Predictive factors of sleep quality in patients with chronic migraine.

INTRODUCTION: One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. METHODS: A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. RESULTS: A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P < .05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P = .016) and pain catastrophising (P = .036). CONCLUSIONS: The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms.

Factores predictores de la calidad del sueño en pacientes con migraña crónica / Predictive factors of sleep quality in patients with chronic migraine

Introducción: Uno de los factores contribuyentes en la cronificación de la migraña son los trastornos del sueño que pueden actuar como un factor precipitante y/o perpetuador en estos sujetos. El objetivo primario de este estudio fue identificar los factores predictores relacionados con la calidad del sueño en pacientes con migraña crónica (MC) y el objetivo secundario fue identificar si existían diferencias en variables psicológicas y de discapacidad entre los pacientes con MC que presentaban menor o mayor calidad del sueño. Métodos: Se llevó a cabo un estudio observacional, transversal, formado por 50 participantes con MC. Se registraron una serie de variables demográficas, psicológicas y de discapacidad mediante cuestionarios de autorregistro. Resultados: Se observaron correlaciones directas, moderadas-fuertes, entre las diferentes variables de discapacidad y psicológicas analizadas (p < 0,05). En la regresión, se estableció como variable criterio la calidad del sueño y las variables predictores fueron los síntomas depresivos, la discapacidad relacionada con la cefalea y el catastrofismo ante el dolor que, en conjunto, explican el 33% de la varianza. En cuanto a la comparación de los grupos de mayor y menor afectación del sueño, se encontraron diferencias estadísticamente significativas en la variable de síntomas depresivos (p = 0,016) y catastrofismo ante el dolor (p = 0,036). Conclusiones: Los factores predictores de la calidad del sueño en pacientes con MC fueron los síntomas depresivos, la discapacidad relacionada con la cefalea y, en menor medida, el catastrofismo ante el dolor. Los sujetos con peor calidad de sueño presentaron mayores niveles de catastrofismo ante el dolor y síntomas depresivos. (AU)

Introduction: One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. Methods: A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. Results: A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P < .05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P = .016) and pain catastrophising (P = .036). Conclusions: The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms. (AU)

Predictive factors of sleep quality in patients with chronic migraine. / Factores predictores de la calidad del sueño en pacientes con migraña crónica.

INTRODUCTION: One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. METHODS: A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. RESULTS: A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P<.05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P=.016) and pain catastrophising (P=.036). CONCLUSIONS: The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms.

[Does medication abuse in patients with chronic migraine influence the effectiveness of preventive treatment with topiramate?]. / ¿El abuso de farmacos en pacientes con migraña cronica influye en la efectividad del tratamiento preventivo con topiramato?

INTRODUCTION: Patients with chronic migraine (CM) and medication abuse are difficult to treat, and have a greater tendency towards chronification and a poorer quality of life than those with other types of headache. AIM: To evaluate whether the presence of medication abuse lowers the effectiveness of topiramate. PATIENTS AND METHODS: A series of patients with CM were grouped according to whether they met abuse criteria or not. They were advised to stop taking the drug that they were abusing. Treatment was adjusted to match their crises and preventive treatment with topiramate was established from the beginning. The number of days with headache and intense migraine in the previous month and at four months of treatment was evaluated. RESULTS: In all, 262 patients with CM criteria were selected and 167 (63.7%) of them fulfilled abuse criteria. In both groups there was a significant reduction in the number of days with headache/month and number of migraine attacks/month at the fourth month of treatment with topiramate. The percentage of reduction in the number of days with headache/month in CM without abuse was 59.3 ± 36.1%, and with abuse, 48.7 ± 41.7% (p = 0.0574). The percentage of reduction in the number of days with intense migraine/month in CM without abuse was 61.2%, and with abuse, 50% (p = 0.0224). Response rate according to the number of days with headache/month in CM without abuse was 69%, and with abuse, 57%. Response rate according to the number of intense migraines/month in CM without abuse was 76.8%, and in CM with abuse, 61% (p = 0.0097). CONCLUSIONS: Topiramate was effective in patients with CM with and without medication abuse, although effectiveness is lower in the latter case.

TITLE: El abuso de farmacos en pacientes con migraña cronica influye en la efectividad del tratamiento preventivo con topiramato?Introduccion. Los pacientes con migraña cronica (MC) y abuso de medicacion son dificiles de tratar y tienen peor calidad de vida que otros pacientes con migrañas. Objetivo. Valorar si la presencia de abuso de farmacos disminuye la efectividad del topiramato. Pacientes y metodos. Una serie de pacientes con MC fueron agrupados segun presentasen criterios de abuso o no abuso de farmacos. Se les aconsejo la supresion del farmaco del cual abusaban. Se ajusto el tratamiento de sus crisis y se inicio tratamiento preventivo desde el principio con topiramato. Se valoro el numero dias con cefalea y migrañas intensas en el mes previo y al cuarto mes de tratamiento. Resultados. Fueron seleccionados 262 pacientes con criterios de MC, y de ellos 167 (63,7%) cumplieron criterios de abuso. En ambos grupos hubo una reduccion significativa del numero de dias con cefalea/mes y numero de crisis de migraña/mes al cuarto mes de tratamiento con topiramato. Porcentaje de reduccion de dias con cefalea/mes en MC sin abuso, 59,3 ± 36,1%; y con abuso, 48,7 ± 41,7% (p = 0,0574). Porcentaje de reduccion de migrañas intensas/mes en MC sin abuso, 61,2%; y con abuso, 50% (p = 0,0224). Tasa de respondedores segun numero de dias con cefalea/mes en MC sin abuso, 69%; y con abuso, 57%. Tasa de respondedores segun numero de migrañas intensas/mes en MC sin abuso, 76,8%; y en MC con abuso, 61% (p = 0,0097). Conclusiones. El topiramato fue efectivo en pacientes con MC sin y con abuso de farmacos, aunque con menor efectividad en estos ultimos.

