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Assessment of the efficacy and tolerability of triptans in clinical practice
No full textIn most cases a triptan is prescribed to a patient suffering from
migraine who has been taking OTCAs for years, alone or combined
with caffeine, antiemetics, barbiturates, etc.
A proper use of triptans is therefore indispensable to correctly assess
whether they are efficacious and/or toxic in a completely different setting
from the one in which controlled clinical trials are conducted.
Patient’s judgments on the treatment are therefore fundamental to
assess if it is ineffective and/or causes toxic effects.
The physician knows that the efficacy and toxicity among triptans are
similar in clinical practice and that the response is individual and closely
connected to the patient’s compliance and expectations. Most side
effects of triptans appear the first time they are taken and their efficacy
is rarely the same each time they are taken. It is therefore advisable to
agree with the patient upon the use of the triptans: triptans are indispensable
drugs to treat migraine, but they are not miraculous. To prevent
the patient from stopping treatment or from trying different triptans
and then returning to self-medication, the patient must agree to fill
out a form on the efficacy and toxicity of the drug being taken.
Naturally, before preparing this form, the physician has to decide
whether to use the same parameters of efficacy and tolerability in clinical
practice and controlled clinical trials.
Whatever instruments are used to assess the drug, there are some key
elements to consider: time when the migraine attack started; time when
the drug was taken; presence of autonomic symptoms or aura; intensity
of the pain when it started and at the moment when the drug was
taken; duration of attack; should there be any relapse, at what time it
appeared; should there be any side effects, their intensity and duration.
The information gathered must then be discussed with the patient to
decide whether to continue or modify the treatment. Data on the efficacy
and tolerability of triptans, also if combined with other drugs,
could help to identify sub-groups of patients suffering from migraine
who are non-responders to triptans and/or prone to toxic effects
Limits of medication-overuse headache classification (code 8.2 according to ICHD-II)”
No full textThe major chamges that we propose are: 1. classifying the drugs inducing MOH into 2 groups: drugs with psychotropic effects that produce tolerance, dependence, repetition of intake and, sometimes, abstinence symptoms after withdarawal; drugs related to non-dependence-producing substances; 2 including in the first group also the combinations of analgesics and drugs with psychotropic effects, since we consider the latter as the most important component to maintain overuse
Pharmacoepidemiology of drug abuse in headache patients: comparison between sufferers of medication-overuse headache and migraine
No full textChronic headache patients often overuse symptomatic drugs while episodic headache patients usually take drugs in a very cautious way. It is unknown if the differences between the two groups of headache sufferers concern only the amount or also the type of drug used. Our aim was to compare the pharmacological habit between medication-overuse headache (MOH) and migraine patients. Methods We compared a) all drugs that 138 MOH patients (F/M=5.3; mean age +DS: + years) consecutively admitted at the in-patient ward of the Headache Centre of the University of Modena and Reggio Emilia, were taking and b) all drugs that 78 migraine patients (F/M= 2.3; mean age +DS: + years) consecutively referred at the out-patient ward of the Centre. Data were collected by means a standardized clinical chart and recorded in an apposite database. The study was carried out between June 2004 and March 2005. Results There were great differences in the type of symptomatic medications used between MOH and migraine patients. In particular MOH patients used concomitantly more than one type of symptomatic: triptans 43.5%, NSAIDs 42%, association of indomethacin, prochlorperazine and caffeine (IPC) 14.5%, and weak opioid 10%. Migraine patients took: NSAIDs 56%, triptans 30%, IPC 5%, and other analgesic combinations 2.6%. In both groups most used drugs, respectively among NSAIDs and triptans, were nimesulide and sumatriptan. Fifty-eight per cent of MOH but only 20% of migraine patients were taking prophylactic treatments. More than 71% of MOH patients were using other medications, too: antihypertensive agents 27.5%, benzodiazepines 27%, antidepressants 23%, hormones 23%, antilipemic agents 7%, antiplatelet agents 6%. Among migraine patients 54% were using other medications, too: hormones 33%, antihypertensive agents 8%, antidepressants 10%, benzodiazepines 5%. Conclusions Even if MOH often evolves from migraine, our study indicates that pharmacoepidemiology of drug use was different between the two headache forms: MOH overused triptans more than NSAIDs and were poli-medicated; migraine patients for acute treatment took mainly NSAIDs, did not use weak opioid and overall took few other medications
