[Migraine burden and clinical inertia: what can we do?] / Migren' i klinicheskaia inertsiia: chto my mozhem sdelat'?

AIM: To study the compliance of neurologists and headache specialists to chronic headache and chronic migraine (CM) diagnosis and treatment guidelines. MATERIAL AND METHODS: The survey included 634 neurologists from all regions of the Russian Federation. Mean age of respondents was 40.7±8.5 years, mean years of experience 14.2±7.8 years. RESULTS: Most doctors work in outpatient or hospital settings (49% and 24%, respectively), 7% were headache specialists. Tension-type headache (TTH) was diagnosed in 30% and CM in 17% of patients while 44% of patients were presumed to have a mixed headache disorder (TTH+CM). Only 10% of physicians do not use instrumental diagnostic methods in chronic headache. This study has shown sufficient attention to comorbid conditions and frequent prescription of headache preventative treatment. Botox prescription data is equivocal: 35% of physicians recommend such treatment, 27% do not, while other doctors prescribe it for off-label indications. CONCLUSION: To overcome clinical inertia, further education in chronic headaches and their optimal treatment is warranted.

[Migraine in women: clinical and therapeutical aspects]. / Migren' u zhenshchin: klinicheskie i terapevticheskie aspekty.

Migraine is one of the most common neurological disorders, affecting women. Physiological changes in the hormonal status can modulate the functional status of pain and analgesic systems of the brain and, by involving different pathophysiological mechanisms, change the course of migraine. In addition to an analysis of epidemiological data, the review provides current views on the clinical features of the disease in women population at different periods of life, particular attention was focused on menstrual migraine. It has certain features, such as acute and long attacks and treatment difficulties. One of main issues is the use of oral contraceptives in women with migraine according to the ratio of potential benefit to cardiovascular risk. The problems of treatment headaches in pregnant and breastfeeding women are also considered. An influence of migraine on the course and outcome of pregnancy was shown. The authors analysed the results of the studies on the course of migraine during perimenopause and postmenopause and recommendations for women with migraine attacks and climacteric syndrome. The data presented in the review are useful for clinicians, because this information represents new views on pathogenetic mechanisms, clinical features and treatment of migraine in women.

[Real-world migraine burden: clinical and economic aspects]. / Bremia migreni v real'noi klinicheskoi praktike: klinicheskie i ékonomicheskie aspekty.

AIM: To evaluate the rationale for different approaches to preventive chronic migraine (CM) treatment by comparing clinical outcomes and financial burden of the disease in the real-world practice. MATERIAL AND METHODS: Sixty-six patients with CM were enrolled at the Alexander Vein Headache Clinic (60 women and 6 men, aged 28-51). All patients were divided into 3 groups: group 1 (n=22) received oral preventative treatment with topiramate, up to 100 mg daily, for three months; group 2 (n=20) received 12 acupuncture sessions (3 sessions a week); group 3 (n=24) received 155-195 units of botulinum toxin type A (botox, BTA). The follow-up period in all groups was 3 months. Efficacy was evaluated by clinical examination, the Headache Impact Test (HIT-6) and questionnaires to assess subjective patient satisfaction and treatment tolerability. RESULTS: BTA demonstrated the highest efficacy in this study. Compared to the oral preventative treatment and acupuncture, BTA reduced the frequency of headache faster and more significantly facilitating CM transformation into episodic migraine (headache frequency was 16.1±0.1; 18.0±0.02; and 13.9±0.3 in groups 1, 2 and 3, respectively, after one month of treatment). BTA also improved the quality of life faster and more significantly and was better tolerated (good - 51%, 75% and 85% in groups 1, 2 and 3, respectively; satisfactory - 35%, 25% and 15% in groups 1, 2 and 3, respectively; bad 14% in the oral prevention group). In the BTA group, the majority of patients demonstrated earlier treatment satisfaction. Despite higher (compared to topiramate) direct costs in the BTA group (RUB 29 931.51 and RUB 32 085.87, respectively), the predicted cost of a headache-free day was the smallest and totaled RUB 652.15 (compared to RUB 692.86 and RUB 1017.60 in the topiramate and acupuncture groups, respectively). CONCLUSION: The data on the efficacy and costs of different CM prevention strategies would facilitate optimal treatment choice for neurologists and patients.

