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Update on medication-overuse headache and its treatment
Get PDFOPINION STATEMENT:
Medication-overuse headache-i.e., a too-frequent consumption of acute headache medications leading to increased headache frequency and reduced effectiveness of acute and preventive treatments-is a serious medical condition whose pathophysiology still remains incompletely known, which is reflected into a lack of mechanism-based treatments. The first mandatory step in the therapeutic strategy remains withdrawal of the abused drug, preferably abrupt, in concomitance with a detoxification pharmacological regimen to lessen withdrawal symptoms. Intravenous hydration, antiemetics, corticosteroids (prednisone), tranquilizers (benzodiazepine), neuroleptics, and rescue medication (another analgesic than the overused) should be delivered in various combinations, on an inpatient (hospitalization and day hospital) basis or outpatient basis, depending on the characteristics of the specific patient and type of overuse. Inpatient withdrawal should be preferred in barbiturate and opioid overuse, in concomitant depression, or, in general, in patients who have difficulty in stopping the overused medication as outpatients. In contrast, in overuse limited to simple analgesics in highly motivated patients, without high levels of depression and/or anxiety, home detoxification should be chosen. Re-prophylaxis should immediately follow detoxification, ideally with local injections of onabotulinumtoxinA every 3 months or topiramate orally for at least 3 months. Adequate information to patients about the risks of a too-frequent consumption of symptomatic headache medications is essential and should constantly parallel treatment to help preventing relapse after detoxification and re-prophylaxis
Update on Medication-Overuse Headache and its treatment
No full textMedication-overuse headache—i.e., a too-frequent consumption of acute headache medications
leading to increased headache frequency and reduced effectiveness of acute and
preventive treatments—is a serious medical condition whose pathophysiology still remains
incompletely known, which is reflected into a lack of mechanism-based treatments.
The first mandatory step in the therapeutic strategy remains withdrawal of the abused
drug, preferably abrupt, in concomitance with a detoxification pharmacological regimen
to lessen withdrawal symptoms. Intravenous hydration, antiemetics, corticosteroids
(prednisone), tranquilizers (benzodiazepine), neuroleptics, and rescue medication (another
analgesic than the overused) should be delivered in various combinations, on an
inpatient (hospitalization and day hospital) basis or outpatient basis, depending on the
characteristics of the specific patient and type of overuse. Inpatient withdrawal should be
preferred in barbiturate and opioid overuse, in concomitant depression, or, in general, in
patients who have difficulty in stopping the overused medication as outpatients. In
contrast, in overuse limited to simple analgesics in highly motivated patients, without
high levels of depression and/or anxiety, home detoxification should be chosen. Reprophylaxis
should immediately follow detoxification, ideally with local injections of
onabotulinumtoxinA every 3 months or topiramate orally for at least 3 months. Adequate
information to patients about the risks of a too-frequent consumption of symptomatic
headache medications is essential and should constantly parallel treatment to help
preventing relapse after detoxification and re-prophylaxis
Guidelines for the organization of headache in Europe: the headache school II.
No full textIn order to promote education on headache disorders, European Headache Federation (EHF) in conjunction with National Headache Societies organizes educational courses meeting uniform standards according to previous published guidelines. Based on six headache summer schools' experience, an EHF subcommittee has reviewed these guidelines, and here the revised version is presented. The goals remain the same: quality courses that will attract physicians and neurologists seeking to increase their knowledge, skills, and understanding in the area of primary and secondary headache. Detailed guidelines, a day-to-day program, and a multiple-choice test battery have now been outlined. It is recommended to include practical sessions with patient interviews and hands-on demonstrations of non-pharmacological treatment strategies. For countries that want a 'low cost' education program, a Video School program of a similar scientific standard has been developed. To be certified for CME credits, patronage, and financial support from EHF, it is highly recommended to adhere to the suggested teaching strategies. We hereby aim to promote and professionalize the education in headache disorders and endorse the educational courses meeting uniform standards of excellence
Fathoming the kynurenine pathway in migraine: why understanding the enzymatic cascades is still critically important
Get PDFKynurenine pathway, the quantitatively main branch of tryptophan metabolism, has been long been considered a source of nicotinamide adenine dinucleotide, although several of its products, the so-called kynurenines, are endowed with the capacity to activate glutamate receptors, thus potentially influencing a large group of functions in the central nervous system (CNS). Migraine, a largely unknown pathology, is strictly related to the glutamate system in the CNS pathologic terms. Despite the large number of studies conducted on migraine etio-pathology, the kynurenine pathway has been only recently linked to this disease. Nonetheless, some evidence suggests an intriguing role for some kynurenines, and an exploratory study on the serum kynurenine level might be helpful to better understand possible alterations of the kynurenine pathway in patients suffering from migrain
Safety, tolerability and nocebo phenomena during repetitive transcranial magnetic stimulation: a systematic review and meta-analysis of placebo-controlled clinical trials
No full textGreater occipital nerve as target for refractory chronic headaches. from corticosteroid block to invasive neurostimulation and back
No full textHeadache disorders are one of the major causes of disability worldwide, recently classified as the third cause by the Global Burden of Disease 2010 [1]. Their chronic form and refractory headaches are to be considered important challenges in the daily management of a third-level headache center. The pyramidal progression toward structures characterized by more and more complex and multidisciplinary competences is a given fact based on the research of innovative solutions and multimodal approaches. The clinical definition of the most relevant forms of chronic headaches not responding to conventional therapies is best figured in refractory chronic headaches (rCHs), more precisely refractory chronic cluster headache (rCCH) and refractory chronic migraine (rCM) complicated by acute drug overuse. The European Headache Federation (EHF) has defined the clinical concept of refractoriness in two separate consensus papers, one for rCM [2] and the other for rCCH
EFNS guideline on the treatment of tension-type headache - Report of an EFNS task force.
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe 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
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