva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Family Health Unit “Pulsar”, Coimbra, Portugal
| | - D. Uludüz
- Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - I. Varsberga-Apsite
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | | | - L. Zvaune
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
| | - T. J. Steiner
- Norwegian University of Science and Technology, Trondheim, Norway
- Division of Neuroscience, Imperial College London, London, UK
| | - on behalf of European Headache Federation and Lifting The Burden: the Global Campaign against Headache
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Republic of Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
- Hospital da Luz Headache Center, Lisbon, Portugal
- Riga East Clinical University Hospital, Neurology and Neurosurgery Department, Headache Unit, Riga, Latvia
- Kagıthane Yahya Kemal ASM, Istanbul, Turkey
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Centre for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Family Health Unit “Coimbra Centro”, Coimbra, Portugal
- Kartal 10 Nolu ASM Istanbul, Istanbul, Turkey
- Family Health Unit “Pulsar”, Coimbra, Portugal
- Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
- Esenler Havaalanı ASM, Istanbul, Turkey
- Bagcılar Yıldıztepe ASM, Istanbul, Turkey
- Norwegian University of Science and Technology, Trondheim, Norway
- Division of Neuroscience, Imperial College London, London, UK
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12
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Ashina M, Buse DC, Ashina H, Pozo-Rosich P, Peres MFP, Lee MJ, Terwindt GM, Halker Singh R, Tassorelli C, Do TP, Mitsikostas DD, Dodick DW. Migraine: integrated approaches to clinical management and emerging treatments. Lancet 2021; 397:1505-1518. [PMID: 33773612 DOI: 10.1016/s0140-6736(20)32342-4] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed clinical management. First, we discuss the efficacy, tolerability, and safety profile of various pharmacological therapies for acute and preventive treatment of migraine. Second, we review the current knowledge on non-pharmacological therapies, such as neuromodulation and biobehavioural approaches, which can be used for a multidisciplinary approach to clinical management. Third, we emphasise that any effective treatment strategy starts with building a therapeutic plan tailored to individual clinical characteristics, preferences, and needs. Finally, we explore the outlook of emerging mechanism-based treatments that could address unmet challenges in clinical management of migraine.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache Research Group, Vall d'Hebron Institute of Research, Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mario F P Peres
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Headache Science Centre, Institute for Research, Hospitalization and Healthcare, Mondino Foundation, Pavia, Italy
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dimos D Mitsikostas
- First Neurology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
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13
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Donnet A, Ducros A, Radat F, Allaf B, Chouette I, Lanteri-Minet M. Severe migraine and its control: A proposal for definitions and consequences for care. Rev Neurol (Paris) 2021; 177:924-934. [PMID: 33810839 DOI: 10.1016/j.neurol.2020.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
Currently many patients with severe migraine do not receive appropriate treatment and are never referred to specialist headache centres. On the other hand, specialist headache centres are frequently attended by patients whose migraines could be managed adequately in the community. One reason for this may be the absence of standardised definitions of migraine severity and control and of a treatment algorithm for orientating difficult-to-treat patients to specialist headache centres. Based on a review of the relevant literature and consensus meetings, proposals have been made for these items. We propose that migraine should be considered severe if headache frequency is at least eight migraine days per month or, if headaches are less frequent, the HIT-6 score is ≥60 or ≥50% of headaches require complete interruption of activity. The proposed definition of migraine control is defined on the basis of appropriate response to acute headache therapy and to preventative therapy. A treatment algorithm is proposed to assess migraine control regularly and to adapt therapy accordingly. These proposals may contribute to developing and testing strategies for management of severe disease with appropriate and effective preventive treatment strategies. With the anticipated introduction of new possibilities for migraine prevention in the near future, the time is ripe for a holistic approach to migraine management.
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Affiliation(s)
- Anne Donnet
- Centre d'évaluation et de traitement de la douleur, CHU de la Timone, Marseille, France; Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Anne Ducros
- Service de Neurologie, CHU Gui de Chauliac, Montpellier, France
| | - Françoise Radat
- Unité de traitement de la douleur chronique, CHU de Bordeaux, Bordeaux, France
| | | | | | - Michel Lanteri-Minet
- Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France; Département d'évaluation et de traitement de la douleur CHU de Nice, FHU InovPain Université Côte Azur, Nice, France.