[Ways of optimizing the management of patients with migraine in Russia (resolution of the council of experts)]. / Puti optimizatsii vedeniia patsientov s migren'iu v Rossii (rezoliutsiia soveta ékspertov).

Migraine is the third most common disease in the world. The overall prevalence of migraine in the Russian Federation is estimated at 20% with an estimated global prevalence of 14.7%. Migraine affects mostly people of working age and has a significant negative impact on the quality of life, the level of adaptation, ability to work, social functioning. Migraine represents a significant social and economic burden for patients and society as a whole. A team of national experts on migraine offers a program to prioritize quality of management of patients with headache.

[Temporomandibular disorder as the most prevalent cause of facial pain: current evidence]. / Disfunktsiia visochno-nizhnecheliustnogo sustava kak naibolee chastaia prichina boli v litse: sovremennoe sostoianie problemy.

Orofacial pain is a comprehensive and multi-faceted syndrome. After dental causes have been excluded, neurologists are challenged to diagnose the cause of pain. The paper gives a detailed review of one of the most common causes of facial pain - temporomandibular disorder (TMD). Current DC/TMD diagnostic criteria, patient examination protocols and a new perspective on TMD pathophysiology based on the recent neurological studies are presented. The article also discusses modern approaches to TMD management.

[Diagnosis and treatment of migraine: Recommendations of the Russian experts]. / Diagnostika i lechenie migreni: rekomendatsii rossiiskikh ékspertov.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.

[Diagnosis of refractory forms of chronic primary headache]. / Diagnostika refrakternykh form khronicheskoi pervichnoi golovnoi boli.

A number of patients with primary headaches remain insensitive or refractory to treatment despite correctly selected drugs, adequate therapeutic dose and duration of therapy. The importance of refractory problem is determined by the fact that patients are completely maladjusted, disabled, and keeping these patients is very difficult even for seasoned professionals. Determination of the correct tactics and success of the treatment depends, in the first place, on the correct diagnosis. This article discusses the diagnostic criteria for the most important forms such as refractory chronic migraine or refractory chronic cluster headache presented by experts of the European Headache Federation in two separate Consensus.

[The optimization of management of chronic daily headache patients]. / Optimizatsiya vedeniya patsientov s khronicheskoi ezhednevnoi golovnoi bol'yu.

AIM: To optimize the management of chronic daily headache (CDH) using cognitive-behavioral therapy (CBT). MATERIAL AND METHODS: The study included 90 patients (76 women and 14 men), aged from 23 to 78 years (mean age 46.71±11.99) with primary forms of CDH. The patients were followed-up by the neurologist during 12 months, psychological characteristics were studied together with the psychiatrist. Patients received combined treatment, including optimized pharmacotherapy, educational program, relaxation training, CBT and exercise therapy. RESULTS: The diagnosis of CDH has not been previously established in 86.7% of the patients. All patients received unnecessary additional diagnostic examinations, ineffective treatment (86.7%) that resulted in the formation of wrong conceptions about their state (90%). Three months after combined treatment, a significant positive effect has been achieved in 62.2% of the patients and after 12 months in 72.2%. CONCLUSION: The combined treatment program that included CBT can relatively rapidly help patients with CDH and exerts a stable positive effect during 12 months of the follow-up.

[Evaluation of the interferon system and major cytokines in patients with bronchial asthma].

AIM: Study of the interferon system (IFN) and the production of major cytokines in patients with bronchial asthma of various course severity. MATERIALS AND METHODS: 204 patients with atopic bronchial asthma (BA); 32 patients with allergic rhinitis (AR) and 93 mostly healthy volunteers were examined. Blood cells of patients with BA of various course severity were studied by biological method in HEP cell culture for the ability to produce IFN. Levels of cytokines in the blood sera were determined by EIA method with the corresponding commercial test systems: IL-4, IL-10, IL-13 and IFN-gamma according to user manual. RESULTS: Disorders in the ability ofleukocytes to produce IFN-alpha and IFN-gamma were detected in patients with bronchial asthma and allergic rhinitis. Misbalance in the production of pro- and anti-inflammatory cytokines depending on the level of disease severity was noted. The highest serum IFN-gamma was noticed in patients with mild persistence BA course, that is most probably determined by higher frequency of ARVI in this group of patients. Maximum level of IL-10 was detected in mild BA form and was nearly undetected in the severe course of the infection, which is characterized by higher content of IL-4 in blood sera. CONCLUSION: Increase of course severity of chronic (allergic) inflammation in bronchial tissue and higher frequency of ARVI among patients with persistent BA of medium and severe course is characterized by a lack of interferon link of the immune system and disorders of regulatory mechanisms, that is expressed by a change in the ratio of IFN-gamma/IL-4 parameters and decrease of IL-10 content in blood sera.