[Triptans in clinical practice: effectiveness, tolerance and patient's satisfaction with medication (TRIPRACLI study)]. / Los triptanes en la practica clinica: eficacia, tolerancia y satisfaccion del paciente con los farmacos (estudio TRIPRACLI).

INTRODUCTION AND AIMS: This study was aimed determining the effectiveness, tolerance and satisfaction of patients with migraine as regards different triptans, according to the characteristics of their attacks. At the same time it sought to establish a predictive model that can be used to recommend one or another, depending on those characteristics. PATIENTS AND METHODS: Retrospective observation-based study conducted in headache units in a number of different centres. Patients included in the study were those with migraine who used the same triptan to treat their attacks. Data concerning preference, effectiveness, speed and tolerance were analysed. RESULTS: The analysis included 160 patients (88 females), with a mean age of 42.92 years. The most commonly used triptans were eletriptan, almotriptan and rizatriptan. Both patients and doctors reported a high degree of satisfaction (88% and 65%) with the triptan that was used. In the surveys on preference, patients preferred their current triptan to the previous one (83%) or to non-specific drugs. The overall score on a visual analogue scale was above 7 for all the triptans, without any differences from one to another. On analysing the use of a particular triptan depending on the characteristics of the attacks, no statistically significant differences were found. CONCLUSIONS: In this selected group of patients, triptans are a treatment that patients claim to be very satisfied with. Although there are no overall differences in the scores among different triptans, the fact that certain triptans are used more by patients after previous experiences with others suggests that they are more effective. We did not find any parameter that predicts the use of a particular triptan.

[A study to compare independent groups of patients with episodic migraine who were treated preventively with flunarizine or nadolol]. / Estudio comparativo de grupos independientes de pacientes con migrana episodica tratados preventivamente con flunaricina o nadolol.

INTRODUCTION. Flunarizine, with level of evidence A, and nadolol, with evidence level C, would be indicated as preventive treatment of migraine. Yet, no previous studies have been conducted to compare the effectiveness of the two drugs. AIM. To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study, the same protocol being applied in both cases. PATIENTS AND METHODS. The subjects selected for the study were patients with episodic migraine (according to 2004 International Headache Society criteria) who had undergone preventive treatment for the first time, with flunarizine (5 mg/day) or nadolol (20-40 mg/day). The main effectiveness variables (reduction in the number of seizures at four months of treatment and responder rates) were analysed. RESULTS. The study included 227 patients who intended to receive treatment: 155 with flunarizine (80.5% females; mean age: 38.3 ± 12.1 years) and 72 with nadolol (63.8% females; mean age: 37.1 ± 12.0 years). The mean number of seizures prior to treatment was 6.09 ± 2.6 in the flunarizine group and 5.1 ± 1.7 in the nadolol group (p = 0.0079); at four months of treatment it was 2.61 ± 2.4 in the flunarizine group and 2.77 ± 2.4 in the nadolol group (p = NS). Percentage of reduction of migraines: 55.2% with flunarizine and 50.4% with nadolol (p = NS). The responder rate was 69% with flunarizine and 67% with nadolol (p = NS). The excellent response rate (reduction in the number of seizures by 75% or more) was 52.2% with flunarizine and 36.1% with nadolol (p = 0.0077). Percentage of adverse side effects: 48.3% with flunarizine and 25% with nadolol (p = 0.0009). The satisfaction rate was similar in both groups, 68%. CONCLUSIONS. Both flunarizine and nadolol proved to be effective in the preventive treatment of episodic migraine. Flunarizine is used more often in our milieu and was less well tolerated.

Pacientes con cefalea y abuso de medicación. Indicadores de respuesta al tratamiento ambulatorio / Patients with headache and medication aubse. Indicators of response to ambulatory treatment

