Drug-induced Headache Research Articles

Analyzing the predictors of relapse in drug-induced headache: a prospective clinical and psychological study

Analyzing the predictors of relapse in drug-induced headache: a prospective clinical and psychological study

Refractory migraine

Many patients with chronic migraine abuse symptomatic medications, have drug-induced headaches, psychiatric comorbidities and respond poorly to conventional preventive therapy. In these cases, the terms “resistant” and “refractory migraine” are used and an expanded therapeutic armamentarium is recommended. Currently, the use of monoclonal antibodies against calcitonin gene-related peptide is the best-studied and most effective method of preventive therapy in resistant migraine cases.

Health care resource utilization and costs associated with diagnosed medication overuse headache and potential acute medication overuse in individuals with migraine.

Estimate health care resource utilization and costs associated with medication overuse headache and potential acute medication overuse. A retrospective analysis was conducted with Clinformatics Data Mart data (1 January 2019-31 December 2019) that included continuously enrolled commercially insured adults with migraine (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] code G43.xxx). Medication overuse headache was defined as ≥1 inpatient or ≥2 outpatient claims with an ICD-10-CM code G44.41/40 (drug-induced headache). Potential acute medication overuse was defined as possessing sufficient medication for >10 mean treatment days/month for ergots, triptans, opioids, or combination analgesics or >15 mean cumulative days/month for simple prescription analgesics (e.g., acetaminophen, aspirin, other non-opioid analgesics) for >6 consecutive months. All-cause and migraine-related health care resource utilization and costs were compared after adjusting for demographic and clinical characteristics. Among 90,017 individuals with migraine, the frequency of medication overuse headache/potential acute medication overuse was 12.6% (diagnosed medication overuse headache: 0.6%; potential acute medication overuse: 12.1%). Adjusted all-cause total costs ($31,235 vs $21,486; difference: $9,749 [P < 0.001]) and adjusted migraine-related total costs ($9,770 vs $6,207; difference: $3,563 [P < 0.001]) were higher in the medication overuse headache/potential acute medication overuse group versus those without medication overuse headache/potential acute medication overuse. Individuals with diagnosed medication overuse headache/potential acute medication overuse had higher all-cause and migraine-related health care resource utilization and costs versus individuals without medication overuse headache/potential acute medication overuse, suggesting that improved migraine management is needed to reduce associated costs.

Interdisciplinary treatment including cognitive behavioral therapy and mindfulness for chronic migraine and drug-induced headache

The presented clinical case describes the management of a patient with chronic migraine (CM), drug-induced headache (LIH), and generalized anxiety disorder. It shows the influence of genetic factors (hereditary predisposition to the development of addiction, anxiety disorder), biological factors (migraine attacks from adolescence, overuse of painkillers), psychological factors (stress, development of generalized anxiety disorder, pain catastrophizing), social factors (lack of rational supportive family environment) on the clinical picture of CM.A modern, evidence-based approach to the preparation of a treatment plan for a patient with CM and concomitant LIH and generalized anxiety disorder has been demonstrated. The interdisciplinary plan was developed and successfully applied for the treatment of the patient. It included withdrawal of painkillers, due to which LIH developed, symptomatic pharmacotherapy for the withdrawal period, an alternative drug for the relief of headache with a limited number of doses and dosage frequency allowed to the patient, prophylactic pharmacotherapy for CM, pharmacotherapy for the concomitant generalized anxiety disorder, and psychological methods such as cognitive behavioural therapy (CBT) and mindfulness. Recent studies showed that mindfulness helps patients with LIH successfully overcome the period of painkiller withdrawal, the effectiveness of mindfulness is comparable to the effectiveness of preventive pharmacotherapy during the period of pain killer withdrawal. Mindfulness therapy was included in the structure of the CBT sessions. The CBT helped to replace the patient's misperceptions of her disease and maladaptive behaviour towards pain and anxiety with alternative, realistic ideas about her disease, adaptive behaviour towards pain and anxiety. The interdisciplinary treatment resulted in the conversion from chronic to episodic migraine, regression of LIH, and significant improvement of her emotional state in just 3 months. At the 12-month follow-up the treatment showed a persistent positive effect.

