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Souza MNP, Cohen JM, Piha T, Ribalov R, Lengil T, van der Laan A, Calderaro M, Lee LK. Burden of migraine in Brazil: A cross-sectional real-world study. Headache 2022; 62:1302-1311. [PMID: 36426738 DOI: 10.1111/head.14413] [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: 01/03/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the burden and consequences of migraine in Brazil in terms of health-related quality of life (HRQoL), work productivity and daily activities, and healthcare resource utilization (HRU). BACKGROUND Despite existing data on how migraine affects populations worldwide, there are limited data on the burden of migraine in Latin America. METHODS This cross-sectional study used patient-reported data from the 2018 Brazil National Health and Wellness Survey. HRQoL scores (EuroQol 5-dimension 5-level [EQ-5D-5L]; 36-item Short Form Health Survey, version 2 [SF-36v2]; and Short Form 6-dimension [SF-6D]), impairments to work productivity and daily activities (Work Productivity and Activity Impairment questionnaire), and all-cause HRU were compared between migraine respondents and matched non-migraine controls. RESULTS Of the 12,000 total respondents in the survey database, 1643 self-reported a physician diagnosis of migraine and were propensity score matched 1:1 with controls without migraine. HRQoL was lower in patients with migraine versus non-migraine controls, with significantly lower SF-36v2 physical (mean [± SD] 50.3 [7.5] vs. 52.0 [7.6]) and mental component (mean [± SD] 42.9 [10.2] vs. 46.0 [9.9]) summary scores and SF-6D (mean [± SD] 0.7 [0.1] vs. 0.7 [0.1]) and EQ-5D-5L (mean [± SD] 0.7 [0.2] vs. 0.8 [0.2]) utility scores (all p < 0.001). Patients with migraine reported higher levels of work productivity loss (mean [± SD], 40.6% [31.4%] vs. 28.6% [30.9%], including absenteeism 12.8% [19.1%] vs. 8.4% [17.1%] and presenteeism 35.0% [28.7%] vs. 24.8% [28.0%]; all p < 0.001); activity impairment (mean [± SD] 36.0% [28.8%] vs. 25.5% [28.1%]; p < 0.001); and significantly higher HRU in the past 6 months (healthcare provider and emergency department visits [mean [± SD] 7.2 [9.5] vs. 4.5 [6.3] and 1.7 [3.8] vs. 0.9 [2.2]; both p < 0.001] and hospitalizations [mean [± SD] 0.4 [2.7] vs. 0.2 [1.1]; p = 0.002]) than controls. CONCLUSION Migraine is associated with poorer HRQoL, higher all-cause HRU, and greater activity impairment and work productivity loss versus non-migraine controls in Brazil.
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Affiliation(s)
| | - Joshua M Cohen
- Teva Pharmaceutical Industries, Ltd., West Chester, Pennsylvania, USA
| | - Tony Piha
- Teva Pharmaceutical Industries, São Paulo, Brazil
| | - Rinat Ribalov
- Teva Pharmaceutical Industries Ltd., Petah Tikva, Israel
| | - Tamar Lengil
- Teva Pharmaceutical Industries Ltd., Petah Tikva, Israel
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Melhado EM, Santos PSF, Kaup AO, da Costa ATNM, Roesler CADP, Piovesan ÉJ, Sarmento EM, Theotonio GOM, de Campos HC, Fortini I, de Souza JA, Maciel JA, Segundo JBA, de Carvalho JJF, Speziali JG, Calia LC, Barea LM, Queiroz LP, Souza MNP, Figueiredo MRCF, Costa MENDM, Peres MFP, Jurno ME, Peixoto PM, Kowacs PA, Rocha-Filho PAS, Moreira PF, Silva-Neto RP, Fragoso YD. Consensus of the Brazilian Headache Society (SBCe) for the Prophylactic Treatment of Episodic Migraine: part I. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:845-861. [PMID: 36252594 PMCID: PMC9703891 DOI: 10.1055/s-0042-1756441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Brazilian Headache Society (Sociedade Brasileira de Cefaleia, SBCe, in Portuguese) nominated a Committee of Authors with the aim of establishing a consensus with recommendations regarding prophylactic treatment for episodic migraine based on articles published in the worldwide literature, as well as personal experience. Migraine affects 1 billion people around the world and more than 30 million Brazilians. In addition, it is an underdiagnosed and undertreated disorder. It is well known within the medical community of neurologists, and