Introducción. Los pacientes con cefalea y abuso de medicación (CAM) son difíciles de tratar, presentan mayor tendenciaa la cronificación y peor calidad de vida que los que cursan con otras cefaleas. Objetivo. Valorar los indicadores de respuesta de estos pacientes al tratamiento ambulatorio. Pacientes y métodos. De una serie de pacientes con migraña, seleccionamos aquéllos con criterios de CAM según el apéndice de la International Classification of the Headache Disease (ICHD-2) de 2006 y que nunca habían llevado previamente tratamiento. Ambulatoriamente, se les aconsejó la supresión del fármaco del que abusaban. Se ajustó el tratamiento de sus crisis con los fármacos más eficaces y se inició tratamiento preventivo desde el principio, con topiramato o flunaricina. Se agrupó a los pacientes según persistieran con CAM o no. Se valoró el número días con cefalea en el mes previo y al cuarto mes de tratamiento y la persistencia de abuso. Resultados. Cumplieron criterios de CAM 178 pacientes (edad media: 40,9 años; 88,7% mujeres). El 68,5% (122 pacientes) respondió y dejó de cumplir criterios de CAM tras el tratamiento. En ambos grupos, los tratamientos de sus crisis (triptanes, antiinflamatorios no esteroideos, analgésicos) y preventivos utilizados (topiramato o flunaricina) fueron similares. La media de días con cefalea previa al tratamiento fue de 18,52 en el grupo que respondió y de 20,87 (p = 0,0263) en el grupo que no respondió al tratamiento. Un 7,3% abandonó el tratamiento preventivo en el grupo de respondedores frente al 35% (p = 0,0001) en los no respondedores. Conclusiones. El mayor número de días con cefalea en el mes previo al tratamiento y el abandono del tratamiento preventivo fueron indicadores de mala evolución (AU)

Introduction. Patients with headache and medication abuse (HMA) are difficult to treat, have a greater tendency owards chronification and a poorer quality of life than those with other types of headache. Aim. To evaluate the indicators showing that these patients are responding to ambulatory treatment. Patients and methods. From a series of patients with migraine, we selected those who satisfied HMA criteria according to the appendix of the 2006 International Classification of the Headache Disease (ICHD-2) and who had never previously undergone treatment. As outpatients, they were advised to stop taking the drug that they were abusing. The treatment of their seizures was adjusted with the most efficient drugs and preventive treatment was started from the outset with topiramate or flunarizine. Patients were grouped according to whether they continued with HMA or not. Comparisons were made between the number of days with headache during the previous month and after four months of treatment and the persistence of abuse. Results. HMA criteria were met by 178 patients (mean age 40.9; 88.7% females). Results showed that 68.5% (122 patients) responded and no longer met HMA criteria after treatment. The treatment used for their seizures (triptans, nonsteroidal antiinflammatory drugs, analgesics) and preventive treatment (topiramate or flunarizine) were similar in both groups. The average number of days with headache prior to treatment was 18.52 in the group that responded and 20.87 (p = 0.0263) in the group that did not respond to treatment. In the group of responders 7.3% dropped out of preventive treatment compared with 35% (p = 0.0001) in the group of non-responders. Conclusions. A higher number of days with headache during the previous month and withdrawing from preventive treatment were indicators of a bad progression (AU)

[Patients with headache and medication abuse. Indicators of response to ambulatory treatment]. / Pacientes con cefalea y abuso de medicación. Indicadores de respuesta al tratamiento ambulatorio.

INTRODUCTION: Patients with headache and medication abuse (HMA) are difficult to treat, have a greater tendency towards chronification and a poorer quality of life than those with other types of headache. AIM. To evaluate the indicators showing that these patients are responding to ambulatory treatment. PATIENTS AND METHODS: From a series of patients with migraine, we selected those who satisfied HMA criteria according to the appendix of the 2006 International Classification of the Headache Disease (ICHD-2) and who had never previously undergone treatment. As outpatients, they were advised to stop taking the drug that they were abusing. The treatment of their seizures was adjusted with the most efficient drugs and preventive treatment was started from the outset with topiramate or flunarizine. Patients were grouped according to whether they continued with HMA or not. Comparisons were made between the number of days with headache during the previous month and after four months of treatment and the persistence of abuse. RESULTS: HMA criteria were met by 178 patients (mean age 40.9; 88.7% females). Results showed that 68.5% (122 patients) responded and no longer met HMA criteria after treatment. The treatment used for their seizures (triptans, nonsteroidal antiinflammatory drugs, analgesics) and preventive treatment (topiramate or flunarizine) were similar in both groups. The average number of days with headache prior to treatment was 18.52 in the group that responded and 20.87 (p = 0.0263) in the group that did not respond to treatment. In the group of responders 7.3% dropped out of preventive treatment compared with 35% (p = 0.0001) in the group of non-responders. CONCLUSIONS: A higher number of days with headache during the previous month and withdrawing from preventive treatment were indicators of a bad progression.

[The importance of chronic migraine in a general neurology service]. / Importancia de la migraña crónica en una consulta general de neurología.

INTRODUCTION: Chronic migraine is a primary headache that is difficult to treat and has an important impact on the patient's quality of life. The international headache classification recently modified the criteria for chronic migraine and therefore few studies have been conducted that analyse groups according to these new criteria. AIM. To analyse a group of patients with chronic migraine who were referred to a general neurology service. PATIENTS AND METHODS: The first 100 patients with migraine were selected. Researchers established and analysed a number of subgroups of patients with episodic, chronic or chronic migraine with probable headache due to medication abuse, in accordance with the International Headache Society (IHS) headache classification and its revised version from 2006. RESULTS: Of the total sample of 738 new patients, 100 (13.5%) suffered from migraines and of these 100 new patients with migraine 42 (5.6% of the total series) satisfied criteria for chronic migraine and 15 patients with chronic migraine met the criteria for probable headache due to medication abuse. Before visiting the neurology service, only 41% had been diagnosed as suffering from migraine, 38% had received no information about this condition, only 17% took triptans for symptomatic relief and 23% had followed some kind of preventive treatment. CONCLUSIONS: One notable finding was the importance of episodic and chronic migraine in a general neurology service, on applying the recent IHS criteria. A high percentage of patients with chronic migraine who were referred to the neurology service have not been diagnosed or given any information or proper treatment; an elevated degree of self-medication and medication abuse also exists. Preventive treatment and triptans in cases of intense migraines are still not commonly used in primary care.

