Medication overuse headache (MOH) is now recognized as a biobehavioral disorder, a condition wherein emotion and pain are intermingled. This review discusses the steps to consider when treating this ...condition. The first step involves educating patients about MOH and the pathways to chronicity. The second step concerns working with patients to identify risk factors and behaviors that are present and contributing to the condition. The final step involves behavioral intervention. Examples for accomplishing each step are provided.
Objective: To determine work impact of chronic migraine (CM) versus episodic migraine (EM). Methods: Data were from the 2005 American Migraine Prevalence and Prevention study, a longitudinal ...population survey of more than 11,000 migraineurs. Lost productive time (LPT) was measured as missed work hours plus reduced productivity hour equivalents. Results: Those with CM were 19% less likely to be working for pay compared with migraineurs with ≤3 headache-days/month. On average, those with CM lost 4.6 hours/wk from headache compared with 1.1 hours for those with ≤3 headache-days/month. Those with 10 to 14 headache-days/month or with CM accounted for 9.1% of employed migraineurs, 20.8% of work-related LPT, and 35% of the overall lost work time when considering medical leave and unemployment. Conclusions: The work impact of CM and high frequency EM will be underestimated if employment status is not measured.
Abstract
One important factor in the abuse potential of an opioid product is the ease with which active drug can be extracted. There are currently no standards for testing or reporting ...extractability. This article describes the development of an Extractability Rating System for use by the pharmaceutical industry and regulators. Despite several limitations, this effort serves as a call for standardized testing and reporting so that products can be accurately rated, and should help establish goals for drug developers who wish to develop "abuse-resistant" opioid products.
We conducted a 2-part systematic review of published studies to examine the evidence that combination oral contraceptives can aggravate or cause headache.
We used trials with a control group to ...assess headache risk that was attributable to oral contraceptive use and prospective cohort trials to answer important clinical questions about the natural history and treatment response of headache that occurs with oral contraceptive use.
Because of differences in study populations, oral contraceptive formulations, trial end points and trial duration, it was not possible to pool data; but the evidence supports several conclusions. There is little indication that oral contraceptives have a clinically important effect on headache activity in most women.
Headache that occurs during early cycles of oral contraceptive use tends to improve or disappear with continued use. No evidence supports the common clinical practice of switching oral contraceptives to treat headache; however, manipulating the extent or duration of estrogen withdrawal may provide benefit.
Background: Some studies of premenopausal women suggest that the severity of psychopathology associated with schizophrenia may be related to levels of estrogen.
Methods: We examined psychopathology ...in community-dwelling postmenopausal women with schizophrenia who had received (
n = 24) versus had never received (
n = 28) hormone replacement therapy.
Results: Users of hormone replacement therapy and nonusers did not differ significantly with respect to age, ethnicity, education, age of onset, duration of schizophrenia, global cognitive functioning, or neuroleptic-induced movement disorders. The hormone replacement therapy users received lower average daily doses of antipsychotic medication; they had similar levels of positive symptoms but significantly less severe negative symptoms compared with hormone replacement therapy nonusers, independent of differences in antipsychotic dosage.
Conclusions: Our results suggest that the use of hormone replacement therapy in conjunction with antipsychotic medication in postmenopausal women with schizophrenia may help reduce negative, but not positive, symptoms.
Background
We evaluated the effect of erenumab, a fully human monoclonal antibody that inhibits the canonical calcitonin gene-related peptide receptor, on migraine-related disability, impact, and ...health-related quality of life among patients with episodic migraine.
Methods
Patients enrolled in a phase 3, 6-month, double-blind, placebo-controlled study of once-monthly erenumab 70 and 140 mg for migraine prevention (STRIVE) used an eDiary during the baseline and double-blind treatment phases to complete validated, specific questionnaires, including the modified (monthly) Migraine Disability Assessment Questionnaire; Headache Impact Test; and Migraine-Specific Quality of Life Questionnaire-role function-restrictive (MSQ-RFR), -role function-preventive (MSQ-RFP), and -emotional function (MSQ-EF).