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14
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Rouw C, Munksgaard SB, Engelstoft IM, Nielsen M, Westergaard ML, Jensen RH, Bendtsen L, Carlsen LN. Dependence‐like behaviour in patients treated for medication overuse headache: A prospective open‐label randomized controlled trial. Eur J Pain 2021; 25:852-861. [DOI: 10.1002/ejp.1715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/12/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Carolien Rouw
- Danish Headache Centre Rigshospitalet, Glostrup Denmark
| | | | | | - Mia Nielsen
- Danish Headache Centre Rigshospitalet, Glostrup Denmark
| | | | | | - Lars Bendtsen
- Danish Headache Centre Rigshospitalet, Glostrup Denmark
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15
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Lipton RB, Munjal S, Buse DC, Alam A, Fanning KM, Reed ML, Schwedt TJ, Dodick DW. Unmet Acute Treatment Needs From the 2017 Migraine in America Symptoms and Treatment Study. Headache 2019; 59:1310-1323. [PMID: 31410844 PMCID: PMC6771753 DOI: 10.1111/head.13588] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2019] [Indexed: 12/20/2022]
Abstract
Objectives To characterize unmet treatment needs in a sample of Migraine in America Symptoms and Treatment (MAST) Study participants using oral, acute prescription migraine medications. Background The MAST Study is a 2017 study of US adults with migraine that profiles current treatment patterns and identifies and quantifies unmet treatment needs. Methods Cross‐sectional data from an online survey of US adults meeting ICHD‐3 beta criteria for migraine. For inclusion in this paper, respondents self‐reported a history of 3 or more monthly headache days (MHDs) in the past 3 months and at least 1 MHD in the past 30 days, and current use of orally administered acute prescription medication for headache. Three domains of unmet need were identified: inadequate treatment response (ie, inadequate 2‐hour pain freedom, recurrence within 24 hours of initial relief), demanding attack characteristics (rapid onset of attack, headache associated with sleep), and unique patient characteristics (opioid or barbiturate overuse, cardiovascular comorbidity). Sociodemographics, oral medication use, and coexisting conditions and symptoms (ie, level of treatment optimization, psychological symptoms, attack‐related cutaneous allodynia, and migraine symptom severity) were assessed for each domain and by the number of unmet need domains. Results Overall, 15,133 respondents met inclusion criteria, 26.0% (3930/15,133) reported current use of oral acute prescription medication to treat headache. Eligible participants had a mean age of 45.0 years, 73.6% [2892/3930] were women and 81.1% [3186/3930]) were White. A total of 95.8% (3765/3930) of respondents had at least 1 unmet acute treatment need; 89.5% (3516/3930) reported demanding attack characteristics, 74.1% (2912/3930) reported inadequate treatment response, and 16.1% (634/3930) presented with unique patient characteristics. Common areas of unmet need were rapid headache onset (65.3% [2567/3930]), moderate to severe disability (55.6% [2187/3930]), inadequate 2‐hours pain freedom (49.0% [1892/3930]), and headache recurrence within 24 hours (38.0% [1493/3930]). An increasing number of unmet treatment need domains was associated with worsening psychological symptoms, attack‐related cutaneous allodynia and migraine symptom severity. Conclusion Nearly all MAST Study respondents using acute oral prescription medications for migraine reported at least 1 unmet treatment need. As unmet needs increased, so did coexisting conditions and symptom severity.
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Affiliation(s)
- Richard B Lipton
- The Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Dawn C Buse
- The Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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16
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Cotta Ramusino M, De Cillis I, Costa A, Antonaci F. Impact of Medical Care on Symptomatic Drug Consumption and Quality of Life in Headache: A One-Year Population Study. Front Neurol 2019; 10:629. [PMID: 31275226 PMCID: PMC6591309 DOI: 10.3389/fneur.2019.00629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Chronic headache is one of the most common pain conditions, often leading to symptomatic drug overuse. The aim of this study was to provide data on symptomatic drug consumption in an Italian outpatient population and to describe how the clinical picture of headache may change after headache experts take charge of the care of affected individuals. Methods: A total of 199 adults complaining of chronic headache were recruited through 32 pharmacies in the Pavia health district. Participants underwent four evaluations: a baseline assessment (T0) and three follow-up evaluations performed by a neurologist at 3, 6, and 12 months (T3, T6, and T12, respectively). On each occasion, they underwent a complete neurological assessment and received therapeutic adjustments to achieve better management of their headache. Results: On the basis of a preliminary telephone interview, the prevalence rates of chronic headache and medication overuse headache (MOH) were 16 and 12%, respectively. At 12 months of follow-up, we observed a significant decrease in the frequency of attacks (T0: 9 ± 9/month vs. T12: 2 ± 2/month; p < 0.001), in the number of days/month with headache (T0: 11 ± 9 vs. T12: 4 ± 4; p < 0.001) and in single attack duration (T0: 34 ± 30 h vs. T12: 10 ± 19 h; p < 0.001). Careful headache management resulted in a significant decrease in analgesic consumption (T0: 12 ± 16 vs. T12: 4 ± 6 doses/month; p = 0.014) and a significant increase in quality of life, measured using the Migraine Disability Assessment Scale (MIDAS) and Headache Under-Response to Treatment (HURT) scales (p < 0.001). Conclusions: Headache management by a specialist is more effective than self-treatment, resulting in an overall benefit for headache patients.