Importancia de la migraña crónica en una consulta general de neurología / The importance of chronic migraine in a general neurology service

La migraña crónica es una cefalea primaria difícil de tratar que produce gran afectación de la calidadde vida del paciente. La clasificación internacional de cefaleas modificó los criterios de migraña crónica recientemente, por lo que existen pocos trabajos que analicen grupos con estos nuevos criterios. Objetivo. Analizar un grupo de pacientes con migrañacrónica remitidos a una consulta de neurología general. Pacientes y métodos. Se seleccionaron los primeros 100 pacientes con migraña. Se establecieron y analizaron subgrupos de pacientes con migraña episódica, crónica o crónica con probable cefalea por abuso de fármacos según la clasificación de cefaleas de la Sociedad Internacional de Cefaleas (IHS) y su revisión delaño 2006. Resultados. Del total de 738 nuevos pacientes, 100 (13,5%) sufrieron migrañas. De estos 100 nuevos pacientes con migraña, 42 (el 5,6% de la serie total) cumplieron los criterios de migraña crónica, y 15 pacientes con migraña crónica, los criteriosde probable cefalea por abuso de fármacos. Antes de acudir a la consulta de neurología, sólo al 41% se le había diagnosticado migraña, un 38% no había recibido información sobre esta entidad, sólo el 17% tomaba triptanes como tratamiento sintomático,y un 23% había seguido tratamiento preventivo. Conclusiones. Destacamos la importancia de la migraña episódica y crónica en una consulta general de neurología, aplicando los criterios recientes de la IHS. Los pacientes con migraña crónica enviados a la consulta de neurología siguen, en un alto porcentaje, sin haber sido diagnosticados, ni informados, ni tratados correctamente, con un alto grado de automedicación y abuso frecuente de fármacos. Los tratamientos preventivos y triptanes en migrañasintensas se siguen utilizando poco en atención primaria (AU)

Chronic migraine is a primary headache that is difficult to treat and has an important impact on the patient’s quality of life. The international headache classification recently modified the criteria for chronic migraine and therefore few studies have been conducted that analyse groups according to these new criteria. Aim. To analyse a group of patients with chronic migraine who were referred to a general neurology service. Patients and methods. The first 100 patients with migraine were selected. Researchers established and analysed a number of subgroups of patients with episodic, chronic or chronic migraine with probable headache due to medication abuse, in accordance with the International Headache Society (IHS) headache classification and its revised version from 2006. Results. Of the total sample of 738 new patients, 100 (13.5%) suffered from migraines and of these 100 new patients with migraine 42 (5.6% of the total series) satisfied criteria for chronic migraine and 15 patients with chronic migraine met the criteria for probable headache due to medication abuse. Before visiting the neurology service, only 41% had been diagnosed as suffering from migraine, 38% had received no information about this condition, only 17% took triptans for symptomatic relief and 23% had followed some kind of preventive treatment.Conclusions. One notable finding was the importance of episodic and chronic migraine in a general neurology service, on applying the recent IHS criteria. A high percentage of patients with chronic migraine who were referred to the neurology service have not been diagnosed or given any information or proper treatment; an elevated degree of self-medication and medication abuse also exists. Preventive treatment and triptans in cases of intense migraines are still not commonly used in primary care (AU)

[Topiramate in chronic daily headache due to migraine]. / Topiramato en cefalea crónica diaria por migraña.

INTRODUCTION: Chronic daily headache (CDH) includes primary headaches that last more than four hours with a frequency equal or superior to 15 days a month over the last three months. It has a prevalence of 4-5% in the general population and is a frequent reason for visiting the physician in headache units. AIM: To evaluate the effectiveness of topiramate, as the primary drug, in CDH due to probable chronic migraine with or without medication abuse. PATIENTS AND METHODS: From the 447 patients with migraine in our database, we selected those: a) satisfying Silberstein criteria for CDH; b) that had not followed prior prophylactic treatment; and c) who were treated with topiramate as the primary drug. The mean number of days with headache and bouts of severe migraine in the fourth month of treatment using topiramate as compared to the month preceding treatment, as well as the percentage of responses and the rate of respondents in the fourth month were all analysed. RESULTS: Eighty-three patients (88% females) with a mean age of 38.0 +/- 14.13 years were selected. Medication abuse was reported in 44% of cases. At the fourth month of treatment, the mean number of days with headache dropped significantly from 20.8 to 7.9 (p < 0.0001) and the mean number of bouts of severe migraine diminished from 4.4 to 1.7 (p < 0.0001). The rate of respondents was 72%. Medication abuse continued in 14% of cases. Side effects were produced in 58% of patients and the dropout rate was 24%. CONCLUSIONS: Topiramate proved to be effective in the treatment of CDH due to probable chronic migraine and with probable medication abuse in de novo migraine patients.

