RESUMEN
Case report of a patient with ergotism. ergotism is a complication of acute intoxication of chronic abuse of ergot derivates. Ergot is a fungus that grows on rye and less commonly on other grases such as wheat. Ergotism is a severe reaction to ergocontaminated food (such as rye bread). Ergot refers to a group of fungi of the genus Claviceps. It is a condition that develops of longterm ingestion of ergotamines. In excess, ergotamine can cause symptos such as hallucinations, severe gastrointestinal upset, a type-of dry gangrene and a pain-ful sensation in the extremities. Our patient is presented with anterior unilateral ischemic optic neuropathy. The studies performed and the clinical evaluatiion, are presented, and the treatment the same as the follow-up, are described in the article.
Asunto(s)
Humanos , Adulto , Ergotismo/diagnóstico , Neuropatía Óptica Isquémica/terapia , Ritonavir/efectos adversos , Ritonavir/uso terapéutico , Interacciones Farmacológicas , Ergotaminas/efectos adversos , Ergotaminas/uso terapéutico , Abuso de MedicamentosRESUMEN
BACKGROUND: The most commonly prescribed medications used to treat migraine acutely are single analgesics, ergots, opioids, and triptans. Due to varying mechanisms of action across drug classes, there is reason to believe that some classes may be less likely than others to elicit Medication Overuse Headache (MOH) than others. We therefore aimed to determine whether certain classes of acute migraine drugs are more likely to elicit MOH than others. METHODS: A comprehensive systematic literature was conducted to identify studies of varying designs that reported on MOH within the considered treatment classes. Only studies that reported MOH according to the International Classification of Headache Disorders (ICHD) were considered. Since no causal comparative design studies were identified; data from prevalence studies and surveys were retrieved. Prevalence-based relative risks between treatment classes were calculated by integrating both medication overuse and medication use from published studies. For each pair wise comparison, pooled relative risks were calculated as the inverse variance weighted average. RESULTS: A total of 29 studies informed the relative risk between treatment classes, all of which reported country-specific data. Five studies reported country-specific medication use data. For triptans versus analgesics the study relative risks generally favored triptans. The pooled relative risk was 0.65 (i.e., relative risk reduction of 35 %). For ergots versus analgesics, a similar trend was observed in favor of ergots with a relative risk of 0.41. For triptans versus ergots, the direction of effect was mixed, and the pooled relative risk was 1.07. Both triptans and ergots appeared favorable when compared to opioids, with pooled relative risks of 0.35 and 0.76, respectively. However, the evidence was limited for these comparisons. Analgesics and opioids also appeared to yield similar risk of MOH (pooled relative risk 1.09). CONCLUSION: Our study suggests that in patients receiving acute migraine treatment, analgesics and opioids are associated with a higher risk of developing MOH compared with other treatments. These findings provide incentive for better monitoring of use of analgesics and opioids for treating acute migraine, and suggest possible clinical preference for use of so-called "migraine-specific" treatments, that is, triptans and ergots.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Ergotaminas/uso terapéutico , Cefaleas Secundarias/epidemiología , Trastornos Migrañosos/tratamiento farmacológico , Triptaminas/uso terapéutico , Analgésicos/uso terapéutico , Humanos , Prevalencia , Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: Medication overuse headache (MOH) is a very disabling and costly disorder due to indirect costs, medication and healthcare utilization. The aim of the study was to describe general demographic and clinical characteristics of MOH, along with the national referral pathways and national painkillers distribution in several European and Latin American (LA) Countries. METHODS: This descriptive cross-sectional observational study included 669 patients with MOH referred to headache-centers in Europe and LA as a part of the COMOESTAS project. Information about acute medication and healthcare utilization were collected by extensive questionnaires, supplemented with structured patient interviews. RESULTS: Triptans were overused by 31 % European patients and by 6 % in LA (p < 0.001), whereas ergotamines were overused by 4 % in Europe and 72 % in LA (p < 0.001). Simple analgesics were overused by 54 % in Europe and by 33 % in LA (p < 0.001), while combination-analgesics were more equally overused (24 % in Europe and 29 % in LA). More European patients (57 %) compared with LA patients (27 %) visited general practitioners (p < 0.001), and 83 % of European patients compared to 38 % in LA consulted headache specialists (p < 0.001). A total of 20 % in Europe and 30 % in LA visited emergency rooms (p = 0.007). CONCLUSION: There are marked variations between LA and Europe in healthcare pathways and in acute medication overuse regarding patients with MOH. This should be considered when planning prevention campaigns against MOH.