Results
A total of 955 patients were randomized to receive erenumab 70 mg (n = 317), erenumab 140 mg (n = 319), or placebo (n = 319). Erenumab versus placebo resulted in significantly greater improvements in all patient-reported outcomes; changes from baseline were numerically higher with 140 mg erenumab. Improvements occurred rapidly and were maintained over 6 months of treatment. Between-group differences from placebo over months 4–6 for the 70- and 140-mg dose groups were, respectively, −2.1 and −2.8 for modified (monthly) Migraine Disability Assessment Questionnaire, −2.1 and −2.3 for Headache Impact Test, 5.1 and 6.5 for MSQ-RFR, 4.2 and 5.4 for MSQ-RFP, and 5.2 and 6.7 for MSQ-EF (p < 0.001 for all). Erenumab also significantly reduced the proportion of patients with severe and very severe migraine-related disability and increased the proportion of patients with clinically meaningful improvements in migraine-related impact and health-related quality of life.
Conclusion
Erenumab reduced migraine disability and impact and improved patients’ health-related quality of life, reinforcing its role as a promising new therapy for migraine prevention.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Chronic migraine is a common and disabling complication of migraine with a population prevalence of about 2%. Emerging evidence suggests that episodic migraine and chronic migraine differ not only in ...degree, but also in kind. Compared with patients with episodic migraine, those with chronic migraine have worse socioeconomic status, reduced health-related quality of life, increased headache-related burden (including impairment in occupational, social, and family functioning), and greater psychiatric and medical comorbidities. Each year, approximately 2.5% of patients with episodic migraine develop new-onset chronic migraine (ie, chronification). Understanding the natural disease course, improving treatment and management, and preventing the onset could reduce the enormous individual and societal burden of chronic migraine, and thus, have become important goals of headache research. This review provides a summary of the history of nomenclature and diagnostic criteria, as well as recent studies focusing on the epidemiology, natural history, and burden of chronic migraine.
Objective
In a population sample of persons with migraine treating with a single category of acute migraine medication, to identify rates and factors associated with acute treatment outcomes, ...including 2‐hour pain freedom (2hPF), 24‐hour pain response (24hPR), and 24‐hour sustained pain response (24hSPR). Key predictors include acute treatment type (triptans and other medication categories), the influence of allodynia on response to medication, and the interaction between medication category and presence of allodynia in response to treatment among people with migraine.
Background
Cutaneous allodynia was previously associated with inadequate 2hPF, 24hPR, and 24hSPR (sustained response at 24 hours among those with adequate 2hPF) among people with migraine in the American Migraine Prevalence and Prevention (AMPP) Study.
Methods
The AMPP Study obtained data from a representative US sample of persons with migraine by mailed questionnaire. The 2006 survey included 8233 people with migraine aged 18 or over who completed the Migraine Treatment Optimization Questionnaire (mTOQ). mTOQ was used to assess acute treatment outcomes including 2hPF, 24hPR, and 24hSPR. Eligible individuals used only a single category of acute prescription migraine treatments (n = 5236, 63.6%). This sample was stratified into 5 categories of type of acute prescription headache medication used (triptans, nonsteroidal anti‐inflammatory drugs, barbiturate‐combinations, opioids, and opioid combinations and ergot alkaloids). Separate binary logistic regression models evaluated: (1) triptans vs other medication types; (2) presence of allodynia vs no allodynia; and (3) the interaction of medication category with allodynia. Sociodemographic variables, health insurance status, over‐the‐counter and preventive medication use were included as covariates. Odds ratios (OR) and 95% confidence intervals (CI) were generated for each acute treatment outcome.
Results
Among eligible participants, the mean age was 46 years, and 82.5% were women. The triptan use group had better outcomes than other medication groups for 2hPF (OR range: 2.00‐2.63, all significant except ergot alkaloids) and 24hPR (OR range: 2.10‐6.22, all significant). No significant medication effects were found for the 24hSPR outcome. The presence of allodynia was associated with significantly worse outcomes for both 2hPF (OR range: 1.42‐1.55, all significant) and 24hPR (OR range: 1.30‐1.32, all significant, except for ergot alkaloids, P = .051). Allodynia effects were not significant for the 24hSPR. The interaction between medication and allodynia was also not significant (OR range for 2hPF: .68‐2.02; OR range for 2hPR: .35‐1.34; OR range for 24hSPR: 1.21‐2.72) in any of the models, suggesting allodynia is an important predictor of treatment response regardless of the medication group prescribed.
Conclusions
The use of triptan medication was associated with significantly better 2hPF (except vs ergot alkaloids) and significantly better 24hPR outcomes compared with other acute medication categories. The presence of allodynia significantly increased the likelihood of an inadequate treatment response for both of these outcomes. Triptan use was generally associated with the best outcomes. Because allodynia was associated with inadequate outcomes for all medication groups, we suggest that allodynia is an area of unmet treatment need.