Topiramato en cefalea crónica diaria por migraña / Topiramate in chronic daily headache due to migraine

La cefalea crónica diaria (CCD) incluye aquellas cefaleas primarias de más de cuatro horas de duracióny frecuencia igual o superior a 15 días al mes en los últimos tres meses. Presenta una prevalencia del 4-5% entre la población general y es un motivo frecuente de consulta en las unidades de cefaleas. Objetivo. Valorar la efectividad de topiramato, como primer fármaco, en la CCD por probable migraña crónica con o sin abuso de fármacos. Pacientes y métodos. De nuestra base de datos de 447 pacientes con migraña se seleccionaron aquellos: a) con criterios de Silberstein de CCD, b) queno habían llevado un tratamiento profiláctico previo, y c) tratados con topiramato como primer fármaco. Se analizaron la media de días con cefalea y crisis de migraña intensa en el cuarto mes de tratamiento con topiramato en relación con el mes previoal tratamiento, los porcentajes de respuesta y la tasa de respondedores en el cuarto mes. Resultados. Se seleccionaron 83 pacientes (88% de mujeres) con una edad media de 38,0 ± 14,13 años. El 44% abusaba de fármacos. Al cuarto mes de tratamiento, la media de días con cefalea disminuyó significativamente de 20,8 a 7,9 (p < 0,0001) y la medía de crisis de migrañaintensa, de 4,4 a 1,7 (p < 0,0001). La tasa de respondedores fue del 72%. Un 14% continuó abusando de los fármacos. Se produjeron efectos adversos en el 58% de pacientes y hubo un 24% de abandonos. Conclusión. El topiramato se mostró efectivo en el tratamiento de la CCD por probable migraña crónica y con probable abuso de fármacos en pacientes migrañosos de novo

Chronic daily headache (CDH) includes primary headaches that last more than four hours with afrequency equal or superior to 15 days a month over the last three months. It has a prevalence of 4-5% in the general population and is a frequent reason for visiting the physician in headache units. Aim. To evaluate the effectiveness of topiramate, as theprimary drug, in CDH due to probable chronic migraine with or without medication abuse. Patients and methods. From the 447 patients with migraine in our database, we selected those: a) satisfying Silberstein criteria for CDH; b) that had not followed prior prophylactic treatment; and c) who were treated with topiramate as the primary drug. The mean number of days with headache and bouts of severe migraine in the fourth month of treatment using topiramate as compared to the monthpreceding treatment, as well as the percentage of responses and the rate of respondents in the fourth month were all analysed.Results. Eighty-three patients (88% females) with a mean age of 38.0 ± 14.13 years were selected. Medication abuse was reported in 44% of cases. At the fourth month of treatment, the mean number of days with headache dropped significantly from20.8 to 7.9 (p < 0.0001) and the mean number of bouts of severe migraine diminished from 4.4 to 1.7 (p < 0.0001). The rate of respondents was 72%. Medication abuse continued in 14% of cases. Side effects were produced in 58% of patients and thedropout rate was 24%. Conclusions. Topiramate proved to be effective in the treatment of CDH due to probable chronic migraine and with probable medication abuse in de novo migraine patients

Evaluación económica del tratamiento de la crisis aguda de migraña con triptanes en España. Respuesta / Economic evaluation of acute migraine attack treatment with triptans in Spain. Response

No disponible

[Topiramate or flunarizine in the preventive treatment of migraine. A comparative study of two series of cases]. / Topiramato o flunaricina en el tratamiento preventivo de la migraña. Estudio comparativo de dos series de casos.

INTRODUCTION: Both flunarizine and, more recently, topiramate have proved to be effective in the prophylaxis of migraine. AIM: To compare two independent groups of patients with similar clinical and demographic characteristics who were treated with flunarizine or topiramate as the preferred drug in the prevention of their migraines and to evaluate effectiveness and safety according to the medication they received. PATIENTS AND METHODS: All the patients reported more than four episodes a month and/or transformed migraine according to Silberstein's criteria, and had never received prophylactic treatment. Data determined: the number and average number of migraines in the previous month and at the fourth month of treatment, and the rate of respondents. RESULTS: A total of 125 patients were included in each group. No significant differences were found between the groups as regards mean age or the average number of migraines in the previous month. With both drugs there was a significant decrease (0.0001) in the mean number of episodes in the fourth month of treatment, but with no significant difference between them: topiramate (5.88 +/- 3.7 to 2.1 +/- 2.5) and flunarizine (5.24 +/- 3.2 to 2.3 +/- 2.7). The mean reduction in the number of migraines at the fourth month was 58.2 +/- 38.2% with topiramate, and 55.4 +/- 37.5% with flunarizine. The respondent rate was 71% with topiramate and 67% with flunarizine. The percentage of dropouts with topiramate (28%) was higher than with flunarizine (11%) (0.0013). With topiramate 69 patients reported side effects and 53 patients reported them with flunarizine (0.0427). CONCLUSIONS: Both drugs showed a high degree of effectiveness when used as the preferred drug in the preventive treatment of migraine. Topiramate offered better results as far as effectiveness is concerned, but also more side effects, none of which were serious.