Asunto(s)
Analgésicos/efectos adversos , Ergotaminas/efectos adversos , Cefaleas Secundarias/inducido químicamente , Uso Excesivo de Medicamentos Recetados , Triptaminas/efectos adversos , Adulto , Analgésicos/uso terapéutico , Estudios Transversales , Ergotaminas/uso terapéutico , Europa (Continente) , Femenino , Humanos , América Latina , Masculino , Persona de Mediana Edad , Triptaminas/uso terapéuticoRESUMEN
Mujer de 51 años que acude por algias faciales, cefalea y dificultad para la visión lejana de 24 h de evolución. Antecedentes personales de episodios de presión elevada y migraña en tratamiento con un compuesto de paracetamol, ergotamina y cafeína. A la exploración física destaca PA 170/110 mmHg y ptosis palpebral derecha con miosis ipsilateral, sin anhidrosis. Pruebas complementarias: radiografía de tórax y TC craneal normales; en la analítica destaca discreta anemia. Eco-doppler de troncos supraaórticos (TSA) con alteración del flujo. La angio-RM muestra la presencia de un bucle y estrechamiento de la arteria carótida interna (ACI) derecha que corresponde a una disección focal con un aneurisma disecante. Se orienta el caso como un síndrome de Claude Bernard-Horner secundario a disección de la ACI. Se inicia tratamiento con AAS 100 mg/día y enalapril 5 mg/12 h, presentando a los 3 meses con angio-RM de control, recuperación del calibre respecto a estudio previo (AU)
A 51 year-old woman who consulted due to a 24-hour history of facial pain, headache and blurred vision. She had a history of hypertension and migraine under treatment with a combination of paracetamol, ergotamine and caffeine. The physical exam showed highblood pressure (170/110 mmHg) and right ptosis with ipsilateral miosis without an hidrosis.The complementary tests including a chest x-ray and cranial CT scan were normal. The labtests showed mild anemia. The echo-doppler of the supra-aortic trunks (SAT) showed flow alteration. MR angiography of SAT showed a loop and narrowing of the right internal carotid artery (ICA) corresponding to a focal dissecting aneurysm. The case was oriented as Claude Bernard-Horner syndrome secondary to the ICA carotid dissection. Treatment was initiated with aspirin 100 mg/day and enalapril 5 mg/12 hours. At 3 months the control angio-MR showed caliber recovery in regards to the previous study
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Síndrome de Horner/complicaciones , Hipertensión/complicaciones , Disección de la Arteria Carótida Interna/complicaciones , Ergotaminas/uso terapéutico , Trastornos Migrañosos/tratamiento farmacológico , Antihipertensivos/uso terapéuticoRESUMEN
BACKGROUND: Diabetes is associated with an increased risk of several other chronic diseases. In contrast, a previous study found an inverse relation between diabetes and migraine, whereas another large population-based study showed that the prevalence of migraine among patients with diabetes varied strongly depending on age. We aimed to investigate how the prevalence of medically treated migraine in patients with diabetes varied depending on diabetic drug treatment, sex, and age in the complete Norwegian population. METHODS: Data on all persons in Norway being prescribed medication for diabetes (n =124,649) or migraine (n = 81,225) in 2006 were obtained from the National Register of Prescriptions and analyzed in a cross-sectional design. RESULTS: Persons using diabetic drugs had an overall reduced prevalence of medically treated migraine when compared with the nondiabetic population (odds ratio [OR] = 0.72 [95% confidence interval = 0.68-0.75]). The OR was strongly associated with age. Although young persons receiving oral diabetic medication had, in fact, an increased prevalence of medically treated migraine, the prevalence declined with increasing age to about the same reduced prevalence (OR = 0.4-0.6) for all types of diabetes treatment in patients 60 to 69 years of age. The prevalence was equally decreased between men and women. CONCLUSIONS: The results suggest a markedly reduced prevalence of migraine among older patients with diabetes, when compared with the general population. One may speculate that the seemingly protective effect of diabetes on migraine could be a result of neuropathy.
