101,859 research outputs found
Chronic daily headache: management and rehabilitation.
No full textIn 2001, WHO evidenced headache among the first twenty disability agents in the world. The International Classification of Headache Disorders, II version (ICHD-II) recognises 24 types of chronic headache and states primary headaches as chronic when attacks appear for more than 15 days per month, for at least three months. Migraine given by drugs overuse, defined by ICDH-II in 2004 (and revised in 2005) as MOH, represents a common and debilitating disorder, which can be defined as generation, perpetuation and persistence of intense chronic migraine caused by the frequent and excessive use of (symptomatic) drugs, giving an immediate relief. MOH is associated with overuse of a combination of analgesics, barbiturates, opiods, Ergot alkaloids, aspirin, FANS, caffeine and triptans. Furthermore, some psychological and behavioural states seem particularly important in promoting and sustaining drugs abuse. The management and rehabilitation of patients affected by CDH, over-using symptomatic drugs, consists in the suspension and gradual reduction of their assumption, because of tolerance and addiction possibilities. Therapeutic success, defined as total absence of headache or frequency reduction over 50% in a period of time from 1 to 6 months, stands around 72-74%
Reduction in expenditures on analgesics during one year of treatment of chronic tension headache with BoNTA
No full textThe aim of this study was to investigate the impact of the use of botulinum toxin type A (BoNT-A; BOTOX; Allergan, Inc.; Irvine, CA) as preventive treatment of chronic tension-type headache (CTH) on analgesic use and expenditure.
This was a prospective, single-center, 1-year, open-label study of the effect of BoNT-A treatment on acute analgesic use and expenditure in CTH patients.
A structured headache questionnaire, which included questions about medication costs, was completed by CTH patients attending a specialist headache clinic in Rome prior to BoNT-A injections. Repeat injections were administered every 3 months for up to 1 year. Patients were required to complete the questionnaire prior to each injections cycle. A pharmacoeconomic analysis was performed at each assessment to determine the effect of BoNT-A treatment on analgesic use and expenditure. Three hundred questionnaire were distributed and 296 (98%) were completed. The study population consisted of 67.8% (201) females and 32.2% (95) males, with a mean age of 46.7±16.1 years.
The economic evaluation of the pharmacologic treatment of CTTH was conducted on the 101 (34.12%) patients who gave complete information on posology. Pharmacoeconomic data analysis focused on the whole group using analgesics compared to those who self-prescribed and those who turned to health specialists before and after treatment with BoNT-A. Prior to treatment with BoNT-A the median monthly pharmaceutic expenditure per patient was euro (€) 24.30 for the whole group using analgesics, and € 34.93 and € 18.51 for the ldquoself-prescribersrdquo and the ldquoprescribed by specialistrdquo groups, respectively. Median monthly pharmaceutic expenditure decreased significantly for the whole group (p<0.001), the rdquoself-prescribersrdquo (p<0.01), and the ldquoprescribed by specialistrdquo group (p<0.002) (3rd month: € 13.3, 9.3, 7.2, respectively; 6th month: € 8.9, 9.0, 4.1, respectively; 9th month: € 5.7, 12.4, 3.0, respectively; 12th month € 4.1, 9.8, 3.4, respectively).
BoNT-A treatment produced significant reductions in both analgesic use and expenditure. The data suggest that consultation with a specialist would be helpful in patients with CTTH. Cooperative studies on cost analysis of chronic daily headaches, including both CTTH and chronic migraine, comparing the economic cost package borne by patient and community both before and after treatment with BoNTA, are warranted. However, in the near future additional studies to compare clinical efficacy of BoNT-A in CTTH with its painkiller use/expenditure in the control of pain are needed in order to avoid any possible interference due to placebo effect
Headache and mood disorders
No full textThe aim of the study was to estimate the occurrence of mood, anxiety and disability disorders in 300 patients affected by chronic daily headache and MOH, who were observed for a 16-month period in our centre. We monitored the patients on an interview basis, concerning the anamnestic data collection related to the pre-morbid period, information given by relatives regarding the patient's behaviour during the day, attitudes towards others, maintenance of previous interests and enjoyments, and modifications of the biological rhythm. Several tests were conducted, underlining a significant correlation between headache and mood disorders, impairment of working activity, social and family life. The study shows that patients affected by chronic daily headache and MOH present high levels of anxiety, a depressive symptomatology associated with alexithymia. Moreover, it has been discovered that anxiety and depression facilitate the onset of headache, while patients suffering from pain persistence were more vulnerable to psychiatric problems. In consideration of these results, more exhaustive evaluations relating to the psychopathological aspects in patients affected by headache are necessary. © Springer-Verlag Italia 2005
A one-year prospective costing study of botulinum toxin type A treatment of chronic tension headache
No full textThe objective was to measure the cost of botulinum toxin type A (BTX-A) treatment of chronic tension-type headache. A prospective pharmaceutical costing analysis was completed in the Day Hospital of the Regional Referral Headache Centre at Sant'Andrea Hospital in Rome, chronic tension-type headache patients were treated from February 2003 to January 2004. Patients were treated with 100 U of BTX-A every three months for one year by using the Fixed Doses Fixed Sites procedure. The cost of treatment was based on drug acquisition costs, supplies and professional time needed to administer treatment. The average cost of conventional headache medications was € 853.43 before BTX-A treatment, and € 450.47 after. The cost of BTX-A treatment was € 642.00. Adding the cost of adjunctive conventional medications brought the total cost of BTX-A treatment to € 1092.47. BTX-A treatment reduced use of conventional headache medications and expenditures although the net cost of treatment increased with BTX-A use. © Springer-Verlag Italia 2004
