RESUMEN
OBJECTIVE: This study aims to describe the cognitive representations of migraine through the migraineurs' discourse. METHOD: A sample of subjects taken at random from a representative sample of the French general population is interviewed about their representations of migraine. A content analysis is performed using the ALCESTE software. RESULTS: The population is composed of 51 subjects. The analysis shows that throughout the corpus, the word 'migraine' does not appear spontaneously. It seems that migraine as a chronic disease that may require long-term treatment is not well understood; people have rather a 'successive crises' representation of illness. In reaction to the crises, it is surprising not to find any clue evoking the field of catastrophsising. However, the cognitive coping strategy of resignation is to be found. The favourite interlocutor to start therapeutic education of the patient is the doctor since subjects say that they do not expect anything of the kind from the media. CONCLUSION: The results allow us to understand better why migraineurs do not consult for their illness and do not follow recommendations concerning treatments utilisation. The results allow to propose interventions that include patient education taking into account patients' cognitive representations of their illness.
Asunto(s)
Actitud Frente a la Salud , Trastornos Migrañosos/psicología , Adulto , Anciano , Estudios Transversales , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/terapia , Investigación CualitativaRESUMEN
OBJECTIVE: The objective of the nationwide EXPERT survey carried out in France in 2005 was to compare satisfaction with treatment with treatment effectiveness in migraine patients consulting general practitioners (GPs) for migraine, and to establish an instrument to easily evaluate the adequacy of acute treatment of migraine. BACKGROUND: Many migraine patients feel satisfied with their current acute treatment of migraine whereas objective evaluation reveals poor treatment effectiveness. METHODS: A total of 2108 GPs included 11,274 migraine patients. Satisfaction with treatment was evaluated using a 4-point verbal scale and a 10-cm visual analog scale (VAS). Treatment effectiveness was assessed by the 4-item questionnaire designed by the French Medico-Economic Evaluation Service (ANAES) and the French Society for the Study of Migraine Headache (SFEMC). RESULTS: In total, 5224 patients (49.8%) stated that they were satisfied with their treatment. Mean VAS score was 5.1. Only 17% of patients (1789/10,539) gave positive responses at the 4 questions of the ANAES/SFEMC questionnaire. VAS score was high for patients satisfied with their treatment and with good treatment effectiveness. Two VAS thresholds were determined using receiver operating characteristic curves that allowed easy identification, with high sensitivity and specificity, of patients satisfied/dissatisfied with their current treatment and with good/poor treatment effectiveness. Based on EXPERT data, this instrument showed that only 16% of patients using triptans (597/3719) were dissatisfied and reported poor treatment effectiveness, whereas treatment was inadequate for 63% of those using aspirin or nonsteroidal anti-inflammatory drugs (1882/2992), 74% of those using paracetamol or other analgesics (2229/2998), and 53% of those using ergotamine (253/474). CONCLUSIONS: The new instrument should allow easy identification in general practice of the patients receiving an effective or ineffective acute treatment of migraine and thus facilitate the implementation of treatment guidelines for migraine.
Asunto(s)
Analgésicos/uso terapéutico , Encuestas de Atención de la Salud/métodos , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/psicología , Satisfacción del Paciente , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
We report two patients with reversible cerebral vasoconstriction syndrome (RCVS) and carotid glomus tumour. The first patient presented with multiple thunderclap headaches. Cervical and cerebral magnetic resonance imaging showed diffuse cerebral vasoconstriction on magnetic resonance angiogram (MRA) and a carotid glomus tumour. The second patient presented with a cervical mass and was diagnosed with a non-secreting paraganglioma of the carotid body. Surgery with pre-operative angiography was followed by thunderclap headaches and MRA showed segmental cerebral vasoconstriction. Both patients were treated with nimodipine and headaches stopped. Both had normal cerebral arteries on the control MRA at 3 months. These two cases suggest that a paraganglioma may increase the susceptibility to develop RCVS. As a consequence, patients with RCVS should be investigated for a carotid glomus tumour, and patients with paraganglioma reporting severe headaches should have a cerebral MRA in order to rule out cerebral vasoconstriction.