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Trastornos Migrañosos/etiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Bases de Datos Factuales , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Ergotaminas/uso terapéutico , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Lactante , Modelos Logísticos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/epidemiología , Noruega , Oportunidad Relativa , Prevalencia , Factores Sexuales , Triptaminas/uso terapéutico , Vasoconstrictores/uso terapéutico , Adulto JovenRESUMEN
Triptans revolutionized medical recognition and the acute treatment of migraine. Yet, throughout a lifetime, millions of patients who live with migraine endure hundreds of days of disability due to their disease. Most migraine attacks respond to migraine-specific interventions, but attack response does not predict patient response. Generally, migraine patients respond to acute treatment for some, but not necessarily all, attacks of migraine. Consequently, there remains a substantial unmet clinical need for better acute treatment of migraine. Numerous avenues of research and clinical observation provide insight into potential advances in acute treatment of migraine. These include better delivery systems for existing drugs, as well as the development of potential new therapeutic agents. In addition, new changes in migraine taxonomy and clinical observations of migraine suggest additional important therapeutic opportunities. Based on clinical observations, this article explores future acute treatment needs, drugs in development for acute migraine, and new products that deliver established drugs to improve treatment response.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Ergotaminas/uso terapéutico , Trastornos Migrañosos/tratamiento farmacológico , Agonistas de Receptores de Serotonina/uso terapéutico , Triptaminas/uso terapéutico , Enfermedad Aguda , Evaluación de la Discapacidad , Descubrimiento de Drogas , Humanos , Trastornos Migrañosos/clasificación , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoAsunto(s)
Dolor Facial/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/administración & dosificación , Ansiolíticos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Interacciones Farmacológicas , Ergotaminas/uso terapéutico , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Fármacos Neuromusculares/uso terapéutico , Triptaminas/uso terapéuticoRESUMEN
Introducción. La población inmigrante es cada vez más numerosa en la consulta neurológica. No está bien establecido si existen diferencias geográficas en la prevalencia de las cefaleas primarias y la posible influencia de la emigración. Pacientes y métodos. Estudio retrospectivo (12 meses) y prospectivo (18 meses) de las primeras visitas en la Unidad de Cefaleas del Hospital de la Santa Creu i Sant Pau. Identificamos el país de origen, parámetros temporales de la cefalea y de la inmigración, diagnósticos según criterios de la Sociedad Internacional de Cefaleas y tratamientos realizados. Se considera cefalea relacionada la que se inicia en el período de un año tras la inmigración. Resultados. La población inmigrante representa el 13,6% (n = 142) del total de las primeras visitas por cefalea (n = 1.044). Proceden principalmente de Latinoamérica (83,9%). La cefalea comenzó posteriormente a la inmigración en el 40,1% de los casos, sin existir relación temporal con la inmigración. La distribución de los diagnósticos de la cefalea son semejantes a los de la población autóctona; los más frecuentes son migraña (57,7%) y cefalea tensional (15,5%). Al comparar los tratamientos anteriores y posteriores a la inmigración, encontramos diferencias en el uso de triptanes (2,1% frente a 46,2%), ergotamina (9,8% frente a 2,1%) y utilización de tratamientos preventivos (2% frente a 45%). Conclusiones. La población inmigrante representa el 13% de las primeras visitas de cefalea y sus diagnósticos son similares a los de la población autóctona. El hecho de la emigración no es desencadenante ni agravante de la cefalea en nuestra serie. El tratamiento sintomático y preventivo difiere significativamente entre el período anterior a la inmigración y el posterior(AU)
Introduction. The immigrant population (IP) is visiting neurology departments on an increasingly more frequent basis. Research has still not made it clear whether there are geographical differences in the prevalence of primary headaches and the possible influence of emigration. Patients and methods. We conducted a retrospective (12 months) and prospective study (18 months) of the first visits to the Headache Unit at the Hospital de la Santa Creu i Sant Pau. Data collected included the country of birth, time parameters of the headache and of the immigration, diagnoses according to the criteria of the IHS and treatments that had been used. Related headaches were considered to be those that began within one year of having immigrated. Results. The IP represents 13.6% (n = 142) of the total number of first visits because of headaches (n = 1044). Immigrants came mostly from Latin