scholarly journals Migraine patients in Germany - need for medical recognition and new preventive treatments: results from the PANORAMA survey

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M. Koch ◽  
Z. Katsarava ◽  
C. Baufeld ◽  
K. Schuh ◽  
A. Gendolla ◽  
...  
Keyword(s):  
Prophylactic Treatment ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Comprehensive Overview ◽  
Treatment Algorithms ◽  
Primary Headache Disorder ◽  
Professional Perspective ◽  
Few Data ◽  
Healthcare Situation

Abstract Background Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients’ daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany. Methods Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics. Results The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6 % of migraine patients receive prophylactic treatment. 45.4 % of prophylactic treatments are initiated with a beta-blocker and 28.1 % with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0 %). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1 %). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment. Conclusions PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.

scholarly journals Migraine patients in Germany - Need for Medical Recognition and New Preventive Treatments: Results from the PANORAMA Survey

2020 ◽  
Author(s):  
Mirja Koch ◽  
Zsazsa Katsarava ◽  
Caroline Baufeld ◽  
Katrin Schuh ◽  
Astrid Gendolla ◽  
...  
Keyword(s):  
Prophylactic Treatment ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Comprehensive Overview ◽  
Treatment Algorithms ◽  
Primary Headache Disorder ◽  
Professional Perspective ◽  
Few Data ◽  
Healthcare Situation

Abstract Background: Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients’ daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany.Methods: Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics.Results: The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6% of migraine patients receive prophylactic treatment. 45.4% of prophylactic treatments are initiated with a beta-blocker and 28.1% with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0%). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1%). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment. Conclusions: PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.

Complete alleviation of treatment refractory primary SUNCT syndrome with clomiphene citrate (a medicinal deep brain hypothalamic modulator)

Cephalalgia ◽  
2014 ◽  
Vol 34 (12) ◽  
pp. 1021-1024 ◽  
Author(s):  
Todd D Rozen
Keyword(s):  
Clomiphene Citrate ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Decompression Surgery ◽  
Sunct Syndrome ◽  
Primary Headache Disorder ◽  
Treatment Refractory ◽  
Putative Mechanism ◽  
Deep Brain

Objective To report the first ever case of primary short-lasting unilateral neuralgiform headache attacks (SUNCT) syndrome completely responsive to clomiphene citrate. Methods Case report. Results SUNCT is a primary headache disorder marked by frequent attacks of one-sided headache with cranial autonomic associated symptoms. When SUNCT is deemed medicinally treatment refractory, it can cause tremendous patient-related disability. Surgical treatment options are available including hypothalamic deep brain stimulation, occipital nerve stimulator placement or arterial decompression surgery, but these procedures carry significant morbidity. A patient presented with a 10 month complaint of multiple, daily short-lasting, right-sided headaches each lasting from 60 to 120 seconds in duration and occurring from 100 to 200 times per day. The head pain was associated with ipsilateral eyelid ptosis and conjunctival injection. The patient was diagnosed with SUNCT but was unresponsive to multiple recognized medicinal treatments. He had complete alleviation of his attacks with clomiphene citrate, a synthetic, non-steroidal, ovulatory stimulant that directly binds to hypothalamic estrogen receptors. The clomiphene was tolerated without any adverse events. A putative mechanism of action for clomiphene in the prevention of SUNCT will be presented. Conclusion Clomiphene citrate is a unique treatment for SUNCT and appears to be very safe and effective.

Cluster Headache

Cephalalgia ◽  
2000 ◽  
Vol 20 (9) ◽  
pp. 787-803 ◽  
Author(s):  
DW Dodick ◽  
TD Rozen ◽  
PJ Goadsby ◽  
SD Silberstein
Keyword(s):  
Gender Differences ◽  
Cluster Headache ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Primary Headache ◽  
Headache Disorder ◽  
Autonomic Symptoms ◽  
Head Pain ◽  
Primary Headache Disorder

Cluster headache is a stereotypic, primary headache disorder that is marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Cluster headache is probably due to an abnormality in the circadian hypothalamic generator with subsequent trigeminovascular activation. We have reviewed the clinical manifestations, pathophysiology, gender differences, and treatment options in cluster headache.

