Widespread mechanical pain hypersensitivity in patients with chronic migraine and temporomandibular disorders: relationship and correlation between psychological and sensorimotor variables.

OBJECTIVE: This study aimed to assess mechanical hyperalgesia in the trigeminal and extra-trigeminal regions in patients with chronic migraine (CM) and temporomandibular disorders (TMD) in comparison to asymptomatic subjects and to determine the association between sensorimotor variables and psychological and disability variables and evaluate the prediction of a sensorimotor variables though psychological and disability variables in patients with CM and TMD. MATERIAL AND METHODS: A total of 52 subjects with concomitant CM and TMD and 30 asymptomatic subjects were included in the study. The pressure pain threshold (PPT), maximal mouth opening (MMO) and a series of self-reported factors were compared. RESULTS: There were 52 CM and TMD (92.3% women and 7.7% men; age = 46.2 ± 9.5) and 30 asymptomatic subjects (80% women and 20% men; age = 47.4 ± 10). Differences were found between patients with CM and TMD and asymptomatic participants (p < .01) when comparing the PPTs in the trigeminal and extra-trigeminal regions. The PPT for the trigeminal region was predicted by depressive symptoms (variance of 18%) as well as disability and craniofacial pain (variance of 20%). The extra-trigeminal region PPT was predicted by depressive symptoms (variance of 10%), and pain-free MMO was predicted by disability and craniofacial pain (variance of 24%). CONCLUSIONS: This study suggests that patients with CM and TMD present with generalized mechanical hyperalgesia. In addition, an association between sensorimotor, psychological and disability variables was observed.

Effects of a Physical Therapy Protocol in Patients with Chronic Migraine and Temporomandibular Disorders: A Randomized, Single-Blinded, Clinical Trial.

AIMS: To investigate the effects of adding orofacial treatment to cervical physical therapy in patients with chronic migraine and temporomandibular disorders (TMD). METHODS: A total of 45 participants with chronic migraine and TMD aged 18 to 65 years were randomized into two groups: a cervical group (CG) and a cervical and orofacial group (COG). Both groups continued their medication regimens for migraine treatment and received physical therapy. The CG received physical therapy only in the cervical region, and the COG received physical therapy in both the cervical and orofacial regions. Both groups received six sessions of treatment that consisted of manual therapy and therapeutic exercise in the cervical region or the cervical and orofacial regions. Scores on the Craniofacial Pain and Disability Inventory (CF-PDI) and the Headache Impact Test (HIT-6) were primary outcome variables, and the secondary outcome variables were scores on the Tampa Scale for Kinesiophobia (TSK-11), pain intensity measured on a visual analog scale (VAS), pressure pain thresholds (PPTs) in the temporal, masseter (2 points, M1 and M2) and extratrigeminal (wrist) regions, and maximal mouth opening (MMO). Data were recorded at baseline, posttreatment, and after 12 weeks of follow-up. The α level was set at .05 for all tests and two-way repeated-measures analysis of variance (ANOVA) for within- and between-group interactions. RESULTS: There were 22 CG participants (13.6% men and 86.4% women) and 23 COG participants (13% men and 87% women). The ANOVA analysis revealed statistically significant differences for group × time interaction in CF-PDI, HIT-6 in the last follow-up, pain intensity, PPTs in the trigeminal region, and MMO (P < .05), with a medium-large magnitude of effect. No statistically significant differences were found in the PPTs of the extratrigeminal region or in the TSK-11 (P > .05). CONCLUSION: Both groups reported a significant improvement in CF-PDI, HIT-6, and pain intensity. Cervical and orofacial treatment was more effective than cervical treatment alone for increasing PPTs in the trigeminal region and producing pain-free MMO. Physical therapy alone was not effective for increasing the PPTs in the extratrigeminal region (wrist) or decreasing the level of TSK-11.