America (83.9%). Headaches began after immigration in 40.1% of cases without the existence of any temporal relation with immigration. The distribution of the diagnoses of headache is similar to those of the local population, the most frequent being migraine (57.7%) and tension-type headache (15.5%). On comparing treatments prior to and following immigration, we find differences in the use of triptans (2.1% versus 46.2%), ergotamine (9.8% versus 2.1%) and in the use of preventive treatments (2% versus 45%). Conclusions. The IP accounts for 13% of all first visits due to headaches and their diagnoses are similar to those of the local population. Emigration is neither a precipitating nor an aggravating factor for headaches in our series. There is a significant difference in symptomatic and preventive treatment between the period prior to immigration and afterwards (AU)
Asunto(s)
Humanos , Cefalea/epidemiología , Analgesia , Cefalea/tratamiento farmacológico , Migración Humana/estadística & datos numéricos , Estudios Retrospectivos , Trastornos Migrañosos/epidemiología , Ergotaminas/uso terapéutico , Triptaminas/uso terapéuticoAsunto(s)
Trastornos Migrañosos/tratamiento farmacológico , Analgésicos/efectos adversos , Analgésicos/uso terapéutico , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/uso terapéutico , Terapia Combinada , Urgencias Médicas , Ergotaminas/efectos adversos , Ergotaminas/uso terapéutico , Humanos , Trastornos Migrañosos/etiología , Prevención Secundaria , Triptaminas/efectos adversos , Triptaminas/uso terapéuticoRESUMEN
BACKGROUND: Prior research has not examined the association of patient expectations or preparation by providers for the postpartum experience with depressive symptoms. We investigated whether lack of preparation for the postpartum experience and physical health after uncomplicated childbirth were associated with early postpartum depressive symptoms. METHODS: We conducted a telephone survey of 720 early postpartum mothers in New York City. Mothers reported on depressive symptoms, physical symptoms, provider preparation for the postpartum experience, and other factors. RESULTS: Nearly 39% of patients reported depressive symptoms; 24% did not feel adequately prepared by their provider for the postpartum experience. Mothers reported a range of physical symptoms: 98% reported daily vaginal bleeding, 79% reported cesarean section or episiotomy site pain, 82% reported breast pain, and 32% reported urinary incontinence. Patients who reported inadequate preparation by their provider were more likely to report depressive symptoms compared with patients who reported adequate preparation (53% vs. 35%, p < 0.001). In a multivariable model predicting postpartum depressive symptoms, adjusted odds ratios (ORs) remained elevated for perceived lack of preparation for the postpartum experience, more physical symptoms, and more physical functional limitations. CONCLUSIONS: Further research is needed to investigate whether preparing patients for expected health consequences after pregnancy may reduce the incidence of early postpartum depressive symptoms.
Asunto(s)
Depresión Posparto/psicología , Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Educación del Paciente como Asunto , Adulto , Alcaloides de Belladona/uso terapéutico , Ciclohexanoles/uso terapéutico , Combinación de Medicamentos , Ergotaminas/uso terapéutico , Femenino , Humanos , Isoflavonas/uso terapéutico , Bienestar Materno/psicología , Análisis Multivariante , Ciudad de Nueva York , Fenobarbital/uso terapéutico , Embarazo , Resultado del Embarazo , Clorhidrato de Venlafaxina , Salud de la Mujer , Adulto JovenRESUMEN
The aim of this study was to assess the treatment patterns of migraine and tension-type headache in the Croatian population. Analysis included the proportion of patients who were taking specific antimigraine therapy and the number of tablets per attack per month, the proportion of patients who were taking prophylactic therapy or using alternative treatment methods and their satisfaction with the treatment. The design of the study was a cross-sectional survey. Self-completed questionnaires were randomly distributed to adults >18 years of age in the Croatian population. A total of 616 questionnaires were analyzed: 115 patients with migraine (M), 327 patients with tension-type headache (TTH), and 174 patients with probable migraine (PM) and TTH. Specific antimigraine therapy was taken by half of patients with migraine: 35.7% of patients used triptans and 21.7% ergotamines. Prophylactic treatment had been used by 13.9% of M, 1.2% of TTH, and 6.9% of PM patients. Alternative methods of treatment were tried by 27% of M and TTH patients. Only 16.8% of patients with M pay regular visits to physicians, while 36.3% never visited a physician. More than half of TTH patients have never visited a physician. The majority of patients are only partially satisfied with their current treatment, and almost one-third are not satisfied. Results of this study indicate that the treatment of primary headaches in Croatia should be improved.