Treatment of chronic migraine and insomnia with cognitive behavioral therapy

Introduction. Chronic migraine (CM) is a neurological disease which is often comorbid with chronic insomnia (CI). The interdisciplinary approach including the cognitive behavioural therapy (CBT) is recommended for the treatment of patients with CM and comorbid CI.Aim. To evaluate the effectiveness of the interdisciplinary treatment program including CBT in the treatment of patients with CM and CI. Materials and methods. A total of 54 patients with CM and CI (19 men and 35 women, mean age 34.1 ± 8.5 years), were enrolled in the study. The clinical and psychological characteristics were assessed before and after treatment (at Month 3, 6, 12) using interviewing, testing, headache and sleep diaries. All patients received the interdisciplinary treatment, including pharmacotherapy, discontinuation of pain medications in the presence of drug-induced headache (DIHA), CBT for headache and insomnia.Results. Three months after treatment, there was a statistically significant decrease in mean scores for headache frequency, pain drugs dosing interval, insomnia severity index, as well as according to the Spielberger Khanin's Reactive and Personal Anxiety Scale, Beck Depression Scale, Impact of Migraine on Daily Activities Scale (p &lt; 0.05). The achieved improvements were maintained at Months 6 and 12 of the follow-up period. At Month 3, 35 (65%) patients achieved a clinical effect in the treatment of CM: the frequency of headache decreased by 50% or more, 41 (76%) patients achieved a clinical effect in the treatment of CI: the insomnia severity index decreased by 8 scores and more. At Month 6, 42 (77.8%) patients had a clinical effect in CM therapy, and 44 (81.5%) patients in CI therapy. The achieved clinical effects have been shown to be maintained by Month 12 of the follow-up period.Conclusion. The interdisciplinary program including CBT is effective in the treatment of patients with CM and CI over the shortand long-term horizon.

Virtual reality technology in the treatment of drug-induced headache (description of a clinical observation)

Virtual reality technology in the treatment of drug-induced headache (description of a clinical observation)

EE314 Relative Frequency, Healthcare Resource Utilization, and Costs of Diagnosed Drug-Induced Headache and Potential Acute Medication Overuse in Patients with Migraine

Limited data exist on the economic burden of medication overuse among patients with migraine. This study aims to estimate a) annual all-cause healthcare resource utilization (HRU) and costs and b) annual migraine-related HRU and costs associated with drug-induced headache (DIH) and with potential acute medication overuse (AMO) among commercially insured migraine patients.

Relative Frequency, Healthcare Resource Utilization, and Costs of Diagnosed Drug-Induced Headache and Potential Acute Medication Overuse in Patients With Migraine (S4.009)

Relative Frequency, Healthcare Resource Utilization, and Costs of Diagnosed Drug-Induced Headache and Potential Acute Medication Overuse in Patients With Migraine (S4.009)

Erenumab efficacy predictors for chronic migraine

The diagnosis of chronic migraine (CM) is made when there are 15 or more days of headache per month in a patient with migraine. Approximately 2.5% of patients with episodic migraine develop chronic migraine, which is more difficult to treat and often leads to drug-induced headache (LIH). Such patients are rarely included in clinical trials.&#x0D; Aim. To analyze in clinical practice the effectiveness of the CGRP monoclonal antibody erenumab after 6 months of therapy in patients with CM with and without LIHD, and to evaluate possible predictors of the effectiveness of prophylactic therapy.&#x0D; Materials and methods. The study included 47 patients with CM taking erenumab at a dose of 70 mg monthly for at least 3 months. Patients completed a headache diary throughout the study. The 12-item Allodynia Symptom Checklist (ACS-12) was used to assess the presence of allodynia. After 6 months of therapy, the efficacy and safety of treatment, the presence of LAH and possible predictors of efficacy were evaluated.&#x0D; Results. After 6 months of therapy, 22 (78.6%) patients no longer met the criteria for LIHD. The factors that positively influenced the outcome of therapy were the absence of allodynia (p0.05), the presence of photo- and phonophobia, and the one-sidedness of pain (p0.05). The age and number of days with headache in patients with HM before treatment did not have a statistically significant effect on the effect of therapy. The presence of LIHD did not statistically significantly affect the outcome of therapy.&#x0D; Conclusion. CGRP monoclonal antibodies are reasonable in patients with LIHD. The presence of LIHD does not affect the efficacy of erenumab prophylactic therapy, the presence of allodynia may be a predictor of failure, and the unilaterality of pain and irritability to light and sound indicate likely efficacy. Real-world studies with a large cohort of patients and longer durations of therapy are required to confirm these results.