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

Introducción. Los pacientes con migraña crónica (MC) y abuso de medicación son difíciles de tratar y tienen peor calidad de vida que otros pacientes con migrañas. Objetivo. Valorar si la presencia de abuso de fármacos disminuye la efectividad del topiramato. Pacientes y métodos. Una serie de pacientes con MC fueron agrupados según presentasen criterios de abuso o no abuso de fármacos. Se les aconsejo la supresión del fármaco del cual abusaban. Se ajustó el tratamiento de sus crisis y se inició tratamiento preventivo desde el principio con topiramato. Se valoró el número días 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 reducción significativa del número de días con cefalea/mes y numero de crisis de migraña/mes al cuarto mes de tratamiento con topiramato. Porcentaje de reducción de días con cefalea/mes en MC sin abuso, 59,3} 36,1%; y con abuso, 48,7} 41,7% (p = 0,0574). Porcentaje de reducción de migrañas intensas/mes en MC sin abuso, 61,2%; y con abuso, 50% (p = 0,0224). Tasa de respondedores según numero de días con cefalea/mes en MC sin abuso, 69%; y con abuso, 57%. Tasa de respondedores según 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 fármacos, aunque con menor efectividad en estos últimos (AU)

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 (AU)

[A comparative study of the effectiveness of topiramate and flunarizine in independent series of chronic migraine patients without medication abuse]. / Estudio comparativo de la efectividad del topiramato y la flunaricina en series independientes de pacientes con migraña cronica sin abuso de medicacion.

INTRODUCTION: Topiramate and onabotulinumtoxin A have proven to be effective in chronic migraine with or without medication abuse according to recent criteria of the International Headache Society's Headache Classification. AIMS: To show that flunarizine is as effective as topiramate in cases of chronic migraine without medication abuse. PATIENTS AND METHODS: We conducted a prospective, non-randomised, comparative study of two groups of patients paired by age and sex, with chronic migraine without abuse, who had been treated preventively for the first time with topiramate or flunarizine. RESULTS: Forty patients treated with flunarizine were assigned a patient of their same sex and age who was being treated with topiramate. The mean rate of reduction in intense migraines in the topiramate group was 59% and in the flunarizine group, 58.5% (p = 0.9444); the responder rate at four months of treatment did not show any significant differences either, the figures being 75% for topiramate and 70% for flunarizine (p = 0.6236). The mean reduction of other headaches in the topiramate group was 57% and in the flunarizine group, 64% (p = 0.4261); the responder rate at four months of treatment was similar in the two groups: 76%. The percentage of dropouts from treatment was higher with topiramate (19.5%) than with flunarizine (10%) (p = 0.3493). No serious side effects occurred in either of the groups. In all, 78.9% of the patients who took topiramate said they were satisfied with the drug versus 75% of those in the flunarizine group (p = 0.7903). CONCLUSIONS: Flunarizine proved to be as effective as topiramate in the treatment of chronic migraine without medication abuse.

TITLE: Estudio comparativo de la efectividad del topiramato y la flunaricina en series independientes de pacientes con migraña cronica sin abuso de medicacion.Introduccion. El topiramato y la onabotulinumtoxina A han mostrado ser eficaces en la migraña cronica con o sin abuso de farmacos segun los criterios recientes de la Clasificacion de Cefaleas de la Sociedad Internacional de Cefaleas. Objetivo. Demostrar que la flunaricina es tan efectiva como el topiramato en la migraña cronica sin abuso de farmacos. Pacientes y metodos. Estudio prospectivo, no aleatorizado, comparativo de dos grupos de pacientes con similar edad y sexo, con migraña cronica sin abuso, tratados preventivamente por primera vez con topiramato o flunaricina. Resultados. A 40 pacientes tratados con flunaricina se les asigno un paciente del mismo sexo y edad tratado con topiramato. La media de reduccion de las migrañas intensas en el grupo del topiramato fue del 59% y en el grupo de la flunaricina, del 58,5% (p = 0,9444); la tasa de respondedores al cuarto mes de tratamiento tampoco mostro diferencias significativas, ya que fue del 75% para el topiramato y del 70% para la flunaricina (p = 0,6236). La media de reduccion de otras cefaleas en el grupo del topiramato fue del 57%, y en el grupo de la flunaricina, del 64% (p = 0,4261); la tasa de respondedores al cuarto mes de tratamiento fue del 76%, similar en ambos grupos. El porcentaje de abandonos del tratamiento fue mayor con el topiramato (19,5%) que con la flunaricina (10%) (p = 0,3493). En ninguno de los dos grupos hubo efectos adversos graves. Un 78,9% de los pacientes que tomo topiramato presento satisfaccion con el farmaco frente al 75% del grupo de la flunaricina (p = 0,7903). Conclusion. La flunaricina mostro ser tan efectiva como el topiramato en el tratamiento de la migraña cronica sin abuso de farmacos.