Asunto(s)
Analgésicos/uso terapéutico , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Trastornos Migrañosos/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos , Cefalea de Tipo Tensional/terapia , Adulto , Terapias Complementarias/estadística & datos numéricos , Croacia/epidemiología , Estudios Transversales , Ergotaminas/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/epidemiología , Educación del Paciente como Asunto/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Médicos/estadística & datos numéricos , Encuestas y Cuestionarios , Cefalea de Tipo Tensional/epidemiología , Triptaminas/uso terapéuticoRESUMEN
Cluster headache is a strictly unilateral headache that is associated with ipsilateral cranial autonomic symptoms and usually has a circadian and circannual pattern. Prevalence is estimated at 0.5 to 1.0/1,000. The diagnosis of cluster headache is made based on the patient's case history. There are two main clinical patterns of cluster headache: the episodic and the chronic. Episodic is the most common pattern of cluster headache. It occurs in periods lasting 7 days to 1 year and is separated by at least a 1-month pain-free interval. The attacks in the chronic form occur for more than 1 year without remission periods or with remission periods lasting less than 1 month. Conservative therapy consists of abortive and preventative remedies. Ergotamines and sumatriptan injections, sublingual ergotamine tartrate administration, and oxygen inhalation are effective abortive therapies. Verapamil is an effective and the safest prophylactic remedy. When pharmacological and oxygen therapies fail, interventional pain treatment may be considered. The effectiveness of radiofrequency treatment of the ganglion pterygopalatinum and of occipital nerve stimulation is only evaluated in observational studies, resulting in a 2 C+ recommendation. In conclusion, the primary treatment is medication. Radiofrequency treatment of the ganglion pterygopalatinum should be considered in patients who are resistant to conservative pain therapy. In patients with cluster headache refractory to all other treatments, occipital nerve stimulation may be considered, preferably within the context of a clinical study.
Asunto(s)
Analgésicos/uso terapéutico , Cefalalgia Histamínica/diagnóstico , Cefalalgia Histamínica/terapia , Medicina Basada en la Evidencia , Dimensión del Dolor/métodos , Ergotaminas/uso terapéutico , Humanos , Oxalatos , Ondas de Radio , Sumatriptán/uso terapéuticoRESUMEN
OBJECTIVE: To determine the percentages of patients receiving migraine-specific therapy and to estimate the rate of unnecessary neuroimaging studies in the emergency department (ED). METHODS: A retrospective study was conducted analyzing medical records and hospital charge data of ED visits for migraine during 2005 in 2 university-affiliated hospitals. Following a preliminary review of 23 randomly selected ED charts selected to determine the reliability of the coding process, 172 other charts were selected to include 1 visit per patient with a primary discharge diagnosis code of 346.0, 346.1, or 346.9. The diagnosis of migraine was confirmed using predefined criteria. Demographic information, treatment strategies, laboratory and neuroimaging tests, response to therapy, discharge planning, and charge data were evaluated. RESULTS: Of 156 patients with completed visits, neuroimaging studies were performed in 36 patients (23%), and only 4 patients had no documented justification for obtaining imaging studies. Seventy-eight patients (50%) had a potential contraindication to receiving migraine-specific therapy. Nine patients (11.5% of eligible patients) received migraine-specific therapy. Most patients were treated with a combination of parenteral antiemetics, narcotics, or ketorolac. CONCLUSION: This analysis supports previous studies indicating the underutilization of migraine-specific treatment in the ED, and suggests that the ED is generally used as a "last resort" when the patient's home medication fails. Because of various contraindications, migraine-specific medications may not be a treatment option in up to 50% of patients seen in the ED. Although almost all of the neuroimaging studies were justified, the radiology charges were a major contributing factor to the overall financial burden of emergency migraine care.