especially among headache specialists, that there is a need to disseminate knowledge about prophylactic treatment for migraine. For this purpose, together with the need for drug updates and to expand knowledge of the disease itself (frequency, intensity, duration, impact and perhaps the progression of migraine), this Consensus was developed, following a full online methodology, by 12 groups who reviewed and wrote about the pharmacological categories of the drugs used and, at the end of the process, met to read and establish conclusions for this document. The drug classes studied were: anticonvulsants, tricyclic antidepressants, monoclonal anti-calcitonin gene-related peptide (anti-CGRP) antibodies, beta-blockers, antihypertensives, calcium channel inhibitors, other antidepressants (selective serotonin reuptake inhibitors, SSRIs, and dual-action antidepressants), other drugs, and polytherapy. Hormonal treatment and anti-inflammatories and triptans in minimum prophylaxis schemes (miniprophylaxis) will be covered in a specific chapter. The drug classes studied for part I of the Consensus were: anticonvulsants, tricyclic antidepressants, monoclonal anti-CGRP antibodies, and beta-blockers.
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Affiliation(s)
- Eliana Meire Melhado
- Centro Universitário Padre Albino, Faculdade de Medicina, Departamento de Neurologia, Catanduva SP, Brazil
| | - Paulo Sergio Faro Santos
- Instituto de Neurologia de Curitiba, Departamento de Neurologia, Setor de Cefaleia e Dor Orofacial, Curitiba PR, Brazil
| | - Alexandre Ottoni Kaup
- Houston Headache Clinic, Houston TX, United States,Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil,Universidade de Santo Amaro, São Paulo SP, Brazil
| | | | | | - Élcio Juliato Piovesan
- Universidade Federal do Paraná, Departamento de Clínica Médica, Disciplina de Neurologia, Curitiba PR, Brazil
| | | | | | | | - Ida Fortini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Jano Alves de Souza
- Universidade Federal Fluminense, Departamento de Medicina Clínica, Disciplina de Neurologia, Niterói RJ, Brazil
| | - Jayme Antunes Maciel
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil
| | | | - João José Freitas de Carvalho
- Unichristus, Curso de Medicina, Disciplina de Neurologia, Fortaleza CE, Brazil,Hospital Geral de Fortaleza, Serviço de Neurologia, Núcleo de Cefaleias, Fortaleza CE, Brazil
| | - José Geraldo Speziali
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurologia, Ribeirão Preto SP, Brazil
| | - Leandro Cortoni Calia
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil
| | - Liselotte Menke Barea
- Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Disciplina de Neurologia, Porto Alegre RS, Brazil
| | - Luiz Paulo Queiroz
- Universidade Federal de Santa Catarina, Hospital Universitário, Serviço de Neurologia, Florianópolis SC, Brazil
| | | | | | | | | | - Mauro Eduardo Jurno
- Fundação José Bonifácio Lafayette de Andrada, Faculdade de Medicina de Barbacena, Barbacena MG, Brazil,Fundação Hospitalar do Estado de Minas Gerais, Hospital Regional de Barbacena Dr. José Américo, Barbacena MG, Brazil
| | | | - Pedro André Kowacs
- Instituto de Neurologia de Curitiba, Serviço de Neurologia, Curitiba PR, Brazil,Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Neurologia, Curitiba PR, Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área de Neuropsquiatria, Recife PE, Brazil,Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Ambulatório de Cefaleias, Recife PR, Brazil
| | - Pedro Ferreira Moreira
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Departamento de Medicina Clínica, Niterói RJ, Brazil
