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Environmental Protection
Published in Lawrence S. Chan, William C. Tang, Engineering-Medicine, 2019
in a chronic disease called “medication overuse headache” associated with documented abnormal brain structure and function (Symvoulakis et al. 2015, Schwedt and Chong 2017). To achieve this reduction, there is a great need for evidence-based medical publications which provide solid evidences of proper treatments and non-treatments. Such evidence-based medical information will greatly help healthcare professionals in making appropriate medication decision and to avoid prescribing unneeded medications. Artificial intelligence, particularly machine learning, will likely be a great help in this regard.
Migraine: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Acute headache medication is the best approach when attacks are infrequent or compliance is a problem. Treat at least two different attacks before deciding that a drug is ineffective. Be sure the dose is adequate and that no other factors interfere with its effect. It may be necessary to change formulation or route of administration or add an adjuvant. Consider changing the drug when the response is incomplete or too slow, the headache recurs, the results are inconsistent after an adequate trial at an adequate dose, or if the side-effects are bothersome. Guard against medication–overuse headache. In general, limit treatment with acute headache treatment to 2–3 days per week. Medication–overuse headache results from the too frequent use of acute headache medications, often resulting in more frequent headaches that are refractory to treatment. If medication overuse is suspected, keeping a diary can be very informative for both patient and physician.
Headache
Published in Hani Ts Benamer, Essential Revision Notes in Clinical Neurology, 2017
➤ Medication overuse headache is a chronic daily headache (dull or throbbing pain) resulting from taking analgesia (especially those containing codeine) almost on a daily basis to treat tension or migraine headache. The headache is transiently relieved by analgesia.
Gepants for the treatment of migraine
Published in Expert Opinion on Investigational Drugs, 2019
Andrea Negro, Paolo Martelletti
Another important concern is the cardiovascular safety of blocking the CGRP system. This issue is particularly relevant for the anti-CGRP and anti-CGRP receptor antibodies that are thought to be effective for 1.5 months after administration of the therapeutic dose [51] and require a long-term use for migraine prevention. Available data from RCTs on anti-CGRP antibodies do not show cardiovascular AEs but the longest treatment did not reach the two years, and higher-risk patients were excluded by those studies [104]. The cardiovascular issue could be less relevant for gepants that are aimed to treat migraine in acute, unless patients do not limit their use and avoid overuse. Indeed, drugs overuse and the possible following medication overuse headache represent a common issue for all the marketed drugs used for acute migraine attacks. Only studies with repeated use design and real-life studies will clarify if this risk exists for gepants too.
Treating status migrainosus in the emergency setting: what is the best strategy?
Published in Expert Opinion on Pharmacotherapy, 2018
László Vécsei, Délia Szok, Aliz Nyári, János Tajti
The most severe manifestation of the disease is status migrainosus (SM), which is considered to be a subclass of migraine-related complications according to ICHD-3 [7]. SM equally appears in both main subcategories of migraine, i.e. migraine with and without aura [7]. By definition, SM is a debilitating migraine attack that lasts for more than 72 h and associates with devastating accompanying symptoms (e.g. nausea and vomiting). The essence of the diagnostic criteria is the following: SM can occur in patients of migraine both with or without aura, and it is typical of previous attacks except for the duration and severity of the attack. SM is often a consequence of medication overuse headache or the malpractice of acute treatment of migraine attacks [8]. The definition of medication overuse headache is based on the acute or prophylactic medication-associated headache, which occurs 15 or more days per month for three or more consecutive months [7].
Optimizing the long-term management of chronic migraine with onabotulinumtoxinA in real life
Published in Expert Review of Neurotherapeutics, 2018
Cristina Tassorelli, Gioacchino Tedeschi, P Sarchielli, Luigi Alberto Pini, Licia Grazzi, Pierangelo Geppetti, Marina De Tommaso, Marco Aguggia, P Cortelli, Paolo Martelletti
A recent systematic review of 68 articles on the treatment and prognosis of medication overuse headache concluded that overused medication should be discontinued when preventive medication is initiated [58]. The authors of this review pointed out that the evidence supporting the use of OBT-A and topiramate without discontinuation of drug overuse is limited since data are mostly from post hoc analyses. With regards to the use of OBT-A in CM patients with medication overuse, a planned secondary analysis of the pooled PREEMPT data showed that even in this subgroup (n = 904, 65.3% of the overall population of the PREEMPT program), treatment with OBT-A was associated with significantly greater reductions in headache days versus placebo (−8.2 vs. −6.2, p < 0.001) at 24 weeks, in line with the results obtained in the overall study population [59]. This was also true for secondary outcomes. Of note, changes from baseline to week 24 in the frequency of acute headache medication intakes were not statistically significant between groups, except for triptan intake that significantly decreased in the OBT-A group [59].