Asunto(s)
Servicios Médicos de Urgencia/economía , Servicios Médicos de Urgencia/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/terapia , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Antieméticos/uso terapéutico , Técnicas de Laboratorio Clínico/economía , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Diagnóstico por Imagen/economía , Diagnóstico por Imagen/estadística & datos numéricos , Ergotaminas/uso terapéutico , Femenino , Control de Formularios y Registros , Humanos , Ketorolaco/uso terapéutico , Masculino , Registros Médicos , Trastornos Migrañosos/economía , Narcóticos/uso terapéutico , Aceptación de la Atención de Salud/estadística & datos numéricos , Derivación y Consulta , Estudios Retrospectivos , Triptaminas/uso terapéuticoAsunto(s)
Trastornos Migrañosos/complicaciones , Trastornos de la Visión/etiología , Ergotaminas/efectos adversos , Ergotaminas/uso terapéutico , Humanos , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/fisiopatología , Migraña con Aura/complicaciones , Drusas del Disco Óptico , Enfermedades del Nervio Óptico/inducido químicamente , Neuropatía Óptica Isquémica/etiología , Enfermedades de la Retina/diagnóstico , Factores de Riesgo , Accidente Cerebrovascular/etiología , Trastornos de la Visión/fisiopatología , Visión Monocular , Campos Visuales , Vías Visuales/fisiopatologíaRESUMEN
Migraine headache is a common, disabling clinical problem afflicting millions of Americans. Many dental problems are related to headaches and many conditions can cause orofacial pain and headaches, which complicates a definitive diagnosis. Temporomandibular joint disorders, toothache, jaw and sinus pain often coexist with headaches. A toothache of nonodontogenic origin may require a team of dentists and physicians to diagnosis and manage. It is important for the dentist to recognize and understand the management of common headaches, such as migraine, and be able to differentiate between a nonodontogenic headache and a "real" toothache.
Asunto(s)
Trastornos Migrañosos/diagnóstico , Antagonistas Adrenérgicos alfa/uso terapéutico , Analgésicos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Diagnóstico Diferencial , Ergotaminas/uso terapéutico , Dolor Facial/diagnóstico , Humanos , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/prevención & control , Agonistas de Receptores de Serotonina/uso terapéutico , Trastornos de la Articulación Temporomandibular/diagnóstico , Odontalgia/diagnóstico , Triptaminas/uso terapéuticoRESUMEN
Women presenting with recurrent disabling headache frequently have migraine; but physicians need to rule out other headache disorders before they reach a diagnosis of migraine with or without aura. Many women who experience migraine in close association to their menstrual cycle may meet the diagnostic criteria for either menstrually related migraine (MRM), or pure menstrual migraine (PMM). Once an accurate diagnosis is made, treatment may be established to best suit the individual needs of that patient. Most women will find that migraine associated with hormone fluctuations respond well to standard treatment approaches including pharmacological and nonpharmacological treatments. Pharmacological approaches include acute, preventive, and short-term prophylaxis. Herein we review the difference between non-menstrual migraine, PMM, and MRM and identify effective treatment strategies for appropriate management of migraine associated with hormonal fluctuations.
Asunto(s)
Hormonas Esteroides Gonadales/sangre , Ciclo Menstrual/fisiología , Trastornos de la Menstruación/diagnóstico , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/terapia , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Diagnóstico Diferencial , Ergotaminas/uso terapéutico , Femenino , Humanos , Trastornos de la Menstruación/fisiopatología , Trastornos de la Menstruación/terapia , Persona de Mediana Edad , Trastornos Migrañosos/fisiopatología , Educación del Paciente como Asunto/normas , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Resultado del Tratamiento , Adulto JovenRESUMEN
During the past few years, several surveys have highlighted the high prevalence of migraine amongst the general French population and the large healthcare burden associated with suboptimal treatment. Since it opened, the Centre d'Urgences Céphalées (EHC) has treated more than 55 000 patients, the majority of whom were suffering from migraine. Expert diagnosis of the type and causes of the headache, followed by immediate medication, allows patient stabilization. Detailed assessments can then determine the most appropriate treatment for each patient to improve outcomes and reduce the necessity for further emergency admissions. Triptans are generally recommended, and for those patients who currently have ineffective migraine control with one triptan, individual evaluation allows prescription of an alternative triptan which will better suit their needs. Follow-up is crucial to ensure that treatment remains optimal and that patient expectations are being met. Although a minority of patients with severe headache will continue to require repeated emergency treatment, more than 90% of patients seen at the EHC can be successfully managed with this combination of accurate diagnosis, effective treatment and individualized follow-up care.