Asunto(s)
Tumor del Cuerpo Carotídeo/complicaciones , Tumor del Cuerpo Carotídeo/diagnóstico por imagen , Vasoespasmo Intracraneal/diagnóstico por imagen , Vasoespasmo Intracraneal/etiología , Adulto , Tumor del Cuerpo Carotídeo/fisiopatología , Femenino , Cefaleas Primarias/diagnóstico por imagen , Cefaleas Primarias/etiología , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Radiografía , SíndromeRESUMEN
The objective of the open-label, multicenter Migraine--Satisfaction with Treatment: Reality with Almogran study was to assess efficacy, tolerability, and satisfaction with almotriptan 12.5 mg among migraineurs who were not achieving adequate results with their current acute therapy. Data from 434 patients (342 evaluable), were obtained for 929 attacks by 154 neurologists in France. Using a questionnaire developed by the National Agency for Accreditation and Evaluation in Health (ANAES), almotriptan was associated with an increased proportion of patients experiencing significant relief at 2 h (69.3 vs. 26.6%), tolerating the medication well (91.2 vs. 76.0%), able to resume activities (70.5 vs. 24.9%), and taking only 1 dose (59.4 vs. 28.1%) compared with previous therapies. At 2 h, headache pain had disappeared in 33.4% of attacks and was mild in 26.9%. Recurrence rate was 28.4% and rescue analgesics were used in 20.9% of attacks. The rate of adverse event-related discontinuations was 2.6%. The proportion of patients who were very satisfied/satisfied overall with almotriptan treatment was 69%. Almotriptan 12.5 mg was effective, well-tolerated and associated with a high rate of treatment satisfaction in patients whose previous acute migraine therapy was inadequate according to the ANAES recommendations.
Asunto(s)
Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/psicología , Agonistas de Receptores de Serotonina/uso terapéutico , Triptaminas/uso terapéutico , Adolescente , Adulto , Anciano , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/prevención & control , Satisfacción del Paciente , Seguridad , Autoevaluación (Psicología) , Encuestas y CuestionariosRESUMEN
Randomised controlled trials cannot collect all the data relevant for use in everyday clinical practice because drug exposure is limited, endpoints are restricted and some patient populations are excluded. Postmarketing surveillance (PS) studies can add important information for real-world clinical practice. Acute migraine therapy with almotriptan 12.5 mg was evaluated in 4 PS studies, 2 conducted in Spain, 1 in Germany and 1 in France. Almotriptan was associated with a high rate of treatment response and was well tolerated in all 4 studies. In the Spanish and German studies, 2-hour pain-relief, 2-hour pain-free, and sustained painfree rates were enhanced when patients treated mild pain. Patient satisfaction with almotriptan, assessed in the German and French studies, was high and the majority of patients preferred almotriptan to their previous acute migraine therapy. In conclusion, PS studies augment our knowledge of antimigraine therapy, giving a more complete picture of how such agents work in the general population.
Asunto(s)
Trastornos Migrañosos/tratamiento farmacológico , Vigilancia de Productos Comercializados , Agonistas de Receptores de Serotonina/uso terapéutico , Triptaminas/uso terapéutico , Humanos , Cooperación Internacional , Dimensión del Dolor , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del TratamientoRESUMEN
The objective was to evaluate the efficacy and tolerability of oral sumatriptan (100 mg) in patients who self-reported with menstrually related migraine. A prospective, multicentre, randomised, double-blind, placebo-controlled, two-group crossover study was carried out in 20 UK primary and secondary care surgeries. Of 115 patients with a self-reported history of menstrually related migraine that entered the study, 93 patients completed it. Patients treated all migraine attacks for 2 months with sumatriptan (100 mg) and for 2 months with placebo. The primary endpoint was the proportion of patients reporting headache relief at 4 hours for the first treated attack. Only 11% of patients fulfilled the protocol definition of menstrually related migraine. Patients reported a variable pattern of migraine attacks occurring inside and outside the menstrual window. For the first attack, significantly more patients receiving sumatriptan than placebo reported headache relief for attacks occurring inside (67% vs. 33%, p=0.007) and outside (79% vs. 31%, p<0.001) the menstrual period. Sumatriptan was generally well tolerated. Oral sumatriptan (100 mg) is an effective and well tolerated acute treatment for patients who report menstrually related migraine.