Long-term benefits of botulinum toxin type A (BOTOX) in chronic daily headache: a five-year long experience
No full textBotulinum toxin type A (BoNT-A) has been recently suggested as prophylaxis therapy for the treatment of primary headache chronic forms. Several studies on its efficacy are available, but results are often contradictory and not univocal. The effects of BoNTA on chronic forms of both tension- type headache and migraine have been investigated. In this study we introduce our five-year long experience with BoNT-A (Botox, Allergan, Irvine, CA). The employed dosage was 100 U and the Fixed Sites-Fixed Doses (FSFD) protocol was used. The period of study was April 2001 to July 2006. A sum of 1347 patients suffering from chronic daily headache (CDH) were treated. We registered in these patients the number of headache days per month and observed their reduction in relation to the number of injections. The best results were found after 12 months of treatment, with patients being free of attacks 23 days per month. The BoNT-A treatment was safe and well tolerated, as only 1.6% of patients reported adverse events, and they were all mild and transient. In conclusion, BoNT-A therapy appears to be an efficacious new therapeutic choice in the prophylaxis of CDH, especially for patients not responding to previous prophylactic treatments
Chronic daily headache and medication overuse headache: Clinical read-outs and rehabilitation procedures
No full textThe impact of headache on the person and society represents a public health issue. Recently a study evaluated 51% of headache's prevalence in Europe, of which 14% is affected by migraine. Besides, 4% of adult population is affected by chronic forms, which constitute therefore an even more relevant problem in terms of health and social policies. The International Classification of Headache Disorders, II version (ICHD-II) recognises 24 types of chronic headache and states primary episodic headaches as chronic when attacks appear for more than 15 days per month, for at least three months. Headache given by drugs overuse, defined by ICDH-II in 2004 (and revised in 2005) as Medication Overuse Headache (MOH), is associated with overuse of a combination of analgesics, barbiturates, opioids, ergot alkaloids, aspirin, AINS, caffeine and triptans. Patients affected by MOH present a reduced working performance and a significant alteration in the quality of life. Furthermore, some psychological and behavioural states seem particularly important in promoting and sustaining drugs abuse. The management and rehabilitation of patients affected by CDH, abusing symptomatic drugs, consists in the withdrawal and/or gradual reduction of their assumption, because of tolerance and addiction possibilities
Future drugs for migraine
No full textMigraine is a complex, neurovascular disorder in which genetic and environmental factors interact. At present, frontline therapies in the acute treatment of migraine include the use of non-steroidal anti-inflammatory drugs and triptans. Evidence indicates that calcitonin gene-related peptide (CGRP) plays a fundamental role in the mechanism of migraine. CGRP is a strong vasodilatatory neuropeptide that is released from activated trigeminal sensory nerves. The development of CGRP antagonists has also been driven by the fact that triptans are vasoconstrictive and cannot be safely used in patients with cardiovascular risk factors. Olcegepant (BIBN4096) is the first CGRP antagonist for the treatment of migraine that has been tested in clinical trials, but because of its poor oral bioavailability, only the intravenous formulation has been tested. The first oral non-peptide CGRP antagonist, telcagepant, has been shown recently to be highly effective in the treatment of migraine attacks. This development can be considered as the most important pharmacological breakthrough for migraine treatment since the introduction of sumatriptan in the early 1990s. These results are also of importance, since they support an interesting pathophysiological hypothesis of migraine. The pipeline of future compounds for the treatment of acute migraine headaches include TPRV1 antagonists, prostaglandin E receptor 4 (EP(4)) receptor antagonists, serotonin 5HT1(F) receptor agonists and nitric oxide synthase inhibitors. The immediate future of a preventative treatment for migraine headaches is well represented by botulinum toxin type-A, glutamate NMDA receptor antagonists, gap-junction blocker tonabersat and an angiotensin type 1 blocker candesartan
A one-year retrospective economic evaluation of botulinum toxin type A treatment of chronic tension headache
No full textThe objective was to measure the impact of botulinum toxin type A (BTX-A) treatment on symptoms and medication utilisation patterns in patients with chronic tension-type headache. A retrospective chart analysis was completed in the Day Hospital of the Regional Referral Headache Centre at Sant' Andrea Hospital in Rome. Clinical charts were randomly selected for 100 patients treated from February 2002 to January 2003. Patients were treated with 100 U of BTX-A every three months for one year by using the Fixed Doses Fixed Sites procedure. Treatment outcome ranged from complete resolution of headache symptoms to a worsening of symptoms resulting in discontinuation. Headache medication use before and after treatment was analysed. After BTX-A treatment, 85% of patients experienced at least some degree of pain relief and reduced their use of analgesics. The reduced percentages of patients using a variety of headache medications after BTX-A treatment results from a reduction in their headache symptoms. © Springer-Verlag Italia 2004
Bibliographie Hilarion G. Petzold 1958 – 2009 mit Anhang als Einführung
No full textDieses Archiv enthält die Gesamtbibliographie der Werke des Autors nebst einiger Texte „Über H. G. Petzold“ im Schlussteil der Bibliographie sowie einen Anhang mit einer Einführung in die Architektur des Werkes in seinem wissenslogischen Aufbau als Ausarbeitung seines „Tree of Science Modells“ (2007).This archive contains the complete bibliography of the author and some texts about H. G. Petzold, moreover an epilogue with an introduction to the architecture of the works in its epistemological structure and composition and as an elaborations of Petzold’s „Tree of Science Modell (2007).https://www.fpi-publikation.de/polyloge/01-2009-petzold-h-g-gesamtbibliographie-h-g-petzold-1958-2009-updating-november2009/peerReviewedpublishedVersio
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