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Soares ADA, Louçana PMC, Nasi EP, Sousa KMDH, Sá OMDS, Silva-Néto RP. A double- blind, randomized, and placebo-controlled clinical trial with omega-3 polyunsaturated fatty acids (OPFA ɷ-3) for the prevention of migraine in chronic migraine patients using amitriptyline. Nutr Neurosci 2017; 21:219-223. [PMID: 28056704 DOI: 10.1080/1028415x.2016.1266133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the prophylactic effect of OPFAϖ-3 in migraine. SUBJECTS AND METHODS This was a prospective, experimental, controlled, double-blind, and with comparison groups study. Sixty patients diagnosed with chronic migraine, according to the criteria of the International Classification of Headache Disorders, Third Edition (beta version) (ICHD-3β), were prophylactically treated with amitriptyline. They were divided into two equal groups: in group 1, prophylaxis was associated with OPFAϖ-3 and in group 2 with placebo. After 60 days, both groups were assessed by a second researcher. RESULTS Of the 60 patients with chronic migraine, only 51 patients (15 men and 36 women) completed the treatment. The group that received OPFAϖ-3 consisted of 27 (52.9%) patients (six men and 21 women), while the control group was equal to 24 (47.1%) patients (nine men and 15 women). These differences were not significant (χ2 = 1.428; P = 0.375). In 66.7% (18/27) of the patients who used OPFAϖ-3, there was a reduction of more than 80.0% per month in the number of days of headache, while in the control group, the same improvement occurred in 33.3% (8/24) of patients. This difference was significant (χ2 = 5.649; P = 0.036). CONCLUSIONS Polyunsaturated omega 3 fatty acids (OPFAϖ-3) are useful for prophylaxis of migraine attacks.
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Krymchantowski AV, Jevoux CDC. The Pharmacological Treatment of Migraine in Brazil. Headache 2015; 55 Suppl 1:51-8. [DOI: 10.1111/head.12513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/29/2022]
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Silva-Néto RP, Almeida KJ, Bernardino SN. Analysis of the duration of migraine prophylaxis. J Neurol Sci 2014; 337:38-41. [DOI: 10.1016/j.jns.2013.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/30/2013] [Accepted: 11/11/2013] [Indexed: 11/29/2022]
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Giacomozzi ARE, Vindas AP, Junior AADS, Bordini CA, Buonanotte CF, Roesler CADP, Brito CM, Perez C, Carvalho DDS, Macedo DDPD, Piovesan EJ, Sarmento EM, Melhado EM, Éckeli FD, Kowacs F, Sobrino F, Rabello GD, Rada G, Souza JAD, Casanovas JR, Durán JC, Calia LC, Medina LRP, Queiroz LPD, Ciciarelli MC, Valença MM, Cusicanqui M, Jimenez MKV, Goycochea MT, Peres MFP, Sandoval MVF, Vincent MB, Gomes MV, Diez M, Aranaga N, Barrientos N, Kowacs PA, Filho PFM. Latin American consensus on guidelines for chronic migraine treatment. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:478-86. [DOI: 10.1590/0004-282x20130066] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/20/2013] [Indexed: 11/22/2022]
Abstract
Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Fernando Kowacs
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Ferreira TP, Coan AC, Guerreiro CAM. Comorbidities associated with epilepsy and headaches. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:274-7. [PMID: 22358309 DOI: 10.1590/s0004-282x2012005000008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 11/29/2011] [Indexed: 11/22/2022]
Abstract
UNLABELLED Comorbidities are often associated with chronic neurological diseases, such as headache and epilepsy. OBJECTIVES To identify comorbidities associated with epilepsy and headaches, and to determine possible drug interactions. METHODS A standardized questionnaire with information about type of epilepsy/headache, medical history, and medication was administered to 80 adult subjects (40 with epilepsy and 40 with chronic headache). RESULTS Patients with epilepsy had an average of two comorbidities and those with headache of three. For both groups, hypertension was the most prevalent. On average, patients with epilepsy were taking two antiepileptic medications and those with headache were taking only one prophylactic medication. Regarding concomitant medications, patients with epilepsy were in use, on average, of one drug and patients with headache of two. CONCLUSIONS Patients with chronic neurological diseases, such as epilepsy and headaches, have a high number of comorbidities and they use many medications. This may contribute to poor adherence and interactions between different medications.