Treatment and management of migraine

2020 ◽  
pp. 138-151
Author(s):  
Miguel J. A. Láinez ◽  
Veselina T. Grozeva
Keyword(s):  
Treatment Options ◽  
Correct Diagnosis ◽  
Primary Headache ◽  
Headache Disorder ◽  
Dopamine Antagonists ◽  
Individual Treatment ◽  
Acute Migraine ◽  
Primary Headache Disorder ◽  
General Management ◽  
Status Migrainosus

The chapter is a review of the possible treatment options for acute migraine. This primary headache disorder has a huge social and economic impact. The combination of a correct diagnosis, good general management and the election of the most appropriate pharmacological treatment can significantly reduce the patient’s disability. Here we provide a thorough description of the most commonly used specific (ergots and triptans) and nonspecific (analgesics, NSAIDs, dopamine antagonists, etc.) medications, as well as some of their effective combinations. We discuss how to use the different medications in relation with the clinical presentation of the migraine attacks and in special situations as status migrainosus, or refractoriness to conventional treatment. Advantages and disadvantages of the most used strategies are pointed out to assist professionals to choose the best individual treatment for their patients with acute migraine attack.

An Overview of the Treatment Options for Acute Migraine

2011 ◽  
Vol 6 (4) ◽  
pp. 265 ◽  
Author(s):  
Fabio Antonaci ◽  
Natascia Ghiotto ◽  
Maurizio Evangelista ◽  
◽  
◽  
...  
Keyword(s):  
Acute Treatment ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Symptomatic Therapy ◽  
Acute Migraine ◽  
Primary Headache Disorder ◽  
Inflammatory Drugs ◽  
Socioeconomic Burden ◽  
Over Time

Migraine is a primary headache disorder associated with a high socioeconomic burden. The first step in effective migraine management, following confirmation of the diagnosis, is patient education: the condition is carefully explained, to ensure that it is properly understood, and realistic expectations are set. The choice of acute treatment has changed over time as the available therapeutic options have increased. Abortive migraine therapy can be either specific (ergot derivatives and triptans) or non-specific (analgesics and non-steroidal anti-inflammatory drugs). Even though acute symptomatic therapy can be optimised, migraine remains a chronic and potentially progressive condition.

Red ear syndrome: A review of all published cases (1996–2010)

Cephalalgia ◽  
2012 ◽  
Vol 33 (3) ◽  
pp. 190-201 ◽  
Author(s):  
Suzanne Ryan ◽  
Benjamin R Wakerley ◽  
Paul Davies
Keyword(s):  
Young Woman ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Burning Sensation ◽  
Primary Headache Disorder ◽  
Red Ear Syndrome

Background Red ear syndrome is characterised by episodic unilateral erythema of the ear associated with pain and burning sensation. Patients and methods We describe the case of a young woman with daily, frequent, recurrent episodes of red ear syndrome in the absence of any structural lesions, primary headache disorder or obvious triggers. We review all previously described cases and discuss postulated mechanisms for this syndrome. Conclusions The exact cause of this rare headache disorder remains unknown and treatment options vary considerably.

scholarly journals Effectiveness of paranasal air suction on acute migraine using portable air sucker – a randomized, double blind study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
S. M. R. Bandara ◽  
S. Samita ◽  
A. M. Kiridana ◽  
H. M. M. T. B. Herath
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Sri Lanka ◽  
Primary Headache ◽  
Headache Disorder ◽  
Low Pressure ◽  
Outcome Variable ◽  
Double Blind ◽  
Primary Headache Disorder ◽  
Before And After