[Migraine and "sleep-wake" cycle].

The results of the comparative analysis of patients with migraine attacks developing in the waking period (AP) and night sleep period are presented. Patients with sleep-related migraine (SM) had higher levels of depression and anxiety, marked autonomic dysfunction and stable sleep disturbances that resulted in significant maladaptation of these patients in the between-attacks period and low quality of life. Depression plays a role in the transformation of AP to SM and formation of stable sleep disturbances in the between-attacks period in patients with SM. It is suggested that common serotoninergic mechanisms involved in migraine attack may contribute to formation of "sleep-wake" cycle and depression development. The principles of optimal therapy of such patients are formulated.

[Hemodynamics, electrophysiological parameters of the heart and differential therapy of attacks of atrial fibrillation in patients with subclinical thyroid dysfunction]. / Osobennosti gemodinamiki, élektrofiziologicheskikh pokazatelei serdtsa i differentsirovannaia terapiia paroksizmov fibrilliatsii predserdii u bol'nykh s subklinicheskoi disfunktsiei shchitovidnoi zhelezy.

Thirty patients with subclinical thyrotoxicosis and 32 with subclinical hypothyroidism with attacks of atrial fibrillation were investigated. At levels of thyroid-stimulating hormone below 0.1 or above 10.0 mIU/l average triiodothyronine and thyroxine levels in patients with subclinical thyrotoxicosis were 89.6 and 73.2%, respectively, higher than in patients with subclinical hypothyroidism. Some relationships were found between levels of thyroid hormones and hemodynamic and electrophysiological parameters of the heart. Differential therapy of attacks of atrial fibrillation was effective in 80 and 62.5% of patients with subclinical thyrotoxicosis or hypothyroidism, respectively.

[Gender differences in migraine and wake-sleep migraine attacks]. / Polovye osobennosti migreni i migren' bodrstvovaniia i sna.

A follow-up clinical study was made of 320 patients examined in Autonomic Pathology and Headache Center, Nervous disease clinic, Sechenov Moscow Medical Academy, since 1989 to 1999. The peculiarities of migraine attack course and remission period, psychological characteristics, concomitant diseases and quality of life in men and women were described. In women, migraine attacks were more typical, prolonged and severe, being often stipulated by provoking factors, especially by emotional ones, as well as accompanied by autonomic disturbances, anxiety and depression. Despite a more favorable migraine course, men proved to score lower on quality of life, revealing more maladaptation. Patients with sleep migraine attacks were distinguished by more severe migraine course, multiple disturbances in remission period, higher depression and anxiety levels, as well as lower quality of life. Common serotoninergic mechanisms were suggested to underlie sleep migraine and depression. The leading role of depression in the origin of night migraine attacks is discussed.

[Clinical and psychological analysis of migraine population]. / Kliniko-psikhologicheskii analiz bol'shoi populiatsii bol'nykh migren'iu.

The study presents a clinical analysis of a large population of migraine patients (n = 320). Computed database used in the study included over 100 clinical parameters and was based on analysis of primary medical records. As a result of statistic processing of the migraine archive, a general review of clinical picture and migraine course in patients from Moscow and Moscow region community and analysis of the peculiarities of migraine heredity, concomitant symptoms, provoking factors, co-morbid diseases, state in attack-free period, psychological characteristics and quality of life are provided. Factors determining course severity and quality of life in migraine are discussed.

[Clinical and psychological characteristics and therapy of patients with cluster (bunch) headache]. / Kliniko-psikhologicheskaia kharakteristika i terapiia bol'nykh klasternoi (puchkovoi) golovnoi bol'iu.

The paper presents a discussion on clinical psychological peculiarities of patients with cluster headache (CHA), an analysis of these data in dependence on CHA form (episodically or chronically), on the sex of the patients, on the side of the headache localization (right-sided, left-sided). Taking into consideration a correlation of the headache attacks and the quality of the night sleep, the therapy with imovan (zopiclone) preparation was proposed. Such therapy resulted in positive changes including disappearance of the night attacks and the decrease of the intensitivity of the algesic attacks during daily time.