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Affiliation(s)
- Matteo Cotta Ramusino
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Alfredo Costa
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Fabio Antonaci
- IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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17
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Steiner TJ, Jensen R, Katsarava Z, Linde M, MacGregor EA, Osipova V, Paemeleire K, Olesen J, Peters M, Martelletti P. Aids to management of headache disorders in primary care (2nd edition) : on behalf of the European Headache Federation and Lifting The Burden: the Global Campaign against Headache. J Headache Pain 2019; 20:57. [PMID: 31113373 PMCID: PMC6734476 DOI: 10.1186/s10194-018-0899-2] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 07/31/2018] [Indexed: 12/03/2022] Open
Abstract
The Aids to Management are a product of the Global Campaign against Headache, a worldwide programme of action conducted in official relations with the World Health Organization. Developed in partnership with the European Headache Federation, they update the first edition published 11 years ago.The common headache disorders (migraine, tension-type headache and medication-overuse headache) are major causes of ill health. They should be managed in primary care, firstly because their management is generally not difficult, and secondly because they are so common. These Aids to Management, with the European principles of management of headache disorders in primary care as the core of their content, combine educational materials with practical management aids. They are supplemented by translation protocols, to ensure that translations are unchanged in meaning from the English-language originals.The Aids to Management may be individually downloaded and, as is the case for all products of the Global Campaign against Headache, are available without restriction for non-commercial use.
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Affiliation(s)
- T. J. Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| | - R. Jensen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Z. Katsarava
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany
- Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - M. Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, Norway
- Norwegian Advisory Unit on Headache, St. Olavs Hospital, Trondheim, Norway
| | - E. A. MacGregor
- Centre for Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
| | - V. Osipova
- Research Department of Neurology, First “I. Sechenov” Moscow State Medical University, Moscow, Russian Federation
- Research Center for Neuropsychiatry, Moscow, Russian Federation
| | - K. Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - J. Olesen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - M. Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - P. Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy
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18
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Nielsen M, Carlsen LN, Munksgaard SB, Engelstoft IMS, Jensen RH, Bendtsen L. Complete withdrawal is the most effective approach to reduce disability in patients with medication-overuse headache: A randomized controlled open-label trial. Cephalalgia 2019; 39:863-872. [DOI: 10.1177/0333102419828994] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Medication-overuse headache leads to high disability and decreased quality of life, and the best approach for withdrawal has been debated. Aim To compare change in disability and quality of life between two withdrawal programs. Methods We randomized medication-overuse headache patients to program A (two months without acute analgesics or migraine medications) or program B (two months with acute medications restricted to two days/week) in a prospective, outpatient study. At 6 and 12 months, we measured disability and headache burden by the Headache Under-Response to Treatment index (HURT). We estimated quality of life by EUROHIS-QOL 8-item at 2-, 6-, and 12-month follow-up. Primary endpoint was disability change at 12 months. Results We included 72 medication-overuse headache patients with primary migraine and/or tension-type headache. Fifty nine completed withdrawal and 54 completed 12-month follow-up. At 12-month follow-up, 41 patients completed HURT and 38 completed EUROHIS-QOL 8-item. Disability reduction was 25% in program-A and 7% in program-B ( p = 0.027). Headache-burden reduction was 33% in program-A and 3% in program-B ( p = 0.005). Quality of life was increased by 8% in both programs without significant difference between the programs ( p = 0.30). At 2-month follow-up, quality of life increased significantly more in program-A than program-B ( p = 0.006). Conclusion Both withdrawal programs reduced disability and increased quality of life. Withdrawal without acute medication was the most effective in reducing disability in medication-overuse headache patients. Trial registration Clinicaltrials.gov (NCT02903329).
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Affiliation(s)
- Mia Nielsen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Louise Ninett Carlsen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Signe Bruun Munksgaard
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Ida Maria Storm Engelstoft
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
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