Estudio comparativo de la efectividad del topiramato y la flunaricina en series independientes de pacientes con migraña crónica sin abuso de medicación / A comparative study of the effectiveness of topiramate and flunarizine in independent series of chronic migraine patients without medication abuse

Introducción. El topiramato y la onabotulinumtoxina A han mostrado ser eficaces en la migraña crónica con o sin abuso de fármacos según los criterios recientes de la Clasificación de Cefaleas de la Sociedad Internacional de Cefaleas. Objetivo. Demostrar que la flunaricina es tan efectiva como el topiramato en la migraña crónica sin abuso de fármacos.Pacientes y métodos. Estudio prospectivo, no aleatorizado, comparativo de dos grupos de pacientes con similar edad ysexo, con migraña crónica sin abuso, tratados preventivamente por primera vez con topiramato o flunaricina. Resultados. A 40 pacientes tratados con flunaricina se les asignó un paciente del mismo sexo y edad tratado con topiramato. La media de reducción de las migrañas intensas en el grupo del topiramato fue del 59% y en el grupo de la flunaricina, del 58,5% (p = 0,9444); la tasa de respondedores al cuarto mes de tratamiento tampoco mostró diferencias significativas, ya que fue del 75% para el topiramato y del 70% para la flunaricina (p = 0,6236). La media de reducción de otras cefaleas en el grupo del topiramato fue del 57%, y en el grupo de la flunaricina, del 64% (p = 0,4261); la tasa de respondedores al cuarto mes de tratamiento fue del 76%, similar en ambos grupos. El porcentaje de abandonos del tratamiento fue mayor con el topiramato (19,5%) que con la flunaricina (10%) (p = 0,3493). En ninguno de los dos grupos hubo efectos adversos graves. Un 78,9% de los pacientes que tomó topiramato presentó satisfacción con el fármaco frente al 75% del grupo de la flunaricina (p = 0,7903). Conclusión. La flunaricina mostró ser tan efectiva como el topiramato en el tratamiento de la migraña crónica sin abuso de fármacos (AU)

Introduction. Topiramate and onabotulinumtoxin A have proven to be effective in chronic migraine with or without medication abuse according to recent criteria of the International Headache Society’s Headache Classification. Aims. To show that flunarizine is as effective as topiramate in cases of chronic migraine without medication abuse. Patients and methods. We conducted a prospective, non-randomised, comparative study of two groups of patients paired by age and sex, with chronic migraine without abuse, who had been treated preventively for the first time with topiramate or flunarizine. Results. Forty patients treated with flunarizine were assigned a patient of their same sex and age who was being treated with topiramate. The mean rate of reduction in intense migraines in the topiramate group was 59% and in the flunarizine group, 58.5% (p = 0.9444); the responder rate at four months of treatment did not show any significant differences either, the figures being 75% for topiramate and 70% for flunarizine (p = 0.6236). The mean reduction of other headaches in the topiramate group was 57% and in the flunarizine group, 64% (p = 0.4261); the responder rate at four months of treatment was similar in the two groups: 76%. The percentage of dropouts from treatment was higher with topiramate (19.5%) than with flunarizine (10%) (p = 0.3493). No serious side effects occurred in either of the groups. In all, 78.9% of the patients who took topiramate said they were satisfied with the drug versus 75% of those in the flunarizine group (p = 0.7903). Conclusions. Flunarizine proved to be as effective as topiramate in the treatment of chronic migraine without medication abuse (AU)

Los triptanes en la práctica clínica: eficacia, tolerancia y satisfacción del paciente con los fármacos (estudio TRIPRACLI) / Triptans in clinical practice: effectiveness, tolerance and patient’s satisfaction with medication (TRIPRACLI study)