Topiramato o flunaricina en el tratamiento preventivo de la migraña. Estudio comparativo de dos series de casos / Topiramate or flunarizine in the preventive treatment of migraine. A comparative study of two series of cases

Introducción. La flunaricina y recientemente el topiramato han mostrado su eficacia en la profilaxis de la migraña. Objetivo. Comparar dos grupos independientes de pacientes con similares características clínicas y demográficas tratados con flunaricina o topiramato como primer fármaco en la prevención de sus migrañas y valorar la eficacia y tolerabilidad según el fármaco recibido. Pacientes y métodos. Todos los pacientes presentaban más de cuatro crisis al mes y/o migraña transformada según los criterios de Silberstein y nunca habían recibido tratamiento profiláctico. Se determinó: número y media de crisis en el mes previo y al cuarto mes de tratamiento y tasa de respondedores. Resultados. Se incluyó a 125 pacientes en cada grupo. No hubo diferencias significativas entre ambos grupos en edad media y media de crisis en el mes previo. Con ambos fármacos hubo un descenso significativo (0,0001) de la media de crisis en el cuarto mes de tratamiento, aunque sin diferencias significativas: topiramato (5,88 ± 3,7 a 2,1 ± 2,5) y flunaricina (5,24 ± 3,2 a 2,3 ± 2,7). La reducción media de crisis al cuarto mes fue del 58,2 ± 38,2% con topiramato y del 55,4 ± 37,5% con flunaricina. La tasa de respondedores fue del 71% con topiramato y 67% con flunaricina. El porcentaje de abandonos con topiramato (28%) fue superior que con flunaricina (11%) (0,0013). Con topiramato 69 pacientes refirieron efectos adversos y 53 pacientes con flunaricina (0,0427). Conclusiones. Ambos fármacos mostraron una alta efectividad cuando se usaron como primer fármaco en el tratamiento preventivo de la migraña. El topiramato mostró mejores resultados de efectividad, pero más efectos adversos, aunque ninguno grave

Introduction. Both flunarizine and, more recently, topiramate have proved to be effective in the prophylaxis of migraine. Aim. To compare two independent groups of patients with similar clinical and demographic characteristics who were treated with flunarizine or topiramate as the preferred drug in the prevention of their migraines and to evaluate effectiveness and safety according to the medication they received. Patients and methods. All the patients reported more than four episodes a month and/or transformed migraine according to Silberstein’s criteria, and had never received prophylactic treatment. Data determined: the number and average number of migraines in the previous month and at the fourth month of treatment, and the rate of respondents. Results. A total of 125 patients were included in each group. No significant differences were found between the groups as regards mean age or the average number of migraines in the previous month. With both drugs there was a significant decrease (0.0001) in the mean number of episodes in the fourth month of treatment, but with no significant difference between them: topiramate (5.88 ± 3.7 to 2.1 ± 2.5) and flunarizine (5.24 ± 3.2 to 2.3 ± 2.7). The mean reduction in the number of migraines at the fourth month was 58.2 ± 38.2% with topiramate, and 55.4 ± 37.5% with flunarizine. The respondent rate was 71% with topiramate and 67% with flunarizine. The percentage of dropouts with topiramate (28%) was higher than with flunarizine (11%) (0.0013). With topiramate 69 patients reported side effects and 53 patients reported them with flunarizine (0.0427). Conclusions. Both drugs showed a high degree of effectiveness when used as the preferred drug in the preventive treatment of migraine. Topiramate offered better results as far as effectiveness is concerned, but also more side effects, none of which were serious

[Effectiveness of topiramate in migraine prophylaxis, an observational study in a consecutive case-serie]. / Valoración de la efectividad del topiramato en el tratamiento preventivo de la migraña. Estudio observacional de una serie consecutiva de pacientes.

INTRODUCTION: Open-label studies and three large and controlled trials had demostrated the efficacy of topiramate in migraine prophylaxis. OBJECTIVES: The objective of this study was to assess the effectiveness and tolerability of topiramate in patients not previously treated with any prophylactic drug. PATIENTS AND METHODS: Patients selection was made on sequential patients attending our outpatient clinic. Patients were adults diagnosed of either transformed migraine or migraine with a frequency of more than four migraine attacks per month. Topiramate was started at 25 mg and titrated in 4 weeks by weekly increments of 25 mg, up to 100 mg/day. Patients were then followed up for a 12-week maintenance phase. Efficacy was assessed by change in mean monthly migraine attack frequency from baseline. Additional assessments included responder rates, mean number of migraine days and global impression by a seven-point improvement scale. RESULTS: Mean monthly migraine attacks decreased significantly from baseline (from 5.2 +/- 2.6 to 2.1 +/- 2.2; p < 0.0001). Sixty-nine percent of patients were considered responders and mean reduction rate in migraine was 55.6 %. Topiramare was overall well tolerated. Twentyfive (28.4 %) patients stopped treatment due to adverse events. The most common adverse events were paresthesia, weight loss and cognitive effects. Some grade of satisfaction was reported by 55 % of patients at the end of the study. CONCLUSION: This naturalistic study confirms clinical trial data that 100 mg/day is an effective target dose for patients with migraine and presents the possible beneficial effect in transformed migraine.

[Economic evaluation of acute migraine attack treatment with triptans in Spain]. / Evaluación económica del tratamiento de la crisis aguda de migraña con triptanes en España.