The rationality of recommendations of drugs for patients with cephalgia in simulated situations in the pharmacy

Relevance. According to statistics of the World Health Organization, at least half of the world’s adult population experienced headaches at least once a year. Patients suffering from headaches do not always have the opportunity to visit a doctor, therefore, an important role in helping these patients is assigned to pharmacists. Purpose. Based on the pharmacoepidemiological study to identify the features of providing pharmaceutical care to patients with headache in pharmacies in the issue of rationality of recommendations of pharmaceutical workers. Materials and methods. A pharmacoepidemiological study was conducted based on a survey of 153 pharmaceutical workers (Saratov) using a specially developed questionnaire that includes free-form questions with a simulated situation. The data was processed using Microsoft Excel 2010 and STATISTIKA 6.0. Results Of the groups recommended to visitors, INNs in the group «Nonsteroidal anti-inflammatory and antirheumatic drugs [M01A]» account for 45.0 % of all INNs, and the group «Analgesics [N02]» - 55.0 %. Ibuprofen (62.8 %) and the combination of drotaverine + caffeine + naproxen + paracetamol + phenylephrine (41.2 %) were noted as the most frequently recommended. A visit to a doctor was recommended by the majority of respondents (52.3 %, n=153) in the case of a patient with a headache accompanied by nausea and vomiting. Ibuprofen (90.8 %) or paracetamol (45.8 %), moreover in the form of suspension or suppositories, are the preferred recommendations for headache in children under 3 years of age (n=131). Paracetamol in combinations (69.2 %) prevails as the first recommendation for headache associated with acute respiratory viral infections (n??=146). Non-selective NSAIDs for a patient with gastrointestinal complications could be recommended by 43.4 % of specialists (n=113). The NSAID recommendation is the most frequent (51.8 %, n=110) in the case of an 80-year-old patient without concomitant diseases. Paracetamol (50.0 %) or ibuprofen (34.7 %) would be more often recommended by pharmaceutical workers for a pregnant woman with headache (n=98). In case of headache after trauma, 47.1 % recommend a visit to a doctor (n=153). Conclusion. The frequent recommendation of combined analgesics and their association with the development of drug-induced headaches indicates the need for careful recommendation of these drugs. Not always correct recommendations indicate the need to increase the level of professional knowledge, study clinical recommendations for the therapy and diagnosis of cephalgia, which can make it possible to make a rational choice of the drug, initially assume that the visitor has conditions that require a visit to a doctor, and ultimately improve the quality of pharmaceutical care.

Особенности пациентов с частой эпизодической и хронической мигренью

Study Objective: To study the characteristics and compliance of patients with bilious headache. Study Design: Observational сomparative clinical trial. Materials and Methods. We reviewed medical records of 184 patients treated for bilious headaches. The mean age was 42 ± 12 years old. Diagnosis of 82 (44.6%) patients combined bilious headache and drug-induced headaches (DIH). We examined the past history of bilious headaches, frequency of visits to the doctor, life-long use of medications to kill bilious headache, and preventive therapy. Also, we reviewed the factors impacting DIH development depending on prevalence of bilious headaches, comorbidities and medications used. 6 months after discharge from the hospital, participants took a survey on the efficiency of preventive management. We compared patients with and without DIH. Compliance of patients who started drug prevention was assessed using Morisky–Green questionnaire. Study Results. 125 (67.9%) patients had chronic bilious headache, while in 59 (32.1%) patients, bilious headaches were episodic. Patients with chronic bilious headaches included 66 (52.8%) persons with DIH and 59 (47.2%) did not have any bilious headaches, while among patients with episodic bilious headache the figures were 16 (27.1%) and 43 (72.9%), respectively. In chronic bilious headache group, the frequency of DIH was statistically higher (p = 0.001). The correlation analysis of the relation between the duration of the history of bilious headaches and past drug therapy did not demonstrate any significant correlation between the amount of drugs used (grouped by the active ingredient) and course of disease (ρ = 0.115, p = 0.12); however, when drugs are counted on their trade names, there is a statistically significant correlation (ρ = 0.149, p = 0.048). Also, statistically significant correlation is seen when reviewing the duration of disease depending on the presence of DIH (p = 0.001): a longer past history of bilious headaches is associated with DIH development. 22 out of 184 patients (12%) did not start prescribed therapy. According to Morisky–Green questionnaire results, 137 (84.6%) patients were highly compliant, 21 (13%) were inadequately compliant, and 4 (2.5%) were not compliant at all. Most highly compliant were patients on antidepressants (p = 0.024). Patients with combined chronic bilious headache and DIH were also more compliant with preventive therapy (p = 0.045); patients without DIH mentioned beneficial effect from the therapy more often (p = 0.047). Conclusion. A majority of patients were compliant with the therapy. We found out that 142 (78%) patients were familiar with preventive therapy; however, there was no statistically significant difference in compliance between such patients and naive subjects. Patients taking antidepressants and those without DIH are most compliant; they mentioned the beneficial effect of the preventive therapy more often, and this is a result not only of good compliance, but also of initially less severe disease. Keywords: chronic bilious headache, drug-induced headache, compliance.