Introducción y objetivos. Conocer en nuestro medio la eficacia, tolerabilidad y satisfacción del paciente migrañoso con diferentes triptanes en función de las características de sus crisis e intentar establecer un modelo predictivo para recomendar uno u otro en función de dichas características. Pacientes y métodos. Estudio retrospectivo observacional multicéntrico en unidades de cefalea. Se incluyen pacientes con migraña que utilizan un mismo triptán para el tratamiento de sus crisis. Se analizan datos de preferencia, eficacia, rapidez y tolerancia. Resultados. Se analizan 160 pacientes (88 mujeres), con una edad media de 42,92 años. Los triptanes más utilizados fueron eletriptán, almotriptán y rizatriptán. Tanto pacientes como médicos mostraron un alto grado de satisfacción (88% y 65%, respectivamente) con el triptán utilizado. En las encuestas de preferencia, los pacientes preferían el triptán actual sobre el previo (83%) o fármacos no específicos (93%). La valoración global en una escala analógica visual estuvo por encima de 7 para todos los triptanes, sin diferencias entre ellos. Al analizar la utilización de un determinado triptán en función de las características de las crisis, no se encontraron diferencias estadísticamente significativas. Conclusiones. En este grupo seleccionado de pacientes, los triptanes son un tratamiento por el que los pacientes muestran un alto grado de satisfacción. Aunque no existen diferencias globales en las puntuaciones entre los diferentes triptanes, el hecho de que determinados triptanes sean más utilizados por los pacientes después de experiencias previas con otros sugiere una mayor eficacia por su parte. No hemos encontrado ningún parámetro que prediga la utilización de un determinado triptán(AU)

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(AU)

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

Introducción. La flunaricina, con nivel de evidencia A, y el nadolol, con nivel de evidencia C, estarían indicados como tratamiento preventivo de la migraña. No existen estudios previos que comparen la efectividad de ambos fármacos. Objetivo. Comparar parámetros de efectividad en grupos independientes de pacientes tratados preventivamente con uno de los fármacos del estudio a los que se aplicó el mismo protocolo. Pacientes y métodos. Se seleccionó a pacientes con migraña episódica (criterios de la Sociedad Internacional de Cefaleas del 2004) que se habían sometido a tratamiento preventivo por primera vez, con flunaricina (5 mg/día) o nadolol (20-40 mg/día). Se analizaron las variables principales de efectividad (reducción del número de crisis al cuarto mes de tratamiento y tasa de respondedores). Resultados. Se incluyó a 227 pacientes con intención de recibir tratamiento: 155 con flunaricina (80,5% mujeres; edad media: 38,3 ± 12,1 años) y 72 con nadolol (63,8% mujeres; edad media: 37,1 ± 12,0 años). La media de crisis en el mes previo al tratamiento fue de 6,09 ± 2,6 en el grupo de la flunaricina y de 5,1 ± 1,7 en el grupo del nadolol (p = 0,0079); la media de crisis al cuarto mes de tratamiento fue de 2,61 ± 2,4 en el grupo de la flunaricina y de 2,77 ± 2,4 en el grupo del nadolol (p = NS). Porcentaje de reducción de migrañas: 55,2% con flunaricina y 50,4% con nadolol (p = NS). La tasa de respondedores fue del 69% con flunaricina y del 67% con nadolol (p = NS). La tasa de respuesta excelente (reducción mayor o igual al 75% de las crisis) fue del 52,2% con flunaricina y del 36,1% con nadolol (p = 0,0077). Porcentaje de efectos adversos: 48,3% con flunaricina frente a 25% con nadolol (p = 0,0009). La tasa de satisfacción fue del 68%, similar en ambos grupos. Conclusión. Tanto la flunaricina como el nadolol mostraron ser efectivos en el tratamiento preventivo de la migraña episódica. La flunaricina se utilizó con mayor frecuencia en nuestro medio y fue peor tolerada (AU)

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 (AU)

Factores predisponentes al abandono del tratamiento preventivo en una serie de pacientes con migraña / Predisposing factors affecting drop-out rates in preventive treatment in a series of patients with migraine