OBJECTIVE: To perform an economic evaluation of migraine attack treatment comparing standard doses of existing triptans in 2003, and using different outcome measurements of anti-migraine effectiveness. METHODS: A cost-effectiveness analysis was performed from the National Health System perspective, using 2003 prices, comparing almotriptan 12.5 mg, eletriptan 40 mg, naratriptan 2.5 mg, rizatriptan 10 mg, sumatriptan 50 mg, sumatriptan 100 mg, zolmitriptan 2.5 mg and zolmitriptan 5 mg. Effectiveness measurements were obtained from an efficacy meta-analysis of published clinical trials, and they consisted of therapeutic gain (crude effect of triptan after placebo effect subtraction) for 2 h--anti-migraine response, pain free at 2 h, and 24 h--sustained pain free. Rescue medication use and 24 h-attack relapse rates were assessed. RESULTS: Thirty-eight clinical trials (19,872 patients) were used to assess triptans effectiveness. Eletriptan 40 mg and rizatriptan 10 mg showed the highest 24 h-sustained pain free response (20.2 % in both cases), pain-free at 2 h (27.7 % and 32.2 %) and antimigraine response at 2 h (38.6 % and 31.3 %), respectively. Less rescue medication was used with eletriptan 40 mg and sumatriptan 50 mg (21 % and 20 %), and the lowest 24 h-relapse rates were observed with eletriptan 40 mg and naratriptan 2.5 mg (27 % and 21 %). Eletriptan 40 mg and sumatriptan 50 mg showed the lowest costs per successfully treated attacks with 2 h--anti-migraine response (16.50 and 17.44e) and with 24 h--sustained pain free (31.47 and 33.61e), while the lowest costs per attack that was pain free at 2 h were observed with rizatriptan 10 mg (21.36e) and eletriptan 40 mg (22.99e). CONCLUSIONS: Considering the cost-effectiveness measurements assessed, eletriptan 40 mg was the most costeffective triptan in the majority of economic analyses carried out.

Evaluación económica del tratamiento de la crisis aguda de migraña con triptanes en España / Economic evaluation of acute migraine attack treatment with triptans in Spain

Objetivo. Realizar una evaluación económica del tratamiento del ataque de migraña con triptanes, a sus dosis habituales, utilizando tres medidas de efectividad antimigrañosa. Métodos. Se realizó un análisis coste/efectividad (ACE) desde la perspectiva del Sistema Nacional de Salud, a precios de 2003, comparando almotriptán 12,5 mg, eletriptán 40 mg, naratriptán 2,5 mg, rizatriptán 10 mg, sumatriptán 50 mg, sumatriptán 100 mg, zolmitriptán 2,5 mg y zolmitriptán 5 mg. Los valores de efectividad se obtuvieron de un metaanálisis de eficacia de ensayos clínicos publicados y fueron la ganancia terapéutica (GT) (efecto antimigrañoso tras sustraer el efecto placebo) de respuesta antimigrañosa a las 2 h, ausencia de dolor a las 2 h y respuesta completa. Se determinaron las tasas de medicación de rescate y recurrencia a las 24 h. Resultados. Se incluyeron 38 ensayos clínicos (19.872 pacientes). El eletriptán 40 mg y el rizatriptán 10 mg presentaron la mayor GT en respuesta completa (20,2 % en ambos casos), ausencia de dolor a las 2 h (27,7 y 32,2 %) y respuesta antimigrañosa a las 2 h (38,6 y 31,3 %), respectivamente. Se usó menos medicación de rescate con eletriptán 40 mg y sumpatriptán 50 mg (21 y 20 %) y la recurrencia fue menor con eletriptán 40 mg y naratriptán 2,5 mg (27 y 21 %). Los menores costes por ataque de migraña con respuesta a las 2 h y con respuesta completa se observaron con eletriptán 40 mg (16,50 y 31,47e) y con sumatriptán 50 mg (17,44 y 33,61e), respectivamente, mientras que el menor coste en ausencia de dolor a las 2 h se observó con rizatriptán 10 mg (21,36e) y eletriptán 40 mg (22,99e). Conclusiones. Considerando las medidas de coste-efectividad evaluadas, el eletriptán 40 mg fue el triptán más eficiente en la mayoría de los análisis efectuados

Objective. To perform an economic evaluation of migraine attack treatment comparing standard doses of existing triptans in 2003, and using different outcome measurements of anti-migraine effectiveness. Methods. A cost-effectiveness analysis was performed from the National Health System perspective, using 2003 prices, comparing almotriptan 12.5 mg, eletriptan 40 mg, naratriptan 2.5 mg, rizatriptan 10 mg, sumatriptan 50 mg, sumatriptan 100 mg, zolmitriptan 2.5 mg and zolmitriptan 5 mg. Effectiveness measurements were obtained from an efficacy meta-analysis of published clinical trials, and they consisted of therapeutic gain (crude effect of triptan after placebo effect subtraction) for 2 hanti- migraine response, pain free at 2 h, and 24 h-sustained pain free. Rescue medication use and 24 h-attack relapse rates were assessed. Results. Thirty-eight clinical trials (19,872 patients) were used to assess triptans effectiveness. Eletriptan 40 mg and rizatriptan 10 mg showed the highest 24 h-sustained pain free response (20.2 % in both cases), pain-free at 2 h (27.7 % and 32.2 %) and antimigraine response at 2 h (38.6 % and 31.3 %), respectively. Less rescue medication was used with eletriptan 40 mg and sumatriptan 50 mg (21 % and 20 %), and the lowest 24 h-relapse rates were observed with eletriptan 40 mg and naratriptan 2.5 mg (27 % and 21 %). Eletriptan 40 mg and sumatriptan 50 mg showed the lowest costs per successfully treated attacks with 2 h-antimigraine response (16.50 and 17.44e) and with 24 h-sustained pain free (31.47 and 33.61e), while the lowest costs per attack that was pain free at 2 h were observed with rizatriptan 10 mg (21.36e) and eletriptan 40 mg (22.99e). Conclusions. Considering the cost-effectiveness measurements assessed, eletriptan 40 mg was the most costeffective triptan in the majority of economic analyses carried out