Asunto(s)
Trastornos Migrañosos/tratamiento farmacológico , Síndrome Premenstrual/complicaciones , Sumatriptán/administración & dosificación , Vasoconstrictores/administración & dosificación , Administración Oral , Adulto , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Fase Luteínica/metabolismo , Persona de Mediana Edad , Trastornos Migrañosos/etiología , Trastornos Migrañosos/fisiopatología , Placebos , Síndrome Premenstrual/fisiopatología , Estudios Prospectivos , Autocuidado , Sumatriptán/efectos adversos , Resultado del Tratamiento , Reino Unido , Vasoconstrictores/efectos adversosRESUMEN
The determinant of patient compliance with an anti-migraine drug is a complex alchemy. Studies of patient needs consistently show that pain freedom, speed of onset and no headache recurrence are important features of an anti-migraine product. Adverse events are important in migraine management, and concerns about them may significantly affect patient compliance. A high efficacy/tolerance ratio is definitely an essential factor, but irrational factors, such as the patient's expectations, knowledge, prejudices and concerns about the drug, may also interfere. Patients' worries about such events may instigate avoidance of prescription medicine that leads to increased intensity and duration of pain, an increased need to rest, reduced productivity and cancellation of social and work-related activities.
Asunto(s)
Trastornos Migrañosos/tratamiento farmacológico , Cooperación del Paciente , Humanos , Trastornos Migrañosos/prevención & control , Trastornos Migrañosos/psicología , Relaciones Médico-Paciente , Agonistas de Receptores de Serotonina/uso terapéuticoRESUMEN
OBJECTIVE: To determine the long-term efficacy of oral rizatriptan 10-mg wafers in the treatment of menstrual migraine attacks. METHODS: Data from an extension study where patients with migraine used rizatriptan 10 mg to treat moderate or severe migraine attacks occurring over periods of up to 6 months were included in a retrospective analysis. Patients used a diary card to record details of each migraine attack and onset of menstruation. Attacks in women were classified as menstrual or nonmenstrual according to 3 time windows relative to onset of menstruation (day 0): -3 to +3 days (7-day window), -2 to + 2 days (5-day window), and 0 to +1 days (2-day window). The analysis looked at the efficacy of rizatriptan 10 mg by menstrual category of attack for each definition on three measures: pain relief at 2 hours (reduction of pain to mild or none), pain free at 2 hours, 24-hours sustained pain free (pain free at 2 hours with no headache recurrence and no use of additional medications from 2 to 24 hours). RESULTS: Ninety-five women used rizatriptan 10 mg to treat a total of 1,839 attacks. The percentage of menstrual attacks was 30% for the -3 to +3 days definition, 23% for the -2 to +2 days definition, and 11% for the 0 to +1 days definition. Rizatriptan 10 mg was equally effective in menstrual and nonmenstrual migraine attacks regardless of the definition used. For example, using the -3 to +3 days definition, 78% of menstrual migraine attacks were relieved at 2 hours after dosing compared with 78% of nonmenstrual attacks. Pain relief rates for the other definitions were as follows: -2 to +2 days, menstrual = 78%, nonmenstrual = 78%; 0 to +1 days, menstrual = 79%, and nonmenstrual = 78%. No differences between menstrual and nonmenstrual attacks were found for the 2-hour pain free and 24-hour sustained pain free measures for any of the three definitions. CONCLUSIONS: Rizatriptan 10-mg wafers were equally effective in the treatment of menstrual and nonmenstrual migraine attacks occurring over 6 months, regardless of the precise definition of menstrual association used and even when the outcome criteria were very stringent. These data provide further evidence that triptans are effective treatments for menstrual migraine.