Introducción. Más de un 30% de pacientes abandona el tratamiento preventivo de la migraña. Esta situación es poco conocida y los factores de riesgo que llevan al abandono del tratamiento tampoco están identificados. Objetivo. Valorar alguno de los factores que pueden predisponer al abandono de un tratamiento preventivo. Pacientes y métodos. Es un estudio prospectivo de pacientes con migraña que precisaron tratamiento preventivo por primera vez con uno de tres fármacos considerados de primera línea: un betabloqueante (nadolol), un neuromodulador (topiramato) o un antagonista del calcio (flunaricina). Se establecieron dos grupos según se produjese abandono o no del tratamiento. Se analizaron y compararon diferentes variables demográficas y clínicas en ambos grupos. Resultados. En un total de 800 pacientes con migraña que precisaron tratamiento preventivo por primera vez, hubo un 19,7% de abandonos. En el grupo que abandonó, las variables ‘edad’, ‘número de crisis previas al tratamiento preventivo’ y ‘efectos adversos’ mostraron diferencias significativas con las del grupo de pacientes que no suspendieron el tratamiento preventivo. Conclusiones. El fármaco utilizado como tratamiento preventivo, los efectos adversos, la edad más joven y el menor número de crisis antes de iniciar el tratamiento preventivo favorecieron su abandono. El tipo de migraña episódica o crónica, la presencia de abuso de fármacos y los fármacos utilizados para el tratamiento de las crisis no guardaron relación con la suspensión del tratamiento preventivo (AU)

Introduction. The drop-out rate among patients receiving preventive treatment for migraine is higher than 30%. This situation is not very widely known and the risk factors that lead patients to drop out from treatment have yet to be identified. Aim. To evaluate some of the factors that can predispose patients to drop out of preventive treatment. Patients and methods. We conducted a prospective study of patients suffering from migraine who required preventive treatment for the first time with one of what are considered the top three first-choice drugs, i.e. a beta-blocker (nadolol a neuromodulator (topiramate) or a calcium antagonist (flunarizine). Two groups were established according to whether patients dropped out of treatment or not. Different demographic and clinical variables were analysed and compared in the two groups. esults. Of 800 patients with migraine who required preventive treatment for the first time, the drop-out rate was 19.7%. In the drop-out group, the variables ‘age’, ‘number of seizures’, ‘number of seizures prior to preventive treatment’ and ‘side effects’ showed significant differences with those from the group of patients who did not drop out of preventive treatment. Conclusions. The drug used as preventive treatment, the side effects, a younger age and a lower number of seizures before starting the preventive treatment favoured higher drop-out rates. Whether the migraine was episodic or chronic, the presence of medication abuse and the drugs used to treat the seizures were not related with dropping out of preventive treatmen (AU)

[Predisposing factors affecting drop-out rates in preventive treatment in a series of patients with migraine]. / Factores predisponentes al abandono del tratamiento preventivo en una serie de pacientes con migraña.

INTRODUCTION: The drop-out rate among patients receiving preventive treatment for migraine is higher than 30%. This situation is not very widely known and the risk factors that lead patients to drop out from treatment have yet to be identified. AIM: To evaluate some of the factors that can predispose patients to drop out of preventive treatment. PATIENTS AND METHODS: We conducted a prospective study of patients suffering from migraine who required preventive treatment for the first time with one of what are considered the top three first-choice drugs, i.e. a beta-blocker (nadolol), a neuromodulator (topiramate) or a calcium antagonist (flunarizine). Two groups were established according to whether patients dropped out of treatment or not. Different demographic and clinical variables were analysed and compared in the two groups. RESULTS: Of 800 patients with migraine who required preventive treatment for the first time, the drop-out rate was 19.7%. In the drop-out group, the variables 'age', 'number of seizures', 'number of seizures prior to preventive treatment' and 'side effects' showed significant differences with those from the group of patients who did not drop out of preventive treatment. CONCLUSIONS: The drug used as preventive treatment, the side effects, a younger age and a lower number of seizures before starting the preventive treatment favoured higher drop-out rates. Whether the migraine was episodic or chronic, the presence of medication abuse and the drugs used to treat the seizures were not related with dropping out of preventive treatment.