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Affiliation(s)
- Thalles P Ferreira
- Departamento de Neurologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, SP, Brazil
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Ruiz Jr FB, Santos MS, Siqueira HS, Cotta UC. Clinical features, diagnosis and treatment of acute primary headaches at an emergency center: why are we still neglecting the evidence? ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:1130-3. [DOI: 10.1590/s0004-282x2007000700007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 10/01/2007] [Indexed: 11/22/2022]
Abstract
In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of Uberlândia (HC-UFU) throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7%), followed by probable tension-type headache (37.6%), unspecified headache (11.9%), and headache not elsewhere classified (2.8%). As to characteristics of the crisis, the location of the pain was described in 86.2% of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5%), tenoxicam (31.8%), diazepam (20.9%), dimenhydrate (10.9%), and metochlopramide (9.9%). The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients.
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Matta APDC, Ribas MCA, Moreira Filho PF. Postmeningitis headache: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:521-3. [PMID: 17665028 DOI: 10.1590/s0004-282x2007000300031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 02/19/2007] [Indexed: 11/21/2022]
Abstract
We report a case of a 18-year-old female patient that developed a migraine-like headache following an acute meningococcal meningitis. She had no previous history of recurrent headaches. The pain was intense, pulsatile and throbbing, typically unilateral, without aura. Its frequency increased during the following weeks and a prophylactic treatment with amitriptyline and atenolol was initiated. There was remission of the attacks.
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Bigal ME, Bordini CA, Antoniazzi AL, Speciali JG. The triptan formulations: a critical evaluation. ARQUIVOS DE NEURO-PSIQUIATRIA 2003; 61:313-20. [PMID: 12806521 DOI: 10.1590/s0004-282x2003000200032] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The migraine-specific triptans have revolutionized the treatment of migraine and are usually the drugs of choice to treat a migraine attack in progress. Different triptans are available in different strengths and formulations including oral tablets, orally disintegrating tablets, nasal sprays and subcutaneous injections. In Europe, sumatriptan is also available as a suppository. Specific differences among the triptans exist as evidenced by different pharmacological profiles including T1/2, Tmax, Cmax, AUC, metabolism, drug-drug interaction profiles, amongst other parameters. How or whether these differences translate to clinical efficacy and tolerability differences is not well differentiated. Clinical distinctions among these agents are subtle and proper choice of triptan requires attention to the specific characteristics of each individual patient, knowledge of patient preference, accurate history of the efficacy of previous acute care medications as well as individual features of the drug being considered. Delivery systems may play an important role in the onset of action of triptans. The selection of an acute antimigraine drug for a patient depends upon the stratification of the patient's migraine attack by peak intensity, time to peak intensity, level of associated symptoms such as nausea and vomiting, time to associated symptoms, comorbid diseases, and concomitant treatments that might cause drug-drug interactions. The clinician has in his armamentarium an ever-expanding variety of medications, available in multiple formulations and dosages, with good safety and tolerability profiles. Continued clinical use will yield familiarity with the various triptans, and it should become possible for the interested physician to match individual patient needs with the specific characteristics of a triptan to optimize therapeutic benefit.
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Affiliation(s)
- Marcelo E Bigal
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
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