Abstract Background Migraine is a primary headache disorder and is the most common disabling primary headache disorder that occurs in children and adolescents. A recent study showed that paranasal air suction can provide relief to migraine headache. However, in order to get the maximum benefit out of it, an easy to use effective air sucker should be available. Aiming to fulfil the above requirement, a randomized, double blind control clinical trial was conducted to investigate the efficacy of a recently developed low–pressure portable air sucker. Methods Eighty-six Sri Lankan school children of age 16–19 years with migraine were enrolled for the study. They were randomly allocated into two groups, and one group was subjected to six intermittent ten-second paranasal air suctions using the portable air sucker for 120 s. The other group was subjected to placebo air suction (no paranasal air suction). The effect of suction using portable air sucker was the primary objective but side of headache, type of headache, and gender were also studied as source variables. The primary response studied was severity of headache. In addition, left and right supraorbital tenderness, photophobia, phonophobia, numbness over the face and scalp, nausea and generalized tiredness/weakness of the body were studied. The measurements on all those variables were made before and after suction, and the statistical analysis was performed based on before and after differences. As a follow–up, patients were monitored for 24-h period. Results There was a significant reduction in the severity of headache pain (OR = 25.98, P < 0.0001), which was the primary outcome variable, and other migraine symptoms studied, tenderness (left) (OR = 289.69, P < 0.0001), tenderness (right) (OR > 267.17, P < 0.0001), photophobia (OR = 2115.6, P < 0.0001), phonophobia (OR > 12.62, P < 0.0001) nausea (OR > 515.59, P < 0.0001) and weakness (OR = 549.06, P < 0.0001) except for numbness (OR = 0.747, P = 0.67) in the treatment group compared to the control group 2 min after the suction. These symptoms did not recur within 24-h period and there were no significant side effects recorded during the 24-h observation period. Conclusion This pilot study showed that low–pressure portable air sucker is effective in paranasal air suction, and suction for 120 s using the sucker can provide an immediate relief which can last for more than 24-h period without any side effects. Trail registration Clinical Trial Government Identification Number – 1548/2016. Ethical Clearance Granted Institute – Medical Research Institute, Colombo, Sri Lanka (No 38/2016). Sri Lanka Clinical Trial Registration No: SLCTR/2017/018. Date of registration = 29/ 06/2017. Approval Granting Organization to use the device in the clinical trial– National Medicines Regulatory Authority Sri Lanka (16 Jan 2018), The device won award at Geneva international inventers exhibition in 2016 and President award in 2018 in Sri Lanka. It is a patented device in Sri Lanka and patent number was SLKP/1/18295. All methods were carried out in accordance with CONSORT 2010 guidelines.

scholarly journals Diagnosis and management of migraine in ten steps

2021 ◽  
Author(s):  
Anna K. Eigenbrodt ◽  
Håkan Ashina ◽  
Sabrina Khan ◽  
Hans-Christoph Diener ◽  
Dimos D. Mitsikostas ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Consensus Statement ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Headache Disorder ◽  
Clinical Decision ◽  
Diagnosis And Management ◽  
Primary Headache Disorder ◽  
Management Of Complications ◽  
European Headache Federation

AbstractMigraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.

scholarly journals Topiramate Versus Propranolol in the Prophylaxis of Migraine in Bangladeshi Population

2020 ◽  
Vol 18 (2) ◽  
pp. 12-17
Author(s):  
Muhammad Tayeb ◽  
Md Hasanuzzaman ◽  
Abul Mansur Md Rezaul Karim ◽  
Mohammad Sanaullah ◽  
Md Ashraful Islam
Keyword(s):  
Migraine Attack ◽  
Divided Dose ◽  
Low Dose ◽  
Primary Headache ◽  
Headache Disorder ◽  
Treatment Groups ◽  
Primary Headache Disorder ◽  
Significant Difference ◽  
The Mean ◽  
Bangladeshi Population

Background : Migraine is primary headache disorder characterized by recurring attacks of pain and associated symptoms. The management modality is still unsatisfactory due to poor understanding of its cause and pathogenesis. To assess the efficacy and safety of low dose Topiramate vs Propranolol in migraine prophylaxis. Materials and methods : A randomized clinical trial including 130 patients with frequent migraine headache >5 attacks per month was performed in the out patients Department of Medicine and Neurology, CMCH for a period of 12 weeks. The patients were randomly divided into two treatment groups – treated by Topiramate 50mg/day and Propranolol 80mg/day respectively. Topiramate started with 25mg/day for 7 days then increased up to 50mg/day in two divided dose. Propranolol started with 40mg/day for 7 days then increased up to 80mg/day in two divided dose. The patients were assessed at 0, 8 and 12 weeks of the study. Results: The Topiramate group showed a reduction in the mean (±SD) of frequency of migraine attack from 6.95(±2.88) to 1.75(±1.08) episode per month, headache days per month from 7.62(±4.14) to 1.83(±1.10), intensity of headache per attack from 8.98(±1.05) to 6.10(±2.50) based on VAS scale, duration of headache per episode from 11.56(±9.16) to 5.40(±2.97) per hour and MIDAS score from 16.19(±3.91) to 8.14(±3.93). In patient treated with Propranolol, the mean (±SD) of monthly frequency of migraine attack declined from 7.09(±2.87) to 1.92(±0.98) episode per month, headache days per month from 8.17(±4.52) to 1.86(±o.83), intensity of headache per attack from 8.47(±1.10) to 6.03(±2.05) based on VAS scale, duration of headache per episode from 11.16(±8.08) to 5.97(±3.45), MIDAS score from 15.48(±3.55) to7.77(±3.49). Pre- and post-treatment values were significantly different for individual groups but no significant difference observed between groups. Conclusion: This study demonstrated that both low dose Topiramate and propranolol could significantly reduce migraine frequency, intensity and duration. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 12-17