[Comparative study of the effectiveness of topiramate and nadolol in the preventive treatment of episodic migraine in independent series of patients]. / Estudio comparativo de la efectividad del topiramato y del nadolol en el tratamiento preventivo de la migraña episodica en series independientes de pacientes.

INTRODUCTION: Topiramate and nadolol with levels A and C of scientific evidence, respectively, would be indicated as preventive treatments of migraine. To date only one study of satisfaction has been carried out to compare the two pharmaceuticals. AIM: To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study. PATIENTS AND METHODS: From a database of 700 patients with migraine, those with episodic migraine and who had followed a course of preventive treatment, for the first time, with topiramate or nadolol were selected for the study. The effectiveness variables (reduction in the number of crises at four months of preventive treatment and responder rates) were analysed. RESULTS: Altogether 208 patients with were included for treatment: 140 with topiramate (77.8% females; mean age, 37.9) and 68 with nadolol (69% females; mean age, 36.9). The mean number of crises in the month prior to treatment was: topiramate group, 6.3 +/- 2.6; nadolol group 5.3 +/- 2.0 (p = 0.0066). At four months after starting treatment: topiramate group, 2.69 +/- 2.6; nadolol group 2.6 +/- 2.2 (NS). The percentage of reduction in the number of migraines was 56.6% with topiramate and 51.6% with nadolol (NS). The responder rate (reduction in the frequency of crises by at least 50%) was 71.3% with topiramate versus 69% with nadolol (NS). The excellent response rate (reduction in crises by at least 75%) was 53.3% with topiramate versus 32.2% with nadolol (p = 0.0077). Adverse side effects were reported by 54% of patients treated with topiramate versus 30.8% of those treated with nadolol (p = 0.0015). The rate of satisfaction was 61% for the topiramate group and 71% for the group with nadolol (NS). CONCLUSIONS: Both topiramate and nadolol proved to be effective in the preventive treatment of episodic migraine. Topiramate was found to be more effective than nadolol, although it was used in patients with a higher frequency of crises, and was not tolerated so well.

Estudio comparativo de la efectividad del topiramato y del nadolol en el tratamiento preventivo de la migraña episódica en series independientes de pacientes / Comparative study of the effectiveness of topiramate and nadolol in the preventive treatment of episodic migraine in independent series of patients

Introducción. El topiramato con nivel A y el nadolol con nivel C de evidencia científica estarían indicados como tratamientos preventivos de la migraña. Sólo existe un estudio de satisfacción que compare ambos fármacos. Objetivo. Comparar los parámetros de efectividad en grupos independientes de pacientes tratados preventivamente con uno de los fármacos del estudio. Pacientes y métodos. De una base de datos de 700 pacientes con migraña, se seleccionaron aquéllos con migraña episódica y que habían llevado tratamiento preventivo, por primera vez, con topiramato o nadolol. Se analizaron las variables de efectividad (reducción del número de crisis al cuarto mes de tratamiento preventivo y tasa de respondedores). Resultados. Fueron incluidos 208 pacientes con intención de tratar; 140 con topiramato (77,8% mujeres; edad media: 37,9 años) y 68 con nadolol (69% mujeres; edad media: 36,9 años). La media de crisis en el mes previo al tratamiento fue: grupo con topiramato, 6,3 ± 2,6; grupo con nadolol, 5,3 ± 2,0 (p = 0,0066). Al cuarto mes de tratamiento: grupo con topiramato, 2,69 ± 2,6; grupo con nadolol, 2,6 ± 2,2 (NS). El porcentaje de reducción de migrañas fue del 56,6% con topiramato y del 51,6% con nadolol (NS). La tasa de respondedores (reducción en la frecuencia de crisis al menos del 50%) fue del 71,3% con topiramato y del 69% con nadolol (NS). La tasa de respuesta excelente (reducción de las crisis al menos un 75%) fue del 53,3% con topiramato y del 32,2% con nadolol (p = 0,0077). El 54% de los pacientes tratados con topiramato y el 30,8% de los pacientes tratados con nadolol presentaron efectos adversos (p = 0,0015). La tasa de satisfacción fue del 61% en el grupo de topiramato y del 71% en el grupo de nadolol (NS). Conclusión. El topiramato y el nadolol mostraron ser efectivos en el tratamiento preventivo de la migraña episódica. El topiramato mostró mayor efectividad y se utilizó en pacientes con mayor frecuencia de crisis, pero se toleró peor que el nadolol (AU)