[Differences between migraine patients referred to a headache unit or a general neurology service]. / Diferencias entre los pacientes con migraña enviados a una unidad de cefaleas o a una consulta general de neurología.

INTRODUCTION: Migraine accounts for 10% of patients first visits due to neurological reasons in Spain and over half the new visits in headache units (HU) and hence the importance of this pathology. AIMS: The aim of this study is to determine whether there are any differences between migraine patients referred to a general neurology service (GNS) or to a HU. PATIENTS AND METHODS: Two groups of patients with migraine were compared: those sent for the first time to a GNS and the others, who were sent directly to a HU. RESULTS: In a GNS, 10.7% (374 patients) of the overall number of new visits concerned migraines; these were compared with 107 migraines (64%) from the total number of headaches treated for the first time in the HU during the year 2000. The average age and distribution of sexes were similar in both groups. In the group of migraines from the HU there were more requests for CAT/MRI (20%), 77.5% had previous treatment, 71% were given preventive therapy, 51% received triptans and 44.8% needed an examination. In the group of migraines from visits to general service, there were fewer requests for CAT/MRI (14%), only 20% had previous therapy, preventive therapy was started in 45%, 6% received triptans and 25% required an examination. CONCLUSIONS: The group of patients with migraine who were sent to the HU presented a more serious pathology, required more preventive therapies, more triptans and more monitoring than the group of patients with migraine referred to the GNS.

Diferencias entre los pacientes con migraña enviados a una unidad de cefaleas o a una consulta general de neurología / Differences between migraine patients referred to a headache unit or a general neurology service

Introducción. La migraña representa el 10 por ciento de las primeras consultas neurológicas en España, y más de la mitad de las nuevas consultas en las unidades de cefaleas (UC); de ahí la importancia de esta patología. Objetivo. Valorar si existen diferencias entre los pacientes con migraña enviados a una consulta general de neurología (CGN) o a una UC. Pacientes y métodos. Se comparan dos grupos de pacientes con migraña: unos enviados por primera vez a CGN y otros enviados directamente a una UC. Resultados. En la CGN, el 10,7 por ciento (374 pacientes) del total de nuevas consultas fueron por migraña; se compararon con 107 migrañas (64 por ciento) del total de cefaleas atendidas por primera vez en la UC durante el año 2000. La edad media y el sexo fueron similares en ambos grupos. En el grupo de migrañas de la UC se solicitaron más TAC/RM (20 por ciento); el 77,5 por ciento de los pacientes llevaba tratamiento previo, se puso tratamiento preventivo al 71 por ciento, triptanes al 51 por ciento y precisó revisión el 44,8 por ciento. En el grupo de migraña de la consulta general se solicitaron menos TAC/RM (14 por ciento), sólo el 20 por ciento llevaba tratamiento previo, se instauró tratamiento preventivo al 45 por ciento, triptanes al 6 por ciento y precisó revisión el 25 por ciento. Conclusiones. El grupo de pacientes con migraña enviados a la UC presentó una patología más grave, precisó más tratamientos preventivos, mayor utilización de triptanes y mayor control posterior que el grupo de pacientes con migraña enviados a la CGN (AU)

Introduction. Migraine accounts for 10% of patients’ first visits due to neurological reasons in Spain and over half the new visits in headache units (HU) and hence the importance of this pathology. Aims. The aim of this study is to determine whether there are any differences between migraine patients referred to a general neurology service (GNS) or to a HU. Patients and methods. Two groups of patients with migraine were compared: those sent for the first time to a GNS and the others, who were sent directly to a HU. Results. In a GNS, 10.7% (374 patients) of the overall number of new visits concerned migraines; these were compared with 107 migraines (64%) from the total number of headaches treated for the first time in the HU during the year 2000. The average age and distribution of sexes were similar in both groups. In the group of migraines from the HU there were more requests for CAT/MRI (20%), 77.5% had previous treatment, 71% were given preventive therapy, 51% received triptans and 44.8% needed an examination. In the group of migraines from visits to general service, there were fewer requests for CAT/MRI (14%), only 20% had previous therapy, preventive therapy was started in 45%, 6% received triptans and 25% required an examination. Conclusions. The group of patients with migraine who were sent to the HU presented a more serious pathology, required more preventive therapies, more triptans and more monitoring than the group of patients with migraine referred to the GNS (AU)