Selective serotonin re-uptake inhibitors (SSRIs) for preventing migraine and tension-type headaches.

BACKGROUND: Headache is a common medical problem. In view of recent discoveries about the role of serotonin in pain mechanisms, selective serotonin re-uptake inhibitors (SSRIs) have been evaluated for the prevention of migraine and tension-type headaches (TTH). OBJECTIVES: To evaluate the efficacy and tolerability of SSRIs for preventing migraine and TTH. SEARCH STRATEGY: We searched MEDLINE (1966-2004), EMBASE (1994-2003), the Cochrane Central Register of Controlled Trials (Issue 4, 2003), and reference lists of retrieved articles. Headache Quarterly was hand searched from 1990 to 2003. SELECTION CRITERIA: We included randomised controlled trials comparing SSRIs with any type of control intervention in patients of either sex, over 18 years of age, with migraine or TTH. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data (headache frequency, index, severity, and duration; use of symptomatic/analgesic medication; days off work; quality of life; mood improvement; cost-effectiveness; and adverse events) and assessed the methodological quality of trials. MAIN RESULTS: Thirteen studies utilizing five SSRIs met the inclusion criteria (636 participants). Most of the included studies had methodological and/or reporting shortcomings; follow up rarely extended beyond 3 months. After 2 months SSRIs did not significantly lower headache index scores in patients with migraine when compared to placebo (SMD -0.14; 95% CI -0.57 to 0.30). Patients with chronic TTH treated with an SSRI had a significantly higher analgesic intake of 5 more doses per month when compared to patients treated with a tricyclic antidepressant (WMD 4.98; 95% CI 1.12 to 8.84). Tricyclics also significantly reduced headache duration by 1.26 hours per day (WMD 1.26; 95% CI 0.06 to 2.45) and marginally reduced headache indexes (SMD 0.42; 95% CI 0.00 to 0.85) when compared to SSRIs in patients with chronic TTH. When the data on adverse events were considered without regard to headache diagnostic subgroups, there were no significant differences between SSRIs and placebo for withdrawals due to adverse events (Peto OR 1.02; 95% CI 0.31 to 3.34). For minor adverse events, SSRIs were generally more tolerable than tricyclics (OR 0.34; 95% CI 0.13 to 0.92). However, there were no differences in the number of patients withdrawing due to any reason in the SSRI and tricyclic groups (OR 1.01; 95% CI 0.56 to 1.80). AUTHORS' CONCLUSIONS: Over 2 months of treatment, SSRIs are no more efficacious than placebo in patients with migraine. In patients with chronic TTH, SSRIs are less efficacious than tricyclic antidepressants. In comparison with SSRIs, the burden of adverse events in patients receiving tricyclics was greater. These results are based on short-term trials and may not generalise to longer-term treatment.

[Cochrane EPOC group: closing the gap between quality assurance and organization of care research and front line professionals]. / Cochrane EPOC group: chiudere il gap tra ricerca sul miglioramento della qualità dei servizi sanitari e professionisti sul campo.

Keeping physicians informed on an ongoing basis is a new challenge for continuing medical education and quality assurance. In Italy over the last 5 years interest in evidence based literature is growing. This is demonstrated by the launch of an Italian edition of Clinical Evidence and by the growing number of guidelines and systematic reviews produced by Italian authors and institutions. However, there is some uncertainty concerning the familiarity of Italian policy makers and public health physicians with the evidence-based resources, including also how to access them. This article attempts to close this gap, by describing the activities of the Cochrane Collaboration and, within it, of the Cochrane Effective Practice and Organisation of Care Group (EPOC), both aim to prepare and maintaining SR of health care interventions. Specifically, the EPOC group develops systematic reviews of professional, financial, organisational and regulatory interventions that are designed to improve professional practice and the delivery of effective health services. EPOC has 31 reviews and 24 protocols published in Issue 4, 2004 of the Cochrane Library and has developed standard methods to assist people, such as quality criteria for study design specific to health services research. The EPOC specialized register contains details of over 2200 studies that fall within the group's scope. Systematic reviews provide a valuable and efficient source of information for policy makers and health care professionals aimed at implementing effective and efficient strategies to encourage medical behavioural change and deliver of high quality services.

[Communicating with patients: how good are our pamphlets and other written materials? An evaluation of the quality of the written information available to patients with asthma and diabetes in out-patients' clinics in Milan]. / Comunicazione medica scritta: costruiamo informazioni di qualità per il paziente? Una valutazione della qualità del materiale informativo a disposizione dei pazienti asmatici e diabetici negli ambulatori milanesi.

OBJECTIVES: 1) To identify the extent and the nature of information pamphlets available for asthmatic and diabetic patients in secondary care hospitals in Milan; 2) To investigate what patients think about the quality of pamphlets using a questionnaire developed ad hoc. METHODS: Pamphlets have been identified by contacting 8 specialised ambulatory hospitals. The questionnaire was developed to achieve a quality rate in 3 dimensions of the materials (Style and readability, The condition and Treatment options). Patients were recluted in the same ambulatory hospital. RESULTS: 4 ambulatory hospitals and 40 patients agreed to participate in our survey. We identified 8 pamphlets (5 diabetes, 3 asthma). 6 of these have been promoted byfarmaceutical companies. The mean length was 31 pages and the issue most covered was treatment options (33% of pages dedicated). 30 pages (12% of the total) presented with publicity advertisements (6% direct and 6% indirect). The dimension with the best satisfaction rate was Condition, followed by Style and readability. CONCLUSIONS: In Milan, in secondary care asthmatic and diabetic patients, are often invited to consult pamphlets. They positively judged this material. During the study ambulatory physicians were poorly attentive about problems concerning patient access to information.