Treatment of chronic migraine and medication overuse
No full textAccording to the 2nd edition of “International Classification of
Headache Disorders”, migraine is classified as “chronic” when occurring on 15 or more days per month for more than 3 months”. Most cases of chronic migraine start as migraine without aura, and chronicity may be regarded as a complication of episodic migraine. Usually, if migraine attacks occur on 15 or more days per month, medication overuse is present. But a sample of patients presents both migraine attacks and tension-type headache, so it is difficult for patients to estimate how many attacks fulfil one or another set of criteria. In all cases, the first step of treatment is to stop the intake of drugs used for many
years and to start an intravenous therapy and a preventive treatment program. Another preliminary step is the identification of comorbid psychiatric conditions and exacerbating factors. If large amounts of butalbital-containing analgesic combinations are used, phenobarbital should be administered in order to prevent withdrawal symptoms.
Similarly, benzodiazepines and opiates must be gradually reduced. In some cases in-patient treatment is required
Medication-Overuse Headache: clinical and therapeutic problems
No full textThe interactions between chronic headache and medication overuse are
complex and not yet fully clarified. In particular, the mechanisms by
which medication overuse takes part in the chronicization process are
still object of hypotheses. Certainly, medication overuse complicates
the therapeutic approaches to chronic headache. Medication overuse
hampers the effect of prophylactic therapies, and only the interruption
of the overuse, over a variable period of time, leads to the disappearance,
or at least the reduction in the frequency of headache. Only at that
point it is possible to start the prophylactic treatment with a wellfounded
probability of success. Unfortunately, interrupting medication
overuse is not an easy task, due to both the severity of the pain symptomatology
and to rebound headache which can compel the patient to
resume medication.
Objectives The aim of our research was to analyze patients with medication-
overuse headache, with respect to the characteristics of drug
medication behaviour and its consequences for headache treatment.
Patients and methods We studied a consecutive series of 50 patients,
newly admitted to the in-patient service of the Headache Centre of the
University of Modena and Reggio Emilia. Data were collected by
means of a questionnaire, specifically prepared for this study, recorded
into a specific database and analysed by SPSS 6.1.2 program, version
for Windows 98.
Results The combination of indomethacin plus caffeine plus prochlorperazine,
and triptans were the medications most frequently overused
by our patients; only a few patients overused ergot preparations. The
majority of patients used the same type of drug daily. All patients
referred they increased the frequency of self-medication because the
headaches were getting worse. For most patients medication overuse
made the headache more endurable, thus allowing them to work or
function more or less normally in daily life. Only a minority experienced
withdrawal symptoms after discontinuation of the medication
overuse. After detoxification, antidepressants were the class of drugs
most used for prophylaxis.
Discussion During chronic use of a medication indicated for acute
treatment of headache, the therapeutic results do not derive solely from
the drug but also from the organism’s adaptation to the repeated use.
This time-process of compensatory adjustments might partly explain
both the chronicization of headache and the withdrawal symptoms
when medication overuse is interrupted.
Conclusion Medication-overuse headache should be prevented because
its management is very difficult. It is necessary to address, at the same
time, both the chronic pain condition and the medication overuse
Comparison between patients with transformed migraine and medication overuse and patients with episodic migraine and occasional medication use
No full textMost transformed migraine patients overusing medications had caracteristics substantially different from those of episodic migraine patients. Transformed migraine, even after withdrawal from medication overuse, could not be completely reverted by current prophilactic treatments; therefore, a large number of patients, with transformed migraine remain at risk of relapse
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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