Treatment of chronic migraine and neck pain with cognitive-behavioral therapy. Case report

The article presents a case of a patient with chronic migraine, neck pain, drug-induced headache and generalized anxiety disorder. We analyzed the relationship between migraines and neck pain. The article discusses the interdisciplinary treatment of chronic migraine, which included educational conversation, detoxification therapy, rational relief of migraine attacks, preventive pharmacotherapy and cognitive-behavioral therapy. The latter allowed to change the patient's perception of the disease, reduce anxiety and catastrophization of pain, cope with fears, stop taking benzodiazepines, reduce the intake of pain relievers, and increase daily activity and productivity at work. Clinical efficacy (reduction in the frequency of headaches per month by 50% or more) was achieved after 3 months of treatment. Long-term (12 months) follow-up of the patient showed long-term clinical effect of the interdisciplinary treatment.

Abuse of medications for the treatment of migraines: results of an online survey

Background. The abuse of headache medications is an important factor in the formation of drug-induced headache.&#x0D; Aim. To determine the prevalence and nature of drug use among patients with migraine and chronic cephalgic syndrome.&#x0D; Materials and methods. An Internet survey was conducted among 1598 Internet users, as well as through social networks (Instagram, Facebook, VK) using Google Forms.&#x0D; Results. 60% of respondents with chronic headache and migraine symptoms did not have a reliable diagnosis. More than 70% of patients choose a drug for pain relief on their own and 62.7% take the drug in every headache attack.&#x0D; Conclusion. Among patients with chronic headaches and migraines, there is a high percentage of people abusing symptomatic drugs, which indicates a high risk of drug-induced headache formation.

Migraine: features of pharmacotherapeutic and drug-free preventive treatment

Migraine is one of the most common forms of headache, which can lead to a significant reduction in quality of life. There is migraine with aura, migraine without aura, as well as chronic migraine, which significantly reduces the efficiency of patients and is often combined with mental disorders and drug-induced headaches. Complications of migraine include migraine status, persistent aura without a heart attack, migraine heart attack (stroke) and epileptic seizure caused by migraine aura. The diagnosis of migraine is established based on complaints, medical history, objective examination data, and diagnostic criteria of the International Headache Classification of the 3rd revision. Additional research methods are recommended only in the presence of “red flags” — symptoms that alert to the secondary nature of the headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks, reducing the number of pharmatherapeutical analgesics. It includes three main approaches: seizure relief therapy, preventive therapy, and non-drug methods. Non-steroidal anti-inflammatory drugs, simple and combined analgesics, triptans, as well as anti-nausea drugs (for severe nausea or vomiting) are recommended for seizures relief. In case of frequent or severe migraine attacks, as well as in case of chronic migraine, prophylactic therapy is indicated, which includes antidepressants, topiramate, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide receptors. Pharmacotherapy is recommended to be combined with non-drug methods, which include cognitive-behavioral therapy, the method of transcranial magnetic stimulation, the method of biological feedback, postsphygmic period, acupuncture, therapeutic exercises, block of greater occipital nerve, and stimulation of the first trigeminal nerve.

Severe drug-induced headache with its possible recurrent statuses in a patient with chronic tension headache

The paper deals with the actual problem of managing patients with drug-induced headache (DIH) in patients with primary headaches. It describes a clinical case of extremely severe DIH in a patient with chronic tension headache (TH). The paper analyzes the typical and atypical manifestations of DIH and discusses the role of prolonged stress in the development of TH. Special attention is paid to the problems with therapy and compliance during a long-term follow-up of the patient. Based on the clinical features of pain syndrome in the described patient, the authors suggest for the first time that the use of extremely high number of daily doses of combined narcotic analgesics for many years can result in recurrent DIH statuses. The paper discusses whether it is expedient to introduce the concept “DIH severity” and whether an additional clinical parameter “the number of doses of painkillers per month” can be of informative value, which has not been proposed yet in the literature. All the issues given in the paper are conjectural and are raised by the authors for further investigation of the DIH problem.

Drug-induced headache: an analysis of therapeutic strategies

To manage patients with drug-induced headache (DIH) is an unsolved problem of modern neurology in developed countries, since DIH is becoming a common cause of temporary disability and leads to lower quality of life in patients. Patients with primary headache (for example, those with tension headache or migraine) frequently take symptomatic headache relief medications uncontrollably, which can result in the higher frequency and intensity of DIH episodes. In turn, new headache attacks make the patients take the increasing number of symptomatic medications, which leads to the development of DIH.The International Classification of Headache Disorders, 3 rd Edition, defines DIH as a distinct form of secondary headache. To date, there is no consensus on the tactics of DIH treatment and prevention. The paper discusses different approaches to DIH prevention and treatment, the effectiveness and appropriateness of their use, as well as factors influencing illness course and possible outcomes. Particular attention is paid to the management of patients during the withdrawal period, risk factors for DIH recurrences, and ways of their prevention.