scholarly journals Hypnic headache: a rare type of primary headache disorder

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S120-S120
Author(s):  
Muhammad Sayed Inam ◽  
Saifun Nahar ◽  
Mohammad Zubayer Miah
Keyword(s):  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Lithium Carbonate ◽  
Hypnic Headache ◽  
Rare Type ◽  
Falling Asleep ◽  
History Of ◽  
Waking Up ◽  
Secondary Causes

ObjectiveHypnic Headache are is a very rare primary headaches that affect the elderly, with an average age of 60 years. Research in the areas of neurophysiology and treatment options for Hypnic Headache are necessary in order to better understand, and improve outcomes for this rare headache disorder.Case reportMr. X is a 70-year-old patient, has been presenting with the complaints of headache during sleep at night for the last 1 year. The Headache started after 3 to 4 hours after falling asleep. Due to headache, he wakes up from sleep around 03:00 to 04:00 am almost every night and his headache persist for 30 to 40 minutes. After waking up from sleep he keeps himself busy with religious activity and the headache gradually resolves. He then goes back to bed again.Mr. X also informed that, the headache is dull in nature and located in left temporo occipital region. It is not associated with photophobia, phonophobia, nausea, vomiting, tearing or discomfort in the leg. He gives no history of early morning headache or day time headache, sleep disorder, snoring or sleep apnea. He has no past history of trauma to the head, fainting attack, unconsciousness, weakness or paralysis of limbs, seizures or non-epileptic seizures. He is an non-smoker, non-alcoholic, non-hypertensive & non-diabetic person.On general examination, his heart rate is 70 beats/min, blood pressure 138/68 mm of Hg. There are no anemia, jaundice or oedema present in him. His both lung fields are clear. On neurological examinations there are nothing abnormality detected. His Serological investigations, CBC (Complete Blood Count) FBS (Fasting Blood Glucose), lipid profile are within normal limit. CT scan of the brain is normal. There are no cerebral atrophy or volume loss compatible with age.Mr. X was treated by several general practitioners with paracetamol, diclofenac sodium, mefenamic acid, tramadol hydrochloride. He used these drugs either singly or in combinations. But with this treatment there were no significant improvement occurs. Mr. X is scared and depressed for his sleep time headache.DiscussionHypnic headache is a very rare headache disorder. It occurs in age groups over 60 years. It is occur at night during in sleep and waking the patient up, hence the name of it “alarm clock headache”. It is commonly unilateral and lasts for 15 minutes to 4 hours. Hypnic headache commonly dull or throbbing in character and does not make the patient restless, unlike in Cluster Headache. After waking up from sleep, most patients engage in some activity. Hypnic headache is not associated with rhinorrhea, tearing and ptosis. Diagnosis is mainly clinical. Secondary causes headache must be excluded. International Classification of Headache Disorders 3rd Edition (ICHD-3)-beta provides diagnostic criteria for hypnic headache. Pathophysiology of hypnic headache is not clearly identified. Usual treatment options of Hypnic headache includes bed time coffee, lithium carbonate, indomethacin. Our patient fulfil all the criteria of Hypnic headache and he fells improvement with Indomethacin 50 mg in devided doses.ConclusionHypnic Headache is a very rare type of primary headache. It should be diagnosed only after other secondary causes of headache have been excluded. Caffeine, lithium carbonate, flunarizine, indomethacin, used to treat the patient of Hypnic Headache. Lack of study and awareness about these disorders can lead to delays in diagnosis and treatment. Clinical trials are needed to find out proper treatment, but it will be difficult to perform because of the rareness of this disorder.

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