Introduction. Topiramate and nadolol with levels A and C of scientific evidence, respectively, would be indicated as preventive treatments of migraine. To date only one study of satisfaction has been carried out to compare the two pharmaceuticals. Aim. To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study. Patients and methods. From a database of 700 patients with migraine, those with episodic migraine and who had followed a course of preventive treatment, for the first time, with topiramate or nadolol were selected for the study. The effectiveness variables (reduction in the number of crises at four months of preventive treatment and responder rates) were analysed. Results. Altogether 208 patients with were included for treatment: 140 with topiramate (77.8% females; mean age, 37.9) and 68 with nadolol (69% females; mean age, 36.9). The mean number of crises in the month prior to treatment was: topiramate group, 6.3 ± 2.6; nadolol group 5.3 ± 2.0 (p = 0.0066). At four months after starting treatment: topiramate group, 2.69 ± 2.6; nadolol group 2.6 ± 2.2 (NS). The percentage of reduction in the number of migraines was 56.6% with topiramate and 51.6% with nadolol (NS). The responder rate (reduction in the frequency of crises by at least 50%) was 71.3% with topiramate versus 69% with nadolol (NS). The excellent response rate (reduction in crises by at least 75%) was 53.3% with topiramate versus 32.2% with nadolol (p = 0.0077). Adverse side effects were reported by 54% of patients treated with topiramate versus 30.8% of those treated with nadolol (p = 0.0015). The rate of satisfaction was 61% for the topiramate group and 71% for the group with nadolol (NS). Conclusions. Both topiramate and nadolol proved to be effective in the preventive treatment of episodic migraine. Topiramate was found to be more effective than nadolol, although it was used in patients with a higher frequency of crises, and was not tolerated so well (AU)

[Zonisamide in the preventive treatment of refractory migraine]. / Zonisamida en el tratamiento preventivo de la migraña refractaria.

INTRODUCTION: Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine. PATIENTS AND METHODS: Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of 'response' (reduction in attack frequency below 50%) at the third month of treatment. RESULTS: Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms. CONCLUSIONS: These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migraine.

Zonisamida en el tratamiento preventivo de la migraña refractaria / Zonisamide in the preventive treatment of refractory migraine

Introducción. La migraña crónica refractaria al tratamiento preventivo habitual es una situación frecuente en consultas de neurología. Se pretende analizar la experiencia con zonisamida en el tratamiento de pacientes con migraña frecuente refractaria. Pacientes y métodos. Aquellos pacientes sin respuesta o con intolerancia a topiramato y al menos otro fármaco preventivo para la migraña recibieron zonisamida. El fármaco se incrementó a razón de 25 mg/semana, hasta un máximo de 200 mg/día. La eficacia de la zonisamida se evaluó en términos de ‘respuesta’ (disminución en la frecuencia de las crisis al menos del 50%) al tercer mes del tratamiento. Resultados. Nuestra serie comprende 172 pacientes de entre 22 y 69 años. El 81% eran mujeres. Las dosis de zonisamida oscilaron entre 50 y 200 mg/día, y la dosis más frecuentemente administrada fue de 100 mg/día. La zonisamida mostró eficacia (respuesta) en 76 (44%) de los pacientes; la respuesta fue excelente en 22 (13%). La puntuación en el test de MIDAS se redujo en un 43,2%. Un 27% de los pacientes no toleró el fármaco, fundamentalmente por bradipsiquia subjetiva o clínica digestiva. Conclusiones. Estos resultados, obtenidos en un número amplio de pacientes refractarios o intolerantes a topiramato y otros fármacos, indican que, al menos en condiciones de práctica clínica, la zonisamida, en dosis relativamente bajas, es una opción que se debe considerar en el tratamiento preventivo del paciente con migraña frecuente

Introduction. Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine. Patients and methods. Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of ‘response’ (reduction in attack frequency below 50%) at the third month of treatment. Results. Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms. Conclusions. These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migrainev