Diagnosis and treatment of migraine: Russian experts' recommendations

Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).

Improving the management of patients with a diagnosis of chronic cerebral ischemia

The diagnosis of сhronic cerebral ischemia is widely used in domestic neurological practice. A significant part of the patients observed with a diagnosis of сhronic cerebral ischemia suffer from primary or secondary headache, dizziness of various origins, emotional disorders and other diseases that are not diagnosed and therefore do not have effective treatment. Improving the management of patients with a diagnosis of сhronic cerebral ischemia requires the diagnosis and treatment of other diseases that are erroneously defined as сhronic cerebral ischemia. The observation data of 90 patients are analyzed, in which the identification of primary headaches (chronic migraine, chronic tension headache) and drug-induced headache allowed an adequate and effective combination treatment, including rational pharmacotherapy, educational conversations, cognitive-behavioral therapy sessions, relaxation classes and therapeutic exercises, with a pronounced positive effect. The results of a survey of 700 patients are discussed, in which the identification of the causes of dizziness (benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuronitis, emotional disorders with instability) made it possible to carry out effective treatment, while most patients were observed for a long time with a diagnosis of chronic cerebral ischemia or vertebrobasilar insufficiency. In the management of patients with vascular cognitive impairment, which is the main clinical manifestation of chronic cerebrovascular disease, the leading role is given to both non-drug methods (regular physical activity, smoking cessation) and drug therapy aimed at normalizing blood pressure and blood lipid spectrum, preventing blood clots and improving cognitive function. The possibilities of naftidrofuril and nimodipine as drugs for improving cognitive function are discussed.

Drug-induced headache in young people of reproductive age with tobacco addiction

Drug-induced headache (DIH) is one of the most common forms of chronic headache (CH). Management of patients with DIH remains a pressing problem of modern medicine. This condition is characterized by headache over 15 days a month for more than 3 months. On the basis of the BSMU Clinic, we assessed the health status of young people with DIH and nicotine addiction. Patients with nicotine addiction were evaluated for the degree of negative effect of smoking on respiratory function.&#x0D; It was found that the majority of patients took monocomponent analgesics, and the minority of patients took combined analgesics and triptans; compared with young men, young women were less likely to seek medical advice if the episodes of headache became more frequent; however, uncontrolled use of painkillers was observed more often in males. In the absence of an analgesic effect 30 h after medication intake, young men repeated the medication in 60% of cases.&#x0D; Educational programs about DIH and the development of CHs with associated nicotine addiction may play an important in preventing the development of the condition.

Synbiotics and Treatment of Asthma: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial.

Background: We examined the efficiency and safety of a specific synbiotic compound, brand name Kidilact®, in the treatment of asthma in children 12 years of age or younger. Materials and Methods: This double-blinded, randomized, placebo-controlled clinical trial was conducted in Tehran, Iran, from May 22, 2016, to May 21, 2017. One hundred children, 12 years of age or younger, who suffered from mild to moderate asthma were recruited in this study. The subjects were randomly divided into two groups; the experimental group received a sachet of Kidilact®, and the control group received a sachet of placebo once a day for six months. Both groups were compared in terms of the frequency of asthma attacks that were severe enough to require administration of fast-acting medications, the number of outpatient visits for asthma-related problems, and the frequency of hospitalization due to exacerbated symptoms of asthma. Results: There were fewer complaints of drug-induced side effects, e.g., vomiting, headache, stomachache, and diarrhea, exacerbated cough, and constipation in the experimental group than in the control group. Overall, a significantly greater number of participants in the experimental group were satisfied with the therapeutic intervention than those in the control group, as verified by the participants and their parents/guardians self-report. There was no significant difference between both groups in the frequency of asthma attacks and hospitalization due to exacerbated symptoms of asthma. The only significant difference between both groups was the count of outpatient visits. While the control group made 55 outpatient visits to the hospital, participants in the experimental group visited the hospital only 19 times (P=0.001). Conclusion: Results of our study indicates that synbiotic compound Kidilact® generally alleviates the symptoms of asthma in children of 12 years of age or younger, resulting in less frequent outpatient visits to the hospital due to asthma-related problems while rarely causing any side effects. Due to ease of use, the rarity of side effects, and their indirect positive effects on quality of life of asthmatic patients, we recommend that synbiotics be incorporated in regular treatment and management of children with asthma.